For Instant Pooh-Poohing, Just Add Sex

A few months ago, I visited a doctor for reasons utterly and completely unrelated to my reproductive status and health, unless you view all nulliparous women as potential mothers: it was to renew a prescription. After he had asked me all of the relevant questions and I was approved, he decided to tack on a warning, one that I had heard before, about how I should not use the medication if I were nursing, pregnant, or planning on becoming pregnant. I laughed and said that said situation was as close to impossible as it could get for me.

I don’t know what reaction I expected — an answering laugh, perhaps. What I didn’t expect was for him to give me a stern lecture on how no measures could totally preclude pregnancy as a possibility and that no matter how careful I was, “something could still happen.”

Is there any other area of life where safety measures are so underhyped?

Entire sex ed curricula are built on this notion of “well, nothing is foolproof.” Everyone, especially those of us with wombs, is warned that though we might take preventative measures, we could still end up diseased or pregnant — if those preventative measures are discussed at all.

The fact-withholding fear-mongering doesn’t end there. Some gynecologists spread factually-inaccurate information, sometimes in the hopes that patients would conform to their narrow understanding of what constitutes healthy sexuality. People are generally horribly misinformed about sex, and medical school doesn’t fix that problem for everyone.

Of course there are risks to sexual activities, especially if performed without safer sex measures such as barriers and the discussion of test results. However, it is rarely if ever assumed that people will drive more recklessly due to the use of automotive safety devices. For example, the admonishment to always wear a seat belt is never accompanied with the admonishment that they don’t work 100% of the time. Indeed, a relative of mine was fatally injured by her seat belt. Unless the Catholic Church is to be believed, condoms can never actually cause STIs or pregnancy.

If only “no glove, no love” were the new “buckle up — it’s the law.” After all, dying from an STI or pregnancy is far less likely than dying in a car crash.

Main image via.

For Instant Pooh-Poohing, Just Add Sex

49 thoughts on “For Instant Pooh-Poohing, Just Add Sex

  1. 1

    As a female medical provider, I frequently give pregnancy warnings to my young female patients when writing prescriptions. Some medications can cause birth defects and the law suits become extremely costly when lifelong care of a disabled infant is considered… even if the drug likely had nothing to do with it. I’m always a little excited if they have an IUD or tubal ligation because we get to use any medicine we think will work best.

    In all fairness, with the drug Accutane the men get the same pregnancy lecture because even the drug dose in the semen can harm a developing fetus.

      1. Heina, reading your post again I’d agree that you’re being a bit unfair.

        Yes, telling you that no contraception is absolutely effective all the time might be redundant an dumb for you. But that’s YOU. Not the 500 other people your doc sees. (And it is not uncommon for a GYN to have hundreds of patients, and in a particularly awful HMO more than that).

        Yeah, you’re informed, you know stuff. The doc doesn’t know that. He doesn’t have the slightest idea what you do all day, or if much of what you self-report about habits is true. My mother is a GYN, and deals with the following all the time: “Doctor I’ve read…” — insert the latest woo from Cosmo here. Patients lie. Not deliberately, but for the very reasons you state (bad sex ed).

        Or, with younger women especially, all kinds of nonsense that she has to disabuse them of about getting pregnant (or not) in the first place. Now, a large chunk are smart people, but being smart doesn’t mean you won’t get stuff wrong and there is no way my mother can read minds and see who knows what.

        Some of this is a reflection of the very problem you bring up. Sex education int he US is completely off the wall bad. But now you have to tack on the lawsuit factor.

        I know, I know, you would never sue your doctor, right? You are smart, well-informed, and aware of the risks and benefits. But he doesn’t know that, and can’t verify it without quizzing you for an hour. And even then he can’t know you won’t sue.

        Here’s a fun fact: an OBGYN is responsible for everything that could at all possibly be traced to a birth injury until a child is 21. You read that right. So if ANY problem arises that a creative lawyer can say might, maybe, be birth-injury related the doc is on the hook.

        So put yourself in your doc’s shoes. He can’t tell if you aren’t another one of the patients with a lawyer on speed dial. What would you do then, given the danger to your livelihood and career?

        Lots of docs (my mom included) think red-label warnings, as they are known in the trade, are stupid. A woman using an IUD+condoms has pretty small to nonexistent risk of ever getting pregnant. But people change their minds, and sometimes don’t tell the docs. There’s a ton of things that are absolutely not in your control as a physician. At the same time, you can get sued any second. They don’t *dare* leave the warnings out.

        Yes, there are bad GYNs out there. There is a lot of misinformation. But given that the doctor can’t read your mind and is isn’t often given the time to sit with you and talk for an hour, the lecture you got isn’t surprising.

