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April 10, 2026
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"In 1961, Wagner had concerns that his wife, Doris, wouldnât reliably take her new birth-control pills, which came in a glass bottle with a complex set of instructions. She was to begin taking a five-milligram tablet on the fifth day of her period, continue taking one a day for 20 days, then take five days off, at which point her bleeding would start. âI was constantly asking her whether she had taken âthe pill,â and this led to some irritation and a marital row or two,â he later recalled. So Wagner, a product engineer for Illinois Tool Works, came up with a solution: a pill dispenser in the shape of a round plastic disc, which could be rotated to reveal the dose you were to take on any given day. It held 20 pills, plus a weekâs worth of pill-size dimples that indicated the off week. His jerry-built design â he fashioned it out of a childâs toy, sheets of clear plastic and double-sided tape â was quickly picked up by Ortho Pharmaceuticals, and in 1963, the company began selling the pill in a Dialpak, a round foil blister pack with pills labeled with the days of the week. âThe package that remembers for her,â the company advertised in 1964. âEasy for you to explain ... for her to use,â another ad promised."
"First thereâs Rock, a Harvard fertility expert and a developer of the pill. Thereâs a longstanding myth that Rock, a Catholic, designed the pill in the 1950s with the church in mind and included a week of hormonal withdrawal â and therefore bleeding â to make his invention seem more natural. In fact, the thought never crossed his mind, the Rutgers University historian Margaret Marsh says. Instead, it was Gregory (Goody) Pincus, the other developer of the pill, who suggested that the pill be given as a 20-days-on, 5-days-off regimen. Pincus wanted to provide women in his trials with reassurance that they werenât pregnant, and to know himself that the pill was working as a contraceptive. Rock agreed. After the F.D.A. approved the pill in 1960, however, those few days of light bleeding took on a new significance. Anticipating the churchâs opposition, Rock became not just a researcher but also an advocate. In his 1963 book âThe Time Has Come: A Catholic Doctorâs Proposals to End the Battle Over Birth Control,â he argued that the pill was merely a scientific extension of the church-sanctioned ârhythm method.â It âcompletely mimicsâ the bodyâs own hormones, he wrote, to extend the âsafe periodâ in which a woman could have intercourse and not become pregnant. âIt must be emphasized that the pills, when properly taken, are not at all likely to disturb menstruation,â he wrote. âIt has been my consistent feeling that, when properly used for conception control, they merely serve as adjuncts to nature.â He was stretching the truth. Rock knew that the pillâs synthetic hormones caused the lining of a womanâs uterus to thin out, making it inhospitable for a fertilized egg. During the off week, when the hormones were withdrawn, her body got the signal that it was time to shed the lining. But because this event didnât involve ovulation, it was better described as withdrawal bleeding than menstruation."
"As more companies bought into the idea, the week of placebo pills was here to stay. Doctors liked that they made explaining the instructions to women easy. Women liked having one fewer thing to remember about their birth control. Few questioned why women on the pill should be having a âperiodâ at all. Today there are a small handful of options that reduce or eliminate monthly bleeding: Seasonale, a form of the pill sold in packets of 84 active pills and seven placebos that make it so bleeding happens just four times a year, became available in 2003. In 2007, the F.D.A. approved Lybrel, the first oral contraceptive to provide continuous active pills, with no breaks for withdrawal bleeding. Doctors agree that a menstrual cycle can be a useful indicator of overall health, and yet it still isnât necessary. When Dr. Lori Piccoâs patients ask if they can skip the inactive pills, she says she tells them to go right ahead. âItâs completely fine â thereâs no medical concerns,â says Dr. Picco, a gynecologist at Capital Womenâs Care in Washington and a fellow of the American College of Obstetrics and Gynecology. âHonestly, I would think people would want to do it all the time.â"
"Oral contraception is now one of the most scrutinised medicinal products on the market. Two British investigations that celebrated their 40th anniversaries in 2008 have been major contributors to the evidence base for current clinical practice. Both illustrate the enormous research opportunity of NHS clinical records. The Oxford/Family Planning Association (Oxford/FPA) Study began in 1968, when 17 family planning clinics in England and Scotland started recruiting 17 000 white, married women using oral contraception, the IUD or the diaphragm.3 The Royal College of General Practitioners' (RCGP) Oral Contraception Study started at the same time, with 1400 GPs throughout the UK recruiting 47 000 mainly white, married (or living as married) women, half of whom were using oral contraception. Both studies have followed up their cohorts through a mixture of clinic or practice reports, personal contact, and the cancer and death notification services of the NHS Central Registries. Each study has provided, in different ways, key insights into the effects of different contraceptives; as well as novel information about other women's health issues. For example, the RCGP study was the first to show that the risk of cardiovascular disease is much higher in pill users who smoke,5 especially among older women, and that the risk of hypertension and arterial disease is related to the combined pill's progestogen content.6 The Oxford/FPA study assessed the effectiveness, safety, and return to fertility after stopping different methods. Long-term mortality and cancer results from both studies have been reassuring."
