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Oral contraceptive (OCs) which are highly effective, simple to use, and reversible, are used by 50 million women globally. In Germany 37.1% of women used them in 1985. Recently their acceptance has declined because of the fear of side effects such as cancer, thrombophlebitis, and frigidity. Other negative factors are opposition of partner, religious views, inconvenience of daily intake, negative reports from the press, discussion by family physician, and anxiety about complications in the offspring. Psychological and psychosomatic side effects very from 1% to 56%. Most are psychovegetative symptoms: headache, sweating, heart disorders, gastrointestinal tract (GI) disorders, nausea, and sleep disturbance. Psychological symptoms include increased irritability, impulsiveness, affective lability, anxiety, depressive feelings, reduced libido, and sexual disorders. Unconscious and ambivalent feelings about wanting a child and problems with the partner can result in forgetting to take the pill. Inhibitions, shame, guilt, and repressed feelings about sexuality lead to a sense of victimization in the form of pregnancy. The Catholic Church holds the view that contraception and abortion are unnatural as enunciated in a 1968 encyclical on human life. Conflicts with the partner can be resolved by compromise and by medical counseling of both parties. True psychopathological disorders have to be distinguished from the psychological problems of healthy people. The soundness of the physician-patient relationship is essential for contraceptive counseling and for resolving such conflicts.
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PMID:[Psychosomatic aspects of oral contraception]. 179 82

A discussion of unconscious psychological resistance to contraception is illustrated by the case of a woman with a 10-year history of use of oral contraceptives and IUDs marked by repeated development of side effects and changes of formulation culminating in a serious depression after tubal ligation at age 35. The woman's postligation complaints of abdominal pain resistant to analgesic treatment were the expression of a serious depressive syndrome that responded poorly to antidepressants. The request for contraception normally contains 2 propositions: the individual desires to have sexual relations, and the individual does not wish to procreate. The logical connection between these 2 propositions at the conscious level is absent at the level of the unconscious, where there is no logic or possibility of reasoning. Forgetting a pill is a relatively minor form of resistance to contraception. Other symptoms, such as pain, vertigo, nausea, nervousness, insomnia, and anxiety with the pill or unexplained pain, repeated local infections, or anxiety and depression with the IUD may be manifestations of the psychological modifications inevitably caused by the psychic symbolism of the contraceptive. The difficulty experienced by certain women in accepting in their unconscious the 2 propositions about contraception causes the symptoms to be produced. Unconscious motives for resistance to contraception may include a woman's dependence on the potential for maternity for her sexual identity, or anxiety at the degree of sexual freedom offered by the contraceptive method. The unconscious elements related to resistance are sometimes open to modification. A study of women undergoing abortion at a center in Rennes indication that 91% failed to use an effective method of contraception at the time of the pregnancy, but that 1 year later 76% had accepted a method. Only 12% at risk of undesired pregnancy were not using a method. A large part of the increased usage was probably explained by contraceptive information provided at the time of the abortion, but the very fact of the abortion may have helped some of the women resolve their feelings of ambivalence about contraception. But 53% of the contraceptive acceptors complained of side effects, mainly anxiety, decreased sexual pleasure, weight gain and menstrual problems. It appears that an abortion may influence the decision to use a method without greatly changing the resistance to contraception. The practitioner wishing to assess the potential tolerance or resistance of a woman to contraception should take the time to discuss her feelings about contraception, menstruation (which signifies absence of pregnancy and thus maternity), and her sexual and emotional life. the dialogue can continue in subsequent visits if the women had complaints about side effects.
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PMID:[Resistance to contraception]. 219 28

