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Contraception, in one form or another, has been practiced by humans for thousands of years. Before the development of modern methods, women placed ground herbs mixed with oil or honey in their vaginas or inserted sea sponges soaked in lemon juice to act as barriers to conception. For many years douches were used as a popular, although ineffective, method of birth control for women. Since the sixteenth century, men have had the option of using condoms. There is no record of how successful the many methods used in the past actually were, but their prevalence in folklore demonstrates a great interest in controlling fertility by preventing pregnancy.

Men and women want birth control that is safe, effective, affordable, and convenient to use, and today more than ever we have a variety of choices that come close to these ideals. People often need different types of contraceptives to suit the different stages in their lives. A method that is useful for spacing pregnancies, for instance, is not necessarily adequate for the woman who wants to stop child-bearing completely. And a contraceptive that works well for someone who has sexual intercourse only occasionally may not be sufficiently effective for those who have sex often.

This book is not written for any one age or lifestyle, but addresses all women and men who are interested in birth control.

Although methods of contraception are very effective, the surest protection against pregnancy and sexually transmitted diseases is abstinence.

CONTRACEPTIVE CHOICES IN THE UNITED STATES

Various methods of contraception are available in the United States today, including condoms for men and women; spermicidal foams, gels, and vaginal films; diaphragms and cervical caps; the Pill; IUDs; and fertility awareness methods that rely on periodic abstinence. There are injections that last for 3 months and implants that last 5 years. There is emergency contraception. The most frequently used birth control is female sterilization; the Pill and male condoms are second and third most common.

CONTRACEPTIVES AND SEXUALLY TRANSMITTED DISEASES

Barrier contraceptives, such as condoms and diaphragms, can have an important use beyond birth control—they can also reduce the chance of spreading sexually transmitted diseases (STDs), including AIDS. AIDS is now the leading cause of death for U.S. men between the ages of 25 and 44. It is spread among heterosexuals as well as homosexuals. Today, AIDS is spreading the most rapidly among women, among whom it is a major cause of death. As of early 1997 it was the third leading killer of women of reproductive age, two-thirds of whom were infected through sex.

Anyone who is sexually active can acquire a sexually transmitted disease—even if they have sex only once with an infected person. And anyone who has ever had sex can have an STD without knowing it, no matter how healthy they look or feel. The AIDS virus, HIV, can be present without symptoms for many years after a single sexual encounter with someone who had the virus.

While other STDs seldom kill in this country, they can undermine your health and fertility and be passed on to a baby who is still in the womb. STDs also can lead to pelvic inflammatory disease (PID), which is fairly common today in the United States. PID results when bacteria that is passed from the man to the woman during sex travels to the uterus and the fallopian tubes. (PID also can follow childbirth or abortion.) The infection, inflammation, and scar tissue caused by these microbes can block the delicate fallopian tubes. Blocked or scarred tubes lead to infertility or to tubal (ec-topic) pregnancies that can be life threatening. If caught early, most cases of PID can be treated with antibiotics; if neglected or not recognized, the disease can lead to chronic pain, major surgery, or even death.

Unfortunately, most STDs, including AIDS, do not always produce symptoms in their early stages and sometimes not at all. At least 24 different STDs have been identified, including syphilis, gonorrhea, AIDS, genital warts, chlamydia, herpes simplex, and hepatitis B. The germs that cause these diseases can be carried in semen, blood, and other body fluids.

A woman does not need to have sex frequently with an infected person in order to acquire a sexually transmitted disease. Medical researchers have found that a woman has a 50 percent chance of getting gonorrhea from having intercourse just once with an infected man. A man has a 25 percent chance of acquiring gonorrhea after a single act of intercourse with an infected woman. Unless a sexually active individual is in a long-term relationship that is mutually faithful, the surest protection against STDs is a barrier contraceptive.

The barrier methods available today are male condoms, female condoms, the diaphragm, and the cervical cap. We know that male condoms plus a spermicide provide excellent protection against bacterial and viral STDs, including AIDS. If used with a spermicide, the diaphragm and cervical cap provide good protection against bacterial diseases, but effectiveness against AIDS, a virus-caused disease, has not been shown. Because the female condom is fairly new, not very much is known about its effectiveness against disease.

The only other protection against these infections is abstinence from sex or a long-term, strictly monogamous relationship between uninfected partners. Unless a person brings a sexually transmitted disease into a relationship, if both partners remain faithful, there is no chance of catching such a disease. When a relationship is on the brink of becoming sexually intimate, some couples have themselves tested for STDs so they do not unknowingly infect their partners.

NOTE: No matter what type of contraceptive you use, it is a good idea to have a Pap smear and a pelvic exam periodically. The Pap test can detect early cancerous cervical changes and the pelvic exam can find other conditions that may not have symptoms.

ABOUT THIS BOOK

The Whole Truth About Contraception is a detailed guide to the methods of birth control currently available in this country, plus a brief review of new methods being developed. Each chapter describes a specific method and provides information to help you choose a contraceptive suited to you and your current situation. Chapters discuss the advantages and disadvantages of each contraceptive, safety concerns, general effectiveness, side effects, costs, and how to obtain and use it.

You will notice that we frequently refer to "practitioners" or "health care providers" instead of physicians in this book. Most family planning services, particularly education and counseling services, are provided by specially trained nonphysicians working in a variety of agencies: health departments, hospitals, Planned Parenthood affiliates, and independent clinics.

As you think about the birth control options available to you, remember that no single method may be ideal or totally reliable. Furthermore, many contraceptives have some side effects and most require a certain amount of care in their use. To choose the right one for you, be thoughtful about the disadvantages as well as the advantages. If you are comfortable with your birth control choice, you are more likely to use it every time and to stick with it. If possible, the decision about what method to choose should be made with your sexual partner. As these chapters demonstrate, it is much easier to use a contraceptive correctly when both of you are involved.

The information in this book is as up-to-date as we have been able to make it. We discuss only birth control methods that are available now or show every promise of being available soon. Many of the methods discussed in the following chapters require a visit to a health care practitioner. You can make such a visit an opportunity to have a checkup of your general health, to get answers to the questions you have, and to obtain the latest information.

If you are under 18, be reassured that clinics and physicians will not automatically inform your parents or a guardian that you have been asking about birth control. To be absolutely certain, do not be afraid to ask directly about the policy on this issue.

A word of caution: Reports appear in the media about this or that newly discovered danger related to a particular contraceptive. Such early reports often are not substantiated by further research, or the danger may apply only to a small, special group of those who use the method. When such reports are publicized, it is important not to panic, but to continue using your method until you and your doctor have had a chance to learn more about the particular study and whether it applies to you. Unless you want to get pregnant, it is important not to stop using a contraceptive even for a short time, unless you have begun to use another method.

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