Spongeworthy, Bank Holiday weekend, Erika

The Today contraceptive sponge

The photo: The Today sponge, shown folded for insertion.

Benefits of the Sponge: The contraceptive sponge is safe, simple, and convenient. In the U.S. you can buy it in a drugstore without a prescription. It does not need to be fitted by a health care provider and with some practice, inserting and using the sponge is easy. Women like the sponge because it can be conveniently carried in pocket or purse to be prepared should a spongeworthy occasion present itself. It generally cannot be felt by you or your partner. It has no effect on a woman's natural hormones. It does not interrupt sex play — the sponge can be inserted hours ahead of time and can be worn safely and effectively for up to 30 hours after you insert it. During that time, you can have intercourse as many times as you like during the first 24 hours without removing or reinserting the sponge. It can be used during breastfeeding. According to the 19^th revised edition (2008) of Contraceptive Technology the sponge is 91% effective for nulliparous women if used correctly and for every act of intercourse.

Disadvantages of the Sponge

• It may be difficult for some women to insert or remove the sponge. If you cannot remove a sponge, or if one breaks into pieces and you cannot remove all of the pieces, see your health care provider immediately to have the sponge removed.
• It may cause vaginal irritation.
• It may make sex too messy or too dry. Some women complain that the sponge is messy because it requires too much liquid. Others have complained the sponge makes sex too dry. Using a water-based lubricant may help dryness.

Using Spermicide

The sponge contains the chemical spermicide nonoxynol-9. Nonoxynol-9 has certain risks. If it is used many times a day, or by people at risk for HIV, it may irritate tissue and increase the risk of HIV and other sexually transmitted infections.

Inserting the sponge:

• Wash your hands with soap and water.
• Before inserting the sponge, wet it with at least two tablespoons of clean water.
• Gently squeeze the sponge. The spermicide, Nonoxynol-9, (N9) will become active when the sponge is completely wet.
• Fold the sides of the sponge upward and away from the loop on the bottom to make it look long and narrow. Then slide the sponge as far back into your vagina as your fingers will reach.
• The sponge will unfold and cover the cervix when you let go of it. To make sure the cervix is covered, slide your finger around the edge of the sponge and check its position. You also should be able to feel the nylon loop on the bottom of the sponge.
• The sponge can be inserted up to 24 hours before intercourse. It must be left in place for at least six hours after the last time you have intercourse. It should not be worn for more than 30 hours in a row.

How long should the sponge be left in?

The sponge can be inserted up to 24 hours before intercourse. It must be left in place for at least six hours after the last time you have intercourse. It should not be worn for more than 30 hours in a row.

Removing a sponge:

• Wash your hands with soap and water.
• To remove the sponge, put a finger inside your vagina and through the loop. Pull the sponge out slowly and gently.
• Use a sponge only once. Always discard a used sponge in a waste container. Do not flush it down the toilet.

The Today sponge is available over the counter in the U.S but NOT available in stores in the UK. However, it is available on the Internet which makes it easily available with a little planning. A box of three costs about £15. 

Sponge sabotage: Our clinic knows of instances where the spermicide has been rinsed out of the sponge and the sponge dried and reused. One source is the trash cans where used sponges are discarded in women’s loos in clubs and communal restrooms in women’s dorms. Then the sponge is given to an unsuspecting woman to insert leaving her with a much less effective method protected only by the moist sponge’s ability to absorb her partner’s semen with no spermicidal activity. If a rinsed and dried sponge is reused it’s also more likely to come apart during use further decreasing its effectiveness.

I’m CD9 and newly fertile this cycle: its Sunday August 30^th as I’m writing this post. I always become aroused when I’m fertile and am writing about contraceptive sabotage occurring either among my friends or to patients who come to our clinic to get help afterward. I think when you are going to be with a new or mischievous man its best even when a woman is on hormonal contraceptives to wear a flat spring rim diaphragm with spermicide to prevent any unexpected decrease in the effectiveness of her hormonal birth control from putting her at risk of pregnancy. Even The LARC methods Nexplanon, Mirena and Kyra can be made less effective by the users intentional or unknowing use weight loss supplements, some prescription meds or even the EllaOne morning-after pill.

