I saw this article and
thought it was a great read. Yes it’s long but it could just save your life.
'So… wait," I
asked my friend Hayley, over some overpriced wine in my local one evening,
"you don't use any contraception, at all?" "None," she said
matter-of-factly. "I've had unprotected sex so many times with no results
that I think I might be infertile." I doubt that she needed my
judgment face at that particular moment, but she got it. She's no teenager, and
I have to admit I'd thought she would know better.
Unprotected sex. At
one point or another, we've all had it (haven't we?Haven't we?).
I've stopped asking my friends if they've used a condom when we do
our regular one-night-stand postmortems, not because it makes me look like a
neurotic teenager, but because I know that they haven't. And I have no idea how
we, well educated in the dangers of unprotected sex and way past our teens,
have got to this stage. I am shocked, when canvassing my friends, that in
taking the contraceptive pill I am in the minority. Some friends are using
other methods, but others aren't using anything. They are just
styling it out. Bareback.
I'll admit, I've been
lackadaisical with contraception myself (Dad, if that isn't enough to make you
stop reading now, then I don't know what is) and have taken the morning-after
pill six or seven times (perhaps that?) so I'm in no position to be casting stones,
but my several trips to the genitourinary medicine (GUM) clinic for various
tests (including one for HIV) were scary enough to convince me that I had been
conducting myself like a fool. Add an abnormal smear test result into
the mix (pre-cancerous cells on the cervix are usually caused by human papillomavirus,
HPV; up to eight out of 10 people will be infected with it at some point.
As a character in Girls says, "all adventurous girls"
have it) and I became pretty convinced of the importance of strapping it up.
In the UK, sexually
transmitted infections are on the rise among all age groups, as is the abortion
rate. According to Public Health England figures, STI diagnoses rose 5% in
2012, with those under 25 experiencing the highest rates (they account for 64%
of chlamydia cases).
Public Health England acknowledges that this is in part to
due to improved data collection, but also warns that "the continuing high
STI rates in England suggest too many people are still putting themselves at
risk through unsafe sex, especially young adults and men who have sex with
men". That young people engage in risk-taking behaviour will be
a surprise to no one, of course, but what is interesting is that we're seeing
such behaviours in those who are mature and responsible in other parts of their
lives. We pay our rent and bills on time, we hold down careers – but
responsible contraception use seems to be a stumbling block. We don't have the
excuse of a lack of education to fall back on. While there are problems with
the way sex education is taught, vagueness about contraception and the
mechanics of sex does not appear to be one of them (many people I spoke to
recall the infamous cartoon Jonny Condom song, a source of much
classroom hilarity).
Some even claim that
twentysomethings are the poster demographic for unprotected sex. The increase
in risky sex among my age group (I am 26) led to American journalist Ann
Friedman describing us as the "pull-out generation". As monikers go,
I have to admit it's not my favourite, but it does resonate. Most of my friends
have admitted to having used this fallible and messy technique to avoid pregnancy,
while some rely on it as their only method of contraception.
"These women
describe a deliberate transition from the pill to the pull-out," wrote
Friedman. "They buy organic kale and all-natural cleaning products, and so
can't quite get down with taking synthetic hormones every day. They see orgasms
as a right, not a privilege."
Pulling out has, for
me, never really had much to do with kale. In my group of friends, it
seemed to be something that occurred accidentally or due to poor organisation.
Penny Barber, area director for sexual healthservice Brook in
the Midlands, agrees: "Typically we hear that young people have
unprotected sex because they ran out of condoms or pills, or they had too much
to drink."
According to the Family
Planning Association, there is scant research on modern use of coitus
interruptus (which they describe as "the oldest form of birth control
practised today") in Britain, but an American study conducted by Duke
University last year found that 31%
of young women in America aged between 15 and 24 had relied on the withdrawal
method at least once.
