
The IUD: The Best Form of Birth Control is the One No One is Using - minikites
http://time.com/the-best-form-of-birth-control-is-the-one-no-one-is-using/
======
solutionyogi
One of the biggest plus point for condoms is that both the partners can be
confident about whether it's being used or not.

IUD may be verify effective but as a male, I have to trust my partner that she
is using IUD. Of course, this is not important when couple already trusts each
other and are committed. [Similar logic applies for vasectomy]

~~~
elemeno
In non-committed relationships, or in the early days of a relationship, surely
it's sensible to use condoms anyway - as much for protection against STDs as
for having to trust that your partner isn't lying when she says she's using a
contraceptive.

I might be an outlier and I've also got the benefit of free health care and
sexual health clinics being in the UK, but it seems like sensible practice to
not stop using condoms until you've both had an STD screen - which takes all
of ten minutes plus a week to get results - just to be safe. Especially since
it's possible to have an STD while also being unaware of it.

~~~
DanBC
Condoms do not protect against herpes.

But I agree, it's a good idea to use them until you've both had a screen.

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splat
Wikipedia has a pretty comprehensive comparison of ~30 different birth control
methods:

[http://en.wikipedia.org/wiki/Comparison_of_birth_control_met...](http://en.wikipedia.org/wiki/Comparison_of_birth_control_methods#Comparison_table)

It lists both the perfect use failure rate and the typical use failure rate.
When I first saw this I was surprised at how often condoms fail! I'm also a
little puzzled by the infographic in the article that claims that natural
family planning is less effective than condoms. While the rhythm method is
less effective than condoms, symptoms-based fertility awareness is as
effective as the copper IUD in the perfect use case, and its typical use case
is still far better than the pill, patch, and ring.

~~~
mountainair
What is the perfect use case for symptoms-based?

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splat
The perfect use failure rate for symptoms-based fertility awareness is
(according to Wikipedia anyway) 0.6% per woman per year. (So, 1 woman in 167
per year.) The typical use failure rate is 1.8%, or 1 woman in 56.

~~~
mountainair
Sorry, my question is: How does one use symptoms-based perfectly? My
understanding is that a perfect use case happens only a few days each month.
So on those few days, you might have very low "failure" rates, but on the
other 25 days per month, is a "perfect use" possible?

~~~
sp332
It's not a few days, it's a week or two. And the "perfect use" on the other
days is not to do anything that might get you pregnant!

~~~
gjm11
In other words, "natural family planning" achieves its very low "perfect use"
failure rate by solving a different (and easier) problem from the ones
addressed by other methods.

It's easy (in principle) to solve the problem of avoiding pregnancy: "just"
avoid all sexual activity. The problem contraceptives were invented to address
wasn't the problem of avoiding pregnancy but the problem of _having sex
without getting pregnant_.

"Natural family planning" is -- when done optimally -- very effective at the
"without getting pregnant" part of that, but not so good on the "having sex"
part, since somewhere around half the time it's equivalent to abstinence.

Redefining the problem isn't always a bad thing, but it's as well to be aware
of when it's being done.

~~~
sp332
That's fair as far as it goes. But you can mix NFP with other birth control
methods to combine the advantages. Sex without condoms is valued by lots of
people, so it's useful to know that even if you use condoms the rest of the
time. On top of that, NFP can also help if you are _trying_ to get pregnant.

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chollida1
From the chart in the article I'm surprised the pill has such a poor
performance record of 6-12 pregnancies out of 100 women.

When I was in high school, university and in my 20's almost all the women I
knew were on the pill and I didn't hear once about an unplanned pregnancy or
abortion.

Infact all the women I know joked about how they were surprised when they went
off the pill how easy it was for them to get pregnant given that the pill had
never failed them when they were younger.