4810 U.S. married women under 45 years were questioned extensively in 1965 on contraception. Information on duration of use and particularly on details of stopping oral contraception are included in this report. About one-third (285) of these women who had ever used the pill had discontinued. The 216 dropouts who used pills for contraception only provided data for this report. 65% (140) quit because of side effects, usually pregnancy-like symptoms (such as nausea or weight gain), or menstrual symptoms (such as hemorrhaging or cramps). 15% (32) stopped for other difficulties related to taking pills such as fear of forgetting pills or religious worries. 20% (43) stopped for reasons unrelated to the pill such as desire to conceive or no need for contraception. Dropout rates were higher (50%) after 2 years for those who used the pill in 1960-1962, than for those who used it later, reflecting lower dosage pills and increased physicians' experience in later years. Most stopped in the first 3 months and usually because of side effects; dropouts for other reasons were constant. Women who were older, less educated, had more children, or who were non-white tended to drop the pill sooner. After quitting oral contraception 12% used new methods (IUD or foam), 30% used no method, 8% used multiple methods, and 41% (89) used the method they had used before trying pills.
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PMID:Duration of use of oral contraception in the United States, 1960-65. 496 17

To approach the question of motivation toward contraception, the new French law on contraception passed in 1967, and the mode of action and risks of pills, IUDs, and diaphragms are reviewed. The new law governs import sale, prescription, placement of IUDs, consent for minors, and facilities of the clinics that issue contraceptives. Physicians dislike the prescription registration system, the written consent, lack of reimbursement by social security, and neglect of abortion. Oral contraceptives act on gonadotropin release, cervical mucus, and endometrial development. The can cause nausea, weight gain, bleeding, and thromboembolism. The relationship of medicine phobia, forgetting pills, and religion to success with pills remains to be studied. IUDs act on tubal and uterine motility and the endometrium. They frequently cause bleeding, pain, and expulsion, and rarely infection or perforation. Their failure rate is .5-2%. They are indicated when contraception must be separated from sexuality. Diaphragms and caps require technical fastidiousness and usually are preferred by older women. Their failure rate is 10-12% Now that contraceptive research can be done openly in France, more information about contraceptive motivation will become available.
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PMID:[Motivations, acceptance and refusal of contraceptive methods]. 575 71

Results are presented of an evaluation of the contraceptive efficacy, cycle control, and tolerance of a low dose triphasic pill, Trigynon, used by 353 reproductive-aged women for a total of 1668 cycles. 20 physicians in different Belgian centers recruited and followed the women. Average weight of the patients was 56.8 kg, average age was 24.8 years, average parity was 1.07, and 1/3 smoked. None had any medical condition contraindicating the use of the preparation. 156 of the women had never used contraception, 163 had used combined pills, 4 had used injectables, 6 had used progestin-only minipills, 21 had used IUDs, and 22 had used other methods. 2.5% of the patients forgot to take at least 1 pill in a typical cycle. No pregnancies were imputed to forgetting, but 3 pregnancies occurred during the study: 1 already established but not recognized at the start of treatment, 1 in a woman taking antituberculosis drugs, and 1 in a patient suffering an attack of dysentery. Almost 90% of patients had regular cycles of 28 days with treatment, compared to only 57.5% before treatment. The duration and quantity of bleeding were significantly decreased. Compared to the last pretreatment cycle, the 3rd and 6th cycles with Trigynon showed a decrease in percentage of patients complaining of dysmenorrhea, nervousness, headaches, breast tenderness, nausea, vomiting, decreased libido, depression, thrombophlebitis, and edema. The percentage complaining of acne and vertigo increased slightly at 3 months and then declined to below pretreatment levels. Average weight was almost unchanged. It appears that Trigynon offers reliable protection, excellent cycle control and few side effects, and would be an appropriate contraceptive choice for most women except those with benign breast disease or hyperestrogenism.
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PMID:[Clinical evaluation of 1,668 cycles of triphasic oral contraception (Trigynon). Multicentric Belgian study]. 681 54

