Human sexuality; Contraception, part 1

Human Sexuality the sixth in a series of seven classes is given as part of a four college course in human sexuality sponsored jointly by Amherst Mount Holyoke and Smith Colleges and the University of Massachusetts today. Dr. Phillips they got an ecologist at Westover Air Force Base discusses contraception. As I listened to the tape of last week's lecture. I came away with the feeling that all of a sudden I had become anti a natural childbirth. And all my life I have been very at least all of my professional life I have been very pro. Natural childbirth and I. Thought I ought to let you know that. I brought along a because I think that many girls in the audience just as you expressed. Last week feel I just wrongly that you want to be as much with it for the birth of your children as possible. I brought along a description just to sort of make up. For my sins last week and instead of bringing oxygen this time I brought a little note about

my description of a woman's natural childbirth. And the baby was born. In April. So that's not very long ago at the beginning of this month April 5th I was third child in her store. And the patient describes her labor in this way. I was a third child and first daughter arrived April 5th 1969. Our third prepared child birth experience my labor began on a Sunday morning at 8 a.m.. Most of the contractions were mild. About 20 minutes apart for the first few hours and anywhere from 5 to 15 minutes apart for the remaining five hours or so. During the first seven and a half hours of labor at home none of the contractions lasted longer than 20 seconds. I did not feel the need to use any special breathing techniques until the contractions would became five to 10 minutes apart and then I did a deep slow chest reading. After speaking with my doctor we decided to leave the hospital. At 4:30 near afternoon. Upon arrival

I was three Sana meters dilated. My husband and I had the private labor room where his calm and reassuring manner added to my relaxation. After the doctor broke the back of waters the contractions became quite intense and I had a great deal of back pressure. My husband did a grand job of applying pressure with his hands on the lower back and I felt some relief. But I was still more uncomfortable than I might have been had I not under estimated the situation. I had forgotten to give each breathing technique at least five contractions and if it isn't helping to switch to the next I couldn't believe that it was time to try transitional breathing so I never used it. In the meantime I had gone to being completely dilated in 35 minutes when the desire to push came. The feeling of discomfort left and I felt great relief with pushing the pushing stage was very Shalott. Even the lens presentation was post Steria. The time I am sure was less than 10 minutes her birth was recorded at seven forty eight p.m.. I watched it all in the mirror. Once again

modeling at the miracle she cried with just her head with one just her head was gone. The identification was immediate. I knew this was my baby and the days of practice were well worth the effort. The support of my husband my doctor and the nurses contributed greatly to the kind of experience I had. It is so comforting to have very kind interested people with you. Also very important was discussing my desires with doctors and hospital before hand. Well now that I've convinced you that having a baby is such a great thing I have to convince you that not having a baby is a pretty great thing to. See. We are at a time in the development of civilization where all of a sudden we have to worry as much about birth as we have to worry about that. Because all these years that we have been worried about death. And all these years that doctors have worked at the problem of overcoming disease. And he did not work at the problem of excessive birth.

And so we face a great great problem a population explosion. How great is the problem. Well so great. That by 300 if we continue at the present rate of population explosion three hundred years from now every square foot of the face the face of the earth will be covered by two feet. And. If we continue at the present rate and we do this we increase the population of the earth at the present rate for the next 6000 years. A very long period of time we can go back in time six thousand years. If we can continue if we do continue at this rate and we consider that each time somebody else is born they are added on. To a. Radius of the circle. Reaching outward from the earth. Then by six thousand years from now the radius will be increasing. At the rate of the speed of light. That's a rather frightening thought.

So from a demographic point of view. We are very worried about population explosion. From my point of view I have to get into New York about four o'clock in the afternoon on Wednesday and I'm really worried about. The flights over New York so the population explosion is bound to get me. And that's when people really find that it is a problem. It's interesting that Planned Parenthood in many areas of the country have little stickers that they put on back of cars that say parking problem got you support Planned Parenthood. Well you can talk about it from a demographic point of view and of course it's not very interesting to you personally from a demographic point of view in fact we don't even have a lecture on demography in this whole series. Demography has become very flustered at the fact that we leave them out. But in reality. These tremendous problems are not very personal.

After all in the United States we're not very far away from the point where our population will be exploding. I don't rate consistent with what our economy can support it's still too great. But we've been whittling it down little by little to the point where in the foreseeable future the United States population will be stable. The problem of controlling population though from a personal point of view is a very ancient one and irregardless of the culture that you go back into. To study you find that methods evolved. That. Did control population. I had the interesting experience of listening to Philip Hauser who is the director of the population center at the University of Chicago and really one of the great great demographers in this country and he proposed that we could use to population control mechanisms of. The past by cannibalism which does work.