~~~
elemeno
Part of the performance record might well be due to not everyone taking the
pill remembering to always take it. If you miss the odd day, I'd imagine that
the chance of accidental pregnancy goes up a fair bit.

~~~
nostrademons
Also having to take it the same time every day, and the interaction between
the pill and antibiotics. I've heard that many women don't realize that most
antibiotics destroy the effectiveness of the pill, meaning that a back-up
birth control method needs to be used in a cycle where she gets strep, or an
ear infection, or a UTI, or many other common illnesses.

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olliej
However the problem these various anti-BC people have (and the court cases
that has again bought up IUDs) is that "birth control" drugs are used by huge
numbers of people for completely unrelated reasons - numerous thyroid
conditions are best treated with "birth control".

Also IUDs are solely for BC, and require (out patient) procedures that fall
under the 'religious' exemptions. So you don't get coverage for that either.

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KaiserPro
In britian at least its important to talk to the correct part of the NHS. The
sexual health clinics are great for information, thats what they specialize
in.

You GP might have a decent grounding, if you're lucky. However the NHS prints
a range of excellent leaflets with the 4 main approaches compares side by
side.

In the US you have to run the gambit of worrying if you doctor has recently
been taken on a golf trip by a pharma rep.

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cauterized
The IUD isn't problem-free. A lot of women have painful allergic reactions to
the copper ones, and the hormone-based ones a) have hormones, which cause
their own problems, and b) have a bad history of getting lodged in the wrong
places and having to be surgically removed.

Of course, in Europe and Asia, there is also a much broader range of options
to choose from, which helps women select one that has fewer risks for their
particular needs. In the US we have problems with regulatory agencies holding
up approval of birth control for really dumb political reasons.

~~~
xxxargs
^^^ This information is incorrect.

1) "A lot of women have painful allergic reactions to the copper ones" \-- No.
Copper allergies are rare and occur in less than 1% of the population,
according to the FDA. If you suspect you have a copper allergy or are
sensitive, you can do a simple patch-test on your arm before considering a
copper IUD to check for copper reaction.

2) [IUDs] "have a bad history of getting lodged in the wrong places and having
to be surgically removed" \-- Also wrong. The most common occurrence of
perforation is during insertion, and even then perforations during insertion
happen in less than 0.001% of cases. I would not consider this a "bad history"
or common occurrence.

SOURCE:
[http://en.wikipedia.org/wiki/IUD_with_copper](http://en.wikipedia.org/wiki/IUD_with_copper)
& I have a hormonal IUD currently and have had copper before.

Your information about IUDs is over 50 years old, and is based on the copper
"coil" IUD which hasn't been in use for decades. Current IUDs (both hormonal
and copper) are extremely safe, effective, and perhaps the most error-proof
and reliable form of birth control out there. The largest risk with an IUD is
rejection, where your device falls out -- the solution is simple, it's just
reinserted. The largest barrier to getting IUDs is the belief in the US that
you need to have had children first, to have a cervix wide enough to tolerate
insertion. This is also untrue. You can have an IUD at any time in your life,
insertion is just much more painful if you haven't had children.

Additionally, you don't need to scan a woman's womb before having sex to
confirm she has an IUD. You can usually feel the strings from the IUD (there
for easy removal) at the top of the cervix, with your fingertips. And if
you're a man worth half his salt, you'll have had the opportunity to... check
that out before having sex with her ;)

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tuxidomasx
The IUD may be effective for an individual woman because it will be in place
for 100% of her sexual partners. The IUD isn't ideal for an individual man
because there's no guarantee that 100% of his sexual partners have it
installed.

For males, a better form of birth control would be a reversible vasectomy
(like RISUG/Vasalgel) because it would be in place for 100% of his sexual
partners. I think there is a version of RISUG that will be available in the US
soon. If I'm not mistaken, some other countries already have it on the market.

~~~
colanderman
Vasalgel (the US version of RISUG) is in clinical studies right now, run by
the non-profit Parsemus Foundation. Donations to aid the studies are more than
welcome: [http://www.parsemusfoundation.org/vasalgel-
home/](http://www.parsemusfoundation.org/vasalgel-home/)

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poulsbohemian
Am surprised there wasn't a more balanced discussion of bleeding and allergy-
like symptoms with IUDs. Among our circle of friends, they all tried IUDs at
some point and every one had issues - no pregnancies, but was a bad experience
nonetheless. I have to wonder if this article is really a submarine - it
mentions "moms" \- maybe the IUD was such flop with that demographic that now
they are doing PR pieces like this trying to target a different group of
women?

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needacig
Funny, on my FB feed just last week a woman posted an X-ray or some such image
with the caption "perforated uterus due to IUD migration" and another woman
commented on her photo that it had happened to her too. I don't know how rare
it is but that possibility alone would be enough to make me turn and run the
other way. At least condoms generally won't perforate your internal organs.

~~~
harshreality
No matter how effective it is, who wants pointy plastic against muscle inside
the body?

