Showing posts with label Implanon. Show all posts
Showing posts with label Implanon. Show all posts

Sunday, August 25, 2013

Next of kin


A 40 foot Bristol sloop

The arrival: The authorities in Spanish Town contacted us by radio and told that Sailor Girl’s  older sister, Miranda, and her partner would be arriving in the cove aboard her 40’ Bristol Sloop, the Sell Short. Then Miranda radioed that they should be expected on Wednesday after a stop in Spanish Town to identify the body of her sister, Veronica and get it released to the family by the authorities. The Sell Short didn’t appear in the cove until very early Friday just in time for breakfast as they had to re-stock provisions after arriving from Bermuda and take care of funeral arrangements. They had begun the leisurely sail several weeks ago intending to meet Veronica in Spanish Town for several weeks of diving when they were contacted by radio to notify them of her death.

The family: Veronica (Roni) was 26 and working on her masters in marine biology at Florida State.  She had been working for the summer as crew on a large rental yacht out of Spanish Town. Miranda is 31, has a PhD in finance from the Wharton School and is a vice president in a small but highly regarded Wall Street Merchant Bank. Her partner, Ralph, is a 32 y/o bond trader for J.P Morgan; both are avid sailors and excellent swimmers. Miranda is a petite blond with a lovely figure (isn’t that always the way) and Ralph is a rugged 6’2” with magnificent shoulders a gloriously hairy chest, superbly proportioned thighs and buns and washboard abs. An absolute hunk he stirred my carnal interest immediately.

A change in plan: From Miranda’s superior attitude during our radio conversation I had taken an immediate dislike to her.  So when I saw Ralph I decided I would seduce him taking him from her temporarily while she was in her bereavement when I thought she would need him the most. I needn’t have bothered. He fell into my lap!

From the way Miranda acted she and Roni hadn’t been close at all and her death was a mere inconvenience.  Given the circumstances I was amazed that both Miranda and Ralph had roving eyes which I spotted immediately since Ralph didn’t try to hide that he was staring hungrily at me and Miranda seemed fascinated by Chris, the Brit Gyn who always accompanies us on vacations. Perhaps on a long sea voyage Ralph and Miranda had gotten bored with one another or were both looking for a little variety in partners. Whatever the reason Ralph definitely wanted me. And Miranda who sat next to Chris at breakfast couldn’t keep her hands off him. Given that Miranda was supposed to be bereaved she hid it extremely well.

With seduction in mind I had dressed for our meeting wearing a bright yellow swimsuit intended to offset the sadness of the occasion and accent my dancer’s body as I showed the bereaved couple around my villa before breakfast which was when I told them how Cyndi and I had found Roni. I wore a custom made canary thong bikini by Gottex and for Ralph’s benefit took off my pareo to display my legs while showing the villa intentionally preceded them up a long flight of stairs on pointe in yellow satin Grishko 2007 toe-shoes, an ability which I use to test an interesting man’s concentration. He tried to hide his interest as he struggled for control, but I turned as I reached the top and immediately spotted the change in the drape of his shorts. I smiled at him and he returned my smile. Miranda was looking off the stairway at the chandelier hanging from the three story high ceiling so she missed our visual exchange.

Or perhaps she was intentionally looking away as my tight buns and contracted calves (far better than hers) were swaying in front of her lover as we climbed the two long flights of stone steps and she recognized the effect I was having on Ralph. By the time breakfast was over he was in thrall to me and she was talking primarily to Chris while occasionally stroking his hand or putting her hand on his thigh as she hung spellbound on his every word in answer to her questions about his medical  training in the UK. Watching him seduce her was like watching a mongoose hypnotize a cobra. Not that she was at all dangerous.

Roni’s cause of death: Miranda and Ralph had brought along a few of Roni’s things off the sloop she sailed into the bay as well as the personal items off her body as Miranda said she had questions about some of them. Veronica’s rings and All-Flex were there, but not the inserted tampon which I suppose the police kept for DNA analysis and possible match. The doctor acting as coroner said she wasn’t pregnant. He said that, as I guessed from the blood in her throat when we got her aboard, she had a rare pulmonary aneurism which burst. He thought it probable that the strain her body had been under from a very tiring series of recent long deep dives (recorded on her dive computer) contributed to the aneurism rupturing. She bled to death or drowned in her own blood either of which would take only a short time to kill her. Apparently she had had the aneurism for some time though Miranda said she never heard her complain about chest pain in any of their conversations.  

Personal effects and plan comes together: Miranda asked wistfully about the kinky rimmed All-Flex, asking why it was bent like that and why there was no spermicide in Roni’s slit kit if she was using a diaphragm. The answers to her questions are that the All-Flex was kinked from water pressure and was the wrong rim style to use for dive-sex because the rim would distort below 10 meters. There was no spermicide because she was on the pill and was using the diaphragm only for flood insurance. Miranda mentioned several times while handling the bent All-Flex that Roni had been going to teach her how to protect her upper reproductive tract during underwater sex and she and Ralph had been so looking forward to the dive-sex experience.

