Friday, October 24, 2003

"Partial-Birth Abortion", Still Propaganda

Slate has an article by William Saletan, The "Partial-Birth" Myth - No, it's not a birth. Here are a few passages:

"I'm no fan of second-trimester abortions. They're horrible, and if you can avoid having one, you should. They can be particularly disturbing when they're done by extracting the fetus intact, in a manner that looks like birth. But they aren't births."

"It's easy for journalists..." "... to gloss over this fact when we talk about the ban the Senate just passed. We know the procedure in question is an abortion that sort of looks like a birth, not a birth interrupted by an abortion. But it's far from clear that we've adequately conveyed this distinction to the public.

I watched the whole Senate debate yesterday. I lost count of how many times pro-life senators used language implying that the procedure they were banning was a birth interrupted by an abortion."

I think this is the most important point the article makes: the public simply, and regrettably, doesn't understand the issues involved. And the reason it doesn't is because the media, politicians, and healthcare professionals haven't done their duty. Yes, you read that correctly: their DUTY.

If you're a healthcare professional it's your duty to convey complete and correct medical information. Equally your duty: to make the patient understand what you're talking about. If you're a journalist, your duty is to report, accurately, the facts. If you're a politician, at least in theory, it's your duty not to lie to, or mislead the public.

After I read the article, I took a look at the discussion board associated with it. Oh, I shouldn't have done that! On one hand, the posts there clearly support the point that the majority of people don't know/understand the basic facts. On the other hand, I spent hours there, trying to shed some light. Here are a few examples. I hope they will serve to further clarify the "real" facts.

"Eighty percent of Americans demanded that their elected representatives outlaw the procedure loosely described as partial birth abortion."

When it comes to medicine and legislation, you don't want any "loosely described" terms. Here's one scenario. You and your pregnant wife/girlfriend/family member are in the ER, and she's having a spontaneous abortion (a miscarriage). She's bleeding, in pain, and scared. And so are you (scared, that is). Yet the ER physician is just sitting there, scratching his head. Why? Well, because this new legislation about "partial-birth abortion" was just enacted, and he's not really sure what to do, since the terms are loosely defined = open to interpretation, and he's afraid that if he misinterprets something, he'll end up in jail.

"The argument that, if only The People of the United States knew that a viable human being is killed "only" one in seven times the procedure is performed, that the overwhelming consensus against the outlawed procedure would evaporate, is as idotic a premise as has ever been uttered in human history."

The argument is not that "if only The People of the United States knew that a viable human being is killed "only" one in seven times the procedure is performed, that the overwhelming consensus against the outlawed procedure would evaporate". The argument is that THERE IS NO SUCH TERM OR MEDICAL PROCEDURE.

"You may call the procedure whatever you like, but saying that "partial birth abortions" do not exist is just silly. Call it whatever you want, but what happens is clear enough -"

What you, or I for that mater, call the/a procedure is irrelevant. What matters is what the medical procedure actually is.

"There is no medical necessity for vacuuming the brain and crushing the skull. The head could exit the birth canal quite easily without this being done - it has already travelled the length of it and has but inches left to go."

When a preterm fetus is passing through the birth canal (regardless of the reason--spontaneous labor or abortion, induced abortion, etc.) there is one crucial danger--that the fetus' head will get trapped in the birth canal (specifically, in the cervix, the end part of the uterus which protrudes inside the vagina). This happens because a preterm fetus has a very large head (when compared to the rest of the body) + because of the "preterm" situation, the cervix never fully dilates. (In normal, term labor, the cervix dilates fully=10 cm, to allow passage; in preterm cases it usually only dilates to 4-5 cm.) If the head gets stuck in the vagina, this is a life and death situation for the woman--the area is very vascularized (full of blood vessels), the tissue is fragile and can tear easily, and if this happens the woman can bleed to death. So, yes, indeed, there is a very important medical reason to insure that the fetal head passes through. As an aside, you should know that in surgery there is no such thing as performing a procedure without an indication.

