condoms

 

What are condoms ?

Condoms provide some protection against sexually transmitted infections (STIs), including HIV.

Condoms are sheathes that trap the sperm when a man climaxes ('comes').
Wearing them greatly reduces the chances of pregnancy. They also provide some protection against sexually transmitted infections (STIs), including HIV. But this protection is not 100 per cent.
Both for contraceptive purposes, and for the avoidance of infection, it's important to wear the condom throughout the sexual act and not just at the end of it.
Condom use has become widespread throughout the world, though there are whole areas of the globe where these devices are difficult to obtain. Religious opposition toward them has played a part in restricting their availability.
However, in late 2010 the Pope appeared to modify the Catholic Church's view on condom use.
In an interview published in a new book, he seems to have said that it might be permissible to use a condom in order to prevent the transmission of infection.
Various translations of this interview have appeared. The Vatican has recently tried to clarify Benedict XVI's comments, saying he meant that the use of a condom by a man or a woman to prevent HIV transfer 'could be an act of responsibility,' if intended to protect life.

What types of condom are there?

There are now two types of condom: male and female. However, in 2010, male condoms still remain far more commonly used than female ones, which have not ‘caught on’ in the way that was widely expected in the 1990s.
The latest official figures from the Office for National Statistics for 2008/9 show that about 25 per cent of British women aged 16 to 49 say that the male condom is their current method of contraception. Only 2 per cent use the female condom.

The male condom

The male condom is also known as a sheath, a prophylactic, a rubber or a johnny.
It's usually about 7 inches (18 to 19cm) long, but various other sizes are available.
Most condoms are made of thin latex – a form of rubber. A polyurethane type is also available, which can be used by those who are allergic to latex. There is also a sheath made from animal intestine, but it is not easily obtainable.
Some brands of condom contain spermicides, but these chemicals can occasionally cause allergies.
A recent development has been a German invention: a condom which contains local anaesthetic on the inside, designed to combat premature ejaculation. Caution: the local anaesthetic can cause a sensitivity reaction in the skin of the man’s penis. If it leaks out, it can also cause a sensitivity reaction in the woman.

How effective are male condoms in preventing pregnancy?

A condom's effectiveness largely depends on the person who uses it. If a man pulls it on roughly, lets his partner snag it with her teeth, or only puts it on halfway through intercourse, this will greatly reduce the protection it offers.
When used correctly, a male condom is about 98 per cent effective. This means that only about 2 in every 100 women would get pregnant in the course of a year. This is more effective than several other forms of contraception, such as withdrawal or using spermicides (chemicals) alone. And it's far better than using nothing!

Warning!

Pregnancy may occur if:

• you don't put the condom on before intercourse starts
• the condom splits – unlikely if you handle it gently and avoid snagging it with rings, etc
• you use an oil-based lubricant, such as Vaseline, body oils, creams or lotions – these can make holes in latex condoms.

What are the best male condoms?

Buy only condoms that carry either the European CE mark, or the BSI Kitemark (BS EN 600), or the approval stamp of your national Family Planning organisation – this means that they have had thorough quality checks.
The Family Planning Association (fpa) strongly recommends using condoms with the British Kite mark wherever possible. They say the European CE mark simply means that the condom will not harm you, whereas the British Kite mark guarantees greater protection against pregnancy and infection.
Fun condoms, ie those with tickly bits, lights, or which 'say' things or play music when you put them on, are least likely to be effective in preventing pregnancy or infection.

How do you put them on?

Most packs of reliable male condoms come with step-by-step instructions, which you should follow carefully. Try not to get so carried away with passion that you rush things. Use this guide to help you.

1. Take the fresh condom out of the packet carefully. Avoid 'catching' it on your nails.
2. Do not blow it up, because this can weaken it.
3. There's usually a 'teat' at the end. Squeeze the air out of it.
4. Now roll the condom onto the erect penis. (Don't try putting it on before you're hard.)
5. Roll it all the way down to the base of your penis.
6. Some men lose their erection – through nerves – while rolling the condom on. This is now known as 'condom collapse'. If this sometimes happens to you, get your partner to put it on for you – rubbing you at the same time.
7. As soon as you've climaxed, hold the condom firmly onto your penis with your fingers, and withdraw from the vagina. Take care not to spill any fluid.
8. Now, take off the condom, wrap it in paper or tissue, and dispose of it in a bin.
9. If you're going to have sex again that day, wash your penis and put on a new condom.
10. Never try to reuse a condom.

The female condom

The female condom (UK trade name: Femidom) was invented about 20 years ago. It looks like a tiny plastic bin liner. There is a ring round the opening and another one at the closed end – which is the end that goes into the top of the vagina.
It is made of polyurethane, and not latex. So it is unlikely to provoke allergies, and should not be damaged by oil-based lubricants.
It is pre-lubricated, but does not contain a spermicide.
In 2009, a new female condom was invented. It’s called FC2, and is manufactured by the Female Health Company of Chicago. It is made of synthetic nitrile, which is a form of rubber. Its main advantage is that is is cheaper to manufacture than the traditional female condom, and so could be more easily afforded by third world countries.
Another advantage is that unlike its predecessor, it does not make a rustling or squeaking sound during sex. The noise which the Femidon can cause during intercourse has put some people off.

How effective are female condoms in preventing pregnancy?

The female condom is pretty effective, as long as it is correctly inserted into the vagina – and provided the man doesn't put his penis outside it.
One trial gave a ‘success rate’ of 95 per cent over a year, but a couple who know what they’re doing and who use the device really carefully will run only a very low risk of pregnancy.
The woman (or her partner) puts the female condom inside her vagina before sex. You are not adequately protected if you only put it in halfway through sex. The man should take great care to ‘aim’ his penis inside the female condom, and not outside it.

Warning!

Always take the female condom out of the pack with care – don't tear it with fingernails or rings.

How do you put them in?

You may need to try out several 'insertion positions'. Some women put it in while lying down, others while standing with one leg on a chair, and others while squatting.
The insertion procedure is described in the leaflet inside the pack. What you do is this:

1. Hold the 'closed' end of the female condom (the tip), feeling the ring inside it.
2. Squeeze the ring between your fingers, in preparation for insertion.
3. With your other hand, open up the lips of your vagina.
4. Now push the squeezed ring inside, and up to the top end of your vagina. There's a diagram on the leaflet that shows you how to do this.
5. Next, put two fingers inside the female condom and use them to push the inner ring as far into the vagina as it will go – so the whole vaginal cavity is snugly lined.
6. Ensure that the outer ring now covers the opening of your vagina. The top of this ring should be approximately over your clitoris – something that a number of women have reported favourably on.
7. Guide the man's penis in through this outer ring – so he is inside the condom. Take care: it is easy to mistakenly put the penis outside the condom.
8. After sex, remove the female condom by twisting the outer ring and pulling it out gently.
9. Wrap and dispose of it (in a bin). Do not try and use it again.

Although the female condom is still nowhere near as popular as the male one, some couples do like it. And some women are keen on the idea that it lets them control their own fertility.
Many Family Planning Clinics stock Femidoms, but most couples buy their own, over the counter from larger pharmacies. FC2 is still (2010) quite difficult to obtain outside the USA.