        Put it another way: given the potential for lawsuits, no doctor dares assume that any woman of childbearing age does NOT plan, as it were, to get pregnant. Logically they know that you won’t. But that isn’t the way lawyers work.

        All of this is a terrible reflection of the very points you brought up in addition to the way we finance medicine and administer malpractice in the US. It’s also a huge, honking reason why there is an acute shortage of qualified primary care docs. (OBGYN, in particular, has some of the highest malpractice insurance premiums in the business, on the order of $50,000 per year).

        And lawsuits aren’t always because of malpractice in the traditional sense. There’s a joke among my mother’s colleagues: if you haven’t been sued you haven’t been doing this long. And suits are sometimes brought precisely to drive some good OBGYNs out of the business. If the local DA is a devout Catholic or Evangelical, you can bet everyone in the state is looking over their shoulder when they want to provide comprehensive care.

        Again I stress that all this isn’t to say your points about bad practice or attitudes about sex are wrong. I mean, the best example of a doc who doesn’t “get” sexuality outside of a narrow range is Dr. Drew Pinsky (who isn’t even a GYN and says things that are pretty stupid).

        But there’s a difference between what a social scientist sees, as it were, and what has to happen in day-to-day decision making when you’re worried about giving good care AND keeping your job. It’s kind of the gap between what we would like in a perfect world and the one inhabited by lawyers, you know?

        1. I suppose, except he’s not my gyno or even my GP. This random doc was totally within bounds to warn me about the risk to any potential pregnancy caused by this drug (which I’ve been using for two years already but whatever). What I found to be wrong was his lecture about how no matter what, there was some risk. It’s not like I said “I can’t get preggo, la la can’t hear you,” I said something along the lines of “with condoms and an IUD, my risk of pregnancy is really, really low.” He still felt the need to lecture me, which was inappropriate and unprofessional.

          My actual GP and gyno are the same person. During my first visit, when I told her that I use barriers along with an IUD, her response was “Good, you’re being responsible. Just make sure you keep using those consistently as well as come in to see me regularly so that you can get tested.”

          Using both condoms and an IUD is not common practice and, as I’ve noted, reduces risk quite significantly. There’s nothing more drastic I could do other than becoming surgically sterile (not sure if I’m childfree for life yet, so no) or abstaining from sex altogether. My GP/gyno recognized that but some random doctor didn’t. That made my blood boil. A warning is one thing, a lecture about how I’m going to get pregnant no matter what I do is another.

          Underhyping the protection and helpfulness of a safety measure causes harm when teachers and doctors spend most of the small amount of time when they do talk about them harping on the fact that “nothing is 100%.” Most of us have heard that lecture so many times that even someone like me, i.e. who is well-informed, occasionally thinks “well, then, why bother? Let’s go crazy because I keep having it burnt into my brain that bad things could happen no matter what.” All too many people actually act on that thought. I’ve had people literally say to me, “You use condoms? That’s stupid. They don’t always work and they get in the way. What’s the point of using something that doesn’t work as well as kills the mood?” Is that what we really want?

          1. Heina: if he wasn’t your regular doc then there’s another factor: the pre-packaged lecture.

            This doc doesn’t know you and has no time to get to do that. You say “I use IUD and condoms” and he hardly hears you b/c he say 30 other people that day. To cover his ass it is even MORE likely that he gives you a lecture about pregnancy you think is stupid.

            I might also add, about patient behavior: I am (I like to think) a pretty well-informed guy. I was a science major even, when I started college.

            I got strep throat in college. I was 19. I took the pills. I felt better after a couple of days. Now, the instructions from the doc were to finish them. What do you think I did?

            I call my mother. “Hey mom, these antibiotics are great, I feel much better. I still have a bunch left over for next time and won’t have to pay again!”

            Her answer “What the hell are you doing? How long since your last dose? Aaaaagh! Do you know the sequelae from failing to complete a course when you have STREP?”

            (I had to look up what “sequelae” meant).

            And yes, my mother scared the living shit out of me when she told me I could die of a nasty infection or suffer permanent heart damage. Nowadays if my doc tells me to do something I mindlessly follow directions. Screw “patient-centered,” I want to live and that’s what I pay the doc for, you know?

            Now multiply this kind of stuff by a million. Not just with antibiotics, but all kinds of other meds, including contraception. YOU might be smart about it. Lots of other folks are not. You have to remember you are in a world where docs deal with morons all day long. Heck, I wouldn’t say I was a moron, but I was pretty dumb.

            This actually reinforces your point about bad sex ed, by the way, but I think you see what I mean about the incentive to “underhype” birth control effectiveness.

