Trust Women

Today is the 37th anniversary of Roe v. Wade and the 5th annual Blog for Choice event. For the Past 5 years NARAL has been asking bloggers questions related to the right to choose in order to raise awareness for reproductive rights and ask what they mean to us. This year's question is:

In honor of Dr. George Tiller, who often wore a button that simply read, "Trust Women," this year's Blog for Choice question is:
What does Trust Women mean to you?

To me, trusting women is about understanding that we can make our own informed decisions. We do not need to be coddled. We do not need to be told misinformation in order to make the "right decision." We do not need to be forced to look at ultrasounds of the fetus to make a decision that we've already thought long and hard about. We do not need to be ordered by a court to do what is best for us and our families. If kids are given comprehensive sex education they will be given the tools with which to make informed decisions about sex and family planning. Women will have the ability to prevent unwanted pregnancies and to plan families if and when they want to. We need to help women to be able to make the right decisions for them by helping everyone to be educated about sex and sexuality.

I also think that part of trusting women is listening to their stories and having more women coming forward with them (if they so choose) to show that they make hard decisions that are right for them. Abortion especially is so demonized and we normally only talk about it in terms of rape or incest cases, but what about the rest of the women out there who get them? So many women feel like they can't come out and share their stories because they do not want to be demonized or judged for making a decision that was right for them. That was why I shared my story back in August soon after Dr. Tiller's murder. Read it here.

Related reading:
1. STIs and Sexual Responsibility
2. Contraception
3. Can you Get Pregnant from the Withdrawal Method?

My Story

In light of recent events – specifically Dr. Tiller’s murder, federal marshals being removed from the aide of Dr. Carhart, and the ongoing violence focused on reproductive health clinics – I’ve decided to tell my own story. I believe that it is extremely important for women (and men) to come out and talk about how their reproductive health clinics have helped them and why they are a positive necessity in our society. We should all tell our own stories.

My story isn’t a pretty packaged story about how I was a victim of incest or rape. Not that these stories are ever pretty, but they are the ones that so often come to view when we are talking about women who need to be able to have abortions. The stories of innocence lost. The women who “deserve” to have a pregnancy terminated. What about the rest of us? We all need control over our own bodies.

I expect that a lot of people won’t agree with my decisions. And I also expect that there may be some backlash because of it. But I refuse to hide when the people who are trying to help women are being murdered.

I tell this story from a sex positive viewpoint; the idea that there is nothing inherently evil about sex. In fact there is a lot of good in it, but there are risks as well.

When I was 18 I was a typical teenager. I thought I was invincible. I thought that nothing bad could happen. And so, even though I knew full well what the consequences were, I had unprotected sex with my boyfriend. I was not a victim of abstinence-only education, I had comprehensive sex ed starting in 5th grade. I was also raised in a sex positive household where information about sex and condoms were always available. I did know better. But I was in love and the sex was fantastic.

What I didn’t know was that I was with a young man who was also extremely fertile, as many 18 year olds are. He hadn’t told me that he had gotten two other women pregnant before me. And he definitely should have known better. But we’re both to blame for what happened. A couple of months before my 19th birthday I got pregnant.

I had always thought that if I got pregnant before I was ready that I would have an abortion. It would be an easy decision. When it actually happened I was struck by how difficult the decision actually was. After all, this life had been created out of love.

After thinking about it for a few weeks though I knew that it was the right decision. I had not been planning on bringing a baby into the world and was smoking at the time. Not a great way to start a pregnancy. My mom, a very supportive woman in general, refused to support me emotionally or financially if I chose to have the child. My boyfriend whom I loved dearly, all of a sudden disappeared when I became pregnant. I had my whole life ahead of me. And even dedicating 9 months to pregnancy was a burden my body could not handle. The first couple months that I did go through were awful and I knew it would only get worse. My body has always had issues with health and pain.

I did not know how to go about seeking an abortion. I am so incredibly lucky that it all turned out as well as it did considering I was doing my research via the yellow pages and, being a broke teenager, cost was my main concern. Had I lived in the Bible Belt instead of a suburb of Chicago I’m sure I would have ended up talking to a crisis center that would’ve misinformed me about pregnancy and abortion. And in my relatively fragile state, that would have been very difficult to deal with.