The mini-Pill .progestogen-only Pill, or POP

In 2008, the mini-Pill is still nowhere near as popular as the ‘ordinary’ Pill. For every one woman taking the mini-Pill, there are more than 30 who use the ‘real’ Pill.
However, this progestogen-only Pill (POP) does provide very satisfactory contraception for over 100,000 British women – including a lot who can’t take the Pill. Recent research suggests that that the mini-Pill is particularly popular with females over 35.
The POP’s great advantage is that – as far as we know – its health risks appear to be less than those of the actual Pill. But official advice is that it should not be taken by women with:

• undiagnosed vaginal bleeding
• severe artery disease
• liver tumours
• the rare disease porphyria
• a history of breast cancer (with certain exceptions).

In addition, the latest instructions say that the mini-Pill should only be used ‘with caution’ by certain women – including those who have ever had an ectopic pregnancy. Your doctor or Family Planning nurse will advise you about this.
Its two chief drawbacks are that it doesn’t control your periods – and that it is rather less effective than the ordinary Pill.
Nevertheless, new versions of the mini-Pill seem to be better at preventing pregnancy than the traditional type and have an effectiveness that isn't all that much below that of the Pill itself.

Why take the mini-Pill?

If you enjoy a good sex life, you almost certainly want to protect yourself against unwanted pregnancy. The mini-Pill can do that for you. But you have to remember to take it every single day of the year. No breaks at all - even when you're on your period.
Even the newest brand of POP is not quite as effective as the ordinary Pill, but the mini-Pill is a good deal freer of side-effects than the Pill.
It's particularly useful for some groups of women who shouldn’t take the Pill or for whom it is a little risky - for instance:

• new mums who are breastfeeding
• diabetics
• women who smoke
• women whose blood pressure has gone up on the Pill
• older women.

What is the mini-Pill?

There's a lot of confusion about this name. Many women don't understand it - and, regrettably, even a few doctors have got the wrong end of the stick about it!
The mini-Pill is not just a low-dose version of the Pill. Unfortunately, lots of women who are taking low-dose brands of the Pill think they are on the mini-Pill, but they aren't.
The POP is quite different from the ordinary or 'combined' Pill. Unlike the ordinary Pill it contains just one hormone - not two. That hormone is a progestogen (often mistakenly called a 'progesterone'.)
A progestogen - which is an artificially manufactured hormone - is very like progesterone, which is one of the female hormones the body produces. Unlike the 'ordinary' Pill, the mini-Pill contains no oestrogen at all.
It is the oestrogen in the ordinary Pill that is responsible for many of its side effects - including some of the rare but very serious ones. So going on the mini-Pill, instead of the Pill, immediately reduces your chances of dangerous side effects.

How does the mini-Pill work?

The POP stops you from getting pregnant by doing three things:

• it thickens the secretions round the neck of your womb - this makes it very difficult for the sperm to get through
• it makes the lining of the womb thinner, and so less 'receptive' to ova (eggs)
• some of the time, it stops you ovulating (releasing an egg). The latest mini-Pills (such as Cerazette) do this most of the time, which makes you even less likely to get pregnant.

How effective is it?

It's not quite as efficient in protecting you against pregnancy as the ordinary Pill, but it is pretty good. If 100 sexually active women took the mini-Pill regularly for a year, less than two of them would get pregnant. This makes the POP about as effective as the coil (IUD).
However, newer types of mini-Pill – such as Cerazette – probably have a failure rate of only about 1 per cent per year. But take care: much depends on your ability to take the tablet every single day at roughly the same time each day. If you can’t manage this (and it isn’t easy!), you’ll increase your risk of pregnancy.

How do I take it?

You must take the mini-Pill at roughly the same time of day, every day - even when you are menstruating.
You can pick your own time of day when you start on the POP. For instance, you might decide to take it at 12 noon, or when you’re having your supper. But from then on, you need to stick to that time. A few women actually arrange for ‘mini-Pill alarms’ to sound each day on their mobiles!
If you're more than three hours late in taking the tablet, you could fall pregnant. (But with Cerazette, it's said that you can get away with being 12 hours late; I don't recommend making a habit of this.)
Obviously, the mini-Pill is not a great idea for you if:

• you're not very good at taking tablets regularly
• you're in a job - like being part of an airline crew - where hours are irregular and disrupted.

Also, if you’re significantly overweight (and particularly if you’re over 11 stone – that’s 70 kg), the POP may not be effective enough for you.
If you’re determined to try the POP, then Cerazette would probably be your best choice. Alternatively, a few doctors are willing to prescribe two mini-Pills per day for larger women. But very big people (over, say, 16-and-a-half stone – that’s 105 kg) really shouldn’t try the mini-Pill at all in my view, because the risks of falling pregnant are probably too great.
An attack of diarrhoea or vomiting can also prevent the mini-Pill from working effectively.

How do I get it?

Begin by going to a doctor or a family planning clinic and asking them about the mini-Pill. (In practice, family planning clinic staff tend to know more about POPs than almost anyone else.)
Discuss whether the mini-Pill would be suitable for you. Ask about the latest situation regarding side-effects.
If you decide to go ahead with the mini-Pill, you'll be given a prescription for several packs. Read the leaflet inside the packet. Then start taking the tablet on the first day of your next period – this will give you immediate protection.
However, if you’re absolutely sure that you’re not pregnant, you can start taking the mini-Pill on any day of your cycle – but you may not be protected immediately. Take the doctor’s or nurse’s advice about this.
If you're not having periods at the moment because you've recently had a baby, then you can start taking it immediately. (Don't do this if there's any suspicion that you might be pregnant again!)

What special categories of women take the mini-Pill?

Although nearly all women can use the mini-Pill if they want to, in practice it is commonly taken by people who would have difficulties with the ordinary Pill. These include:

• breastfeeding mums - mainly because the Pill tends to stop milk production
• women who cannot take oestrogens
• women over 35 to 40 years of age who have been medically advised not to take the Pill
• women who are at special risk of heart disease or strokes - though these patients should definitely not take the mini-Pill without seeking specialist advice first
• women who are heavy smokers - smoking and the ordinary Pill make a very dodgy combination, and may cause heart attacks or clots. If you can't give up cigarettes, your doctor might suggest that the POP is less of a risk for you.

What are the side effects of the mini-Pill?

At present, the POP seems to carry considerably less risk than the ordinary Pill – but please remember that while the long-term effects of the ordinary Pill have been extensively studied over nearly 50 years, the amount of research into long-term effects of the mini-Pill has been rather less.
So it’s possible that unsuspected side-effects might emerge later in the 21st century. Currently, it is believed that the mini-Pill might carry a slightly increased risk of breast cancer.
The chief known side effects are:

• periods tend to be irregular, which can be a considerable nuisance
• sometimes periods stop - this may be a worry to you, and you may need the reassurance of a pregnancy test
• if you did become pregnant while taking the mini-Pill, there is a chance that the pregnancy might be ectopic, that is outside the womb - so if your period is late and you get pain in your lower tummy, contact a doctor fast (ectopics are said to be rarer with Cerazette)
• you may get spots on your skin
• you could get tender breasts
• there's a small risk of cysts in the ovaries – indeed, it’s best not to use the POP if you’ve already had an ovarian cyst
• women sometimes report nausea and headache and also dizziness, depression and weight change.

Who shouldn't take the mini-Pill?

Doctors may refuse to prescribe the mini-Pill for you if you have one of the conditions listed at the beginning of this article. Also you may not be able to take the mini-Pill if you are on a drug that interacts with it and reduces its effectiveness.