"What Pike discovered in Japan led him to think about the Pill, because a tablet that suppressed ovulationâand the monthly tides of estrogen and progestin that come with itâobviously had the potential to be a powerful anti-breast-cancer drug. But the breast was a little different from the reproductive organs. Progestin prevented ovarian cancer because it suppressed ovulation. It was good for preventing endometrial cancer because it countered the stimulating effects of estrogen. But in breast cells, Pike believed, progestin wasnât the solution; it was one of the hormones that caused cell division. This is one explanation for why, after years of studying the Pill, researchers have concluded that it has no effect one way or the other on breast cancer: whatever beneficial effect results from what the Pill does is cancelled out by how it does it. John Rock touted the fact that the Pill used progestin, because progestin was the bodyâs own contraceptive. But Pike saw nothing ânaturalâ about subjecting the breast to that heavy a dose of progestin. In his view, the amount of progestin and estrogen needed to make an effective contraceptive was much greater than the amount needed to keep the reproductive system healthyâand that excess was unnecessarily raising the risk of breast cancer. A truly natural Pill might be one that found a way to suppress ovulation without using progestin. Throughout the nineteen-eighties, Pike recalls, this was his obsession. âWe were all trying to work out how the hell we could fix the Pill. We thought about it day and night.â"
"The invention of the pill was one of the most significant advancements in the fight for reproductive agency; it allowed us, as a society, to dramatically reconceptualize sexuality and gender relations. At the same time, our relationship to this groundbreaking medical technology has been shaped and con-strained by our own conceptions of what's "natural" and what defines a woman. Similar reproductive and sexually liberating advancements that target menâViagra, for instanceâhave not led to similar debates on what it means to be a man, or to have an "unnatural" hard-on. And while Viagra is covered by insurance, Dr. Naliboff says that most insurance companies do not cover extended cycle birth control to this day, even in cases where patients are on the pill for medical issues like primary ovarian insufficiency or endometriosis. The discrepancy in education and affordable access is telling: The normalization of placebo pills and subsequent withdrawal bleeding means that even in 2017, many women do not know that extended cycle pills exist, let alone that menstrual suppression is a safe option. Combined with the fact that the percentage of schools teaching students about contraception has declined drastically since 2000, this means that many women are likely to stay in the dark about their options when it comes to choosing whether or not they want to bleed once a month."
"Today, a growing movement of reproductive specialists has begun to campaign loudly against the standard twenty-eight-day pill regimen. The drug company Organon has come out with a new oral contraceptive, called Mircette, that cuts the seven-day placebo interval to two days. Patricia Sulak, a medical researcher at Texas A. & M. University, has shown that most women can probably stay on the Pill, straight through, for six to twelve weeks before they experience breakthrough bleeding or spot-ting. More recently, Sulak has documented precisely what the cost of the Pillâs monthly âoffâ week is. In a paper in the February issue of the journal ââObstetrics and Gyne-cologyââ, she and her colleagues documented something that will come as no surprise to most women on the Pill: during the placebo week, the number of users experiencing pelvic pain, bloating, and swelling more than triples, breast tenderness more than doubles, and headaches increase by almost fifty per cent. In other words, some women on the Pill continue to experience the kinds of side effects associated with normal menstruation. Sulakâs paper is a short, dry, academic work, of the sort intended for a narrow professional audience. But it is impossible to read it without being struck by the consequences of John Rockâs desire to please his church. In the past forty years, millions of women around the world have been given the Pill in such a way as to maximize their pain and suffering. And to what end? To pretend that the Pill was no more than a pharmaceutical version of the rhythm method?"
"In 1965, a brand called Oracon became the first to include placebo pills in its packaging. Oracon's most documented motivation behind the first placebo pills was to help women ensure that they were taking their pills correctly: Inactive pills meant that women now took a pill every single day, thus putting them on a more routine schedule and making it easier to notice if they'd missed one. Of course, the pill's engineers could have just as easily added an extra week of active pills so that women were still taking one a day. That, however, would have meant that women no longer bled once a month, and the 60s weren't quite ready for that. This formulaâthree weeks of hormonal pills, followed by one withdrawal week, complete with the requisite bleedingâremained unchanged for over 40 years. Then, in 2003, the drug company Barr released Seasonale. This was the first oral contraceptive to give women the option of foregoing monthly withdrawal bleeding; it contained 84 hormone pills and seven placebo pills. Women using this method would ex-perience withdrawal bleeding just four times a yearâor once per season, as the drug name intimated. Four years later, the FDA approved Lybrel, the first oral contraceptive to offer continuous active pills with no breaks for withdrawal bleeding whatsoever."
"The rapid increase in the world population makes it mandatory to develop new contraceptive methods. Disseminating reversible inexpensive and practical hormonal methods to developing countries is a target of many international agencies and funds."
"Today, the science is more settled, though there hasn't been a long-term study on the continuous use of oral contraceptives yet. But based on data from the long-term use of non-extended cycle birth control pills, which are chemically the same as extended cycle contraceptives, gy-necologists have largely reached the conclusion that the practice is safe. "At this point, I can't think of any OB/GYNs that would have a problem with [extended cycle oral contraception]," says Dr. Lauren Naliboff, a fellow at the American Con-gress of Obstetricians and Gynecologists. A study by the Cochrane organization found that women on extended cycle pills "fared better in terms of headaches, genital irritation, tiredness, bloating, and menstrual pain" than those on pills with monthly bleeding. A peer-reviewed article by Acta Obstetricia et Gynecologica Scandinavica acknowledged that long-term studies are lacking, but ultimately concluded that continuous use oral contraceptives showed no unique side effects beyond increased spotting, and still resulted in less "bleeding days" than non-continuous birth control pills. Philosophical and scientific debates aside, perhaps the largest barrier between women and their right to decide whether or not they want to bleed is a lack of information. Many women are una-ware that consistently skipping withdrawal bleeding is an option, let alone that extended cycle pills ex-ist, or that menstrual suppression can also be accomplished with hormonal IUDs, NuvaRing, birth control injections, and contraceptive patches."
"In the 1960s, manufacturers of the new birth-control pill imagined their ideal user as feminine, maternal and forgetful. She wanted discretion. She was married. And she wanted visible proof that her monthly cycle was normal and that she wasnât pregnant. In 2019, the user of the pill is perceived as an altogether different person. Sheâs unwed, probably would prefer to skip her period and is more forthright about when itâs that time of the month. As such, many birth-control brands now come in brightly colored rectangular packs that make no effort to be concealed. But one part of the equation remains: the week of placebo pills, in which hormones are abruptly withdrawn and a woman experiences what looks and feels a lot like her regular period â blood, cramps and all â but isnât. Physicians have widely described this pseudoperiod as medically unnecessary. So why do millions still endure it? Thatâs largely the legacy of two men: John Rock and David Wagner."
