Sunday, April 30, 2006

Would You Be Comfortable Using NuvaRing, the Vaginal Ring?

Somewhat surprising news from a study looking at Nuva Ring user characteristics--you don't have to be all that comfortable with touching your genital area to be a satisfied NuvaRing user:

At least 30% of women starting a reversible contraceptive method discontinue use within 6 months, and many women have difficulty using pills consistently. New delivery systems, including the vaginal ring, may be easier to use than traditional oral contraceptives because they require no daily action from users. The vaginal contraceptive ring cycle consists of 3 weeks of continuous ring use followed by 1 ring-free week. In observed trials, the vaginal ring has an efficacy and an adverse-effect profile similar to those of oral contraceptives.

Women's experience with their bodies may affect acceptability, satisfaction and continuation of contraceptives in a complex way. This may be especially salient for use of the vaginal ring, which requires women to touch their genitals for insertion and removal. Thus, clinicians may not offer the vaginal ring as an option because they believe that their patients would be uncomfortable touching their genitals to insert and remove the ring.

Anticipated discomfort may impede willingness to use the vaginal ring. Data from the National Health and Social Life Survey (NHSLS), with a probability sample of 3432 Americans, indicate that 58% of women report never masturbating. The NHSLS also found that 14% of women reported experiencing pain during intercourse. Women who do not masturbate or who report painful intercourse may have more discomfort with genital touching and be less willing to use the ring. Recent use of vaginal contraceptives has been extremely low in the United States; in the 2002 National Survey of Family Growth, less than 1% of current contraceptive users reported using a diaphragm, cervical cap, female condom, sponge or any other vaginal contraceptive. This suggests that vaginal contraception may not be attractive to many American women. This may be due to vaginal contraceptives' lower efficacy and to some women's unwillingness to touch their genitals.

We carried out this study to identify factors associated with vaginal ring satisfaction and continuation. We hypothesized that women who reported greater comfort in touching their genitals, greater frequency of masturbation, more comfort with intercourse and past use of vaginal contraceptives and products would be more likely than others to be satisfied with the ring and continue using it for birth control.

And yet, when it comes to continued NuvaRing use, the study found that:

High user satisfaction and continuation of the vaginal ring for birth control were not associated with prior use of vaginal contraceptives or products, masturbation, discomfort with intercourse or other behaviors that involve genital touching such as waxing and shaving pubic hair or having tattoos and/or body piercings. Neither demographic characteristics nor vaginal experiences identified successful ring users.

Some limitations of the study:

In this study, we did not collect data regarding frequency of vaginal intercourse; therefore, we do not know if this factor is related to satisfaction with ring use. Our findings indicate that most women who are willing to try the vaginal ring as part of a clinical trial are likely to be highly satisfied with the method and to continue using it. Women willing to participate in a randomized clinical trial are not, however, representative of average ring users, so these findings may not be generalizable.

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At 1:09 AM, Blogger Lynn Gazis-Sax said...

1) 14% of women have painful intercourse? I didn't realize it was that common.

2) My biggest problems with the pill (which I only used for a few months many years ago) were breakthrough bleeding (I already have a long and heavy period, and having it not lessened at all while getting still more bleeding just wasn't acceptable) and the business about needing to take it every day. I found out that, first, I didn't keep a consistent enough schedule that I would take it at the same time every day, and, second, there were a couple of times when I forgot a day and had to do the doubling up the next day thing. Never more than one day, but the thought of having my contraceptive method fail and having it be *all my fault* because I didn't do it right wasn't OK; I'd rather have a condom fail and have it not be *my* fault. Especially since my plan in case of contraceptive failure was to go ahead and have the kid.

So, from where I sit, I can see a big advantage to any delivery method that gets rid of the need to remember the pill every day. Even better would be not having to remember the pill every day, and having a dosage/schedule that involved bleeding less every month, rather than more. That daily remembering seems way more inconvenient than having to get comfortable touching yourself.

At 12:11 PM, Anonymous Anonymous said...