What are the various kinds of mini-Pill?

There are several groups, so if one brand doesn't suit you (say, if it gives you bad spots on your face), you can easily switch to one from another group. At the time of writing, there are five brands available in Britain – and others in overseas countries. The British brands are:

Group 1 (both identical)

Micronor, Noriday.

Group 2

Femulen.

Group 3

Norgeston.

Group 4 (the newest)

Cerazette.

If you are in doubt about any issues concerning the mini-Pill (POP), please don’t hesitate to consult a GP or a family planning clinic.
In December 2008, the Royal College of Obstetricians’ and Gynaecologists’ Faculty of Sexual and Reproductive Health Care issued new guidelines about the mini-Pill. The essence of them is as follows:

1. The mini-Pill should not be used by women who currently have breast cancer.
2. The health professional who is going to prescribe the mini-Pill should first take a ‘clinical history’ from the woman, to make sure it is safe for her.
3. Women should be told that, if taken properly, the mini-Pill is over 99 per cent effective.
4. They should be told that at present there is no evidence that one mini-Pill is better than another
5. If a woman is sick (vomits) within two hours of taking a mini-Pill, then another one should be taken as soon as possible.
6. Women who are using drugs called ‘liver enzyme-inducers’ must be told that the effectiveness of the mini-Pill may be reduced by them.
7. They should be advised that after stopping the mini-Pill, there is no delay in return of fertility.
8. They should be advised that the mini-Pill commonly causes changes in period patterns, and that 20 per cent of females will have no bleeding.
9. They should be told that there is no scientific evidence that the mini-Pill causes weight gain, depression, or headache.
10. The mini-Pill can be used up to age 55. If a woman wants to used it after that age, she should have her blood levels of hormone checked to see if it is still necessary.

Contraceptive coils

Intrauterine devices (IUDs) have remained quite popular during the 21st century, especially among women who have had babies. The word ‘intrauterine’ means ‘inside the womb’.
IUDs are not so easy to insert in young women who have not had children. Also, official advice is that young, sexually active women must be carefully screened for sexually transmitted diseases (STDs) before having an IUD put in.

Names

You may hear the IUD referred to by any of these names:

• the IUCD – short for intra-uterine contraceptive device
• the coil – because in the early days of IUDs, back in the 1960s, some devices were coil shaped (they aren’t now)
• the loop – because a lot of the IUDs of 45 years ago were loop shaped (again, they aren’t now)
• the copper T – because many of today’s devices contain some copper (to make them more effective ) and are T shaped
• various brand names – see below.

Please do not get confused between the IUD and the IUS. The IUS isn’t the same thing at all. It’s a hormone-containing contraceptive device that’s also good for treating period problems.

What is an IUD like?

It’s very small – not much longer than a matchstick. Indeed, any IUD could comfortably sit in the palm of your hand.
Your womb (uterus) is actually about the size of your clenched fist. So if you close your hand round a matchstick, you’ll have a rough idea of how an IUD sits inside your womb.
As I’ve just said, most IUDs are now T shaped. They’re made of plastic and copper, sometimes with a little silver inside. (But the silver is of no real financial value – so it’s not worth saving your old IUDs.)
All IUDs have either one or two little threads that hang down a short distance into your vagina. These are useful when you (or a doctor or nurse) are checking to see that the device is still in place.
Also, most importantly, the threads are used when it’s time to remove the IUD; the nurse or doctor just grasp a thread with a surgical ‘clip’ and pull the device out.

How do IUDs work?

They sit in your womb and prevent you from getting pregnant. They do this in three main ways:

• they prevent your partner’s sperm from getting through your womb and into your tubes
• they alter the secretions (mucus) in your cervix, creating a further barrier for sperm
• they affect your womb lining – making it less likely to ‘accept’ an egg.

Pretty well all family planning doctors and nurses say that the IUD does not work by ‘causing an abortion', as some people have alleged.

Do a lot of women use them?

Yes. In the UK about 4 per cent of all sexually active women are using IUDs.
But, in some other countries they’re much more popular: in Scandinavia, around one in five of all women of reproductive age have IUDs.
However, it’s unlikely that IUDs will ever be as popular as the Pill or the condom.

How well do they protect you against pregnancy?

Today’s IUDs are almost 98 per cent effective, which makes them not all that far off being as good as the Pill (and about as good as the the mini-Pill).
What this means is that if 100 women use IUDs for a year, then only about two of them would become pregnant. This isn’t very much when you consider that if they used nothing, then up to 20 of them would get pregnant.

Are there any side-effects?

There are a number of side-effects and you must be aware of these before you decide to have an IUD.
These devices generally:

• make your periods heavier
• make them longer
• may make them more painful.

Furthermore, because of the increase in menstrual flow, it’s possible that you might become anaemic.
So the IUD is not usually the best choice of contraceptive for a woman who already has heavy or prolonged periods. She might well do better with another method, such as the Pill or the IUS.

Can anybody use an IUD?

No. Most women can use them, but not all. You shouldn’t have an IUD if:

• you have some structural abnormality of the womb or cervix
• you have a pelvic infection, for instance an STD
• you have unexplained vaginal bleeding
• you have heart valve problems (unless a heart specialist thinks you should go ahead)
• you have an allergy to copper (which is rare)
• you’ve previously had an ectopic pregnancy
• you think you might already be pregnant.

The doctor will advise you if you have any other condition that makes using a ‘coil’ inadvisable.

How do I get myself an IUD?

Start by going to a family planning clinic, or to one of the minority of GPs who have experience of fitting IUDs. Also, a few women have their devices fitted by gynaecologists – either under the NHS or privately.
Please make sure that whoever puts it in is properly trained! In the past, a few doctors who had little or no experience of IUDs ‘tried their hands’ at inserting them – often with poor results for the unfortunate patient.

What happens when you have an IUD insertion?

Once you’re fully informed about having a ‘coil’ (and happy with the idea), you’ll be asked to come to the clinic/surgery on a specific date. This is often at the end of your period (when the flow should be light) or just after it.
Current advice is that device should not be fitted during the ‘heavy’ days of the period. You must make sure you haven’t run any risk of pregnancy.
You’ll be asked to take off your pants and tights, and to lie on the examination couch. The doctor will insert the little device called a ‘speculum’ which lets them see your cervix.
They’ll then check the length of your womb with an instrument called a ‘sound'. This might hurt slightly.
All IUDs fold up so that they can go inside a medical instrument that looks like a drinking straw. The doctor or nurse pushes this ‘straw’ into your vagina and then through your cervix – and so into your womb. Finally, they eject the IUD from the ‘drinking straw’ - and it’s in!.
This whole process usually takes about 10 minutes.

Is it painful?

Yes it is – a bit. Of course, it’s easy for me – as a man – to say that it’s only ‘a bit’ painful. But in practice, most women say that it’s much less unpleasant than a visit to the dentist. Others exclaim in a surprised way: ‘Is that it? I thought it would be much worse than that.’
A small proportion of women do find it very painful. The amount of pain you feel depends on various factors, like:

• how relaxed you are
• how skilled the doctor is
• the size and shape of your womb
• whether you’ve ever been pregnant – insertions in women who’ve had babies are usually not very uncomfortable at all.

You can take a painkiller an hour or two before the insertion if you like to decrease any discomfort.

What happens after the insertion?

