The sponge and the IUD

The Today contraceptive sponge

Sponge wary: There is a very pretty 26 y/o with an athletic build who was a patient at the clinic this past weekend. She was in again for Mifeprex. She works in the athletic department at UNLV and is obsessed with young male athletes. She told me her job was like being a taster in a candy store. I thought the comparison was apt since both a steady diet of candy or young men can be fattening. In her case she should have known better since this is her third pregnancy in two years using a sponge for contraception while having sex with student athletes. Go figure! If you are in your late 40s and marginally fertile the sponge may be a good choice, but not when you’re at the peak of your fertility in your twenties and are routinely being filled with semen by lusty young men at the height of their fertility.

The Today sponge is convenient and at about $5 each they aren’t that expensive when you consider that they can be worn for at least 24 hours for as many acts of intercourse as the wearer wants. You just open the packet, moisten the sponge with tap water to activate the N9 spermicide in the sponge and insert the sponge with the concave side facing the cervix. The sponge is left in place for at least 6 hours after the last act of intercourse then pulled out and tossed in the trash. However, I tell all my students in my Contemporary Sexual Health and Advanced Sexual Techniques classes at St Lucy’s that the convenience of the sponge is far outweighed by its lack of effectiveness. It’s not a barrier it’s a spermicide delivery device because there is nothing to hold the sponge over the cervix so it can be easily displaced by a penis large enough to reach it. That’s not to say it shouldn’t be used if that is the only option available.

So anyway, we gave her the Mifeprex and she will return for a follow-up in a few days to make certain she passed all the tissue associated with this pregnancy. I’m trying to talk her into having an IUD inserted so she won’t have to be going through a termination every few months. She said a diaphragm or a FemCap took too much effort to use correctly. She’s not a swimmer so dive-sex doesn’t seem too likely for her so she would be ideal candidate for a ParaGard that can be left in place for more than ten years. She said she would think about it. Her insurance would pay for it so it would be amazingly inexpensive and extremely effective contraceptive solution to her reoccurring problem.

An IUD expulsion: Also on Saturday while I was at the clinic fitting diaphragms for escorts I was between patients and was asked to try to help calm a patient who had come in because she had expelled her IUD during an intense underwater sexual encounter. The drama was because she had been with the husband of the friend - a roommate from med school - she was staying with. She was a Gyn in her early 30s who had come to Vegas to attend a seminar on birth control methods. Go figure! I’m not making this up! Her ParaGard had been inserted two months before in NYC where she practices as a clinical gynecologist. She said she hadn’t been having any trouble with it and that she was fertile and her lover had a very high sperm count (according to his wife) because he had fathered their two children (born 10 months apart) while she was on hormonal contraceptives.

IUD expulsions are fairly common, from 2% to 8% during the first year after insertion, but expulsions are most likely during the first three months after insertion and during menstruation when cramps may expel it. I found her in the exam room with Chuck, our lead male Gyn who knew her from medical conferences they had both attended. I talked to her about having a frameless copper IUD, a GyneFix, inserted. We weren’t supposed to insert a GyneFix in a woman who wasn’t going to be part of the clinical trial, but Chuck agreed to do it as a professional courtesy. The patient wasn’t excited about having a GyneFix until Chuck explained that the new implantation technique that was developed a year ago had decreased the expulsion rate dramatically so the percent of GyneFix devices expelled within a year after implantation using the new technique is less than 2%.

The nice thing about GyneFix is that it is not subject to expulsion from menstrual cramps or from uterine cramps caused by intense sexual encounters. And because it is copper once implanted it has an immediate emergency contraceptive effect so she would be very safe even after the expulsion of her ParaGard. She was given 800 mg of ibuprofen and since she was fertile her cervix was already soft and opens so she didn’t need to be dilated to get the implantation tool through her cervix and up against the fundus where the knot of the thread was buried deep in the muscle. Chuck gave her a ten day regimen of antibiotics to minimize the likelihood of infection while the implantation site healed.

Reflexions as a prophylactic: She was feeling frisky enough after her GyneFix was implanted that she asked to have a diaphragm fitted (she had used one her first few years in med school) so she could continue having sex with her roommate’s husband w/o having to worry about his sperm in her uterus complicating the healing of the implantation site. She said he is really Hot! So I asked if she had a latex allergy and when she said no I fitted her with a 75 mm Reflexions flat spring so it would be very difficult for her ‘hot’ married lover to under-thrust her diaphragm to get semen into her uterus. I also gave her a 100 ml tube of DiveGel+ because her vaginal walls were slightly abraded by the poor lube used during her initial dive-sex encounter. The wife is an ER doctor at a local hospital and as a junior member of the team she gets a lot of 12 hour night shifts leaving her husband available for what ever games her visiting friend wants to play with him.

God knows, I don’t mind a little adultery, as I think it can add spice to a relationship, but that woman was so fixated on her friend’s husband it’s hard to see anything good coming out of it as obsessive as she seems to be. Sometimes we think a guy is hot because he belongs to someone else. I don’t know enough about her to know if that’s what’s driving her lust or if she is just that competitive with all her women friends. Or, if there is real chemistry between her and the guy and he is coming on to her as much as she is encouraging him.

