Diving cervical caps while fertile

Clockwise from the top: FemCap, Oves & Prentif cervical caps

Self fitting cervical caps: Before I begin, a warning to do-it-yourselfers, self fitting of cervical caps is not a good idea and should be avoided if you plan to use one for contraception or flood insurance. That’s because:

• The FemCap maker says that a woman’s OB history is the primary indicator of her cap size. However, that is not always the case and in addition a severely anteverted or retroverted cervix will not allow the brim to seal properly against the vaginal walls and cause the cap to fail and the male partner to hit the brim. FemCap was approved for a continuous wearing interval of 48 hours.
• Self fitting a Prentif can be even more difficult because it suctions on the wall of the cervix itself and it comes in only 4 sizes so a significant percentage of women who wanted Prentif couldn’t be fitted. The wall of the cervix must be symmetrical and smooth so that the cavity rim can seal tightly around the entire circumference to develop the strong suction that holds the cap in place. Prentif hasn’t been produced for at least 5 years so availability is extremely limited and experienced fitters are very difficult to find. Prentif was approved for a continuous wearing interval of 48 hours.
• Oves, when it was available, over-the-counter in the UK, was the easiest to self-fit because you could buy a fitting kit with one of each of the three sizes and the dome was so soft that a woman could fairly easily fit herself, but it still required having a smooth cervical wall so the toothed rim could grip the cervix tightly. The dome membrane clings to the cervix by surface tension. Oves was approved in the EU for a continuous wearing interval of 72 hours.

Diving cervical caps while fertile: As I write this I’m CD3 and bleeding heavily so I’m wearing a Milex Omniflex for flow control for the five or six days of my period, unless I want menstrual sex, then I will switch to a flat spring so I can more fully enjoy the encounter and to minimize the possibility of under-thrusting. Returning readers know that my primary cervical barrier for contraception and flood insurance is an Oves cervical cap, but cervical caps can’t be worn effectively during menses.

Before I dive I always remove, empty, clean and reinsert my Oves cap so that the dome will be empty of cervical secretions when I enter the water. That way, when pressure collapses the dome, it won’t force the secretions out breaking the seal and cause the Oves to displace off my cervix. It’s necessary to stay well hydrated and I empty my bladder before diving because diving is very dehydrating. Water pressure squeezes fluids out of body tissues and into the kidneys. Even after emptying before entering the water the pressure will invariably cause me to need to urinate if I’m underwater for 30 minutes or longer and I end up peeing in the pool anyway. Severe dehydration can lead to loss of stamina, overheating and low blood pressure during a dive so going into a dive well hydrated is very important.

On the plus side for women divers dehydration due to diving minimizes menstrual flow and also fertile cervical mucus which is a good thing for divers wearing cervical caps for protection. From my own experience and discussions with other women divers the reduced uterine/cervical secretions while underwater seem to be a common side effect of diving for those of us of reproductive age. Emptying my cervical cap before each dive has worked well for me as I’ve never had a cap displace during an underwater sexual encounter. When I’m not fertile or menstrual and will be underwater for long intervals I take a 0.1mg tablet of Minirin (desmopressin acetate) an hour before I dive and then I don’t have to pee for about eight hours. It can react with antidepressants and pain meds but I’m not on any and have had no side effects with such a low dose.

The question: I had wondered what it felt like to have a cap displace, or float off my cervix, but until the multiplace hyperbaric chamber recently became available at Adolph’s training facility [I wrote about it in my post for July 1, 2012 entitled: The vacuum sealed cervix] I had no safe and effective way to see for myself what would happen if I dived my caps with spermicide and copious cervical secretions in the domes. So several weeks ago, when I was fertile this past cycle, I experimented with my cervical caps; 26mm silicone FemCap, 25mm latex Prentif and 26mm silicone Oves to see what happened when the domes collapsed from squeeze while filled with secretions. I wore each on a test dive in the hyperbaric chamber to simulate dives to 66 feet, three atmospheres (ATA), and how much that affected any thrust buffering the domes provide. The results are below.

A silicone rubber FemCap


The FemCap full dome test dive: After wearing my 26mm FemCap for two days, with a ¼ tsp of spermicide in the dome (as called for) and 36 hours of fertile cervical mucus (FCM) discharge in the dome I simulated a 66 foot dive in the hyperbaric chamber. Before proceeding I checked that the cap was properly in place by squatting and pressing upward on the strap and dome for more than 10 seconds to make sure the cap was correctly positioned with strong suction.

Then while lying on my back on one of the beds as the pressure increased and I worked to equalize the pressure in my ears and sinuses I inserted two fingers in my vagina to feel any changes in the dome due to squeeze. As I expected the pressure forced my cervix deeper into the dome then the dome collapsed filling any remaining void between the top and my cervix. At 15 feet it wasn’t painful just a lot of pressure, but as I passed the 2 atmosphere depth, 33 ft., the pressure became very uncomfortable then disappeared entirely as I felt the spermicidal gel and fertile cervical mucus gushing out between the brim and my vaginal walls as the cap was floated off my cervix. It was just as I thought; as the cervix fills the dome spermicide and cervical secretions were squeezed out by the pressure breaking the seal and dislodging the cap. A dislodged FemCap provides no contraceptive protection. Only the spermicide remains as a contraceptive barrier and any thrust buffering a properly placed FemCap can provide may disappear unless the cap is forced back on to the cervix by a thrusting penis.

A pair of 22mm latex Prentif cavity rim cervical caps:


The Prentif cavity rim cap test dive: Two days after FemCap I tested my 25mm Prentif cap. Prentif is no longer made, but was very popular in Europe where caps were available long before the Prentif was approved by the FDA 1n 1988 for use in the U.S. so there are women both in the U.S and Europe still using them.