After the device has been put in, you should rest in the clinic or surgery for a good half-hour. Don’t drive yourself home – just in case you feel faint.
You may well need to take aspirin (eg Aspro clear) or paracetamol (eg Panadol) during the next few hours, because you’ll probably experience some crampy pain.
Have some pads available, as it's likely you'll lose a little blood that night and over the next few days. (Personally, I advise against using tampons until you have your next period.)

What about love-making?

I have known one or two highly sexed women who went out and had intercourse immediately after an IUD insertion, but I feel that commonsense suggests that you should give the device 24 hours to settle down before having sex.

Are there any other drawbacks with the IUD?

Yes, a few.

Expulsion

Surprisingly few people realise that IUDs are often ‘expelled’ - that is, they can come out! (In a few clinics, the expulsion rate is as high as 10 per cent.)
This is why it’s a good idea to check your vagina regularly with your fingertips, to make sure that your IUD is not ‘coming down'. All you should be able to feel are the threads – not the device itself, which would feel hard to the touch.

Perforation

Rarely, the device goes through (‘perforates’) the wall of the womb. Usually, it’s at insertion that this happens.
Perforation is an emergency, so if you ever get a great deal of pain in the lower part of your tummy, contact a doctor at once.

Infection

Infections are a little more common in IUD users, and are most likely to cause symptoms in the three weeks following insertion.
It’s now thought that often the woman is ‘carrying’ a sex infection, such as chlamydia, and the insertion makes it flare up.
If you get a smelly discharge, pain or a fever, consult a doctor urgently.

Ectopic pregnancy

The IUD is very good at preventing normally located pregnancies – ie in the womb. So if a pregnancy does occur, there’s an above-average chance that it might be ectopic (outside the womb).
Symptoms are lower abdominal pain and bleeding; contact a doctor urgently if these occur.

Fertility problems

These are unlikely to occur unless you are unlucky enough to catch an infection.

How often should I have check-ups?

In the UK, it’s common to have a check-up by a doctor or nurse at about six weeks after insertion. Thereafter, a yearly check is sufficient.
But don’t hesitate to go back to the clinic earlier if you’re having problems – for instance, if your periods are driving you crazy!

How long will the IUD last me?

Some of the original coils and loops were designed to last ‘forever', and a few women are still using these devices.
But all of today’s British IUDs have a lifetime of between five and 10 years, because they gradually ‘wear out'. At the end of that time, you need to have the IUD changed - or if you prefer, you can switch to another method.

What types of IUD are available – and how can I choose?

To be honest, it’s very rare for a woman to pick her own IUD, unless she’s a nurse or doctor and knows a lot about these devices. But the following list of ‘coils’ may well be of help to you in discussing the choice with the clinic staff.

Important

Make sure you know what brand you’ve been fitted with, so that in years to come you will be able to tell any doctor or nurse you consult.

In 2008, there are ten types of IUD available in Britain.

• The Flexi-T 300. T shaped. Lasts five years.
• The Flexi-T +380. Similar to the one above, but for slightly larger wombs. Lasts five years.
• The GyneFix. Different from the rest, because it isn’t T-shaped, and just consists of six copper tubes on a polypropylene thread. Lasts five years.
• Load 375. U-shaped. Lasts five years.
• The Multiload Cu 375. Lasts five years.
• The Nova-T 380. Copper and silver. Lasts five years.
• The T-Safe Cu 380A. Yet another T shape. Manufacturers say it lasts 10 years.
• TT380 Slimline. Currently intended to last 10 years.
• UT 380 Short. For the shorter womb. Lasts five years.
• UT 380 Standard. For the larger womb. Lasts five years.

Some women are still ‘wearing’ brands that are not on the above list, because they’re no longer manufactured, notably the Gyne-T 380. To find out when yours needs to be changed, check with the clinic that fitted it.

Emergency post-coital contraception with an IUD

The morning-after pill (which should really be called ‘the post-coital pill’) can be used up to three days after sex. The IUD can also be used post-coitally.
A ‘coil’ can be inserted as emergency contraception, up to five days after unprotected sex. It works well, but isn’t 100 per cent effective.
Unfortunately, it’s a lot more difficult to obtain than the morning-after pill. If you’re in difficulties, try calling a family planning clinic

Depression – how it affects sex and relationships

Depression adversely affects every aspect of our lives – including our relationships – and when one partner is depressed, the relationship may suffer badly.
This is a great shame because a good relationship is very therapeutic for somebody with depression.
When we're low we need love, support and closeness more than ever – even if we're not good at showing it.

What is likely to happen if your partner has depression?

Depressed people usually feel withdrawn. They don't feel they can raise enough energy to pursue their normal routine, do things with the family or even notice when their partners are being attentive.
This can quickly lead to the non-depressed partner feeling that he or she is in the way, unwanted, or unloved. It can be easy to misinterpret the low moods as hostility, or as evidence that the depressed person wants out of the relationship.
Frankly, it’s really hard to stay calm and confident when the person you thought you knew is acting strangely and appears to be so unhappy. So if you’re finding your partner’s depression a real pain, try to take heart from the fact that this is natural.
Being the partner of a depressed person is very difficult.
So, even if you're at your wits' end because your loved one has lost the ability to concentrate on what you're saying, or to raise a smile, or to appreciate any of the good moments in life, try to accept that all these things are part of the illness.

Sex and performance

We don't know enough about the chemical changes that occur in the brain during depression and little research has been done on how these changes affect sex.
From a clinical point of view, however, it's clear that a depressive illness tends to affect all the bodily systems, dislocating them and often slowing them down.
This effect is most marked with regard to sleep, which is invariably disrupted.
But there can be adverse effects on any activity that requires verve, spontaneity and good co-ordination – and that includes sex.
So, many people who are depressed tend to lose interest in sex.
Admittedly, this isn't always the case, and some depressed people manage to maintain normal sex lives – sometimes even finding that sex is the only thing that gives them comfort and reassurance.

• In men, the general damping down of brain activity causes feelings of tiredness and hopelessness, which may be associated with loss of libido and erection problems.
• In women, this diminished brain activity tends to be associated with lack of interest in sex and very often with difficulty in reaching orgasm.

All these problems tend to diminish as the depressive illness gets better. Indeed, renewed interest in sex may be the first sign of recovery.

Sex and antidepressants

It's not just the illness that affects a person's sex-life – antidepressant medicines such as Prozac can interfere with sexual function.
One of the most common side-effects is interference with the process of orgasm so that it's delayed or doesn't occur at all.
If this happens – and you are keen to have and enjoy sex – you should ask the doctor about changing medication.

How depressed people can help themselves and their relationship

Some days will seem better than others. On your better days, try to make an effort to show love and appreciation to your partner.

• Try to go for a walk every day, preferably with your partner. Walking not only gets you out in the fresh air, which will give you a bit of a lift, but like other forms of exercise it releases endorphins in the brain. These are 'happy' chemicals that rapidly elevate your mood. And there's increasing evidence to suggest that exercise can be as good for combating depression as any antidepressant.
• Even on your worst days, try to spot happy moments like a bird singing or a new flower blooming in your garden. Try to train yourself to notice three of these heart-warming moments per day.
• You may have an odd relationship with food while you're depressed (you could have little appetite or constantly comfort eat), but try to eat five pieces of fruit per day. This is a caring thing to do for yourself and is good for your physical and mental health.
• Listen to music that matters to you.
• Have faith that the depression will pass and that you will enjoy your life again.
• Even if you don’t feel like full-on sex, do make the effort to have a cuddle. If you are worried that cuddling will project you into full sex when you don’t want it, just tell your partner that you’re not feeling like having sex, but that you would really like to cuddle up. If you do this, you may both feel a lot better. Touch and closeness can keep a relationship intact.