That gave me the opportunity I was looking for to explain about the proper equipment to provide upper reproductive tract protection at depth and to offer to teach them myself with Chris’ help. Doing that would solve two problems simultaneously; letting me fuck Ralph’s brains out under the guise of training, while giving Miranda an excuse to be with Chris who would teach her the fine points of dive-sex while fucking her brains out which she so obviously and desperately wanted, perhaps as bereavement release if not just for the pure carnal pleasure of it. 

The business of pleasure: I explained that Chris could fit her with the correct type and size diaphragm then act as her trainer for a dive-sex lesson and she was all smiles as she agreed. What woman hasn’t wanted to fuck her male Gyn, right? Which, afterward she confided to me had been her fantasy since her first pelvic. But first we needed to take care of checking everyone’s sexual health. I accessed Chris and my health records at our Vegas clinic and printed out copies of our current negative full STI panel results. I also printed out copies of Cyndi and Bea’s Full STI panels just in case they had an opportunity to be with Ralph. Then Miranda and Ralph accessed their medical records held by their primary care physicians and printed copies of their most recent full STI panel results. That’s at least one good thing to come from digitalizing medical records. I was interested to see that both of them had all three of the Gardasil, HPV vaccine, shots just as I and my circle of men as well as women friends have even though both are outside the target population, girls and boys from ages 9 to 26. But with oral sex now being the cause of so much throat and rectal cancer I think it is beneficial for older adults to minimize their chances of HPV related infections. And Miranda was so pleased about having Chris all to herself that she didn’t ask why I was showing Cyndi and Bea’s STI panel results to Ralph.

Once everyone was assured that we were all STI free it was a simple matter for Chris to fit Miranda with a 70 mm Reflexions and show her how to insert and remove it correctly in the exam room I have set up for his use in my villa. She is using the single rod etonogestrel implant Nexplanon for contraception so assuming she watches her meds the progestin should suppress her ovulation and she can use the Reflexions w/o spermicide, but with a good quality silicone lube strictly for flood insurance unless Fred likes the feel of the stretchy dome as his thrusts force it into her anterior fornix and wants her to wear it all the time.   

Training dives: Miranda and Ralph’s used their own SCUBA gear except tanks which I provided.  Their training went very well after we got them to concentrate on taking full breaths and exhaling completely before taking the next breath. Hyperventilating is a common problem when divers are nervous or concentrating on a task and don’t empty their lungs before taking the next breath. It’s a very common problem when new to dive-sex. I thought they should have already known about how to avoid hyperventilating, but since they were both into new partners and a new sexual experience perhaps they forgot.

After 45 minute session in the villa’s swimming pool we found that Chris could massage Miranda’s G-spot and thrust into her anterior fornix giving her massive orgasms. She was sucking so much air that I decided to give her an 80 cu ft. tank rather than the 60 when we went into the cove. Also in the pool I found that Ralph’s pelvic equipment was marvelously thick while being just long enough to reach into my anterior fornix when I was aroused and he was about to ejaculate. If I have to choose between thick or long I’d much prefer thick and so I was very pleased with his equipment, but not initially with his performance. It was as though he hadn’t had much experience pleasing a woman with his penis so I adjusted my hips and tightened my legs around him to direct his thrusts where they would do me the most good and after a few minutes he caught on. Then he was magnificent with his pile-driving butt pounding away and his recovery time was very short. I actually had to stop him in the pool so he would save his ardor for sex at depth in the cove.  

Dive-sex in the cove: We took the Zodiac out in the cove and showed Miranda and Fred the spot where we found Roni’s body. The girls wore bikinis and the guys slingshots and dove briefly to the bottom (60 feet) there for them to look around before moving out of the lava tube to tether pointes elsewhere in the cove where the water was shallower (25 feet) and much warmer so the men could perform w/o having performance anxiety. I went over tethering again as I had in the villa swimming pool, showing them how the women use the ankle leashes on each ankle to tether ourselves to the anchors then inflate our BCs to hold us with our legs spread wide and the leashes tight because of our positive buoyancy so our partners have a relatively stable target.  I showed Miranda how to apply a 10 ml disposable applicator of DiveGel+ while tethered. With dive sex, especially in the salty water of the ocean there is no such thing as having too much silicone lube. Because once your delicate vaginal lining becomes raw the salt water burns like fire and you have to surface and rinse out with a water/vinegar douche and are out of action for a few days until you heal.

Burial at sea: Miranda invited us aboard the Sell Short and Ralph raised the anchor and took us out into North Sound. She prepared a cold lunch of lobster and shrimp after which she invited us to walk aft and there presented each of us with an orchid blossom. On the afterdeck on a small teak table sat a small cardboard box containing Roni’s ashes. Miranda read parts of the funeral service from the Episcopal Book Of Common Prayer and then with the breeze off the starboard quarter opened the box and poured the ashes into the sea and threw her orchid blossom after them and we all tossed our orchids after hers. Miranda said she was returning her sister to the ocean she had loved so much. Once the burial was completed Ralph took us back into the cove and anchored again. I had no idea that the authorities would release a body that quickly. One assumes they kept enough evidence to open an investigation if questions should arise, but with a burst aneurism the cause of death was undeniable. 