I had applied spermicide in the dome and worn my Prentif for 36 hours while fertile so that it would have plenty of FCM in the dome before I went into the hyperbaric chamber and increased the pressure to three ATA. Again, while lying on my back on one of the beds as the pressure increased and I worked to equalize the pressure in my ears and sinuses I inserted two fingers in my vagina to feel any changes in the dome due to squeeze. As I expected the pressure forced my cervix deeper into the dome then the dome collapsed filling any remaining void between the top and my cervix. But the dome of the 25mm Prentif is deeper than the FemCap dome and the pressure of having my cervix squeezed into the dome was more uncomfortable and then at 30 feet the dome collapsed, the cavity rim filled spermicide and FCM and the suction disappeared as the secretions were pushed out under the base of the rim and the Prentif floated off. It was still on my cervix, but not firmly attached and if I’d been having dive-sex with a bareback partner when it popped off I would have been in trouble and would have needed to use emergency contraception. A Prentif has some thrust buffering value. The tab on the shoulder of the cavity rim, to aid in screwing the cap on to the cervix, can hurt a partner so should be rotated to the back.

A pair of Oves silicone rubber cervical caps

The Oves cap test dive: Several hours after I removed my Prentif cap and my cervix had returned to normal I inserted my 26mm Oves cap and screwed it down tight on my cervix. At that point in my cycle I was two days before I ovulated the most fertile part of my cycle. I let the FCM build up again for 36 hours then as I had done for the other tests while lying on my back on one of the beds as the pressure increased and I worked to equalize the pressure in my ears and sinuses I inserted two fingers in my vagina to feel any changes in the dome due to squeeze. Because the dome is so thin and soft the FCM in the cap was squeezed out of the dome and the cap floated off at about 15 feet, less than the depth of an encounter pool. It sent a chill down my spine as I realized that wearing an Oves with a days worth of FCM in the dome on a dive-sex encounter would quite possibly result in an unintended pregnancy.

Not that I wear my Oves that way as I mentioned earlier, but I’d come to think of being invincible, well at least impregnable, while wearing Oves so it was sobering – though not totally unexpected - to have it proven that If I forget to empty, clean and then reinsert my Oves before a dive during my fertile days then even on a shallow dive I would be setting myself up for trouble. Fortunately for me the dehydration effect of diving plays an important role in limiting the production of FCM so that the effectiveness of diving Oves is not compromised when the dome is emptied immediately before a dive. The Oves cap provides no thrust buffering.

Conclusions: My experiments in the hyperbaric chamber show that a cervical cap with spermicide and fertile cervical mucus in the dome when worn for dive-sex will displace anywhere from a depth of 15 to 30 feet. The domes of FemCap and Prentif have a crush depth of about 30 feet at which point even when worn dry (w/o spermicide) they become extremely uncomfortable to wear and in my case would cause me to break off a dive to return to shallower water or the surface. FemCap shouldn’t be worn w/o spermicide so I think it shouldn’t be worn for dive-sex except at depths of less than 15 feet. A Prentif with an excellent fit can be effectively worn w/o spermicide so could probably be worn for a sexual encounter down to its crush depth where it becomes extremely uncomfortable at about 30 feet. Oves, emptied before a dive, can be worn to any depth because the dome is already collapsed and clinging to the cervix so there are no voids to create squeeze.

Intimate pharmaceuticals and devices

Adderall 20mg

Pharmaceuticals in a sexually active woman’s daily life: You would be surprised what a major role Big Pharma plays in an Escort or St Lucy’s student’s life. There are birth control devices: IUDs (GyneFix, ParaGard, or Mirena); the single rod implant' Implanon; Arcing, coil or flat spring rim diaphragms and the FemCap as well as the Today sponge and condoms both male and the female FC2.

For contraceptive accidents or unplanned/unprotected encounters there are emergency contraceptive pills; Plan B one step, a 1.5 mg levonorgestrel tablet that is effective for up to three days after a suspected birth control failure and ella, a 30 mg Ulipristal acetate tablet which is effective for up to five days after a suspected birth control failure. And there is a girl’s best friend, Mifeprex, if EC fails.

Then there are the intimate lubricants and spermicides: Labia Labs professional products line O9 spermicide made with DiveGel and Octoxynol-9 ‘Semécide+’ contains a biocide that reduces the chances of contracting HIV as well as the standalone lube DiveGel and the spermicide Semécide.

And to be at the top of your game mentally there is the neuroenhancer, Adderall which Anya, Cyndi and I use before we go on cleanup projects or when we will be around Adolph where we need to be as alert as possible and the amphetamine Sudafed to open our sinuses before we go diving where clear nasal passages to maximize oxygen capacity become critical.

Even though some shortages of popular social meds are beginning to occur (see the article below) our clinic, which supplies our escorts and St Lucy’s students pharmaceutical needs, has access to large amounts of all the meds our patient population could possibly need. So a gorgeous escort or an adventuresome young St Lucy’s woman patient of our clinic can be assured of having the devices or meds she needs when she needs them.


Last Call for Adderall: Where'd all the 'neuroenhancers' go?
By Gregory B. Hladky
12:52 p.m. EDT, October 31, 2011

“There are a bunch of Connecticut college students who are likely getting a little jittery right now, and it’s not from taking too many drugs. Their problem is a shortage of one of their favorite “neuroenhancers,” commonly known as Adderall.

Adderall is a drug made up of “mixed amphetamine salts” that’s commonly prescribed for people suffering from attention-deficit hyperactivity disorder (ADHD, also known as attention-deficit disorder or ADD) to help them concentrate better.

The months-long shortage of the drug is obviously a pain in the ass for lots of people, adults as well as children, who need Adderall to deal with their medical condition.