How to help your depressed partner

• Don't keep saying that you understand what your partner is going through. You don’t. Instead say: 'I can't know exactly how you're feeling, but I am trying very hard to understand and help.'
• Many people who are depressed lose interest in sex. Try to remember that this loss of interest is probably not personal, but connected with the illness.
• Don't despair. Some days you'll feel your love for your partner doesn't seem to make any difference to them at all. But hang on in there. Your love and constant support should be of great help in persuading your partner of his or her value.
• Do encourage your partner to get all the professional help available. Nowadays, there are plenty of alternatives to antidepressants. Cognitive behaviour therapy (CBT), for example, is becoming much more readily available on the NHS. Many GP practices can also provide CBT by means of Internet programmes. These can have a good effect quite quickly in many cases.
• Try to act as though your partner were recovering from a serious physical illness or from surgery. Give plenty of tender loving care. But don't expect improvement to be rapid.
• Do something nice for yourself. Being around a depressed person is very draining, so make sure you look after yourself. Have some time alone, or get out to a film or to see friends. Depressed people often want to stay home and do nothing, but if you do this too, you'll get terribly fed up.
• Remember that this period in your life will pass and that your partner is the same person underneath the depression that he or she was before.
• Try to take some exercise together. Most depressed people feel an improvement in their spirits if they do something active. And doing something that will raise the heartbeat – for example, sport or dancing – may well help you too.

Contraceptive injections

Worldwide, many millions of women use the contraceptive injection. At the moment, about 3 per cent of British women of reproductive age are on it.
In its early years (back in the 1970s and 1980s), this injection was highly controversial. That was partly because of the thoughtless way in which some doctors had used it – often giving it to poorer women, especially those from ethnic majorities, without really explaining the nature of the drug.
In addition, many women who received it were not warned that it tends to disturb the periods very markedly.
These days, many people do make an informed choice to use ‘the jab’ – or ‘the jag’, as it is known in Scotland. The majority of them are very happy with it, and a lot are simply not interested in changing to any other method. Nonetheless, the method is not ideal for everyone.
Before you agree to have it, please bear in mind the saying, ‘Once it’s in, it’s in'. You should be counselled about the jab’s side-effects and given a leaflet about its mode of action.
In the case of the most commonly used version of the jab, it’ll be a good three months before the drug has vanished from your body. So be sure that you really do want it.

What are contraceptive injections?

These jabs contain hormones. When injected into a muscle (usually in the buttock), the medication keeps you from getting pregnant for a considerable period of time.
A very good thing about it is that you don’t have to remember to keep on taking anything, which makes this method very useful for the many people who forget Pills!
Also, the jab does ensure that sex is spontaneous; you don’t have to bother about putting on condoms, or inserting chemicals. Quite a few women regard this as a plus.
There are currently just two types of contraceptive jab available in Britain. They are:

• Depo-provera (medroxyprogesterone), which is by far the most commonly used. It protects you – almost fully – against pregnancy for 12 weeks
• Noristerat (Norethisterone), which provides contraceptive protection for eight weeks. In practice, it is mainly used ‘short-term’ in Britain – for instance, in women whose partners are awaiting a vasectomy. It is not widely available now.

Both these jabs contain a type of hormone called a ‘progestogen’, which has similar effects to the natural female hormone progesterone.
In the USA and in certain other countries, there is another type of contraceptive jab that, like the Pill, contains two hormones. It is called ‘Lunelle’ and the idea behind it is that it should control the periods better than Depo-Provera and Noristerat do. There are plans to bring it to the UK, possibly in 2009 or 2010.

Who shouldn’t use contraceptive injections?

Neither jab is suitable for women who are already suffering from undiagnosed abnormal vaginal bleeding.
You shouldn't have the injection if you’ve had a hormone-dependent cancer, and it may not be suitable for you if you have migraine, liver problems, or a history of thrombosis (clots).
There are certain rare conditions in which use of the injection is ruled out, but your doctor will advise you if this applies to you.
Also, if during a pregnancy you’ve ever had the condition of cholestatic pruritus (intense itching), then the jab is not for you.
The Committee on Safety of Medicines have issued the following advice about the use of the jab.

• In adolescent girls, it should be used only where other methods are inappropriate.
• In women of all ages, the benefits of using the jab for more than two years must be evaluated against the risks.
• In women with risk factors for osteoporosis, other methods should be considered, as it is now clear that regular use of the jab causes a small reduction in bone mineral density.

How do contraceptive jabs work?

They have three useful anti-fertility effects.

1. They stop you from ovulating (producing eggs).
2. They thicken the mucus in your cervix – making it difficult for sperm to get through.
3. They make the lining of your womb thinner, so that if an egg (ovum) became fertilised, it would have difficulty attaching itself to the lining.

How effective are these injections?

They are very efficient indeed. Most experts rate them as around 99 per cent effective, which means that if 100 women used the jab for a year, only about one would become pregnant. This makes the injection one of the most efficient of all contraceptives.
However, you do have to remember to turn up for your next injection. Many of the pregnancies that occur in people who are ‘on the jab’ happen because somehow the injection doesn’t get given on time.
Also, please bear in mind that a few prescription medicines can interfere with the efficiency of the jab. Your doctor or nurse should give you fuller details, but if you prescribed other medications by a doctor, it’s always best to mention that you are on the jab.
In practice, it’s chiefly medicines for epilepsy and tuberculosis that can interfere with the working of the contraceptive injection.

What are the advantages of the injection?

Firstly, there’s the fact that the only action you have to take is to turn up for your jabs on time.
Secondly, it now seems probable that Depo-Provera gives you some protection against cancer of the womb lining. Balanced against that is the fact that there is still a chance that it might increase the chances of breast cancer.
Both of the jabs used in Britain are thought to help protect you against

• ovarian cysts
• ectopic pregnancy.

What are the side effects?

Don’t let anyone give you the idea that the jab is without side effects! In particular, there is a very high chance (40 per cent) that your periods will be disrupted in some way.
For Depo-Provera, the more common side-effects are as follows:

• heavy periods (menorrhagia)
• prolonged periods
• irregular or infrequent periods (oligomenorrhoea)
• absent periods – though many women are very grateful for this effect
• headaches
• tummy ache
• weakness
• dizziness
• weight gain
• delayed return of fertility after stopping the jab – however, there’s no evidence at present of long-term infertility.

There are other, rarer, side-effects, and you should talk these over with the doctor or nurse before you start, and read about them in the leaflet you’ll be given.
Noristerat has similar side-effects, and may cause breast tenderness or reactions at the injection site.

Where can I get the injection?

