Remote Contr-aception

Implantable contraceptive devices have been discussed on this blog here. One problem with these devices is that for women who want to come off the devices they must be surgically removed.

A new device created by MicroCHIPS hopes to change that. This device, currently in pre-market saftey and efficacy trials, is theoretically able to have the same contraceptive efficacy as conventional implants. What makes it exciting is it can last for 16 years (most current implants have a 5 year turn around) and most importantly it can be turned on and off using radio waves.

This small device (20x20x7mm) is implanted in the armpit, abdomen or buttock. From here it is able to secrete levonorgestrel, at 30mg/day (a drug currently used in contraceptive devices to prevent pregnancy). It holds the levonorgestrel in small reservoirs surrounded by thin membranes. These membranes are melted by electrical currents resulting in the release of the dose of levonorgrestel into the body.

By turning this signal on and off through a remote control the drug can be stopped or started whenever the woman sees fit, assumedly by her GP.

This would allow women more control over their sexual health. Specifically it would make the decision to become (or not become) pregnant easier, they would not have to visit an outpatient clinic to start trying.

Obviously it's early days but this is another development we will keep our eye on. 

Sex, Squats and Pelvic Floor Control

It's no real surprise to anyone that uses social media that exercise is the flavour of the month. In the modern age there has been massive shift in attitudes surrounding exercise and being fit, it's not just for athletes anymore. This change in attitude is doubly true for females.

To put on my feminist hat, it's bloody great (mostly). I recall a friend of mine from high school, a middle distance runner who struggled through high school with her identity as a woman. She was strong, muscly and flat chested. Kids are cruel. I remember class mates teasing her for looking like a man.

Now the aesthetic and the discourse is changing. Fit women not only have a place but are lorded and accepted for being strong.

Of course this new fit, strong and sexy aesthetic can put some pressure on other women who don't fit that mold. Thankfully however, there are multiple different societally accepted roles in which women can establish their femininity (the same cannot be said for men, but that's a whole other topic).

Whilst fit is very faddy at the moment, with people getting into fitness for aesthetics rather than health, I don't mind. Does the vessel matter if the outcome is the same?

So I'm gonna go there. I'm gonna bust out the hashtag.

What's your #fitspiration?

Is it aesthetics, health or functional ability (sport, flexibility etc)? If they don't motivate, sorry #fitspirate, you into picking up a dumbbell (and activating your long lost instagram account) why not exercise for sex?

Firstly sex is (or should i say can be?) a workout in and of itself. It involves coordinated activation of the cardio-respiratory and musculoskeletal systems for short to long periods. So just like sprinting the 100ms or running a marathon, sex has demands on the body.

The fitter sexual participant will be able to cope with the change in cardio-respiratory homeostasis better and thus may have longer lasting sex. The stronger participant will also be less muscularly sore after sex and able to experiment with more different positions, potentially increasing both partners enjoyment.

From a more medical angle physical activity is also known to: increase libido, decrease the risk of developing erectile dysfunction, decrease rates of prostatic disease and improve the quality of sperm in men. In women it improves libido, menstrual cyclcity, ovulation and fertility.

That said it is not all roses. Constant bouts of "extreme" exercise (running a daily marathon etc) can result in negative energy balance leading to detrimental effects on the reproductive system (especially in women read: amenarchy and infertility). It is best to do a moderate amount of exercise (30-60minutes/day).

So are there are any particular exercises you should be doing?

Yes and no. Any exercise is better than none but there are a few things you should be focusing on.

Guys
Think abdominals (crunches), hip flexors (lunges, squats, deadlifts) and glutes (squats, deadlifts). Extra flexibility isn't going to hurt either so keep up your stretches and maybe think about a yoga class (could be something you do together).

Girls
Think hamstrings (lunges, hamstring curls), glutes (squats, deadlifts) also you want to have some pretty loose hip flexors to get those legs up and out of the way (yoga, pilates). Also probably an idea to think about your pelvic floor. The muscle of interest here is the the pubococcygeus muscle (PC to it's friends). PC runs on each side of the vagina and contracts on orgasm. Strengthening this may make the vaginal canal appear tighter and increase sensation for both you and your partner.

If you type "pelvic floor exercises" into Google you will get all manner of results, plenty to play with. One easy way to work the PC muscle is to stop urination midstream, hold it for 3-10seconds and repeat.

So what are you waiting for? Jump on the fitness bandwagon (remember it only works if you use hashtags). Reinforce your bed and get to the gym!