But Adderall has become an illegal FAVORITE OF college students looking for more effective ways to pull off all-nighter marathon study and writing sessions or to be able to both party and make classes the next day. The fact it’s a federally controlled drug hasn’t reduced its underground popularity one bit. By some estimates, Adderall use on college campuses is at the 20 percent level or higher.

Reports of Adderall supply problems have been making headlines across the nation for some time now and Connecticut hasn’t been immune.

“It’s probably been going on for a couple of months,” says Rick Carbray, a licensed pharmacist with the Apex Pharmacy in Hamden. He says the shortages in Connecticut at the moment involve “instant relief” Adderall tablets in various dosage categories.

“There’s no problem with Adderall extended relief,” he adds, but that’s no comfort for patients looking for the instant relief tablets.

Marghie Giuliano, executive vice president of the Connecticut Pharmacists Association, says reports from the group’s members across the state indicate that “supply has been sporadic.”

The Federal Drug Administration website lists a number of different reasons for the Adderall difficulties, depending on which manufacturer is involved.

The listed causes include chemical “supply issues,” “inadequate finished product supply to support current demand,” “increase in demand,” and “manufacturing delays.”

The FDA normally limits the amount of ingredients available to companies producing amphetamine-based drugs, but federal officials say those companies can apply to have those limits raised.

There were reports earlier this year of shortages of the extended-relief form of Adderall made by Shire, and that the company boosted prices for that drug by 20 percent or more. A spokesman for Shire says there’s no current shortage of Adderall Extended Relief.

Carbray says the problems at the moment seem to involve shortages of 5 milligram and 20 milligram tablets of the instant-relief variety. The result is that pharmacists are having to mix and match different dosage combinations to get patients the right amounts for their prescriptions, according to Carbray.

He says it stands to reason that, if legitimate users are having trouble getting Adderall, illegal users like college students will be having even more difficulty. That’s because virtually all illegal Adderall usage involves someone getting the drug from a person who has a prescription.

One California study found that full-time college students in the 18-22 age group were twice as likely to have used Adderall as non-students. A recent report in a University of Virginia newspaper quoted one illegal Adderall dealer as saying sales of the drug spike just before mid-terms and finals.

While students who use Adderall as a “neuroenhancer” claim it helps them stay awake and focused for long periods of time, use of the drug comes with some ugly risks. Side effects from overdoses can include confusion, uncontrollable shaking, depression, irregular heartbeats, hallucinations, upset stomach and loss of appetite, even vomiting and diarrhea.”

FDA approves ulipristal acetate for EC

ellaOne Emergency contraceptive

FDA OKs new, five-day emergency contraceptive
By MATTHEW PERRONE, AP Business Writer
August 13, 2010

WASHINGTON – Federal health officials on Friday approved a new type of morning-after contraceptive that works longer than the current leading drug on the market.

The pill ella from HRA Pharma reduces the chance of pregnancy up to five days after sex. Plan B, the most widely used emergency contraceptive pill, begins losing its ability to prevent pregnancy within three days of sex.

The Food and Drug Administration approved the drug Friday as a prescription-only birth control option. The ruling clears the way for U.S. sales of the drug, which is already approved in Europe.

Morristown, N.J.-based Watson Pharmaceuticals will market the drug in the U.S. under an agreement with HRA. Watson said it will launch the pill in the fourth quarter.

Studies of ella by its manufacturer showed the drug prevented pregnancies longer and more consistently than Plan B.

In a head-to-head trial between the two drugs, women who took ella had a 1.8 percent chance of becoming pregnant, while women who took Plan B had a 2.6 percent chance. Experts tracked nearly 1,700 women who randomly received one of the two pills within three to five days of having unprotected sex.

Plan B is made by Teva Pharmaceuticals and is also marketed in several generic versions. Unlike ella, Plan B and other generic versions are available without a prescription for women 17 years and older.

HRA Pharma did not request over-the-counter status for its drug.

Ella uses the hormone progesterone to delay ovulation, a key step in the fertilization process.

Despite this, the drug has drawn criticism from anti-abortion groups who say it is closer to an abortion pill than an emergency contraception pill.

Groups including the Family Research Council argue the drug is chemically similar to the abortion drug mifepristone, which can be taken to end a pregnancy up to 50 days into the gestation period. That drug has been associated with severe infections and bleeding after abortion. However, FDA reviewers reported no life-threatening medical side effects with ella.

The most common side effects with the drug included headache, nausea and abdominal pain, according to an FDA release.

Abortion rights groups hailed the approval as an important step for the FDA, which was criticized in 2006 for its handling of Plan B's approval.

Last year a federal judge ruled that the FDA deliberately delayed making a decision on whether to permit over-the-counter sales of Plan B to teenage girls, at the behest of the Bush administration.

"Approval of ella is another indication that the FDA is committed to restoring scientific integrity in its decisions," said Kirsten Moore, president of the advocacy group Reproductive Health Technologies Project.

Privately held HRA Pharma is based in Paris and specializes in women's health products.

Personal comment: because of the way ulipristal acetate works I think it is unlikely to ever be available behind the counter for women 17 y/o and older as Plan B is today. Used for EC an effective dose is 30 mg, but in a far higher dose it could terminate a pregnancy.

The copper-T as emergency contraception

The ParaGard IUD

Published on RHRealityCheck.org (http://www.rhrealitycheck.org)
By Amie Newman
Created Aug 9 2010

IUDs: Now for Emergencies?

“According to the results of a study undertaken in China by the National Research Institute for Family Planning, the Copper IUD (sold under the name ParaGard in the United States) can be an excellent emergency contraceptive if inserted within five days of unprotected sex.

Researchers followed 2000 women who came to eighteen different clinics around the country for emergency contraception, within the five day window, and then were implanted with the Copper IUD. Women returned for follow-up visits, according to the study published in BJOG [1](an international journal of obstetrics and gynecology), at 1, 3 and 12 months post-insertion. Prior to or at the first follow-up visit, not one woman (all but 70 women returned) had become pregnant.

