FDA alert concerning COCs and Drospirenone

Birth control pills containing the progestin Drospirenone

Tuesday, May 31, 2011 3:34 PM
From: "FDA MedWatch" fda@service.govdelivery.com

Food and Drug Administration MedWatch
FDA Safety Information and Adverse Events Reporting Program

Birth Control Pills Containing Drospirenone: Possible Increased Risk of Blood Clots

AUDIENCE: OBGYN, Family Practice, Patient

ISSUE: FDA is aware of two newly published studies that evaluated the risk of venous thromboembolism (VTE) in women who use birth control pills that contain drospirenone. The two recently published studies looked at whether there is a higher risk of blood clots in women taking birth control pills containing the progestin drospirenone when compared to similar women taking birth control pills containing a different progestin called levonorgestrel. These two new studies reported that there is a greater risk of VTE associated with birth control pills that contain drospirenone. This risk is reported to be up to 2 to 3 times greater than the risk of VTE associated with using levonorgestrel-containing pills. Other studies have not reported an increase in risk. The FDA is currently evaluating the conflicting results from these studies and will look at all currently available information to fully assess the risks and benefits of drospirenone-containing birth control pills. FDA will continue to communicate any new safety information to the public as it becomes available. Read the drug safety communication for more information on these studies.


BACKGROUND: Drospirenone is a type of female sex hormone called a progestin. Most birth control pills contain two types of hormones--estrogen and progestin. Birth control pills work by preventing the release of eggs from the ovaries (ovulation) and changing the cervical mucus and the lining of the uterus to prevent pregnancy. Brand names of drospirenone-containing products include Yaz (generics Gianvi and Loryna), Yasmin (generics Ocella, Syeda, and Zarah), Beyaz, and Safyral.


RECOMMENDATION: If your birth control pill contains drospirenone, do not stop taking it without first talking to your healthcare professional. Contact your healthcare professional immediately if you develop any symptoms of blood clots, including persistent leg pain, severe chest pain, or sudden shortness of breath. If you smoke and are over 35 years of age, you should not take combination oral contraceptives because they increase the risk that you could experience serious cardiovascular events, including blood clots.

Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program:

• Complete and submit the report Online: www.fda.gov/MedWatch/report.htm
• Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178

Read the MedWatch safety alert, including a link to the Drug Safety Communication and Questions and Answers, at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm257337.htm

Personal comment: It’s been known for some time that there may be an increase in serious side effects of combined oral contraceptives (COCs) containing Drospirenone. The risk, if proven, is still slight for young women who are not overweight and don’t smoke. St Lucy’s girls taking pills containing Drospirenone have all been counseled by the school’s reproductive health staff and most plan to stay on their current pill. No St Lucy’s students have had serious side effects while on pills containing Drospirenone.

Beavertail seduction

Lesbian escort candidates training in beavertails

The beavertail seduction jacket: The beavertail jacket is easy to get in and out of and is ideal as a dive-sex tease. In lighter moments, as a tension release, I teach ‘Beavertail Seduction’ in my Advanced Sexual Techniques class at St Lucy’s and it is a popular facet of the course. Modern copies of the vintage beavertail jacket complete with brass twist-latch crotch fasteners and wrist zippers are available in the new neoprene materials that allow more flexibility in a form fitting jacket so a girl can show off her legs while by opening the front zipper midway she can display her breasts appearing to be available while at the same time seemingly protected from the male gaze. The beavertail-girl and her admirers all knowing that in seconds with one pull on the zipper and opening two twist-latches the delights of her ripe body can be made fully accessible for a sexual encounter. The self lubricating zipper pulls and precision detent twist-latches make Gepettos faux-vintage line of beavertail jackets a must-have in any sexually active female diver’s wardrobe. Another nice thing about the beavertail jacket is that the 5 mm neoprene back protects the wearer if a rented tank harness still isn’t comfortable after adjustment or if she is pushed into and penetrated against a wall while on the surface in a training facility which often happens during training at Adolph’s.

Hoods with beavertails: I’ve mentioned the utility of hoods before, but it doesn’t hurt to mention it again because we see young divers with large sections of their long hair cut away because they couldn’t get it untangled from their dive gear after they wore it loose while on a dive. It’s undeniable that long hair floating around a divers face or streaming behind her when she is moving can be gorgeous, but entangled in hoses, valves and regulators it can limit the range of movement of a woman’s head and sometimes impair the functioning of her equipment. Hoods are ideal for controlling and protecting a diver’s long hair while also providing thermal protection and keep her hair from being used as a weapon against her in a fight. I prefer wearing a hood for an additional reason. I think it adds an element of mystery about me showing the shape of my head while hiding the color and style of my hair and a hood provides an element of anonymity concealing my long auburn hair when I’m trying to go unnoticed.

Our ‘Rapture’ celebration: The get-together at Adolph’s Saturday afternoon (5/21) with a small group of friends was to celebrate the passing of yet another end-of-the-world pronouncement with no apparent effect. Was Harold Camping's ‘prediction’ a scam to suck millions from the credulous, or does he just need a new calculator? This is the second time he has missed his own prediction of an EOW date. But wait! He’s trying again! He has revised his apocalyptic prophecy, saying he was off by five months and the Earth actually will be obliterated on Oct. 21. Go figure! Will the third time be the charm? Will he scam millions more from true believers? I think we have far more to worry about from religious extremists with WMDs.

In any case, we had a great time though Diané was far more sensitive to nitrogen narcosis than any of the rest of us and couldn’t go below 100 feet w/o flooding her mask. Peter stayed with her and they had their own more or less private encounter at 80 feet while the rest of us were enjoying the buzz of nitrogen intoxication at depths between 125 and 150 feet. All the guys behaved themselves, I mean by not pulling their partner’s gas guard out, which I was a bit concerned about since some of the guys think that sort of thing is extremely funny because it leaves the girl vulnerable. Afterward Adolph had a lovely buffet of pulled pork barbecue, smoked salmon, prawns, raw oysters, caviar on toast points, and raw veggies. I thought it was pretty much a male menu, heavy on the protein, but not the usual German dishes he serves so that was a welcome change.

Big Pharma and dive-sex: Pharmaceutical representatives for the major drug houses like Pfizer, Barr, Watson, Johnson & Johnson, Bayer-Schering, Ortho McNeil-Jansen etc routinely meet with the Gyns and Nurse Practitioners at our clinic to educate the practitioners about their contraceptive products. The Pharma Reps are all young, attractive, athletic well educated women who can get and hold the attention of the (mostly male) medical professionals who are their clients. One of the Reps who I have recently become friends with works for Pfizer and until recently she pretty much ignored me. She was courteous enough, but her attention was directed toward the Gyns and PAs who prescribe contraceptives. However, after a friend with an IUD got PID and ended up with a badly scarred fallopian tube from having pool water forced into her uterus during dive-sex Ms Pfizer sought me out. She wanted to be fitted with a professional level diaphragm to use as a gas-guard during dive sex. She had heard from friends in a professional woman’s group she is in that I am the go-to girl for dive-sex protection and training.

It’s nice to be appreciated, but that’s not quite accurate because I don’t train clients who walk in off the street. I have quite enough to do working with the Casino’s escort trainees and with students in my St. Lucy’s Contemporary Sexual Health and Advanced Sexual Techniques classes which are in addition to my being AD for the casino’s ballet company. But she provided an opportunity for me to become valuable to a major Pharma Rep who has the authority to dispense samples of all sorts of meds at her own discretion. My new BFF, Ms Pfizer, is taking a Pfizer contraceptive, the continuous COC Lybrel that is taken 365 days a year (13 packs) so in theory she has no periods in a year. However, in real life that isn’t quite the way Lybrel works for many (about 60%) of the women who take it. A Lybrel blister pack contains twenty-eight (28) yellow tablets each containing 90 mcg of levonorgestrel, and 20 mcg of ethinyl estradiol and after taking Lybrel for about two years she is still experiencing occasional instances of spotting. But because her pill-periods were so painful with other pills she tried she thinks the occasional unexpected spotting is worth the bother. So she has been using an All-Flex diaphragm, inserting it daily, to prevent any possibility of embarrassing bleed-through instances when spotting.

The invitation: She has been invited for an all expenses paid weekend at The Lorelei by Adolph (he is inviting all the Pharma Reps one at a time) and she said she wanted me to give her at an overview of what to expect during dive-sex, but she really wanted more. She had heard she needed to wear a gas-guard during dive-sex and thought that her All-Flex would serve that purpose. However, she recently had an instance with a lover where he managed to under-thrust the rim of her All-Flex and left his seed in the dome. She wasn’t concerned about pregnancy, but was worried, and rightly so, that if her All-Flex was under-thrust during dive-sex she could be at risk of PID or an embolism. So she sought me out to be fitted for the style gas-guard a professional escort uses for dive sex, Reflexions, and to discuss the possibility of it being under-thrust. Additionally, she wanted to know what to expect from Adolph because she had heard I know him well.

The good news: She is not allergic to latex, has a wide pelvic ledge and a 70 mm Reflexions fits her perfectly. She is also PADI qualified for open water so at least she knows how to use her SCUBA equipment which was a big help when we went into the training pool first to practice underwater insertion with a G-spot dildo and then a bit later a male escort candidate joined us (he needed the practice) to give her her first heterosexual dive-sex encounter. I reassured her that while it is possible for a determined man to under-thrust the rim of a Reflexions it is very unlikely because it hurts the man to under-thrust a flat spring rim and it is unpleasant for the woman as well so she would know if the attempt was made. I also coached her to pay close attention to the amount of air she has left because during underwater sex you tend to forget about breath control and gas conservation. Running out of air during an encounter really ruins the mood and makes a man like Adolph very angry.

I told her he has a habit of preventing a partner who runs out of air from starting for the surface until he plants his seed inside her so that delay can be very unpleasant and sometimes extremely dangerous. While things are going his way he has the appearance of amiability. However when something goes wrong he has a very quick and violent temper, so when she is depending on him for her safety I said she should do whatever is necessary to please him. My advice initially took some of the enthusiasm out of her anticipation of the weekend, but she is determined to do whatever it takes to meet Adolph’s expectations – if it gets her a free weekend at The Lorelei – because she has heard how luxurious the spa is. She promised to let me know how her weekend at The Lorelei goes.

Pointe shoe quiz May 22, 2011

Who is the maker of these shoes?

A Rapture party

‘Rapture of the deep’ by Sue Dawe

A ‘Rapture’ party: To celebrate the end of the world, which is supposed to occur here in Las Vegas at 6:00 PM PDT today, at that very hour I’m co-hosting a ‘rapture’ party at Adolph’s. We will be diving regular gas (21% oxygen) down to a depth of 150 feet in his training facility (there is a net across the pool at that depth to prevent anyone from going deeper) to enjoy the effects of nitrogen narcosis during dive-sex encounters. We will have five Dive-masters who will be breathing Trimix to watch out for those of us who may get too narced and start behaving dangerously and to make sure we all deco properly on the ascent.