Sex, Butter and Sausage Rolls

"Let's do it again Rick,
for old times sake." 

As discussed previously  being sexually healthy is far more than being absent of infection and pregnant/not pregnant (dependent on your wants). Sex is a natural part of life and safe, consensual, practice of it can help to make us happier and more fulfilled. To understand its pervasiveness just look at how much sex and love are referred to in the pop culture of both the present and past.

However many people, even those who are active sexually, report poor sexual satisfaction. The reason may be as simple as us buttering up too much.

According to ABS data in 2011-12, 62.8% of Australians were overweight (35.3%) or obese (27.5%). The pervasiveness of obesity presents problems on many fronts, one of which may be sexual dissatisfaction.

Sexy ButtHer
(http://edibleblog.com/wp-content/uploads/2010/08/Butter-Scupted-by-Jim-Victor.jpg)

According to a 2006 publication in the journal of Obesity people with higher BMIs reported lower sexual quality of life. Obesity is associated with less enjoyment of sexual intercourse, less 'sex drive' (desire to have sex), more problems with sexual performance leading to avoidance of sexual encounters. This loss of sexual quality of life was found to be greater in women than in men.

A 2014 publication in JAMA Surgery discusses this further. In this prospective cohort study women were assessed for sexual quality of life and functionality before, 1 year and 2 years after bariatric surgery. Most women responded well to the surgeries and lost weight. These women also reported improvements in sex specific functionality and sexual (as well as general) quality of life at both 1 and 2 years after post surgery. Women who didn't respond well to the surgery (who didn't loose weight) saw no significant improvement in sexual variables.

What is not clear from this paper is why the women who improved improved. The reason may be hormonal, psychological (i.e the thinner women felt more attractive) or something different altogether. Hopefully this question will be answered in further research.

From a practical viewpoint if you are experiencing loss of sexual quality of life, some weight loss is not going to hurt. Though before you rush to the specialist's office and ask for a gastric band I'd suggest good old fashioned diet and exercise.

Sexual Health: More Than Just Bugs and Babies

From a scientific perspective, sexual health is if often discussed in the contexts of procreation and disease. However to focus on these aspects alone gives a false representation of sex and the role it has in our lives.

The question stands:
Bees do it, trees do it, we do it, but, why do it? 

The answer may seem to be obvious to some (pleasure) but a more detailed answer isn't clear.

Evolutionary speaking having sex for pleasure is quite a new phenomenon yet sexual reproduction itself is not. So why did were our single-celled ancestors having sex if there was no pleasure?

A commonly touted argument is that sexual reproduction allows natural selection to act leading to increased variation and more viable offspring. The full discussion of these assertions is beyond the scope of this post but is discussed well in this article in Nature Education. Interestingly, according to models, sexual reproduction actually decreases variation and leads to less viable offspring. So no luck getting an answer from evolutionary biologists.

What have the psychologists got to add?

A lot.

I'm scared to type 'psychology' and 'sex' into Google. I don't want to break the internet.

Instead of going down the psychological rabbit hole (where the only way out is to wake up and admit you're in love with your mother/have penis envy) I'll keep this discussion brief and talk about Maslow's Hierarchy of Needs (pictorially depicted to the right). I'm sure many of you are familiar with this model but I will describe it in brief anyway.

Maslow's Heirachy of Needs - Depicted as a triangle
with the more basic needs at the bottom.

Maslow was a psychologist who postulated the theory that certain needs that must be met for people to live, and live well. There are different types of needs, some more fundamental to life itself and some essential to a 'good' life.

The lower the level the needs are on the triangle the more fundamental they are to life. For instance for the person who cannot breathe or eat (physical/phsyiological needs) having a sense of self-esteem (esteem need) is inconsequential. It is only when all needs in each category are met that people ascend the pyramid to self actualisation. (live their life to it's full potential).

Ok. So let's have a look at the physiological needs.
Sex is there.
As essential to life as eating, drinking and breathing.

Whilst this contention may not hold too much weight in biological circles its inclusion highlights the importance that sex has for all of us. A lot of behaviour can be drawn back to sex either doing it or trying to do it.

So the psychologists tell us we have sex because it is a natural as inhaling and exhaling, but (as the 4 year old product of our nature may ask) why?

Is it purely for the pleasure of orgasm? the pleasure of the experience? Because it brings us closer to others? Because it makes little versions of us? Because there was nothing good on T.V that night?

Who knows.