"The problem is, if that head exits, we have to call the "fetus" a "baby," and you can't go vacuuming the brains and crushing the skulls of babies, can you?"

If the head has already exited the canal, there's no need to do anything to it and, if I may be flip for a moment, guess what, nothing is done to it! The medical procedure is done to FACILITATE EXTRACTION, NOT TO TERMINATE the pregnancy. Regardless of what you call the products of conception ("fetus", or "baby"), once a pre-viable fetus (remember, by definition, abortions only involve pre-viable fetuses) is delivered and is outside the uterus, that fetus will die. THE DELIVERY ITSELF TERMINATES THE PREGNANCY.

(via Advice Goddess)

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Wednesday, October 22, 2003

I Am a Technical Goddess (/delusion)

On the one day the Advice Goddess is kind enough to link to me (a big "Welcome!" to her readers), I manage to make a technical spectacle of myself: the entire left side of my blog vanishes! Well, in an effort to save face, I should like to point out that there were mysterious forces involved. (As a general rule, nothing is ever my fault, especially when it comes to technical things.) Also, I did manage to "find" (exactly how, remains a mystery to me) the archives, and I reconstituted the links. The one thing gone forever (or so I think) is my Site Meter counter. Well, fine; I might as well continue the delusional theme of this post's title, and imagine I have a lot of hits.


Template Change

I changed the template in the hope that I'll be able to retrieve my archives. If this doesn't work, I'll create a back-up site, and re-post the old articles there. Fingers crossed!


Where Did All My Links Go?

Hmm, I just noticed that all my links (used to be on the left) have vanished! Full of conviction, and without a bit of reservation I blame my computer. So there!


"Partial-Birth" Abortion Is Propaganda

Or, "How to Become a Physician Without Going to Medical School."

Want to make your mother proud, by allowing her to refer to you as "My son/daughter, the doctor"? Or, perhaps you wish to impress your friends, or you think you care about the well-being of your fellow human beings?

In other words, do you want to become a physician, but don't really want to go to Medical School, spend 3 to 7 years as a virtual slave doing a residency, and begin your professional life with an average of $100,000 in student loans? Well, then have I got the solution for you. Get thyself elected a U.S. Senator or House Representative, and get ready to make medical decisions.

Regardless of what your personal preference/opinion is vis-a-vis abortion, the recent passage of Bill S 3, the Prohibition on Partial-Birth Abortions, should really scare you. Why? Because this bill has nothing to do with abortion. It has to do with unlicensed, unqualified individuals making religious/moral decisions about the quality of medical care you should receive. I was almost certain this is illegal in this country, but clearly I was mistaken.

First, let's examine the medical facts. Bill S 3 (to see all 5 versions, go here) states the following (emphasis added):

'(a) Any physician who, in or affecting interstate or foreign commerce, knowingly performs a partial-birth abortion and thereby kills a human fetus shall be fined under this title or imprisoned not more than 2 years, or both. This subsection does not apply to a partial-birth abortion that is necessary to save the life of a mother whose life is endangered by a physical disorder, physical illness, or physical injury, including a life-endangering physical condition caused by or arising from the pregnancy itself. This subsection takes effect 1 day after the date of enactment of this chapter.

'(b) As used in this section--

'(1) the term 'partial-birth abortion' means an abortion in which--

'(A) the person performing the abortion deliberately and intentionally vaginally delivers a living fetus until, in the case of a head-first presentation, the entire fetal head is outside the body of the mother, or, in the case of breech presentation, any part of the fetal trunk past the navel is outside the body of the mother for the purpose of performing an overt act that the person knows will kill the partially delivered living fetus; and

'(B) performs the overt act, other than completion of delivery, that kills the partially delivered living fetus;

This bill is not about abortion because THERE IS NO MEDICAL TERM OR PROCEDURE CALLED "PARTIAL BIRTH ABORTION". Abortions are classified in 2 ways: based on the mechanism of initiation; and based on abortion technique.