Or homosexuality which also works. But we have our own system now that we're working rather hard on. And that's the ICBM's and they have bound to work too. So that if our population does start to increase with a radius equal to the speed of light it will solve it. By one way or the other. Some of the more interesting aspects in the history of contraception and I would like to make the point tonight that. We are at a point. In the study of human reproduction where the techniques of contraception that have evolved are still old techniques. We are on the brink of discovering new approaches to contraception. So that whatever I tell you about contraception tonight. Will probably not be applicable to you as a method of contraception or for you as a method of contraception in your reproductive lifetime. That is how quick.

This field is changing. And of course it has to change because the problem has become so great. And when I say that our basic ideas are very ancient really the idea of keeping sperm from an egg is an ancient idea. The Egyptians developed contraceptive. Phones or contraceptive creams that were put in the vagina that block the sperm from getting to the egg and they worked. Mexican Indians ate squash squash contain a compound that. Prevented avi lation and they didn't become pregnant. Now we have very sophisticated techniques we take squash grind up in outcome thousands of little pills. But. The fact of the matter is that the hormonal approach to preventing an egg from being released was an ancient one. The Australian Aborigines have a neat technique. They take a stick and shop

in it and then they puncture. The undersurface of the penis so that a canal is created from the penis to the outside. When the Aborigine urinate she puts a finger over the opening to the canal and then he can urinate when he's having intercourse he doesn't put an opening a finger over the opening and the sperm goes out through the little opening. So. We think of ourselves as rather sophisticated. I mean even now the most recent of devices intrauterine devices are not a very new technique may have the first light. We think of putting a loop. In the uterus as a rather original idea. But the fact of the matter is that two thousand years ago. In the near east the camel drivers put stones into the uterus of a camel. So that. Just as they didn't want to be stuck in the desert with a pregnant camel on their

hands. They they developed this technique of contraception. Now we put fancy devices in the uterus and it does work. When we think of contraception. It's a very important thing for us to keep in mind. The fact that sperm and egg and the factors of the woman's menstrual cycle. But I'd like to think that in a course like this we can be a little more sophisticated. Sure an egg and sperm have to get together in order for pregnancy to occur. However. We ought to know a little bit about what causes the sperm. To be produced and how they are produced. We had a go where pregnancy occurs and what causes the egg to be released. And on a very superficial level. You recall the slides of last week's showing model of woman Jina and the uterus inside and then

me sperm by sending into the tubes. Pregnancy occurring in the tubes and descending to the uterus. And before you knew it there was a picture of a baby crawling. Well there is a very fine interaction. I have lots of mechanisms in the body. Which cause. First the egg to be released and sperm to be produced. The central nervous system is the input center. And many things will affect the central nervous system. For example many women who are on tranquilizers don't Davi late. Because the signal that is sent from the central nervous system is not sent and so the rest of the system the hypothalamus the pituitary the gonads don't respond. Many many things will affect the central nervous system. So for example sound if you. Expose

rats to very loud noises they will stop populating. That is the center which picks up sound will cause a cut off. In the release of the factors in to Terry Allison and to Terry which cause an egg to be released. There are women who are extremely sensitive to smell. And smell particular odors will so affect a central nervous system that they don't obviously emotion because it's very well known. Comes final exams freshman year the girl stops obviating and two years later she starts up again. That very strong emotions affecting the central nervous system will do this so that in trying to make this point. I want you to go beyond thinking in terms of just the pelvis.

The structures in the pelvis and sperm getting to those those structures in the head rests a great deal of what one needs to know about human reproduction. Now the cortex of the brain then under various kinds of influences will affect lower centers in the brain the hypothalamus is the main center for the release factors which stimulate the pituitary to release factors would stimulate the gonads to produce an egg. I don't sounds complicated but I. You've got to grasp it because our whole future understanding of what's going to happen in the field of contraception is based on understanding that. The pituitary gland which is at the base of the brain is not the mass of the gland. I hope you don't learn this anymore. In school. Pituitary gland is completely under the influence of the hypothalamus. The higher

center. Which release is factors which in turn caused the pituitary to release the proteins which cause a woman to go through her menstrual cycle. Now in the first 10 to 12 days of the cycle one type of hormone is released. This causes changes in cells in the ovary so that eggs mature. Around the 13th to 14th day in a 28 day cycle. Another. Substance protein is released from the pituitary gland under the stimulus of the hypothalamus and the egg then is able to be released from the. Ovary. Then a third substance is released from the pituitary gland and this in turn causes changes in the ovary that will support the lining of the uterus until about three days before the period. So in a woman's 28 day cycle.