Couples invited to enjoy the rapture are: 1) Cyndi & Chris, 2) Anya & Robin, 3) Shelly & Jeff, 4) Marie-Claude & Pirate, 5) Diané & Peter, 6) Adolph and Elke, 7) Gigi and Jon, 8) Aimée and Doug and 9) Jacques & me. This will be the first time the teens; Cyndi, Gigi and Aimée will be intentionally exposed to the effects of nitrogen narcosis (NN) which is somewhat similar to nitrous oxide in relieving anxiety and providing a feeling of wellbeing, but NN can affect the same diver differently on different dives so its hard to tell how they will do – they could freak out – when they get intentionally narced. Most of the women have GyneFix IUDs implanted (all except me and I have an Oves sucking on my cervix) so pregnancy from having our partners plant their seed deep inside us isn’t a concern as much as if some of the guys will lose touch with reality enough to intentionally pull out some of our gas-guards. The article about nitrogen narcosis on Wikipedia says this about the symptoms: “The most dangerous aspects of narcosis are the loss of decision-making ability and focus, and impaired judgment, multi-tasking and coordination. Other effects include vertigo, and visual or auditory disturbances. The syndrome may cause exhilaration, giddiness, extreme anxiety, depression, or paranoia, depending on the individual diver and the diver's medical or personal history. When more serious, the diver may feel overconfident, disregarding normal safe diving practices.”

This should be an amazing party!

More Strauss-Kahn fallout

Hotel housekeeping staff at work

The New York Times
May 20, 2011
By STEVEN GREENHOUSE

Sexual Affronts a Known Hotel Hazard

A lot of people were shocked by the charges that the head of the International Monetary Fund sexually assaulted a hotel housekeeper in New York last weekend.

But housekeepers and hotel security experts say that housekeepers have long had to deal with various sexual affronts from male guests, including explicit comments, groping, guests who expose themselves and even attempted rape.

“These problems happen with some regularity,” said Anthony Roman, chief executive of Roman & Associates, a Long Island company that advises hotels on security matters. “They’re not rare, but they’re not common either.”

Hotels are reluctant to discuss such incidents, but security experts say the accusations against Dominique Strauss-Kahn, the I.M.F. chief, will prompt some hotel managers to review their security practices to better protect their housekeeping staff.

Zemina Cuturic, a refugee from Bosnia who works at the Tremont Chicago Hotel, said she remained frightened whenever she had to clean Room 410 because of what happened there a year ago. She was vacuuming, she said, and the guest, who had left the room minutes earlier, suddenly reappeared and “reached to try to kiss me behind my ear.”

“I dropped my vacuum, and then he grabbed my body at the waist, and he was holding me close,” Ms. Cuturic recalled. She persuaded the guest to let her go, and she fled. “It was very scary,” she said. Ms. Cuturic reported the incident to hotel management, but decided against going to the police. “I was kind of scared that he’d come back the next day if I did,” she said.

A Tremont official said the hotel, part of the Starwood chain, has a full-time security guard whose only job is to watch over the housekeeping staff. In the incident that Ms. Cuturic described, the official said that management confronted the man and insisted that he leave the hotel.

Housekeepers, nearly all of whom are women, talk of guests who offer them $100 or $200 for sex, apparently thinking that the maids, often low-paid immigrants, are desperate to earn more money. Some women complain of episodes in which they were bending over to, say, clean a bathtub, and a guest sneaked up and stuck his hand up their skirt.

Tom Whitlatch, president of Risk Services, a security consulting firm, said many hotel companies were taking a new look at safety after the accusations against Mr. Strauss-Kahn, who has resigned from the I.M.F. to focus on fighting the charges against him.

“I can assure you that the big hotel chains are aware of this incident and are saying, ‘We need to make sure our housekeepers are trained about this and we’re doing enough to prevent things like this from happening,’ ” he said.

Mr. Whitlatch said that there was little that hotels could do to prevent some of the incidents, but that training and good security procedures could reduce the risks to housekeepers.

Kathryn Carrington, a retired housekeeper who worked 30 years at the Grand Hyatt in Manhattan, recalled several occasions when she went into a room to clean, only to have a male guest emerge from the shower in his bathrobe, which then suddenly opened.

In one case, she said, a guest propositioned her, saying, “I see a pretty dark girl. Can you do something for me?” Ms. Carrington acknowledged that she used to carry a can opener with her in case she ever needed to defend herself from a guest.

The Grand Hyatt’s management was very supportive, she said. “They’d tell you, ‘If any situation occurred, get to the nearest phone and call the supervisor and leave the room. Someone else will help you do the room,’ ” she said.

The Hyatt Corporation declined an interview request, but said in a statement, “The safety and security of guests and associates is one of our top concerns.” It noted that its hotels employed many security measures and safety protocols. “Any time an associate raises a concern, we take it very seriously, promptly investigate the situation and follow as appropriate,” the company said.

Andria Babbington, a union safety official and a former room attendant at a major Toronto hotel, said at least five guests exposed themselves to her during her 17 years in housekeeping. She remembers once having to deliver a bathrobe to a guest who had called for one. “I knocked on the door. He said, ‘Come in,’ and I saw the guest had no clothes on,” she said. “He asked whether I could touch a certain part of his body.”

Some safety experts recommend that hotels send a male employee to deliver bathrobes or blankets when guests call for them, although they say that even male hotel workers are occasionally grabbed or propositioned by female guests.

There is also debate about whether an open or closed door is safer for a housekeeper cleaning a room.

Mr. Whitlatch recommends that housekeepers keep the door closed, saying that makes it harder for an outsider to enter to attack them or to steal the guest’s belongings. If the guest enters with a key, he said, the housekeeper should return later to finish the room.

But some maids disagreed, saying an open door can discourage a guest from misbehaving because another guest might be walking by outside.

“Keeping it wide open is the best option,” Ms. Babbington said. “When the door is shut, no one knows you’re inside.”

Ms. Carrington, the retired Grand Hyatt housekeeper, said the smartest approach was to keep the door open with the cart wedged in the doorway. “If someone comes into the room, they have to move the cart, and you hear it,” she said.

The Embassy Suites hotel in Irvine, Calif., mandates closed doors during cleaning — a policy that bothers Argelia Rico, a housekeeper there. She recalled an incident in 2009 when she was cleaning a bathroom and the guest walked in. “He asked me to change the sheets, and he went to the living room,” she said. “I was bending over tucking in the sheets, and suddenly he had come up right behind me. He was naked.”

She said the man lay down on the bed, aroused, and asked her to leave. “I was very scared because he could have just locked the door and raped me,” she said.

Christopher Daly, a spokesman for HEI Hotels & Resorts, which manages the hotel in Irvine, said it had no record of such an incident. “If any such activity, including sexual assault, was brought to our attention, we at the hotel would contact authorities ourselves, whether or not the employee asked us to or was planning to file charges,” he said.

Guests are not the only threat to housekeepers. Police in the Washington area suspect that a still-unidentified attacker raped seven housekeepers in a series of incidents several years ago.

Housekeepers and officials with the main hotel workers union, Unite Here, said that housekeepers were often too embarrassed or scared to report incidents to management or the police. Sometimes they fear that management, often embracing the motto “the customer is always right,” will believe the customer over the housekeeper and that the worker may end up getting fired.

Ms. Babbington said a co-worker once encountered a naked guest who chased her around the room. “She was just panicking,” Ms. Babbington said. “She was very new in the country and she demanded to talk to the police. Her manager sat her down to calm her down and told her not to call the police, that it wouldn’t be good for the hotel.”

Personal comment: This is something the Hotel/Resort industry really doesn’t want to talk about since no property wants to get the reputation of having sexual attacks occurring on the premises, though we all know that a certain amount of it does occur. Because Vegas is a party and convention town you might expect that we would see a higher incidence of this sort of behavior, but that doesn’t seem to be the case. Perhaps because encounters are so easily arranged in any of the thousands of bars cabarets and lounges in town.

Strauss-Kahn fallout

Grope central - IMF Headquarters Washington, DC

The Washington Post
May 20, 2011
By Howard Schneider and Mary Pat Flaherty

IMF moves to bolster ethics rules prompted by ex-chief’s 2008 affair

“As it copes with the fallout from its former chief’s arrest on sexual-assault charges, the International Monetary Fund is still working to recover from Dominique Strauss-Kahn’s 2008 affair with a staff member — an incident that triggered reform of the agency’s ethics laws and new training programs for employees.

On May 6, the agency put in place new rules ordering staff members to disclose relationships that develop among them so that any conflict of interest can be resolved. That was not required in 2008, when Strauss-Kahn had an affair with IMF staffer Piroska Nagy. After a board investigation, he kept his job.

Virginia Canter, the IMF’s ethics officer and a former White House associate counsel, said she is also rolling out new harassment training programs for the IMF’s 2,400-person staff and hopes to make them mandatory. She has already held personal training sessions with about 400 managers and new employees.

In an interview, she said there was nothing about Strauss-Kahn’s arrest last weekend while on a private trip to New York that she felt warranted a review of the IMF’s ethics policies. She said she regarded the policies as “solid” following the recent revisions. Those changes toughened the harassment and ethics rules for all employees, including the managing director, in line with recommendations made by an outside lawyer who investigated Strauss-Kahn’s 2008 affair. Like the World Bank and similar international institutions, the IMF is not subject to U.S. workplace laws.

“I did not have a heart attack when I walked in here” and took over the IMF ethics operation in 2010, Canter said. Of the internal ethics breaches alleged during 2009 and 2010, none related to sexual harassment between managers and subordinates, she said.

The former IMF chief, until this week a possible contender for the French presidency, was released from New York’s Rikers Island jail Friday after posting $1 million bail and agreeing to electronic monitoring of his movements and 24-hour-a-day surveillance by an armed guard. He will be confined to a New York apartment until trial, although it is unclear which one: His initial attempt to secure lodging fell through after building residents complained about the media attention and potential disruption.

Also on Friday, the IMF board set new procedures for choosing Strauss-Kahn’s replacement, which open the door for non-Europeans to compete for the post. By tradition, the IMF’s top job since World War II has been held by a European, but the process outlined by the board allows any of the fund’s members to nominate a candidate. Nominations will be accepted until June 10. The board said it will develop a shortlist of three candidates to interview and try to make a decision “by consensus” by July 1.

That puts the process on a faster track than the three months needed for Strauss-Kahn’s selection, but it also is a response to developing nations’ calls for a more open competition and clearer selection process.

Strauss-Kahn’s indictment on seven counts, including attempted rape, has refocused attention on the 2008 staff affair and what some believe is lax oversight of the fund’s top management by its 24-member executive board.

An outside investigation by the Morgan Lewis law firm resulted in a reprimand by the board and an apology by Strauss-Kahn for a lapse in judgment.

The body — in part appointed by major powers like the United States and chosen by groups of smaller nations assembled from among the IMF’s members — is a “resident board,” meaning its members are paid a full-time salary of $230,000 a year and have offices at IMF’s headquarters. While expected to oversee the managing director, they also work with him and other staff on a day-to-day basis.