1. Classification based on mechanism of initiation: An abortion is either Spontaneous, or Induced.

A Spontaneous abortion is an abortion which "occurs without medical or mechanical means to empty the uterus" (p 856). The lay term for Spontaneous abortion is Miscarriage.

An Induced abortion is "the medical or surgical termination of pregnancy before the time of fetal viability" (p 869). A subset of the Induced abortion is the Elective (Voluntary) one, which is "the interruption of pregnancy before viability at the request of the woman but not for reasons of impaired maternal health or fetal distress" (p 869).

2. Classification based on technique: Abortion can be performed either Medically or Surgically.

Medical regimens involve the woman taking a drug, or combination of drugs which will cause labor to start.

The Surgical techniques are:

MENSTRUAL ASPIRATION-- The contents of the uterine cavity are manually aspirated using a small tube (5- or 6-mm Karman cannula) attached to a syringe. This is used within 1-3 weeks after a missed menstrual period.

DILATATION AND CURETTAGE-- The cervix (the bottom part of the uterus which protrudes partway into the vagina) is first dilated, and then the pregnancy is evacuated by scraping (sharp curettage), or vacuum aspiration (suction curettage) of the uterine cavity. Because the likelihood of intra-op complications increases after the first trimester, the technique of curettage is best used before 14 weeks.

DILATATION AND EVACUATION-- The cervix is dilated, followed by mechanical extraction (using an instrument called a forceps, which is introduced inside the uterus and is used to grasp POC tissue) and evacuation of fetal parts. This technique is used after 16 weeks, up to 24 weeks.

DILATATION AND EXTRACTION-- Same as above, except part of the fetus is first extracted through the dilated cervix, in order to facilitate the evacuation.

*Please note that this technique involves partial delivery of fetal parts through the cervix in order to facilitate EVACUATION (as in physical removal), not TERMINATION.

HYSTEROTOMY-- The pregnancy is evacuated via an incision made in the uterus (entry is via the abdomen, like in a Cesarean section). (This technique is only used in an emergency or when the other techniques are contraindicated.)

HYSTERECTOMY-- The entire uterus is removed. (This technique is only used in an emergency or if there's a medical indication.)

If you are interested, here's a step-by-step description of the surgical techniques. And here's a link to Williams Obstetrics, if you want to verify the accuracy of the medical information I used (the pages quoted are from the 21st edition). This is an expensive book, $139, so you might want to borrow it from the Library.

So, the medical classification, of the medical procedure of abortion does not include such a thing as "partial-birth abortion". This is because, BY DEFINITION, AN ABORTION CAN ONLY OCCUR BEFORE THE FETUS IS VIABLE.

Viability is the ability of the fetus to live independently of the mother. This usually occurs at 24 weeks (if you happen to live near a Level III, NICU hospital).

Once the fetus reaches viability, an abortion, either spontaneous (miscarriage), or elective (induced) can not occur. Instead, a PRETERM (PREMATURE) DELIVERY (birth) happens. (A pregnancy is considered full term after 37 weeks.)

Bill S 3 defines partial-birth abortion as follows:

'(1) the term 'partial-birth abortion' means an abortion in which--

'(A) the person performing the abortion deliberately and intentionally vaginally delivers a living fetus until, in the case of a head-first presentation, the entire fetal head is outside the body of the mother, or, in the case of breech presentation, any part of the fetal trunk past the navel is outside the body of the mother for the purpose of performing an overt act that the person knows will kill the partially delivered living fetus; and

`(B) performs the overt act, other than completion of delivery, that kills the partially delivered living fetus;

Medically, this definition is nonsensical:

-- performing the abortion...delivers a living fetus

By definition, an abortion can only occur before fetal viability. If you are performing an abortion you can not have a "living" fetus. During an abortion, there is no "living" fetus: the fetus does not have functional lungs. Of course, the fetus has the POTENTIALITY for viability. However, the potentiality for being alive at some point in the future, and actually being alive and living are not one and the same. Two points. First, just because a fetus has the potential for viability, nothing, and I mean NOTHING known to man, can actually insure, or even predict with certainty that said fetus will be delivered as a living neonate (newborn). Second, the language of the bill makes no mention of "potential" viability. It states as a given that the person "delivers a living fetus", a medically impossible fact. (A pre-viable fetus can not be a living fetus.)