From day one until Day 14 she's not released today. She then releases the egg and between days 14 days 24. She has a situation where an egg could have been fertilized and developing in the uterus and then from days 24 to day twenty seven or twenty eight. There are changes in the lining of her uterus that apre menstrual changes and then she starts a period. Well understanding. How one would have the lights please. How one would affect. Contraception. You have to approach it. And from the point of view. First of all controlling avi lation. Controlling Abi lation could be done by cutting off the factors from the pituitary gland. Which cause the ovary to go through changes. You could have let's say a substance which inhibits the protein from causing the

egg to mature. Or another substance which causes which affects the protein which causes the egg to be released or another substance which affects the ovary so that even if the egg is released it is released that it won't be supported in its development within the uterus. And these have all been very important recent areas of research and trying to develop a good contraceptive. The sperm in the egg has to go through the tube and pregnancy does occur too. And one could develop substances or devices which would affect the tubes one way of course would be to put a tie around the tubes. That's called a tubal ligation and it's a rather common method of sterilization. If you tie a lawful woman's tubes she can't become pregnant. The pregnancy rate is extremely low and with some techniques it's not unheard of falling into the ligation. However this is a permanent method of birth control and we

haven't found any kind of reversible. Tubal ligation. But the egg goes through the tube due to little fine little hairs in the tube swishing it through. They create a stream and the egg has to go along that stream. And if you can somehow cause the switches to switch a little faster you might get the angle through before it could be fertilized. Or are you might get it through the tube and into the uterus before the uterus was ready for the egg to grow in it. Because you see in order for a fertilized egg to grow within the uterus the lining of the uterus has to be prepared to receive it and has to form a rather lush. Vascular rather than blood and go I just kind of structure so that an egg will. Land and grow. And if he gets there before the lining of the uterus is ready. Then you've got a method of birth control. It won't grow.

So implantation is one of the things that you could affect. You could. Also affect the egg after it has implanted. I recall my saying that a protein is produced by the pituitary which sustains the ovary after. A woman has Abi laid it on tell about day 25. This is called the luteal or the corpus saluting him phase of a woman cycle. And you could devise a substance to cut off that phase which in turn would stop the hormone being produced that affects the lining of the uterus and even if an egg was there the egg would be released. It wouldn't grow. Now the reason why I tell you about all these things is that these are current methods of birth control and will talk about them in just a few minutes. What about the sperm. Well we know that you could affect sperm production in many ways for example with hormones. If a boy took. A man

took. The pill the female pill. It's a very potent antagonist of the pituitary stimulant so it would shut off his pituitary and his testicles would not produce sperm. However because it is a female pill it contains female hormone he'd grow breasts. So although no man could take their wives pills or boyfriends their girlfriends pills they're a little bit reluctant to do it for. The reason I mention. There are other aspects to it too. And I think the most significant aspect is that whereas the changes in the ovary that occur because of the pill are reversible usually reversible and the changes in testicle often are not. And so the man doesn't bounce back and stop producing sperm when he stops taking his wife's house. But we do have male pillows and I'll mention those and a little while. We could

affect the sperm. And of course there are the mechanical approaches you could cover the penis with a condom a rubber prophylactic called whatever you wish. And for about two cents and then go to a drugstore Maicon. And when he has into cos have the condom cover the opening to the penis. And in most instances the sperm would not come out. I did see a patient today who was pregnant who became pregnant while her husband on the one day in the month when she had intercourse has been was which was using a condom and she was using contraceptive foam. And. I think it's just some evidence to the fact that even methods of birth control that I'm mechanical I'm with and you would think would block the sperm from getting to the egg far from 100 percent effective. The sperm go through maturation. That is you can have sperm that look normal. They wiggle around and you certainly could envision them swimming up

into the tube and finding an egg and fertilizing it. But they have to go through a step in maturation of all capacity and as they have to develop the capacity to fertilize an egg. And we know that there are hormones that will affect sperm. So it may very well be that we will be able to give a woman hormones that don't affect her period but merely affect sperm and their capacity to fertilize an egg. After the woman has had and cos. And this is a method which is now. In the stage of field trials. That is such a hormone has been developed. There are several thousand women who are now using it as their only method of birth control. And it appears that this effect on the capacity of sperm is a very potent one. And that may be the method of birth control that many of you will be using two or three years from now. Well you see when you have I didn't mention abortifacients I think you talk about that next