The study is based on data from the 1978 Manawatu Family Growth Study concerning use, user satisfaction, and experience of side effects and fears among oral contraceptive (OC) users. 1085 (78%) of the 1390 women aged 16-44 interviewed had ever used OCs, 411 were current users. The proportion ever using OCs varied by age from 48.3% of women 16-19 to around 90% for those 25-34, 75.9% of current and 43.3% of former users were aged 16-29. 21.5% of previous users discontinued to become pregnant, and 65.6% switched to another method. 45.2% of current users admitted to sometimes forgetting to take the pill. 50% reported they were not entirely happy with the pill, with dissatisfaction lowest among current users aged 16-19 and 35-39 and greatest among those 25-34. Substantial proportions of dissatisfied current users and of previous users reported various side effects, among which swelling or weight gain, dizziness, headache, or feeling weak were among the most common; nausea, bleeding, and changes in skin or hair were reported also by many. Fears of permanent damage to their health were reported by over 1/2 of dissatisfied current users and of previous users, and 46.9% of ever users reported that publicity about possible side effects had caused them concern. Subgroup variation was found in use and experience, as illustrated by greater incidence among Maori women of both forgetting and satisfaction among current users. Study findings suggest a need for instruction, guidance, and counseling for OC users.
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PMID:The oral contraceptive pill: use, user satisfaction, side effects and fears among Manawatu women. 695 20

91 patients with trichinosis were treated at the Clinic of Infectious and Dermatovenereology Diseases in Novi Sad during a one-year period. In 64% of patients the onset was intestinal, while in 36% it was invasive. Diarrhea (in 28.89%) and abdominal pain (in 22.22%) are the most common symptoms of the intestinal stage. Nausea, vomiting and opstipation are less common. The main symptoms of the invasive stage are myalgia (65.54%), high temperature and eyelid edema (57.78%). Facial edema (38.89%), general weakness (24.44%), conjunctivitis (15.56%) and rash (8.89%) are somewhat less common. Heavy sweating, headache, nervousness, psychic instability and fast forgetting occur in a small number of treated patients. Myocarditis and encephalitis occurred in 3.33% of patients. There were 43.33% of patients with mild clinical picture, 40% with mild-to-severe and 16.66% with severe clinical picture. 54.44% of patients were males and 45.56% were females, and it can be said that sex did not influence the severeness of the clinical picture. The youngest patient was 5 years of age, the oldest 72. Most patients were 21-50 years of age but we did not establish statistical importance between clinical picture severeness in regard to age. The shortest period of incubation was 5 days, the longest 40 days. Average incubation period was 18.05 days (x = 18.05). Studying period of incubation and severeness of the clinical picture we established the following (x2 = 28.535). The shorter the incubation period, the severer the disease.
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PMID:[Clinical characteristics of trichinosis]. 901 31

This work uses clinical examples to explore sources of conflict and denial of patients and physicians during contraception consultations. The discovery of oral contraceptives (OCs) and improvements in mechanical contraception raised hopes that couples could achieve total control of their fertility. But continued high abortion rates and the persistence of sexual problems and maladjustments have demonstrated that contraception alone is not a panacea. Conflicts about contraception may be conscious and quickly expressed during a consultation, even if a medical pretext is given. The resentment when 1 partner desires a child and the other does not for example can translate into a conflict about contraception. Some women are fully aware of their own ambivalence about pregnancy and contraception and able to express it openly, but very often the woman's concerns are expressed by questions, fears, and verbal slips. The fear that pills are unnatural or will cause congenital defects can be interpreted as an expression of guilt over the pleasure that pills permit. Sterility is the ultimate fear caused by this unlimited possibility for pleasure. In the majority of cases, physical complaints are the means by which contraception clients address their physicians. In some cases, intolerance to OCs may actually be a hysterical manifestation that is not understood. Such symptoms as nausea, breast swelling, dizziness, vomiting, nervousness, and insomnia may be signs of early pregnancy as well as of intolerance for pills. Intolerance to pills may be caused by intolerance of a sexuality in which all things seem possible but in which the individual feels unrecognized by the partner. The resulting aggression may be turned inward in the form of a morbid symptom or of forgetting or stopping pill use, recourse to abortion, and demand for recognition. Acting out, especially by adolescents, is common in the area of contraception. In some cases the psychological or emotional needs of the patient might be better met by contraception that leaves some risk of failure, such as low-dose progestins or local methods. Their relative efficacy may allow the ambivalent desire for a child not to be completely stifled. Cases also arise in which patients use contraceptives to mask problems and to give the illusion of a normally functioning body. The possibility of having a child is very seldom raised during contraceptive consultations, perhaps because for the physician contraception subconsciously evokes the forces of death. The doctor can take refuge in the technical aspects of contraception, ignoring the emotional needs of the client.
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PMID:[The difficulties of contraception: conflicts and paradoxes]. 1231 42

