Birth Control/Pregnancy

A student from URI wants to know…..

I have a rather embarrassing problem. When I am with my girlfriend we have no problems until I put on a condom - then I lose my erection.  I think it's the tightness that causes this, but I'm quite sure I'm not particularly large.  I try not to make a big deal out of it, and I am very lucky to have such an understanding and loving girlfriend, but it's still very frustrating.  I was wondering if this is a common problem, and what, if anything, I can do about it.  Thank you. Male, Sophomore

Dr. Caron's Answer: Your situation is not uncommon.  Please remember that condoms come in different sizes.  If tightness is a problem, how about switching to a larger brand.  That should provide some relief.  Many men - tight-fitting condom or not - experience some loss of sensation.  Condoms take some getting used to.  Rather than putting the condom on within seconds before intercourse, you may want to expand your sex play to include putting on the condom a few minutes before intercourse - so that you or your girlfriend can stimulate you to the point of another erection (think how much fun she'll have bringing it back up!).  I might also suggest switching methods - for example, you might want to try using the female condom.  It might be a nice alternative - providing protection from disease and pregnancy.  You would not wear the condom - she would "wear" it.  You may want to talk to someone about other alternatives methods of protection.

A student from Western Kentucky wants to know...

My girlfriend and I are thinking about birth control - we've been together over a month and want to move things further along - but we don't want to end up pregnant. neither of us have ever had sex before, so we are not worried about infections or those types of things. Can you make any suggestions of what might be the best one to use?
Male, First-Year

Dr. Caron's Response:

Good for you for thinking about this issue BEFORE becoming sexually involved. Fortunately, you live in a time when there are many options. In general, the best method is the one that combines the greatest effectiveness with acceptance by the individual using it. If someone feels more comfortable and natural using a given method of birth control, they will be more inclined to use it correctly and consistently. An individual's attitude toward the method they're using makes all the difference; no method works if the individual doesn't use it.

Deciding on a method is a choice that should be based on several factors, including age, amount of sexual activity, lifestyle, medical history, and religious beliefs. I think it would be best for the two of you to visit your local health clinic that distributes birth control for a consultation (either your local campus health center or the local family planning). Certainly, The Pill is popular because it is easy to use and has been shown to be very effective in preventing pregnancy. It works by suppressing ovulation. Without an egg ever being produced, there is no risk of pregnancy. Examples of other methods that work similarly include Depo Provera and The Patch. Of course there is also the condom, that is effective if used correctly and consistently each time. No matter what you decide to use, you should both keep in mind that no method is 100% effective, so be sure to educate yourself on emergency contraception (e.g., should the condom slip off or break), and talk about what you might do if you found yourself pregnant. Best wishes on your decision.

A student from the University of Maine wants to know….

Emergency contraceptive pills—where do we go to get it? We had sex without any birth control and we’re worried she will get pregnant. I know we were stupid.... She’s going on the Pill as soon as we get past this. Help! Male, Junior

Dr. Caron’s Answer:
Emergency contraception (also called “morning-after birth control” or “after-sex birth control”) prevents a pregnancy from occurring only if used within 5 days of unprotected intercourse (although effectiveness is greater if taken within 72 hours/3 days). It reduces your chance of becoming pregnant by almost 90%. Approved by the FDA, it is available by prescription thru your medical provider, Family Planning, Planned Parenthood, and other health clinics. It is sold under the name Plan B, and involves taking two pills containing progestin as soon as possible after unprotected sexual intercourse. The directions suggest taking one pill as soon as you can and the other 12 hours later. New research indicates that both doses can be taken at the same time. Be sure to follow up with the clinic about using an effective method of birth control. Please note: It is not an “abortion pill” – since you are not pregnant. Unfortunately, there has been some confusion around emergency contraception and RU-486, which is the drug now available to terminate a pregnancy within the first 2 months. RU-486 leads to abortion and you would see a medical provider for this once you know you are pregnant, unlike emergency contraception that you take to prevent the pregnancy from occurring. For more information on emergency contraception or for information on the closest provider, check out www.not-2-late.com.

A student from the University of Wyoming wants to know...
I got my girlfriend pregnant.  What do I do?

Male, Sophomore

Dr. Caron's Answer:
Don't panic and don't run.  This is a human life you have started together and you both need to sit down and seriously talk about what you want to do.  Legally, she has the power of decision whether to carry through with the pregnancy or abort.  But if you are continuing to be caring and supportive with her, chances are that your views will be included in the decision.  Pregnancy counseling and referral to medical services are probably available at your student health center and many local agencies, including Family Planning and Planned Parenthood.

A student at Boston University wants to know....
What is emergency contraception and is it pretty easy to buy?