The same people who review the managing director’s performance — or, in Strauss-Kahn’s case, decided to keep him despite the Nagy affair — might also make appeals to him if their country needs help. The senior member and “dean” of the board is A. Shakour Shaalan, an Egyptian who was a veteran of the IMF staff before joining the executive board in 1992, where he has since remained, representing a collection of Arab states.

Shaalan, 82, did not respond to requests for an interview.

“It is a really widespread concern,” said one former executive director, who spoke on the condition of anonymity because of the sensitivity of the issue. “They want a favorable report [for their country], then they are supposed to oversee the managing director and the functioning of the institution. There is an inevitable tension. They are structurally dependent on the managing director.”

The U.S. executive director, Meg Lundsager, appointed by the Treasury Department, did not respond to an interview request.

The changes underway at the IMF in part track policies developed at its sister organization, the World Bank, which went through its own soul-searching after then-president Paul Wolfowitz’s resignation over pay and other benefits given to a female staffer.

The World Bank considers relationships between an employee and a manager “a de facto conflict of interest” and requires employees to take mandatory training on misconduct, including sexual harassment.

Female IMF staff said in interviews that they, like all employees at the agency, were rattled by Strauss-Kahn’s arrest, but they were hesitant to criticize the board’s decision to retain him and said they thought his behavior was not representative of the agency.

Staff writer Brady Dennis in New York contributed to this report.”

Personal comment: I helped fit two European members of the IMF staff with diaphragms about 18 months ago while they were in Vegas for a conference. I thought European women preferred cervical caps, but they both said that the men they worked for preferred they wear diaphragms and were told to ask for Reflexions flat spring devices because their lovers liked the feel of thrusting into the stretchy latex dome. These women were midlevel staffers in their early 30s and on the pill so they were using their Reflexions as fetish devices, which I thought was pretty amazing and great, for their bosses.

Pointe shoe quiz May 19, 2011

Who is the maker of this dancer’s shoes?

Men behaving badly

Arnold Schwarzenegger

LOS ANGELES (KTLA)
May 18, 2011

Mother of Schwarzenegger's Love Child Revealed

The identity of the staffer who became pregnant with Arnold Schwarzenegger's love child more than 10 years ago has been revealed.

Mildred "Patty" Baena, 50, got pregnant with the former California governor's child while working as the family's housekeeper, RadarOnline, Star Magazine and TMZ are reporting.

Baena pursued Schwarzenegger in the late 90s and told friends she would have unprotected sex with him during the day at the family's mansion, TMZ reports.

She reportedly did not tell Schwarzenegger he was her son's father until the boy was a toddler.

She threatened to go public with the story four weeks ago, according to RadarOnline.

Baena, who retired in January, lives in a 4-bedroom home in Bakersfield with her 4 children, neighbors tell KTLA. She stayed at the home mostly on weekends and lived at an apartment in Calabasas during the week.

"I feel for the young boy more than anything because he's a very, very nice, polite young man," Baena's neighbor Roger told KTLA.

Roger describes the boy as a "very handsome young man" who enjoys martial arts and sports.

Neighbors say he is now 14 years old.

Pictures of the boy show a strong resemblance to the Terminator star.

The boy's identity is being hidden for his protection.

Maria Shriver was reportedly pregnant with Schwarzenegger's youngest son, Christopher Sargeant, at the same time Baena was pregnant with his child.

Meantime, former California First Lady Maria Shriver calls her husband's betrayal "heartbreaking."

"This is a painful and heartbreaking time," Shriver said in a statement to KTLA partner The Los Angeles Times.

"As a mother my concern is for the children I ask for compassion, respect and privacy as my children and I try to rebuild our lives and heal. I will have no further comment."

Shriver's words come after her husband -- former California Gov. Arnold Schwarzenegger -- recently admitted that he fathered a child with their staff member.

"After leaving the governor's office I told my wife about this event, which occurred over a decade ago," Schwarzenegger, 63, said Monday night in a statement issued to The Times. "I understand and deserve the feelings of anger and disappointment among my friends and family. There are no excuses and I take full responsibility for the hurt I have caused. I have apologized to Maria, my children and my family. I am truly sorry."

Shriver moved out of the family's Brentwood mansion after Schwarzenegger made the revelation earlier this year, The Times reported, adding that the staffer worked for the family for 20 years.

The staff member told the Times that she voluntarily left on good terms and received a severance payment. She was married when she got pregnant and claimed her husband was the child's father, according to the Times.

Once Schwarzenegger admitted he was the father, the woman had no comment when questioned by the Times.

"I ask that the media respect my wife and children through this extremely difficult time," Schwarzenegger's statement concluded. "While I deserve your attention and criticism, my family does not. " Schwarzenegger and Shriver announced their split last week after 25 years of marriage.

The couple's 17-year-old-son, Patrick, posted his thoughts on the news Tuesday via his Twitter account.

"some days you feel like s**t, some days you want to quit and just be normal for a bit, yet i love my family till death do us apart," he wrote.

21-year-old daughter Katherine also posted on Twitter: "This is definitely not easy but I appreciate your love and support as i begin to heal and move forward in life. I will always love my family."

TMZ.com reports that Schwarzenegger had late-night meetings with more than one woman at a Santa Monica office.

Sources told the website that at least two women repeatedly met Schwarzenegger at the office around 1 a.m. and would spend hours there. The sources also said there were bedrooms in the office building.

Personal comment: The Terminator always had a reputation. Perhaps not as the Fastest Gun in the West, but he was certainly known to Have Gun Will Travel and in his younger days was an amazing chick-magnet. It’s part of the Macho body-building and film culture and I don’t blame him for it. It’s not unusual in the entertainment and gaming industries which seem to attract men with overactive libidos and the view that they are entitled to any woman they want. That is why I wear a Penetrator plug when I go to meetings with that sort of men. But unprotected sex with a servant! He knew he wasn’t shooting blanks. What could he have been thinking?

Dominique Strauss-Kahn

The Wall Street Journal - Europe
Thursday, May 19, 2011

Across Europe, Views on Strauss-Kahn Diverge

From Gender Politics in Spain to a Legal Debate in Germany, Reactions to Case Expose the Region's Cultural Divisions

By SANTIAGO PEREZ in Madrid, ALISTAIR MACDONALD in London and VANESSA FUHRMANS in Berlin

Varied responses across Europe this week to the arrest of Dominique Strauss-Kahn highlight deeply rooted differences in how countries view the case and how they have dealt with sexual transgressions by their leaders over the years.

In Athens this week, newspapers are filled with headlines about the arrest of International Monetary Fund chief Dominique Strauss-Kahn.

On the Continent's Latin rim, known for its male-dominated culture, vivid accounts of what allegedly happened in the International Monetary Fund director's hotel room—and the detailed description of the sexual-assault charges leveled against him—have hit a raw nerve. Lawyers for Mr. Strauss-Kahn, who was being held without bail in the U.S., said he will plead not guilty.

In Spain, for example, which in recent years has made fighting domestic violence against women a top policy priority, a popular blog in El País daily newspaper said, "It's an earthquake for French politics...but what are the consequences for the maid?" The posting got dozens of replies. The heightened sensibility, said Madrid-based criminal lawyer Gonzalo Martínez-Fresneda "could be because historically, this has been a more sexist country."

Finance Minister Elena Salgado's comments that her "solidarity" in the Strauss-Kahn case would be "firstly with the woman who has suffered an assault, if that indeed proves to be the case," reflects increased impatience with sexist views, analysts say.

In Italy, where for years Prime Minister Silvio Berlusconi has regularly made sexual innuendoes and jokes, the premier's recent trial on charges of paying an underage girl for sex—charges he denies—has prompted women's groups to protest what they call the male establishment's demeaning attitude toward women. Comparisons between Mr. Strauss-Kahn's case and Mr. Berlusconi's trial abound, with editorialists widely commending the U.S. justice system's thus-far swift handling of the case. "Public opinion has become less tolerant of such behavior," said Italian sociologist Domenico De Masi.

In countries to the north, there has been more criticism of what many see as America's excessively media-friendly and trigger-happy judicial process. U.S. use of the death penalty is a topic followed closely in countries such as Germany and France, where capital punishment is illegal and often described as barbaric.

A number of commentators not only in France—where images of Mr. Strauss-Kahn in a "perp walk" have offended many—but in other European countries have criticized the way the IMF chief was marched before television cameras.

The usually aggressive U.K. media have mainly played it straight in covering the Strauss-Kahn incident—a reflection, some say, of strict rules U.K. journalists must negotiate on reporting of details that could influence a jury. In France, showing images of people in handcuffs or otherwise restrained by authorities before any condemnation is illegal, as the country's television watchdog reminded on Tuesday.

Despite such similarities, reactions in individual countries are influenced not only by their own experience with national sex scandals, but also by their relationships with France, a country that has prided itself on a cultural superiority, evoking both scorn and envy.

"We've gone from the image of the French lover to that of the French rapist," said Mehmet Koksal, Brussels correspondent for Courrier International, a French newsmagazine. In Belgium, tolerance for sexual crimes is low, especially after the 1990s case of Marc Dutroux, who was convicted for raping and murdering four girls in a case that led to a reform of the criminal justice system.

British politicians have often wondered why their French peers get away with affairs and other sexual misconduct in a way they would not. "We are, in Britain, a sort of eye to the keyhole, prurient society, trained to be voyeuristic by the newspapers, so any bit of sex that they can claim is inappropriate is enough to stimulate enormous pressure," says David Mellor, who in 1992 resigned as a government minister after finding himself on the front pages for an extramarital affair, which he admitted.

In Germany, citizens tend to shrug off the love lives of their leaders. When Christian Socialist Union leader Horst Seehofer admitted four years ago he had fathered a child in an extramarital affair, it briefly dimmed his popularity but didn't stop him from becoming Bavarian prime minister a year later.

The Strauss-Kahn case, of course, involves allegations of a crime, not peccadillos. "Normally Europeans don't care about politicians' sex lives, but rape is a different matter," said Katja Kempa, a college student in Berlin. Still, she added, "the whole thing with handcuffs was a bit extreme."

In Germany, the Strauss-Kahn scandal has quickly extended into a critique of the U.S. justice system, often a topic of cool-eyed scrutiny in German media and political circles. "Maybe Americans are used to this kind of thing," went an opinion piece in Wednesday's Süddeutsche Zeitung, headlined "Presumption of Innocence in Handcuffs."

Media in Greece, normally a hotbed of satirical political programs, are taking a serious approach. A possible reason: Greeks recognize Mr. Strauss-Kahn was instrumental in securing aid for the country when it was near default in May 2010. His departure from the scene is seen with a sense of foreboding. "The very uncertainty of his departure is not seen as a good development," said Theodore Couloumbis, vice president of Greek think tank Eliamep.

Meanwhile, in a survey conducted Monday in France and published Wednesday, pollster CSA found 57% of respondents thought Mr. Strauss-Kahn had been the victim of a plot, with just 32% saying he hadn't.

—John Miller, Nathania Zevi and Alkman Granitsas contributed to this article.