I was interested to
find out whether or not we are seeing a more conscious shift away from hormonal
contraceptive methods in favour of the pull-out method. The most recent
figures available on contraceptive use are from the Office for National
Statistics from 2008-2009. They revealed that the
majority of women under 50 were using contraception (75%), with
condoms (25%) and the contraceptive pill (25%) the most popular methods.
Of those women who weren't using contraception, just over half were not engaged
in a sexual relationship with a member of the opposite sex. But that was
more than five years ago. Could it be true that women are being turned off the
pill and condoms, too? Among the many twentysomethings I spoke to from all over
the UK, it would appear so.
Alex, 24, a charity worker,
says that unprotected sex is something that she and her partner go through in
phases, "depending on how sensible either of us is feeling at the
time", and that a dislike of condoms is a factor. She has relied on the
withdrawal method in the past and has had chlamydia, gonorrhea and one
pregnancy scare. She has made a conscious decision not to take the pill:
"I have never taken hormonal contraception and I can't see me ever wanting
to take it; there is something about the idea of adding hormones to my body
that I just hate. Perhaps it's the fact that they can change your mood. During
my MA year, one friend slept her way through an entire city using nothing but
the pull-out method and remained pregnancy- and disease-free – while at the
same time I got chlamydia from sleeping with one man for
eight months." Despite having contracted an STD, Alex is
philosophical about her methods, as were many of the women
I spoke to. "I see unprotected sex as a choice made by
adults, and as a fairly intelligent and informed adult I take responsibility
for any consequences," she says.
Elise, 32, uses withdrawal with her long-term
partner and is similarly laid-back. She is perhaps what you'd call
"pregnancy ambivalent": "I don't have the terrible anxiety
about accidental pregnancy that I had when I was 20," she says. "We
both hate condoms and I got tired of taking the pill. I couldn't settle on one
and had to keep going back to the doctor with bleeding. I ended up saying I'd
take a break and never went back."
When Elise was younger, it was different. Although
she says she was worried about getting pregnant, she did have unprotected sex
at least five times. It was, she says, a period "characterised by
carelessness and drunken decisions at a time where I didn't feel anything bad
would happen to me. I think some of the men would rather I had insisted we use
a condom but didn't speak up themselves.
"I was very lucky not to get pregnant, or
to get an STD worse than the almost inevitable chlamydia I ended up with. When
the GUM nurse called me to tell me I had chlamydia I was overcome with relief.
I think she thought my reaction was inappropriate." Inappropriate,
perhaps, but not unusual – many of the women I interviewed admitted they were
much more concerned about unwanted pregnancy than they were about STIs, and
chlamydia, which is treated with antibiotics, no longer seems to strike the
fear of God into young women.
But it's not just
youth that can make you feel invulnerable, as Danni, 32, a communications
manager, explains: "Very few single women I know would use condoms with
any regularity. I've had unprotected sex with about 15 men, in relationships
and casually, and I can say I've used a condom about three times. I'm not that
confident about using condoms – putting them on. Guys seem to hate them,
and sometimes, I'm too drunk or turned on to care."
The idea of condoms not being conducive to
spontaneity – especially drunken spontaneity – is cited as a reason for
rejecting them again and again, as is pressure from men. Gina, 29, an IT
helpdesk supervisor, has had unprotected sex while drunk but says she wouldn't
do it now, having once contracted chlamydia. I can understand young people in
their teens feeling too embarrassed or intimidated to broach the subject of
condoms, but I expected women who are a bit older to feel more confident and
assertive when it came to contraception. Then I thought about all those
morning-after pills, and remembered that I hadn't been, either.
At times, the young women I spoke to seemed to
resent feeling that they had to take responsibility for contraception.
"I've never felt personally pressured by a guy I've slept with not to use
a condom – most have been absolutely fine with it," says Beatrice, 20, a
student. "However, none of them took the initiative to suggest using
one." She blames a lack of confidence for the fact that she has had unsafe
sex more times than she can count, saying that she takes emergency
contraception and has regular STI tests "due to my inability to question
guys I sleep with on their own testing history".
