I was surprised that you didn't mention the most obvious answer to "Tired Of Pills," the a woman in this week's column who can't stand the pill who's married to a man who can't stand condoms. The copper IUD (Paragard) is hormone-free, extremely effective, much safer than the Pill, and can't be felt during sex. In America the IUD still has a bad reputation, but this is based on some very old and, frankly, unscientific evidence that has been amply disproved and should be relegated to the status of an old wives' tale.

I am in exactly her situation: married, hate pills, hate condoms, don't want to get pregnant. I haven't had any babies, which some doctors insist means you can't get an IUD, but that isn't true. It just means you need to go to a proper gynecologist who knows what she's doing, since it's a little more difficult to get it fitted. It took me two visits, once to get fitted, and again to have it inserted. It felt like really bad cramps but was totally bearable. In exchange for that mild discomfort, I have had flawless and effortless birth control for the past 5 years and won't have to even think about it for at least 3 more.

Considering how many women have trouble with the hormones, and how many horrible, disastrous side effects they can have (Yasmin class action, anyone?), I would love it if practical and intelligent authorities would broach the topic of IUDs more often. Most of the women I know have never even considered it.

We Have Options

Thanks for taking the time to write, WHO. Lots more suggestions for TOP from highly-fertile-but-successfully-childless "Savage Love" readers after the jump...

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I think that you overlooked an excellent option in your reply to Tired of Pills: a diaphragm. They're just as effective as other barrier methods when used properly and consistantly, without any of the side effects of hormone based birth control. My wife and I used one for decades before I had my vasectomy, and once it was in I couldn't tell that it was there. It became just a part of our foreplay where I would sensually load it up on the inserter with the spermicidal jelly and she would coyly play with herself inserting it. Effective, safe and fun.—Snipped Now

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Tired of Pills should get an intra-uterine contraceptive. I've had mine for five years and I love it. After trying every friggin pill and shot on the market, and even the nuvaring, I was still having depression, low sex-drive, and weight gain and loss, from the hormones. It's a tiny piece of plastic and copper that fits in your uterus and prevents pregnancy with something like 99.9% effectiveness. You should tell her to read about all the positives and negatives on Planned Parenthood's website. It has not messed with my hormones at all, I still ovulate — which means I still get horny. Saved my penis-in-vagina sex life.—Good Sex Awaits

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The letter from Tired of Pills mentioned that her doctor doesn't think non-pill options would be a good fit for her, but I'd encourage her to get a second opinion on that. Lots of doctors, especially those who went to med school a few decades ago, are reluctant to prescribe IUDs, especially for women who've never given birth. They tend to believe IUDs will cause infection and/or fall out without being noticed. This may have been true in the past, but in fact the current generation of IUDs is extremely safe, reliable, and effective. I also can't take hormonal birth control (gives me jaundice), and I've had, and loved, my IUD for about 18 months. If she gets a copper IUD, TOP can expect to have longer, heavier, and more painful periods for the first six months or so, but after that, they're likely to go back to whatever they'd be without the influence of hormones.—I Use Device

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I just wanted to add my two cents about the lady who isn't able to take the pill without adverse side effects, yet her husband flatly refuses to wear a condom. There are a couple of other barrier options that aren't IUDs, specifically diaphrams, the sponge, and female condoms. (If TOP can't tolerate the pill then she shouldn't go anywhere near injectables such as Depo Provera.) If they decide that they don't want to have children, her condom-phobic husband can get a vasectomy. Sterilizing women (tubal ligation) is full-on surgery and will require a hospital stay. A vasectomy is a day procedure and will require a cold pack and gentle treatment for a few days. I think, also, that this situation is an interesting result of the complete lack of effective contraceptive options for men. Men have condoms or sterilization. Why aren't men asking for more?—AMN

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Just a note to "Tired of Pills" who wrote in to say hormonal birth control pills weren't working for her, but her husband didn't want to wear a condom. There's another option all women should be aware of: biology. Your body will tell you when it's fertile if you pay attention to your cervical fluid and waking temperature. If you 1) track these on a calendar chart and 2) follow the Fucking Rules (based on how long YOUR fertile period is + how long sperm can survive in a woman's body), your husband only needs to wear a condom (or explore creative non-vaginal-intercourse options) between 7-10 days out of a typical thirty-day menstrual cycle. The rest of the time, have all the vaginal sex you want. This is called Fertility Awareness Method. FAM is NOT the same thing as the old calendar/counting method, which doesn't take into account the differences in each woman's cycle. Once you get the hang of charting your cycle for a few months it's really minimal work. There's more info on FAM at www.tcoyf.com, but IMHO, every woman should have a copy of "Taking Charge of Your Fertility" by Toni Weschler, MPH, on her shelf. Well worth the $15 at Amazon to know and understand what your body is telling you already.—Six Fucking Years and No Baby Yet

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I love your column and I agree with your response to Tired of Pills who wants her husband to wear a condom so she can go off the pill. However, please post a follow-up that TOP must do some research (because she is the best expert on her body) and visit another doctor who will work with her on this issue! As a women's health advocate I have encountered doctors, even gynecologists, who have set opinions and aren't willing to work with women on the huge array of contraceptive options available. Planned Parenthood has great info about contraceptive options here. My immediate thought was that TOP should try hormone-free barrier devices like a diaphragm or the sponge. If she wants to increase the contraceptive effectiveness her husband can pull out before ejaculation. A good doctor will help her find a birth control method that really works for her and her husband, not just keep cycling her through variations of the pill. Thank you for all your sex positive work.—Women's Health Advocate

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I know exactly how TOP feels. I've been with guys who can't stand condoms. They've either whined like little boys, or acknowledged it like gentlemen. But all of them preferred I be on the pill. I feel their pain, I really do. Condoms don't exactly feel amazing for me, either, especially after marathon sessions. But too bad, for both of us. I can't stand the way I feel when I'm on the pill. The weight gain, skin issues, extreme mood swings including depression, change in arousal (or complete lack thereof) make me crazy. It nearly ended one of the best relationships I have ever been in. (If I could have dumped myself, I would have.) My boyfriend was extremely understanding and patient partly because he's awesome, and partly because he recognized it was his idea to begin with. We were both shocked to realize how much of an effect hormones had on my personality, and agreed that I needed to get off the pill if we were going to stay together. Could I have tried more than the two different brands? Sure, but it could have taken months if not years to find the right one, if at all. I wasn't willing to put myself through that, let alone my boyfriend.

After the pill disaster, we now use a variety of methods, all nonhormonal. Sometimes I use a diaphragm and spermicide, so my boyfriend can go without a condom. Sometimes he uses a condom, so I can go without a diaphragm (not many options for spermicide, and they can fuck up your system too). I'm charting my cycle, so we can up the protection during my fertile days, or get creative otherwise. Sometime we take a risk, and just go for it. We always pull out. We've tried dozens of different types of condoms to find the best fit. We've talked about what would happen if I got pregnant, and have Plan B, and C and D and E in place. Is it fool proof? No, but what is, really? The point is he was more than willing to work something out, because he loves me more than he loves not using condoms. And I know how much condoms suck for him, so I'm willing to do the same. Compromise and creativity on both sides.

Anywho, that's it. Love your advice, and wanted to add to it.—Pills Aren't My Thing Either

P.S. I can't wait for the male pill to come out. Then guys might actually experience some of what we go through and shut the hell up.

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You should tell the lady whose husband hates condoms about this.—Birth Control For Men