"We now have a clearer picture of the cancer risks associated with combined oral contraception. Compared with non-users, current users have an increased risk of being diagnosed with breast,11 cervical,12 or hepatocellular cancer.13 Hepatocellular cancer is rare in developed countries. The breast and cervical cancer risks decline after stopping oral contraception, returning to that of non-users within about 10 years.11,12 Conversely, combined oral contraceptive users have a reduced risk of endometrial,13 ovarian,14 and colorectal cancer.13 The ovarian and endometrial benefits appear to persist for many years after stopping oral contraception, perhaps more than 15 years.13,14 Limited evidence suggests that today's lower oestrogen dose formulations provide similar protection against endometrial and ovarian cancer as older, higher-dose preparations.15,16 At least within the RCGP cohort, the long-term cancer benefits appear to counterbalance the short-term harmful ones; indeed there may even be a net public health gain.8 Collectively, the research shows that benefits of oral contraception use outweigh risks, when provided appropriately. Importantly, prolonged use of oral contraception does not appear to reduce future fertility.17"
"In the early 20th century, Margaret Sanger became one of the most avid proponents of contraception in the United States. By 1950, she and Katharine McCormick had contracted with biologist Gregory Pincus to develop an effective birth control pill. A collaborative effort by Pincus and other researchers led to trials of the pill in Puerto Rico, Haiti, and Mexico between 1956 and 1957, which pro-vided the basis for an application to the Food and Drug Administration for approval of the first oral contraceptive."
"Over the last couple of decades a reduction of estrogen by at least 80% in combined oral contraceptives (OCs) and much research have resulted in effective and safe contraception. We still do not know longterm effects of OCs however. OCs may protect against endometrial and ovarian cancer. A link between current OC use and liver cancer exists in areas where liver cancer is rare. An association between OC use and cervical cancer disappears when researchers control for sexual activity and barrier method use. Some research shows OC use increases the risk of breast cancer, while other research does not. There does appear to be an increased risk of breast cancer developing in women younger than 46 years of age and who have used OCs for at least 10 years. Women who have a preexisting cardiovascular condition and/or smoke should not use OCs. OC progestogens may impair glucose metabolism in healthy women, but just for 6 months. Women with diabetes mellitus can use OCs, but may need to increase insulin intake. OCs can cause hypertension in 4-5% of healthy women and worsen hypertension in about 9-16% of hypertensive women. Progestogen-only OCs have fewer systemic side effects than combined OCs, but often cause menstrual changes. Their long term effects are not yet known. Injectables containing a progestogen cause few, if any, adverse effects. The subdermal implant, Norplant, tends to cause menstrual disturbances, but is safe and effective. Progestogen - only vaginal rings are as effective as progestogen-only OCs, but menstrual irregularities are common. Failure rates for combined vaginal rings match those of combined OCs. Long-term effects of vaginal rings are not known. Postcoital contraception does not cause serious side effects, but may cause vomiting and menstrual irregularities. A levonorgestrel-releasing IUD is effective and reduces menstrual blood loss, sometimes resulting in amenorrhea. Hormonal injections in men are unlikely in the near future."
"The large influx of poor immigrants and advocacy by women's rights groups provided the impetus for the birth control movement of the early 1900s. The subsequent development of the oral contraceptive pill gave women, for the first time, the ability to control their fertility."
"In subsequent years, resourceful investigators produced scores of originally (and sometimes peculiarly) shaped plastic IUDs. One of these was the notorious Dalkon Shield fitted by the inventor (Dr H.J. Davis, 1970) with a soft sheath filled with hundreds of nylon filaments instead of the usual stiff monofilament polyethylene thread. Serious, and even lethal, infections were observed, and it was claimed that the tailpiece of the Shield IUD acted as a wick conveying bacteria from the vagina upward into the uterine cavity. The thousands of lawsuits which followed discredited the inventor of the Dalkon Shield, caused financial ruin to the producer ( A.H. Robbins Corporation) and had a deleterious effect on the practice of intrauterine contraception."
"In fact, Dr Lippes had a predecessor in this field; Dr Lazar C. Margulies (Figure 4). Dr Margulies was born in Galicia (now part of Poland) in 1895. As a medical student, he had served in the Austro-Hungarian army during World War I. Following the armistice, he graduated from the University of Vienna in 1921, where he specialized in obstetrics and gynecology. He started practising in Vienna, but, expelled from the hospital, this Jewish gynecologist emigrated to the USA in 1941. In New York City he joined the staff of the Mount Sinai Medical Center in 1954 and was promoted to Associate Professor 9 years later. Dr Margulies died of a cerebral hemorrhage in 1982. His Chief at Mount Sinai, Dr Alan Guttmacher, who had opposed intrauterine contraception during Gräfenberg's life (Gräfenberg himself had practised at Mount Sinai for a decade and a ha1f) encouraged Dr Margulies to attempt to improve the Silver Ring. Most certainly, Guttmacher's change of mind was prompted by the alarm over the world's demographic surge, and was reinforced by the 1959 IUD papers from Israel and Japan. Gambling on the use of thermoplastics, Dr Margulies conceived his famous spiral-shaped IUD in 1960, the Perma-Spiral, marketed by the Ortho Pharmaceutical Company as Gynecoil. To insert the Margulies Spiral, the unwound device was introduced into a thin plastic tube and expelled with a plastic plunger. Dr Lippes later borrowed this technique for the insertion of his Loop IUD."