In reference to the unattractiveness of vaginal contraception to American women:
This may be due to vaginal contraceptives' lower efficacy and to some women's unwillingness to touch their genitals.

Why all the focus on the latter rather than the former reason? Lower efficacy seems that it would be a much bigger deterrent.
I don't know the sales rates for applicator vs. non-applicator tampons, but I'd guess that there are a lot more women out there using non-applicator tampons (which require genital touching) than there are using vaginal contraceptives.

At 2:08 PM, Anonymous Anonymous said...

Many women I've talked to about the Ring cringe when I explain how it works. I immediately offer them options like the patch, which are external, and easy for even the most squeamish. To me, the ring seems far easier to use than a diaphragm or cervical cap, mainly because there is not a "right" way to insert the ring, and there is only one insertion per cycle.

At 10:59 PM, Blogger The Red Queen said...

I used to use the ring and I loved it. I never had anything close to the same side effects I had with the pill and I just programed my cell phone to remind me to take it out.

I used a diaphragm before that but it never fit quite right.I always felt like I had to pee when it was in.

The boyfriend did say he could feel the ring- but whatever. It didn't stop us. Boyfriend has now had a vasectomy, but if I ever had to go back to a birth control method it would be the ring.

At 6:54 PM, Anonymous Anonymous said...

This may be due to vaginal contraceptives' lower efficacy and to some women's unwillingness to touch their genitals.

As far as I know, the ring has a higher efficacy because it provides a continuous dose of hormones. The statistics I see at the doctor's office along with percentages reported in prescription information all seem to indicate that the ring is more effective because you will never miss/forget a dose.

On a sidenote, I love the ring. It is so easy to use.

At 5:22 AM, Blogger Betsy said...

I have wondered about this. I absolutely love the ring but I find that I am more hesitant to talk about it than I was when I was on the pill b/c the idea of inserting something into my vagina, while fine by me, is not something I feel comfortable advertising. I felt a little odd the first couple of times I picked my script up from my male pharmacist but I got over it. I think women should definitely be more open about this! If every woman had the option of using the ring we could avoid all unwanted pregnancies.

At 12:05 PM, Anonymous Anonymous said...

I find it odd that some women would be terribly uncomfortable touching their genitals. Don't most women wash their genitals with water in the shower once a day, and insert tampons on a monthly basis if they're having a period? What's the big deal, as long as it's not painful? I'm not trying to be judgmental, I just want to understand why inserting a floppy little ring is any different from washing or inserting a tampon.

I use the ring and I think it's the greatest thing ever. My excruciating pain during periods is gone even when I choose to have my period, and the amount of bleeding is way more manageable. It's easy to insert after the first time, I don't notice the ring when it's in and my boyfriend doesn't mind it at all. I also think the lower dosage per day is appealing.

At 5:36 AM, Anonymous Anonymous said...

I am a 19 year old first-time birth control user, and I absolutly love the Ring. Once it was in i never though about again, plus the little sticky reminders on my calendar help me to remember to take it out. Even if I took it out a week late, I just stuck another back in as soon as I remembered. Even though I have never had a heavy period, mine now where much much lighter. As for feeling it during intercourse, me nor my partner felt it at all. It was so easy to forget it was in there. I would recommend this product for teens simply because of the low side effects and the fact that you don't have to remember to take anything, which for a teen would be a plus.

At 2:19 PM, Anonymous Anonymous said...

Ive been on the ring for a month and a half and I am NOT satisfied... Ive never had a problem with intercourse before but now If I have sex too frequently it hurts extremely bad almost like my vagina is closing up... The cramping is also a lot worse...The pain doubles me over..Ive found tons of websites that report the same problems. I think I need to switch b/c. I have no problem with inserting it though many women do. I think it really depends of your comfortability level.

At 7:48 PM, Blogger ema said...

anon @2:19 PM,

1. Remove the ring during intercourse (DO NOT leave out for more than 3 hours or you'll not be protected).

2. If you can, chart your cramping/month to see if you can identify a pattern. Re the pain, that's unlikely to be a SE of the ring; better to call your Ob/Gyn.


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