Odalisque injuries: There is good news and bad news. The bad news is that another of the small group of corps dancers who are competing amongst themselves to seduce Nikolai out of my bed has been injured. It occurred during a ballet-sex tryst with him when she bruised a big toe when landing from a thrust-drop while wearing Freeds. The good news is that it’s not too serious. Even better news is that this second injury has caused the other Odalisques to rethink purchasing Gaynor Minden shoes in which to play with him. Neither the dislocated toe nor the bruised nail has been linked to Nikolai as the women didn’t want to explain truthfully how their injuries occurred so he is safe for now. I don’t have an immediate replacement, but I think the four remaining Odalisques, including the recent replacement for the one who dislocated her big toe, should take care of his needs until bruised toe can get back into competition.

Summer Bank Holiday: This coming Monday August 31^st is the Summer Bank Holiday. The unionized workers on First Great Western railroad which covers parts of South West England and Wales from Brighton to the tip of Cornwall at Penzance on the south coast of England and along the south coast of Wales from Newport on the East to Pembroke on the west have decided to have a strike this weekend. Most routes are operating, but at reduced service. Fortunately rail service to Caersws, Wales was not affected. On a spur of the moment decision I decided to take Nikolai aboard The Dragon to Blackthorn Castle, my ancestral home in the Cumbrian Mountains. The trip gives us an opportunity to be alone together – with just the servants - where we can work on his pointe training and sexual stamina. The weather so far has been as expected Cool, in the low to mid 60s (F) at mid-afternoon with showers and forecasted thunderstorms Monday afternoon… Sigh! It seems strange not to have my Wards with me to enjoy girl gossip. I think I have a bit of empty-nest syndrome. But I can lose myself with my nose buried in Nikolai’s armpit enjoying the male testosterone musk of his sweat after he keeps me in orgasm for so long I’m breathless and can hardly move much less stand.

Tropical storm Erika and Lost Cove on Virgin Gorda: Alice, Duchess of M**** phoned to say that tropical storm Erika passed over Virgin Gorda on the 28^th with heavy rain and gusty winds and thankfully relatively little damage. Her place and mine on Lost Cove were undamaged. I hope that sort of things continue as we still have another eight weeks of Hurricane season to go.

Vegas vaginas and the contraceptive sponge

A Today vaginal contraceptive sponge

The photo: The Today vaginal contraceptive sponge hanging from an orchid by its ribbon removal loop. Today is a soft, disposable polyurethane foam sponge containing 1000 mg of the spermicide Nonoxynol 9 (N9) and is slightly less than two inches in diameter. The Today sponge while recommended for only 24 hours of continuous wear was originally approved for a 48 hour continuous wearing interval. However, wearing a sponge continuously makes it more likely that the wearer may become allergic to the N9 spermicide and that the sponge will develop an odor. The concave side fits over the cervix and the manufacture says it is effective protection for an unlimited number of acts of intercourse during the approved wearing interval making it ideal for a teen get-away weekend with a spongeworthy man..

Sponge pregnancies: For women who have given birth the contraceptive sponge failure rate is very high (20%) even when used perfectly so is not a good alternative. However, for a young woman who hasn’t been pregnant and has the willpower to use it consistently and correctly the Today vaginal contraceptive sponge can be an attractive birth control alternative if hormonal contraceptives; diaphragms and caps or a LARC method do not suit in her circumstances.  Walmart currently has a three count box advertised for less than eleven USD or about $3.33 each for 48 continuous hours of protection which is pretty good if you are going on a very spontaneous weekend with a new love interest. Of course it provides no STI protection, but does offer some thrust buffering if the man is large and frequently hits the cervix and it is readily available in most pharmacies w/o an Rx.

Bea has had some St Lucy’s girls to our home for weekend sleepovers with escort trainees for entertainment as an ice breaker for new girls entering the prep school during the spring semester. I was surprised to learn that several of the new girls, all Bea’s age, were using the sponge for protection.  There is no danger of contracting STIs on the sleepovers as the escorts and students have all been screened, but the likelihood of them using the sponge correctly at that age isn’t very good. So I made sure they all took the EC pill ella before they left for school the following Monday.  There is some risk but it was a major bonding experience for everyone involved. And I talked with their sexual health counselor at school to see if the girls can’t be convinced to switch to IUDs.

The sponge’s effectiveness: Source: Trussell J. Contraceptive efficacy. In Hatcher RA, Trussell J, Stewart F, Nelson A, Cates W, Guest F, Kowal D. Contraceptive Technology: Eighteenth Revised Edition. New York NY: Ardent Media, 2004.

Failures (unplanned pregnancies) per 100 women during the first year of use.