      2. I’ve gotten similar lectures after telling a doctor I have a hormonal IUD AND my boyfriend has had a vasectomy (the IUD is really just for period control at this point). Really? I use the closest thing to sterilization you can get without being sterilized and my boyfriend has been sterilized and still this guy thinks I need a lecture on getting knocked up by accident? I think some doctors (not all) ask these questions and then just don’t actually absorb the information they’ve been given and just regurgitate their usual lecture they give any woman using BC regardless of the type.

  2. 2

    I have had the dire pregnancy warnings more than once. That’s with having had my tubes tied 20 years ago, and being a nurse, myself.

    I wish there was more overall discussion on barriers and safer sex as well. I think there is a real lack of safer sex information out there. I was at a munch recently, and knowledge was all over the board.

  3. 3

    In all fairness, I just looked up Isotretinoin on Wikipedia and teratogenic issues aside, it looks like I drug I’d never, ever want to take.

    But for other drugs, what’s the risk? Are drugs which engender this sort of lecture (where the patient is not pregnant at the time of prescription and expresses an intent to stay that way) harmful to the unexpectedly pregnant woman, to the blastocyst/embryo, or both?

  4. 4

    I guess I don’t see the warning as necessarily bad. If you are prescribed that drug for 12 months, and in that time frame something changed in your life where you had the IUD removed or what not… the doctor did their due diligence by disclosing the information. I don’t think that the doctor necessarily feels that your methods aren’t working or you were dishonest, but people do make changes and don’t always consult their doctor when they do.

    1. 4.1

      Wouldn’t that have been better expressed as “okay, well, if something changes with your birth control in the next 12 months, make sure to come and talk to me.” As opposed to a lecture on the efficacy of birth control?

  5. 5

    Sorry, but as a feminist and a female physician I have to say your physician doesnt have a choice here. Every method has a failure rate, however small. Your physician doesnt know whether or not you’ll decide to have your IUD removed next month. Teratogenic substances do the most harm in weeks 3-8 of pregnancy, when many women do not yet realize they are pregnant. If you had a “damaged” child and your doctor had not discussed teratogenicity with you, your doctor could be considered liable. We are not willing to hang our licenses and personal savings on assuming you will not become pregnant. In the eyes of the physician you are reduced to your biology because that’s the business we deal in; we are expected to view things that way, and held accountable when we don’t.

    1. 5.1

      He could have simply said, “This drug can cause complications during pregnancy.” and spared me the long lecture about how I could still get pregnant using both IUDs and condoms.

      I wasn’t annoyed that he mentioned the risks to a pregnancy, I was livid that he was paranoid about my BC choices.

    2. 5.2

      In the eyes of the physician you are reduced to your biology because that’s the business we deal in; we are expected to view things that way, and held accountable when we don’t.

      As a feminist and medical anthropologist (as long as we’re throwing qualifications around), this is one of the things I find most disturbing about biomedical training. What you’ve expressed is what Michel Foucault called the medical gaze. The problem is, physicians don’t actually do this. They bring along with them all of their cultural baggage such that it affects health outcomes of patients. They may think they are only looking at symptoms/biology when really they are also adding in unexamined/unrecognized cultural biases.

      Further, even if they were successfully being biological reductionists, that also has poor affects on health outcomes as research shows that patient-centered care increases positive health outcomes.

      There are ways of talking to patients without lecturing. Heina is not stupid, she’s not a child, she doesn’t need a physician acting like her parent.

    3. 5.3

      Heina was right, the doctor was wrong. While the risk does exist, it’s small. That’s essentially what the doctor said, but it’s also what Heina said.

      When she said it, she was right. When he said it, he was correcting her. That makes him wrong. He’s implying that it isn’t rare or at least that she should be worried about it. No, that’s not correct.

      Worrying is good at motivating people to better protect their health, but what exactly is the doctor hoping she’ll do? She’s got an IUD and uses condoms. I’m pretty sure that’s the maximum level of being responsible about avoiding pregnancy.

  6. 6

    I was “throwing around” my credentials since I have been in the position of her physician. I am sure the bedside manner could have been finessed. Certainly a “lecture” would have been annoying. But I fail to see how “cultural baggage” or “patient-centered care” apply here. It’s still a fact that no method is 100%, and pregnancy happening while an IUD in place happens, and addressing it was appropriate, and does not in itself constitute fearmongering or treating her like a child. I’m not saying Heina doesn’t have a right to be annoyed. Maybe I glossed over her statement “stern lecture” which yes, would be tiresome. I was pointing out the reality of the situation for practicing physicians.

    1. 6.1

      But I fail to see how “cultural baggage” or “patient-centered care” apply here.

      I was pointing this out in response to your claim that physicians only see their patients as biological entities and not as people.

      I was pointing out the reality of the situation for practicing physicians.