Traditionally, the jab has mainly been given by the contraceptive experts – that is, doctors and nurses at family planning clinics. But these days, more and more GPs are prescribing contraceptive injections in their surgeries.
Usually, the drug is started during the first five days of your period – because this gives you immediate protection against pregnancy.
However, quite often the jab is given postnatally – that is, by the staff of the Obstetric Department, after you’ve had a baby.
Very commonly, you have the injection about six weeks after giving birth. Having the injection any earlier than this seems to be more likely to cause problems with heavy bleeding.
If you are hoping to breastfeed, you should definitely not have the jab until your baby is at least six weeks old.
At the end of 2008, the Faculty of Sexual and Reproductive Health Care of the Royal College of Obstetricians and Gynaecologists issued new guidelines about the jab. The most important ones are these:

1. It must not be used by women who have breast cancer.
2. The doctor or nurse must take a full medical history from the women before prescribing it.
3. Women should be advised that the ‘failure rate’ is less than 4 in a 1000 over two years.
4. They should be told that after using the jab, there can be a delay of up to one year in the return of fertility.
5. When ceasing to use the jab, women who do not wish to conceive should start employing another method of contraception before the next injection would have been due.
6. All women should be informed about the altered patterns of period bleeding which the jab can cause.
7. They should be told that up to 70 per cent of jab-users have absent periods.
8. They should be advised that there is an association between jab use and weight gain.
9. The jab is safe for use while breastfeeding.

the contraceptive pill

Is the Pill popular?

If you’re thinking of going on the Pill, you’ll be joining a band of about 100 million women worldwide who use this method.

Did you know?

More than 100 million women worldwide use the contraceptive pill.

How many women take it in the UK?

In the UK alone, there are 3.5 million women who take the Pill. This is roughly one in three of all females of reproductive age.
The Pill has always been a bit controversial. Although it is now well over 50 years since it was first used (in Puerto Rico in 1956), there are still occasional ‘Pill scares’ – when newspaper headlines trumpet the dangers of Pill taking.
However, the fact that it remains so staggeringly popular does indicate that for huge numbers of women, the slight risks are outweighed by the benefits.

So is the Pill safe?

Basically, yes. But very occasionally, it can have serious side-effects.
However, recent news about Pill safety has been remarkably good.
The Royal College of General Practitioners has produced an important report that revealed the remarkable fact that Pill-users have a 12 per cent reduction in their risk of developing cancer.
The report also found that breast cancer rates were the same in women who have used the Pill, and women who haven’t.

Warning!

A very tiny number of women should not take the Pill, because they have serious medical conditions.

Nevertheless, most doctors don’t think that the Pill should be ‘dished out’ to absolutely everyone, without any need for a preliminary chat.
So when you want to start on the Pill, you should see a doctor (or family planning nurse) and have a short check-up.
The this is to see if you have any ‘risk factors’ – especially smoking – that would make you more liable to deep vein thrombosis (DVT), heart attacks or strokes.

Once you're on the Pill, what then?

You should return to the surgery or clinic for occasional ‘Pill checks’. In Britain, they are usually done at six-monthly intervals.
These visits are very brief, and generally all the nurse or doctor does is ask you whether you’re having any problems with the Pill, ensure that you haven’t developed any ‘risk factors’ in the last six months and check your blood pressure (and possibly weigh you).
A lot of people still think that you have to have a vaginal examination and a smear test before going on the Pill but this is no longer true.

What is the Pill?

The Pill is a tablet containing two female hormones – an oestrogen and a progestogen.
Various oestrogens and progestogens are used in the many different types of Pill which are available. There are currently 28 brands on the market in Britain. Six new ones have just been introduced.
These two hormones stop you from ovulating (producing an egg) each month. And if you don’t ovulate, you won’t get pregnant.
In addition, the hormones thicken the secretions round your cervix, making it more difficult for sperm to get through. Also, they make the lining of your womb thinner, so that it’s less receptive to an egg.

Is the Pill the same as the mini-Pill?

Pill versus mini-Pill

The two are not at all the same. The Pill contains two hormones; the mini-Pill only one. The mini-Pill has fewer side effects but is also less effective.

The mini-Pill is not a low-strength version of the ordinary Pill. It’s a completely different product, because it contains only one hormone instead of two. This makes it ‘milder’ and freer of side-effects, but also less effective.
Adverse effects of the mini-Pill can include breast discomfort, headache, dizziness, weight changes and spots on the skin. For a full list, read the package leaflet, or talk to your nurse or doctor.

How effective is the Pill?

It’s very effective indeed, which is why so many millions of women rely on it.
If you take it exactly as prescribed, then its effectiveness is likely to be almost 100 per cent.
Put it another way: let’s say that 100 women use the Pill for a year, and that all of them never forget to take a tablet. It’s likely that not a single one of them will get pregnant.
In contrast, if they were all relying on the condom instead, then probably about two to five of them would become pregnant. And if they used no contraception at all, then at least 20 of them would fall pregnant!
So the Pill is just about the most effective method of contraception there is, apart from sterilisation.

How do you take it?

In the UK, you’re given a pack which usually contains 21 pills and you take one every day for three weeks. At the end of those three weeks, you ‘break’ for a week. During those seven days, you’ll have your period.
If you wish, you can take seven ‘dummy’ tablets during the week’s break.
It’s stopping the Pill at the end of the 21-day pack that brings on the period.
After the week’s break, you start on your next packet. So it’s ‘three weeks on and one week off’ throughout the year.
If you want to, you can set your mobile phone so that it beeps at the same time every day, to remind you to take your Pill.
Note: one newly-introduced Pill, called Qlaira is different from all the rest, because the makers have decided that you should have hormones on 26 out the 28 days of your cycle.

But how do I get started?

Go to a GP or a family planning clinic to see the doctor or nurse, discuss risk factors and possible side effects, and get a prescription.
In Britain, it is now the practice to take your first-ever Pill on the first day of your period.
If you do this, you should be protected immediately – so you can have sex whenever you like.
Practices vary in other countries, and their Pill packs may contain more than 21. In the USA, it is extremely common for women to be given packs containing 28 tablets – but seven of which are ‘dummies'.

What are the good points about the Pill?

The Pill has now been shown to have certain major health advantages:

• it abolishes period pains
• it makes periods shorter
• it makes them lighter.

Because of this, you are less likely to become anaemic.
If you have acne, the Pill should improve it.
The Pill is very useful if you want to delay having a period for a special occasion, such as a holiday. By taking two packets back-to-back without a week's break you can avoid having your period at an inconvenient time.
In addition, it decreases your chances of getting certain cancers (though it increases the risk of others).

But can’t it give you a lot of side effects when you start?

Yes. During the first few packs of the Pill, many women get minor, passing side-effects, such as:

• headaches
• nausea
• breast tenderness
• slight weight gain
• slight ‘spotting’ of blood between the periods.

These side-effects usually go away after the first few packs. If they don’t, it’s very easy to get rid of them by simply switching to another brand.

What about serious side-effects?

There is no doubt at all that the Pill can occasionally cause serious problems like:

• deep vein thrombosis (DVT) or clotting (this is now thought to be slightly more common in women who are taking Pills containing the progestogens desogestrel and gestodene)
• heart attacks
• strokes.

Fortunately, these events are rare, but ... they are much more likely to happen if you have certain ‘risk factors,’ which include:

• being a smoker
• having a family history of thrombosis or some similar illness (say, if your mother had a heart attack or a deep vein thrombosis at 40)
• being severely overweight
• being diabetic (though quite a few non-smoking diabetics do use the Pill, under careful supervision)
• having high blood pressure
• having a high cholesterol level (hypercholesterolaemia)
• a past history of phlebitis (vein inflammation) or thrombophlebitis
• being immobile for a while (especially when having a surgical operation).