"Because the first intrauterine contraceptive device proposed by Dr Richard Richter in 1909 was ignored, the Silver Ring of Dr Ernst Gräfenberg (1928) is currently labeled as the prototype of modern IUD generations. The Ring of Gräfenberg, however, was proscribed in the 1930s, and, although the basis for the condemnation was more political than scientific, three decades had passed before the rebirth and general acceptance of intrauterine contraception. The development of the plastic IUDs, announced by Dr Lazar Margulies and Dr Jack Lippes in 1960-61, solved the insertion problem of metallic IUDs, but did not eliminate the main side-effects, that is, bleeding and pain. In 1969, the first copper-bearing device was introduced by Dr Jaime Zipper and Dr Howard Tatum. The metallic contraceptive adjuvant, though allowing reduction of the platform size, did not solve the menorrhagia problem. This was achieved by Dr Tapani Luukkainen thanks to the invention of the gestagen- releasing IUD (Ng Nova-T) in 1977. The final step in IUD engineering was the invention of the GyneFix, a flexible, frameless copper-bearing IUD anchored permanently to the uterine tissues, which the inventor (Dr Dirk Wildemeersch) calls an intrauterine contraceptive implant or IUCI."
"In 1961, when the pill was introduced to Britain, women pushed their, often reluctant, doctors to give them the drug. By the late 1960s, young women were talking about a revolution in womenâs sexual attitudes, but since then the suggestion that the pill just meant women couldnât say no has been widely repeated, alongside negative assessments of the âsexual revolutionâ. As early as the 1880s, there had been suggestions that fear of pregnancy gave wives an excuse for denying their husbands their conjugal right of sexual intercourse. By the early 1990s, over 80 per cent of British women of reproductive age since the early 1960s had taken the pill."
"In Japan, Dr. Tenrei Ota, born in 1900, began pioneering intrauterine contraception in the 1930s. Once his country had joined the Axis and contraception was forbidden, Dr Ota became a political target, changed his name and finally went into hiding. As a consequence, knowledge of the Ota Ring would reach the Western world only after the end of World War II. Dr Ota had initiated his experiments in intrauterine contraception by inserting objects made from a great variety of materials and shapes, from gold spheres to coils of human hair. Since the rudimentary IUDs were expelled too easily, he decided, in 1933, to modify the Gräfenberg Ring (of which he had heard but never seen). He stiffened the Silver Ring by providing it with a central disc attached to the outer ring by spokes. Dr Ota called his silver or gold IUD the 'Precea Ring', âprecea' being Anglo-Japanese for 'pressure'. The Pressure Ring was to remain popular in Japan well into the 1980s. Less well-known is that Dr Ota may have been the first physician to devise a plastic IUD. However, the inferior quality of plastic material put at his disposal ruined the idea."
"In 1909, an authoritative German medical journal, Deutsche medizinische Wochenschrift, published a paper by Dr Richter of Waldenburg (near Breslaw) entitled 'Ein Mittel zur VerhĂźtung der Konzeption' (a means of preventing conception). Because of the taboo surrounding contraception, the very title of the article will no doubt have surprised many readers and shocked some. The device described by Dr Richter was the first genuine IUD. It consisted of two strands of coarse silkworm gut (crin de Florence) wound in a particular pattern, the free ends of which were capped with celluloid to prevent injury to the endometrium. The threads were united by a thin bronze filament to diagnose expulsion and to facilitate retrieval of the IUD, which was inserted using a metal female bladder catheter. Dr Richter's invention had no impact on the practice of birth control and clinical data were never supplied. Contraception continued to use the traditional interuterine devices, for example, the metal wishbone spring pessary patented by Dr Carl Hollweg (1902) and the cervico-uterine pessary made of silkworm gut attached to a cervical glass button described by Dr Karl Pust."
"In the 1940s, alarm about the worlds burgeoning population, and the naive belief that the phenomenon could be curbed by the introduction of improved contraceptive methods, led to extensive research in the USA. The results of these endeavors were the pill and the plastic IUD. Plastic devices solved the problem inherent in the insertion and retrieval of the Rings of Gräfenberg and Ota. Made of thermoplastics, the new IUDs were given a memory of their original shape, could be straightened to fit inside a narrow straw-type inserter tube and regained their initial contour after introduction into the uterus. The notion that intrauterine contraception is safe and effective was proven in the early 1960s by the medical statistician Dr Christopher Tietze (1908-84), a Jewish emigrant to the USA, and a great admirer of Gräfenberg (Figure 2). Having collected and analyzed clinical results obtained with the Gräfenberg and Ota Rings, Dr Tietze organized the first international symposium on intrauterine contraception in New York City in 1962, sponsored by the Population Council. At the conference, the pioneers of the plastic devices, Dr Margulies and Dr Lippes, were invited to demonstrate their invention and report preliminary clinical results."
"In 1962, Population Council gave Guttmacher a grant âto travel around the world to assess what methods of birth control they should back.â He reported that conventional contraceptives were not working and advised the council to invest in development of the IUD. The council invited forty-two clinicians to a conference on intrauterine contraception. Tietze remembered the âconspirational airâ that surrounded the conference âIt was a very exiting period. . . . we were working with something that had been absolutely rejected by the profession . . . we had a great feeling of urgency to produce a method that worked. It seemed to work. Now we had to establish it. And we had to start from scratch.â The council invested more than $2.5 million in the clinical testing, improvement, and statistical evaluation of the IUD, which proved to be highly effective for the approximately seven out of ten women who could retain one. Tietze, an unusually candid man with the habit of precise expression, recalls the care with which clinicians were recruited and the effort poured into making sure that their records were accurate. There was such a feeling of urgency among professional people, not among the masses, but something had to be done. And this was something that you could do to the people rather than something people could do for themselves. So it made it very attractive to the doers. Armed at last with a method that was inexpensive and required little motivation from the user beyond initial acceptance, family planning programs began to have an effect on birth rates in South Korea, Taiwan, and Pakistan. By 1967 a review article in Demography criticized the over optimism of the Population Council technocrats about the prospects for controlling world population growth. Other social scientists claimed that population control was getting too much of the development dollar and pointed out that population control was no substitute for social justice. Lower birth rates did not guarantee a better society. Whether or not world population growth could be controlled remained an unanswered question."
