Contraception prep for college

Oh my God! I think I’m expelling my Skyla!

The photo: Ladies, you know the feeling when something in there moves that shouldn’t; a diaphragm, FemCap, menstrual cup or an IUD. The Skyla is a smaller version of the Mirena hormone releasing IUD and was designed for nulliparous women. Skyla releases the progestin levonorgestrel at a rate of 14 mcg/day after 24 days and declines to 5 mcg/day after 3 years at which time it must be replaced.  Menstrual cups can usually be used safely with IUDs as the cup should be worn low in the vagina where it should not come in contact with the IUD strings. Of course in the case of my wards their GyneFix copper bead IUDs were implanted w/o strings so they can wear diaphragms or FemCap with no fear of interacting with the strings and causing an expulsion.

Student’s contraception prep for college: While most teens starting college are on hormonal contraceptives a few use the copper ParaGard IUD and a few still use cervical barriers, a silicone Milex diaphragm or a FemCap. For readers who may not be aware of it the silicone Ortho All-Flex diaphragm that had been available for years by Rx through most pharmacies in the U.S. was discontinued in December of 2013. That leaves only the silicone CooperSurgical Milex- in two rim styles arcing and coil spring – and FemCap as options for women in the U.S who want or need a cervical barrier or the latex Reflexions flat spring which can be ordered from the UK..

This past week we have seen the usual summer increase in teen cervical barrier fittings as they prepare to go away to college for the first time or are having their annual well-woman pelvic exam and diaphragm fit check before returning to sexual activity with college men and some professors.  I fit three 17 y/o patients with 60mm wide seal Milex Omniflex (coil spring) diaphragms. They were the first diaphragms for all three because of health problems after having used only condoms.

One girl has Factor V Leiden a mutation of one of the clotting factors in the blood called factor V. This mutation can increase the chance of developing abnormal blood clots made worse by taking anything with estrogen in it. Factor V Leiden while it can appear in men is primarily found in women. The second, diaphragm patient was a petite gymnast with a full athletic scholarship to a major Midwestern university. She has terrible side effects from the progestin Levonorgestrel in the Skyla IUD that was designed for use by small women and she is too small to have ParaGard inserted. And the third girl does not want to use hormonal birth control of any sort and has a nickel/copper allergy so can’t use a ParaGard IUD.

Their moms came with them and were comfortable that while their daughters ages were below the age of consent for some relationships they were open about sex with boyfriend and the mothers only concern was that their daughters would be well protected by a method under their control. The girls assured me they would wear their diaphragms whenever they were around men as sex can often be spontaneous and the need for effective protection is very important to all of them. The girls had no problem inserting and removing the Milex Omniflex as they all use Diva menstrual cups so were familiar with their pelvic anatomy and folding a device for insertion. They see wearing their diaphragms as a rite of passage and an act of independence accepting the responsibility for managing their own fertility and being able to enjoy the delights of sex with a man while reducing the likelihood of unintended consequences to an acceptable level.

I fit another 17 y/o with a 22mm FemCap as her post-pubic vault was far too shallow to enable her to effectively use even a Reflexions flat spring diaphragm. She and her mom did not want her using anything with hormones in it and they both think IUDs are too invasive so a cervical cap was the only option left for a method over which she will have control. The good news is that for her age she is tall and has a relatively long vagina when not aroused – so a partner is unlikely to hit the removal strap during deep thrusting - and she also has long fingers which allow her to reach her cervix when squatting and pushing down, an ability needed to place a FemCap effectively and equally important to be able to reach it to break the seal for removal.

Elbow hinge arcing spring Vs. latex flat spring: Another patient, a returning UNLV grad student, came in to discuss changing the style of diaphragm she is using. She was last fitted with 70mm latex Reflexions with which she was very pleased. However, she has developed a latex allergy and she wanted something that would provide the same protection and pleasure for her and her very well endowed partner during deep thrusting encounters. What I recommended was a Milex wide seal arching spring which has two elbow hinges that fold for insertion. Once inserted and open when thrust into by a penis the rim flexes only slightly remaining circular and stiff (as long as the device does not rotate significantly in either direction), but not as inflexible as the Reflexions allowing the silicone dome to be stretched across the cervix and glans as it is pushed into her anterior fornix by a thrusting penis.  

There are tradeoffs using a silicone arcing spring instead of a latex flat spring. However, for anterior fornix thrusting I think the two can be equally pleasurable. With the silicone arcing spring the dome is stiffer than the flat spring so the rim flexing is offset by the less stretchy dome which puts the same or perhaps a bit more pressure on the tip of the cervix to push the uterus up and to squeeze the glans simultaneously during maximum anterior fornix thrust depth.  Too, the central dome logo on the Reflexions used as a stimulator for men long enough to reach it is replaced by the extrusion bump in the center of the Milex dome that is easily felt by a thrusting penis when the silicone dome is stretched into the anterior fornix.  The only detracting factors in comparing the Milex to Reflexions is that that Milex costs more and the heat transfer properties are much better with latex. Factors against the latex Reflexions are that couples with latex allergies can’t use it. Latex is more easily destroyed by oily lubes or meds so its useful life is much shorter and latex is more likely to contribute to infections than is silicone. The only major difference in favor of the flat spring rim is that it can be worn effectively by some women with shallow post-pubic vaults. 

The only unknowns with the Milex Arcing spring diaphragm used for deep thrust anterior fornix play is how much the diaphragm will rotate which can affect the pressure deep thrusting will develop and how well the elbow hinges will withstand the reverse pressure when the dome is stretched into the wearer’s anterior fornix by a well endowed partner. The good news is that if the elbow hinges begin to fail a replacement is easily obtained.

Breeding dancers: I was going to title this section Breeding Ballerinas for the alliteration, but while I have helped some of my ballet dancer friends conceive most of the women who come to me for help getting pregnant are statuesque full figured show girls 5’10” or taller so are well over 6” in heels or en pointe; lovely but not with ballet bodies, technique or speed necessary for classical ballet.

My method has been fairly successful and is low cost, fun to use and counter intuitive as a conception aid. I have the friends I’m counseling use a silicone Milex wide seal Omniflex (coil spring rim) breeding diaphragm – one that is two sizes smaller that the size the woman should use for contraception – and have the couple lubricate the dome and vagina with pre-seed, a pH balanced sperm friendly gel, rather than acidic spermicide. This allows a partner to easily under-thrust the rim of the diaphragm especially when the woman is being penetrated from behind while bent over holding on to a barre, chair or table or on her hands and knees.

In that position with the trunk of her body parallel to the floor the uterus is pulled down and back by gravity increasing the depth of the vagina. As the vagina lengthens the rim of the diaphragm in the posterior fornix will be pulled deeper with the cervix which in turn pulls the anterior rim further away from the pubic bone where it can be more easily under-thrust by the smooth upper side of her lover’s glans. Once under the dome the frenulum of an uncut man can freely caress his lover’s G-spot bringing her to orgasm with its strong vaginal contractions that squeeze the thick cream rich with millions of sperm from his vas glands where it spews against her ripe unprotected cervix. Once her breeding partner withdraws the diaphragm reseals against the vaginal walls trapping the ejaculate in the prepared dome along with her fertile cervical mucus.

A few minutes later, the inseminated woman basking in the afterglow lies quietly on her back as her vagina returns to its unaroused state submerging the tip of her ripe cervix in the pool of fertile cervical mucus, pre-seed and semen contained in the dome. So far with the small group of friends who have tried to conceive this way almost 50% have been successful within three cycles, but the group is far too small to be able to make any sort of meaningful claim.