It’s June, which means Masturbation May is over (without me mentioning it even once) and we’re all bracing for the final version of the decision that will likely overturn Roe v. Wade. Advocates are likely lying awake at night asking questions that they might not want answered. Will Alito’s draft –which relies on Victorian-era medical terms like quickening, refers to abortionists and murderesses, and puts all rights that are not specifically enumerated in the constitution at risk—become official without any significant edits? How quickly and on how many fronts will we have to fight for other unenumerated rights like emergency contraception (as an Idaho legislator would like), birth control, or same-sex marriage? Will we ever be able to wipe the smug, frat-boy look off of Brett Kavanaugh’s face?
While we await answers, people across the country doubling down on pregnancy prevention. Nurx, an online provider of birth control, saw a 300% jump in the number of requests for emergency contraception pills “to have on hand” the day after Alito’s draft was leaked. The Washington Post also reported that Google searches for IUDs, Plan B, and just simply “contraception” all rose in that week as well. While it may be too soon to tell if the people checking Dr. Google followed through with their actual health care providers, we do know that data from the month after Donald Trump was elected—when people who were paying attention rightfully started fearing for their reproductive rights—show a 21% rise in insurance claims for IUDs insertion.
It looks like men—presumably cisgender men having sex with women or thinking about it—are getting in on preemptive pregnancy prevention as well. According to Innerbody Research, there was a 99% increase in Google searches related to vasectomies in the week following Alito’s manifesto. Searches for “how much is a vasectomy” and “is a vasectomy reversible” went up by 250%.
Vasectomies are the surgical sterilization option for people with penises. They involve snipping or sealing the vas deferens which is the tube that carries sperm from each teste. Men continue to ejaculate because there’s more to semen than just sperm, but there are no swimmers in the mix meaning they can’t get anyone pregnant.
The reversibility question suggests that men are wondering whether they could get snipped now while they don’t want children and reattach the plumbing later in life. Technically the answer is yes, but this is not a good strategy even in a place without abortion access. While a vasectomy is an easy procedure that takes just a few minutes, reversal requires far more invasive microsurgery. Pregnancy rates after a reversal range from 90% to just 30%.
For people with penises who really really really don’t want to knock someone up, a better strategy would be banking some sperm now, getting the vasectomy, and investing in a turkey baster somewhere down the road though this also sounds more extreme than necessary. There are very good birth control methods out there though most are controlled by the partner with the uterus. Talk to your partner about finding a Long-Acting Reversible Contraceptive (LARC) method that will work for them—like an IUD or implant. If you’re still worried, consider adding condoms for extra protection (they’re 98% effective in preventing pregnancy on their own when used correctly).
New Device Could Make IUD Insertion Less Painful
Speaking of LARC methods, research on a new device called the Carevix suggests that it helps prevent the pain of IUD insertion which might make this option, which is more than 99% effective in preventing pregnancy, even more appealing.
IUDs are small T-shape pieces of plastic that are inserted in the uterus and stay in place for up to 10 years. They prevent pregnancy by preventing sperm from moving through the uterus to the fallopian tubes where fertilization would take place. Paragard, also called the Copper-T, contains copper which can be toxic to sperm (further preventing them from swimming toward the golden egg). All of the other IUDs on the market today include hormones which means that in addition to slowing sperm down, they can also prevent ovulation and thicken cervical mucus to keep sperm out in the first place.
After the Dalkon Shield disaster in the 1970s (one model of IUD didn’t work AND caused infertility and death in some women), IUDs were unpopular in this country and only offered to women who had already given birth. Today’s IUDs are safe for women of all ages and child-bearing status. In fact, many of them are marketed toward young women who appreciate the “set-it-and-forget-it” nature of the device—get an IUD put in, do nothing, and you’re protected from pregnancy for up to a decade or until you choose to take it out.
One thing those marketing materials don’t mention, however, is how much getting an IUD put in can hurt.
The current standard of care uses a device called a tenaculum—essentially surgical forceps—to stabilize the uterus so that a health care provider can first measure the length and direction of the cervical canal and uterus and then insert the IUD in the proper location. The Carevix is a soft-side suction device designed to replace the forceps. If a picture says 1,000 words, it certainly looks less painful.