Personal comment: Mr. Dominique Strauss-Kahn also has a reputation, seemingly with hotel maids, reporters and underlings at the IMF if the women who are now coming forward can be believed. The charge of attempted rape is quite different from consensual sex so I hope the prosecution will have forensic evidence to support the maid’s charges. If the charge is true one has to wonder about his timing, shortly before he was due at the airport for a flight to Europe, to get amorous with the hotel staff. Apparently marital infidelity is far more widely accepted in political and business life in France than in the U.S. But if he was attempting to rape a member of the hotel housekeeping staff in NYC? What could he have been thinking?

Crush training

A BDSM trainee in a ‘Crush’ drysuit w/o inflator hose

In the photo above: A BDSM trainee is wearing a shoulder entry heavy rubber drysuit with no low pressure hose connected to the inflator port, for ‘crush’ training. You can see details of her suits neck seal and the hood she wears to keep her long hair from getting tangled in her dive gear. She is on the preparation shelf and from her suits inflated chest area it’s obvious she hasn’t completely vented her suit to get as much of the ambient air out as possible before beginning her descent. She has been coached to leave as much air in her suit as she can and still have negative buoyancy as the more air remaining in her suit the slower she will descend to aid in equalization. In a suit like this with a weight belt and no BCD her descent will be uncontrolled down to a net stretched across the diameter of the well. She will have to work on equalizing as best she can and will pick up speed as she descends because the remaining air will be compressed inside her suit. Her goal, once she reaches the net at the 100 foot (30 meters) level will be to masturbate against the rubber crotch of her suit while holding her air consumption to 1.75 cuft per minute or less. She is wearing a nylon/lycra bodyskin to minimize the effect of being pinched by the rubber folds of the suit as it compresses around her. As she gains more experience in crush diving she will wear only a bikini under the crush suit or be completely nude except for nylon booties.

Crush diving is one aspect of BDSM training that I’ve intentionally avoided. I have inadvertently been squeezed in one of my fully functioning drysuits when I accidentally vented air and it collapsed around me. But since I’m lactating it is not a good idea to compress even empty breasts after I’ve pumped much less when they are filled with milk. Not only can the folds of rubber pinch and hurt like blazes, but breast compression can cause clogged milk ducts, something I wouldn’t wish on my worst enemy.


‘Crush training’ in a collapsed drysuit: Adolph uses several old heavy rubber drysuits with no low pressure hose connected to the suits inflator fitting for crush training. He uses old suits because the deflated suits ‘squeeze’ causes an even greater need to urinate than the dive itself and the trainee is not allowed to wear a diaper to absorb her urine. Without an inflator hose and valve connected the wearer is unable to control her buoyancy with the suit and needs to wear a buoyancy control device, BCD, or have a lift bag available to be able to return to the surface on her own or needs a handler to assure her safety. No crush training student is allowed to wear a BCD and her instructor, Adolph, is her handler and he will leave her at depth to reach the surface as best she can as, among other things, her ingenuity is being tested. She is not allowed to remove her weight belt so that any positive buoyancy of the empty tank (There is none, an empty the tank is -2 lbs), the air in her mask and hood would float her to the surface. The crush diver wears a single HP steel Nitrox-Ready Worthington X8-130. The specs for that 130 cuft tank are:

*Volume: 130 cubic feet (16.0L)
* Service Pressure: 3,442 psi
* Outside Diameter: 8.0"
* Weight: 43.0 lbs (empty)
* Height: 25.5 inches* Width: 8.00 inches
* Buoyancy Empty: -2.0 lbs
* Buoyancy Full: -11.7 lbs

The trainee breathes Nitrox II (36 % oxygen) to reduce her nitrogen loading on the dive and he gives her a lift bag, but no Spare Air bottle to fill it with so she needs to watch her gas and inflate the bag with the bubble stream from the exhalations of her last few breaths of gas from her tank rather that removing her mouthpiece and pushing the purge button and she must be sure to put a foot in the ascend loop before the bag gets away from her. Her performance score is heavily dependent on how long she is able to remain at depth not how little air remains in her tank when she reaches the surface because she could intentionally purge gas w/o using it. So crush training teaches tolerance to pain and breath control under adverse conditions and requires steady nerves, all important attributes for young divers (either Domme or Sub) entering the BDSM lifestyle.

Dive-sex bottom time calculations: Typically an experienced diver/escort’s surface air consumption (SAC) rate can vary between .5 and 1.1 cu ft and during orgasm it can rise to 2.5 cuft/min or more. For dive-sex training we assume an average of 2.25 cuft/min. If we assume a surface air consumption rate (SAC) for penetrative dive-sex of 2.25 cuft/min x 5 min = 11.25 cuft on the surface.

Crush training bottom time: For Crush training (with masturbation to orgasm) we are estimating an average of 1.75 cuft/min X 5 min = 8.75 cuft on the surface. At 100 fsw (4 ATA) 8.75 cuft x 4 ATA = 35 cuft divided into the tank capacity 130 cuft = 3.7. To get bottom time in minutes: 3.7x5 = 18.5 minutes and that is w/o any rock bottom time air for ascent and deco so the tank will be empty in about 18 minutes +/- depending on how good the divers breath control is. Breathing regular (21% O2) air if the trainee’s bottom time is no more than 20 minutes she needs no deco stop. Breathing Nitrox II (36% O2) her max bottom time is about 25 minutes bottom time before deco is required. So with good breath control she can get her minutes of bottom time into the low 20s if she can stand the pain of her suits squeeze.

Conception in a drysuit: It’s impossible to have penetrative sex with a man when the woman is in a sealed drysuit. However it’s not impossible for her to become pregnant if the woman had sex a few hours prior to diving and she is wearing the wrong style gas-guard. I’ve written about this before and it’s frustrating to me because this is an area that hasn’t been covered in women’s contraceptive training. We are seeing gas-guard problems more frequently now since the weather is warming up and The Lorelei guests are taking drysuit dive excursions to Lake Mead and Adolph has begun crush training in the well. I’ve tried talking with Adolph about alerting the guests at The Lorelei and his BDSM students who use diaphragms as gas-guards and I’ve talked to both guests at The Lorelei and his students when I meet them, but they don’t seem to understand, until it’s too late.

After Adolph tampers with a woman’s hormonal birth control all she has as backup is her gas-guard and if she remembers what it was like to be fertile before she went on hormones she may use a diaphragm for contraception and feel she is well protected. But the diaphragms that European women are most often fitted with are Milex, which is popular in the EC and will protect them in typical residential swimming pools but neither rim style, arcing or coil spring, will protect them on a dive below 30 feet. As I’ve written so often before they need a Reflexions flat spring rim diaphragm that won’t distort due to pressure during a deep dive and it’s frustrating to try and help and get rebuffed and then I’m sought out when they are in trouble from something that could have been easily avoided by using the proper protective equipment.

So there they are typically having sex in their suites or in ballet class the morning of a deep dive and with fresh semen still in their vaginas are sealed into a drysuit and descend deeper than 30 feet either on an excursion to Lake Mead or in The Well during crush training. The women use no spermicide since they are protected by the pill - so they think – and therefore are in the habit of wearing their gas-guards dry (w/o spermicide) and rim of the diaphragm they are wearing distorts, leaks and semen is suckled into the dome and sperm swim into the diver’s cervix. By examining the fluid collected in the dome when a woman removes her gas-guard she can get an idea if it leaked and she is in trouble or not. But, most of the women haven’t been taught to examine the fluid in their diaphragms immediately upon remove. The fluid can be a mixture of liquefied spermicide, fertile cervical mucus (FCM), natural lube from the anterior vaginal wall, or semen that leaked past the rim. If they were familiar with the differences and something looked suspicious they could take ella right away, but even with the ones who suspect many are reluctant to take EC hoping that they are safe and that none of the fluid was semen leakage and two weeks later they miss their periods and test positive for hCG.

Videoing porn during a 6 ATA dive

Looking toward the surface of Adolph’s training facility

Videoing in ‘The Well’: When the Producer from Taryn’s Adult Media video crew (in town to video the ‘French Schoolgirl’ story) saw Adolph’s 200 ft deep training facility, which we call ‘The Well’, she decided to have the script rewritten to have The Well included in the video. It wasn’t as though there was a lot of dialogue to rewrite since the audio will be background music and the sound of gas being sucked through demand valves, moans and gasps of the copulating couple and roar of bubbles rushing toward the surface. The change worked out well since I wanted to give Gigi her first 200 foot (6 atmospheres) dive and she was going to help me clean up the debris, primarily contraceptive devices and bits of bondage apparatus off the bottom. The bottom was overdue for a cleaning since the last time Taryn and I had cleaned it was in December of last year and the debris hadn’t been picked up since.

Deep diving and Reflexions as a gas-guard: The Director wanted the obligatory underwater teen sexual encounter for this sort of video and since Gigi has had sex with Adolph several times and enjoyed him being rough with her we figured why not give her two bites of the apple and let her experience his style of lovemaking at 6 atmospheres and she was enthusiastic about the opportunity. She would wear her Reflexions gas-guard since 200 feet below the surface is no place for something to go wrong during sex. Returning readers will remember that the Reflexions flat spring diaphragm is the only style that can safely protect a diver below 10 meters (30 feet) since the rims of other styles will distort and cause leakage at depths below 30 feet. That isn’t usually a problem because there are so few training facilities deeper than 30 feet, but in my 68 ft deep pool and Adolph’s 216 ft deep facility Ortho or Milex diaphragms are useless below 30 feet. Of course an embolism is an embolism and is either extremely serious or fatal. It’s bad enough if an air bubble is forced into the vagina in water at any depth, but the deeper the woman is when that happens the larger the bubble becomes as it expands during her ascent. So if a woman’s gas-guard failed at a depth of 200 feet the bubble would expand to 5 times its size when it entered her bloodstream by the time she reached the surface, almost certainly assuring her death.

Adolph and contraception: Adolph is a very dangerous man for a woman to have sex with if she is serious about avoiding pregnancy. One of his favorite tricks is to provide ‘vitamin supplement’ pills to the female students sent to him for training. This supplement has a progestin receptor blocker in it that makes the woman’s hormonal birth control worthless. There is some initial withdrawal bleeding as her body adjusts to the lack of a continuous level of progestin which he explains away by saying it’s a side effect of altitude diving – his facility is 3,000 feet above sea level – and the extreme depth of his training facility. Not even women with traditional IUDs (Mirena and ParaGard) are safe because he will try to pull them out by the strings during a training exercise. While the wearer is menstrual, when her cervix is low and soft, she will rarely feel it being removed. That’s more difficult to do with a woman who has a Mirena inserted because 20% of them stop bleeding completely, but if he can reach the strings he can pull it out.

