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  1. Sexual avoidance
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  8. Evaluating contraceptive effectiveness and safety
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  12. Every poll since the Crimean War has shown that one of women’s main beefs is that men ejaculate too soon
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EVALUATING CONTRACEPTIVE EFFECTIVENESS AND SAFETY

The decision to use contraception and the choice of one method over another depend primarily on two practical matters: how well it works (its effectiveness) and its health risks (its safety). Evaluating these two issues is complicated. No one contraceptive method is always best or safest.

When evaluating effectiveness and safety, remember that information from various sources may be biased. The popular media, for instance, are eager to report the latest "news" about the real or suspected hazards of a contraceptive method. Yet the story is usually condensed to a few paragraphs in the newspaper or is crammed into less than sixty seconds of TV or radio broadcast time. Scientific accuracy or caution is often lost in a process of oversimplification, misinterpretation, and unwarranted conclusions. In addition, much of the research on the effectiveness and safety of birth control methods is paid for by the drug companies that manufacture them. These companies have an obvious interest in presenting their merchandise in a way that will boost sales. Finally, all scientific studies are not equivalent in their applicability to you. In general, studies about people close to your age, cultural background, and socioeconomic status are more meaningful than studies about other groups. For example, if you are a twenty-two-year-old single American woman, you cannot put much faith in the findings of a study about thirty-five-year-old married women in Lapland.

Understanding some other aspects of evaluating effectiveness can also be helpful. First, it is important to distinguish between two factors: theoretical versus actual effectiveness. The theoretical effectiveness of a particular method is how it should work if used correctly and consistently, without human error or negligence. The actual effectiveness is what occurs in real life, when inconsistent use or improper technique ("user failure") combines with failures of the method alone ("method failures"). For example, if a couple runs out of condoms on a week-long camping trip yet continues to have intercourse, the woman's subsequent pregnancy is not counted as a method failure. But if she conceives even though each time she had intercourse, she has used a contraceptive foam exactly according to instructions, her pregnancy qualifies as a method failure.

Second, for most types of contraception, the longer a person uses a particular method, the more effective it becomes. The reason is that people improve their technique and become more accustomed to using the method regularly.

Third, effectiveness rates for almost every nonsurgical contraceptive method vary depending on whether a couple uses the method to prevent pregnancy or to delay (space) pregnancy. Failure rates are generally 50 to 100 percent higher for delay compared to prevention, since there seems to be less consistency in method use.

There are other difficulties in assessing the safety of contraceptive methods. First, there are often wide differences in the frequency of side effects reported by different investigators. Their results reflect differences in research design, choice of control groups, different characteristics in the populations studied (such as age, health, socioeconomic status), and the methods investigators use to identify a problem (self-administered questionnaire, personal interview, laboratory testing). Second, there are some relative aspects to the safety question. How important is avoiding pregnancy? Are the side effects of a contraceptive method more or less serious than the risks of pregnancy and childbirth? How do the risks of a contraceptive method compare to other health risks (such as the risk of getting cancer or having high blood pressure) or to risks of everyday life? These questions will be addressed in more detail as we review the safety and side effects of each method of contraception.

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Men's Health Erectyle Dysfunction