Ten days after my 19th birthday my best friend took me to a women’s reproductive health clinic. There were lots of women with boyfriends in the waiting room. I was the only one with my best friend.

I don’t really remember much of that day except for having a difficult time peeing in the cup, accidentally stepping on a button on the floor in the operating room that made a loud noise, waking up in another room with my underwear back on, and my best friend taking care of me that evening (mmm Blue’s Clues macaroni and cheese). But it all went pretty well.

As the years went on I became pretty loyal to Planned Parenthood. I really wish I had gotten the procedure there, but I’m happy that it went well. Planned Parenthood has been there for me through thick and thin. They’ve helped me through condom breakage, STI testing, genital warts, pap smears, putting me on the pill to prevent pregnancy, and then keeping me on it to prevent ovarian cysts. They’ve been there when I’ve cried, they’ve laughed at my jokes, and they’ve been non-judgmental of my lifestyle choices. They’ve been like a really good friend to me. And as a good friend I’ve tried my best to give back as well. I’ve donated time and money to them. I ran the local college campus chapter of VOX (Planned Parenthood’s student outreach) and I’ve worked as an escort keeping myself between women entering and leaving the clinic and those who did not agree with why they thought those women were there. I will always support Planned Parenthood and I hope that they are always able to support me.

Really Important!

This is super important so please go sign the petition! Don't let Bush and his cronies do this to us.

Can you get pregnant from the withdrawal method?

Hi, I am 23 years old, I am not yet ready to get pregnant but my boyfriend keeps asking about my virginity. I told myself that I will not give my virginity but the time we had romance we both felt hot we can't control. My question goes like this: We had sex after my period and almost 1 week we involved in sex but we use withdrawal method, is there a possibility that I get pregnant?

Most questions I receive don't phase me, but this one got me. In fact I often don't even answer questions right away when I get them, but I think this one deserves a quick answer.

Yes, you can get pregnant from the withdrawal method. This method is far from fool proof. When a man gets an erection a clear fluid leaks out of his urethra. This is called precum and it can have sperm in it. This can get you pregnant. Also, a lot of guys, especially the younger and/or more inexperienced ones, don't have the control or the body awareness to be able to pull out before ejaculation. This can definitely result in pregnancy.

And then there are all the possible infections and/or diseases you can contract from unprotected sex. Just genital to genital contact is enough for a lot of stuff to be contagious.

So please PLEASE go out and get yourself some condoms. Also go to the doctor and get yourself tested for any STIs (Sexually Transmitted Infections) and get yourself a pregnancy test.

And for those of you out there who are committed to remaining virgins: this doesn't mean that you shouldn't still be prepared. The heat of the moment happens and it is better for you to have safer sex gear (condoms, lube, dental dams, gloves) on hand just in case. Please be safe and have fun.

Hormonal Birth Control

What do you know about the long term effects of hormones? (ie birth control pills, the ring) I've been on the pill for 10 years (switching to different ones throughout) and am on my 2nd month of the ring now. I feel like I don't know what my body wants/needs anymore, because its been without normalcy for so long now--how do I know? I know a doctor wouldn't test me hormonally normally at my age (27) but I feel like it might be a huge contributor to my long time (at least 10 years) migraines. How do I know if I need the hormones anymore?? Is there even a test?

Thanks Garnet

Let me preface this with saying I am not a doctor. Your best bet is to talk to someone who is. That being said however, I do have to say that there is a very good chance that your migraines are caused by the pill. There are a lot of side effects to hormonal birth control that a lot of us don't think about since its a pill that is taken every day. Afterall how are you supposed to know the difference if you're never off of it?

Now, I don't know what you mean exactly by asking if you need the hormones anymore. If you're talking specifically about birth control then there are non-hormonal methods on the market. The IUD is even as reliable as the pill if not more so since you don't have to remember to take it. But I would only recommend an IUD if you're in a longterm monogamous relationship as there can be severe complications if you contract an STI.