"There are two inconsistencies in the âpro-lifeâ movement from the viewpoint of pro-choices: There appears to be relatively little mention of IUDâs (Intra-uterine devices). The precise mechanism by which IUDS prevent pregnancy is unknown. Some researchers believe that the IUD immobilizes sperm, preventing them from reaching the ovum. Others believe that it causes the ovum to pass through the fallopian tube so fast that it is unlikely to be fertilized. Most believe that the IUD interferes with the implantation of fertilized ovum in the uterine wall. If the third property is true, then IUDs terminate the development of a fertilized ovum after conception, and cause its expulsion from the body. To a person who believes that human personhood begins at the instant of conception, there is no difference between using an IUD, having a first trimester abortion, or having a partial birth abortion, or âfor that matter âstrangling a newborn just after birth. Yet pro-life groups actively campaign against PBAâs, picket abortion clinics, and attempt to pass restrictive legislation limiting choice in abortion. Some have made negative statements about IUDs. But none have, to our knowledge, picketed IUD manufacturing facilities, or sponsored anti-IUD legislation. This is surprising, because in those countries where IUDs are widely used, the number of fertilized eggs which IUDs apparently expel from womenâs bodies far exceeds the number of surgical abortions. About 43% of American women will have had a surgical abortion sometime during their lifetime. Women who use an IUD will expel about one fertilized ovum annually (assuming that they engage in intercourse once per week) IUDS are becoming increasingly popular. Two studies have reported effectiveness rates of 99.4 and 99.9%"
"By the late 1960s discussion of the population problems of underdeveloped countries had helped to stimulate renewed interest in family planning programs in the United States. Happy, there was a growing discussion about the social and philosophical issues involved in the management of human reproduction, whereas only a decade before, informed interest had been limited to a few social scientists. The whole nature of the debate, however, as well as the prospects for controlling population growth, had been radically altered by the availability of the plastic intrauterine device, an American gift to the world."
"Dr J. Lippes (Figure 3) is an example of the thoroughbred American (born at Buffalo, NY in 1925), who since 1957 has been Head of the Department of Obstetrics and Gynecology of the State University of New York at Buffalo. Although he had become acquainted with the Gräfenberg Ring in 1952, he had not dared to use it for fear of being accused of malpractice. Seven years later, two papers on intrauterine contraception appeared, both in English. The first, written by the Japanese gynecologist Ishihama and published in the Yokohama Medical Journal, gave an enthusiastic clinical assessment of the Ota Ring. In the second paper, Dr W. Oppenheimer of Jerusalem overviewed the results of three decades of personal experience with the modified Silk Ring. The fact that the latter paper had been accepted by the authoritative American journal of Obstetrics and Gynecology was perceived by Dr Lippes as a sign that intrauterine contraception had become a discussable subject in his country. That same year he started inserting Silk and Presea Rings under the auspices of the Buffalo PIanned Parenthood Center. The former device being too flexible, and the latter too stiff, Dr Lippes decided to remove the spokes from the Ota Ring and affix a piece of monofilament nylon to the IUD to facilitate removal and to allow the wearer to check that the device was still present. However, the modified Ring tended to rotate in utero and to wind the marker thread into the cavity, eliminating its intended uses. Therefore, to prevent IUD rotation, a radical change of shape was needed. After many experiments, the double-S Loop (the Lippes Loop) emerged in 1961. Due to its particular shape (trapezoid), the Lippes Loop fits the (relaxed uterine cavity snugly. The Lippes Loop was to become extremely popular and, of all first-generation IUDs, had the greatest worldwide impact."
"[T]he pill did produce a situation in which these pre-existing social conditions led to a new twist on male sexual exploitation of young single women in the 1960s. Throughout the nineteenth and twentieth centuries, the family, the Church, and later schools had attempted to supervise and control unmarried womenâs sexual behavior. In this social setting women might have had to struggle against persuasive male arguments and persistent groping but they had the entire weight of society, backed up by the ulti-mate sanction of pregnancy, supporting them if they did not wish to have intercourse. In the 1960s the arrival of the pill meant that for the first time women could have confidence that they would not get pregnant. There is a new sense of excitement and possibilities present in many accounts by heterosexual women who were young and single at this time. In choosing to reject the control of their sexual be-haviour they saw themselves as rejecting control over their lives as a whole However, abandoning the traditional moral position left many confused, with no substantial arguments against casual or dishonest male sexual exploitation. By the early 1970s, men assumed fashionable young women were on the pill and statistics show that well over half actually were."
"Matching a cap to a woman depends on multiple factors related to the angle, shape, and size of her cervix. Careful attention to the anatomy of the cervix is essential when fitting a woman for a cap. An assessment of the angle at which the cervix enters the vagina is crucial. If the capâs rim can be touched by the penis during intercourse, then the potential for cap displacement is greatly increased. The length of the cervix must also be assessed. If the cervix is exceptionally long or short, it may be impossible to create a suction between the cervix and the capâs interior."
"The cervical cap, used even in antiquity, has been modified and improved so that it now promises to be an effective, safe, and convenient method of fertility control. Gynecologist U. Freese and dentist R. Goepp, working at The University of Chicago, have combined the techniques of their 2 disciplines to provide this improved form of the cervical cap. Using dental techniques, a method has been established for fitting the cervical cap exactly to the individual cervix. Such a method allows for longterm use of the device without appreciable dislodgment and odor. The method is comfortable and permits sexual spontaneity. No chemical spermicides are necessary. A 1-way valve in the cap allows the menstrual flow to be released each month without removal of the device. Minimal time and cost are required for the initial fitting. Most women will be able to remove and replace their own caps."
