Introducing Cecily the Cervical Mucus Fairy

This week, a state senator in Maryland introduced a resolution to teach “Female Monthly Cycle Tracking for Adolescent Girls.” An old male legislator thinks young women should be tracking their periods and checking their cervical mucus every day, and he wants schools to help. Yes, it’s as creepy as it sounds (see the story below). It also got me thinking about just how many times we’ve talked about cervical mucus in this newsletter. It came up when I tried to tell Ted Cruz how birth control does and doesn’t f**king work, when a TikToker taught us that Mucinex could help with conception, when we learned about superfetation, and, just last week, when I mentioned two new methods of tracking ovulation. I promise that I did not set out to write a newsletter on cervical mucus. I hate the word mucus as much as the next guy. I was never committed enough to getting pregnant or not using birth control that I tracked my own. And yet, I seem to talk about it. A lot. In celebration (or perhaps apology), I would like to introduce   you to Cecily the Cervical Mucus Fairy, artwork by my husband. He’s lobbying for her to become the official mascot of Sex on Wednesday but I’m not sure how often I want to look at her (or at least at her wand). 

Hormonal IUDs are Highly Effective as Emergency Contraception

Though many people are not aware of this option, Paragard, the copper IUD, is approved as a form of emergency contraception. If inserted within five days of unprotected sex, the copper IUD is 99.9% effective at preventing pregnancy. And now, a new study suggests that hormonal IUDs—like Skyla, Kyleena, and Mirena—are also good options for after-the-act prevention.

Of course, when we think about emergency contraception, we usually think about the “morning after pill” which was finally approved by the FDA in the late 1990s even though health care providers had been prescribing high doses of birth control pills for this exact purpose for decades. Since then, emergency contraceptive pills (ECPs) have gotten a lot of attention, especially during the battle to move them over-the-counter which was delayed against expert advice and then temporarily subjected to age restrictions in yet another episode of policymakers being convinced that access to prevention would lead to unchecked promiscuity.

Interest in and use of IUDs has gone up in the last few years as more options came on the market and providers began to promote them as a good birth control option regardless of a patient’s age or whether they’d already had a child. Still, few people look to IUDs for emergency contraception despite the fact that research continues to find that they are more effective than ECPs.

For this study, which was published in the New England Journal of Medicine, researchers recruited 700 women who sought emergency contraception at Planned Parenthood clinics in Utah. Participants were considered if they had had unprotected intercourse at least once in the previous five days but were not currently pregnant, had regular menstrual cycles and knew the date of their last period, wanted to prevent pregnancy for at least a year, and were interested in the IUD. Ultimately 638 women completed the study; 317 were given hormonal IUDs (Skyla, Kyleena, or Mirena) and 321 received Paragard.

Follow up a month later found one pregnancy in the hormonal IUD group and none in the copper IUD group. Researchers calculated this as a 0.3% risk of pregnancy when hormonal IUDs are used as emergency contraception, and compared it to existing research which has found copper IUDs have a 0.1% risk of pregnancy and ECPs have a 2% risk of pregnancy (though there is research to suggest ECPs do not work as well in women over 155 or 165 pounds).

In addition to efficacy as emergency contraception, once the IUD is in place it will continue to prevent pregnancy for between 3 and 10 years with no further action required of the user. This makes it a great option for those who are not planning to get pregnant anytime soon. And, as always, IUDs can be removed at any time if a person changes their mind about family planning. 

That said, there are some serious barriers to using an IUD as emergency contraception, especially given the five-day window. They can be expensive for those without insurance and require professional insertion. Moreover, some health care providers are not set up to do same-day insertion of the IUDs because they don’t keep any stock on hand.  

As with most things pregnancy-prevention, I say the more the merrier. Options allow each of us to choose what works best at any given moment. While it may be easier for some people facing a pregnancy scare to get ECPs from their local pharmacy and work on long-term birth control later, others may want to take care of both at once. Hopefully this research will mean the hormonal IUDs are soon added to our list of emergency contraceptive options.