-- for the purpose of performing an overt act that the person knows will kill the partially delivered living fetus and performs the overt act, other than completion of delivery, that kills the partially delivered living fetus

Since an abortion occurs before fetal viability, THE DELIVERY OF A PRE-VIABLE FETUS WILL TERMINATE THE PREGNANCY. In other words, a pre-viable fetus, by definition, can not exist/survive independent of the mother (i.e., outside the uterus). Once a delivery has been initiated, the delivery will terminate the pregnancy. Medically, the delivery is the "overt" act in this case.

Second, let's look at the non-medical aspects of this bill.

Any physician who, in or affecting interstate or foreign commerce, knowingly performs a partial-birth abortion and thereby kills a human fetus

I am not a legal expert, but what does interstate or foreign commerce have to do with performing medical procedures? The only possible explanation I could think of is a patient who crosses state lines to have a procedure performed. But, if she doesn't have any money, how is that "commerce"? Moving on, legally, how can you kill something which is not alive?

' (c)(1) The father, if married to the mother at the time she receives a partial-birth abortion procedure, and if the mother has not attained the age of 18 years at the time of the abortion, the maternal grandparents of the fetus, may in a civil action obtain appropriate relief, unless the pregnancy resulted from the plaintiff's criminal conduct or the plaintiff consented to the abortion.

Again, this is a legal issue, but it appears that Bill 3 gives a woman's husband and/or her parents a legal claim to her body. I shall abstain from making any sarcastic comments here, out of respect for the American men and women who are fighting and dying in foreign lands. While they are working towards bringing about freedom and rights to the women of Afghanistan and Iraq, our own legislators see fit to go the opposite direction, and treat women as property.

"This is very important legislation that will end an abhorrent practice and continue to build a culture of life in America," he said in a statement. "I look forward to signing it into law."

The above is President Bush's statement. Specifically, what is the "abhorrent" practice? (The legislation doesn't contain any reference to a known medical practice.) In general, when and why is it appropriate to characterize an/any established, approved medical procedure as "abhorrent", and what are the criteria used? Why is legislation used to "build a culture of life in America" and, more importantly, what is the meaning of a "culture of life" in this context?

Senate Majority Leader Bill Frist, R-Tenn., a heart surgeon, said the ban could save the lives of thousands of soon-to-be-born babies.

And daily reality in American hospitals says the ban could doom the lives of thousands of actual, live women.

And last, but not least:

"Today we have reached a significant victory as we continue to build a more compassionate society and a culture that values every human life," said Sen. Rick Santorum, R-Pa., the bill's sponsor.

Except, of course, the human life of over 60 million U.S. women considered by Sen. Santorum incapable of making a responsible decision, too "weak-minded" to be trusted with important issues. And, also except the life work of hundreds of thousands of dedicated healthcare professionals, viewed by Sen. Santorum as incompetent buffoons.

Some time ago, Andrew Sullivan criticized Sen. Santorum's comments on homosexuals as "an expression of a bleak future, in which tolerance and privacy are subject to the approval of "moral" majorities". Yesterday, Steven Den Beste had a post supporting the rights of men accused of rape, and Armed Liberal had a post in support of women taking responsibility for their own actions. I hope they take the time, and use their considerable talent to strongly condemn the passage of Bill 3, a piece of legislation based, not on science, but on the approval of "moral" politicians, on the premise that medical professionals have less rights than accused rapists (the accused rapist is innocent until proven guilty; the medical professional is guilty for practicing medicine), and on the assumption that women are infantile, second-class citizens.