A failure to communicate was a common factor,
which makes me question whether British sex education – which focuses very much
on the mechanics – might have a lot to answer for after all. I also wonder if
porn – not renowned for its on-screen condom use – might play a part. Sex
educators seem hellbent on convincing young people that condoms can be sexy and
often provide them with tips and tricks to make the experience more erotic.
Perhaps they'd be better off encouraging better conversations. It wasn't that
anyone I spoke to didn't know how to use condoms, or that they were one of the
few methods that protected against STIs, it was that they didn't feel they had
the language to talk about them. Gina said she felt unable to bring up the
topic: "I'm unable to ask, or stop someone when they have gone that
far." Harriet, a 23-year-old student, agrees. "In the past I have
definitely felt ashamed to ask someone to put a condom on, kind of like you're
being a bit of a bore. Never in my whole time of sleeping with guys has one of
them done it or offered." She has had unprotected sex with one-night
stands roughly 15 times – "I always just thought I'd get the morning-after
pill" – and she eventually got pregnant and had an abortion. Four of her
friends have also had abortions following unprotected sex.
Male distaste for condoms isn't the only
reason unprotected sex takes place. There's also the fact that the side effects
of the pill are too much for some young women to bear. Like many of the young
women I spoke to, Harriet's reasons for using withdrawal or having unprotected
sex were partly as a result of male pressure not to use condoms, but also
because of a genuine discomfort with the possible side effects of hormonal
contraception. "The [contraceptive] pill sent me crazy. There was a
definite change in my moods and when I wasn't sleeping, I was screaming or
crying… it put me off for good," she says. "I fell head over heels
for someone. The thought of putting anything hormonal back in my body scared me
but he refused to wear condoms. Every time I'd get a period it would just be
like a green light saying, 'You're not pregnant! Carry on!' Obviously the day
came where I was pregnant. I had the op" – meaning an abortion – "and
at the same time had the implant shoved into my arm. Six months of what can
only be described as hell followed. I was constantly bleeding and I went into a
deep dark depression."
Scare stories about
hormonal contraception hit the newspapers every few months. In January, doctors
were advised by the Medicines and Healthcare Products Regulatory Agency to warn
patients taking "third generation pills" including Yasmin, Femodene
and Marvelon, that they are twice as likely as older medication to cause
life-threatening blood clots. (The risk applies to women who are already
more likely to develop clots.)
It's no wonder that
women are hyperconscious of potential side effects. Holly Grigg-Spall, author
of Sweetening The Pill: Or How We Got Hooked On Hormonal Birth Control, says
that side effects such as depression and loss of libido steer many women away.
"I felt oppressed by the pill," she tells me. It was when she started
a blog on the topic that she realised other women felt the same way. "Many
women don't want to be taking these drugs any more," she says.
She endorses a natural familyplanning method that involves combining a period
tracker app with other indications of fertility, such as cervical mucus
and body temperature, to work out when it is safe to have sex.
"There are two camps," she says.
"[There are] women who haven't used condoms for a long time or don't want
to use them, and rather than using condoms as a stopgap they just decide
they'll use the withdrawal method." Then, she says, you have those who use
the (little-understood) fertility awareness methods, noting their cycles to
work out when they can have sex. "We also have this movement of women who
are really interested in learning about their cycles so that they're very much
in control of their bodies." It's true that the pill can play havoc with
libido, but with all of society's technological advances, isn't returning to
the "old way" of doing things a little bit backwards?
"It's a real shame that natural family
planning is getting confused with the withdrawal method," says Natika
Halil, of the Family Planning Association. "It's a form of contraception
and it is 94% accurate when used properly." Grigg-Spall agrees that the
confusion has not been helpful, and the boom in period tracker apps has added
to the confusion. "They can try to say when you're going to get your
period but these apps shouldn't be telling you when you're fertile, because
they don't know," she says, emphasising that there are apps available that
capture more data and so are much more reliable. Fertility awareness is a
method of contraception that has, according to the figures available, very
little uptake in Britain – less than 1% of sexually active people – and Brook
doesn't recommend it for those under 25 "as it doesn't tend to fit in with
their lifestyles". (She's not wrong: I struggle to envisage myself taking
the time out of freshers' week to check my cervical mucus.)