Women involved in the study did report some side effects: increased menstrual bleeding and menstrual disturbances (however vague that might be). Twenty-nine women "experienced a difficult IUD insertion process, requiring local anaesthesia or prophylactic antibiotics," notes the study.

It's an interesting find.

The old kid on the block, Plan B, the brand name for the emergency contraceptive (EC) pills sold in the United States, is effective at preventing pregnancy in 1 out of 100 pregnancies. Women have been encouraged to keep them "on hand" or in their medicine cabinet so, if there comes a time when they do need them, they do not need to struggle with finding a pharmacy open and available as soon as possible or finding a pharmacy that won't judge or refuse to sell the pills to you [2]. A recent study concluded that though women who keep EC on hand are not as likely to use the pills as previously thought, it is still an important option for women to have.

But how likely is it that a woman who is in immediate need of emergency contraception would actually choose to undergo insertion of an IUD into her uterus, have access to a health provider in a timely manner or be able to afford the "option," in order to make use of this successful form of emergency contraception?

From a Reuters [3] article on the study:

"...despite the benefits of Copper T, it's not easy to get for many women seeking emergency contraception in the United States. One deterrent is that while women 17 and over can buy Plan B over-the-counter at a pharmacy, Copper T must be inserted by a doctor - an extra step for women who only have a window of time when emergency contraception can work.

"The issue," Godfrey said, "is immediate access. In the U.S. it's easier just to go to a pharmacy."

And while Plan B runs for about $50 off the shelf, Godfrey said that depending on her insurance a woman could pay more than $500 to have Copper T inserted. "Cost could certainly be prohibitive," she said."

There are two different IUDs sold in the United States, currently. The hormonal IUD, sold under the brand name Mirena continually releases hormones into your body for up to five years; and the Copper IUD. Both work to prevent fertilization of an egg or to create an inhospitable environment for a fertilized egg to attach to the uterine wall.

The IUD is a more permanent form of birth control so if you use have one inserted, it's a one-time only occurrence (or at least a one-time every 5-10 years occurrence). While these sorts of studies are important from an efficacy perspective, they don't take into account the reality of women's lives. What are the real benefits of a study such as this one if most women cannot ultimately make use of the results?

Dr. James Trussell, a long-time proponent for emergency contraception, and head of the Office of Population Research at Princeton University was quoted as saying,

"It's too bad it's [Copper IUD] not used more often...If there were many, many more IUD insertions rather than emergency contraception pills (used), it certainly would have an impact on lowering pregnancy rates and abortion."

And while I cannot argue with his logic, it's the realistic implementation in women's lives with which I take issue. It seems to me that if we look at women's lives first and see how we can best address unplanned pregnancy rates given, well, the givens then we can "impact" said rates much more effectively.

I'm sorry if I'm short sighted here but the IUD, while effective at preventing pregnancy, is not the right method of birth control for every woman. Here's a basic run-down, from Planned Parenthood [4], on when you shouldn't use the IUD:

You should not use an IUD if you:
-have had a pelvic infection following either childbirth or an abortion in the past three months
-have or may have a sexually transmitted infection [5] or other pelvic infection
-think you might be pregnant
-have cervical cancer that hasn't been treated
-have cancer of the uterus
-have unexplained bleeding in your vagina
-have pelvic tuberculosis [6]
-have a uterine perforation during IUD insertion

There's a lot of room between thinking "you may have" an STI and finding out for sure. Would a doctor insert an "emergency" IUD in that case? What about not knowing if you have cervical cancer or not? Would a woman be honest about her symptoms if she were so intent on preventing pregnancy and getting an IUD put in place? This is a long list of "ifs" to me. I'm not discounting the IUD as a form of EC but I'm not sure this study would be enough to persuade me that inserting an IUD so swiftly is a bright idea, unless the woman has already done her research and was planning on having one inserted anyway."

Personal Comment: I suppose the copper IUD as an effective method of EC is getting attention right now because of the research findings published in the British journal of obstetrics and gynaecology. However it has been known as effective EC for a long time. I remember at least fifteen years ago when I began researching EC when I was on the pill, Planned Parenthood was even then providing the ParaGard as EC.

I agree with the point this article is making, that while a copper IUD is extremely effective as EC it is not for everyone and it is even more difficult to get in a timely manner than Plan B was before it became OTC.

Dive-sex at Lake Tahoe

Gigi diving a Kirby Morgan Band Mask at Tahoe

Altitude Diving in Lake Tahoe: I’ve mentioned several times in earlier entries that there is a significant increase in altitude – about 4300 feet (1311 meters) - between Vegas and Lake Tahoe. Adolph’s place is on the Calif side just south of Truckee. Dive computers with digital altitude adjustment are a must as there is a considerable difference between dive tables for altitude and surface diving. For example: at Lake Tahoe a 96 ft dive at an altitude of 6220 ft makes it the equivalent of a 125 ft dive at sea level. That could get a diver in serious trouble if she was pushing her limits for a safe dive. I mentioned in an earlier post (my entry January 31, 2010) about one of Adolph’s girls who had a DCS attack at Lake Tahoe because she had been multiple diving in Vegas the day before and drove to Tahoe the next morning.

Dive-sex in Lake Tahoe: The water in the lake is primarily the result of snow melt from the Sierra Nevada range on the west and the Carson range on the east. The water temperature near the surface generally cools to 40 F to 50 F during February and March, and warms to 65 F to 70 F August and September. Below 600-700 foot depths, the water temperature remains a constant 39 F. so even in august the surface water is chilly for shallow dive-sex. It’s uncomfortably cold for women even for a short interval in a wetsuit with an open crotch zipper, but with dive gel at least we stay lubed. For guys it’s almost impossible for most of them to maintain a working erection even when using a performance enhancer and cock-ring. Some of my stallions are experimenting with heated Laddy-Caddys, but so far have had mixed results. For dive-sex at Lake Tahoe its best to use a heated swimming pool and Adolph has two large ones at his place there.