If you're talking about needing hormones for other things like regulating your cycle or relieving severe menstrual cramps then the only way to know is by going off hormones to see if your cycle is still really haywire or if your cramps are as bad as they used to be.

If you're talking about needing hormones to prevent anything like ovarian cysts or endometriosis then you should consult a doctor. They may decide to take you off the hormones for a period of time and watch you carefully to see if you do in fact need them. But only a doctor will have the tools to do so.

While hormonal birth control can have many benefits there can also be health risks especially as you get older. At 27 you don't have to worry too much, but once you start nearing 35 the risks go up. So that's something you should keep in mind as you start this process.

Contraception

I have a question from a female friend; she and her boyfriend are in a long term relationship. They're both serious about it and there's not really any risk of STD (since it's a single partner situation) so she was looking for an alternative contraceptive that would allow her and her boyfriend to have sex without a condom. What would your recommendation be, how reliable are the various options, and how safe are they?

As a biologist I know a fair amount, but I'm sure you have more specific knowledge of this than I do, so I thought I'd ask the expert.

Before they decide to go on an alternative form of birth control they should both get tested to find out if they are both disease free and keep in mind that 1. Sometimes certain STIs won't show up on a test for 6 months after it has been contracted and 2. There are some STIs that may not have tests like HPV in men and some STIs that aren't automatically tested for like herpes. When they go in to get tested they need to specifically tell the doctor/nurse that they want to be tested for HIV and Herpes as well.

If they are both clean then they can start thinking about what kind of birth control she wants to be on. There are several on the market, some are more effective than others and some have more side effects than others. Any hormonal forms of birth control are going to have more side effects than non-hormonal forms, but they will also be more effective. If a woman is over 35 or smokes she should not use hormonal forms of birth control as they increase the risk of blood clots and stroke.

First, the hormonal forms:
The most used form of birth control in the US is The Pill. There are many many different brands of pills out there with different hormone dosages. Finding the right one can be difficult, but worth it to find one that works well with a woman's body chemistry. The goal is to find the pill with the least amount of side effects that actually makes life easier, not more difficult. A woman's doctor or nurse should work with her to find the right dosage. Some possible side effects include: nausea, weight gain, fatigue, moodyness, loss of sexual desire, depression. The Pill is about 99% effective when used correctly. If you cannot remember to take your pills at the same time every day then they will not be anywhere near as effective. They are also less effective if you take St John's Wart or are on antibiotics.

If you cannot remember to take your pills every day at the same time there are a few other options. The NuvaRing is a small plastic ring that a woman inserts into her vagina that emits a low dosage of hormones. The ring is kept in place for 3 weeks and then on the fourth week the woman must take it out to allow for her period. After that week is over she puts in a new ring. The NuvaRing is just as effective as The Pill if used correctly and also has the same side effects. This option should not be used if a woman is at all squeamish about touching her genitals or feeling around inside of her vagina. It may also be more expensive than The Pill and is not covered under a lot of insurance plans.

Another option is The Patch, Ortho Evra. This is a patch that is placed on the body for a week at a time for 3 weeks, with a week off for your period. The patch sends hormones through your skin and into your blood system. The patch has more estrogen in it than The Pill and may cause more side effects because of that. It is as effective as The Pill if used correctly. There is risk of The Patch falling off if a woman leads an active (read: sweaty) lifestyle and if this is not noticed right away it can increase risk of pregnancy. The Patch can also cause irritation to the skin where it is applied.

Another option is Depo Provera. This is a shot that the woman gets once every three months. If a woman has a difficult time remembering to do the above three options then depo may be a good option. However, depo is in your bloodstream for 3 months, which means that you are stuck with any bad side effects that you may have for three whole months. This can be unbearable for some women. Depo is, however, very effective since there is very little risk of human error. It is about 99% effective.