time. When you have so many different approaches to birth control you realize that there isn't an ideal one. Let's take some of the individual methods of birth control. Now the diaphragm is a mechanical method of birth control. It is a I want ins method of birth control. This is our model moment. Here is the opening to the vagina. By the way this is a life size model and if the uterus looks small to you it is small. That pink structure is a uterus in a woman who has never had a baby. That's the size of the universe. Prior to pregnancy I remember that sperm I left in the vagina. And will go up to the tube. If you take a diaphragm I think you can see how it would block the sperm from getting to the egg. Is that clear to the diaphragm. Is your mother's method of birth

control. The diaphragm was invented a long time ago. But. In the 1940s the late 1930s 1940s and early 1950s before other methods of birth control became fashionable. It was really a matter of a diaphragm for a woman or a condom for a man. This works in the same way simply mechanically blocking the sperm from getting to where the egg is. The problems are first of all for your generation that. You want methods of birth control that you know are a little less removed from the sexual act. You want methods of birth control that you don't have to insert each time or use each time. It always upsets me that men have stopped using condoms conquests to sense and go into any drugstore and buy it. And of course in the military they make a big deal out of the con as a method of preventing venereal disease. And it is true that there has been an increase in venereal disease

particularly among the teenage population. It's estimated that we will have. Something like 200000 teenagers. Develop an Ariel disease this year. And if a condom was used by a man each time or a boy each time he had. Called us and he wouldn't contract of a new male disease. The. Problems with this mechanical method from my point of view of. Preventing pregnancy is that there are significant pregnant pregnancy rates with them. If 100 couples were to use Well let's say 100 couples were to have into costs regularly and not use any method of birth control. In the course of 12 months. 80. Of 100 couples would become pregnant. Now that's in the United States. They are all pretty healthy law Abhi light pretty regularly. So you have a rather

significant pregnancy rate. One way of looking at it is that if you use no method of birth control. Each time that you have into cos you have a 3 percent chance of becoming pregnant and there aren't any of you in mathematics majors and can figure out probability. You figured out that each time you have intercourse without a method of birth control you have 3 percent chance of becoming pregnant. Now you can imply rhythm method and the rhythm method means that you don't have into cos at that time in the month. When the egg is released when it's floating around and sperm could get at it. This is fine for the patient who knows when she's obviously many girls don't know when they're operating. Many girls obviously irregularly. One month your period may be 28 days apart the next month or maybe 35 days a pot. That's not unusual and so you don't know on which days of the month you're going

to obviously. You can have certain signs of the rhythm method of the violation rather that help you at the time that the egg is released. There is an increased secretion from the woman's vagina a sort of mucus discharge that most women have when they obviously one way you could figure it out is if you know when your next period is going to come two weeks before is the day when you will obviously. That doesn't take into effect how long sperm stay within a woman's body. There is some evidence that some women are reflex obviously it is. That is they respond to sexual and to cause by putting out an egg. Dangerous Women to hang around with I say. This is. This is well known. This is well known in animal studies and as I reviewed literature a few weeks ago there are several studies of women who have shown been shown to be weak like

Savi ladies. And I have had some patients who after having delivered them every year for five years and all and convinced that in order for them to become pregnant that often they must be reflects on feelings. Well the rhythm method doesn't work very well if you're a reflex obviously. And. You should also keep in mind that sperm can stay alive within a woman system for more than 24 hours and fact it's been reported as long as six days. So a couple can have intercourse six days before I view lation and cars and pregnancy kind of car. Now that of course is a real long period of time and from a practical point of view 48 to 72 hours. Is it pretty safe period. I personally wouldn't take any chances. And so if I was going to use the rhythm method I wouldn't have intercourse for six days before the time when I expected avi lation to occur. If you use the

rhythm method if 100 couples use the rhythm method then about 14 to 15 will become pregnant in the course of a year. Now those are statistics from several different clinics and there are some clinics for example the what they call me. I can't think of the expression they have for it. It's a clinic run at St. Vincent's Hospital in New York where women take their temperatures in via an elevation of their body temperature they can tell that they put out an egg and so they use the rhythm method in conjunction with that and then they report a pregnancy rate of only about 5 percent. Or so. Or five women or five couples in the course of a year. The diaphragm about 12. Couples will become pregnant and a year. If they use the diaphragm as their regular method of birth control. So of