From my conversations with women in their
teens, 20s and 30s, there is certainly a sense of dissatisfaction with the
contraceptive options available. For every woman who says that she felt
pressured by men into not using condoms, there's another who says that she
dislikes the sensation. Many, like Frieda, 27, are also wary of the pill.
"I just didn't feel right on it. I felt less sexy and a little
bit depressed," she says. "I came off it and was horrified not to
have a period for six months. I didn't like that I had been altering my
natural state for so long." Frieda also dislikes the implication that her
methods are irresponsible. "I have a very regular period and know when I
ovulate, so I go by that."
Dr Georgina Noble, a specialist in integrated
sexual health, is quick to point out that, unlike in America, the NHS
makes it easy for female patients to try different kinds of contraception; in
the US, insurance companies will cover only certain types, so there's less
freedom to experiment. Working in a GUM clinic, she's much more likely to
see withdrawal used by teenage girls who haven't yet found out how to get
access to contraception. "They don't consider condoms, they think, 'It's
OK because he pulled out.' Eventually they pluck up the courage and tend to
come to the clinic in a group with their friends."
She's quick to highlight the risks of using
the withdrawal method. I hadn't heard pre-ejaculate referred to since I was a
reader of teenage magazines, which were obsessed with it, but Noble cites a
study indicating that sperm is present in 41% of samples. Noble also mentions a
patient who had never had penetrative sex and yet became pregnant through
contact with pre-ejaculate.
Luke, 25, told me a
similar story. "Unwanted pregnancy has happened to me twice. The first
time, the first relationship I was in, I got a girl pregnant from using
the pull-out method," he says. "It was through the magic of pre-come.
It was quite stressful as a 17-year-old." The second time he made a girl
pregnant was due to a defective coil. "It's made me massively more
careful now." Noble says that most women are happy on Microgynon 30, the
default contraceptive that the NHS offers, and, though she admits there can be
some side effects, these might be bearable considering the alternative.
"Pregnancy is also life-altering," she says. "I want my patients
to get the most effective contraception that is acceptable to them. I take
hormonal contraception and am happy to recommend all hormonal and long-acting
reversible contraceptions to friends and family."
Many of the women I interviewed expressed
regret at the fact that they had used the withdrawal method or had unprotected
sex when they were younger. Elise, for instance, says, "There's no excuse
for being so stupid and I don't know why I did it." Jane, a
32-year-old civil servant, caught chlamydia when she was 19. "I have
never felt so dirty," she says. "I wish I'd used a condom. True, they
make sex less spontaneous, but I'd swap that for an internal examination and
accompanying swabs, quite frankly."
There's a palpable
sense of embarrassment from those who feel that the unprotected sex they had
was a result of carelessness. Several of my friends avoid the pill because of
concerns about weight gain, despite the fact that studies reveal it to be
minimal. Others, like Harriet, find the mood swings unbearable. Having had an
abortion and been fitted with the implant, she finally had it removed and went
back to relying on the pull-out method. Earlier this year the National
Institute for Health and Care Excellence (Nice) recommended that young women
should be allowed to keep a supply of the morning-after pill at home in case
they need it. At the moment you can purchase only one pill at a time, but the British
Pregnancy Advisory Service has argued that allowing women to buy packets of
pills will reduce the number of unwanted pregnancies. In the same
report, Nice also recommended that health professionals not be too quick to
prescribe the contraceptive pill, and to make other long-acting
methods available to all young women.