Pointework, gender and desire

pointework, femininity and fantasy

The New York Times
August 4, 2010
By ALASTAIR MACAULAY

For Ballet, Plots Thicken, or Just Stick?

“DEAR friends,” the retired ballerina Gelsey Kirkland wrote in an open letter on the Web site for the new Gelsey Kirkland Academy of Classical Ballet (gelseykirklandballet.org), “I have come to believe over the years that the future of ballet lies in the art of dramatic storytelling, drawing on the wellsprings of classical tradition.” The school’s mission statement underscores this belief: “To encourage a renaissance of dramatic storytelling in ballet by providing specialized training for gifted students and by establishing a classically oriented studio company capable of creating new dramatic works.”

Ballet, as Ms. Kirkland knows, has been telling dramatic stories since at least the 18th century. Yet throughout that time storytelling has often been uphill work for ballet. The pure-dance sections, which provide a release from the acting and mime portions, slow down the narrative, putting a story ballet on pause for long periods. And the ballets that have pared away pure dance to maintain a constant narrative thrust have seldom achieved lasting popularity or classic status.

Some of the complaints in the 18th century were just the same as those today: too much dancing or not enough; some stories make incomplete sense while others seem unsuited to dance; some star dancers are poor actors. Ms. Kirkland may or may not be right about ballet’s future, but she and her fellow believers certainly have their work cut out for them.

Nowhere more than in narrative has ballet become the land of low expectations. Audiences regularly sit through a poverty of dance-narrative expression that they would never tolerate in a movie, a novel, an opera, a play or even a musical. I will defend the escapism of “The Nutcracker,” but I cringe at the sensationalism, the triteness and the ham that characterize the majority of story ballets, works like “Don Quixote,” “Le Corsaire” and “La Bayadère.” “Spartacus,” the Bolshoi Ballet’s biggest hit of the last half-century, reduces its freedom-fighting story to the dimensions of trash (irresistible and sensational trash in the right performance), as enjoyable as “Flash Gordon” and scarcely more serious.

Interestingly, Ms. Kirkland’s words come just as a wave of narrative dance drama has been gathering force. At New York City Ballet — the company that consistently did the most to propagate plotlessness in 20th-century classical ballet — the past season was mainly given over to full-evening story ballets. Of the eight new ballets produced by the company so far in 2010, each by different choreographers, four have been storytelling, while a fifth, Alexei Ratmansky’s “Namouna,” has arcane suggestions of narrative.

Mr. Ratmansky, who is also American Ballet Theater’s artist in residence, has created ballets with and without stories. But mainly with, and his storyless ballets have often implied characters, incidents, nonabstract situations. His first Ballet Theater creation, “On the Dnieper” (2009), was a rare Prokofiev love story, while currently he is preparing the company’s new “Nutcracker” and also its first production of his 2003 comedy “The Bright Stream”: narratives both.

Christopher Wheeldon, though he came to fame with plotless ballets (notably “Polyphonia” in 2001), has been of late increasingly preoccupied with stories, like “Estancia,” which had its premiere at City Ballet this season, and next year’s “Alice in Wonderland,” which the Royal Ballet will stage. Meanwhile (though outside ballet) the choreographer with the greatest international box office success is Matthew Bourne, who has made nothing but full-length narratives since 1994. (His “Swan Lake” returns to New York for a month in the fall at City Center.)

So it is indeed story time. What stories, though? In “Estancia,” “Namouna,” Benjamin Millepied’s “Why am I not where you are,” Alexey Miroshnichenko’s “Lady With the Little Dog” and Melissa Barak’s “Call Me Ben,” ballet is stuck merely in romantic-comedy variations on the same old “boy seeks girl, boy finds girl” ballet situation.

Today the traditional “Swan Lake” is usually played like a sentimental “women’s” movie: the swan-queen Odette gives her heart to Prince Siegfried even though he promptly proves himself Prince Wrong by plighting his troth to her wicked lookalike Odile, and of course the martyred Odette then goes on loving him. But both scenario and choreography are more interesting than that: they leave it wholly ambiguous about whether she ever returns his love. She merely needs him to love her so that she may find release from swan form; and the choreography, which focuses on her indecision, shows just how mixed her feelings are about committing herself to accepting his support.

In her constant need to keep withdrawing from him, and her muted response to his ardor, the real suggestion that used to emerge was that she felt unable ever fully to respond to him, as if sensing a reluctant frigidity within herself that she could not eradicate. That’s a far more interesting psychodrama that the one we usually see onstage today.

The expressive possibilities of ballet are increasingly constricted today by the way it hinges on the dichotomy of gender. Once the genre acquired pointework in the early 19th century, it acquired a tragic dimension. A heroine on point is existentially different from the hero; she becomes the Other.

It has sometimes been said that adultery was the great subject of the 19th-century novel. Well, adultery was the great fantasy underlying most of the great 19th-century ballets too. The hero, though engaged or married to one woman, couldn’t help loving another (whom of course he could never, ever marry because she was a sylph or working class — never, at any rate, the kind he could take home to meet Mama). To the hero and to the audience, pointework said, “in your dreams.” The heroine of “La Sylphide,” “Giselle,” “La Bayadère,” “Swan Lake” and many other ballets was what the hero thought he wanted but knew he couldn’t have.