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Friday, October 17, 2003

Seasonale Proves the Earth is Flat--Part IV

In the last 4 paragraphs of the Seasonale: A Eugenicist's Dream article any pretense of logic is abandoned. No attempt is made to show us the alleged link between Seasonale and eugenics. Instead, we are "treated" to, and I'm searching for an accurate description here, utter nonsense.

One of the main goals of the Population Council, an international nonprofit "research" institution, is to "help achieve a humane, equitable, and sustainable balance between people and resources," i.e., to "stop those Third World people from procreating!"

The Population Council's stated mission is:

. . . to improve the well-being and reproductive health of current and future generations and to help achieve a humane, equitable, and sustainable balance between people and resources.

What does the Population Council do? It:

-- Develops contraceptives and other products to improve reproductive health;

-- Improves the quality and outreach of family planning and reproductive health services;

-- Conducts research on reproductive health and behavior, family structure and function, gender issues, and the causes and consequences of population growth;

-- Strengthens professional resources in developing countries through collaborative research, awards, fellowships, and training;

-- Provides a forum for publication of innovative research in peer-reviewed journals, books, working papers, and regional monographs.

Contrary to what the article says, the Population Council doesn't "stop those Third World people from procreating!" Oh, and isn't it telling that an article which purports to be concerned with the well-being of people everywhere would use the term "those Third World people"? Just because some people in this world, due to an accident of birth, are poor and live in the Third World doesn't give anyone the right to be condescending towards them, and even racist. "Those" people are not inferior to us! We just got geographically lucky and, if there is anything we can do to help out, we do it, simply because they are our equals, in need of help.

It all boils down to the old fallacy that the planet will implode if we don't slash how many people live on it, which has long since been proven untrue. But they continue to dupe the public into believing that we must use abortion and birth control to save ourselves.

I know, this is almost too easy to bother with! How exactly does the activity of the Population Council boil "down to the old fallacy that the planet will implode if we don't slash how many people live on it"? Based on all the available evidence, the Population Council is concerned with reproductive health and research on the causes and consequences of population growth. Why is a concern about overpopulation a fallacy? Has it been proven untrue? When? By whom? How does the Population Council "dupe the public"? What evidence is there that this is a continuing practice on their part? Most importantly, why is the assumption made that the public consists of a bunch of boobs (as in dolt, not bosom) which are easily duped? And how exactly does projecting the article's core belief "that we must use abortion and birth control to save ourselves" on to the Population Council make sense?

In keeping with this mission, the Population Council is a leader in the development of new contraceptives. The notion that long-term contraceptive regimens should be used to stifle menstruation was originally the brainchild of Population Council researchers; in particular, former council vice president and endocrinologist Sheldon J. Segal, who co-authored the book, Is Menstruation Obsolete? with Elismar Coutinho, a Brazilian gynecologist. Segal is also a member of a council division known as the International Committee for Contraceptive Research.

Long-term contraceptive (birth control) regimens, which have existed for decades, have never been used to "stifle menstruation". They have been used to treat a wide range of medical problems (painful periods, seizures, migraine headaches, bleeding disorders, ovarian cysts, endometriosis, etc.). Using them is considered the standard of care, and it's approved by the FDA. Drs. Segal and Cautinho's brains do not put forth the "notion that long-term contraceptive regimens should be used to stifle menstruation" in their book (Is Menstruation Obsolete?). I know this because I've read the book. But you don't have to take my word for it. This is part of's editorial review:

Is Menstruation Obsolete? argues that regular monthly bleeding is not the "natural" state of women, and that it actually places them at risk of several medical conditions of varying severity. The authors maintain that while menstruation may be culturally significant, it is not medically meaningful. Moreover, they propose that suppressing menstruation has remarkable health advantages.