Afterward: Miranda stayed on board the Sell Short with Chris for rest of the afternoon while Ralph came ashore with me to meet and have dive-sex in the pool with Cyndi and Bea. They both enjoyed taking a new man who was so well hung and who they could impress with the strength of their pelvic muscles. Cyndi had wanted to wear Roni’s black rubber swim-skin, but fortunately she mentioned the idea to me first and I nixed it. No one had asked why it was missing or they may not have known, but there was no reason to flaunt a souvenir in front of the donor’s relatives lest someone remember. That evening I tool Ralph back to the Sell Short and an hour later Cyndi, Bea and I were still draining his semen while we watched the Sell Short's navigation lights disappear as it sailed for St John in the USVIs.

The temporary swap of partners for training was an ideal solution letting us girls burn off a lot of estrogenic lust with a new man w/o adding him to my circle while Miranda got to enjoy Chris before going back to being submissive enough to eventually capture Ralph as her husband if she wants him. After all he is the eldest son of an extremely rich industrialist and superb marriage material, which may help explain why Miranda didn’t keep him on a much tighter leash.


Wednesday, March 27, 2013

Callisto

Jupiter as Diana seduces Callisto


The photo: Jupiter and Callisto by Francois Boucher oil on canvas. Dimensions: 72 x 98 cm, completed in 1744. It’s in the Pushkin Museum of Fine Art, Moscow, Russia. In Greek mythology Callisto (or Kallisto) was a nymph of Artemis. Transformed by Zeus into a bear and set among the stars, she was the bear-mother of the Arcadians, through her son Arcas.

Fitting the enemy: Guess whose legs were in the stirrups on my exam table a few days ago? She is new to the clinic and rather than being randomly assigned to me had asked for me specifically, which aroused my curiosity as I know most of the women who have asked to be fitted by me. They are either existing patients or referrals from friends and are on my schedule well in advance. She was a walk-in and amazingly I had a cancellation. Her name is Callisto, from Greek Mythology, and she is gorgeous 5’9” raven haired ex-dancer though too tall for classical ballet. She works as a project manager for a well known aerospace company that recently got a large contract at the RPV (remotely piloted vehicle - drone) control base north of town. She came in for an annual pelvic and to check the fit of an old latex Ortho All-Flex that she was fitted for in 2007. She is currently using the single rod implant Implanon the 3 year effectiveness of which is due to expire next month. She said she is planning to start a family soon so wants to go back to using a diaphragm and spermicide combination to allow time for her natural cycles to resume and stabilize before she tries to conceive.

I fit her with a 70mm All-Flex as she said she isn’t into fetish sex for which Reflexions would have been a better choice and suggested she use ContraGel, a natural ingredients spermicide that uses lactic acid as the active ingredient. Blushing, she also asked what I would advise for pelvic muscle toning. So I suggested two sets of Ben Wa balls. The first a set of individual 1.0 inch Pyrex glass balls each weighing .65 oz as a starter set as she was rather tight to begin with and then a set of .75 inch chrome steel balls each weighing 1.0 oz. once she can manipulate the Pyrex set confidently and won’t expel them if she coughs or sneezes. She bought both at the clinic’s toning boutique before she left.

We seemed to be getting along well and at the end of her fitting as she dressed she said “You don’t know who I am, do you?” That caught me off guard and I said, “I know only what you’ve put in your medical record and told me about yourself.” To which she replied, “I’m Brian’s wife.” And my day had been going so well up to that point! She was my last patient of the day and I had planned to spend several hours window-shopping the Spring fashions, but she asked if I had time to talk and since she appeared to have her emotions under control and her clutch was too small to conceal a gun I thought since I’m fucking her husband why not listen to what she has to say. So I asked if she would like to go with me to Panera (the bread place) on West Lake Mead Blvd, where they have wonderful salads and she followed me in her rental. I love their French bread and with my metabolism I can get away with eating a lot of it with Boars Head roast beef, lettuce and tomato as a filling.

Over coffee and a salad at Panera she told me why she had tracked me down. She and Brian have been married for 6 years and she had known for the last three that he was having affairs with some of his former ballet students while touring schools auditioning new students. She said she wants children and Brian does not and her biological clock is ticking. She has found a young widower, her boss (who Brian had told me was married) who loves her and has asked her to marry him and she intends to divorce Brian.

Pillow talk: She said she wondered what I was like, since he has talked about me in his sleep and has even mentioned me and my success as a dancer to her while in bed together and how tight my grip is. I thought my face was on fire I was blushing so badly. Here I am sitting across the table from a woman whose husband is fucking me every chance he gets and she’s telling me he has compared her vaginal grip to mine and he told her I’m much tighter. Which she said is why she asked me how she could tone her muscles to increase her grip. She asked if I was seriously interested in Brian as a husband because he would be available soon. We both agreed that while he is a truly fantastic lover and sex with him is awesome, neither of us wants him as a husband. However, we both want to continue having sex with him, at least for now. We agreed to keep in touch and strange as it may seem I think we parted friends.

No-fault divorce: She’s going to file for divorce in California, which is a no-fault state, citing irreconcilable differences as the reason. The earliest she can expect the court to grant the divorce is six months and she intends to settle with Brian well ahead of that so that she should be free to marry again some time in the fall. She has had a private investigator photographing his assignations for the past few months and thinks he will settle quickly if she agrees to keep his serial infidelities from becoming public knowledge, which would destroy his career. Fortunately she doesn’t seem to know about his fondness for the private coaching sessions with selected student ‘muses’. She has already broached the subject of divorce with Brian which may explain why he seems to have become extremely attentive to my needs while still fucking as many of his ‘muses’ as I will allow him access to.