With the young ones who have recently had IUDs inserted it’s relatively easy for him to do and he’s getting better at it with practice. Adolph says that getting a trainee pregnant, even after the pregnancy is terminated, gives him a powerful psychological hold over her that no other domination technique will since she has experienced his ability to tamper with her reproductive biology which most young Subs don’t realize is possible until it happens to them. Most trainees he impregnates say that while they feel violated they find themselves bonding very closely with him. Perhaps that’s a little known aspect of the Stockholm Syndrome. In recent months he has had about a 20% pregnancy rate with the women sent to him for training. When they test positive He will send them to the casino’s reproductive health clinic for menstrual extractions which are much quicker and more effective than taking Mifeprex. The only IUD that Adolph hasn’t yet tampered with is the GyneFix which has no strings and which is implanted deep in the muscle of the fundus. Although, there have been GyneFix expulsions during intense cervical thrusting encounters that caused severe uterine cramping. The expulsions are thought to be because the device was improperly implanted. GyneFix expulsions have diminished almost to zero since new implantation techniques were developed several years ago.

Gigi has a GyneFix implanted so as far as pregnancy is concerned she is as safe as possible. And, Adolph agreed to leave her Reflexions gas-guard in place, which I insist on when he has underwater penetrative sex with me or any of the women in my inner circle. Even so, I went to the bottom of the well with Gigi, Adolph and the video crew breathing Trimix just to make certain he didn’t compromise her upper reproductive tract protection. The water is a constant 85° F and it took us a while to descend all the way to the bottom at 216 feet as we manipulated our masks to equalize the pressure. We all wore string bikinis weight belts and flippers – including the camera crew - except Adolph who was in a Slingshot. We used Adolph’s deep dive gear. Ocean Technologies Guardian FFMs equipped for Trimix and a Trimix blend of 19/30 in Worthington HP steel X8-130 twin sets with a tank cluster of 100% oxygen pre-positioned at our 40 ft. deco stop accessed by a quick disconnect to a gas block switch worn on the tank harness waist belt.

FFMs for deep dives: The importance of a using an FFM for deep dives and dive-sex can’t be overemphasized. For dive-sex if it gets rough for the woman having her cervix rammed can cause her to expel her reg at best that interrupts the moment. At worst she ingests enough water that she needs to terminate the dive. The other reason a FFM is so important is in case of decompression sickness (DCS) or oxygen toxicity where the diver might pass out or have a seizure and expel his/her regulator and it may be impossible for a dive buddy to get the reg back in his/her mouth. That is a very common cause of dive fatalities especially where the ascent will take too long for there to be a reasonable chance of survival w/o being able to breathe. The only down-side to using FFMs during dive-sex is that it’s impractical to give cunilingus or fellatio while using one.

We didn’t dive for two days before the 6 ATA dive to minimize our nitrogen loading so we could stay down as long as possible and we took a Divemaster who was responsible for the dive safety of all the divers so we could pay attention to what was happening as far as the video storyline and the cleanup were concerned. On the bottom Gigi shed her fins, weight-belt and tanks (which she kept right beside her) and straddled Adolph who was on his back lying comfortably on the padded twin-set tank harness while the tanks were broad enough to provide a stable base for a penetrative encounter. She helped him out of his cup and he was already massively erect. She checked the position of her gas-guard and her lube, nodded and lowered herself onto his erection and gasped when he entered her.

We had talked about how she should take him before the dive and she followed my suggestion. She wrapped her legs around his hips and tightening her legs pulled herself further on to his shaft a bit at a time until he was fully inside her. She said later that she was afraid he would be able to hit her cervix, but she has been thinking how much fun it would be getting pumped full of highly motile German sperm 200 feet below the surface and had psyched her self into nearly full arousal while we were still descending. Once she found he wasn’t able to hurt her she bore down forcing her cervix to push against the tip of his shaft through the stretchy latex membrane of her gas-guard – just to show him he was very close, but unable to reach her prize on his own. With her strong vaginal muscles she was able give herself G-spot orgasms and get them both off several times while the camera crew was recording the encounter. I’ve rarely seen Adolph as exhausted after a sexual encounter, but Gigi tired him out which she and I were very pleased about because shortly after she pulled herself off him he started his ascent leaving us to collect the contraceptive and BDSM debris off the bottom and the camera crew to record it for a ‘behind the scenes’ segment for the blue-tooth version of the video.

Discarded contraceptives inventory:

Ortho latex Coil spring diaphragm: two, 70 & 75mm with tears in the dome
Latex Ortho coil spring diaphragms: two 65 mm one of which had a tear in the dome.
Silicone All-Flex arcing spring diaphragms, six of various, but mostly 65 mm sizes two of which had punctures in the domes.
Cooper Surgical (Milex) Omniflex silicone diaphragms: three a 65 mm and 70 mm
Reflexions latex flat spring diaphragm: five 70 and 75 mm.
FemCaps: four one small 22 mm and three mediums size, 26 mm
Prentif Cavity rim cervical caps: one 22 mm.
Oves cervical caps: three a 26 mm and two 28 mm
ParaGard framed copper IUDs: four, two with bent frames
Mirena, IUD: 1 with a bent frame
FC1 condoms: 2
FC2 condoms: 23
Filled DiveGel applicators: 4
Empty DiveGel applicators: 45
Filled Semécide applicators: 2
Empty Semécide applicators: 54
Filled Conceptrol spermicide applicators: 2
Empty Conceptrol spermicide applicators: 7

From the Number and type contraceptive products we found it seems clear that women being sent for training at a facility deeper than 30 feet are still not being told that if a diaphragm was to be used for training only a Reflexions flat spring latex diaphragm would provide under-thrust and distortion free protection down to at least 200 feet. I’ve told Adolph I would check the fit of his trainees gas-guards and give them a Reflexions to properly protect themselves (Adolph has an account with our clinic), but he seems to like to let most of the women take their chances, knowing any gas-guard other than Reflexions, or a FemCap, used below 30 feet will be ineffective. The only positive thing in this last inventory is that no GyneFix implants totally dislodged while their wearer’s were in the water.

Bottom sweep conclusions: As before the previous bottom sweep inventory all the women sent for training in the past 5 months are adults, tall, beautiful and slim. Therefore, it seems likely that the 65 mm silicone All-Flex devices were too small (under-sizing is a common mistake made by inexperienced fitters) making them easier to dislodge and expel. The number of full lube and spermicide applicators on the bottom suggests that the women were nervous about being in training and not confident about the use of vaginal applicators. Additionally, a lot of their diaphragms or caps are being either expelled or intentionally pulled out by their partner/instructors. That being the case one hopes they are being removed after providing protection as gas-guards during dive-sex since upper reproductive tract protection from a pelvic infection by pool water or an embolism is vital to the woman’s safety.

A contraception failure is a different matter entirely since it can be taken care of easily with emergency contraception especially since Ella is now available in the U.S. And pregnancy at least through the 8th week with Mifeprex or later by vacuum extraction so while it might put the woman in a moral quandary she has options readily available. That isn’t the case if she gets an embolism because her gas guard was pulled out during dive-sex before she was penetrated or it was under-thrust.

The ascent: After we cleaned up the bottom our ascent was uneventful. During our 20 minute deco stop at 40 feet breathing O2 the camera crew and I all masturbated to take care of our arousal from watching Gigi and Adolph fuck each other’s brains out. Gigi really enjoyed her encounter with Adolph because of the depth at which it occurred – she found breathing Trimix ‘awesome’ - and because he let her be in charge and she loved that from a man who can be so demanding and brutal most of the time. We both knew he was doing that for the camera and she probably won’t find him that easy to control again.

The pill and condoms

LoSEASONIQUE

The Photo: Pictured is of one of the newer extended cycle combined (estrogen/progestin) oral contraceptives that allow a woman to have only four pill-periods (withdrawal bleeds) a year. Under the LoSeasonique extended-cycle regimen, women take of 84 orange combination tablets containing 0.1 mg of the progestin levonorgestrel and 20 mcg of the estrogen ethinyl estradiol, and 7 yellow tablets containing 10 mcg of ethinyl estradiol. Levonorgestrel is one of the older and safer progestins, not nearly as likely to contribute to blood clots as etonogestrel (NuvaRing and Implanon) and drospirenone (Yaz and Yasmin) though the likelihood of severe side effects on etonogestrel or drospirenone is still very low. The problem with levonorgestrel is that it doesn’t have as long a half-life in the body as the newer progestins and therefore pills that use it are more sensitive to level fluctuations if not taken correctly.

I’m posting this because: This is the most thorough discussion I’ve found of things to consider and what a woman’s (or a couple’s) reasoning should be when deciding if ‘the pill’ offers enough protection for the woman, or if the couple should use condoms to provide added protection. I am having my Contemporary Sexual Health students at St Lucy’s bookmark this article on the Scarleteen site.

This article addresses things that impact the real-world effectiveness of birth control which Eric, a good friend and frequent reader, obliquely raised in a comment to my May 10, 2011 post ‘Effectiveness rates using 2 methods of birth control.’ He wrote: “I wonder if anyone would be willing to try putting these numbers into real-world practice?” Many women for whom 95% effectiveness isn’t good enough use condoms to improve their chances of avoiding pregnancy and condoms are a must when having sex with a partner whose sexual history is unknown.

Scarleteen.com
By Heather Corinna
May 6, 2011

If You Use the Pill, Do You Still Have to Use Condoms?

“Kori asks:

I'm and 18 years old and have been having sex for a year and been on the pill for about a year. I take my birth control like a ritual at the same time every day (the combination pill). Sometime my boyfriend and I don't use a condom in the beginning to get him hard then we always put one on. My question is, when on the pill do you absolutely have to use condoms? They say that every time you have sex you NEED to use a condom. I know it is the most effective way, but I thought that the one of the points of the pill is so you don't need to use a condom.

Heather Corinna replies:

We get asked about this a lot; about whether once you have a more effective method of contraception than condoms, like a hormonal method or IUD, if they're still needed to prevent pregnancy.

The only right answer to that question, no matter who asks it, is that it really depends on what you and your partner want and need.

All methods of contraception, including condoms, can prevent pregnancy, but some methods are more effective than others. If someone had to choose between condoms and the pill, and just wanted to choose one based ONLY on which was the more effective method of the two in preventing pregnancy when used properly, then they'd choose the pill, because it's more effective in both typical and perfect use. But that's not usually the only factor in people's decisions about contraception or condom use, and plenty of people don't have to choose just one.

If you want the most effective, foolproof protection you can get from unwanted pregnancy and still want to have the kinds of sex that present pregnancy risks, then you'll want to use dual protection: to use two methods, not just one, because using two is always more effective. If you're comfortable with or prefer less protection than two methods can offer, then it's okay to only use one method.

There are no have-to's here, there's just what you want to choose to do as an individual, based on what you want, feel most comfortable with and are or are not willing to take a given level of risk with. If you need a little help making that decision, I can certainly walk you through some of that process, and give you some information that might help inform your choices.

How effective at preventing pregnancy a given method is is often one of the biggest, if not the biggest, factors for people making these choices. So, let's have a look at that first. The combined birth control pill is over 99% effective in perfect use, and 92% effective with typical use (same goes for the ring and the patch). With the pill, specifically, some studies have found that typical use rate is substantially lower for young adults younger than 19, but it sounds like you do use your pill properly, and have for some time, so that probably doesn't apply to you.

