Well, we’ve covered birth control 101, in which we learned that hormonal contraception for women is a fixed cost that has absolutely no relation to how much sex she has or how many partners she has it with (and surprisingly often isn’t prescribed AS contraception but for other kinds of health care), and today, class, we’re going to have the 102, because apparently we still need to learn things!
Today I got linked to a post by Dr. Whitecoat, who appears to feel that a)The Affordable Care Act’s coverage of contraception represents a free handout to women, and b)that it offers nothing to men, who will nonetheless be part of the paying pool. This particular point of view, particularly that it represents a handout specifically to young, sexually promiscuous women, is shared by the Romney Campaign. To wit, “Free contraceptives were very big with young, college-aged women.”
Here’s a quick primer on birth control: there are three primary approaches with it. Surgical sterilization, hormonal contraception in various forms, which does not (yet) exist for men as it’s much easier to stop an egg from getting fertilized or implanting than it is to stop fertile sperm production, and barrier methods, which technically include female condoms and dental dams, but as I’ve never actually met anyone who’s used either, we’ll just go with “condoms and diaphragms”. There’s also various formats of spermicide delivery, but as they are really unreliable compared to everything else, they’re usually used as a backup to the barrier method in case it breaks or was put on/in incorrectly. There’s also IUDs, which technically is a surgical approach but is also temporary and only for women, so in effect it can be lumped in with the hormonal contraceptives.
All birth control methods have their upsides and their downsides. Hormonal contraception is fire-and-forget as long as you’re good about remembering to take your pill or renew your shot or your Norplant, but it has a number of side effects and does buggerall to prevent sexually transmitted diseases. Of the barrier methods, diaphragms have to be fitted, don’t prevent sexually transmitted diseases, and are fiddly as hell to insert; they have the upside that once you’ve managed that you can have sex “spontaneously”, but that’s a sufficiently small upside I’ve never met anyone who uses one of those still, either. Condoms are cheap and protect against sexually transmitted infection, but they reduce sensation for most men that I’ve talked to, you’ve got to have them on hand and ready to go when you’re ready to have sex, and most of them come with spermicidal lube.
Yes, that’s actually an upside AND a downside. The problem with any form of birth control that uses the spermicidal backup is that the vaginal area is an ecosystem unto itself; it’s normally inhabited by friendly, acid-loving bacteria that keep things clean and healthy, but spermicide kills them as well as killing sperm. Use too much, too often, and most women will become vastly more prone to vaginal and urinary tract infections, since the acid-lovers aren’t there making things inhospitable for nastier-tempered invaders anymore. They’re painful, they’re unpleasant, and they stink. They can also be life-threatening- a UTI untreated can happily migrate up into the bladder or kidneys and start doing some serious damage. Condoms that don’t have spermicide exist, but they can be difficult to find, or at least I’ve never managed to find any on the drugstore shelves. Granted, it’s been a long time since I tried, but at the time, it was special order or nothing doing. (I had a friend with a steady boyfriend who was also allergic to the class of antibiotics most useful in treating urinary tract infections. This was the bane of her existence and led to some pretty serious illnesses.)
All contraceptives have tradeoffs, and which downsides you’re willing to accept have a great deal to do with what kind of sex you’re having, and most of the more serious downsides are the woman’s consequence. If you’re a single woman and having casual hookups, sex buddies, or other short-term relationships, condoms are absolutely the way to go: you need the protection from STIs way more than you need anything else other than the pregnancy prevention, and since you probably have no idea when you’re next having sex, there’s less risk that the spermicide will hurt you, and simply grabbing some birth control from the drug store or night stand when you need it is a much more attractive option.
However, if you’re in a long-term, exclusive relationship, particularly if you’re cohabiting, hormonal birth control becomes much more attractive. You’re having regular sex, so the effects of spermicide are a more pressing concern, neither of you (presumably, obviously there are exceptions and the exceptions will usually be using condoms) is carrying an STI and you’re not going to be picking a new one up anytime soon unless someone is both being horrible and doing it without a condom, and since you’re having regular sex, a form of birth control that’s a fixed, steady cost is much more attractive. Since STIs and infections have been taken (mostly, some hormonal birth control raises the risk of vaginal/urinary infections too) off the table, concerns about men’s sensation are much higher on the priority list now.
Now I’m going to get a little more personal, so cut just in case anybody’s sensibilities are more, well, sensitive than I expect.