course when you become pregnant you're not 12 percent pregnant or 15 percent pregnant. The withdrawal method really the method used most in the world and it is the man feels the climax is going to come and withdraws the dance before he comes before the sperm goes into the vagina. One problem there and that is that the first few drops that come out. And I felt. What a man feels when he has climax is a rush of fluid through the penis and as a result the pregnancies of a card with the withdrawal method. There the rate is about. 16 percent among populations that have been studied. What about douche ing a lot of women feel that if they wash out the vagina after him to call us that they'll wash out the sperm. Well we know that it takes something like six minutes for a sperm to go from the vagina to the tubes probably much less

to get up into the uterus so that a woman would have to be practically an Olympic runner. I don't want to have to sing as a effective method of birth control. I was very fascinated in in Hamburg. There's a study is an institute for the Study of prostitution in Homburg. And as I I spent two days there and. Studying. I was very fascinated by the fact. That the prostitutes used to sing as their method of birth control. Well as we talk this over the doctors who were there and psychiatrists and the gynecologist and so on they. Documented in their studies what other people have documented and that is that women will form. Antibodies to sperm. Sometimes this

is an infertility problem and some couples where pregnancy can't occur. What you find is the woman's The woman's body has produced an antibody to her husband's sperm. And if you will prevent the sperm from entering the vagina for a period of something like six months then the antibody disappears. Well apparently the prostitutes have. All kinds of different antibodies and that's really the significant factor in their contraception and not Dushan. And that of course has given us some insight as to a method of birth control but more important I think a method of helping couples who have been infertile to become for to become fertile. And I've had several patients now where the husband has used a condom for a period of six months. We've watched the antibody levels in the woman's blood go right down to zero and then allow them to have into cos without a condom so the sperm go into the body and

pregnancy has occurred. The foam is a pretty good method of birth control. A hundred couples use contraceptive foam. Then the pregnancy right. It is something like eight out of 100 couples. The costs of a year. Now the diaphragm and con work both the same way as a mechanical block. The contraceptive foam or jelly forms a barrier at the opening to the uterus at the cervix and what the foam does is two things first was a mechanical barrier but I think more importantly it spermicidal so that it freezes sperm stops the sperm kills the sperm so that they can't get up into the uterus and up into the tube where the egg is. Now another method of birth control is the camel method the entry in her own device. They are. More designed to be placed within the uterus and a very

simple method. You have an insert and if you pull this up into it you can very simply put this into the cervix and then up into the uterus. Now as you put it in it opens up and stays there. Now how effective is this as a method of birth control. If 100 couples use an intriguer on devices their method of birth control. First of all in three couples the loop will fall out. So they have to be checked after the loop has been put in. If you take a hundred women as loops of 4 on out. And put them back in about half the loops will stay in and if you take the half with loops fill out twice put loops in again. If they stay with you that long then about another half will keep them and so about 25 percent of the women in home loops fall out they stand. The loops have to be removed because of bleeding in about

7 percent of the women and so for about 90 percent of those who have a loo put in. It is a very good method of birth control and the pregnancy rate runs now with the new loops about Point to Point for couples and a hundred. Well that's quite a change because you see if you were to figure out on the basis of probability. What your chances of becoming pregnant are with different methods of birth control. Let's take the method of birth control like. Well for example withdrawal withdrawal where you have about an 80 80 percent of the couples not getting pregnant and you have an 80 percent. Method of birth control. And this is used by a couple for a period of 12 months. Then at the end of 12 months they have about a 50/50 chance of pregnancy

occurring. The next time they have intercourse. Probability wise if you take a method of birth control such as the diaphragm which is approximately 95 percent effective. About a. 11 out of 100 couples become pregnant in a year. Then their chances of pregnancy occurring in 12 months are about two in 11 and they don't get down to a 50/50 chance of pregnancy occurring with the diaphragm until about two years. So a couple can happen to costs for two years and still have a 50 with using a diaphragm still have a 50/50 chance of avoiding pregnancy. If you take a method for example if you carry out the withdrawal method to four years. As a method of birth control that's 48 months of exposure with an 80 percent effective contraceptive. The odds become 12000 to one that you'll become pregnant. Now what about a method of birth

control such as the intrauterine device which is about 99 percent effective there. The chances of pregnancy in the year is about 1 in 30 in 12 months. It really doesn't become about a 50/50 chance until the in the five years. And most women as I mentioned last week have this need to be pregnant so that. Five years is a very long period of time for birth control for most women and most of you will not be using any method of birth control for more than five years. In fact on the average it will probably be something like three or four years. Three quarters of you will be married within 18 months of the time that you graduate and within two years of that time. You'll be pregnant. So it's not so far off for you. Another method of birth control is the pill. And of course you know in order to get the