What any of those percents mean in the real world is this: 92% in typical use means that for every 100 women who report the pill is the method of contraception they have used in one year, 8 of them became pregnant while using that method, and 92 of them did not.

My best advice when people are trying to figure out if they're in perfect or typical use is to remember that perfect use rates are usually from controlled clinical trials, and typical use rates reflect self-reporting and more typical, real-life use, which includes things like taking a pill late or even missing one now and then in a given year (which is very common: taking a pill at exactly the same time for one whole year, never missing any, never throwing one up, and so forth is pretty tough to pull off). To be safest, it's usually best to consider typical use rates when choosing a method or methods, especially with an ongoing method like the pill where how you take it every single day influences your risks, not just how you take it on the day you have sex, unlike with something like condoms, where how you use it only matters each time you use it. To be sure that's clear, how someone used condoms three days ago has no impact on how well using condoms today will protect them, whereas how someone used the pill three days ago IS relevant to possible risks with sex they have today.

But if you know you use your pill as properly as possible, and have swung that for a year of use to know you can do so for a full year, if you average the typical use rate and the perfect use rate, you probably have a good sense of what your effectiveness is. For the combined pill, that'd be 95%.

Once you know the numbers like that, the question to ask yourself is if that's okay with you. Are you comfortable with something around that 5% in-one-year chance of pregnancy? If you are, then it's okay for you, according to you, to use the pill alone when it comes to preventing pregnancy.

If you're still on the fence and want a comparison, let's do the same math once you add a condom. Condoms are 98% effective in perfect use and 85% effective in typical use. We show estimated rates for using combined methods of contraception here. [This information is found in my post ‘Effectiveness rates using 2 methods of birth control’]. On that page, you'll see the combined rate for perfect use of both methods is 99.99% effective the estimated combined rate of both methods used more typically is 98.8%. If we do that same averaging we did with the pill, for those who use condoms really well, that gives us a 91.5% effectiveness. For those who use both methods very well, then we're looking at just over 99%, a little more than a 4 percent difference between using the pill alone, and just about the same effectiveness as the pill by itself in the kind of perfect use found in a controlled study.

Again, in more practical terms, that means that for 100 people using both the pill and condoms really well over one year, that probably less than one will become pregnant as opposed to five with the pill alone or close to nine with condoms alone. In both cases, that's a pretty big difference.

How big or small a difference that seems to you, though, is going to be about you. There are people who don't want to become pregnant and want to try and prevent it, but who also feel like it would not be the hugest deal if they became pregnant. There are other people who earnestly feel the world would come to an end and to whom pregnancy seems like the worst thing that could happen to them at a given time. Sometimes during one time of life or relationship, while we don't feel a pregnancy would be ideal, we feel like it would be okay and that whatever choice we might make, we could deal with that choice. Other times, for whatever reason, it really is just the last thing we want to have happen. I'd say that if and when you're in the world-will-end, last-thing-I can-deal-with group, that if you're going to have the kinds of sex where pregnancy is a risk, dual contraception is the way to go. If a possible pregnancy feels way less dire than that, then it's much sounder to consider only using one method.

This is something you can also talk with your partner about. There are a few reasons why some couples prefer using condoms, specifically, with another method to prevent pregnancy. One of the biggest perks is that then both people get to share responsibility and both people also get to have some control over the prevention of pregnancy. While a pregnancy can't impact your partners' body and health as it would yours, and often asks less of them in terms of the impact on their whole life, it still can have a big impact on their lives, no matter what choice you make with it, particularly should you become pregnant and choose to parent.

Some folks feel fine without that personal control of their own, while it makes other people really uncomfortable. Some folks also react particularly badly to an unintended pregnancy when they didn't have control: it's easy to blame the other person who had it when it happens, even when a birth control failure wasn't that person's fault. I also don't know what your feelings are about taking all the responsibility for birth control here. If you would rather it be shared, that's one reason to keep using condoms, but you also have the option of sharing responsibility for the method you're using alone, too, like having a partner split the bill for it.

You also might want to consider how much you and/or your partner tend to worry about this stuff. Any kind of worry or anxiety can impact the quality of our sex life and our whole life, so if using one less method = more worry for either of you, that may not be so ideal. If, on the other hand, using two methods alleviates worries, it may be a real positive. And if it seems to make no difference, then maybe this just isn't a factor for either of you at all.

How much you and your partner like using a given method and what kind of access you have to that method is often another factor. So, if the pill alone doesn't leave you feeling secure enough, but using condoms is an issue for any number of reasons, you might also bear in mind the pill isn't your only option and there are more effective methods than the pill, and, since the main difference with those others is mostly with typical use, far more goof-proof ones.

You may have the option of choosing a method of contraception that's more foolproof and effective in typical use. Sometimes people use the pill just because it's the only method they knew about or the only one a healthcare provider suggested: I don't know if you've considered other methods or not. Depo-Provera injections, the contraceptive implant and IUDs all have much higher rates of effectiveness in typical use, because they're really, really hard to screw up as a user. With IUDs and implants, there's nothing you really need to do at all, save replacing them every five to ten years. With an injection, you only need to remember to go get a shot once every three months. So, if you want to ditch condoms, but in looking at all this, you feel like the pill isn't leaving you feeling secure enough, you can talk to your sexual/reproductive healthcare provider about some of these other, more effective, options. The healthcare provider you see for contraception is also always a great person to ask the questions you're asking me.

This also isn't a choice you have to make in any permanent way. You may find there are times in your life or relationships where you feel just fine using only one method, or this one method, and times when you feel a lot better backing your method up. And sometimes you may need to use a different method temporarily, like if you've got to or want to go off the pill for any reason or you did wind up missing pills or need to take a medication which may interact with the pill. So, don't feel like this is something you only get to decide once and have to stick to ever after: it's not. You can always change your mind based on any changes in your feelings or circumstances.

Last, but absolutely not least, one of the biggest differences between all other methods of contraception and condoms is that only condoms can reduce your risk of sexually transmitted infections.

Many young people immediately stop using condoms once they have another method of contraception, even if they haven't yet done all they need to to reduce their STI risks. For our readers at Scarleteen specifically, this is a pretty big deal since the age group with the highest rates of STIs are those in their teens and early 20s, with around one in every four people in that age group contracting an STI every year in the United States alone. The risks of STIs are pretty big at your age, and more often that not, it's the folks who worry least about them who tend to be the most at risk, since they also tend to be the folks who don't do enough, or anything, to reduce those risks, which includes using condoms and other barriers for any oral, vaginal and/or anal sex.

My best advice is always to figure that for as much as you're concerned about unwanted pregnancy, you want to be sure you're just as concerned about STIs, and doing just as much to prevent acquiring or transmitting infections as you are in trying to prevent pregnancy.

If you do want that extra protection, either from pregnancy, STIs or both, and your boyfriend is having issues with erection when condoms are on right from the start, know that practice with condoms usually does make perfect. If he gets used to having condoms on from start to finish, chances are that this won't stay an issue like it has been. Of course, you both also always have the option to spend more time before intercourse with sexual activities other than intercourse (or oral sex, if you want to reduce STI risks for that activity by using condoms with it) to get him, and you, more aroused before intercourse starts. You can also try different styles or brands of condoms, including the female condom, so that it's not even going on him at all. Just know that if you're going to use condoms, using them properly is very important, just like using your pill is. Proper use includes a condom being used from start to finish with sexual activities, not being put on or taken off halfway through.

Again, there are no have-to's here. There are just your personal choices, made either on your own -- you are the one who would potentially become pregnant, after all -- or with a partner. I think it's always wise to make these choices very carefully and with as much information as possible, and when it comes to preventing outcomes we don't want, we just want to be sure that whatever choices we do make really fit with what we most want, don't want, and what we do and don't all really feel ready to handle.”

Ballet Beautiful goes mainstream

Mary Helen Bowers Owner of Ballet Beautiful

The New York Times
May 11, 2011
By KAYLEEN SCHAEFER

Lining Up to the Barre

EVEN if you never intend to dance onstage at Lincoln Center, like Natalie Portman’s character in “Black Swan,” you probably want to look as if you do (minus, of course, her stab wound).

Women have long coveted sinewy arms, high and tight derrières, lean legs and a regal posture. Now, in search of this shape, many of them are ditching yoga and Pilates and lining up at the ballet barre. There are at least 10 ballet-based workout studios in New York City and countless others across the country, like Pure Barre or the Bar Method. Even chain gyms like Equinox have added barre-centered classes to their lineup. There’s no sign of the curtain falling anytime soon. Even FlyWheel, the popular spinning classes, added FlyBarre in December.

“Barre methods were popular before ‘Black Swan,’ ” said Mahri Relin, the head instructor at FlyBarre. “But then they were touted as something that made you look like a dancer, and that’s made them even more popular.”

At the front of the corps is Mary Helen Bowers, who trained Ms. Portman for the movie. A former professional ballerina turned fitness instructor, Ms. Bowers taught private clients her Ballet Beautiful workout method for two years before Ms. Portman found her. Then, for about a year and half, she accompanied the actress to various film sets as she prepared for “Black Swan.” (Of being in Northern Ireland while Ms. Portman was filming “Your Highness,” Ms. Bowers said, “Danny McBride has beautiful feet.”)

This month, she is opening her own studio in SoHo to take the Ballet Beautiful method to the masses — and supermodels, apparently. Last week, Helena Christensen sauntered into the whitewashed space for a private lesson. “What I’m doing is ballet-specific in terms of the body type,” Ms. Bowers said. “The program is made to give everyone access to that ballerina body.” For example, to replicate a dancer’s leg, she has clients strengthen their inner thighs, calves, and tops and insides of knees, but skip quads. “You can’t target your quad and expect it to be long and lean,” she said.

During most group barre classes, which cost $30 to $40 each, women focus on four body parts — arms, abdomen, gluteal muscles and thighs — with highly targeted, small movements designed to tone muscles without adding mass. “Go down an inch, up an inch” is an often heard command.

The basic technique isn’t new. It was devised by the German dancer Lotte Berk, who opened her Upper East Side studio in the 1970s (it closed in 2005), and many of the current barre methods are inspired by her. Some, like Core Fusion and the Bar Method, are taught by her former instructors.

Unlike your average ballet class, these aren’t quiet sessions filled with steely competitors. The atmosphere feels more like girlfriends gathering for long-overdue drinks. Most of the instructors do have professional dance backgrounds and use words like “passé” or “relevé,” but they also tend to be unintimidating and relatable — more sorority sister than prima ballerina. On a recent morning, Kate Albarelli, a former ballerina, led the 15 or so women in her Figure 4 class at Pure Yoga on the Upper West Side through a series of leg lifts as they held onto the barre. “Everything is engaged,” Ms. Albarelli said, before joking: “Except me. Yet.”

Jenn Falik, 32, a television style and beauty expert, who regularly goes to Core Fusion, a barre class in the Exhale Spa in Gramercy Park that’s known for being as calming as it is challenging, said that it’s sometimes like a social outing for her. “If I go at a popular time,” she said, “I know everyone.” (She noted, “I also love that you don’t get too sweaty so you don’t have to re-blow out your hair after a hard class. And I think secretly whether they admit it or not many devotees would agree.”)