A reader’s question: Do you feel any responsibility for the death of the guy who was in trouble with the Mob who drowned during his dive-sex fantasy.

Uhhh, no! It was his fantasy. He was an adult and could swim and was a qualified PADI diver. He wanted to fuck tight hairless pussy deep underwater and I was just there to give him a fantasy of that sort that was to die for. Guys need to be careful what they wish for because sometimes they just might get it. You know what I’m saying? I was nothing more to him than a tight warm, deep vessel for him to fill with semen. I clipped the cock-ring off his shaft after we got to the surface and massaged the blood back so it settled in his pelvis while he was still warm. I think all the ME could tell was that he had gotten off recently. He had been cut so there was no foreskin to trap my DNA and the chemicals in the pool washed all my fluids off him.

EllaOne and the pill: One of the French SI students is on Qlaira and vomited her pill shortly after taking it so she took ellaOne (which she had brought with her) as emergency contraception. EllaOne seems to have a lot of the same interactions with other meds that regular birth control pills have. Although, in the case of birth control pills themselves, because ellaOne blocks absorption of progestin it will make continuing to take BCPs less effective. So it’s recommended that a woman on the pill should continue her pills while using back-up until she has finished her pack and been on the new pack for at least a week. The information below is from the ellaOne patient instruction leaflet:

“Taking other medicines
Please tell your doctor, healthcare provider or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription.

Be sure to tell your doctor or pharmacist if you are taking any of the medicines listed below, as these medicines can make Ellaone less effective in preventing pregnancy:

- Certain medicines used to treat epilepsy (phenytoin, phenobarbital, carbamazepine)
- Certain medicines used to treat HIV infection (ritonavir)
- Medicines used to treat certain bacterial infections (for example rifampicin)
- Herbal remedies containing St John's wort (Hypericum perforatum) used for depression or anxiety
- Certain medicines used to treat acidity of the stomach or ulcers (for example omeprazole)

Ellaone may also make regular hormonal contraceptives less effective. Therefore you should use a reliable barrier contraceptive method such as condom until your next period.

Ellaone should not be used together with emergency contraceptives containing levonorgestrel.

The activity of Ellaone may be increased if you are taking certain medicines such as medicines to treat fungal infections (for example, ketoconazole, itraconazole), or certain infections (for example, telithromycin, clarithromycin) as they may increase the amount of Ellaone in your body.”

The birth control riddle

The birth control pill, Ca 1960

The Wall Street Journal
April, 21, 2010
By MELINDA BECK

The Birth-Control Riddle
Fifty Years After the Pill's Debut, Almost Half of Pregnancies in the U.S. Are Unplanned

“Next month marks the 50th anniversary of the birth-control pill in the U.S. The dawn of dependable contraception not only ended the post-war baby boom, it also ignited the sexual revolution and helped millions of women to enter the work force.

Nowadays, women can choose from a bevy of birth-control options, including pills, patches and rings that allow them to have as few periods as they like, even none. Implants and intrauterine devices (IUDs) can prevent pregnancy for years at a time and eliminate the need to refill and remember. Morning-after pills that can decrease the risk from unprotected sex are available without a prescription even to teenagers. Women who want to end their fertility permanently can do so in a doctor's office without undergoing surgery. Abstinence is still taught in many schools and homes as being 100% effective if followed diligently.

On the 50th anniversary of the pill, WSJ's Melinda Beck tells Simon Constable on the News Hub what's new in birth control. There are more options than ever, but despite all the choices, some three million U.S. women have an unplanned pregnancy ever year.

Yet despite all these options, the rates of unplanned pregnancies remain high: Almost half of all pregnancies in the U.S.—some 3.1 million a year—are unintended, according to the most recent government survey, from 2001. One out of every two American women aged 15 to 44 has at least one unplanned pregnancy in her lifetime. Among unmarried women in their 20s, seven out of 10 pregnancies are unplanned.

An updated version of those numbers from the 2006 National Survey of Family Growth is expected to be released next month. But population experts don't anticipate much change; the rate of unplanned pregnancy was the same in 1994, and smaller studies have found that even newer birth-control methods haven't made much of a dent.

Birth Control Methods

Why are the numbers so high?

The answer is a complex tangle of cultural, religious, behavioral, educational and economic factors. Many of those unplanned pregnancies become wanted babies. About a million are aborted each year and others are miscarried.

Almost half (48%) of unintended pregnancies involve contraceptive failures. In 52% of the cases, couples used no birth control at all. Cost is a factor for some of them. Even though most insurers now cover contraceptives, co-pays and deductibles can still present obstacles.

And many young people are in "the fog zone" in which their beliefs about pregnancy don't match their behaviors, according to a 2009 report by the National Campaign to End Teen and Unplanned Pregnancy. In a survey conducted by the Guttmacher Institute of 1,800 single men and women aged 18 to 29, more than 80% of both sexes said it was important to them to avoid pregnancy right now, yet 43% of those who are sexually active said they used no contraception or used it inconsistently.

Some population experts say the rates of unintended pregnancy would be far lower if more women used IUDs and implants that prevent pregnancy for years at a time. Only about 3% of American women currently do.

"There are terrible misperceptions about these methods— and about all forms of contraception," says James Trussell, director of

the Office of Population Research at Princeton University.

Many traditional forms of contraception have been updated in recent years. Here's a look at the latest developments:

The New IUDs

The IUD got a bad name in the 1970s due to the Dalkon Shield, whose design turned out to make it easy for bacteria and STDs from the vagina to ascend into the uterus and fallopian tubes, causing pelvic-inflammatory disease (PID) and infertility. After hundreds of lawsuits and several deaths, the shield was discontinued in 1974, and doctors were urged to remove them from women in 1980.