Parous women     Typical use (not always consistently or correctly) 32%         

      Perfect use (Always used consistently and correctly) 20%

Nulliparous women    Typical use (not always consistently or correctly) 16%         

 Perfect use (Always used consistently and correctly) 9%

Proper use means thoroughly wetting the Today Sponge with tap water before insertion, leaving it in place for six hours after the last act of intercourse, and having it in place every time intercourse occurs. The Today contraceptive sponge does not protect against STIs and should not be used during the woman’s menstrual period or for contraceptive protection during underwater sex. However, it is said to be safe to wear during bathing and while swimming.

Vegas vaginas and the contraceptive sponge: We are seeing a spike in sponge pregnancies coming in to our clinic for blood tests and terminations. That seems to be related to holiday (three day) weekends where the users are trying to stretch a single sponge to a continuous wearing interval of three days, 72 hours. Assuming that all other requirements had been met that leaves them in uncharted territory (as far as the sponges efficacy goes) for the last 24 hours and they are far more likely to have an allergic reaction to the continuous N9 released against delicate vaginal tissue. The scent of a sponge left inserted for three days is pretty ripe, but that is just from the interaction of the polyurethane foam with the wearer’s natural secretions and her partner(s) semen a reaction that occurs with diaphragms and cervical caps left inserted for too long as well.

Birth control hormones, copper IUDs and divorce: Our clinic is beginning to see a pattern in some patients who were recently married (in the past three years), who had been on hormonal contraceptives since their teens and who had come off hormones to get pregnant. The pattern is that the women are coming in for a ParaGard copper IUD before conceiving and having the strings removed so their husbands can’t tell they have An IUD inserted.

I’ve spoken to several of them and they have a common story; that when they came of contraceptive hormones each found they had married the wrong man, meaning that he wasn’t masculine enough for her. All are preparing themselves to divorce their husbands and while hormone free are searching for a more masculine and ruggedly compatible man. I’m not saying this is common, but it does fit with a study that was published last year which found that women who met their partners while they were on hormonal contraceptives chose less masculine men than those who were cycling naturally.    

 

 

Human reproductive fluids and vaginal pH

A human sperm fertilizing an egg

The Photo: A scanning microscope image of a human sperm fertilizing an egg. No form of birth control (except abstinence) is 100% effective so a girl’s worst fear can be realized when a pregnancy is unplanned regardless of why it occurred; from an unprotected casual encounter or from a contraceptive failure. It’s what responsible sexually active women try our best to avoid and what correct use of effective contraceptive methods is all about. Fortunately women facing an unplanned pregnancy now have several options.

pH (potential of hydrogen): The term pH refers to a numerical measure of the acidity or alkalinity of any solution. pH values typically vary across a scale from 0 to 14, with the pH of neutral solutions equal to 7, increasing values have increasing alkalinity and decreasing values have increasing acidity. The pH of the vagina corresponds to the secretions continually produced in conjunction with the vaginal flora.

Normal vaginal pH: pH refers to the vagina’s acidity level. A vaginal pH of 3.8 - 4.5 (slightly acidic) indicates that there is a perfect amount of good bacteria (lactobacilli), and no overgrowth of the bad bacteria that can cause odor, irritation and sometimes infection.  A home vaginal pH test kit measures pH on a scale of 1 to 14. Abnormal vaginal pH may be higher or lower than normal vaginal pH. High vaginal pH numbers indicate less acidity, while lower than normal vaginal pH levels indicate high acidity. Abnormal vaginal pH frequently indicates the presence of a vaginal infection. However, not all vaginal infections cause changes to vaginal pH. This means that having a normal vaginal pH test does not mean that you do not have a vaginal infection.

If the vaginal pH is above normal, the most likely reason is that the woman has bacterial vaginosis (BV) and not a yeast infection. In this case, don't use OTC medications for vaginal yeast infections because the medication does not treat BV. You’ll need to see your doctor for diagnosis and treatment.

On the other hand, if the vaginal pH is normal or below normal and she has had previous vaginal yeast infection diagnosed by a doctor, she could try one of the OTC medications for vaginal yeast infections. If the OTC medication for vaginal yeast infection does not cure the vaginal symptoms or infection, see your doctor for diagnosis and treatment.