The fact of the matter is we do it. Sexual health is much more than just the absence of something (disease or foetus). Sex is part of what makes us who we are and thus a well taken sexual history should be a part of the holistic doctors practice.

The New Condom?

We have talked about the efficacy of condoms in preventing STIs and unintended pregnancy on this site previously. They are are 98% effective when used correctly (though they are often used incorrectly). It may sound simplistic but they are also only effective when they are used, which isn't such a sure thing.

Whilst many people know the benefits of condom use, they are often not used as they are thought to reduce the perceived sensation of sex. Many people instead take the risk (of pregnancy or STIs) and don't use a condom favoring sensual sex over safety.

Another issue with traditional condoms is that they are made of latex and are therefore unusable by people with latex allergies.

In order to make condoms more consistently used, in 2014 the Bill and Melinda Gates Foundation gave 11 grants to different researchers or companies to make the next generation of condoms. An Australian research team based at the University of Woolongong, NSW was a recipient of one of these grants.

Essentially they are trying to see if condoms made from hydrogels (a jelly like substance made of hydrogen) are able to prevent STIs and unintended pregnancies. These hydrogels have a few advantages over the traditional condom, one of which is that they reportedly feel like skin. Theoretically this property may reduce the loss of sensation felt with normal latex condoms.

More information is contained in the video embedded below.

It's early days and though the idea is promising we don't know how this will pan out in the long term. It is however, something we will be keeping a close eye on.

 

The fast facts of non-barrier contraceptive methods

As the name suggests, non-barrier contraceptive methods do not cause a physical barrier between sexual partners. Therefore it is important to highlight that these methods do not protect the user from sexually transmitted diseases. These methods are for the prevention of pregnancy. Fertility-based contraception is not discussed in this post.

The following information is not intended to replace consultation with a qualified medical practitioner. If you wish to make an informed decision about the contraception you use please make an appointment with your local GP or family planning services.

Emergency contraceptive pill 1,2

-          Known as: “the morning after pill”

-          What is it? A tablet used to prevent pregnancy after sex if there is failure of other methods of birth control or the sex was unprotected. Examples of contraceptive failure includes:

o   Condom breakage or removal during sex

o   Movement or breakage of cervical cap or diaphragm

o   Intrauterine device or vaginal ring coming out

o   Failure to take regular birth control pills

-          Options: Hormonal and non-hormonal options available

-          Efficacy: You can take them up to 120 hours (5 days) after sex, although the treatment become less effective as more time goes by

-          Side effects: Most commonly nausea and vomiting

-          The emergency contraceptive pill is available over the counter in Australia without a prescription.

Contraceptive pills 1,3

-          Known as: “the pill”

An example of a contraceptive pill packet. Image from here.

-          What is it? A tablet taken every day containing one or more female hormones used to prevent pregnancy through:

o   Ovulation prevention

o   Maintaining a thin lining in the uterus

o   Maintaining viscous mucus in the cervix to stop sperm

-          Options: There are many different types of contraceptive pills, some will contain the female hormones oestrogen and progestin, while others are progestin only.

-          Side effects: Within the first few months of starting the contraceptive pill it is common to see nausea, breast tenderness, bloating, mood changes and irregular vaginal spotting or bleeding.

-          Efficacy: If taken properly (same time every day with no missed pills) contraceptive pills are very effective with a failure rate of approximately 0.1%. When the pills are not taken properly the failure rate is closer to 9%.

Contraceptive Injection 1,3

Intramuscular injection. Image from here.

-          Known as: “Depo”

-          What is it? This is an injection, given under the skin or into the muscle of the buttock or upper arm. It contains the female hormone progestin that prevents pregnancy by: ovulation prevention and maintaining viscous cervical mucus to stop sperm migration. Contraceptive action lasts approximately 12 weeks.

-          Side effects: Within the first 3-6 months irregular or prolonged vaginal bleeding and spotting are common. After a year approximately 50% of women completely stop having menstrual periods, however the generally return within 6 months of the last injection.

-          Efficacy: Contraceptive injection is very effective, with a failure rate of <1%.

Contraceptive skin patch. Image from here.

Skin Patches 1,3

-          What is it? Contraceptive skin patches, work in a similar way to contraceptive pills. They both contain the female hormones oestrogen and progestin, which work by: ovulation prevention, maintaining a thin uterus lining, and maintaining viscous cervical mucus to stop sperm migration.

When using this method a patch is worn on the upper arm, shoulder, upper back or hip and is changed weekly. Patches are worn for 3 weeks followed by a 1 week break in which the menstrual period occurs.

