A history of contraceptives

Pills, implants, shots — birth control has come a long way from animal-poop suppositories and opium cervical caps.

As long as people have understood where babies come from, they have been trying to control their fertility. Contraceptives have been used for thousands of years, and some cultures have been very creative when it comes to family planning.

Only recently has highly effective birth control been so widely available that it has transformed women’s lives in many countries. The Centers for Disease Control and Prevention named family planning as one of the 10 great public health achievements in the 20th century. The pill allowed women to pursue education, expanded employment opportunities and allowed them to earn more money.

EARLY CONTRACEPTIVES

CONDOMS have been around for thousands of years. In fact, an illustration of a man wearing a condom during sex is painted on the wall of a cave in France and is estimated to be 12,000-15,000 years old. Condoms were often made of animal guts. The famous womanizer Casanova is said to have worn linen condoms.

BARRIERS AND SPERMICIDES were also used by ancient peoples to block, absorb or kill sperm before it reached the uterus. Women used halves of fruits, such as lemons and pomegranates; wads of seaweed, moss and bamboo; sponges soaked in vinegar or brandy; elephant or crocodile dung; beeswax; honey; cocoa butter; balls of opium; and rock salt, among many other substances.

ORAL CONTRACEPTIVES existed long before the pill. For thousands of years, women around the world have ingested a variety of different herbs and fruits, from papayas to pomegranate seeds to Queen Anne’s lace, to control fertility. Modern science suggests they may have been effective, if not always safe. Centuries ago, Chinese women drank mercury or lead to prevent pregnancy, which could be fatal.

MODERN CONTRACEPTIVES

CONDOMS made of rubber were mass-produced beginning in the 19^th century. Today, “rubbers” typically are made of latex, although alternatives are available for people who are allergic. And “lambskin” condoms —actually made from sheep intestines — are still available.

The female condom, also called the internal condom, became available in the U.S. in 1994. These are soft plastic pouches that are inserted into the vagina before sex to block sperm.

BARRIER METHODS became more sophisticated, more effective and less messy. In the 1830s, a German gynecologist created custom-made rubber pessaries, devices that were were inserted into the vagina to block sperm from reaching the uterus.

The modern version is the diaphragm, a shallow, silicone cup that covers the cervix. Cervical caps are smaller and with a different shape. An earlier form of diaphragm was the primary contraceptive provided at Planned Parenthood clinics beginning in 1916.

A sophisticated version of an old method, the Today sponge became very popular when it entered the American market in 1983. Instead being soaked in alcohol, oil or vinegar, the modern sponge contains the spermicide nonoxynol-9.

Diaphragms and cervical caps are also paired with spermicides. Contraceptive foams, jellies, creams and films are the updated version of honey, animal dung and other substances believed to kill or immobilize sperm.

While diaphragms, cervical caps and sponges are still available on the market, they’re fallen out of favor compared to hormonal methods that don’t need to be inserted before sex.

The Pill

The pill revolutionized birth control in America. San Antonio played an important role in the birth of the modern birth control pill, which was under development in the United States by the 1950s.

Dr. Joseph Goldzieher at the Southwest Foundation for Research and Education (now Texas Biomedical Research Institute) tested the drug on 200 women with the cooperation of the Planned Parenthood Center of San Antonio. The FDA approved distribution of the Enovid contraceptive pill in 1960.

Enovid contained large doses of hormones, which caused serious side effects, and is no longer produced. Today, there are many varieties of oral contraceptives with lower levels of hormones. The pill remains the most used form of birth control among Planned Parenthood South Texas patients.

Oral contraceptives paved the way for other hormonal methods that deliver pregnancy-preventing hormones without the necessity of taking a daily pill. Depo-Provera, an injectable hormonal contraceptive that provides three months of protection in one shot, was approved by the FDA in 1992 and remains popular among Planned Parenthood patients.

The patch and the vaginal ring both were approved by the FDA in 2001; the patch provides one week of protection against pregnancy, and the ring provides four weeks.

Emergency contraception (the “morning-after pill”) is a dose of oral contraceptives that can be taken soon after unprotected sex to prevent pregnancy. It’s much more effective and safer than douching with Lysol, as was common in the early 20th century. It was first approved by the FDA in 1998. Some have since become available over the counter, while the most effective type is prescription-only.

Hormonal Implants

The hormonal implant came onto the U.S. market in the 1990s. Norplant, a set of small silicone capsules filled with hormonal birth control, was implanted into the skin of the upper arm to prevent pregnancy for up to five years. The current version is Implanon, a single-rod implant effective for up to three years.

Intrauterine Devices

IUDs took a while to perfect. IUDs made of silkworm gut, gold, and silver were used in the early 20th century but often caused infection. A German physician introduced a safer version in the 1920s. Dr. Jack Lippes, an American doctor, invented the “Lippes loop,” a double S loop made of plastic, in the early 1960s.

The Dalkon Shield was an IUD used in the 1970s that came to market without being properly tested for safety. This device caused severe pelvic infections and even death; too many women became pregnant using it and miscarried. The manufacturer stopped selling the device in 1974. The Dalkon Shield gave IUDs a bad name in the U.S., which persisted even when safe, effective IUDs became available.

The copper IUD, available in the U.S. since the 1980s, is made of a flexible piece of plastic shaped like a T, wrapped with copper wire. Copper ions cause uterine fluids to become toxic to sperm and prevent implantation of a fertilized egg. This hormone-free IUD is extremely safe, highly effective and lasts up to 12 years.

A hormonal IUD was approved by the FDA in 2000. Also T-shaped, it releases small amounts of pregnancy-preventing hormones and is good for up to five years.

IUDs and implants are known as long-acting reversible contraceptives (LARCs), the most effective methods of reversible birth control. Tubal ligation and vasectomies offer lifelong protection. The only 100% effective method in pregnancy prevention is abstinence.

New developments

Researchers continue to develop and refine methods of birth control. For example, a new vaginal ring that can be reused for up a year has recently been approved by the FDA. And some ancient methods are still in use today, including withdrawal and tracking fertility cycles, although they are not as effective as hormonal methods. At Planned Parenthood South Texas, our well-trained, compassionate staff works with each patient to decide on the best birth control method.