 So, what makes pH rise higher than 4.5? There are a surprising number of triggers that can upset the vaginal ecosystem:

• Menstruation: Blood has a pH of 7.4, so during your period, vaginal pH becomes elevated.
• Tampons: Since they retain the fluids that cause pH to increase, tampons can contribute to the problem, especially if you “forget” a tampon and leave it in too long.  
• Intercourse: The pH of semen is 7.1 to 8, slightly alkaline.
• Douching and cleansers: Any vaginal infusion of water or other fluids can affect vaginal pH. The pH of water is 7, and fragrances and perfumes can also irritate the vagina.
• Menopause or pregnancy: These are times where hormones fluctuate, which is associated with elevated pH.
• FCM; Fertile cervical mucus: In normal conditions, fertile cervical mucus has a pH level of 6.5 to 8.5 and should be able to stretch 10cm in either direction. FCM will temporarily decrease the acidity of the vagina to help sperm survive the acidity of the vagina during a woman’s fertile interval.

Semen: A viscous whitish secretion of the male reproductive organs, containing spermatozoa and consisting of secretions of the testes, seminal vesicles, prostate, and bulbourethral glands. It’s also called seminal fluid. The pH of semen is 7.1 to 8, slightly alkaline. 

The average sperm count today is between 20 and 40 million per milliliter in the Western world, having decreased by 1-2% per year, from a substantially higher number, decades ago.

Total sperm count, or total sperm number, is the total number of spermatozoa in the entire ejaculate. By WHO, lower reference limit (2.5th percentile) is 39 million per ejaculate. The median ejaculation (50th percentile) contained 255 million sperm.

Sperm motility: A more specified measure is motility grade, where the motility of sperm is divided into four different grades:

• Grade a: Sperm with progressive motility. These are the strongest and swim fast in a straight line. Sometimes it is also denoted motility IV.
• Grade b: (non-linear motility): These also move forward but tend to travel in a curved or crooked motion. Sometimes also denoted motility III.
• Grade c: These have non-progressive motility because they do not move forward despite the fact that they move their tails. Sometimes also denoted motility II.
• Grade d: These are immotile and fail to move at all. Sometimes also denoted motility I.

Volume: WebMD advises that semen volumes between 1.0 mL and 6.5 mL are normal; WHO regards 1.5 ml as the lower reference limit. Low volume may indicate partial or complete blockage of the seminal vesicles, or that the man was born without seminal vesicles. In clinical practice, a volume of less than 2 mL in the setting of infertility and absent sperm should prompt an evaluation for obstructive azoospermia. A caveat to this is to be sure it has been at least 48 hours since the last ejaculation to time of sample collection.

Semen pH: WebMD lists a normal semen pH range of 7.1-8.0; WHO criteria specify normal as 7.2-7.8 Acidic ejaculate (lower pH value) may indicate one or both of the seminal vesicles are blocked. A basic ejaculate (higher pH value) may indicate an infection. A pH value outside of the normal range is harmful to sperm.

Liquefaction: Liquefaction is the process when the gel formed by proteins from the seminal vesicles is broken up and the semen becomes more liquid. It normally takes less than 20 minutes for the sample to change from a thick gel into a liquid. A liquefaction time within 60 minutes is regarded as within normal ranges.

Spermicides: In order to make barrier contraceptives more effective there are formulations of chemical, Nonoxynol-9 (N-9) and lactic or citric acid mixed with a gel carrier that provides an acidic pH to immobilize sperm should a condom break or a diaphragm leak or become displaced. ContraGel (advertised by its maker not as a spermicide, but as a barrier method when used with a cervical barrier) uses a base of lactic acid with a pH of 3.8 which is hostile to the sperm.

For dive-sex we use a private label product called DiveGel+ (in 10 ml prefilled disposable applicators) which is a specially formulated silicone gel that won’t degrade silicone cervical barriers fortified with a pH balanced biocide and FloraFix a type of Lactobacillus with a pH of 3.8 that helps maintain the acidity of the vagina regardless of how many unprotected men a girl is penetrated by per day. For non-diving encounters the formulation is being rebranded as ‘FloraFix’ and packaged in 5ml disposable applicators and is being used very successfully by our escorts.

My cervical barriers: I dislike using condoms unless the man has an unknown sexual history. I love the skin-on-skin contact which Oves permits me and the feel of a man’s liquefied fluids draining out of me after he has done his biological best to impregnate me. While the rest of my circle is all fitted with copper IUDs I still prefer to use an Oves cervical cap or a diaphragm.  I stocked up on Oves before they went out of business and use them each for multiple cycles, so if I don’t get preggers or have a change to the surface of my cervix I should have enough to last me until menopause. At 42 my fertility is declining, but I still have regular cycles and love how well both Oves and my diaphragm (depending where I am in my cycle) are protecting me.