"A follow-up study on 130 women fitted with a cervical cap over a 12-month period drew a response rate of 43% (56 respondents). The group was young, well educated, and highly motivated. The failure rate was 16.9 per 100 women years (Pearl method), with inconsistent use and dislodgement being of major importance. The continuation rate was 75% (minimum 3 months of use), and 84% expressed satisfaction with the method. No significant side effects or risks to health were encountered. The conclusion is that there is a significant demand for alternative contraceptive methods among a select group of women. However, in the present state of knowledge, use of the cap should probably not be encouraged as a primary means of contraception, but should be reserved for those women with multiple contraceptive problems or for highly motivated women who seek out this means, understand its limitations, and can accept the relative uncertainty of its effectiveness."
"In 1977, Ruth Hall felt there was âlittle evidence to support Stonesâ belief that the vaginal pessary [diaphragm] would stretch vaginal wallsâ. Yet diaphragms came in sizes ranging from 5 to 9 centimetres in diameter and there was no consensus as to whether the use of larger sizes was more or less uncomfortable for users. As vaginas vary in size, the larger sizes must have stretched the vaginal walls and, in some women, pressed on the bladder or otherwise caused discomfort. This is another example of the willingness to see the vagina as inactive."
"The Condum being the best, if not the only Preservative our Libertines have found out at present... yet, by reason of its blunting the Sensation, I have heard some of them acknowledge, that they had often chose to risque a Clap, rather than engage cum Hastis sic clypeatis [with spears thus sheathed]."
"Armour against enjoyment, and a spider web against danger."
"Giovanni Giacomo Casanova takes credit in his autobiography for inventing a primitive version of the diaphragm/cervical cap (Suitters, 1967). He placed the partly squeezed halves of lemons over his loversâ cervices. Casanova was exaggerating his own inventiveness. Similar devices had been used for centuries around the world. Asian sex workers applied oiled paper discs to their cervices. The women of Easter Island used algae and seaweed (Himes, 1963). Sponge, tissue paper, beeswax, rubber, wool, pepper, seeds, silver, tree roots, rock salt, fruits, vegetables, and even balls of opium have all been used to cover the cervix in an attempt to prevent unintended pregnancy (Himes, 1963; London, 1998; Skuy, 1995). In 1838, German gynecologist Friedrich Wilde created rubber âpessariesâ for individual patients with custom-made molds. Wildeâs pessaries resembled today's cervical caps. He used modern materials to imitate the traditional German custom of applying disks of melted and molded beeswax to the cervix to prevent conception. Primitive rubber pessaries were made by Connecticut inventor Charles Goodyear in the 1850s (Himes, 1963). Pharmacies sold them to married women, supposedly to support the uterus or hold medication in place (Chesler, 1992). By 1864, the British medical association was able to list 123 kinds of pessaries being used throughout the empire (Asbell, 1995). In America, sponges enclosed in silk nets with drawstrings attached were commonly used and advertised in newspapers and magazines (London, 1998). But the Comstock laws that were enacted in the 1870s suppressed the dissemination of contraceptive devices and information in the U.S. (Chesler, 1992)."
"By 1941, most doctors recommended the diaphragm as the most effective method of contraception (Tone, 2001). But with the invention of the pill and the increased popularity of the IUD, the diaphragm and cervical cap fell out of favor during the 1960s. Diaphragms continued to be available but U.S. companies stopped producing cervical caps. When the early high-estrogen birth control pills and certain IUDs were found to cause medical problems, American women increasingly returned to using simple barrier methods that didnât affect their hormones or menstrual cycles (Bullough & Bullough, 1990). Diaphragms became quite popular again, but the cervical cap had disappeared from the American scene (Chalker, 1987). The Food and Drug Administration approved the Prentif Cavity-Rim Cervical Cap for use in this country in May 23, 1988 âŻnearly 60 years after it was introduced in the United Kingdom. Strenuous efforts by clinicians affiliated with feminist health centers had brought the cap back to America (Bullough & Bullough, 1990). But by 2002, the Prentif cervical cap was displaced in the marketplace by FemCapÂŽ (Cates & Stewart, 2004). Today, fewer than 0.01 percent of U.S women rely on diaphragms and caps for contraception (CDC, 2010)."
"Years of disappointment had taught Pincus that it wasnât always the science that determined an experimentâs success; it was often the forces surrounding the science, including public sentiment. Now that Pincus had settled roughly on the hormone progesterone as the key to his pill, he needed to build the team to do the scientific work, forge alliances with manufacturers, conduct his trials, and, if all went well, spread the news of the coming invention so that it might have a chance at acceptance. He knew that his progestins (synthetic forms of progesterone) stopped ovulation in rabbits and rats. The next step was to test them on women. And to do that, he would have to add a player to his teamâa doctor who could reassure patients they were safe and would convey to the drug companies supplying the drugs that no one would be harmed. There had never been a medicine made for healthy people beforeâand certainly not one that would be taken every day. The risks were enormous. Pincus settled on a physician named John Rock, a gynecologist respected by his peers and adored by his patients. Rock looked like a family physician from central casting in Hollywood: tall, slender, and silver-haired, with a gentle smile and a calm, deliberate manner. Even his name connoted strength, solidity, and reliability. Rock had one more thing going for him: He was Catholic."
"As only one underpowered study was identified, we cannot distinguish between the contraceptive effectiveness of the diaphragm with and without spermicide. We cannot draw any conclusion at this point, further research is needed. However, the study provides no evidence to change the commonly recommended practice of using the diaphragm with spermicide."