IUDs available in the U.S. now are much safer. The ParaGard is made with copper that is toxic to sperm, lasts up to 12 years and doesn't affect a woman's hormone levels. Mirena releases a small amount of progestin that blocks ovulation, and lasts up to five years. Both are more than 99% effective at preventing pregnancy.

Jeffrey Peipert, a top researcher at Washington University in St. Louis, notes that about 18% of female ob/gyns have opted for IUDs. "The most educated consumers are using the most effective methods at high rates," he says.

Cost: $175 to $700 for years of protection.

Downsides: IUDs do not protect against STDs. The ParaGard may increase cramping. In rare cases, IUDs can slip out or push through the uterine lining.

The Implant

Another long-acting contraceptive is Implanon, a rod a doctor inserts in a woman's arm. It prevents pregnancy for up to three years.

A previous implant called Norplant was beset by lawsuits over side effects and scarring and withdrawn from the U.S. market in 2002.

Doctors are required to undergo special training to insert and remove Implanon, which is also 99% effective at preventing pregnancy.

Cost: $400 to $800 for up to three years' protection.

Downsides: Irregular bleeding, possible headaches, sore breasts, nausea, pain at the insertion site. No STD protection.

Hormone Pills, Patches And Rings

The first birth-control pills had very high doses of hormones, and side effects including mood swings, weight gain and blood clots were common.

Dosages have since dropped to about one-tenth of their original strength. There are far fewer side effects and a host of benefits, including regularized periods and reduced acne, bloating, premenstrual syndrome and less bleeding due to uterine fibroids. What's more, the longer a woman uses the pill, the lower her risk of ovarian and endometrial cancer.

Still, some women remain wary. "For some reason, it has a really bad rap," says Rachel Bernstein, an ob/gyn in Fort Lauderdale, Fla., who says she has to explain that these days, the benefits outweigh the risks.

Today, there are about 40 different brands of birth-control pills, most of which contain a combination of estrogen and progestin.

Other versions work the same way, including the NuvaRing, a flexible ring that is inserted in the vagina every month and worn for three weeks, then removed for one week, and the Ortho-Evra patch, which is replaced every week for three weeks, followed by a patch-free week.

Newer pills, like Seasonique, allow women to have only four periods a year; Lybrel, approved in 2007, is designed to be taken for 365 days straight with no period. Experts say there is no health reason that women need to have a period if they are not ovulating or building up uterine lining each month. The traditional pills were designed to include a monthly period in part so that women would be reassured that they weren't pregnant.

Hormonal birth control is 99% effective at preventing pregnancy if used correctly, but in average use, with some forgetfulness, it's only 92% effective.

Cost: $15 to $50 per month

Downsides: Women who have breast cancer should not take estrogen, but the pill does not seem to increase the risk of getting it. It can cause blood clots in rare cases. But, says Vanessa Cullins, vice president for medical affairs of Planned Parenthood Federation: "We have to keep these things in perspective. A woman's risk for those problems is substantially higher during pregnancy."

A more long-lasting form, the Depo-Provera injection, releases progestin only and prevents pregnancy for 12 weeks. It can be used by women who can't take estrogen and by those who are breast-feeding.

Cost: Each injection costs $35 to $75

Downsides: Possible weight gain, depression, blood clots and bone thinning; usually recommended only for women who can't use other forms.

Condoms, Caps And Sponges

Using a receptacle to contain sperm during sex literally goes back to caveman days: It's depicted on the wall of a cave in France from 12,000 B.C. Over the millennia, condoms have been made of paper, animal intestines, leather and linen (a favorite of womanizer Giacomo Casanova in 18th century Italy). Charles Goodyear paved the way for mass production of "rubbers" when he patented the vulcanization of rubber in 1843, and they were a mainstay of birth-control efforts until the pill emerged as more dependable and convenient.

The popularity of condoms soared in the 1980s, when the AIDS epidemic alerted public-health officials to the need for protection against STDs as well as pregnancy. Nowadays, condoms come in a variety of sizes, colors, materials and even flavors. Most are made of latex, but polyurethane and lamb-skin condoms are also available.

Cost: generally $1 each, but sometimes free; available without a prescription.

Effectiveness is still an issue. Roughly two of every 100 women whose partners use condoms correctly become pregnant each year, as do 15 of 100 women whose partners don't use them correctly.

Female condoms, plastic pouches inserted in the vagina before intercourse, are less effective. About five in 100 women who always use them correctly become pregnant each year, as do 21 out of 100 women who don't always use them correctly. They cost about $4 each and are sold without a prescription.

Other "barrier" birth-control methods include the Today Sponge, an updated version of the brand made famous on "Seinfield," that involves a spermicide-containing foam disc that covers the cervix and blocks sperm from entering; the FemCap, a reusable silicon cup filled with spermicide that covers the cervix, and the diaphragm, a much older rubber bowl filled with spermicide. Although all three are inexpensive, don't involve hormones and have few side effects, they are inconvenient, don't protect against STDs and are not very effective. Even with careful use, as many as 20 out of 100 women using them each become pregnant.

Even combined, they make up a very small percentage of birth-control users today. "There's a whole generation of women who didn't pick them up," says Mr. Trussell.

Emergency Contraception

Versions of "the morning-after pill"—a combination of hormones that abruptly halts ovulation—have been around quietly since the 1970s. In 1999, the FDA approved Plan B, a progestin-only pill that does the same, preventing pregnancy up to five days after unprotected sex or in case of a condom break or forgotten pill. It's currently available in three brands, Plan B, Plan B One-Step and Next Choice. Plan B and Next Choice are 89% effective if used within 72 hours after intercourse.