The Rite of Spring: Jack was here for the ceremony of planting the first seeds of Spring to celebrate the Vernal Equinox on March 20th, which he did with me having an Oves screwed down tight on my ripe cervix because I was CD13 and ovulated the next day. It was a quiet gathering of like minded friends. After the ceremony we feasted on venison steaks and mead. Not a typical modern western U.S. breakfast, though ham and eggs were available. The venison (Red Deer Jack killed on his father’s estate, aged and shipped in especially for the occasion) and mead linked us to the ancients in whose footsteps we follow.

Spring break and viruses: UNLV is on Spring Break this week and Mumps is on campus and at St Lucy’s as well. The two shot combination measles-mumps-rubella (MMR) vaccine is about 88% effective. So even though all our students have been vaccinated Mumps has infected a few girls at St Lucy’s and they have been quarantined because of potentially serious side effects if an adult gets Mumps. The incubation time is about three weeks so it will take a while for the virus to work its way through vulnerable students and faculty. Fortunately I had Mumps after getting the vaccine when I six and living with my parents in Southwest Virginia so I’m not likely to get it again.

Sunday, November 13, 2011

Nexplanon

Merck’s new single rod contraceptive implant

New Version of Contraceptive Implant Is Easier to Insert. Nexplanon Is Designed to Be Put Easily Under Skin by a Health Care Professional

"Nov. 10, 2011 -- The drugmaker Merck has introduced a new version of its long-acting contraceptive implant Implanon, designed for easier insertion and removal by health care professionals.

The new version of the contraceptive is called Nexplanon. Like Implanon, it is a progestin-only hormonal birth control delivered through a flexible rod the size of a matchstick. It is inserted under the skin of a woman's upper arm to prevent pregnancy for as long as three years.

But unlike its predecessor, the new version the rod is made to be easily visible by X-ray, CT, MRI, or ultrasound.

This was done, in part, to make removal of the rod easier when it cannot be located manually.

Inserting Nexplanon

The contraceptive rod still must be implanted by a specially trained health care professional. But a new inserter makes that process much simpler, says ob-gyn Jill Rabin, MD.

Rabin is the head of urogynecology at the Long Island Jewish Medical Center-North Shore LIJ Health System. She has trained other health care professionals to use the new device.

"Instead of four to six steps, the new inserter has two," she tells WebMD. "It is very hard to place it improperly and next to impossible to put in too deeply."

Implanon was first approved for use in the U.S. in 2006, after almost a decade of use in more than 30 other countries.

Effectiveness of Contraceptive Implants

Contraceptive implants are among the most reliable birth control devices, says Juan C. Arjona Ferreira, MD. He is a senior project leader for diabetes and endocrine research with Merck.

"When implanted correctly, this method is more than 99% effective with less than one pregnancy occurring for every 100 women using it for a year," he says.

The implantable contraceptive prevents pregnancy for up to three years but can be removed at any time, making it a completely reversible, long-acting form of birth control.

It can also be used about three weeks after childbirth and by women who are breastfeeding about one month after delivery.

Nexplanon prevents pregnancy in three ways: by inhibiting the release of the egg from the ovaries, changing the mucus of the cervix to keep the sperm from reaching the egg, and making it harder for a fertilized egg to implant and develop.

The most common side effect seen with implantable contraception is change in menstrual cycles. Some women have no periods on the birth control, while others have irregular bleeding or heavy bleeding.

A Merck spokesman says the new version of the contraceptive implant is less likely than earlier versions to be inserted improperly or too deeply, which can lead to scarring and nerve damage."

Personal comment: Gyns and NPs at our clinic have all been trained in the greatly simplified implantation process and our clinic will be one of the first to offer Nexplanon to patients who are good candidates for the progestin etonogestrel, the same one used in NuvaRing.

Tuesday, May 10, 2011

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

Friday, April 15, 2011

Gasmasks and pregnancy while on the pill


U.S. gasmask MCU 2P with filter canister

What goes around comes around: There are three grad students in the Cosplay group at UNLV that have been giving Taryn’s friend a really hard time because she is using a Reflexions latex diaphragm for contraception. They think that is so old fashioned and she has found her contraceptive supplies tampered with since the three Harpies have been on her case. Things like fresh tubes of spermicide being replaced with tubes long out of date and once she found the dome of an old diaphragm had three pin hole punctures in it. So she knows she is the target of malicious tricks. And the women haven’t been shy about teasing her about being careful when having sex with her BF or she may find herself carrying his child.

