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Allison Culp

Dr. Cleaveland

UHON 3560

9 December 2016

Contraceptives: A Brief History and Explanation of the Options Available

Contraceptives have wildly evolved since their origin in the 1600s. Today there are

copious methods of birth control to adequately fit the needs of an individual so they are able to

properly protect themselves. Contraceptives are also used today for a multitude of other reasons

aside from preventing conception such as the regulation of menstrual periods, lessening the pain

of menstrual cramps, the reduction of risks for certain cancers that are found in the female

reproductive tract, and even acne. Researchers today are looking at the possibilities of alternative

male birth control methods aside from the condom, though there are complications within this

advancement. Despite some of the controversies and misconceptions surrounding birth control, it

is undeniably a fascinating and important medical advancement that improves the daily life of

millions both physically and mentally as users feel more at ease when they know they are

protected.

To describe a very brief history of contraceptives, the first form dates back to the 1600s.

Vaginal douching was used to eradicate the sperm from the vagina but is very unreliable and

unhealthy for the vagina. Condoms became a more popular and reliable method around this time

and in the eighteenth century they were primarily made of linen or animal skin. In 1843

Goodyear and Hancock developed the rubber condom though it was very thick and

uncomfortable, but was more effective. The latex condom wasnt invented until the 1930s. In

1956 the first clinical trials for oral contraceptives took place and became FDA approved in
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1957. In the 1990s the sympto-thermal method which combines all fertility indicators such as

temperature, consistency of cervical mucus, breast sensitivity, and mid-cycle ovarian cramping

was used popularly. However this is also not very reliable due to the fluctuations that can occur

in hormones and that cycles are not always consistent month to month. More recently in 2009,

the NuvaRing was invented and has since become quite common and is very effective (FPA). As

mentioned, researchers are studying other forms of birth control for males and the most recent

publication of these trials was on November 3, 2016 (NPR Staff).

To begin with the many types of contraceptive, the most basic form is abstinence. By

abstaining from sexual intercourse there is absolutely no risk for pregnancy or sexually

transmitted diseases. It is also free, making it the least expensive method. Although it is the most

effective form of birth control, abstinence is not the most popular form because it does not meet

the needs of individuals. That is why in the 1950s Gregory Pincus, Carl Djerassi, and John Rock

developed oral contraceptive. The clinical trials began in 1956 and the pill was approved by the

Food and Drug Administration in 1957 and became available to the public in the 1960s. In 1960

the progestogen-only pill, commonly referred to as the mini-pill was developed (FPA). This pill

differs from combined oral contraceptives in that it does not contain estrogen and is therefore a

bit less effective. This is because the progestogen doesnt always prevent the release of an egg; it

only thins the endometrium and thickens cervical mucus. It is also imperative that the

progestogen-only pill be taken at the same time every day because of the small dosage. This type

of oral contraceptive is mainly used by women who are breast-feeding or have complications

taking estrogen.

In contrast, the combination oral contraceptive pills contain both estrogen and

progestogen and can differ in dosage depending on individual need. They can also come in packs
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that are monophasic, biphasic, triphasic, or most recently quadphasic. The phases all depend on

the level of hormones of the pills and how they increase throughout the month. For example, in a

triphasic pill pack the estrogen to progestogen ratio will increase every seven days until the

fourth week of placebo pills that contain no hormones. (Stacy). A new quadphasic combination

pill, Qlaira, has recently been developed to reduce side-effects but is more expensive and

diverges from typical twenty-one active pill regimen. Combination pills work by preventing the

maturation and release of egg, thickening the cervical mucus so that sperm cannot get through,

and thinning the endometrial lining so that even if ovulation occurs and sperm fertilizes an egg,

the blastocyst will not be able to attach to the uterine wall. Combination oral contraceptives are a

very reliable method of birth control. If taken perfectly, less than one in one hundred women will

become pregnant every year and with typical use nine out of one hundred women will become

pregnant in a year (Planned Parenthood). Typical use entails that the user takes pills late or

misses them completely or doesnt properly store the pill packs per the directions. It is important

to note that oral contraceptives efficacy can be reduced by certain medications such as St. Johns

Wort and some antibiotics so a user must be aware of how any new medications interfere with

their prescription. Typically the pill will cost zero to fifty dollars a month depending on the

healthcare provider and insurance coverage. Birth control pills are also not protective against

sexually transmitted diseases.