Which doesn’t mean barre classes aren’t as hard. Most of the moves, like squats in a grand plié position with raised heels, are so intense that they will make your muscles shake and burn within minutes. “Some of these exercises are lethal,” said Fred DeVito, a founder of Core Fusion.

Even professional ballet dancers find them difficult. “It was so hard for me,” Ms. Albarelli said of her class at Physique 57, a barre studio known for its fast-paced choreography. “I was like, ‘What the heck did I just do?’ ”

Alicia Weihl, a former professional ballerina who is now a director of training at Physique 57, was also surprised by how hard she found her first class. “I thought I was so strong because I could dance on my toes for 8 or 10 hours, no problem,” she said. “I was shaking during the thigh workout. I could barely walk out of there.”

Mr. DeVito and his co-founder, Elisabeth Halfpapp, were the first instructors to break away from Lotte Berk — in 2002 after 22 years as instructors there — to start their own studio. “We feel like the mother and father of these classes,” he said. “I can go through the list, and everyone has lineage to the days back at 67th and Madison in that town house with Liz and me running the program.”

Today, the two aren’t bothered by all the imitators — or seeing socks branded with the names of other studios in their own studio (socks are worn to prevent slipping and to imitate a ballet slipper). “I look at it like yoga,” Mr. DeVito said. “The more styles of yoga, the bigger the program becomes, and the word just spreads a little more.”

Brooke Scher, a publicist at Alison Brod, appreciates the variety. She goes to both Physique 57 and Core Fusion. “I like to mix it up,” she said. “Even though they’re very similar, it’s a nice change of pace to do both.” She said the barre workouts, which she does four times a week, had radically revised her body. “My arms are a thousand times toner,” she said. “My core strength went from nothing to something,” she added.

“Every single inch of me has changed.” She paused. “Except I’m still not particularly graceful.”

Personal Comment: I'm glad to see her going mainstream for the non-dancers among us on the East Coast.

Effectiveness rates using 2 methods of birth control

Effective contraceptive methods


I’m posting this because: Some of the students at St Lucy’s have begun to read this Blog and since summer vacation will be here soon I want to give them a familiar site they can bookmark if they have questions about the effectiveness of combining two different methods of contraception. Ideally a girl would insist on using condoms to protect against STIs during hookups or as added protection if she isn’t using her primary method perfectly, but we all know that the world of contraception is not ideal and neither men nor women like to use condoms so all we as their teachers and mentors can do is provide them with the information to make an informed decision.

The Buddy System: Effectiveness Rates for Backing Up Your Birth Control With a Second Method

Scarleteen
By Heather Corinna

You already know that no method of contraception is 100% effective (save permanent sterilization) to prevent pregnancy when you're engaging in sexual activity - read: genital intercourse -- which presents a risk of pregnancy. You probably also know, however, that there are reliable methods which are very effective when used properly, and that if you use contraception correctly and consistently, pregnancy becomes a whole lot less likely. But did you know that by doubling up and using two methods, with almost any combination you use, you can get mighty close to that 100% with many combos?

Hormonal methods of contraception are currently the most effective, reversible methods of birth control with perfect use. But with most of them, we can goof up -- maybe we skipped a couple pills or got a new prescription late, maybe we're not so timely about getting our injections or don't have consistent healthcare to get a new one on time, maybe we didn't realize our patch fell off. Oops. But if we're consistently backing up with a secondary method, even if our primary one fails, we're covered. As well, not everyone can use or wants to use a hormonal method: some of us prefer non-hormonal methods or those are our only safe or affordable options. While they aren't as effective in perfect use, if we add a backup method to the mix, we can be just as protected or even more protected from pregnancy as we could be with a more effective single method.

You'll see that some combinations can increase your level of protection substantially, while with other pairs -- especially where user error is a non-issue, like with an IUD or an implant -- the difference is so slight that backing up is just overkill. Regardless, there is no single combination of any two methods here which would leave you with less than 92% effectiveness, and most combinations will bump you up to over 95% protection. The highest combined methods' typical use effectiveness -- condoms paired with an implant - is 99.99% effective, while the lowest -- withdrawal buddied up with spermicide - is 92.17% effective. But no matter how you slice it, adding a second method always bumps up your protection against unwanted pregnancy.

The Caveats: This is a mathematical application. That doesn't mean it's not accurate -- it is, and I've got the migraine and a pile of paper covered with my chicken scratches to prove it -- but it does mean that these rates are arrived at through math, based on the combined effectiveness rates of single methods, not through specific study or clinical trials of the combined methods. The sources of our efficiency rates for single methods can be found on the Birth Control Bingo pages linked for each method.

In some cases, combining any two or more methods may possibly slightly reduce the effectiveness of one in actual use. For example, because oral contraceptive pills thicken cervical mucus, condoms, when not used with additional lubricant, can be more inclined to break due to increased friction. Using withdrawal with condoms may make it more likely to forget to hold the base of the condom and create a condom slip which may not have been as likely to happen without adding withdrawal to the mix. Without specific study on these things, we can't predict how much it may reduce the effectiveness of one method in those cases nor account for that possibility in the math. However, we have only listed combinations of methods which are safe and sound to use together and make for good mates. For instance, it would not be safe to combine Depo-Provera with another hormonal method. The vaginal effects of combining a ring and spermicides could cause a good deal of vaginal irritation . Using more than one condom is something we know makes condoms less effective, not more. Natural family planning can't be combined with oral contraceptives since a person using oral contraceptives no longer has a natural fertility cycle to chart in the first place.

We've also not done the math for using more than two methods. If you are properly and consistently using two reliable methods of contraception, the risk of pregnancy is incredibly small, and adding a third method is not likely to increase your protection by very much. The difference between a combined method that is 99.8% effective with typical use of both and three methods which are 99.78% effective together, for instance, is so small a statistical difference that adding a third method is likely to just be a needless expense and pain in your butt.

Certainly, if you prefer more than two methods, so long as they don't interfere with one another, you can choose to do that, but we'd also encourage you to evaluate your feelings. If two methods with something like a less than 2% chance of pregnancy in typical use -- and that still allows for room when it comes to user error -- still doesn't leave you feeling safe enough, you might want to consider that you're not comfortable enough with the small amount of risk which will always be a part of sexual activities that can result in pregnancy. It would probably be a good idea in that case to revisit your readiness, and either stick with activities which don't carry those risks, or hold off on heterosex (genital intercourse with an opposite-sex partner) until you're feeling more prepared for some small level of risk. When you're so freaked about the possibility of pregnancy that no amount of birth control feels like enough, it's unlikely that even with four methods, that level of anxiety is not going to leave room for actually enjoying the sex you're having (which is the whole point). Your enjoyment is going to be seriously hindered if you're taking a pill, putting in a diaphragm, having your partner put on a condom, using withdrawal and then taking EC. It's ideal and laudable to be smart and to be safe, but if your contraceptive practices start to feel like you're building a bomb shelter in preparation for a nuclear war every time you have sex, you or your partners are probably better off when it comes to your pleasure and mental health to recognize that you're not up to any risk of pregnancy, even a very statistically unlikely one, and to choose to engage in activities where your risks are far lower or nonexistent.

Listings for each single method are alphabetical. The combinations are listed from most to least effective with typical use, since typical use tends to be the most accurate measure for real people in real -- and frequently imperfect -- life. For more information on any of the single methods listed, just click on the links in their titles.


Cervical Barriers (Diaphragm)
94% effective alone with perfect use - 86% effective alone with typical use
Cervical Barriers + The Contraceptive Implant = 99.99% effective with perfect use - 99.98% effective with typical use
Cervical Barriers + Intrauterine Devices = 99.99% effective with perfect use - 99.89% effective with typical use
Cervical Barriers + Depo-Provera = 99.98% effective perfect use - 99.58% typical use
Cervical Barriers + Combination OCP ("The Pill") = 99.98% effective with perfect use - 98.88% effective with typical use
Cervical Barriers + The Contraceptive Patch = 99.98% effective with perfect use - 98.88% effective with typical use
Cervical Barriers + Minipills = 99.98% effective with perfect use - 98.6% effective with typical use
Cervical Barriers + Male Condoms = 99.88% effective perfect use - 97.9% effective with typical use
Cervical Barriers + Fertility Awareness = 99.88% effective with perfect use - 97.2% effective with typical use
Cervical Barriers + Female Condoms = 99.7% effective with perfect use - 97% effective with typical use
Cervical Barriers + Emergency Contraception = 99.34% effective with perfect use - 96.5% effective with typical use
Cervical Barriers + Withdrawal = 99.76% effective with perfect use - 96.22% effective with typical use

Spermicides with cervical barriers are not listed because spermicide is supposed to be used with them, so effectiveness rates for barrier methods already include the addition of a spermicide. Since the sponge already contains a spermicide, spermicide was also excluded from combination with the sponge.

Combination Oral Contraceptives ("The Pill")
99.7% effective alone with perfect use - 92% effective alone with typical use
Combination OCP + Cervical Barriers = 99.98% effective with perfect use - 98.88% effective with typical use
Combination OCP + Male Condoms = 99.99% effective with perfect use - 98.8% effective with typical use
Combination OCP + The Sponge = 99.97%effective with perfect use - 98.72% effective with typical use
Combination OCP + Female Condoms = 99.98% effective with perfect use - 98.32% effective with typical use
Combination OCP + Emergency Contraception* = 99.97% effective with perfect use - 98% effective with typical use
Combination OCP + Withdrawal = 99.98% effective with perfect use - 97.84% effective
Combination OCP + Spermicide = 99.94% effective with perfect use - 97.68% effective with typical use

Female Condoms
95% effective with perfect use - 79% effective with typical use
Female Condoms + The Contraceptive Implant = 99.99% effective with perfect use - 99.97% effective with typical use
Female Condoms + Intrauterine Devices = 99.99% effective with perfect use - 99.37% effective with typical use
Female Condoms + Depo-Provera = 99.99% effective with perfect use - 99.37% effective with typical use
Female Condoms + Combination OCP = 99.98% effective with perfect use - 98.32% effective with typical use
Female Condoms + The Contraceptive Patch = 99.98% effective with perfect use - 98.32% effective with typical use
Female Condoms + the Vaginal Ring = 99.98% effective with perfect use - 98.32% effective with typical use
Female Condoms + Minipills = 99.98% effective with perfect use - 97.9% effective with typical use
Female Condoms + Cervical Barriers = 99.7% effective with perfect use - 97% effective with typical use
Female Condoms + the Sponge = 99.55% effective with perfect use - 96.64% effective with typical use
Female Condoms + Fertility Awareness = 99.9% effective with perfect use - 95.8% effective with typical use
Female Condoms + Emergency Contraception = 99.45% effective with perfect use - 94.75% effective with typical use
Female Condoms + Withdrawal = 99.8% effective with perfect use - 94.33% effective with typical use
Female Condoms + Spermicide = 99.1% effective with perfect use - 93.91% effective with typical use

Don't forget! The addition of condoms to any method always carries the joint benefit of both allowing men a part in birth control and greatly reducing the risks of sexually transmitted infections.