The Harpies are all girls from wealthy very conservative Catholic families who have gone wild since they got on the pill and away from home. I’m not saying that it’s a bad thing for a woman to enjoy her body and the effect it can have on men when used provocatively before she settles down, but at the same time the three have high profiles in the Right-to-life group on campus. And this is while they are fucking a large percentage of the male undergrads so you would think they would take more care with their own birth control choices. The three are all on Yaz the 24/4 dosing regimen pill from Beyer that uses the long half-life progestin drospirenone. Each of the 24 active pills has: 3mg of drospirenone and 20mcg of the estrogen ethinyl estradiol and there are 4 placebo pills. Yaz is a good pill (it is 99% effective if taken correctly) but taking dietary supplements that increase your metabolism or taking an antibiotic or seizure meds can decrease the effectiveness as can vomiting within 4 hours of taking your pill. So there are things a user of oral contraceptives needs to be careful about if she is serious about trying to avoid an unplanned pregnancy.

Taryn’s friend was very upset and came to me about six weeks ago to vent and for support. She was hoping there was some way to get back at the Harpies to let them know how serious it is to tamper with someone’s birth control. I think if I was as opposed to abortion as they say they are and was living the lifestyle they are, I’d consider using a Long-acting reversible contraceptive (LARC) like a ParaGard (copper) IUD that is effective for more than 10 years. Or, the Mirena IUS that continuously releases a tiny amount of the progestin Levonorgestrel and is effective for 5 years. Or Implanon the single rod implant that releases the progestin etonogestrel and which is effective for three years. But then I’m fucking as many men as they are and using cervical barriers to protect myself which (theoretically) aren’t nearly as effective as the pill so I don’t suppose I have room to be too critical.

The Cosplay group’s latest fad is gasmasks and the masks are a good fit – fetish wise - since most of the group is also into rubber as fetishwear and in the last several months the Harpies have been seen regularly at one of the up-market rubber clubs in the valley. They are easy to spot because the three of them are always together and they all bought the same style gasmask the U.S. MCU 2P with a ballistic polymer lens and oral nasal unit that has the standard 40 mm NATO canister fitting. And filter canisters are readily available if they decide to wear them into hazardous environments, but none of them have ever been anywhere more dangerous than a fetish club ladies bathroom.

The Fertility Project: When Taryn’s friend was telling me about her birth control supplies being tampered with and being verbally harassed by the Harpies I thought of a project that Jeff’s research labs had worked on for the government. They were looking for a way to compromise the effectiveness of female fighters whether they are irregular (guerrilla) fighters or in the uniformed services of opposing forces. Labia Labs developed an odorless colorless liquid that carries a powerful selective progesterone receptor modulator that binds the human progesterone receptor and prevents progesterone from occupying its receptor. Dispensed in an aerosol it enters the woman’s body through her nose and eyes and immediately almost 100% of the steroid is absorbed through the mucus membranes into her bloodstream. Jeff’s chemists also added a trace chemical that stimulates the production of a woman’s natural testosterone in her ovaries which makes her libido spike at the same time her hormonal contraceptive protection becomes useless.

This modified steroid delivered in an aerosol was tested in two clinical trials in Thailand (as a morning after drug) and found to be extremely effective for women on hormonal contraceptives - who were non compliant in taking their pills - in blocking conception from unprotected sex occurring up to five days before the drug was administered. However, two days after being exposed to the drug laden aerosol the long term blocking of the progestin receptors made the women’s hormonal birth control totally ineffective and the pregnancy rate was 53% for women protected by hormonal contraceptives during the remainder of their cycles. That is a huge pregnancy rate for a single menstrual cycle for mixed age group!

Therefore, two days after being exposed to the aerosol only a copper IUD or a reliable barrier method of contraception will be effective with subsequent acts of intercourse that occur in that same menstrual cycle. The government decided that causing enemy women fighters to become pregnant wasn’t what they had in mind (because it didn’t work fast enough) so the project was cancelled and it left the labs with a supply of the progestin blocking steroid that had been intended for another clinical trial.

Bridesmaid’s gifts: It wasn’t difficult to get Jeff to make up a dozen vials of the steroidal fertility drug for me in small gasmask lens anti-fogging atomizer capped dispensers, the sort you see in up-market fetish club ladies bathrooms. I told him they were to be gag-gifts for bridesmaids and other female guests at a rubber fetishists wedding I was helping with. He wanted assurance that I would tell the women that inhaling it would make their hormonal birth control useless and I agreed, I just didn’t say when I would tell them.

Dressing for success: So after putting the dozen small atomizers in a vintage Gucci tote I started dressing to go hunting. I emptied the Reflexions diaphragm I was wearing (I was menstrual) and reinserted it with Semécide, the professional O9 spermicide, in the dome, just in case I found Mr. right now. Anya (who loves this sort of thing and who went with me) and I changed our eye colors with tinted contact lenses, darkened our eyebrows, dressed in vintage House of Harlot latex catsuits – which I don’t personally care for and had never worn to that club - open faced hoods, gloves and Gepetto’s basic up-market style black leather ballet boots - so as not to call too much attention to ourselves - and Mestel SGE 150 gasmasks a style that we ordinarily never wear and went to the rubber club looking for the Harpies. We took Anya’s Porsche and she removed the heels of her boots so she could drive. That’s a nice feature of Gepetto’s BBs, you can remove or change the heels on some of the more expensive models. The three women were there and easy to spot with three male UNLV grad-students so Anya and I mixed with the masked crowd that were groping one another while watching a HD porn video on a large screen while I watched the Harpies and guys at their table. When the women got up to go to the ladies room I followed.

