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  • Title: [Contraception and sexology].
    Author: Black JS.
    Journal: Cah Sexol Clin; 1991; 17(102):45-53. PubMed ID: 12344892.
    Abstract:
    This work argues that contraceptive education urgently requires a new approach that will take into account the client's sexuality at the time the choice of method is made. Emotional factors such as a conscious or unconscious desire for pregnancy or motherhood, family pressures to produce a grandchild, or shame and distrust of contraception may contribute to contraceptive failure. Methods applied at the time of coitus such as condoms or spermicides may not be appropriate for clients for who contraception is a source of anxiety or guilt. The more effective, noncoital-dependent methods including oral contraceptives (OCs), IUDs, and sterilization may generate anxiety over infertility. Their efficacy may lack appeal for clients who enjoy an element of risk. The practitioner's attitude and knowledge may be further influences on the counseling over method choice. Among reversible methods, OCs are ideal for most women as long as they individually prescribed. OCs may be particularly important to the sexual expression of specific groups such as those over 35 with no risk factors other than age. Low-dose progestin-only OCs may be prescribed for this group, although about 10% of users change methods because of menstrual problems. IUDs are usually successfully used by women who have been carefully selected to exclude contraindications. In some cases the partner may be annoyed by the string, which can be rolled up and pushed out of the way or shortened by the practitioner. IUDs are often the best alternative for women with contraindications to OCs or who tolerate their side effects poorly. Spermicides may cause dermatoses or allergies that cause the woman to avoid intercourse. Some women dislike using spermicides because they must be applied prior to each use. Their bad taste is a disadvantage for some couples. Involving the male partner in application of the spermicide may remove some objections. The Billings or cervical mucus method should be avoided by women with irregular cycles and those who are reluctant to touch their genitalia. Diaphragms and cervical caps can be inserted by the male partner is desired. Menstrual extraction, insertion of an IUD within 72 hours of unprotected intercourse, or use of sufficiently high dose of oral hormones prevent pregnancy in most cases, but should not be relied upon for routine contraception. Much misinformation persists about the side effects of female sterilization, which is said to cause weight gain or sexual problems or to be followed inevitably by total hysterectomy. Most women are satisfied with the operation and express no regrets. Although reversal rates are improving, sterilization should be considered definitive. Condom use remains limited despite some increases related to fear of HIV infection. Condoms may increase performance anxiety in some men. Couples should be taught to use condoms in a more sensual manner. Withdrawal is still widely used throughout the world despite lack of esthetics appeal and high failure rate.
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