"Sex is an extremely important part of marriage. When it's good, it offers couples opportunities to give and receive physical pleasure, to connect emotionally and spiritually. It builds closeness, intimacy, and a sense of partnership. It defines their relationship as different from all others. Sex is a powerful tie that binds."
- Michele Weiner-Davis
Although sexual images seem to be everywhere in our society, many couples find it difficult to discuss their personal sexual relationship openly and honestly. For many couples, discussing their sex life is a taboo topic. This makes it difficult for couples to address some of the important issues surrounding their sexual relationship. Issues such as the use of birth control, decisions about when to have children, and a couple's frequency of sexual relations are often left ambiguous in the minds of both partners, or they may not even be addressed at all. The purpose of this section is to get couples talking about these important issues in open and honest ways so that they feel comfortable and confident about their mutual hopes, goals, and dreams surrounding their sexual relationship.
Discussion: The Importance of Agreement and Teamwork
Deciding whether to have children is one of the most important decisions a couple can make and one that should not be taken lightly. Therefore, decisions about the use of contraception should be made by both of you, and you should both be informed about your decisions. Some couples, due to religious conviction or personal values, may believe that using birth control is inappropriate. If that is your belief, then you will want a partner who shares that belief, or at least a partner who is willing to discuss options. All sorts of conflicts can and do arise when couples have different views or understandings of how birth control works. The responsibility for family planning, childbearing, and childrearing falls upon both of you as partners and potential parents. Unfortunately, many couples fail to discuss or learn about the various birth control options that are available to them. This lack of communication and understanding can lead to conflicts over the method(s) used by the couple as well as unwanted or premature pregnancy. In order to help couples make a more informed choice about their birth control options, several methods of birth control will be briefly discussed in the following section.
Discussion: Birth Control Options
The most effective and fool-proof method of birth control is abstinence, but that is typically an unacceptable and even unhealthy method for most newlywed couples. In light of that, we will briefly discuss several more enjoyable forms of birth control including barrier methods, hormone-based methods, and other alternatives. This list is not exhaustive and does not explain all of the potential benefits and side effects of these methods. We recommend you consult your doctor to discuss potential side effects and other health risks for whichever method of birth control you choose.
These methods provide a barrier of some type that prevents the sperm and the egg from interacting.
- Male Condom - Condoms come in several varieties and can be purchased without a prescription from any drugstore. They are generally made from latex rubber. They cover the penis and prevent semen from entering the vagina. They are inexpensive (about 50 cents each) and about 97% effective if used correctly. Condoms are also the only birth control method that prevents the spread of sexually transmitted infections (STIs), including HIV, with near perfect accuracy.
- Female Condom - Female condoms are polyurethane (plastic) bags that line the vagina and stay in place with a diaphragm that fits over the cervix. They are just as effective as male condoms but they cost 5 to 6 times more.
- Diaphragms - They are shaped like a bowl, made from soft latex, and are inserted into the vagina so they cover the cervix. They are usually used in conjunction with a spermicide. They are expensive initially (about $20) and must be prescribed by a doctor. They are about 94% effective when used properly, and they can be used for up to 2 years, making them fairly cost effective. However, the they are not always used correctly and have a failure rate of about 20%.
- Vaginal Spermicides - They come in many forms (e.g., foam, cream, jelly, film, and sponges), are designed to kill sperm, and can be purchased from most drugstores. The spermicide must be inserted into the vagina before sex and they sometimes have somewhat of a numbing effect. Spermicide alone is less than 80% effective so it is recommended that you also use some other method of birth control.
These methods manipulate a woman's hormone levels so that ovulation stops and no egg is released, making pregnancy impossible. The effectiveness rates for these methods are very high - 99% effective. All of the hormone-based methods must be prescribed and/or administered by a doctor.
- Oral Contraceptive (The Pill) - This involves the female taking a pill daily and it works great if you remember to take it, but if you are prone to forget things like that another method of birth control may be best for you. Side effects of the pill may include weight gain or a lessening of sexual desire. The effects of the pill are completely reversible and don't seem to have any lasting effects on fertility.
- Norplant - This consists of matchstick-size time-release capsules that are implanted in a woman's upper arm through a small incision. Norplant can remain in place and effective for up to five years, but it is very expensive initially (about $1,000). Its effects are usually reversible.
- Depo-Provera - This involves getting a shot, usually in your upper arm or rear end. The shot lasts for three months and usually cost about $30 per shot. The effects are reversible but you will have to wait until the shot works its way out of your system before you can become pregnant, which may take six months or more.
- Ortho Evra Patch - This involves wearing a small patch through which hormones are delivered directly through the skin and into the bloodstream. They are the same synthetic hormones used in the oral pill and it is just as effective as the pill. Women generally wear the patch on their buttocks, abdomen, or upper outer arm. The patch needs to be replaced on the same day of the week for three consecutive weeks, and no patch needs to be worn the forth week. The patch remains attached and effective while exercising or bathing.
We will talk briefly about sterilization and natural birth control in this section.
- Sterilization - If you and your partner know that you do not want any children this is the most effective method of birth control available. But it is usually irreversible, so if you think either of you may change your mind about having children someday, choose another option. Sterilization is available for men or women. The procedure for women is called a tubal ligation. This is a surgical procedure that permanently closes a woman's fallopian tubes. It can cost $2,000 or more. The procedure for men is called a vasectomy. This is also a surgical procedure that is designed to prevent sperm from mixing with semen. A vasectomy is less invasive than a tubal ligation and is less expensive (around $250-1,000).
- Natural Birth Control - This is all about timing and does not involve any tried and true method that is very effective. You are really taking a gamble using these methods if you honestly do not want to become pregnant. They include the rhythm method, withdrawal, and ovulation and temperature tracking. The rhythm method involves tracking a woman's menstrual cycle and abstaining from sex for about 8 days (when the woman is most fertile) during the 28 day cycle. It is based on three assumptions: (1) that ovulation occurs fourteen days before the beginning of menstruation, plus or minus two days (2) that sperm remain viable for three days, and (3) that the ovum survives for twenty-four hours. For a woman with very regular cycles, she only needs to count backwards from the first day of her period to locate the day on which she ovulated. Using this information, she can predict when ovulation will occur the following month and avoid having intercourse around that time. However, keep in mind that menstrual cycles in different women can vary from month to month and in their duration. Withdrawal involves having unprotected sex with the intention of the male withdrawing his penis from the vagina just prior to ejaculating. This has a high failure rate and pregnancy often results. Ovulation and temperature tracking is similar to the rhythm method, only the woman tracks her temperature and vaginal mucus levels to determine when she is most fertile. Sex is then avoided at those times.