Condoms are mainly used by males as a physical barrier that prevents spermatozoa from

entering the vagina. In 1842 the first rubber condom was introduced but was very thick and

uncomfortable. In 1997 the first polyurethane condom was developed and is less sensitive to

heat and humidity, and not damaged by oil-based lubricants, (FPA). In 2005 the first synthetic,

non-latex condom was developed to allow those with a latex allergy to still protect themselves
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from sexually transmitted diseases and their partner from an unwanted pregnancy. Unlike oral

contraceptive that protects continuously as long as the pills are being taken, condoms are a one-

time use only. In terms of effectiveness, the condom is ninety-eight percent effective with perfect

use and eighty-two percent effective with typical use, which is usually when the condom slips off

during intercourse or is not used the entire time, or when the condom is damaged in some way

(Planned Parenthood). They are widely available at drugstores for a fairly low price and

sometimes for free at health centers.

One of the most recent forms of birth control to be released is the NuvaRing in 2009 but

contraceptive vaginal rings have been studied since the 1970s. The NuvaRing is a flexible ring

that is inserted into the vagina and acts very similarly to the combination birth control pill by

releasing low doses of progestin and estrogen throughout a three week period. The fourth week it

is to be taken out to allow a menstrual period to occur and then replaced the following week,

even if the menstrual period has not ended. The hormones work to prevent ovulation, thicken

cervical mucus, and thin the lining of the endometrium. It is important to follow the storage

conditions properly and to take out and replace the ring on the same day of the week and time it

was the first month the user begins. While the NuvaRing must be purchased monthly for

approximately zero to eighty dollars some may prefer this method because it is less maintenance

to keep up with. With birth control pills a user has to remember to take it every day at around the

same time which leaves more room for human error, but with the ring it is only necessary to keep

track of what days it needs to be removed and replaced. It is also comparable to the pill in

effectiveness as less than one hundred women will become pregnant in a year while using the

NuvaRing.
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Depo-Provera, usually referred to as the Depo Shot, began its first clinical trials in 1963.

This method must be prescribed and administered by a health care professional, though some

studies are being done to allow self-administration (FPA). It works by releasing the hormone

Depo-Provera, or medroxyprogesterone acetate per the Food and Drug Administration, that

prevents ovulation and thickens cervical mucus. A user must get the injection every twelve

weeks and costs between zero and one hundred and fifty dollars each visit. This method is also

lower-maintenance than some of the others available and is very reliable if a user gets the

injections when they are due.

For some, longevity is an important factor when considering birth control options. The

implant is a long-lasting and reliable form of birth control. The first implant called Norplant was

introduced in 1993 and consisted of six progestogen releasing rods. In 1999 Norplant was

discontinued and replaced by Implanon that only contains one rod that releases etonogestral

which is a a synthetic biologically active metabolite of the synthetic progestin desogestrel that

works by preventing the release of luteinizing hormone and therefore preventing ovulation,

thickening cervical mucus, and thinning the endometrial lining (Maddox and Rahman). In 2010

the name of the implant was changed to Nexplanon and is known by this name today. This

method of birth control has to be prescribed and inserted into the arm and removed by a

professional health care provider. It costs more than the previously mentioned methods at

approximately zero to eight hundred dollars for insertion and up to three hundred dollars for

removal, but again these prices depend on insurance plans. Though it is more expensive, the

longevity can last up to four years and is very reliable during that time. While using the

Nexplanon implant, less than one in one hundred women will become pregnant in a year.
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The Intrauterine Device or IUD is one of the most long-lasting methods of birth control.