But emergency contraception is only effective if it is used every time after unprotected sex. "If you don't use it every time, then you are eventually going to get pregnant," says Mr. Trussell, who runs a Web site called Not-2-late.com with information on emergency contraceptives.

Cost: From $10 to $70, without a prescription for teens 17 and older

Downsides: They may cause temporary nausea, headaches and irregular bleeding; no STD protection.

Permanent Birth Control

Every year, about 700,000 U.S. women who no longer want children have a tubal ligation, a surgical procedure in which the fallopian tubes are cut and tied off. It's an outpatient procedure, but still requires a hospital stay and a cost of $5,000 or more.

A less-invasive version called Essure can be performed in a doctor's office. Using a hysteroscope, the doctor inserts a tiny titanium coil into each tube via the uterus. The woman's own tissue then grows around the coils, forming a natural but permanent barrier.

It's caught on slowly in the U.S., in part because doctors require additional training. Women must also have a follow-up test in three months to make sure a seal has formed, and to use other birth control in the meantime. But it's over 99% effective, without surgery or hormones.

A competing version, called Adiana that uses a smaller implant and radio-frequency energy, was approved by the FDA last year.

Cost: about $2,000

Downsides: The procedure may cause mild cramping, does not protect against STDs and is not reversible.

Vasectomy Variations

On the male side, there are new variations as well. Traditionally, a doctor makes an incision in the scrotum and cuts the two vas deferens, the tubes that carry sperm out of the testicles, and ties, stitches or seals them closed. The procedure takes about 30 minutes and is done in a doctor's office or clinic.

In one newer version, the doctor pokes a clamp through the skin instead of using a scalpel; there's less bleeding and fewer complications. In another, the vas deferens are locked closed with a clip, though some studies have shown that may not be as effective as other methods.

In general, vasectomies are nearly 100% effective—but since some sperm may remain in the blocked tubes, couples must use another form of birth control for three months. In very rare cases, the tubes may grow back together and permit the passage of sperm again.

Cost: $350 to $1000, covered by insurers and Medicaid.

Downsides: There's some minor pain, swelling and numbness for several days after the procedure, but most men can resume sexual activities within a week. Vasectomies theoretically can be reversed, but they are often not effective. Men should consider them permanent.”

Personal comment: This is a good overview of what is available to the general public but does not cover the barrier needs for professional escorts and women fetishists who routinely need gas guards for upper reproductive tract protection. However, those needs are covered in this blog.

Elke and ellaOne

ellaOne the new European emergency contraceptive

Elke completes dive-sex instructor training: Returning readers will remember Elke, the former ballet dancer who is the Athletics Mistress who will be teaching Dive-sex at an elite Swiss girl’s school on Lake Maggiore. She began her two week instructors training course with Robin on January 13th and completed it on the 27th. Robin gives her high marks for strength, stamina and technique. He also said she is nice enough around adults but has a sadistic side and carries a riding crop to discipline students when out of the pool and in pointes. She is a Domme dressed as Miss Julie (without the suicidal tendencies of the character in the story) and with the sting of a scorpion. She is visiting Adolph for a few days before she returns to Switzerland and her position at the school as their parents were friends. Adolph likes a bit of the lash and has been looking for some one to administer it with Teutonic vigor so they should get along well together. She is anxious to have the experience of diving to the bottom of his 200 foot deep diver discipline facility.

I had a talk with her before she left to visit Adolph and cautioned her to be on guard and check her equipment thoroughly before diving. I’m rather attracted to her, especially when she is in a latex body condom, and in many respects I see myself in her when I was her age, though I have to admit I enjoy lashing men rather than girls. She is fun to be with and considerate of her students, well, for a German Domme I mean. So I don’t want to see anything bad happen to her and visiting Adolph can be a high risk activity. The diver’s drysuit inflator that failed while Adolph and I were with her in the discipline facility wasn’t an isolated instance. Rumors are that young women who dive that training facility almost always have equipment problems: dump valves sticking open, inflators not working, masks that flood, low pressure hoses coming lose, running out of air before they should, buckles of weight belts that won’t open etc. and you don’t want to run out of air or have buoyancy problems in water 200 ft deep. Part of that is the way Adolph trains or administers discipline, but I think a lot is because he wants to see if the girls can extract themselves from possibly fatal situations, and inevitably some can’t. I gave her a pony bottle and a lift bag both disguised as lead weights and helped her fit them on her weight belt so as long as she wears that weight set if she has trouble she can reach the surface.

ellaOne: Elke intends to have sex with Adolph during her visit which is a good thing since I’m certain he intends to have sex with her so she has a supply of ellaOne, the new European emergency contraceptive, which uses ulipristal acetate to decrease a woman’s progesterone to prevent ovulation and implantation. EllaOne is effective for 5 days rather than the 3 days for Plan B and is only available by prescription since it can be used as an abortifacient because, like Mifeprex, it stops production of progestin so will cause an implanted egg to detach from the uterine wall, which Plan B won’t do. EllaOne has a single 30 mg pill dosing regimen. Elke has a GyneFix implanted so she is extremely unlikely to become pregnant by him, but she is paranoid about becoming pregnant by a new partner so will take ellaOne every few days while having sex with Adolph.

Swim caps for breath play: A swim cap is something that can be easily carried even by men and a cap looks harmless. However it makes a very effective asphyxiation device and occasionally there are unfortunate breath play ‘accidents’ between BDSM partners where a cap will be fastened over the bottom’s face for a bit too long and brain damage or death results. Out here, my experience in cleaning up after that sort of accident is that most of the brain damage from swim cap asphyxia occurs to men and swim cap deaths occur to women. Almost always swim cap accidents involve penetrative sex where the dominant partner loses track of time and the sub can’t give the safety signal or was ignored. There have been a few security videos which show a bottom frantically signaling and his partner continuing to thrust until he finished inside the guy, much too late to save him. The ones where the guy dies make great snuff videos as they sell to multiple markets; the Gay community that has sympathy for the Dom who in a fit of lust kills his partner and also to the conservatives who are opposed to Gay sex.