"Marie Stopes had championed her âPro-Raceâ version of the rubber cervical cap because the diaphragm âmust be worn so as to cover the whole of the end of the vagina and depends on stretching the vaginal walls to stay in positionâŚ[so] certain movements of physiological value (particularly to the man) which ideally the woman should make are then impossibleâ. Van de Velde agreed with Stopes that the diaphragm limited vaginal movements but he commented dismissively that most âwomen to-day are not able to operate their pelvic muscles voluntarily to the best advantage in coitus, so the inability to do so would not represent any appreciable loss to themâ. It is possible that the sexual upbringings of women over generations ensured they were unaware of the range of movement the muscles associated with vagina were capable of."
"The diaphragm played a special role in Margaret Sangerâs effort to rescue America from the Comstock laws. During a trip to Holland in 1915, she learned about the use of snugly fitting spring-loaded diaphragms that were developed in Germany during the 1880s. In 1916, she was arrested and sent to jail for telling women about them. Her month in jail only strengthened her resolve to teach women how to use diaphragms âshe even taught diaphragm use to the women she was with in jail (Chesler, 1992). Sanger had to find a way around the Comstock laws, which prohibited the transport of birth control devices or information through the mail. Her solution, clever âŻas well as illegal âŻalso involved the diaphragm (Chesler, 1992). Sanger's second husband, Noah Slee, owned the company that manufactured 3-IN-ONE Oil, a lubricant for metal parts. Slee imported diaphragms from manufacturers in Germany and Holland to his factory in Montreal. He had the diaphragms packed in 3-IN-ONE cartons and shipped to New York (Chesler, 1992). Slee also solved Sangerâs difficulty obtaining contraceptive jelly to use with the diaphragm. He got the German formula and manufactured the jelly âŻillegally⯠at his plant in Rahway, New Jersey. In 1925, he put up the money for founding the Holland-Rantos Company, which manufactured the first American diaphragms, and ended the need for contraband versions (Chesler, 1992). Sanger met a Japanese physician at an international conference on birth control and got him to mail her a package of diaphragms in 1932, but the package was confiscated by U.S. Customs officers. Undeterred, Sanger decided to test the Comstock laws that forbade distribution of contraceptives and contraceptive information through the mail (Chesler, 1992). She arranged to have another package of diaphragms mailed from Japan to Dr. Hannah Meyer Stone, a New York City physician who supported Sanger's crusade for reproductive rights. This package was also seized by Customs (Chesler, 1992). In 1936, Manhattan Judge Augustus Hand, writing for the U.S. Court of Appeals of the Second Circuit, ruled that the package could be delivered. The case, United States v. One Packageâsaid package âcontaining 120 rubber pessaries, more or less, being articles to prevent conceptionâ âŻwas a watershed in U.S. birth control history. It severely weakened the federal Comstock law that had prevented dissemination of contraceptive information and supplies since 1873 (Chesler, 1992)."
"By 1941, most doctors recommended the diaphragm as the most effective method of contraception (Tone, 2001). But with the invention of the pill and the increased popularity of the IUD, the diaphragm and cervical cap fell out of favor during the 1960s. Diaphragms continued to be available but U.S. companies stopped producing cervical caps. When the early high-estrogen birth control pills and certain IUDs were found to cause medical problems, American women increasingly returned to using simple barrier methods that didnât affect their hormones or menstrual cycles (Bullough & Bullough, 1990). Diaphragms became quite popular again, but the cervical cap had disappeared from the American scene (Chalker, 1987). The Food and Drug Administration approved the Prentif Cavity-Rim Cervical Cap for use in this country in May 23, 1988 âŻnearly 60 years after it was introduced in the United Kingdom. Strenuous efforts by clinicians affiliated with feminist health centers had brought the cap back to America (Bullough & Bullough, 1990). But by 2002, the Prentif cervical cap was displaced in the marketplace by FemCapÂŽ (Cates & Stewart, 2004).Today, fewer than 0.01 percent of U.S women rely on diaphragms and caps for contraception (CDC, 2010)."
"The cervical cap is an ancient method of contraception revitalized during the 1970s by feminist health care practitioners. It acts as a contraceptive both mechanically and chemically. This study looks at the effectiveness and satisfaction of the cervical cap in 76 women fitted over a 1-year period. The cap is 80.4% effective according to the Pearl Index and 89% of the women are satisfied with using the cap. There is a 51 % continuation rate over a 1-year period. The cervical cap appears to have a satisfactory rate of contraception when compared with other barrier methods and women are adept at its use. A significant finding is that most pregnancies occur in the first three months of cap use. A much higher effectiveness is seen subsequently."
"The cervical cap is a small barrier device which can be filled with spermicidal agent and placed over the cervix. Protocol at the authorsâ practice recommends that women fill the caps two-thirds full with a contraceptive agent containing 5% nonoxynol-9 spermicide. The cap can be left in place for a maximum of seven consecutive days without further attention provided the cap retains its spermicide. The cap should be removed when menstruation begins. Currently, there are no contraceptive caps manufactured in the United States. However, there are several types of cervical caps available from Europe. (The caps discussed below are available from Lamberts (Dalston) Ltd., Queens-bridge Road, London, England: approximate price, $11.00.)"
"During the ninth century, a Persian physician recommended inserting into the cervix paper wound tightly into the shape of a probe, tied with a string and smeared with ginger water (Manisoff, 1973). Also, during certain rituals, the Maori people of New Zealand put small pebbles into womenâs vaginas to make them âsterile as stonesâ (Himes, 1963). Similarly, Casanova, who claimed to have invented almost everything that has to do with sex, soaked a small gold ball in an alkaline solution and inserted it in his loverâs vagina (Suitters, 1967)."