generations together over this thing which has become so controversial we we now put the pill in a cameo so that. It's acceptable to everyone. There are many different kinds of birth control pills. And other different kinds of birth control pills. I think it's important to realize that they are all working. Essentially in the same way and that is in many ways the evidence now is that the pill shuts off the hypothalamus so that it doesn't release the factors that stimulate the pituitary to stimulate the ovary to release an egg. Very important that I at least one understanding of it. There are other kinds of pills and most of the birth control pills cause a discharge at the cervix

which seems to affect sperm so that they lose their capacity to fertilize an egg. There is also some evidence that the pill works on the multilaterally of the tubes so that tubal transport is affected and the egg gets to the lining of the uterus at a time when it can't grow. And we also know that it affects the lining of the uterus and perhaps a way to prevent development of the net. And of course for a method to be as close to 100 percent of effective. For anything to work that well with women it would have to work in all those different ways because there is such a tremendous element of human error when it comes to the pill. You see. We tell you how to take the pill. In fact there are 28 pills not. The 21 or 20 pills that most women are accustomed to and the pills are taken every day.

The drug barons have come to the conclusion that women just can't overcome the intellectual Baria of remembering how to take the birth control pill. So instead of doing that now they prepare all of them. Twenty eight pills you take sugar for seven days and the rest of them if you take. Birth control pills. And women are very very happy with it. And you know if you really the importance of a method of birth control. It's reflected in its discontinuance right. If a method of birth control is used by a hundred women for a hundred years obviously it's a good method of birth control. On the other hand if it's used by a hundred women for two years and at the end of that time none of them are using it and it's not a very effective method in the surface of the earth to still want to be covered in 300 years. When it comes to the pill the discontinuance rate is such that if you follow a group of 100 women for a period of five years women who are taking Pel you will find at the end of that

time 42 of the hundred women are still taking the pill and 58 have stopped. Most are not using another method of birth control and have become pregnant. Now why do women stop. It was a big headline in on the front page of McCall's not too long ago saying why six million women or one million women stopped the pill. And. In terms of. The article I felt it was a terrible distortion of a very fine study that had been done by a group at Princeton and they had shown. That most women stop the pill because they want to become pregnant. Pretty good reason stop the pill. And not because of side effects of the pill. In the many doses that are available today the pill that is circulating is a twentieth the dose of the original birth control pills. It's a fifth the dose of the pill that many women would take in just two or three years ago. And this is one milligram pill there are still many women taking two and a half and two milligram pills so that we're talking

about many Dell spells and that the side effects from these pills are really very few. I think the thing that most people are concerned about are the dangers and there is no question that there are dangers in the pill. There are women who have taken and died as a result of taking the pill. There are some women whose blood clotting system is extremely sensitive. They will take the pill develop a blood clot in the vein blood clot will go to their lungs and they will die. Now how often does that occur. We don't have good statistics in this country. We can only turn to a good study done in Great Britain. This was published recently. And every doctor in the country was informed of these findings. If we take an age group such as yours women aged 20 to 35 who are on the pill and then out of 100000 women using the pill one point four will develop a blood clot in their leg go to their long and it will kill them.

Now that's a fairly. I think in significant number. It's not. A significant enough number for me not to prescribe the pill. And I of course have very much in mind the complications that women have when they become pregnant when they don't want to become pregnant first of all. If you take 100000 pregnant women twice as many will develop a blood clot in their legs and will go to their lungs and kill them. That's not often presented but it is a statistic and a very real one. If you are if you take 100000 women who are pregnant Twenty two of them will die in relation to the pregnancy. About 1 out of 5000 women in this country die in relation to pregnancy most as a result of criminal abortion. Most as a result of criminal abortion. And I've had patients alive cared for sat next to while they

died because they'd had a criminal motion. Now if those particular patients had the pill they would be alive because the chances 1.4 or 100000 of them having a blood clot. I think a very very few. I don't know if it's relevant or not but the auto accident death rate is about 4.8 per 100000 So it's about three times as dangerous to get in a car as it is to take them. I think that when it comes to the college student there are many many things about birth control which are extremely important from a personal point of view. American college students don't in the majority use birth control when they have been to class. Now it's true American college students in the majority don't have it class batch that you know already. Not a very large majority. But even in that northeastern Women's College which is 30 miles from a large city.

The majority still don't have into class before they graduate from college. But for those who do I think it's a rather surprising thing with the state of intelligence of young people today that you don't use birth control so you have to say if they don't use birth control. Well why don't they use it. And I've seen many different answers among my patients and of course we learn from from everything we see and read and do there. In his lectures doc Copeland talked about the template the template that about sexuality that you grew up with and which is a very great part of you. And that template does not include birth control. You have not. Been taught at home that when a woman hasn't COS and she doesn't want to become pregnant she uses birth control. And of course that's where so much of your learning about sexuality occurred.

