Contraceptives: finding the right fit

The following questions showed up in the Ask Dr. Peg box in the SHAC lobby. The first is from a man and the second is from a woman:

1. Why aren’t there more contraceptive options for men?
2. What is the best type of birth control that is most effective and won’t hurt your body?

So, you want to have sex but don’t want to make babies. Join the ranks of most students, who are too busy studying to become parents. When you make a baby, it’s called conception. To avoid conception, you use contraception, or birth control. It takes two people to make a baby, so it makes sense to look at both partners when considering contraception.
But before I talk about how to prevent it, let’s review how it happens in the first place. If you didn’t sleep through middle school health class, you can skip the next part and go straight to the list.

How does a baby get made? The usual way is for a man and a woman to have vaginal intercourse. When the man ejaculates, fluid travels from the prostate gland and testes through a tube called the vas deferens and out the tip of the penis. The fluid contains sperm, millions of them, all with one thing on their wiggly little minds: hooking up with an egg.

The egg, of course, comes from the woman. About once a month, she releases a single egg from one of her ovaries. Once that happens, it takes a few days for the egg to saunter down the fallopian tubes, through the uterus and out the vagina. During those few days, the woman is fertile, which means she could get pregnant if one of those wigglies hits the mark.

You can intervene in this process in a number of places.

1. Prevent the egg from being released. This is how hormonal methods for women work. In order to ovulate, or release an egg, a woman’s body creates certain hormonal fluctuations. If those fluctuations are flattened out, which is what happens when you add hormones from the outside, no egg gets released. The hormones used are estrogen and progesterone. Hormonal methods include the birth control pill (take one a day), the birth control patch (apply one a week), the vaginal ring (insert one a month), the shot (get one every three months) and the implant (lasts three years).

Hormonal methods for women are very reliable in terms of preventing pregnancy but can have side effects that range from annoying to serious.

2. Block the sperm from reaching the egg. The methods that do this are called barrier methods. Male condoms are the most popular. The female condom (picture the inverse of a male condom), diaphragm (a rubber cup that goes in the vagina and covers the cervix, or opening to the uterus) and cervical cap (smaller version of a diaphragm) are also barrier methods. What is nice about barrier methods is that they are temporary, local and help prevent disease. Blocking the union of egg and sperm can also be done on a permanent basis, with tubal ligation for the woman or vasectomy for the man.

3. Prevent sperm from being released. Since there are millions at a time, and it only takes one to tango with an egg, this has been a more daunting problem. But daunting never stopped science, and there are several prospects in the wings. Hormones work on men, too; testosterone and progesterone combinations look promising for stopping sperm production. A technique called vasal occlusion involves putting a temporary plug in the vas deferens to block the sperm from coming out of the man’s body. Finally, there is a group of techniques involving injections into the vas deferens of chemicals that will scar the tube closed permanently or of polymers that will do a temporary job. As of now, all these methods are in the research stage, leaving condoms and vasectomy the only choices for men. But stay tuned.
What is the best method? That has to be answered individually, because the answer depends on you, your body, your partner and your situation. But we can help. Call SHAC at 277-3136 and ask for an appointment to discuss birth control. I think it is useful for couples to come in together, but if you’re not in a relationship or prefer to come in alone, ask for an appointment in men’s health or women’s health. For more information, visit shac.unm.edu.

Dr. Peggy Spencer has been a UNM Student Health physician for 17 years and a Daily Lobo contributing columnist for three years. She is co-author of the book 50 Ways to Leave Your 40s. E-mail your questions to her directly at Pspencer@unm.edu. All questions will be considered, and all questioners will remain anonymous. This column has general health information only and cannot replace a visit to a health provider.