Male Condoms
98% effective alone with perfect use - 85% effective alone with typical use
Male Condoms + The Contraceptive Implant = 99.99% effective with perfect use - 99.99% effective with typical use
Male Condoms + Intrauterine Devices = 99.99% effective with perfect use - 99.88% effective with typical use
Male Condoms + Depo-Provera = 99.99% effective with perfect use - 99.55% effective with typical use
Male Condoms + Combination OCP = 99.99% effective with perfect use - 98.8% effective with typical use
Male Condoms + The Contraceptive Patch = 99.99% effective with perfect use - 98.8% effective with typical use
Male Condoms + the Vaginal Ring = 99.99% effective with perfect use - 98.8% effective with typical use
Male Condoms + Minipills = 99.99% effective with perfect use - 98.5% effective with typical use
Male Condoms + Cervical Barriers = 99.88% effective perfect use - 97.9% effective with typical use
Male Condoms + the Sponge = 97.7% effective with perfect use - 97.6% effective with typical use
Male Condoms + Fertility Awareness = 99.96% effective with perfect use - 97% effective with typical use
Male Condoms + Emergency Contraception = 99.78% effective with perfect use - 96.25% effective with typical use
Male Condoms + Withdrawal = 99.92% effective with perfect use - 95.95% effective with typical use
Male Condoms + Spermicide = 99.64% effective with perfect use - 95.65% effective with typical use

The Contraceptive Implant (Implanon)
99.9% effective with perfect use - 99.9% effective with typical use
The Contraceptive Implant + Male Condoms = 99.99% effective with perfect use - 99.99% effective with typical use
The Contraceptive Implant + Cervical Barriers = 99.99% effective with perfect use - 99.98% effective with typical use
The Contraceptive Implant + Emergency Contraception*= 99.99% effective with perfect use - 99.98% effective with typical use
The Contraceptive Implant + the Sponge = 99.99% effective with perfect use - 99.98% effective with typical use
The Contraceptive Implant + Female Condoms = 99.99% effective with perfect use - 99.97% effective with typical use
The Contraceptive Implant + Withdrawal = 99.99% effective with perfect use - 99.97% effective with typical use
The Contraceptive Implant + Spermicide = 99.98% effective with perfect use - 99.97% effective with typical use

The Contraceptive Patch ("The Patch")
99.7% effective with perfect use - 92% effective with typical use
The Contraceptive Patch + Cervical Barriers = 99.98% effective with perfect use - 98.88% effective with typical use
The Contraceptive Patch + Male Condoms = 99.99% effective with perfect use - 98.8% effective with typical use
The Contraceptive Patch + Female Condoms = 99.98% effective with perfect use - 98.32% effective with typical use
The Contraceptive Patch + Emergency Contraception*= 99.97% effective with perfect use - 98% effective with typical use
The Contraceptive Patch + the Sponge = 99.97%effective with perfect use - 98.72% effective with typical use
The Contraceptive Patch + Withdrawal = 99.98% effective with perfect use - 97.84% effective
The Contraceptive Patch + Spermicide = 99.94% effective with perfect use - 97.68% effective with typical use

Depo-Provera ("The Shot")
99.7% effective with perfect use - 97% effective with typical use
Depo-Provera + Cervical Barriers = 99.98% effective perfect use - 99.58% typical use
Depo-Provera + Male Condoms = 99.99% effective with perfect use - 99.55% effective with typical use
Depo-Provera + the Sponge = 99.97%effective with perfect use - 99.52% effective with typical use
Depo-Provera + Female Condoms = 99.99% effective with perfect use - 99.37% effective with typical use
Depo-Provera + Emergency Contraception*= 99.97% effective with perfect use - 99.25% effective with typical use
Depo-Provera + Withdrawal = 99.98% effective with perfect use - 99.19% effective with typical use
Depo-Provera + Spermicide = 99.94% effective with perfect use - 99.13% effective with typical use

Fertility Awareness (FAM)
98% effective with perfect use - 80% effective with typical use
Fertility Awareness + Cervical Barriers = 99.88% effective with perfect use - 97.2% effective with typical use
Fertility Awareness + Male Condoms = 99.96% effective with perfect use - 97% effective with typical use
Fertility Awareness + the Sponge = 99.82% effective with perfect use - 96.8% effective with typical use
Fertility Awareness + Female Condoms = 99.9% effective with perfect use - 95.8% effective with typical use
Fertility Awareness + Emergency Contraception = 99.78% effective with perfect use - 95% effective with typical use
Fertility Awareness + Withdrawal = 99.92% effective with perfect use - 94.6% effective with typical use
Fertility Awareness + Spermicide = 99.64% effective with perfect use - 94.2% effective with typical use

Intrauterine Devices (IUD)
99.9% effective with perfect use - 99.2% effective with typical use
Intrauterine Devices + Cervical Barriers = 99.99% effective with perfect use - 99.89% effective with typical use
Intrauterine Devices + Male Condoms = 99.99% effective with perfect use - 99.88% effective with typical use
Intrauterine Devices + The Sponge = 99.99% effective with perfect use - 99.87% effective with typical use
Intrauterine Devices + Female Condoms = 99.99% effective with perfect use - 99.83% effective with typical use
Intrauterine Devices + Emergency Contraception* = 99.99% effective with perfect use - 99.8% effective with typical use
Intrauterine Devices + Withdrawal = 99.99% effective with perfect use - 99.78% effective with typical use
Intrauterine Devices + Spermicide = 99.98% effective with perfect use - 99.77% effective with typical use

Minipills
99.7% effective with perfect use - 90% effective with typical use
Minipills + Cervical Barriers = 99.98% effective with perfect use - 98.6% effective with typical use
Minipills + Male Condoms = 99.99% effective with perfect use - 98.5% effective with typical use
Minipills + The Sponge = 99.97% effective with perfect use - 98.4% effective with typical use
Minipills + Female Condoms = 99.98% effective with perfect use - 97.9% effective with typical use
Minipills + Emergency Contraception* = 99.97% effective with perfect use - 97.5% effective with typical use
Minipills + Withdrawal = 99.99% effective with perfect use - 97.3% effective with typical use
Minipills + Spermicide = 99.95% effective with perfect use - 97.1% effective with typical use

Spermicide
82% effective with perfect use - 71% effective with typical use
Spermicide + The Contraceptive Implant = 99.98% effective with perfect use - 99.97% effective with typical use
Spermicide + Intrauterine Devices = 99.98% effective with perfect use - 99.77% effective with typical use
Spermicide + Depo-Provera = 99.94% effective with perfect use - 99.13% effective with typical use
Spermicide + Combination OCP = 99.94% effective with perfect use - 97.68% effective with typical use
Spermicide + The Contraceptive Patch = 99.94% effective with perfect use - 97.68% effective with typical use
Spermicide + Minipills = 99.95% effective with perfect use - 97.1% effective with typical use
Spermicide + Male Condoms = 99.64% effective with perfect use - 95.65% effective with typical use
Spermicide + Fertility Awareness = 99.64% effective with perfect use - 94.2% effective with typical use
Spermicide + Female Condoms = 99.1% effective with perfect use - 93.91% effective with typical use
Spermicide + Emergency Contraception = 98% effective with perfect use - 92.75% effective with typical use
Spermicide + Withdrawal = 99.28% effective with perfect use - 92.17% effective with typical use

The Sponge
91% effective with perfect use - 84% effective with typical use
The Sponge + The Contraceptive Implant = 99.99% effective with perfect use - 99.98% effective with typical use
The Sponge + Intrauterine Devices = 99.99% effective with perfect use - 99.87% effective with typical use
The Sponge + Depo-Provera = 99.97%effective with perfect use - 99.52% effective with typical use
The Sponge + Combination OCP = 99.97%effective with perfect use - 98.72% effective with typical use
The Sponge + The Contraceptive Patch = 99.97%effective with perfect use - 98.72% effective with typical use
The Sponge + Minipills = 99.97% effective with perfect use - 98.4% effective with typical use
The Sponge + Male Condoms = 97.7% effective with perfect use - 97.6% effective with typical use
The Sponge + Fertility Awareness = 99.82% effective with perfect use - 96.8% effective with typical use
The Sponge + Female Condoms = 99.55% effective with perfect use - 96.64% effective with typical use
The Sponge + Emergency Contraception = 99.01% effective with perfect use - 96% effective with typical use
The Sponge + Withdrawal = 99.64% effective with perfect use - 95.68% effective with typical use

The Vaginal Ring
99.7% effective with perfect use - 92% effective with typical use
The Vaginal Ring + Male Condoms = 99.99% effective with perfect use - 98.8% effective with typical use
The Vaginal Ring + Female Condoms = 99.98% effective with perfect use - 98.32% effective with typical use
The Vaginal Ring + Emergency Contraception* = 99.97% effective with perfect use - 98% effective with typical use
The Vaginal Ring + Withdrawal = 99.98% effective with perfect use - 97.84% effective with typical use

Withdrawal
96% effective with perfect use - 73% effective with typical use
Withdrawal + The Contraceptive Implant = 99.99% effective with perfect use - 99.97% effective with typical use
Withdrawal + Intrauterine Devices = 99.99% effective with perfect use - 99.78% effective with typical use
Withdrawal + Depo-Provera = 99.98% effective with perfect use - 99.19% effective with typical use
Withdrawal + Cervical Barriers = 99.76% effective with perfect use - 96.22% effective with typical use
Withdrawal + Male Condoms = 99.92% effective with perfect use - 95.95% effective with typical use
Withdrawal + Combination OCP = 99.98% effective with perfect use - 97.84% effective
Withdrawal + The Contraceptive Patch = 99.98% effective with perfect use - 97.84% effective
Withdrawal + the Vaginal Ring = 99.8% effective with perfect use - 97.84% effective with typical use
Withdrawal + Minipills = 99.99% effective with perfect use - 97.3% effective with typical use
Withdrawal + the Sponge = 99.64% effective with perfect use - 95.68% effective with typical use
Withdrawal + Fertility Awareness = 99.92% effective with perfect use - 94.6% effective with typical use
Withdrawal + Emergency Contraception = 99.56% effective with perfect use - 93.25% effective with typical use
Withdrawal + Spermicide = 99.28% effective with perfect use - 92.17% effective with typical use

* EC is not advised for frequent use while using other hormonal contraceptives, or unless the primary hormonal method was known or strongly suspected to fail. Since the effectiveness rate for emergency contraception is variable, we have used Plan B, and used the most effective rate (89%) as perfect use and the least as typical (75%). We do not list EC as a sole method of contraception because due to the amount of hormones in oral EC, the expense and the perfect use effectiveness rate being lower than all other methods perfect use rates, it is not intended nor designed for use regularly, nor is sole use as a habit something we advise.

Special thanks to Scarleteen volunteer Courtenay for the math formula and her assistance! The link to the original article is: http://www.scarleteen.com/article/reproduction/the_buddy_system_effectiveness_rates_for_backing_up_your_birth_control_with_a_s