So has the pill liberated us? On the one hand,
I am of course relieved that I can have regular sex and not get pregnant. But
on the other, after speaking to so many women who would rather use
withdrawal because of the side effects, I agree with Grigg-Spall that
we have become blindly accepting of its use. "It's very difficult to
criticise publicly," she says. "Sexual liberation has trumped other
kinds of liberation. We've basically linked hormonal birth control with sexual
liberation, which is interesting because many women experience a negative
impact on their sexual libido. And that is apparently fine."
Grigg-Spall points out that there has been a
long history in the women's movement of ambivalence towards the pill, but that
objections have been sidelined. "The pharma industry has a real grip.
We've been led to believe that the choices women have are hormonal birth
control or pregnancy and nothing in between. "Women having unprotected
sex, relying on withdrawal – they should see that as a warning sign that we're
not doing enough.
Harri Wright,
25, exams officer, in a long-tern relationship
Harri Wright: 'Pulling out is our main
method of contraception.
I've had unprotected sex probably hundreds of
times. I've been in a relationship with my boyfriend for eight years, and more
often than not we don't use any form of contraception. I had been on and off
many different kinds of pill – because of moving around during my university
years I wasn't able to settle on one. The hormones always made me feel a bit
weird and later on I started experiencing nausea. In the end my partner and I
were happy for me to stop taking the pill. We've never consistently used
condoms as neither of us like the feel of them.
Pulling out is our main method of
contraception. I keep an eye on my cycle and we avoid peak times or use a
condom. We would prefer to plan a pregnancy, but a surprise wouldn't be the end
of the world. We wouldn't have made the decision for me to come off the pill if
we didn't feel we could handle the repercussions.
Jess Tyrer, 23, travel
advisor
Jess Tyrer: 'Naive as it sounds now, I
didn’t really have any worries about STDs or pregnancy.'
As a teenager I was vigilant about my sexual
health, but after a couple of years, my friends and I became more lax with
contraception. We were being irresponsible and testing our limits.
I've had unprotected sex quite a few times,
and I used the pull-out method with my former partner. Looking back, I don't
think we even discussed it. Naive as it sounds now, I didn't really have any
worries about STDs or pregnancy. I knew that neither of us had any STDs, and
with other people, if we did have unprotected sex I always went to the GUM
clinic.
Unprotected sex happens for several reasons.
It may be that you don't want to stop to put a condom on, sometimes you may be
embarrassed to ask your partner, or they may think that you have an IUD or are
on the pill. Obviously if you have been drinking, that increases the risk.
I think I'm more mature now. I sort
of want to go back and shake the younger me
and make her see sense.
Emma Alfonso, 26, business owner, single
Emma Alfonso: 'Condoms are disgusting
and sometimes funny, and no one wants to feel those emotions when having sex.'
I've had unprotected sex with five different
men, three of whom I was in a relationship with. The other two were
casual.
It starts when you are a teenager and your
loving boyfriend suggests you don't use a condom, because he'll lose
sensitivity. You, being the cool, chilled out kind of girl you're desperately
trying to be, go with it. Once you've done it once and survived, you lose the
fear.
Condoms are disgusting and sometimes funny,
and no one wants to feel those emotions when having sex. No matter how you
colour, flavour or add little ribs and dots "for her pleasure",
condoms are a mood killer.
The pill is a pain to keep track of and has
caused me and my friends horrible side effects from headaches and acne to
weight gain and mood swings. Similarly the contraceptive injection turned me
into a "psycho bitch from hell", according to my boyfriend. Then
there was the coil. I was one of the 0.1% that managed to get up the duff
anyway with it in. Not that I am complaining, my daughter is a delight.
Many people would judge me for having
unprotected sex but it is a risk I take in the same way I don't always use
sunscreen, and I binge drink. Having unprotected sex is one thing, but not
getting checked and having unprotected sex when you're not sure whether you are
"clean" or not is quite another.
• Some names have been changed.
Credit: theguardian.com
Photo Credit: Felicity
McCabe for the Guardian
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