It was first designed by Dr. R Richter in 1898. Plastic IUDs and copper IUDs were further

developed in the 1960s and in 1996 the first hormonal-releasing IUDs were invented. Currently

researchers are experimenting with different shapes, including a frameless version called the

Gynefix that was introduced in 1997, and different levels of copper and hormones. The typical

IUD is a T-shaped device that is inserted into the uterus and works by blocking sperm from

reaching a mature egg. Those that release hormones function similarly to the mini-pill or the

Depo Shot. Copper IUDs release copper that bathe the lining of the uterus [and] produces an

inflammatory reaction in the uterus that is toxic to sperm, which helps prevent fertilization,

(Mayo Clinic Staff). This is the best option for women who may still wish to become pregnant

but not in the near future, want a method that is low maintenance, and is reliable. The IUD can

last between three and twelve years depending on the type of IUD and brand. It must be inserted

by a professional healthcare provider and the cost can range from zero to one thousand dollars

depending on factors such as the type of IUD (hormone or copper releasing), brand, and

insurance. Less than one in one hundred women will become pregnant in one year while using

the IUD and if a woman wishes to become pregnant, a healthcare provider can remove the IUD

by pulling the string that hangs down into the top of the vagina. The arms will collapse, allowing

the device to be pulled out and the female can become pregnant immediately after removal.

Sterilization is a permanent form of contraception. In 1775 the first reference to a

vasectomy, male sterilization, was made. In 1961 rings and clips were used to close the fallopian

tubes in females instead of cutting and tying them. In 2002 a new procedure for female

sterilization called Essure was developed. In tubal ligation, the fallopian tubes are tied, cut, or

closed using the clamps previously mentioned. When Essure is performed, inserts are placed into
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the fallopian tubes and over a period of time (approximately three months) tissue will form

around the inserts and block the sperm from entering the fallopian tubes. There are some clear

advantages to Essure as there are no incisions, abdominal entry, or general anesthesia, and it can

be implanted in office-based settings, (Dhruva et al). This is completely irreversible. When a

vasectomy (male sterilization) is performed, the vasa deferentia are blocked off to prevent sperm

from entering seminal fluid so it will never enter the vagina during sexual intercourse.

Sterilization is extremely effective; five in one thousand people will become pregnant after

having the procedure performed. Essure in females is even more effective as less than three in

one thousand women will become pregnant after having the procedure (Planned Parenthood).

These surgeries must be performed by a medical expert and some federal requirements may be

necessary. The cost depends on the surgery and insurance.

Additional forms of birth control that are not very effective include withdrawal or coitus

interruptus, the sponge, the diaphragm, spermicide, and the emergency contraceptive pill or

The Morning after Pill. All of these methods are reliable to some extent but hover around

seventy-six to eighty percent effective (Planned Parenthood). When there are other methods for

reasonable prices or sometimes for free, it is best to use them. The emergency contraceptive pill,

however, should not be used as a method. As stated in its name, it is to be used for emergencies

only. For example, if an individuals primary form of birth control failed, she may take the

emergency contraceptive pill and significantly reduce the risk of pregnancy. Because it is

essentially a double-strength oral contraceptive pill, the hormones are too high for continuous

use. It is extremely effective if taken within the first seventy-two hours after unprotected sex, but

otherwise it may impact the natural levels of hormones in the body negatively. On Plan Bs

website they state that it is not to be taken in place of regular birth control because it is not as
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effective. It is mistakenly used more than it should be and is definitely not beneficial to overall

health or economically, costing about fifty dollars for one tablet.

There are many misconceptions and controversies surrounding contraceptives.

Unfortunately one of them is the side effects that may accompany the use of birth control.

Women may be deterred from using a method due to the long list of side effects without knowing

that they typically disappear within the first three months of use. It is also important to recognize

that everybody reacts differently to various hormone concentrations and that one method not

working out well doesnt necessarily mean others wont.

Religion is also a source of controversy. In 1930 the Roman Catholic Church officially

banned any "artificial" means of birth control. The Vatican stated that sex is only for procreation,

not enjoyment or leisure and that if one wants to have sex, they must accept the risk of becoming

pregnant. Therefore abstinence and the rhythm method that works like the symptom-thermal

method were the only two forms of birth control. However in 1957, the Church law allowed

women with "irregular" cycles to take the Pill to regularize their cycle. Interestingly enough,

John Rock, who carried out trials for the oral contraceptive pill, was Catholic and advocated for

womens right to use contraceptives. He believed the church should view the pill as a natural

form of birth control because it used the same hormones found in the female body. In 1968 Pope

released his encyclical called Humanae Vitae that classified the pill as an artificial form and

therefore those that used it would be committing a mortal sin. However, many disagreed with

him and birth control is used widely among religious people today (PBS).