Well if you're not taught this as an inherent part of yourself. For example the way the Scandinavians are. Then obviously you're not going to use it. There's a very interesting contrast in two films that I've seen recently in the Swedish film. I Am Curious Yellow. The girl hasn't cos several times in the film she explains that in fact after having intercourse the first time with fellows she pulls out her questionnaire and goes down how many. The list of questions as you go to church and. Some of what his experience has been. And she explains that he is the 23rd person that she's had intercourse with. So she's keeping this study. They talk a lot about a lot of things and I am curious. Martin Luther King is an Indian. You have to shank ozone and all sorts of interesting social commentary comes into it.

They don't talk about birth control yet. Lena Lynsey character in the play in the movie doesn't become pregnant 23 guys maybe she has antibodies that she doesn't become pregnant. But the fact of the matter is that if she's Swedish and she hasn't cos she uses birth control and a very fascinating experience of working in a contraceptive clinic in Stockholm. Not for very long but in two days I saw are about 15 or 16 girls aged 16 17 and 18 almost all of whom were virgins who had come for birth control. None of them were married now in Sweden the lore is that birth control is available to anyone who wants that you do not need parental permission if you're over the age of 15. The same is true in Denmark and usually a family teaches that daughter. If you are in love with the blight you have

a relationship that is going to lead to into cos then you use birth control. And I can tell you I was rather amazed I sat there girl after girl was coming from birth control. I had never had intercourse. I had a boyfriend at the time. I felt that it was a good possibility that they would have intercourse and she was going to be sure that she didn't become pregnant. Now the contrast of the other phone Goodbye Columbus Goodbye Columbus. The girl. Is a Radcliffe student. She is the most beautiful most intelligent most sophisticated thing on two feet and in one scene with a boyfriend. They're taking a shower and he asks her something about the pill. And she says to him. I don't take them. And he says well what are you using. And she says nothing. And he practically passes out in the shower.

And they go tearing out into her room. And of course this is a man in a mansion in West Chester Nolen. The family is in the adjoining rooms and obviously they don't know about the two of them sleeping together. You know the way it is. And he says to her What do you mean you're not using birth control. And she said well I took the pills for a couple of months and I put on some weight and I didn't like them and I stopped and he just couldn't believe it. And he said to her are you so spoiled that you don't believe that something terrible can happen to you. Are you so spoiled. And of course that may be part of it. It may be a dream world you know when nothing bad can happen to you especially if you're beautiful and intelligent and so on and well think nothing bad can happen to you and so you don't have to use birth control you're immune. Or. As in a matter of

being naive or. Is it a belief that can't happen to me. Or does it have something to do with the template the template says that the girl will be a virgin when she marries. And in fact in the end of the movie by the end of the movie The girl receives a letter from her family she left. She finally does go and get a diaphragm and now very happy about it but as this happened with so many patients I have seen she left to die from home where her mother could find it. And of course another does find it. That's not only in movies I've seen that over and over again. The pills are left where a mother can see in like the diaphragm is left with a family finds it and then has a commotion and it goes one way or the other in the film. This was the excuse for the girl to break off from the boy. One of my patients who's a college senior told the story of going to her mother and saying I am in love with silence. We've not had him to call

us. I want you to take me to a gynecologist so I can be fitted for diaphragm. The mother went into shock. She said My God what a terrible thing. I would template doesn't say it. You can have intercourse before marriage and the girl said well but my generation's template is different from your generation's template. And I feel that if a boy and a girl love each other this way that we can have intercourse Well what resulted was a girl had to go alone she was cut off from the family she had to go on scholarship for that year. I didn't talk to her parents for a year. And it was really quite a traumatic thing. In the long run however I think from her point of view it worked out very well that she mature and by the experience and the family learned something about their daughter's sense of responsibility. One reason why I tell you the story is I want everyone in the room to suddenly run home and tell a mother taking the gynecologist because you may be in for a shock. On the other hand I've had many many mothers bring daughters saying My

