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.