The article continues:

Almost all of the latest propaganda used to promote Seasonale comes directly from Segal and Coutinho's book. The Population Council further pushes the concept through a plethora of recent pro-Seasonale articles from other council members, such as "reproductive health" researcher Charlotte Ellertson and Sarah L. Thompson, both quoted earlier in this article.

Contrary to the article's allegation that propaganda is used to promote Seasonale, the FDA's rules concerning approval and promotion of new drugs specifically require scientific evidence, rather than information that is spread for the purpose of promoting some cause, aka propaganda. Again, there's no need to take my word for this. If you want to see the medical evidence used for the promotion of Seasonale, contact Barr Laboratories, the maker of Seasonale, and request a copy of the Seasonale randomized, open-label, multi-center trial.

Also, if you're interested, take a look at Dr. Sulak's excellent review article: Should your patients be on extended-use OCs?

Oh, and one more thing. Dr. Charlotte Ellertson is a reproductive health researcher because she earned a M.P.A. and Ph.D. from Princeton University, and because she has, and is conducting research intended to promote reproductive health for women around the world. Again, using scare quotes around words does not magically cause reality to disappear.

Quotes from these "authorities" have helped clinch public support of Seasonale and everything it stands for. Barr and friends hope to see FDA approval of Seasonale within the year; their expectation is not far-fetched. It seems that the population control agenda is more important than the fact that long-term effects of a constant influx of synthetic hormones has barely been studied, much less proven to be safe and natural.

I am a patient person, so I'll say it again: just using scare quotes ("authorities") doesn't prove anything. (Well, OK, it does indicate one is ignorant and/or lazy, but it still doesn't refute facts.) What is the evidence that the FDA approved Seasonale because "the population control agenda is more important"? A PubMed search returns 1,956 studies on the long-term effects (and safety) of a constant influx of synthetic hormones. As to the "natural=as seen in nature" issue: it is natural for women not to have a monthly period, and the "long-term effects of a constant influx of synthetic hormones" causes women not to have a monthly period.

Finally, the article concludes:

If we really want to get to the root of what is "normal", i.e. what nature intended, it's not going to be what the feminists and population control elitists want to hear: Nature designed most women to be wives and mothers in the traditional sense; fulltime moms--not fulltime executives--who often have more than the politically correct 2.2 children. Sorry, that's just the way it is. And popping a hormonally loaded pill will never take the place of what nature truly intended.

Ah, let us, indeed, get to the root of "what nature intended"! (Please pardon my use of boldface, but this can't be emphasized strongly enough.) To determine "what nature intended" you have to look at what happens in the "wild", over an evolutionary significant (tens of thousands of years) period of time.

You have to look at what happens in the "wild" because humans are social creatures. This means the frequency of our menstrual period is influenced by both nature and nurture. The only way to separate nurture's (society's) influence is to look at our study subjects in the wild. Also, you have to look at what happens over a long period of time because humans aren't fruit flies (Drosophila melanogaster). For humans, we need to look at roughly 1000-10,000 generations (that's about 20,000-200,000 years). I'll go into more details in a future post, but for now the bottom line is this:

-- There is an established scientific method which is used to determine "what nature intended".

-- "What nature intended" is completely independent of what the article's authors want to hear (or, for that matter, of "what the feminists and population control elitists want to hear").

-- Nature designed most women (and men) to insure survival of the species. It didn't design women to be "wives", "fulltime" moms, or "executives" since such things aren't natural (all are social constructs).

-- The replacement fertility level (the level needed to ensure the long-term replacement of a country's population) of 2.1 children per woman is a well-established, scientific fact, completely unrelated to political correctness. "Sorry, that's just the way it is", indeed.

The idea of being able to "induce" a natural state is silly, at best.

Why is the idea of being able to "induce" a natural state silly? The very concept of medicine is based on this idea-- once a natural state is disrupted (you fall and break your arm, your cholesterol level is sky-high, etc.), you/your physician induce a natural state (by applying a cast on the arm, taking drugs to lower the cholesterol, etc.).

