Birth Control Bullies: When He Wants Your Method to Fail

So I was doing some research for this week’s post and came across an awesome article on birth control sabotage.  To my surprise,  it was written by none other than the Medical Director of New Generation Health Center Grace Shih!  Birth control sabotage “means someone is bullying or intimidating their partner into sexual situations that put them at risk for an unwanted pregnancy.”  This wasn’t what I had originally set out to write about for this week’s post but knowing how important and serious this issue is,  I didn’t think it should wait.

Messing with a partner’s birth control is abuse—and it may be depressingly common.

by Grace Shih, MD, MAS

When I was training to become a doctor,  one of my patients was a 25-year-old woman.  She already had one child and didn’t want to get pregnant again.  She’d been using the birth control patch,  but came to me because the patch wasn’t working for her.  When I asked her “why not?” she said,  “Because when my boyfriend sees it,  he pulls it off me.”

That was my first encounter with birth control sabotage.  Birth control sabotage is a form of reproductive coercion, which is a fancy term for a simple but disturbing idea… It means someone is bullying or intimidating their partner into sexual situations that put them at risk for an unwanted pregnancy.  It could mean that a partner is sabotaging a woman’s birth control,  like my patient.  It also includes a partner threatening violence or threatening to leave if a woman doesn’t get pregnant.

Reproductive coercion is abuse—and it may be depressingly common.

There is evidence that birth control sabotage is common,  although we need more research to understand exactly how common.  Birth control sabotage can take many forms.  For example,  women have reported:

• Partners poking holes in condoms or taking condoms off during sex,
• Partners hiding or throwing away birth control pills, and
• Partners removing the ring , or even an IUD.

We do know that all types of reproductive coercion are more common in relationships that have physical or sexual violence.  In the U.S.,  approximately one in four women have experienced physical or sexual violence with a partner at least once during their lifetime.

So what can you do?

If your partner is controlling your birth control,  it is a sign of a larger relationship problem.  All women should be able to protect their bodies from an unwanted pregnancy without threats or sabotage.  You deserve to be with someone who respects you and your plans for the future—including when or whether you want to have a baby.

• If you want support to get out of a violent relationship,  call the National Hotline anytime 24/7 at 800-799-SAFE, or talk to your healthcare provider about local resources.
• If you have friends who can help keep you safe,  connect with them privately using the Circle of Six app on your smart phone.
• There are also online projects like Know More, Say More that are designed to help stop birth control bullying and other types of reproductive coercion.

In the meantime, try tamper-proof birth control.

Ideally your partner should support your birth control choices,  but if you find yourself involved with someone who you suspect wants to get you pregnant against your will,  there are some methods your partner can’t mess with.

The Shot (a.k.a. Depo-Provera): Once you get the shot,  there is no way a partner can change or mess with it—or even know you’ve had it if you don’t tell them.  Each shot lasts for 3 months, so you have to be able to get to the clinic regularly if you want to keep using it.

The Implant: It sits just under the skin on the inside of your upper arm,  so your partner wouldn’t notice it unless he went looking for it.  If your partner does,  he might find it since insertion leaves a bruise for a few weeks.  The implant can last for up to three years,  so it could be more convenient than the shot.

The IUD:  It’s placed in your uterus,  where it should be discreet and difficult to tamper with.  It has small strings that can be tucked behind your cervix when the IUD is placed so that a partner won’t notice them during sex.  If you want an IUD but you’re concerned about a partner finding the strings,  talk to your doctor about possible solutions.

In a bind, there’s emergency contraception:  Actually, the most effective form of EC is the ParaGard IUD.  It is over 99% effective in preventing pregnancy up to 5 days after unprotected sex and it goes on to provide up to 12 years of protection from pregnancy.  The other forms of emergency contraception are pills like Plan B,  Next Choice,  and ella. You need a prescription for ella, but you may be able to get Plan B or Next Choice at your local pharmacy without a prescription depending on your age and where you live. (Insert from Shawna:  You can get Next Choice from us here at NGHC – no appointment necessary! As well as the above mentioned methods).

Grace Shih, MD, MAS, is an Assistant Clinical Professor in the Department of Family and Community Medicine at the University of California, San Francisco. She has a family medicine practice at the San Francisco General Hospital’s Family Health Center. When she’s not seeing patients, you can find her cooking, hiking, or salsa dancing.

The BEST Thing to Wear??? A SMILE!!!!

Happy Thursday Everyone!!!

This week I wanted to share with you a video I feel desperately needs to be seen by all girls and women,  and everyone else for that matter!  I say this because so often girls and women feel that they aren’t beautiful.  There are millions of television,  radio,  and print ads that make us believe that our bodies are unacceptable and in need of constant improvement.  These ads not only tell us what our flaws are and what products we need to buy to fix them,  but they show us images that are airbrushed and touched up to meet impossible standards.

Apparently it works because 80% of U.S. women claim to be dissatisfied with their appearance (Smolak, 1996)!

Well,  I want you to know that you are BEAUTIFUL!  Beautiful for everything that makes you uniquely YOU.  Beautiful not just for what you look like but more importantly for who you are!!!!

In happiness & health,

Shawna

Smolak, L. (1996). National Eating Disorders Association/Next Door Neighbors Puppet Guide Book.