Of course, there is some debate about how much IUD insertion hurts. Ask most providers and they’ll tell you to expect some light cramping. Read any consumer-facing health article about IUDs and you’ll be told the pain is usual mild and brief (I know, I’ve written some of them). Ask a good friend, however, and you will likely hear something more like, “OMG that shit was bad. It was like being in labor without an epidural.” (Well, at least that’s what you’d hear if that good friend was me. My IUD and I did not get along from the outset, but that’s a story for another day.)
One study that was testing the practice of using lidocaine during the procedure asked patients to rate their pain on a scale of 1 to 100 and asked providers to estimate the pain level of their patients. While providers expected an average pain level of 35, the average pain level among patients was actually 65. Interestingly, it turned out that lidocaine did not help—scores were pretty much the same in the group that got this topical anesthetic and the group that got the placebo.
Aspivix, the makers of Carevix, think this new device is the answer. The company’s new study randomly assigned 100 women seeking IUDs to standard insertion procedures or the new suction-based procedure. Women who used Carevix reported significantly lower pain scores at all points of the insertion procedure—pain scores were 52% lower during cervix grasping, 53% lower during cervix stabilization (traction), 30% lower during IUD insertion, and 33% lower during cervix release compared to the tenaculum procedure.
This new device may benefit women who have never given birth (referred to as nulliparous) the most. Twice as many nulliparous women in the Carevix group said they were free of pain compared to those in the tenaculum group, and they reported an 88% lower rate of severe pain.
Carevix is still in investigative phases and won’t be on the market until more research is done. In the meantime, people interested in an IUD can ask their providers if there is anything that will reduce the pain of the procedure. Some will likely recommend anti-inflammatory drugs like Advil before the procedure. Others swear by the coughing method—in which a patient coughs while the tenaculum is placed—but research has found the pain level is no different with this method than others. That study did find that pre-procedure anxiety was linked to increased pain levels during the procedure, so talk to your provider ahead of time to help calm your nerves and set accurate expectations. (If she dismisses your concerns outright and says this doesn’t hurt, like mine did, find a nicer provider.)
Leave the Doctor with a Lollipop and a Prescription for a Vibrator
A new paper in the Journal of Urology argues that the medical benefits of vibrators are so strong that doctors should be prescribing them to patients with vulvas. The authors conducted a meta-analysis of research into vibrators and found that benefits of regular use include reduced vulvar pain, improved pelvic floor strength (which can treat incontinence), and better overall sexual health.
A widely known story about how vibrators were invented suggests that a Victorian-era doctor who had been massaging his female patients’ vulvas to induce “hysterical paroxysm” as a cure for “hysteria” invented the machine to save his cramping hands. At the time, hysteria was a condition diagnosed in women who were just too damn emotional. The key to the story is that the woman didn’t know she was being jerked off to orgasm and the doctor pretended it wasn’t sexual.
The story has been retold in movies, plays, and television shows and appears all over the internet. Unfortunately, it’s apocryphal. As Hallie Lieberman, a sex historian and journalist, explained in the New York Times a few years ago, the vibrator was invented by a doctor but not for use on the vulva. In fact, it was meant to be used anywhere but the genitals. He felt it would treat pain, spinal disease, and deafness. When it hit the market, it was said to have a myriad of uses including getting rid of wrinkles. Eventually customers figured out another use.
The real history of the vibrator is essentially a Brookstone catalogue—we’ll sell it as a personal muscle massager, you’ll buy it for your clit. Win-win. Lieberman points out that while this story isn’t as cute, it reflects better on women who, instead of being clueless about their own sexuality, are the ones who figured out how to use this new tool for pleasure.
Now, perhaps, truth and fiction are meeting in the middle with doctors championing this tool for women. While they are not offering in-office pleasure sessions, the doctors who wrote this article wholeheartedly believe that vibrators should be considered medical devices and patients should leave with a lollipop and a prescription. (Okay, maybe not the lollipop.)