Doctor's Advice On Contraception

By Erich Geiringer

The search for contraceptive methods started close on the heel of the realisation that there was some connection between sexual intercourse and pregnancy and in some instances even antedated this realisation. But in spite of having such a venerable history, the science of contraception is only in its infancy and much of our present knowledge will appear completely primitive and out dated in a relatively short time. The matter has become one of such extreme urgency for mankind that the next few decades are bound to bring remarkable advances.

I shall confine myself to a purely technical discussion of the few commonly used methods:

The simplest although not always the easiest method of contraception is Abstention. Depending on the situation in which the individual is placed this method has a variable number of advantages and disadvantages. Its greatest advantage from a contraceptive point of view is that it is completely successful in all cases. There has been only one reported failure.

Coitus Interruptus is the method in which the male partner pulls out in time to allow ejaculation to take place outside the vagina. This widely practised method has many draw-backs. Sperm-containing fluid may occasionally be secreted before ejaculation but the most common cause of failure is that the necessary amount of will power cannot be summoned at the crucial moment. Even when practised correctly it causes much nervous tension partly because of the unsatisfactory nature of the connection and partly because there is always a lurking fear that it may not have been successful. Although simple and cheap it cannot be recommended.

Another method which is "natural" in the sense that it does not require any props is the use of the Safe Period. The human ovum survives only a few hours after ovulation and if fertilisation does not occur during that time there is no further chance of pregnancy until the next menstrual cycle. The human sperm is capable of fertilising for a maximum of two days after ejaculation. It follows that the risk of pregnancy is confined to two days during each menstrual cycle. The difficulty is to know exactly when those two days are.

Ovulation normally lakes place two weeks before menstruation. In women who have regular periods it is therefore possible to calculate the days during which they are safe from any risk of pregnancy. Since the body is not a machine these calculations have to be made cautiously. Women with regular menstrual cycles of 28 days or more may consider themselves safe from any risk of pregnancy during the last 7 and the first 5 days of every cycle, counting the first day of bleeding as day no. 1. During these 12 days intercourse will not result in pregnancy.

Cave: Some women have a little bleed at ovulation time; if this is mistaken for a menstrual period it would radically alter the outlook.

This method is sufficiently reliable to be suitable for couples who wish to avoid pregnancy but who would not regard failure as a disaster. Failures are usually due to miscalculation or to a derangement of health which disrupts the normal cycle. The method can be refined by using direct means to establish the occurrence of ovulation but a description in sufficient detail of these means would unduly lengthen this article.

All other methods in common use rely on the employment of contraceptive agents, the most popular being the Condom or French letter. This is a protective sheath worn by the man which gives complete contraceptive security if it does not burst. It also considerably lessens any danger of venereal infection for both partners. It is cheap but many men find its employment unpleasant and distasteful. Its chief disadvantage is that its use depends on the good sense of the male partner. Being more excitable and aggressive in sexual matters on the whole, and at the same time less directly affected by the occurrence of pregnancy it is unwise to leave contraceptive arrangement's in his hands.

Of the protective appliances worn by females the Diaphragm is the only one worth considering. This is inserted into the vagina some time before intercourse and forms a mechanical barrier between the womb and the seminal fluid. It costs about £2 and the correct size must be determined by a physician. If correctly used in conjunction with a spermicidal cream or jelly it is both reliable and comfortable. Under those circumstances its failure rate is probably no higher than 1 in a 1000 coitions.

Finally we must consider chemical agents. Some are locally used in the form of tablets, creams, and jellies. Tablets are to be avoided because their dissolution and distribution is too uncertain. Reliable brands of contraceptive creams and jellies are better than no protection but none of them can be relied upon by itself. On the other hand, the use of such spermicidal preparations together with a diaphragm or a condom certainly helps to increase further the safety of these appliances.

The latest and most reliable of the commonly used contraceptives is the Pill. This is a mixture of synthetic substances which imitate the action of the female sex hormones. When taken regularly it prevents the occurrence of ovulation, and pregnancy is therefore impossible. These drugs which are taken by many millions of women the world over do not seem to have any harmful properties although their complete safety in this respect cannot he demonstrated until another twenty years have passed. There are, of course, many other potent drugs which are used quite freely and which also have not yet passed the stringent test of time. If used correctly the pill provides complete contraceptive safety. It must be prescribed by a doctor.

I have also been asked to give some information on the prevention of venereal disease but there is little to be said which would be of interest from the point of view of the individual. The great preventive measures are in the hands of health authorities and of the medical profession. Case findings and adequate treatment in the focal areas i.e. the shipping ports and the entertainment centres of the World are the grand moves in the prevention of V.D. For infectious diseases which pass from person to person without intervening stages, treatment is synonymous with prevention. The only preventive measures for the individual which are worth mentioning are avoidance of stray sexual contact and cleanliness. Any pain, discharge, or sores on in or about the genital organs should be reported at once to a doctor.