Today is NATIONAL COMING OUT DAY!

Today is National Coming Out Day!  For 24 years now,  October 11th has been the day to celebrate those who have had the courage to openly identify as lesbian,  gay,  bisexual,  transgendered,  queer,  intersex,  & questioning  (LGBTQIQ).  Although coming out is different for every person,  many people experience a lot of pain and anguish.  That is because there are many people who believe that being anything other than heterosexual (man & woman) is wrong.  Unfortunately,  there are not only people who feel that being LGBTQIQ is wrong but that it is okay to bully those who identify as such.  Therefore,  many LGBTQIQ  youth experience fear,  doubt,  loneliness,  anger,  and even depression.

While this journey can be tough for many LGBTQIQ teens  (and their allies – friends and family who support them),  it can be exciting to truly be who they are,  100%,  without holding back.  Here at New Generation Health Center we want you to know that we fully support all people,  of all backgrounds and sexual preferences.  We feel that every person has the right to happiness and health.  It’s important for us here at NGHC to help create a world where people feel safe being who they are and to know that we support them as they show themselves in a different light,  as they try new things,  meet new friends,  and keep learning about themselves everyday!

So today,  on behalf of everyone here at NGHC,  HAPPY NATIONAL COMING OUT DAY!!!

We stand by your side!  We stand by the side of those who still may be exploring their sexual orientation,  those who identify as LGBTQIQ,  those who are allies,  and everyone else in this journey of life as a sexual being.

And on that note of support,  along with some bay area pride,  here is a message of support from the SF Giants and SF 49’ers!!!

In happiness & health,

Shawna and the rest of the New Generation Health Center crew!

ITCHING to Know What’s Going On???

Hi Shawna,

A couple of days ago “down there” began to itch really bad and yesterday I started having thick, white stuff come out. What is going on? It really bothers me and it’s embarrassing.
Help!

-Anonymous

Hello!!!

Come see us at New Generation Health Center!!!  We can definitely check out what’s going on.  If you are not in the bay area,  check out: inSPOT .  Inspot can help you find a clinic in your area (they also have some other pretty cool apps on their site).  But let’s get back to your question.  I can’t tell you exactly what is going on with you without having you examined by a clinician,  but I can tell you about some of the common vaginal infections (many of which can cause these types of symptoms).  Again,  this is not a diagnosis.  I am not a clinician and clinicians wouldn’t be diagnosing you without seeing you in person anyhow.

Yeast Infection (candidiasis):

Yeast is a normal part of the vaginal environment.  All girls and women have yeast in their vagina.  However,  sometimes their bodies make too much yeast and that can cause a yeast infection.  There are many reasons why this overgrowth happens:  taking antibiotics,  wearing tight or non-breathable underwear,  or douching (douching is not a good idea for many reasons).  Women who have medical conditions like diabetes are also more likely to get yeast infections.

Common symptoms of a yeast infection include:

• Itching and irritation in the vagina
• Redness,  swelling,  or itching of the vagina or vulva (don’t remember what that is?  Check out my previous post on female anatomy.
• a thick,  white discharge that can look like cottage cheese and is usually doesn’t have a smell (sometimes it might smell like bread or yeast)
• pain or burning when urinating or during sex

Although yeast infections aren’t considered sexually transmitted infections,  they may be able to be spread from one sexual partner to the other.  This doesn’t happen very often.  If you have a yeast infection and your partner isn’t having any symptoms,  there is no reason for them to be treated.

Treatment:

There are over the counter treatments (creams and suppositories) but if you have never had a yeast infection before see a clinician.  Don’t treat yourself as your symptoms may be from something else.  There is also a pill that a clinician can prescribe which only needs to be taken once and it begins to work really quickly.

Bacterial Vaginosis (BV):

Like yeast,  bacteria in the vagina is normal.  Most of it is “good” bacteria and helps keep the vaginal environment healthy.  BV happens when there’s an imbalance between the “good” bacteria and “bad” bacteria in the vagina.  Meaning,  the small amount of “bad” bacteria grew to be more than the “good” bacteria.

Although the causes of BV aren’t exactly known,  it is known that certain things can make the infection more likely,  such as:

• douching
• new sex partners or many different sex partners (male or female)
• smoking cigarettes

What are the symptoms of BV?

• an abnormal white or gray vaginal discharge that’s thin, with a fishy smell that’s more noticeable during a girl’s period or after sex
• pain while peeing
• itching in and around the vagina

Treatment:

Treatment isn’t always necessary because your body often fixes the imbalance on its own.  Some women don’t have symptoms,  so choose not to take any treatment.  However, women with bothersome symptoms can get treatment with prescription antibiotics (pills, vaginal gel, or suppositories).  It’s important to talk to your clinician about any restrictions with your treatment (some have restrictions,  others don’t).

Okay,  that was another long post.  Don’t worry about remembering it all.  Just remember the following few things:

• Not all vaginal infections are related to sexual activity
• If you have any abnormal discharge or vaginal symptoms – see a clinician
• Most vaginal infections are easily treatable

That’s it till next week!!!!

In happiness & health,

Shawna

Reviewed by Grace Shih, MD