The notion that is being promoted--that women must engage in the artificial practice of oral contraception in order to return to the "natural" physiology of infrequent menstruation--should be recognized as the quack medicine that it is.

Besides the unsubstantiated allegation that a " being promoted", this section also reveals a complete ignorance of the subject being discussed. Artificial fertility control (i.e., taking oral contraceptives to prevent a pregnancy) has nothing to do with using Seasonale for menstrual management. (I will elaborate in a future post.) You can not, credibly, judge something to be "quack medicine" if you lack even a basic understanding of it.

Unfortunately, many women are falling for it.

Actually, despite the article's implied conclusion that women are feeble-minded idiots, all the scientific evidence (to say nothing of common sense!) points to the fact that women, given the correct and complete information, are quite capable of judging the quality of the available health information, and making sound decisions on their own.

Hmm, what a scary and alienating concept this must be for people who write articles entitled "Seasonale: A Eugenicist's Dream"!

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Friday, October 10, 2003

Too Much Sex (As If...)

Instapundit points us to this article: Is Sex Necessary? Here are a few highlights:

--Having regular and enthusiastic sex...confers a host of measurable physiological advantages, be you male or female. having sex three or more times a week, men reduced their risk of heart attack or stroke by half.

--...the equivalent of six Big Macs can be worked off by having sex three times a week for a year.

--Oral sex (fellatio) ...could be a far richer, more complex and more satisfying experience than squeezing a tube of Crest--even Tartar Control Crest.

-- there such a thing as too much sex? If you're female, probably not. If you're male? You betcha.

Interesting article, overall. However, it contains a couple of mistakes.


Prostoglandin, a hormone found only in semen, may be absorbed in the female genital tract, thus modulating female hormones.

Prostaglandins (PGs) are one of the most widespread substances in the body. They are produced, in abundance, by both women and men. So, the line "Let's have sex so that you, too, may enjoy the benefits of PGs!" while novel, is medically inaccurate. Also, make sure you consider both the benefits (better sensation) and the risks (pregnancy, increased risk of acquiring an STD) before deciding to have intercourse without a condom.


Dr. George Winch Jr., an obstetrician/gynecologist in Elko, Nev., concurs. If a woman is pre-menopausal and otherwise healthy, says Dr. Winch, her having an extraordinary amount of intercourse ought not to pose a problem. "I don't think women can have too much intercourse," he says, "so long as no sexually transmitted disease is introduced and there's not an inadvertent pregnancy. Sometimes you can have a lubrication problem. If you have that, there can be vaginal excoriation--vaginal scrape."

Far be it for me to discourage any woman from having an extraordinary amount of intercourse . However, please realize that, even if you don't have lubrication problems, a lot of sex can cause vaginal scrapes, tears, and even active bleeding.

What does "a lot of sex" mean? It depends on the woman, but, for example, having sex every day, 2-n times a day (like when you're on your honeymoon, or a romantic vacation) would qualify. The problem is twofold: a) the tissue lining the vagina is fairly delicate, and b) the vaginal tissue is very vascular (it has a rich blood supply).

Every time you have sex, very small vaginal tears are routine (due to the mechanical action of the penis). They are not a problem because the body is equipped to deal with them--they heal spontaneously. However, you have to give your tissue time to heal (a few hours, to 24 hours would be best). If you don't, not only can you increase the number of tears in the vaginal tissue, but you run the risk of aggravating an existing tear and causing it to bleed.

So, in order to have a pleasant experience and avoid trauma to the tissue, use your judgment:

--if intercourse starts to become uncomfortable due to vaginal pain, take a break (for a few hours, at the very least)

--wear loose-fitting clothing (no: G-strings, jeans, stockings; yes: men's boxer shorts, skirts)

--avoid sitting or walking for a long time (best position: lie in bed, legs up, resting on something)

--if you notice labial swelling (labia=vaginal lips), cold water or a cold pack will help
N.B. Make sure not to apply the cold pack directly to the tissue; wear underwear or wrap the pack in a towel.

