Birth Control and the Prevention of STD

Birth Control and
the Prevention of STD

Dr. Cherry Lee

In my business I constantly see the tragic results of sexual ignorance, and so in light of the current moves to defund agencies that provide birth control and sexual disease information, I feel a professional obligation to try-even in some small way-to head off some of the personal and social problems that will inevitably result.

Today, STD (sexually transmitted disease) is the number one communicable diseases in the the United States. Most cases occur in people under 25 years of age. A recent national study found that the vast majority of parents are in favor of schools supplying information on both STDs and birth control.

Too often, I've seen how getting good information comes too late and lives are unalterably changed, just as Amy's was. Amy was forced to work as a prostitute after some devastating personal circumstances resulting from her sexual ignorance. However, later she managed to turn her life around, find employment in one of the largest corporations in the United States, marry, and have a family.

Why I chose her as a kind of an authority on birth control information and the prevention of sexually transmitted disease should become evident in a moment.

Finding Birth Control and
Sex Education Information

As I was researching this topic, I turned first to some of the medical experts on the subject that I could call on. But the information I got was technical, abstruse, and laced with legal waffle words.

I've been in the counseling business long enough to know that people need clear, simple information, straight from people who really know-preferably as a result personal experience. Amy's situation came immediately to mind. Plus, I remember the time when I was a young woman and I tried to talk to my doctor about sex. (My parents always managed to duck the subject.) I had first gone to the library, only to find that all of the books on the subject were securely locked away in a steel caged area in the middle of our small-town library!

When I asked the family doctor about birth control, I got an evasive, lets-change-the-subject answer. That conversation abruptly ended with me very embarrassed and sorry that I had asked.

Although I'm sure that most librarians and medical doctors are more enlightened now, I must sympathize with what some people must do to find needed information-especially in light of the "all you need to know is how to say 'no' approach" that seems to settle the issue for many people.

Amy had sex with around 500 men without getting pregnant or contracting a disease. Not unrelated, she also insisted on keeping a clear head by abstaining from both alcohol and drugs-not an easy task considering the many parties she attended. So in terms of firsthand experience in this area, she is clearly ahead of any medical doctor I know of.

What follows represents the compiled excerpts of our conversation that relates to birth control.

The Rhythm Method

I guess I learned my lesson the hard way on that one. When I marred [my first husband], we were both pretty young, and maybe I was a bit too idealistic about my [Catholic] religious beliefs.

We were really in love, I know that, but my husband was also thinking about his career and looking forward to the time when we would be in a good financial position to raise a family. Before marriage, we had clearly agreed on no children before we were ready. But, for me there was only one birth control method allowed-the rhythm method [when you only have sex during the part of the month when you are supposedly not able to conceive].

He loved me, we were just married, and he wanted to make love to me...and I kept refusing him because it wasn't the "right time." I would literally push him away during intimate times, which created both a physical and mental distance between us. So, we started having arguments.

...I thought we were following the rhythm method, but I found out pretty quick that it flat out didn't work. It's not birth control, it's Russian roulette! Not only does it not work, but there's always that "we can't tonight, dear" routine which can really kill intimacy and even love.

...I can still see the look in his face with I told him that I was pregnant. Somehow, I had totally disappointed him and gone back on our agreement-the only real agreement we had made before going into marriage. And, of course, it was all my fault. Yes, okay, I was in love and pretty naïve, I'll admit it, and now I know now that most Catholics just disregard [birth control prohibitions], but back then I was a product, or maybe a victim, of my strict upbringing.

...We started playing the blame-game, and anger escalated real fast, the way it can when you are young and strong willed. We were saying very cruel things to each other, and before long, he just exploded, chucked it all-me, his job, everything-and took off to parts unknown.

But how are you supposed to be married and not have sex because you don't want to have children-sleep in separate beds for the first five years or something?

Can't you just see a woman saying, "Yes, we've been married for five years, but I'm still a virgin."

I assume they feel that people aren't supposed to get married until they are ready to have children.

Yes, well, that's just not reality, at least not today. And maybe the rhythm method was okay 1,500 years ago when there were no other options, but come on guys, we're not in the 18th century any more!