Maryland State Senator Wants Girls to Know More About Their Cycles (And It’s Creeping Me Out)

I am usually all about calls for more sexual/reproductive health education for young people. Knowledge is power. Information is not dangerous. With facts and tools, young people are capable of great decisions. Etc. Etc. Etc.  But I’ve got to tell you, the proposed resolution in Maryland is just creeping me out. 

State Senator Ed Reilly, a Republican from Crofton, wants to add “female monthly cycle tracking for adolescent girls” to the health education curriculum. His resolution, which will be heard by an education committee next week, starts off okay by noting that the American College of Obstetrics and Gynecology (ACOG) identifies the female monthly cycle as a vital indicator of health and that cycle irregularities in adolescents can be an indicator of future health issues. The research is solid and this is certainly something young people can, maybe even should, know about.

But the language that comes after should start raising the hackles of anyone who’s read or seen The Handmaid’s Tale:

• WHEREAS, The female monthly cycle produces observable signs that adolescents can learn to identify and use in order to track the health of their monthly cycle, including using natural or fertility awareness–based methods; and

• WHEREAS, Adolescent girls can be taught to recognize their cervical mucus patterns and distinguish normal from abnormal monthly cycles; and….

The resolution ends with the suggestion that the state update its health education curriculum to include “instruction on how to track a monthly cycle using natural or fertility awareness–based methods and observing cervical fluids.”  

Reilly, 72, told the Baltimore Sun that he and his wife, who have four children, “used cervical mucus pattern charting for 23 years in their marriage as a means of family planning” and that he wished they’d learned about it sooner. His wife is a certified fertility care practitioner which appears to be specific to the Creighton Model, a method of natural family planning developed in 1980 by the founder and director of the Pope Paul VI Institute.

Despite this connection to the church, the doctor who helped draft the resolution for Reilly says this is not about religion or pre-marital abstinence. Dr. Marguerite Duane, a family practice physician and adjunct associate professor at Georgetown University, told the Baltimore Sun: “Nobody’s ovaries are Catholic.” She says her goal in teaching this to young women is to help them understand their bodies and know when to expect their periods. When she teaches adolescents, she doesn’t mention fertility, but, instead, thinks of it as body literacy. 

While this sounds acceptable, Duane suggests a curriculum in which teachers demonstrate cervical mucus using egg whites or dried glue, send young women home to track their cycles for a few weeks, and then go over the charts together.  

We have trouble getting condom demonstrations in schools, and the mere mention of masturbation sends parents into a tailspin because it supposedly robs kids of their innocence, but, sure, let’s tell 14-year-old girls that their homework assignment is to stick their fingers up their vagina every morning, examine their cervical mucus, and report the results to their teacher and classmates.

It’s intrusive, overly personal, and highly gendered in a way that seems to purposely exclude anyone who is trans or non-binary.

Young people should learn about menstrual cycles, they should know what’s healthy and unhealthy. Heck, this is a tech-savvy generation, we could even mention that period tracking apps can help them understand their own cycles. But Reilly’s suggestion seems less like education and more like early indoctrination into the world of natural family planning. It’s a hop, skip, and a jump from there to telling kids that birth control pills contain harmful chemicals or IUDs cause abortions.

Fertility awareness methods can work but without real effort on the part of the user, they are not nearly as effective as modern methods of birth control and provide no protection against STIs. These methods can certainly be mentioned as one of the many contraceptive options available today and included in discussions of the pros/cons of various methods (pro: inexpensive, no medication; con: you have to track every day and time sex very carefully). But this level of attention and detail is not appropriate for schools and feels like another attempt by a male politician to gain control over women’s reproduction and by extension their sexuality.

I think we should send Cecily to the Maryland Statehouse for the hearing.  

Call for Young Sex Education Activists

The National LGBTQ Task Force is launching its third Sex Ed Leadership Project. The goal of the project is to “strengthen local efforts by young LGBTQ people to advocate for sex ed policy changes.” The course is designed for both young people who are already activists and those new to advocacy. It will help them “learn more about how to advance comprehensive, LGBTQ-centered, and inclusive sex ed.”

This year’s course will consist of 10 virtual sessions “designed to deepen advocacy skills and focus on navigating democratic processes to enact sex ed policy change.”

Please join me in spreading the word about this exciting program. For more information and instructions on how to apply, check out the Task Force’s site.