Female, First-Year

Dr. Caron's Response:
Emergency contraception is commonly sold under the name Plan B. It is a method of birth control one uses after unprotected intercourse (hence, the nickname "The After Sex Pill").  It is sold as two white pills with instructions to take one as soon as possible and the other 12 hours later - however, new research says you should take both pills together as soon as you get the prescription.  Emergency contraception should not be confused with another drug that became available in the U.S. around the same time: RU-486 is commonly referred to as the "abortion pill" and is used once a woman discovers she is pregnant.  Instead, emergency contraception is taken before one is pregnant - it prevents ovulation, fertilization and implantation - and therefore the woman never becomes pregnant.

For a long time, emergency contraception was known as "America's best kept secret" - it is a repackaging of the birth control pills we all are familiar with - simply given in higher doses. It has been used in hospital emergency rooms for decades - most commonly given to rape survivors to prevent a pregnancy.  We have known about it for year's - but avoided giving the information out to the general public until now. Meanwhile, it has been used widely for years and years in other countries. For example, The Netherlands has claimed it has reduced 90% of unplanned pregnancies.

Although it is commonly known as "the morning after pill," this is an inaccurate description of its use. It can actually be taken up to five days after unprotected intercourse, although most instructions will say to use it within 72 hours (3 days) of the unprotected sex. It is most effective when used as soon after unprotected sex as possible.

Emergency contraception is available over-the-counter by talking to a pharmacist in six states (Alaska, California, Hawaii, Maine, New Mexico, and Washington State) and plans are underway to make it available over-the-counter nationally. Right now one can get it through most family plannings, Planned Parenthoods, and college health centers. You can also call 1-800-887-4029 to talk with a trained medical provider who can fax in a prescription to your local pharmacy. Probably the best website on emergency contraception is Not-2-Late.com ( http://ec.princeton.edu/ ). It offers the latest news and political discussions, it also allows you to search for the nearest provider by entering either your zip code, area code, or town. There is also an on-line  service at http://www.getthepill.com/ which will take your request for emergency contraception and fax a prescription to your local pharmacy if it is deemed appropriate. The cost is $24.95 for this service.

Lots of people find themselves in situations where they might need emergency contraception - either because the birth control method they used failed (e.g., the condom slipped or broke) or there was no contraception used. By making emergency contraception widely available, we will be able to reduce the number of unplanned pregnancies, and in turn reduce the number of abortions in this country.  Let's hope politics does not get in the way of good health practice.

A college student from Northwestern wants to know....
I recently had sex with my girlfriend on the first day of her period. After a few "in and outs" I decided to put on a condom. I don't know if I had precum, but now I am worried about pregnancy. I would like to know your thoughts about this.

Dr. Caron's response: Thank you for your question. I want to start by saying you have a right to have concerns, but the risk of pregnancy as you describe the situation is quite small. The first part of your question has to do with whether or not unprotected intercourse on the first day of a woman's period is risky - in other words, could she be ovulating? Please know that most women ovulate and then later (days or weeks later) have their period. Knowing this was the first day of her period would mean that most likely no egg was available to meet your sperm. The second part of your question relates to the discussion of pre-cum and possible presence of sperm in this fluid - which some have suggested could contain sperm if the male had ejaculated just a few hours before and not urinated in between sessions. The presence of sperm in the pre-cum is a remote possibility. Many people have been told that pre-cum might contain sperm - but the new studies show that there is no sperm in pre-cum. The risk of pregnancy with withdrawal has to do with not pulling out in time...not the pre-cum. While we can say anything is possible - in this case, it is unlikely that there was a risk of pregnancy. Best wishes.

A student from UNCC wants to know….
Can a woman get pregnant at any time, or is there a time when she can't get pregnant?

Female, First-Year

Dr. Caron’s response: You get pregnant when an egg and sperm ­ so both need to be present for this to occur. Most women ovulate (release an egg) in the middle of their cycle. For example, if a woman menstruates every 28 days, she typically ovulates on or around the 10-16th day before the start of her next period. The egg lives only 4 to 24 hours after ovulation. Sperm are most active within 48 hours after ejaculation. So, one way to avoid pregnancy is to avoid having intercourse around the time you ovulate. (of course you can also use birth control pills that stop ovulation completely ­ no egg = no way to get pregnant).The problem is trying to determine when you ovulate. For some women the signs are more obvious. For example, some women experience a twinge on one side of the lower abdomen during ovulation, called mittleschmerz (German for middle pain). Around the time of ovulation there is an increase and a change in cervical mucous secretions. The mucus becomes clear, slippery, and stretchy (like egg white). It is at this time that a woman can most easily become pregnant. If you really want to understand your body and your ovulatory cycle, I suggest learning natural family planning (there are books explaining this); this method teaches you how to chart your temperature and mucus changes in order to predict ovulation. You can also buy an ovulation-predication kit at the drug store; but this can be a bit expensive, as it requires you to check your urine daily for the presence of hormones. Best wishes!