The switch: One of the nice things about that club is that the ladies room is large, well stocked and very clean to attract women and where there are women men will follow. The three had pulled off their gasmasks and left them on the vanity while they relieved themselves. While the stall doors were closed I replaced the atomizers of house brand lens anti-fogging solution with six of the ones in similar faux Lalique atomizers I brought with the progesterone receptor modulator in them. Just as I finished two sixth form girls from St Lucy’s came in. They shouldn’t have been in the club - not because of the sex but because they were too young to drink - and recognized me with my mask off, but didn’t say anything and I nodded to let them know I knew who they were. I used some of the progesterone spray on the lens of my mask and then to wipe out the oral nasal unit which was sweaty and had makeup on the cheek pieces. I mentioned how I thought the spray provided by this club helped keep my mask lens from fogging even when I got hot and sweaty during sex and both 18 y/o St Lucy’s girls sprayed the insides of their masks with it. I wasn’t concerned for their reproductive safety because I knew both had GyneFix IUDs implanted.

Just as I was fitting my mask back over my hood and establishing a good seal the Harpies came out of the stalls. They had heard my conversation with the students and they all used the spray to prevent lens fogging and to wipe out the mixture of sweat and makeup that collects quickly in a woman’s gasmask. The UNLV grad students pulled their freshened gasmasks back over their hoods, adjusted the straps to produce a good seal breathing deeply to make sure the seal was tight and sucked the fumes from the steroid into their lungs. Everyone put the progesterone atomizer she used in her purse and the Harpies and St Lucy’s girls left while I fumbled for ‘my car keys’ in my tote. When they were gone I replaced the house anti fogging solution atomizers on the vanity just as another woman entered pulled off her mask and soaked the inside of it with the house solution while muttering about how “fucking hot” the masks were even while breathing through the 40 mm canister connector port with no filter attached. I nodded mumbled “yeah” and left having never taken my rubber gloves off.

Shortly afterward Anya and I left having succeeded in getting the Harpies to ingest the progesterone receptor modulator. I wasn’t worried about what the inhaled steroid would do to my cycle because I was menstrual and my hormones were at their lowest points in my cycle so I thought the lack of progesterone probably wouldn’t even change the length of my cycle and I was right. Though an immediate side effect that was very noticeable was that I became extremely aroused with my nipples and clitoris becoming erect and very hard, especially my clitoris which I played with through my open relief zipper as Anya drove us home.

It is now four weeks later and the three Harpies are all pregnant! Two tested positive for hCG a week ago and the other tested positive yesterday. Ohhh! Who could have known! After the first ingestion at the fetish club Taryn’s friend said they were bedding even more men than usual while wearing their rubber catsuits and gasmasks and showed everyone in the Cosplay group the lovely Lalique atomizer and marvelous anti-fogging solution they had taken from the club and used on their masks every time they had sex. Taryn’s friend is beside herself with joy because somehow the change in the Harpies reproductive status leaked from the files in student health and with their high profile in the right-to-life group on campus they are between a rock and a hard place. They are no longer riding Taryn’s friend about her birth control choices.

Saturday, April 24, 2010

Contraceptive methods use in U.S. (2002)


Contraceptive methods use in U.S. (2002)

This poster - published with the article The Birth Control Riddle in the Wall Street Journal, [see my entry for 4-20-2010] - shows the percentage of users in the U.S. using a particular method of birth control based on 2002 data. Another similar study is due to be released soon but is expected to show little change in the popularity of particular methods.

Implants: Norplant has been replaced as the only hormonal implant by Implanon. Implanon is a single rod implant with 68mg of etonogestrel, the same progestin used in NuvaRing, isn’t shown because it was only approved by the FDA in 2006.

Cervical barriers: Even as popular as diaphragms and cervical caps have become in the last eighteen months to two years out here the spike in usage as gas guards for protection during dive-sex has been too recent and I think wouldn’t be enough to change the figures.

IUDs: Rationally IUDs are by far the best choice as far as effectiveness and long term cost is concerned, but of course only GyneFix, or a stringless Mirena or ParaGard can be worn with a gas guard for dive-sex. And if a girl is having her brains fucked out uterine cramps can sometimes bend the frame of a Mirena or ParaGard so that it expels or perforates the uterus. That is why our clinic is so fortunate to be part of the clinical trial and fits only GyneFix IUDs for escorts or adventuresome women wanting to experience super intense sexual encounters under water. And, there are some of us, like me, who just can’t get comfortable with the idea of having a GyneFix implanted in our uteri. Almost all my circle have a GyneFix implanted and say they can’t feel them and the implant does not interfere with their cycle and I know all the rational arguments for GyneFix, but I just don’t like the idea of having one in my uterus. Every girl has her hang-ups and the thought of an IUD in my uterus gives me chills, while a tiny bit of transparent silicone rubber sucking on my cervix makes me confident and adventuresome. Go figure!

Tuesday, April 20, 2010

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.

Thursday, December 31, 2009

IUDs, NuvaRing & asphyxia


A ParaGard Copper T 380A IUD

A reader asked: “Can IUD strings cause air embolisms?” The answer is that the strings themselves can’t cause an embolism. However, they can make it more difficult for the wearer to protect herself from the possibility that an embolism could occur. That’s because the strings can interfere with the seal of any gas guard she may wear to protect her upper reproductive tract from having fluids and gasses forced into her cervix during BDSM play or dive-sex.