daughter needs birth control information and advice. The American Academy of Pediatrics the American College of Obstetrics and Gynecology the American Public Health Association have all said that doctors should respond to the needs of unmarried women by prescribing birth control for them when they need it. And women. I saw a girl today a college student who came in saying I'm having intercourse and I want to method of birth control. And I said fine I think that that's important. You know what you're doing we discussed her relationship with her boyfriend obviously it was a relationship that had gone on for a while and Bill had insisted on her using birth control and they cared a great deal for each other. They can't get married yet he has to finish his schooling and she would like to finish ours. And so it's a matter of perhaps a couple of years before it's practical for them to get right. So they're not going to become pregnant and I don't think that was wrong. I think there's a lot to be said for such behavior as mature intelligent behavior. And most doctors feel that way. At least

most of the doctors who I've heard talk about it and most of the girls who I have seen of going to other doctors and in this area there are many doctors who will prescribe contraception for unmarried women rather prescribe contraception for unmarried women than to see them going to abortionists or getting married because they're pregnant half the brides in our country about to get OP pregnant obviously. We can explain our divorce rate and the instability of our family as a result. Well. I think one of the problems in deciding to use birth control is this fear of going to a doctor if you have a pelvic examination and so on. And I think that it's important for you to realize that it's an important part of growing up and it's an important part of realizing that there's a particular kind of behavior that you have and recognize it and act maturity about it. And there's no big deal from the doctors point of view. I think a responsible physician is going to answer your need and discuss contraception with you from the boyfriend's point of view. I

think that the really important thing about using birth control is that it means a commitment. Now. I'm not happy when it means a commitment to 10 different points. I think that promiscuity is a real problem. I don't think I truly don't believe. And the studies that I've done now with 300 young girls indicates that giving birth control to unmarried women does not increase promiscuity. And in fact our experience is that it decreases promiscuity. I think that the family is an important factor and how your behavior fits in with the family. And Goodbye Columbus the girl. Her behavior was completely unacceptable to the family and it meant the end of the boyfriend. And you live within that culture. And you live as a psychosocial being and your behavior is your own of course but it is against that background. That's what Dr. Koplan

said for three weeks. And if that's the point we hammer home I think it's extremely important for you to realize that and birth control fits in with an understanding. Now when does a couple decide to use birth control. I think that the use of birth control should be a conscious decision. You know you know just go off and. Get the pill diaphragm and so on. This is something you must think about. You must weigh. Because. Once you use birth control you're going to continue to use it and it is going to involve you in interpersonal relations which you may not be ready for if you're not ready for that and realize it. I think that and what I'm saying now really I'm echoing the thoughts of Dr. Goode Maka. You read his book for the last week and he's had a great deal to say about this. I think that it's important that a couple not use each other when they haven't cos that the guy says to a girl well if you can have intercourse with me then I'll go out with someone else. That's

ridiculous. I mean grown up mature people that's that's not what sexuality and love are about. Not about using each other. I think the promiscuity although it may not be that rare is a problem. And it may be difficult for the promiscuous male as well as the promiscuous female to develop. A continual relationship later on in life. I have one patient now whose husband just can't get used to the idea of one woman. And this is a real hardship for them. And what would be a very model and very happy marriage. Love each other very much. I mean he's used to lots of different women. Alan can't control him and it would probably be the end of their marriage. And I think that it's wrong absolutely wrong. To have him to call us and not use birth control. I think that's that's very important for you to

realize. Well at the present time the average family in this country has two point eight children. I thought right we'll double our population in 35 years so they'll be 400 to 400 million thirty five years from now if we had 2.1 children per family then we wouldn't double our population at all. We would maintain the status quo. So we're not very far away. And as Dr. Hauser said sociologist from Chicago said. Unless we learn before we start having our children how many children we ought to be having unless that message is ingrained then we're never going to face the problem the population explosion. What good is it to delay for two years if you wind up with six children anyway and it's responsible behavior to limit family size not just from the point of view of finances and

education and your own psychic well-being but from a very practical point of view of the whole future and the future is very dismal. If you think in terms of population explosion following this formal presentation on the four college course in human sexuality questions from the audience resulted in an elaboration of the ideas presented in the lecture. What are the Massachusetts laws concerning birth control. One of the laws is that married couples can now use birth control. But that unmarried couples are not allowed to use birth control. Now I don't know how you regulate that you can go into any drugstore and buy contraceptive foam you can buy condom. You can go to practically any doctor or any clinic certainly in the surrounding states. You can go to Planned Parenthood clinics all over the England and have birth control prescribe. And most clinics Of course nowadays don't ask you if you're married or not.

They just ask you your name your age you know for their files. And. Most doctors don't either. Some of the laws I think are way behind the times. Massachusetts will be cut off. Something like 60 million dollars in federal grants unless they change the law because most federal grants internal child tell state that they will only be given of contraceptive services for unwed women are included and I'm under the impression at this time that they are changing that law.