The cost of contraceptives is also an issue. Without insurance it can become quite

expensive and inaccessible. Thanks to the Obama administration and the Affordable Care Act, in

2014 up to seventy-four percent of privately insured women were paying nothing out of pocket
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for their birth control, including the ring, the pill, Depo-Provera, and the IUD (Wind). In addition

to this and touching on the previous subject, the Obama administration passed a rule in July of

2015 that provides free contraceptive coverage through a third party for employees working

under religious employees that denied them otherwise. However given the change that will occur

in the government in January, the state of progress regarding birth control is questionable.

Most birth control options today are veered towards women but there are researchers

investigating other male birth control methods. Most are non-hormonal because the natural

hormones in a male are not as well-regulated as they are in a female who experiences monthly

lows and highs like clockwork. Theres also the issue in number as a female produces one egg a

month while a male produces millions of spermatozoa (NPR Staff). One non-hormonal option is

Vasalgel which is a polymer that is injected into the vas deferens to block sperm specifically. It

creates a type of filter within the male reproductive tract. It is referred to as the reversible

vasectomy because with a second injection it can be dissolved. It has been approved by the

Food and Drug Administration and studies have shown that about half of men would use it

(Hamlin). Gendarussa and Anti-Eppin Agent are also non-hormonal options though the user must

take a pill and work by inhibiting the sperms functions. Gendarussa prevents the spermatozoas

ability to fertilize and egg while Anti-Eppin Agent inhibits its ability to swim. Another two-

hormone injection trial was done but proved unsuccessful as the males experienced unwanted

side effects. Some, however, did say they would willingly take this form of birth control if it

were available (NPR Staff).

A perfect example of why misconceptions about birth control need to be eradicated

comes from an article titled, Birth Control Makes Women Unattractive and Crazy, published

by the right-wing news source Breitbart. Articles such as this one that contains so much false or
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surface-level information and uses completely inappropriate language are the source of

misinformation and negative commentary surrounding contraceptives. Just the title is offensive

and misleading. One of the main points this article focuses on is the myth that all contraceptives

cause weight gain. After fact-checking their source, it is clear that this is an extreme

generalization because the source states that an average of eleven pounds was gained through the

injection specifically. It is simply incorrect to make such a broad statement, especially when

numerous other types of birth control are available and without acknowledging that everybody is

likely to react differently to medications. The author seems to focus only on the effects birth

control may have on the physical appearance as opposed to its intended use which is to prevent

pregnancy and correct issues some women have with their menstrual cycles. Absurd jargon such

as cottage-cheese thighs and [birth control] makes you jiggle wrong, is not only offensive to

women by assuming that physical appearance should come before personal health, but it is also

completely inappropriate and has no accountability.

Another generalization that the author of this article makes is that Healthy, fertile

women seek out men who are genetically different to them. Women on the Pill do the opposite,

seeking out men who are closer to their own tribe. The main issue with this idea is that the

author suggests that women on the pill are infertile which is a common misconception and

completely untrue. Contrary to this belief, a study from 2001 found increased fertility related to

prolonged usage of oral contraception, particularly for five or more years. This was also the case

in women who had never been pregnant before, (Farrow et al). Articles such as this one from

Breitbart are why these misconceptions still surround birth control and sometimes cause women

to refrain from using contraceptives even if they can improve their quality of life.
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After fact-checking the sources used in this article, it is evident that the author did no

extensive research as he or she took quotes directly from the source and never elaborated on the

subject. Under the sub-header The Pill May Have Destroyed the Institution of Marriage there

is a graph showing the relationship between divorces and women who use the pill. However it

has no available source and even after researching nothing reputable was found for the statistic.