Some straight Doms out here just seem to have ‘accidents’, killing women for sport. They will pick up a stray in her teens who came out here to break into show business and ended up waiting tables and working as a dick-a-chick to make a living. Many of those girls just disappear w/o a trace after agreeing to ‘model’ for sadists. The guys don’t want to be seen losing women in their circle so when they need an extreme violence fix they troll for a stray and have their way with her. A swim cap doesn’t set off any alarm bells. Actually many girls think the guy is thoughtful and has the cap to give them so they won’t mess up their hair by getting it wet in the pool. That sort of thinking is very naïve and can often be fatal.

Fantasy, desire & protection

A model poses during a trade show.

Selling refrigerators to Eskimos: The shop-assistant / model in the image accompanying this entry is wearing a Wolford sheer nylon-Lycra string-body that displays her charms while simultaneously keeping them covered and permits immediate access for penetration. A leather mini from Gucci covers her high tight buns as well as the disappearing string between her cheeks and she is shod in exquisite quality calf length ballet boots to protect her legs. That she can stride around confidently in her 7" heels is a given for this very up-market SA. The well put together look of the up-market shop-girl increases sales amazingly by attracting male clients and stunning them with their own testosterone surges. In that condition men are a lot more likely to buy from an attractive girl regardless of what she is selling.

Another woman’s pleasure and protection equipment: Most important contraceptives (hormones and devices) and fetish clothing, footwear, devices and some recreational pharmaceuticals are customized for a particular woman. Borrowing or stealing someone else’s things to use during hazardous encounters – to avoid pregnancy or to prevent severe physical harm to the user – can cause problems ranging from the merely inconvenient to death.

That’s why I teach my students at St Lucy’s and everyone who comes through the casinos Escort training program that it is a very good idea not to borrow other women’s equipment. I’m not talking about the to-die-for shade of lip-gloss that you need for the hottie you are dating or even a pair of killer boots that are a bit too large or small. If you plan to be on your back or knees most of the time it’s no big deal, right? But borrowing or taking w/o asking another girls gas guard or Penetrator plug could lead to serious problems. First for her if she needs the item you have taken for her personal protection and second if it doesn’t fit you properly and so is ineffective in protecting you and perhaps even causes you harm.

Before someone writes to say that I’m not practicing what I preach, because I harvest items I want during my clean-up projects for the Families here in town, let me say I strip the bodies of only the things that are in my size from birth control barriers to heavy rubber encasement suits and ballet boots. I’m very careful that way and the women I take the items from no longer have any need for the things I take.

UNLV students have reciprocal clinic privileges right now because of the seasonal and H1N1 flu vaccine shortages we are having so we are seeing a lot more university girls. Perhaps it’s the economy, but we are seeing a lot of patients with problems from using another woman’s protection. Things like UNLV women coming in for new diaphragms either used for contraception or as gas guards when theirs was returned with a torn dome. Or someone who is short active pills in her BCP pack because someone took a handful of the actives as emergency contraception. Or, a girl who tried to wear her roomies Penetrator plug which was too large. She could get it inserted but when someone kicked her in her groin - the sort of thing a Penetrator is supposed to protect against - the tip of the plug rammed her cervix and tore some of the ligaments supporting her uterus and she was in considerable pain and may need surgery.

The UNLV girls don’t seem to be as careful about partners and using condoms as my casino entertainers and St Lucy’s girls, so almost all the STI cases we are seeing among students are UNLV girls. With the professionals of course it depends on their status. The younger prettier ones can pretty much talk a client into using a condom or going somewhere else and a man burying himself in something that beautiful and tight can fantasize that by wearing a condom he is participating in her latex fetish. The guy’s I’ve made use condoms when penetrating me all bought into the latex fantasy thing right away! My analyst calls that being “blinded by a predisposition to believe” and almost all of them want to believe they are Rubberstuds needing to wear a latex sheath because the fetish requires we both be totally encased in latex. When it’s explained to them that way they actually enjoy spewing into the reservoir tip of a lifestyles ultra thin. Now that’s a proper use of mind-fucking a man.

Getting mind-fucked: And, speaking of being mind-fucked I teach my students to be careful that when they are seducing someone he isn’t also mind-fucking them. That was what happened to the St Lucy’s student who just had the menstrual extraction after becoming preggers from bareback encounters with a partner who mind-fucked her into believing that he had had a vasectomy and was sterile when actually he was very fertile. [For more about that see my entry for October 14, 2009] That was a classic case of a woman being mind-fucked because she had an easy way to check his fertility, it is on the sexual health screening card that every approved male partner has. She should have checked and she didn’t! The good news is that it was a teaching moment both for her and the rest of her Advances Sexual Techniques class.

Generic Plan B approved

Watson Pharama’s Generic Plan B approved

Generic Plan-B approved: Generic Plan B (levonorgestrel) tablets, 0.75 mg has been approved by the FDA for sale by prescription only to women 17 and under for emergency contraception. The Company intends to market the product under the trade name Next Choice.

EC availability: Our ballet Admin office and St Lucy’s student health stocks and dispenses Plan B free to dancers and students on request so a generic will reduce overhead. Two 0.75 mg tablets of levonorgestrel are just as effective when purchased as a generic as they are when branded so we will be switching to Next Choice for women regardless of their age when it becomes available. I think all entertainment venues here supply EC at no cost to performers since it is a lot less expensive to prevent an unintended pregnancy than the cost of other options once the woman is pregnant.