"The IUD is now safer than ever than ever before and it has excellent credentials. Both the World Health Organization and the American Medical Association name it among the safest, most effective, and least expensive reversible methods of birth control available to women (Knowles &Ringel, 1998)"
"Tietzeâs new studies showed that population control programs with conventional methods âwere getting nowhere fast.â Intensive review of old methods continued, but reported results remained contradictory, probably reflecting differences in motivation between populations. Some members of the Population Council were convinced by the futility of programs based on conventional methods that something better had to be found. Frank Notestein, who succeeded Fredrick Osborn as president of the Population Council in 1958, remembers his frustration in knowing that something had to be done to control rapid population growth but lacking the contraceptive means that would enable the council to take decisive action. âIâve never been in another situation in my life that made me feel so helpless.â It was this sense of urgency which prompted a reevaluation of intrauterine devices."
"Alan F. Guttmacher, chief of obstetrics at Mount Sinai Hospital in New York City and a member of the medical advisory committee of the council, had warned against intrauterine devices in his popular marriage manual, but when a member of his department at Mount Sinai approached him in 1958 with an idea for a new kind of IUD, Guttmacher listened. Dr.Lazar Margulies, who was Berlin trained and who had used an intrauterine device in the late twenties in Berlin came to me with the idea that an intrauterine device could be made of molded plastic and the advantage was that you could stretch it to a linear form. . . and it would resume its original shape. Marguies has been inspired to give the old method a second look when he heard John Rock, the Harvard gynecologist who had served on the AMA committee on contraception in the 1930s and who has the object of an intense lobbying effort by Robert Dickinson, lecture on the dangers of overpopulation. The substitution of plastic for wire meant that the device could be inserted without dilating the cervix (stretching the mouth of the womb), a painful procedure that required local anesthesia. The molded plastic coil was unwound into a thin rod, the rod slipped into the uterus, and the coil pushed out of the rod into the uterus, where it regained its original shape. Guttmacher allowed Margulies to try out the device âwith some fear and hesitation because I was taught in medical school how dangerous the intrauterine device was.â They worked. Patients did not die of pelvic inflammatory disease or develop galloping cancer."
"The history of the intrauterine device is remarkably short and its survival has been jeopardized several times from the beginning when Gräfenberg introduced the intrauterine ring in 1928, and later when product liability claims in the USA forced companies to withdraw the IUD from the market. However, a revival is happening, and one of the withdrawn copper IUDs has been re-introduced in the USA. In the 1980s, pessimism about the future of the IUD was based on the fact that there are still two major imperfections inherent in intrauterine contraception: its lack of protection against both 'gyne' and sexually transmitted disease."
"Intrauterine devices (IUDs) were derived from what Marie Stopes (1924) called the interuterine devices, conceived for therapeutic purposes and used in later years for providing contraception. Because an interuterine device connects the external environment (vagina) with the internal genital tract, pelvic inflammatory disease was a frequent complication in an era when gonorrhea was endemic and no adequate therapeutic measures were available. To avert the inherent infective hazard, interuterine devices were replaced by IUDs. The IUD has had a troubled history. Initially ignored by the medical profession, it courted a flourishing period during the early 1930s, which soon came to an end due to largely non-medical reasons. The rehabilitation of intrauterine contraception started in the USA in the early 1960s, as a result of a change of mentality concerning the acceptability of birth control in general, the discovery of the phenomenon of the population explosion, and the introduction of improved IUDs. This review gives an overview of the evolution of intrauterine contraception, focusing on the scientists who were innovative in this field."
"Conscious of the hazards inherent in the use of interuterine devices, Dr Grafenberg took up the search for the serviceable IUD in the early 1920s. Whether he knew about Dr Richter's pessary remains an open question. Initially, he used star-shaped devices and coils of silkworm gut (1924). Because they were expelled too readily, he conceived the Ring IUD, made of helicoidal1y wound silver filaments, which still bears his name. He did not hesitate to publish clinical results (1928-30), thus making his invention known beyond the boundaries of his native Germany. Shortly thereafter, other European physicians added statistics, issuing an increasing number of damaging reports of pelvic inflammatory disease associated with IUD use. Gräfenberg's last presentation on the subject was in 1931 at the German Congress of Gynecology in Frankfurt. His report was denounced by virtually all leaders of German gynecology attending the congress, who branded intrauterine contraception as a medically unacceptable method of birth control. Shortly thereafter, the streamroller of the Nazi regime started poisoning the air of Germany. Jewish physicians were removed from the hospital posts and contraception was proclaimed to be a threat to the physical and mental health of Aryan women. Ultimately, the advertising of contraceptives and/or contraceptive advice became illegal in Germany and the other Axis States. Barred from practice and research, ostracized by his colleagues and persecuted by the authorities, Dr Gräfenberg left Germany in 1940. He arrived in New York in 1941, where he resumed a busy life as an obstetrician and gynecologist. His scientific reputation opened the doors of a teaching hospital (Mount Sinai Medical Center) and the New York Birth Control Clinical Research Bureau (later renamed Margaret Sanger Research Bureau after the nurse who convinced America that control of conception is a basic human right). Dr Gräfenberg was able to resume his research, but in America, as well as in Europe, the fight for the acceptance of family planning had not yet been won. Notwithstanding these barriers, Dr Gräfenberg, according to his friend and his former Berlin assistant Dr Hans Lehfeld, transgressed medical rules and continued to use the Ring, albeit in private practice and in secret."
"Legend has it that Arab camel drivers inspired the modern IUD. According to the story, tiny stones were inserted into the uterus of each female camel to prevent pregnancy during long caravan journeys across the desert (Bullough & Bullough, 1990). The story was a tall tale told to entertain delegates at a scientific conference on family planning, but it was repeated so many times that many people have assumed it is true (Thomsen, 1988)."