...You don't realize how much a new baby can change your life. For starters, being on your own with a kid can really mess up your chances at employment-which, of course, you desperately need at that point. And as far as school, forget it, not when you have to work and you have a baby to look after. In my case, because of the time, place, and circumstances, my options were zero.

The Pill

Anyway, as a last resort, I turned to a man who saw me through the latter part of pregnancy when I was sick a lot, and he found a woman who helped me with the baby. Once the baby arrived and that settled down, the first thing he had me do was go in the pill. And, as you know, he also saw that I was looked after and "employed."

...I was fortunate about the pill, at least, because the first type [the doctor] prescribed worked just fine, but I know that some of my friends had to try different kinds [brands and formulations] before they found one that didn't have effects they didn't like.

"The pill" supposedly can have both long-term positive and negative effects for some people-none of which are as bad as an unwanted pregnancy, of course.

I really didn't see any effects, other than maybe bigger boobs, [resulting from a hormone induced pregnancy effect]. Some women claim they put on weight, but in my case that wasn't a problem. I noticed that my bleeding was reduced during my periods..... But, my doctor told me that after a few years-I forget how many-I needed to go off it for a while before starting again. Something about giving your body a rest.

I stayed on the pill until I got married [again] and we decided on kids. We waited until we had sort of proved our relationship seemed solid-I didn't want to make the same mistake again-and we thought we could provide for them the way we should.

So, our first little boy was not an unwelcome accident by any means-we decided together that we wanted a child-and after I went off the pill, it happened pretty quick; I mean real quick! [A few years later Amy had another boy.]

...Much in contrast, I've read that most pregnancies, especially among some minority groups, are unwanted and unwelcome. I guess that goes a long way in explaining how these kids are then treated and how they turn out-angry and violent, and clogging up the prison system. I'm amazed at how some religious types can't understand that unwanted children that can't be cared for constitute a far greater evil....

Condoms

But the pill doesn't protect against sexually transmitted disease.

No, some women I guess believe that, but it's definitely not true. That's why I and all the other women I knew insisted on condoms. They aren't 100 percent [occasionally they break or slip off], but, then again, the chance of that happening with a person who just happened to also be HIV-positive, or was carrying the herpes virus that just happened also to be in the active [contagious] stage, was pretty low. It's a risk, sure, but so is crossing the street, or going to the 7-11 at night.

But, any woman who jumps in the sack with a man and does not use protection is a fool who doesn't think much of herself or her future. I mean they [men] can assure you that they are "clean," but, come on, how many guys-or women as far as they goes-will tell you that they have been with someone they weren't sure about-which includes about everybody-especially with the immediate goal right in front of them?

Not only that, but a lot of people who have some disease don't even know it-or maybe they don't want to know it. [Knowing that you have a STD such as AIDS and infecting someone is a serious criminal offense.]

I guess you know, the gut type [of condoms] don't protect against viruses [such as AIDS that can apparently go through them], and besides, even though they can be reused, they cost a lot more. I guess some gay men use them-which may explain part of that problem. If I saw one of those [condoms], I just switched it with one of my own.

...The women I worked with were pretty paranoid about getting a disease. They knew that would be the end of their careers, and even screw up their chances of marriage and a family...not even to mention the death part of that equation.

...What kind of dunce does it take to figure that a 50-cent investment is not worth avoiding all that?

We got ourselves tested every 30 days, but that didn't mean that we couldn't in theory have somehow contracted some disease. I'm not sure how it is now, but back then we were told that it [the AIDS virus] didn't show up in a test for a while.

But, at the same time, men were safer with one of us than with the "girl next door," who probably took all this a lot less seriously and never got tested because she just knew that something like this couldn't happen to a nice girl like her. Fact is, we much preferred men who limited their activities to women like us. [Unlike street walkers and call girls, where the story is generally much different, Amy had a rather select clientele and a certain amount of control over the men she met.]

So, anyway, in answer to your question, both the pill and condoms are don't-leave-home-without-them essential. Condoms can come off or break, especially if they are not put on right, or things get a bit wild. Hell, none of this is rocket science; it's no different than putting on seat belts, or something.