--if you notice any active bleeding (bright red blood), don't panic. Use a pad and a pair of TIGHT underwear (this applies pressure) and go to the ER.
N.B. Don't be embarrassed (ER people are there to help you, not judge you), and don't procrastinate. In the ER, ask to see the Ob/Gyn resident/attending--they tend to be more skilled in these matters. And, don't worry--the repair is routine, fairly easy to do, and it isn't painful (despite the delicate location, local pain killers work very well).

Enjoy, and be safe!

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What is the "ideal" method of birth control ? First of all, it's a method that always protects you against pregnancy and Sexually Transmitted Diseases (STDs). It is also a method which can be used by anyone, at any time during their childbearing years. And last, but not least, it's a method without any side effects. Unfortunately, this "ideal" method doesn't exist.

All the 82 methods of birth control currently available can cause side effects, some more serious than others. Also, for each method, there is a particular group of women best suited to use that method. In order to significantly reduce your risk of side effects, and to get the maximum benefit from birth control, you must use a method that uniquely fits you, and your lifestyle. So, how can you choose the best birth control method for you?

You can consult with your physician, which always helps, but is not enough--the average length of an office visit is 17 minutes. You can find out what your friends are using, but what works for a friend might not be best for you. Or, you can research all the methods yourself, but this is not very practical--few of us have time to spend days doing research, or to go to the library to look through medical journals.

A helpful, time-saving way to evaluate if a birth control method is best suited for you is to apply the Test of Ten. Here are the 10 things you need to know about a method, before you use it:

1. What class of birth control does it belong to?
This helps narrow down the field. For example, if you had a bad experience in the past using the birth control pill (the "Pill"), you may not want to use another method from the same class.
Remember: Class

2. How does it work?
This helps you understand the mechanism by which a method prevents a pregnancy. For example, you may feel more comfortable using a method that is approved by the Church and which has a mechanism the Church sanctions.
Remember: Underlying mechanism

3. What is its failure rate?
This tells you how good the method is at preventing a pregnancy. For example, if you have a medical condition that makes it dangerous for you to become pregnant before treatment is over, you want to choose a method that has the lowest failure rate.
Remember: Pregnancy protection

4. Who should use it?
This helps you determine if you fit the "ideal" user profile for the method. For example, if you travel frequently across time zones, or work different shifts, you are not the ideal candidate for using birth control Pills which need to be taken at the same time each day.
Remember: Ideal user

5. Who shouldn't use it?
This helps focus your search. For example, if you are a smoker, over the age of 35, you want to make sure the method you use is not dangerous for smokers.
Remember: Dangers

6. What are the advantages of using this method?
This helps you choose a method which gives you the most benefits. For example, if you have a strong family history of cancer, you should choose a method that protects you from cancer.
Remember: Method advantages

7. What are the disadvantages and side effect of this method?
This alerts you to possible problems. For example, if you know in advance that a method causes spotting, you may not want to use it. Or, if you do decide to use it, you are better prepared to deal with the spotting.
Remember: Any side effects?

8. Does it offer any protection against Sexually Transmitted Diseases (STDs)? This helps you protect yourself. For example, if you, or your partner, have a high risk of acquiring STDs, you want to choose a method that gives you the best possible STD protection.
Remember: The STD risk

9. How soon does fertility return?
This helps you plan for the future. For example, if, once you stop using a method, it takes several months for your fertility to return, and if you plan to become pregnant in the near future, you should not use this method.
Remember: Can it delay fertility?

10. Where can I find more information about this method?
This insures that you always have a handy resource. For example, if you use a method for the first time, you may have additional questions about it, or you may want to learn more about it.
Remember: Handy resource

Tip: the way to remember the Test of Ten is CUPID MATCH