Question from a student at University of Maine: I am rather ashamed to say that my ex-boyfriend and I used to have sex all the time and we never used any sort of birth control. He would always pull out of me before he ejaculated, and luckily, I never had a pregnancy scare. What are the chances of getting pregnant doing this?

Dr. Caron's Answer: Withdrawal (aka "pulling out," coitus interruptus, "pull and pray") is probably the oldest method of contraception. The Bible contains many references to contraceptive techniques, including withdrawal. The story of Onan, for example, implies knowledge of the withdrawal method. This method means that the man removes his penis from the vagina before ejaculating. Withdrawal has a first-year failure rate among typical users of about 20%. That means about 20 in 100 women using this method in their first year will get pregnant. The biggest reason for failure is that the man does not withdraw in time. Even if the penis is withdrawn just before ejaculation, some ejaculate may still fall on the vaginal lips, and sperm may find their way to the fallopian tubes. If a man does not withdraw in time and the woman believes this is her fertile time, emergency contraception should be used to prevent pregnancy. By the way, it used to be thought that there was a risk of pregnancy with withdrawal due to sperm in pre-ejaculatory fluids ("pre-cum"), but new research suggests this is not a risk.

Because of its unreliability and high failure rate, withdrawal is considered an ineffective method of contraception. As Robert Hatcher, author of Contraceptive Technology says, "it is a considerably better method of contraception than no method at all." What is interesting to note is that more than half the couples around the world use withdrawal to prevent pregnancy - it is free, does not require a doctor's presciption, is always available, and is better than nothing at all. One has to wonder though, with all the effective methods available to us here in the United States, why someone would resort to using such a risky method to prevent pregnancy.

Question from a student at Clarke University: Is it possible for me to get pregnant from anal sex?

Female, Senior

Dr. Caron's Answer: No. The man's sperm would have no way to reach the woman's egg via her anus. The egg is fertilized in her fallopian tube. The only way to reach it is via the vagina - the sperm would need to be deposited in the vagina. To help you better understand reproductive anatomy, I suggest you find a book on basic anatomy. The library has many good books on the topic. I think you might find it useful to learn how your body works, and specifically how conception takes place in the body.

Question from a student at University of Memphis: How long has abortion been legal? Up to what month can a girl have an abortion?

Dr. Caron's Answer: In 1973 the Roe vs. Wade decision legalized a woman's right to obtain an abortion from a qualified physician. However, what many people may not realize is that the decision talked about this right in terms of trimesters of pregnancy.

During the first trimester of pregnancy (when over 90% of abortions are performed in this country), a women can request (sometimes called "demand") an abortion; however, during the second trimester, she can only get an abortion with a physician's consent. During the third trimester, an abortion is only permitted in extreme cases - for example, to save the life of the mother or when the fetus has died in utero.

Question from a student at Central Washington University
What is the safest brand of condoms to use? Also, if possible could you give me a list of ratings that condoms got for being safe?

Male, Senior

Dr. Caron's Answer:
There are more than 100 brands of condoms available in the United States today. Latex condoms are the most effective method for reducing the risk of infection from HIV that cause AIDS, as well as other STDs. For people who are sensitive to latex, polyurethane condoms are a good alternative. Some condoms are pre-lubricated. These lubricants do not increase birth control or STD protection. Non-oil-based lubricants, such as water or K-Y jelly, can be used with latex or lambskin condoms. Do not use oil-based lubricants with a latex condom (such as petroleum jelly/Vaseline, lotions, or massage or baby oil) because they can weaken the condom and cause it to break.

The FDA, which regulates condoms as a medical device, reviews production records and examines stock at random. Should leaks turn up on 4 per 1000 condoms in a run, the entire lot is thrown out. It is important to know that an estimated 2-5% of condoms tear during use. Most of those failures are thought to stem from misuse, not inherent product flaws. That's why the U.S. Centers for Disease Control and Prevention provides directions on the importance of consistent and correct use of condoms, including: use a condom with every act of intercourse from start to finish store in cool place, check expiration date, open carefully, use a new condom every time, put condom on erect penis before it touches any part of partner's body, be sure to leave a reservoir tip, withdraw soon after ejaculation while still erect.

Consumer Reports has also tested the effectiveness of condoms. Their report in 1999 tested 30 models of latex condoms major brands and small brands, in different sizes, textures, and lubricants, some promoting extra thinness or strength. Only 2 products of the 30 failed their tests: Durex Pure Protection Spermicidally Lubricated and Trojan Plus 2 Spermicidal so avoid those 2 products!