What about other types of birth control?

...I heard some women who couldn't use the pill, and they would use foam [spermicides], or IUDs, or cervical caps, or something, but they weren't 99% plus effective, or whatever the pill is supposed to be. ...I never heard of anyone getting pregnant on the pill, assuming they didn't forget to take one. But I heard some complaints about the other [approaches].

What kind of complaints?

Well, IUD's would sometimes come out, or cause cramps, or things-at least back then. The foam is messy. I mean, for a husband and wife it might be fine, but in our business, I heard that guys didn't much care for it. ...I don't know about most of the other stuff. Fortunately, I didn't have to deal with any of it. I guess if the pill isn't right [for you], you need to talk to your doctor about what's best in your case.

What about the skin implants and patches?

No personal experience, but I guess they could have a lot of advantages. I've heard the implant type [the type that go under your skin] lasts for a long time; maybe a year or so. That would save you from having to remember to take your pill each day; and, yes, some women forget. And the patch-I've seen that advertised-is just like a Band-Aid that can be hidden somewhere. I guess you would have to check with a doctor or clinic on those.

And you wouldn't recommend just condoms and nothing else.

Only if you like to live very dangerously. Any woman who is even getting close to being sexually active needs to get a prescription for something. My choice is the pill, because I know about it and it's never failed me, and I guess you could say I really put it to the test. And then you need to remember that it will take 30-days or more before you can rely on it.

At parties and stuff, especially where there is alcohol or anything, things can happen real fast. In this day and age parents need to wake up and realize that things are a lot different than when they were growing up. Just look at TV; everybody's jumping in bed with everybody else. [A 2003 study of TV programming preferences among young people found that almost every show that is popular with teenagers depicts or discusses sex.] Parents are fooling themselves if they think that sex isn't a major topic with their kids and all their friends.

If a girl goes on the pill, isn't she sort of announcing that she is interested in sex?

Well, first, unless you run an announcement in the local paper, or something, no one need know. And second, I know a lot of women go on the pill in order to stabilize their periods, control cramps, control bleeding, or whatever. In fact, I know that there are virgins that are on the pill.

Doctors used to have to be assured that a girl was married before prescribing the pill; but, fortunately, that day is long past. It's not hard to find a doctor that will prescribe the pill or something after a few general health questions.

If a guy is smart, he won't take the chance of having sex with a girl who isn't on the pill [or another form of birth control]. Some girls don't think it can happen to them, and some even want to get pregnant and have the guy take care of them both for 18 or more years. If I were a guy, I would insist on seeing that little pill dial or patch with my very own eyes.

And, of course, in the case of the pill, she always has to remember not to forget to take any. If you do, your body can get out of sync with when your period's supposed to be....and, of course, you run the risk of pregnancy. For a lot of reasons women like to have predictable periods.

Have you talked to your boys about these things?

What, you think I'm just all talk here? Yes, a long time ago. I don't want them getting some life-threatening disease or have to marry some girl, drop out of school, and spend the rest of their days working for minimum wage at Walmart or McDonald's, or whatever, to support a family they didn't want in the first place.

And, besides, by just talking to my boys about this, it sort of set an atmosphere where they feel they can be open with me about the subject. How do you think I find out things like the virgins in their high school that are on the pill?

I know that many parents with their "just say no" approach, really close down communication at a time when it's really needed.

I'm sorry, but I'm not about to make the same ignorance-is-bliss mistake my parents did. And, yes, I'm angry about what I had to go through. All it would have taken was a little information, and it could have all been avoided.

Would you have listened back then?

Sure, if it had come from the right people.

The graph below suggests the pregnancy rate with several types of birth control under "average use." This takes into consideration that the method is not always used, and at times used improperly. Totally consistent and proper use would lower these percentages.

Several new types of birth control are on the horizon. One, is a shot for men, which inactivates sperm for a period of months, and is now in the first stages of approval.

Important Note: The above interview consists of opinions of the person being interviewed and should be considered only a starting point for understanding birth control and the prevention of sexually transmitted disease. To appropriately meet unique individual needs a physician should always be consulted.