Commercially available IUDs with frames such as the ParaGard, that uses copper as the spermicidal element or the Mirena, that uses the continuous release of a tiny amount of progestin to suppress ovulation, both have strings which the wearer uses to periodically check the position of the device to make sure it is where it is supposed to be. These IUDs are not suitable for a woman who is into pussy-play and dive-sex, especially the dive-sex variant, ‘vaginal breathing’ where a modified mouthpiece of a single-hose regulator (a VDV or vaginal demand valve) is inserted in the vagina and the wearer operates the demand valve with her vaginal muscles. [For more about vaginal breathing orgasms see my entry for October 4, 2009.] In my opinion any woman who would participate in a vaginal breathing encounter while she has an IUD with strings inserted is playing Russian roulette.

An asphyxia Accident: another accident Taryn and I recently tided up after was an ‘accidental’ death by suffocation or a gassing. With that sort of thing it is usually impossible to prove that it was anything other than an accident. In many cases it could be that the equipment was used incorrectly while soloing or his (or her) partner used a bit too much pressure or left the wearer w/o air for a bit too long which resulted in irreversible brain damage or death. Most of the accidents happen to women - almost certainly while participating in some male fantasy - but this one was a young man in his early 20s and he was in great physical shape. He was beautiful and nude and lying on his bed wearing only a latex hood that had sound deadening cups over the ears and a Mestel 400 gasmask that had a 3 liter black latex rebreather bag screwed into the canister port. When I pulled his mask off it was clear that his death wasn’t totally accidental. That’s because there was still the slightest sweet scent of chloroform in the oral nasal unit and the valve on the rebreather bag was closed. All sorts of gasses and stimulants are commonly inserted into gasmasks through the drinking port so that’s probably how the chloroform was administered. There was no bottle, syringe or other container for the chloroform anywhere in the victim’s apartment. That suggests the anesthetic was administered by someone who left the victim unconscious to suffocate from the buildup of CO2 in the mask because the valve on the rebreather was closed. He must have been using a performance enhancer and developed Priapism because he still had his hand on his penis which was massively erect – with dried semen splattered on his flat belly and chest - and he had been dead for hours when we arrived to tidy up. At first I thought he was wearing a cock-ring but he wasn’t, his erection was naturally huge!

I’m guessing it might have been a girlfriend who offed him after she found him cheating on her. Or perhaps she just wanted him to nap a while and if she was new to the breath play scene perhaps she forgot to open the valve on his rebreather. With his hearing blocked, if he had his eyes closed while masturbating she could have slipped up and inserted the chloroform into his masks drinking port while he was gasping for air during orgasm. Done while he was orgasmic his slipping into unconsciousness would have been almost instantaneous. I really wanted to straddle him and ride his rod because I’ve never fucked a dead man, but not knowing his sexual history even if I used an FC-2 to take him I decided it wasn’t worth the chance of an incurable infection. Dressed in Co-Op housekeeper’s uniforms we rolled him into a latex body-bag and took him out in a laundry cart.

NuvaRing and a rare case of Nymphomania: One of Cyndi’s friends attending a local public high school has recently switched to NuvaRing as her hormonal contraceptive. She was on Mircette which uses Desogestrel, a fourth generation progestin, in a dosing regimen of: 0.15mg DS, 20mcg EE for 21 days, 10mcg only 5 days. She decided to switch to NuvaRing because she wanted a simpler dosing regimen. NuvaRing uses etonogestrel, the first metabolite of Desogestrel so it’s basically the same progestin she was on when taking Mircette but since the hormones are absorbed continuously and transdermally the NuvaRing dosing regimen is: 0.12mg of etonogestrel, and 15mcg of EE per day for 21 or 28 days. The ring is inserted for three weeks and then removed for one for the user’s ring-period. If she needs to move her period the ring can be left in continuously for up to 28 days with no decrease in effectiveness. So as a hormonal method NuvaRing has a lot of advantages over pills.

Cyndi’s friend has been on the Ring for three cycles now and her libido had increased dramatically. Increased libido can sometimes happen but usually if there are libido issues it is often a major decrease in sex drive so she is pretty happy as is her boyfriend who has been getting a lot more action in the last several months. The girl is a ballet student like Cyndi – they met at a local competition – and is in great shape and Cindy says her friend’s vaginal grip is quite strong, which is what she is hearing from her boyfriends, but since she has taken pointe for years that is a common side effect just as callused toes are. The problem Cyndi’s friend has with NuvaRing is that her partner is so large that he can hook the ring and pull it out. The ring can be removed for three hours at a time w/o decreasing it’s effectiveness so what she started doing is removing the ring before sex and reinserting afterward. That worked as long as she remembered to reinsert after sex, but remembering has become a problem and this week she missed her ring period and tested positive for hCG, the pregnancy hormone. So Cyndi is bringing her in for a menstrual extraction tomorrow and no one will be the wiser. Cyndi suggested that she see if she can get an Implanon implant which also uses the progestin etonogestrel and is good for three years so she won’t have to worry about remembering anything.