There are other risk factors, for instance making a very long journey in a plane or a cramped car seat. Your doctor or family planning nurse can give you more details.
The risk is now known to be greater in the first year of taking the Pill. But it also increases a little as you get older.

Varicose veins

Many people have the idea that ‘you can’t take the Pill if you have varicose veins'. This isn’t true.
However, in recent years it has become clear that severe problems with varicose veins are a contraindication to the Pill.
But if you just have mild and superficial varicose veins, it’s quite likely that your doctor will be willing to prescribe a low-dose Pill for you – provided that you have no other risk factors.

Familial blood factors

It’s now clear that certain blood-clotting abnormalities that run in many families make you more liable to clotting.
The best-known of these is Factor V Leiden. If you have this, we suggest you go for another form of contraception.

Hughes' syndrome

In the last few years, it’s become clear that a lot of women have something called Hughes’ syndrome (anti-phospholipid syndrome, or APLS).
This blood disorder predisposes them to serious blood clotting. If you have Hughes’ syndrome, you should definitely not go on the Pill.

Migraine

In the early part of this century, new research showed that women who have severe migraine and use the Pill run an unacceptable risk of having a stroke.
Official advice in the 2010 edition of the British National Formulary (BNF) is that women who have any increase of headache frequency on the Pill should tell their doctors.
The BNF also now says that women who have severe migraine with eye disturbances – or migraine with odd symptoms in other parts of the body – shouldn’t take the Pill.
If you develop these symptoms while on the Pill, you should STOP taking it immediately, and ask your doctor to refer you to a neurology expert.
The Pill is also not suitable for females experiencing migraines lasting 72 hours or more, and those needing treatment with ergot derivatives, such as ergotamine.

Does age make a difference?

Yes. The Pill is extraordinarily safe for young women in their teens or 20s who have no risk factors (such as smoking). But when you get to the age of 35 or 40, the chances of having a thrombosis (clot) are starting to increase.
In practice, there are some women of 40 who take the Pill. But as the years go by, there is more and more reason to switch to the mini-Pill, or to some other method of contraception, such as sterilisation and vasectomy for men.

What about cancer?

Did you know?

The Pill can increase the risk of some cancers and reduce the risk of others. Ask your doctor for advice.

The Pill does affect your risk of certain types of cancer, and when you first decide to go on it, you should be told about this.
But it’s important for you to realise that the Pill actually reduces your chances of getting some cancers – while it increases the risk of others.
As far as we know, the Pill reduces your chance of getting:

• cancer of the ovary
• cancer of the womb (endometrium)
• possibly bowel cancer – a 60 per cent reduction in risk has been claimed, though this is still not proven.

The Pill increases your risk of getting:

Be 'breast aware'

Check your breasts regularly for lumps or anything odd, particularly as you approach middle age, which is when breast cancer starts becoming common.

• breast cancer – though recent research suggests there’s no overall increase in Pill users
• cervical cancer – though this is almost entirely preventable by regular smear tests or (in the near future) by vaccination against the virus that usually causes this cancer
• liver cancer – though this is very rare.

Does anything make the Pill less likely to work?

Yes. These things make it less effective:

• forgetting Pills – especially at the beginning or end of a pack
• having diarrhoea and/or vomiting (a common holiday risk)
• taking certain antiepilepsy drugs, including Epanutin (phenytoin) and Tegretol (carbamazepine)
• taking antibiotics – notably those used for fungus infections and tuberculosis (TB), but also commonly prescribed antibiotics like tetracyclines and Amoxil (amoxicillin).

Although the effect of such common antibiotics on the Pill may be slight, it’s better to be safe than sorry.
In general, take extra precautions for two weeks if you’re put on an antibiotic.
If a doctor wants to prescribe something for you, always tell them you’re on the Pill.
Also, avoid the popular herbal remedy St John's wort while you are taking the Pill. It reduces the effectiveness of the oral contraceptive, and you may get ‘spotting’ of blood.

What if I miss a Pill?

Try not to! Of course people do inevitably miss Pills; it’s only human nature.
If you miss only one Pill, you’ll probably be OK; take it as soon as you remember – and then take the next one on time (even if that means you’re taking the two of them at the same time). If you want to be super careful, you could avoid sex for the next seven days – or take extra precautions.
However, if you’re more than 12 hours late in taking the Pill, avoid sex for the next seven days – or take extra precautions.
Missing more than one Pill is quite risky – particularly near the beginning or end of a packet. To avoid pregnancy, follow the advice on the pack leaflet strictly.
To be frank, the ‘missed Pill advice’ in these leaflets is pretty complicated – and keeps being changed! If you’re in doubt:

• ring a family planning centre for personal advice
• consider using emergency contraception (the morning-after pill)
• don’t have sex until you’re sure you’re fully protected.

Does the Pill reduce sexual desire?

Many experts believe that any reduction of desire is much more likely to be attributable to the woman being with the wrong partner – or at least a partner who does not make proper efforts to romance her and to give her adequate foreplay – than being on the Pill.
At The Congress of The European Society of Contraception in Prague (May 2008) Professor van Lunsen of the Netherlands said that in his view: ‘partner switching is better than Pill switching’.
However, it does seem that a few women may have a reduction of desire because of their reaction to the hormones in the Pill.
Indeed, scientific research presented at the conference seems to point to the Pill somehow being responsible for reducing the amount of androgens in some women.
Androgens are hormones we all have in our bodies which enhance sexual motivation and the frequency of sexual functioning.

So which Pill should I choose?

Regrettably, very few women do actually choose their own brand of Pill. The choosing is mainly done by doctors or nurses. (The main exception to this occurs when a woman asks to go ‘on the same Pill as my friend’ – or ‘the same as my Mum!’)
Unfortunately, some doctors who don’t know much about contraception do tend to pick Pills more or less at random. If you want a more informed choice, go to a doctor who has training in family planning.
You should ask for:

• a low-dose Pill
• a second-generation Pill.

The reason for preferring a second-generation Pill is that the ones that came after them in the late 1980s ( third-generation Pills) carry a minutely increased risk of thrombosis.
I strongly advise you not to pay any attention to newspaper stories or broadcasts that suggest any particular brand of Pill is ‘wonderful’ or ‘better than all the rest'. These tales usually originate from the PR companies employed by the manufacturers!

Sterilisation for women

What is female sterilisation?

During the latter part of the twentieth century, sterilisation became one of the most popular methods of birth control in the world. Indeed, in 2009 about 160 million women are believed to have had the operation.
However, there are now signs that it is becoming a little less popular. In April 2009, I attended a lecture by a leading gynaecologist in which he revealed that sterilisation rates in the UK and in Ireland have dropped recently.
The reason for this is not clear. No new and alarming ‘side-effects’ of sterilisation have been discovered. However, it seems that some women are turning to other ways of limiting their families, such as the Mirena ‘coil’ or intra-uterine system (IUS).
Also, the sociological changes of recent years, with more and more people forming new relationships or deciding on a second marriage, seem to have made some women feel that – instead of getting sterilised – they should keep alive their options of having a second family.

What is female sterilisation?