Why can't IUDs be spheres or at least something a lot less pointy? Something
spherical or much more rounded and with more surface contact with the uterus
could have perforations in the surface and lots of copper inside to maximize
surface area.

The next problem is getting it through the cervix, but existing IUDs have to
get the t-bar through the uterus. Is it so different? Couldn't there be a
design that allows a IUD ball or blob to expand once inside the uterus, in a
way that can be reversed to extract it, all while not presenting any remotely
pointy surfaces to the uterus?

~~~
Zancarius
> The next problem is getting it through the uterus, but existing IUDs have to
> get the t-bar through the uterus. Is it so different? Couldn't there be a
> design that allows a perforated IUD ball to expand once inside the uterus,
> in a way that can be reversed to extract it, all while not presenting any
> pointy surfaces to the uterus?

I can understand why most investment overseas (mostly for poverty-stricken
areas) is focused on barrier methods like condoms (limit the spread of
disease), but something like this seems worthwhile. Since the mechanism of
copper IUDs is believed to be the presence of copper ions in cervical mucus
[1], I'd imagine that the shape of the device isn't quite as important as its
composition (correct me if I'm wrong--I haven't seen a study that the shape is
important for anything more than holding it in place). If it were of a "safer"
design, a woman could be more confident that the device will function without
damaging her innards. As an anecdote, I know I wouldn't be comfortable with
something like that in me--and I know for a fact my girlfriend isn't. (Aside:
It appears they were also invented by men.)

Of note, it appears that IUDs are the most common form of birth control in
China, but I seem to remember reading they were fairly common elsewhere and
can't find the resource. Maybe someone else can chime in.

Edit: xxxargs (below) [2] provides some interesting information that may
alleviate some of these concerns.

[1]
[http://en.wikipedia.org/wiki/Iud#Copper](http://en.wikipedia.org/wiki/Iud#Copper)

[2]
[https://news.ycombinator.com/item?id=7966881](https://news.ycombinator.com/item?id=7966881)

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JustSomeNobody
What about implants for men? Why do women always have to be the
responsible(ish) ones?

 _Note: I say ish, because if people were responsible at all, we 'd not have
unplanned pregnancies. _None 2: I'm a dude and I think it's horribly pathetic
that men always expect women to 'deal' with this.

~~~
chojeen
Because women suffer the most of the consequences of an unintended pregnancy,
I'd think most women would want to take control of the situation.

That being said, I'll be meeting Citizen Snips right after child #2 is born,
whenever that happens.

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husband09876
While not an explanation for all women, considering the percentage of women
who are sexually assaulted, the IUD can provoke fear, anxiety, stress, etc.
Some women don't feel at all comfortable with anyone but their husband down
there, and even then it's not a gimmie that they're comfortable with their
husband at first, if their anxiety approaches PTSD level. The very effective
implant (into tissue of the upper arm) is just as effective (or trivially more
or less so) than an IUD, but has the potential to provoke less anxiety.

That being said, I'm sure that the implant use is still pitifully low compared
to less effective methods like the condom.

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OmIsMyShield
Part of the reason might be that (here in South Africa, at least) IUDs are
generally not advised for use on nulligravid women. The reason quoted to my
partner - there might be other reasons - was that the physical changes of the
cervix that come with pregnancy makes IUD insertion less painful.

Also, random anecdatum, best to disregard: I personally know one woman who
became pregnant while on Mirena. She was told that it is very unusual, though.

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nextw33k
Wow, $900 for one!

Makes me think I am getting value for money from the NHS. Other half has used
three in the last decade and the doctors send a reminder letter when its
coming due for renewal.

Biggest thing that amazes me is that they can create a medicine that has a
known decay rate of 3 years inside the human body.

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trhway
Q:"what is the best form of birth control?"

A:"Mineral water"

Q:"Before or after?"

A:"Instead"

~~~
metacorrector
Advice to women: to prevent pregnancy, take a single aspirin tablet... and
hold it between your knees

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ozi
From personal experience, this seems to be much more common among women closer
to or over the age of 30.

Then again, I'm not sure I would trust a young twenty something I just met if
she said she has an IUD. When an attractive, gainfully employed thirty-year-
old who clearly doesn't want kids says she has an IUD it's much easier to
believe.

~~~
TheCoelacanth
If it's someone you just met, you probably should use a condom for STD
prevention.