Friday, August 14, 2009

Kourtney Kardashian preggers


Kourtney Kardashian unexpectedly Preggers

Celebrity Oops: During an interview with Ryan Seacrest’s KIIS-FM radio show Thursday morning, Kourtney Kardashian singled out a mix-up with birth control as the explanation for her baby-on-the-way, due this Christmas. “This probably sounds so dumb,” she admits, “but there’s so many times I’ll forget to take my pill and I don’t think it’s that big of a deal. I’ve done that several times and never really thought about it. It’s just so stupid.”

User failure: A woman has to be focused enough to remember to take her pill on time. Kourtney’s pregnancy wasn’t a pill failure it was a user failure which is the single largest reason for unintended pregnancies while using oral contraceptives. That’s why I stress the need for young women to use a low maintenance method like Implanon, the single rod implant, or a GyneFix IUD implant. For more mature women I personally prefer a cervical barrier because it is something tangible that I can insert and remove and that will not only protect me against pregnancy but will allow me to participate in deviant sexual practices that would otherwise be extremely dangerous if not fatal.

Thursday, July 23, 2009

Volunteering at the clinic


A Miltex Vaginal speculum

Fitting sports shields: My time fitting sports shields at the clinic this morning was very busy. A woman’s water polo team was in town, for pleasure, and came in for fittings because one of their moms had been fitted here last year. Each had to have a pelvic exam first to make certain her cervix was healthy. That’s because while wearing a cap will not hurt a healthy cervix for women who have cervical dysplasia a cap will make the condition worse. Chuck let me insert the speculums (warmed and lubed before insertion) and I think that’s the part of the pelvic exam women like the least, having our introitus stretched and held open. Five took 22mm FemCaps and 2 took 26mm and they all wanted strapless caps so afterward I taught a short class about the easiest way to remove them and I made sure each girl could properly insert, to make certain she had her cervix covered, and remove her shield. It was pretty much a communal thing with them all standing around watching as they all got fitted. I’d never had that happen before where a room full of women watched one another being fitted. Usually it’s just the occasional mom with a daughter coming in for her first FemCap for dive-sex. But they were very quiet and none of them was shy so it worked out well and it was certainly a bonding experience for the team.

Contraceptive challenges: After I finished fitting sports shields I assisted Chuck as he saw a series of patients. All had birth control problems of one sort or another; pill side effects, an IUD expulsion, incorrect barrier sizes one that was too large and two that were too small and three abortions, two by Mifeprex and one EVA, electric vacuum aspiration.

Hormones: Of the women with pill side effects two were experiencing heavy irregular bleeding while using progestin-only-pills called the mini-pill or POPs. Chuck had them stop hormones and switch to GyneFix IUD implants. The other has started using Ortho Evra (the patch) a month ago and her breasts were so badly swollen that she could hardly stand to wear a tee much less a bra. Chuck took her off the patch – because of the high estrogen dose administered transdermally by the patch breast tenderness is a common complaint – and because she still wanted an extremely low maintenance method, inserted Implanon, a single rod implant the size of a matchstick, in her upper arm.

ParaGard expulsion: The girl with the IUD expulsion was a rubber-chick who had such a brutal sexual encounter at a fetish club that it caused uterine cramping severe enough to bend the frame of her ParaGard, copper IUD. The IUD was protruding from her cervix so Chuck tugged gently and it pulled out painlessly. An ultrasound showed the arms of the frame hadn’t perforated the uterine wall but she was bleeding so he didn’t want to insert a GyneFix until her uterus had healed. So he fitted her with a Milex diaphragm which she had wanted as protection during pool-sex.

Diaphragms: The girl with the diaphragm that was too large (it kept popping out of her pubic notch and she couldn’t pee very well when it was inserted) had gained 15 lbs and the weight had caused her to need a smaller diaphragm, which she was fitted with. Of the two girls who had the diaphragms that were too small one had been miss-fitted by another clinic in Nevada, not here in Vegas, and the other was 16 and had been fitted a year earlier with a 60mm coil spring. She should have returned for a refit in 6 months because she is still growing and because a year ago she was newly sexually active and a woman’s pelvic anatomy stretches with use. That stretching has nothing to do with how tight she feels to a partner which is a function of the strength of her pelvic muscles. She was fitted with a larger Cooper Surgical (the old Milex) Omniflex which is the only coil spring rim diaphragm still made in the U.S.

Terminations:
Of the three abortions, the two medical ones were started with the women taking the first pills in the Mifeprex regimen and they were given the rest of the pills to take two days later. We keep in touch with these patients to make sure they are doing well and schedule them to come back two weeks later as follow-up. The other woman had waited too late to take Mifeprex so she came in scheduled for an electric vacuum aspiration which is a bit more invasive than a menstrual extraction because it requires cervical dilation because a larger diameter cannula is used. The EVA went well and in an hour the woman was on her way with Ibuprofen for any discomfort and doxycycline to prevent possible infection. I’m CD 21 today, so I’m looking forward to my menstrual extraction this time next week.

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Powys , Wales, United Kingdom
I'm a classically trained dancer and SAB grad. A Dance Captain and go-to girl overseeing high-roller entertainment for a major casino/resort