It also fails to show the divorce rates of women who are not on the pill, making it useless as any

kind of comparison. It is to be expected that the amount of women that use the pill increased

over time because the first oral contraceptive pill was FDA approved in 1957 and changed into a

safer, more effective medication as time progressed. Cost and accessibility most likely factored

into the spike in users on this particular graph. While the divorce rate does somewhat correlate

with the amount of women using the pill, it is not always consistent and it is impossible to

generalize that the increase in the divorce rate is due solely to the use of birth control. Surely

other factors such as historical events and social change play roles in the divorce rate and it is

therefore unfair to assume that the two statistics are related at all. Again, this is an example of

misinformation and it is unfortunate that readers will be led astray because of it.

The discourse in this article is not only sexist but its also demoralizing and in no way,

shape, or form appropriate when discussing a revolutionary medication that has improved the

lives of millions. This article fails to illuminate the many benefits besides contraception that the

pill provides such as alleviating the pain of menstrual cramps and volume of blood, regulating

menstrual cycles of those who are irregular, clear acne as hormones are regulated, and reduce the

risk of conditions such as PCOS, endometriosis, and certain types of cancer pertaining to the

female reproductive system (Marquez). It is important to look past misleading articles such as

this one from Breitbart and make attempts at educating the masses about the benefits of
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contraceptives. While there are still misconceptions and controversies surrounding it, medical

advancements in contraceptives are made every day to improve the lives of many around the

world.
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Works Cited

Dhruva, Sanket S., M.D, Joseph S. Ross, M.D, and Aileen M. Gariepy, M.D. "Revisiting Essure -

Toward Safe and Effective Sterilization." New England Journal of Medicine 373.15

(2015): n. pag. Web. 30 Nov. 2016.

Farrow, Alexandra. Hull, M.G.R, Northstone, K., Taylor, H., Ford, W.C.L., Golding, Jean.

Prolonged Use of Oral Contraception before a Planned Pregnancy is Associated with a

Decreased Risk of Delayed Conception. Oxford Journals of Human Reproduction.17

(10). 2002. n. pag. Web. 2 Dec 2016.

FPA. "Contraception: Past, Present and Future Factsheet."

http://www.fpa.org.uk/factsheets/contraception-past-present-future, Nov. 2010. Web. 08

Nov. 2016.

Hamlin, Aaron, 24. "The Male Pill Is Coming- And It's Going to Change Everything." The

Telegraph. Telegraph Media Group, 24 Oct. 2016. Web. 06 Nov. 2016.

Maddox, Dionne D., PharmD, and Zahra Rahman, PharmD. "Etonogestrel (Implanon), Another

Treatment Option for Contraception." Pharmacy & Therapeutics 33.6 (2008): 337-47.

Pharmacy and Therapeutics. MediMedia USA, Inc., June 2008. Web. 3 Nov. 2016.

Marquez, Jennifer Rainey. "Birth Control Pills: Benefits Beyond Preventing Pregnancy."

WebMD. WebMD, n.d. Web. 02 Dec. 2016.

Mayo Clinic Staff. "ParaGard (copper IUD)." Mayo Clinic. 21 Jan. 2015. Web. 29 Nov. 2016.

NPR Staff. "Male Birth Control Study Killed After Men Report Side Effects." NPR. 3 Nov. 2016.

Web. 08 Nov. 2016.

PBS. "People & Events: The Pope Issues Humanae Vitae ("Of Human Life")." PBS Online, n.d.

Web. 06 Nov. 2016.

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Planned Parenthood. "Birth Control Methods." Planned Parenthood. Planned Parenthood

Federation of America Inc., 03 Aug. 2016. Web. 03 Nov. 2016.

Stacy, Dawn. "Multiphasic vs. Monophasic Birth Control Pills." Verywell. N.p., 14 July 2016.

Web. 06 Nov. 2016.

Wind, Rebecca. "New Study Shows Privately Insured Women Increasingly Able to Obtain

Prescription Contraceptive Methods With No Out-of-Pocket Costs." Guttmacher Institute.

Guttmacher Institute, 18 Sept. 2014. Web. 30 Nov. 2016.