If used correctly, only 2 out of every 100 women using a diaphragm would conceive over a year; however, because of forgetfulness the figure increases to 19 out of every 100. With good care they can last up to 12 years. The contraceptive sponge works because of the sperm-killing ingredients in the spermicide and because it blocks the cervix. The condom may also provide some protection against a variety of sexually transmitted diseases (STDs), such as herpes and gonorrhea. Missing one day of a low-dose oral contraceptive formulation (35 mcg) will have no consequences since the pill works by keeping hormone levels in the body elevated over time. With IUDs the only potential pitfall is forgetting to check for the tail every week of the first month and once a month thereafter to be sure the IUD is still in place. Some physicians suggest using a second form of contraception for the first three months after an IUD is inserted, since the odds are slightly higher it will be dislodged during this time. The manufacturers of Cu-7's and Cu-T's, as well as most physicians, recommend replacement of this device every three years. Experts are in agreement, however, that copper-containing IUDs carry a slightly lower risk of infection than Progestasert and the Lippes Loop. For postcoital contraception douching or using a spermicide within 10 minutes may help a bit. Although an IUD insertion can prevent pregnancy 90-95% of the time if it is done within five days of unprotected intercourse, because of the infection risk, this is not recommended unless a woman is planning on leaving the device in place as a contraceptive. The morning-after pill also works by preventing implantation of the fertilized egg. Taking two within 24 hours and two more 12 hours later prevents pregnancy 90-95% of the time, possibly with mild nausea or headache.
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PMID:Birth-control trip-ups. How to avoid just-this-once risks. 1232 Feb 44

This survey of attitudes toward contraception is taken from a document concerning psychological aspects of 233 women seeking pregnancy terminations. 87.12% had utilized a method of contraception at some time, of which 66.5% had used pills, 29.6% had used natural methods, 23.6% had used local methods, and 11.16% had used IUDs. 33.47% of the total sample had refused pills, in 83.65% of cases because of fears for health, and in the remainder because of infrequent intercourse, fears for unborn children, lack of information, belief that women shouldn't be responsible for contraception, or fear of forgetting. 64.38% of the women in the total sample had discontinued use of pills, about 2/3 of them for personal reasons such as nervousness, changes in the relationship, nausea, menstrual changes, frigidity, and depression, which are difficult to evaluate objectively. In most cases of termination of pill use for external reasons, the cause was opposition by the physician. Personality traits of the sample women which could impede responsible fertility control included passivity and inconsistency in 16.47%, dependency in 47.64%, and immaturity and poorly structured personality in 40.34%. Personality disorders among the latter included enjoyment of risk, impulsivity and lack of capacity to anticipate, emotional instability, and significant egocentrism and narcissism. 21.89% had depressive tendencies, 22.75% had sadomasochistic tendencies, and 28.33% had tendencies toward somatization, each of which is often correlated with unconscious choice. The unconscious elements are often more significant than the conscious and apparent motives. More effective contraception and a prevention of abortions might result from making women aware of their unconscious motivations.
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PMID:[Dependable fertility control: hazards and barriers (author's transl)]. 1233 50


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