‘Sterilisation’ means preventing the woman from becoming pregnant by means of various different operations in which her Fallopian tubes are blocked or cut through – thus making it very difficult for her eggs to reach her womb.
Please note that it’s not quite impossible for those eggs to get through; there is in fact a small ‘failure rate’ for this operation, generally estimated at around 1 in 200. (However, it varies with the method used. You should ask your surgeon to tell you what he or she estimates the success rate of her method to be.)
There is an increasing tendency for gynaecologists to offer newer types of sterilisation operation, in which they do not make any cut in your abdomen. Instead, they work through the vagina, inserting an instrument into the womb and using it to insert a blocking device into each Fallopian tube.
The new Essure method involves fitting a small coil into each Fallopian tube. But please note that, like other methods of contraception, it has a small failure rate.
There are other operations which can cause sterility – for instance hysterectomy (which is removal of the womb). But in general, when a gynaecologist offers you a sterilisation ‘op’, she’s talking about the operation on your tubes.

Who can be sterilised?

Almost any woman can be sterilised – and even today thousands of British couples choose this as their method of contraception. As of 2009, about 13 per cent of all UK females who are of reproductive age have had the operation.
Although surgeons are generally more willing to perform it for women who are over 30 and who have had children, some younger women who have never had a baby do opt for sterilisation.
However, if you are young and childless, you should think very carefully before agreeing to be sterilised; do bear in mind that you might change your mind later on in life – and that reversal of the operation would be very difficult indeed.

Are there ever any medical reasons for not having the op?

Yes: surgery could be a bit difficult – but not impossible – if you’ve ever had one of these conditions:

• prolapse
• fibroids
• cysts on the ovary
• pelvic inflammatory disease (PID), including chlamydia infections and salpingitis.

If you are seriously overweight, it can be quite tricky for the surgeon to get at your tubes. Also, if your general health is poor, then you might not be an ideal candidate for surgery.
You need to take the advice of the surgeon or anaesthetist on this and all matters connected with the operation.

How do you go about getting sterilised?

Personally, I think that in most cases you should begin by contacting your GP. Most good family doctors will want to discuss sterilisation with you in depth, as it is something that should be considered very carefully indeed.
The doctor should tell you about the operation, and about its associated risks. Also, most importantly, he should make it clear that – as we have stated above – sterilisation is not 100 per cent effective against pregnancy. The failure rate is usually about 0.5 per cent – but is a little higher in younger women.
Your GP will then refer you to a gynaecologist, either privately, or under the NHS. Some clinics in the family planning field offer a sterilisation service. These include the British Pregnancy Advisory Service (Tel: 08457 30 40 30) and Marie Stopes Clinics (Tel: 0845 300 0212). They do ‘contract sterilisations’ for the NHS, and also private ones.
You can if you wish go directly to a reputable sterilisation clinic such as Marie Stopes or BPAS, without involving your own doctor, and pay them privately. At the present moment (2009) BPAS charges £950 for a sterilisation. They will usually want to write to him after the operation, to tell him it’s been done – but this isn’t compulsory, and a few women don’t actually want to inform their GPs.

Do women regret being sterilised?

You have to accept that once you are sterilised, you will almost certainly not be able to have any more children, since reversal of the operation is difficult. Nowadays, many women have more than one long-term relationship or marriage, and it has become quite common for a sterilised woman to later want another baby if she has a new man in her life.
For the sake of completeness I should add that a woman who has been sterilised, but then really wants to have a baby, does nowadays have the opportunity of ‘in vitro fertilisation’ (IVF treatment). Indeed, one of the world’s first ‘Test tube babies’ was born to a mother who had had her tubes removed. However, IVF is extremely expensive – and only works in a minority of cases.

What is done in the operation?

If you are certain of your decision, the operation itself should be fairly straightforward. The Fallopian tubes (where the egg is fertilised by the sperm) are blocked by the surgeon in one of several ways, thus making fertilisation unlikely – unless you have very bad luck!
Your periods should not be affected by the operation though it is sometimes claimed that post-sterilisation periods are heavier in some women. Recent scientific evidence (2009) does not support this.
Your hormone production and libido should remain the same – unless the operation has somehow affected you psychologically.
In the old days, most women were admitted to hospital for the operation – and stayed in for some days. Nowadays, most sterilisation operations are conducted as day-cases – in other words, you’ll probably be able to go home that evening.
The traditional way of sterilising somebody was through a cut (a few inches long) in the lower part of the tummy. Alternatively, the cut could be made in the topmost part of the vagina. Both these procedures nearly always required a general anaesthetic.
However, in recent years it’s become much more common to do the ‘milder’ and less upsetting laparoscopic operation. (It’s sometimes referred to as ‘the Band-Aid op’ – because incisions in your tummy can be covered by just a small piece of sticking-plaster.)
It is carried out through either one or two tiny ‘nicks’ in your lower abdomen. Generally, the surgeon makes the first little incision immediately below your navel – where a scar isn’t likely to be very visible. Through this incision, she inserts a laparoscope.
A laparoscope is a thin metal 'telescope' that lets the surgeon see your two Fallopian tubes. With the aid of the laparoscope, she can ‘seal off’ the tubes, using rings or electrical coagulation. However, some surgeons prefer to put clips on your tubes. To do this, another instrument has to be inserted through a second small incision.
Although quite a few sterilisations are still carried out under general anaesthetic, recent years have seen an increasing tendency for the operation to be done under ‘local’ – which many women prefer. Also, local anaesthetic is safer for you than having a ‘general'.
At the large charitable clinics, such as Marie Stopes, they tend to use ‘twilight’ techniques – which means combining a local anaesthetic with enough sedation to make you quite pleasantly ‘woozy'.
Obviously, you must not drive yourself home on the day of the operation!

What is the cost of the operation?

In recent years, female sterilisation has become rather more difficult to obtain free – ie under the National Health – in many parts of the country. So, many people go to private gynaecologists, or to large charitable organisations like BPAS or Marie Stopes. Charges at charitable bodies currently range between £950 and £1,300.
A private surgeon can charge whatever the ‘market’ can stand – currently up to £3,000.

Does sterilisation work immediately?

Sterilisation of women should work immediately, but it's important that you're not already pregnant when the op is done – or have active sperm inside you from love-making the night before !
Some women continue using their current method of contraception for a little while – for instance, till the next period. A few will keep a coil (IUD) in for a short time.

What is the risk of pregnancy after sterilisation?

Please note that as we have said above, every now and then a woman who has been sterilised does get pregnant. The approximate risk is usually estimated at 1 in 200 patients, but it might be higher with certain newer ‘quick sterilisation’ methods.
If pregnancy does occur, you must appreciate that it could be an ectopic one – that is, one which develops outside the womb, probably in the remains of the Fallopian tube.
So if you ever miss a period, you should get a pregnancy test done. Pain is often a warning sign of an ectopic pregnancy. If in doubt, ring your doctor.

Are there any other health risks from sterilisation?

Any type of surgery can go wrong, and this is particularly true of laparoscopic surgery.
Very occasionally, a gynaecologist may damage the bowel or womb, or the urinary apparatus. In general, the more experienced the surgeon, the less likely it is that any of these complications happens.
General anaesthetics carry a small risk to health (greater than that of ‘locals’), which is one reason why in 2009 there’s an increasing tendency to opt for local anaesthesia. (Also, the cost is less.)
A new development, reported in 2009, is a 15-minute operation which involves putting a tiny ‘transmitter’ device into each Fallopian tube . It gives out a low-level radio signal which creates heat and thus blocks the tube. How effective this will be still remains to be seen.