There are two types of IUD (Intrauterine Device), hormonal and non-hormonal. The hormonal type is in the shape of a small T, is made out of plastic, and releases progesterone into the body, which thickens the cervical mucus making it difficult for sperm to reach the egg and also by changing the lining of the uterus so that a fertilized egg cannot implant. The device is inserted by a doctor and can be used up to a year. It is 98% effective, but should only be used by women in longterm monogamous relationships as the IUD can cause severe complications if the woman contracts an STI. This caution should also be noted for the non-hormonal IUD as well as the IUS, which follows.

The Intrauterine System (IUS) is very similar to an IUD but the big difference is that it releases a small amount of the hormone levonorgestrel into the body that thickens the cervical mucus which makes it difficult for the sperm to reach the egg. It has to be placed into the uterus by a doctor and stays in for up to 5 years. The IUS is 99% effective.

Non-hormonal options:
The diaphragm, like the condom, is a barrier method, which means that it blocks the sperm. Unlike a condom though, the diaphragm is put into the vagina, covering the cervix so sperm can get into the vagina, but not into the uterus or fallopian tubes. Diaphragms need to be fitted by a doctor and they are a lot less effective than hormonal methods. The chance for human error is also greater. Diaphragms should be used with a spermicide, which makes them more effective, but spermicides can also be harmful to the delicate tissues of a woman's vagina. Diaphragms with spermicide are about 86-94% effective. If a woman chooses this method she should not feel squeamish about touching her genitals or reaching inside of her vagina.

The cervical cap is a lot like the diaphragm, but instead of simply covering the cervix, it is fitted to snuggly cap the end of the cervix. The cervical cap should also be used with a spermicide and is about 84-91% effective, but that effectiveness goes down if the woman has previously given birth.

The sponge is a soft disk shaped device made out of polyurethane foam and contains the spermicide, nonoxynol-9. As stated above, spermicide can cause harm to the tissues inside of the vagina. It doesn't effect all women, but if a woman has had problems in the past she should not use this method or any of the non-hormonal methods mentioned above. The sponge is a bit easier to remove than the cervical cap, diaphragm, and NuvaRing because it does have a small loop attached for ease of pulling it out. But if a woman is at all squeamish about touching her genitals, she should still not use this method. The sponge is about 84-91% effective depending on correct usage, but that effectiveness goes down if the woman has previously given birth.

The IUD, or intrauterine device, is a small t-shaped copper device that is placed into the uterus by a doctor and left for up to 12 years. This device is very effective and there are a few theories as to why exactly. Some include the device's material and some include the shape of it. But basically what any woman needs to know is that it prevents pregnancy by making it practically impossible for a fertilized egg to implant itself in the lining of the uterus. It is about 99% effective. This device should only be used by women in longterm monogamous relationships for the same reason as described above for the hormonal IUD and the IUS.

The last 2 non-hormonal methods are the Rhythm Method and the Withdrawal Method and I really advise against both unless you are a couple who doesn't particularly want to get pregnant, but wouldn't mind it if it happened. These are methods that should never be used by young people as they do not have enough self control. The rhythm method is when a couple only has sex when a woman is least likely to get pregnant. The withdrawal method is when the man withdraws his penis from the woman's vagina right before he ejaculates so that he does not get any sperm into her vagina. Neither of these methods are very effective, but can increase the effectiveness of any of the methods listed above.

The Pill

I started Yasmin and noticed that my emotional stability went totally haywire, is this common for all birth control pills or no?

Different birth control pills have different amounts and kinds of hormones in them. This means that different kinds will have different effects on different people. It is best to experiment with different pills to see what works best with your body and natural hormone levels. You and your doctor need to figure out what is best for you. It really can be a life changing effect.

If you experience some moodiness, fatigue, spotting, or nausea don't discount the pills right away though. Give your body some time to adjust to the new pills. However, if your reactions are severe or the minor annoyances won't go away then consider talking to your doctor about changing your prescription. If your doctor won't listen to you, as I've heard of many who won't, try going to a reproductive health or women's clinic like Planned Parenthood. The goal is to find a pill that will make your life better and easier, not harder.

Unfortunately, not all women will find a pill that works for them. There are other options for contraception. Here is a pretty good chart outlining birth control options. It is slightly out of date on emergency contraception, but other than that it is pretty good.