In the last century the male-female dichotomy made for yet more remarkable drama. Many of the finest male choreographers — George Balanchine, Frederick Ashton, Antony Tudor, Jerome Robbins, Kenneth MacMillan (Ms. Kirkland danced for all of them) — used pointework expressively, so that a woman’s feet became detailed and powerful expressions of her femininity. The contrasts between man and woman in their ballets helped to make the mid-20th century the greatest era for choreography in ballet’s history.

There used to be an antagonism between narrative and plotless ballet. One set of modernists (led by Tudor) argued that ballet was about psychological communication; the other (led by Balanchine) argued that it was about dancing classically. It’s possible that Ms. Kirkland wants to reignite this debate, but I doubt it. Unlike Ms. Kirkland and her peers, most ballet dancers today belong to companies that perform both pure-dance works and, say, “Romeo and Juliet.” It’s easy now to see that Balanchine, Tudor, et al. excelled in both idioms.

What’s more, it’s easier for audiences now to see that the 20th-century pure-dance ballet was never abstract. As Balanchine, Merce Cunningham and Mark Morris all observed, you cannot have abstraction where there are human beings on a stage. Put a man and a woman onstage, Balanchine liked to say, and you already have a story; it has been well said that his plotless ballets actually have more drama than most story ballets.

But society in recent decades has grown far more fluid in its ideas of gender distinctions. Equal rights in the workplace and outside it have been increasingly achieved; various shades of androgyny have been acceptable or fashionable for decades; same-sex marriage is a widespread issue.

Much modern dance reflects various aspects of these blurring lines. Yet ballet still insists on the same either-or distinctions — even makes them more crucial than before. Point work is now a more ubiquitous condition of ballet femininity than it ever was in the 19th century; men, however, may go on point only for an eccentric or animal effect. The man must partner the woman in supported pirouettes; the woman may not return the compliment, and the device is never practiced in same-sex situations. There is also far more lifting — by men of women — than ever before. (John Neumeier’s “Lady of the Camellias,” which joined American Ballet Theater’s repertory in June, is an especially crass example.) Though “pas de deux” means “steps for two,” it is not unusual to hear dancers now use the term to mean the task of lifting and supporting women.

Sure, there have been a very few same-sex duets and a few sequences of male-female parallel-and-equal (unisex) dancing too, but those are never where ballet comes into its own. Almost every ballet, storytelling or otherwise, features at least one partnering passage, usually central, in which the differences between men and women are highlighted. How well equipped is this genre to speak to, or of, the world we know? Will the choreographers of the 21st century change the genre’s ingredients so that it becomes less automatically sexist? Or will they change the dramas that flow from its heterosexual rituals? Most crucially: What future does ballet have as an art of modern expression?

That future may be sci-fi, chick flick, historical costume drama or post-hip-hop body popping: it’s anybody’s guess. But a 21st-century art that knows no alternative to bringing men and women together in situations of love, chivalry or arrant manhandling will retain obvious limitations. Story ballet today is in danger of becoming a particularly sexist form of rom-com.

Personal comment: First I’d like to wish Gelsey Kirkland great success with her new Gelsey Kirkland Academy of Classical Ballet. She had left ABT before I arrived in NYC so I never got to see her perform live, just on video and she was a lovely dancer. Her research in preparation for a role is legendary so I hope she shares a bit of that with her students. I have taken a few classes that she taught and I learned a lot in a short time, mostly about focus and discipline as she can be very demanding.

Now about the rest of Alastair Macaulay’s article. On the one hand he says:

“Once the genre acquired pointework in the early 19th century, it acquired a tragic dimension. A heroine on point is existentially different from the hero; she becomes the Other.” And he says: “To the hero and to the audience, pointework said, “in your dreams.”

Then he goes on to say:

“Point work is now a more ubiquitous condition of ballet femininity than it ever was in the 19th century; men, however, may go on point only for an eccentric or animal effect. The man must partner the woman in supported pirouettes; the woman may not return the compliment, and the device is never practiced in same-sex situations.”

So? A woman supporting a man who is 40+ pounds heavier and an additional 6 inches taller than she is when en pointe? Get a grip! And, what’s this about “never practiced in same sex situations”? You want Bruce and Tim en pointe as Harley mechanics in a hog shop? Or to bourrée couru down the aisle during a same-sex wedding? I can tell you that with the exception of male comedy dance troupes like the Trocks males en pointe are very much an acquired taste and even then only in cabarets in cities like San Francisco, New York, London, Paris, Berlin and Bangkok.

As long as the human species continues to propagate through sexual intercourse between male and female the female will try to make herself as feminine as possible to attract men, and pointework is an unbelievably powerful attractive force for women who can use it properly. With love, lust, envy and jealousy as drivers in relationships between the sexes a woman en pointe is the stuff of fantasy. Here in Vegas we have been successfully accommodating that male fantasy ever since I became AD of the casino’s ballet company.