Discovering Human Sexuality 4e Chapter 9 Summary

Although various forms of contraception have been known since ancient times, moral repugnance, restrictive laws, and lack of knowledge prevented effective contraception in the United States until the 20th century. Margaret Sanger led the struggle to legalize contraception, to educate the public about contraceptive methods, and to introduce improved methods. Contraception was not fully legalized in the United States until 1972. Even today, about 3 million unintended pregnancies occur in the United States every year, on account of nonuse or failure of contraceptive methods.
All currently available contraceptive methods have advantages and disadvantages. Different people have different contraceptive needs in terms of reversibility, reliability, cost, and so on, so no one method is best for all users.
Male condoms (sheaths that cover the penis) require careful use to prevent failure and are somewhat intrusive, but they are cheap and readily accessible and offer significant protection against STIs. They are the only contraception method controlled by the male that is reversible (aside from withdrawal). Female condoms offer similar benefits but are far less popular than male condoms.
Diaphragms and cervical caps are other barrier methods of contraception. They are used in conjunction with spermicides to prevent the entry of sperm into the cervix. They are less intrusive than condoms, but they provide less pregnancy and disease protection and are fairly inconvenient to use. Spermicides used by themselves are not very reliable, and overuse of spermicides can cause vaginal irritation and raise the risk of STI transmission.
Contraceptive pills contain either a combination of estrogen and progestin or progestin only. They work by blocking ovulation and by rendering the uterus hostile to sperm transport. They are fairly convenient once prescribed, nonintrusive, and very reliable if taken regularly. They offer no STI protection. Estrogen-containing pills may have a number of side effects as well as some long-term health risks and benefits. Progestin-only pills often cause irregular bleeding.
Some contraceptive pills may be taken in an extended fashion that reduces the frequency of menstrual periods or eliminates them entirely.
Hormone-based contraceptives may also be administered by non-oral routes, including injections (Depo-Provera), by contraceptive patches (Xulane), by vaginal rings (NuvaRing), or by implants placed under the skin (Nexplanon). These nonpill methods have the advantage of greater reliability than pills in typical use.
Intrauterine devices (IUDs) render the uterus hostile to sperm transport. They are very reliable and convenient once inserted. They offer no STI protection, but this can be provided by adding condoms.
In fertility awareness methods, couples avoid sex near the time of ovulation, which they can determine by a variety of tech-niques, including simple calendar calculations, body temperature measurements, or examination of cervical mucus.
In the withdrawal method, the man withdraws his penis prior to ejaculation. Globally, this method has made a major contribution to population control, but many couples find it difficult to practice, especially if the man tends to ejaculate early or without warning.
Noncoital sex (outercourse) is a reliable form of contraception if adhered to strictly.
Emergency contraception involves taking a high dose of oral contraceptives within a few days after unprotected sex or failure of a barrier contraceptive. These drugs prevent ovulation. Another postcoital contraceptive technique is the insertion of an IUD.
Sterilization is the cutting and/or tying off of the vasa deferentia (in men) or the oviducts (in women). Either procedure prevents sperm and ovum from meeting and is almost completely reliable in preventing pregnancy. The majority of sterilizations are done in women, but the procedure is simpler, safer, and less expensive in men. Although intended to be permanent, sterilization can be reversed in some cases. Sterilization is generally chosen by couples who have all the children they desire.
Globally, poverty, religious proscriptions, and other factors severely limit access to contraception.
In the United States, about 1 million abortions are performed every year. Most abortions are done in the first trimester of pregnancy by the vacuum aspiration method, in which the cervix is dilated and the contents of the uterus suctioned out under local anesthesia. A slightly more complex procedure, dilation and evacuation (D&E), is used early in the second trimester.
Early abortions may also be induced with drugs. Medical abortion is a two-step procedure involving the administration of a drug that terminates the pregnancy (mifepristone), followed about 2 days later by a second drug (misoprostol) that induces contractions and the expulsion of the fetal remains.
Women who choose abortion do not experience negative psychological consequences.
The moral and legal status of abortion is contentious. The extreme anti-abortion (pro-life) position is that abortion is always wrong and should be illegal, except perhaps when done to save the mother’s life. The extreme opposing (pro-choice) view is that a woman should have the right to choose abortion under any circumstances. Most Americans describe themselves as pro-life or pro-choice but actually hold to an intermediate position, believing that abortion should be permitted under certain limited conditions, such as early in pregnancy or when the fetus has a congenital defect.
The U.S. Supreme Court’s 1973 decision in Roe v. Wade established a woman’s constitutional right to have an abortion for any reason before the age of fetal viability. In recent years, however, pro-life activists have used a variety of strategies to restrict the availability of abortion.