All of the following passed their minimum burst standards, as well as their higher threshold test, so these would be brands to consider purchasing:

Lubricated condoms that did well:
Beyond Seven, Class Act Ultra Thin & Sensitive, Durex Extra Sensitive, and Trojan Ultra Thin are thinner than most. Trojan Magnum is longer and wider than most. Kimono Microthin is longer and thinner than most. Lifestyles Vibra Ribbed, Trojan Ultra Texture, and Trojan Ribbed are textured condoms. Durex Enhanced Pleasure, Lifestyles Extra Pleasure, and Trojan Ultra Pleasure are uniquely shaped. Trojan Shared Sensation is textured and uniquely shaped.

Unlubricated condoms that did well: Trojan has a plain end; Trojan-Enz has a nipple shaped reservoir like all other condoms in the ratings.

Question from a student at Arizona State University:
I know it's important to ask your sexual partner to wear a condom, but how should I approach the issue? I'm not comfortable discussing it.

Female, Sophomore

Dr. Caron's Answer: Anyone you know well enough to be sleeping with, you should know well enough to talk about protection with. However, I recognize that talking about sex has never been easy. In fact, some people even think it's wrong or that it ruins the mood. But in this age of "fatal sexuality" - where people can die from unprotected sexual intercourse - it is crucial that you talk about using condoms. Forethought before Foreplay is essential: Talk with your partner before you end up in bed. You might try bringing up the subject by saying, "Gee, I keep hearing all this stuff about AIDS and safer sex. What do you think?" Or, "I'd love to make love with you, but I'm worried about disease." Talk about your need to have sex safely. If he's a former Boy Scout, he'll understand the concept of being prepared. If he's ever played sports he'll understand how important it is to wear protective gear before you play the game.

Question from a student at University of Rhode Island:
Is condom breakage a common problem? And if a condom does happen to break during sex, what could we do to prevent pregnancy?

Male, Senior

Dr. Caron's Answer

Answer: An estimated 2-5% of condoms tear during use. Most of those failures are thought to stem from misuse, not inherent product flaws. The FDA, which regulates condoms as a medical device, reviews production records and examines stock at random. Should leaks turn up on 4 per 1000 condoms in a run, the entire lot is thrown out. If you have the unfortunate experience of a condom breaking, you may want to consider having her insert an application of spermicidal foam immediately, and seeing someone at your local health center or Family Planning clinic in the next day or so. There, they can discuss emergency contraception (after-sex birth control), which must be used within 72 hours (3 days) after unprotected intercourse. If she feels she is at risk of pregnancy - due to the time in her cycle where an egg may have been released - she'll be given 2 pills, and another 2 to take 12 hours later. For future reference when purchasing condoms, check out Consumer Reports for their ratings of condoms.

Question from a student at Colorado State:
W well here is the deal... i am in a relationship where we are sexually active, but i have a problem. We have had unprotected sex, and we tried to use protection. Every time we try, "brian" doesn't cooperate and loses interest. I love my girlfriend to death and when we don't use protection it's the greatest ever... but help! we need/want protection, but its just not working...

Male, Senior

Dr. Caron's Answer

You say you are using protection sometimes, and other times you are not. By protection, I assume that you are referring to use of condoms (the method that is causing "brian" to lose interest). My first question is: What are you and your girlfriend trying to protect yourselves from? If it is only pregnancy, there are several options (e.g., contraceptive pills, shots, and implants). Make an appointment to visit your local family planning together to discuss these options. If you are interested in protecting yourself from sexually transmitted diseases, and a male condom is not working out for you (or "brian"), then perhaps she could consider using the female condom. If this is a monogamous relationship, and both of you are currently disease free, then your best protection from disease is to keep the relationship monogamous. There is no need to use condoms for protection from a disease that does not exist in such a situation. Whatever you decide, remember: FORETHOUGHT BEFORE FOREPLAY is always useful in other words, be sure to talk to your partner about this before you find yourself together beneath the sheets. Facing an unplanned pregnancy is not something either of you should have to contend with at this point in your life.

Question from a student at Michigan State:
How many days out of the month can a woman get pregnant?

Male, Junior

Answer: A woman is technically only fertile for approximately 1 day; that is, the day she ovulates. The egg is generally fertilizable for only 12 to 24 hours following its release from the ovary. Ovulation typically occurs 14 days before the start of her next menstrual cycle. Because sperm only have an effective life of about 72 hours and the egg an even shorter life, conception must occur within 24 to 36 hours of ovulation. Knowing this, it is amazing to think people are even able to get pregnant. If a woman is really interested in tracking her own ovulation, she might want to pick up a book explaining natural family planning. It's a method that assists women in determining their time of ovulation by keeping track of temperature and mucus changes.