-          Side effects: The side effects of the patch are similar to those of a birth control pill (above). There is considered to be a higher risk of developing a blood clot when using the contraceptive skin patch.

-          Efficacy: The contraceptive skin patch is considered as effective as the contraceptive pill. With a 0.3% efficacy for perfect use and 9% efficacy for typical use.

Vaginal Ring 1,4

Vaginal ring positioning. Image from here.

-          What is it? A flexible plastic ring that is inserted into the vagina. The contraceptive vaginal ring contains oestrogen and progestin which is absorbed by the body on contact. It prevents pregnancy by: ovulation prevention, maintaining a thin uterus lining, and maintaining viscous cervical mucus to stop sperm migration.

Similar to the skin patches, the vaginal ring is worn on a cycle of 3 weeks inside the vagina followed by 1 week without the ring, in this week the menstrual period occurs.

-          Side effects: Once again the side effects of the vaginal ring are similar to those of birth control pills (noted above).

-      Efficacy: Like the contraceptive pill and skin patch, the vaginal ring has an efficacy of 0.3% for perfect use and 9% for typical use.          

Contraceptive Implant 1.5

Where the contraceptive implant sits. Image from here.

-          What is it? A small rod shaped implanted which is inserted into the arm by a health care worker. They contain progestin which is slowly absorbed into the body preventing pregnancy by: ovulation prevention and maintaining viscous cervical mucus to stop sperm migration. Action lasts for up to 3 years.

-          Side effect: The major side effect associated with the contraceptive implant is irregular bleeding.

-          Efficacy: The implant is one of the most effective methods of birth control. It is effective within 24 hours of insertion.

Intrauterine devices (IUD) 1,6

-          What is it? IUDs are plastic devices that release either copper or progestin and offer long term contraception. They are placed by a healthcare provider through the vagina and cervix, into the uterus. The mechanism of action is not fully understood however, it is believed that copper-containing IUDs prevent fertilisation through sterile inflammatory reaction. While progestin-containing IUDs, like many of the other contraceptives discussed in this post, prevent pregnancy by ovulation prevention and maintaining viscous cervical mucus to stop sperm migration.

Placing of the IUD. Image from here.

-          Options: IUDs release either copper or progestin. Depending on the IUD selected their lifespan can vary from 3-10 years.

-          Side effect:

o    Copper: women may experience longer and heavier menstrual periods.

o    Progestin: some women stop having menstrual periods when using this method.

-          Efficacy: IUDs are very effective contraceptives with a pregnancy rate of <1% for both the copper-containing and progestin-containing IUDs.

References

1.     Zieman M. Patient information: Birth control; which method is right for me? (Beyond the Basics). Uptodate [Internet]. 2014 [cited 2014 April 12]. Available from: http://www.uptodate.com/contents/birth-control-which-method-is-right-for-me-beyond-the-basics?source=search_result&search=contraception+methods&selectedTitle=2~150

2.     Zieman M. Patient information: Emergency contraception (morning after pill) (Beyond the Basics), Uptodate [Internet].2014 [cited 2014 April 12]. Available from: http://www.uptodate.com/contents/emergency-contraception-morning-after-pill-beyond-the-basics?source=see_link

3.     Zieman M. Patient information: Hormonal methods of birth control (Beyond the Basics). Uptodate [Internet]. 2014 [cited 2014 April 12]. Available from: http://www.uptodate.com/contents/hormonal-methods-of-birth-control-beyond-the-basics?source=see_link

4.     Kerns J, Darney PD. Contraceptive vaginal ring. Uptodate [Internet]. 2014 [cited 2014 April 12]. Available from: http://www.uptodate.com/contents/contraceptive-vaginal-ring?source=search_result&search=vaginal+ring&selectedTitle=1~150

5.     Darney PD. Etonogestrel contraceptive implant. Uptodate [Internet]. 2014 [cited 2014 April 12]. Available from: http://www.uptodate.com/contents/etonogestrel-contraceptive-implant?source=search_result&search=contraceptive+implants&selectedTitle=1~37

6.     Dean G, Goldberg AB. Intrauterine contraception (IUD): overview. Uptodate [Internet]. 2014 [cited 2014 April 12]. Available from: http://www.uptodate.com/contents/intrauterine-contraception-iud-overview?source=see_link&anchor=H23833362#H23833362

Effectivity of Contraception

Image courtesy of: RH Reality Check