      That was my point. You’re not pointing out the reality (that physicians only look at biology). You’re (unintentionally) pointing out that physicians are trained to think this is what they’re doing, but it’s not actually what they do.

      It’s still a fact that no method is 100%, and pregnancy happening while an IUD in place happens

      Heina never claimed it was 100%. She said it was “close to impossible.” I’m pretty sure that whoever put in the IUD would have informed her that it’s still possible to get pregnant.

      Maybe I glossed over her statement “stern lecture” which yes, would be tiresome.

      Did you also gloss over the part where she said she wasn’t in for reproductive health? The physician was only required to warn her that the medication being prescribed could negatively affect a developing fetus. The physician was in no way required to lecture her or even discuss the efficacy of birth control in general with her.

  7. 7

    Heina’s experience seems to me to be a reflection of that physician’s poor bedside manner rather than a reflection of the medical profession itself. I am however in complete agreement with mcfarlee on this. A physician who does not inform his/her patient about the various side effects, drug interactions and reproductive issues of any drug that he/she prescribes should not be practicing medicine.

    Let’s take a hypothetical scenerio of a nulliparous woman who receives Dilantin in the ER after she suffered a seizure. That ER physician will likely never see that patient again and discharge her care to the primary care physician. Thus the ER physician has no choice but to have a discussion with that patient on the reproductive effects of the drug to include the following:

    1. Dilantin reduces the efficacy of oral contraceptives and can result in a breakthrough pregnancy.

    2. Dilantin is most likely to cause congenital malformations during the first trimester.

    3. Owing to pre-partum vitamin K deficiency, there is an increased risk of fetal intracerebral hemorrhage during the 3rd trimester.

    4. Regardless of whether or not the patient is planning on a future pregnancy, she needs to be on daily folic acid while on Dilantin.

    This is the standard of care that any doctor must provide.

    Now all of this can be explained without the physician being condescending or appear as though he/she were “lecturing” a child. That doctor needs to be lectured on good bedside manners.

    Indeed in medical school, there are 6 core competencies that must be fulfilled prior to graduation:

    1. Patiet care
    2. Medical knowledge
    3. Professionalism
    4. Practice based learning and improvement
    5. Systems based practice
    6. Interpersonal skills and communication

    Contrary to public opinion, good doctors will inform and educate their patients as equals and not treat them as mere protoplasm. That is why we have these core competencies.

    1. 7.1

      Heina’s experience seems to me to be a reflection of that physician’s poor bedside manner rather than a reflection of the medical profession itself.

      I don’t really agree (and the literature in medical anthropology and sociology and the medical humanities do not support this assertion, especially in the realm of reproductive health). There definitely is movement within medicine away from paternalistic and biological reductionist models, as reflected in changing medical school curricula and the new MCAT standards, but we’re not there yet.

      (Not to mention there are plenty of practicing physicians who think paternalism is, like, the best thing ever! (And yeah I’m being a bit facetious there with my wording…))

      A physician who does not inform his/her patient about the various side effects, drug interactions and reproductive issues

      That’s not what Heina is has a problem with.

      Seriously people learn to read. She’s talking about being lectured to on the efficacy of birth control. Not about side effects or drug interactions or reproductive issues relevant to the particular drug she was being prescribed.

      Everything in your hypothetical is fine. That’s not the issue here. The issue is that the doc then went on past all that to give a lecture on birth control in general, which was not necessary to the care Heina was seeking. If she has an IUD in, she already knows about the chance of getting pregnant.

      Contrary to public opinion, good doctors will inform and educate their patients as equals and not treat them as mere protoplasm.

      That’s exactly what they should be doing. So how can you say you are “in complete agreement” with macfarlee when they say the exact opposite of this? It’s not “public opinion” that’s the problem here–it’s that you have physicians who are doing this.

      1. Will,

        I read Sandeep Jauhar’s article. What he is describing IMO is the furthest thing from paternalism. If a doctor has an expertise that a patient lacks, then isn’t assisting a patient in making an informed decision “the best thing ever”? Will, you have an expertise in the social sciences that I lack. Would you be paternalistic in educating me on how patriarchical corporate power structures control of the media contributes to disenfranchisement of marginalized groups? Of course not. If a patient refuses surgery for an inflamed appendix and changes his/her mind after being educated by a health care provider, that’s standard of care.

        Shoddy care occurs now because doctors are being further removed from their patients. In the past, a doctor was an integral member of the community rushing to make house calls. Previously doctors spent far more time with their patients. Previously the most important part of a stethoscope was the part in between the ear pieces. Previously it was all about being a good clinician and not perform a bunch of procedures. Gone are those days. Solo practitioners in small towns are closing shop and joining mega groups. Patients no longer see a doctor. They see an impersonal HMO which above all else stays in the black at the patient’s expense. Now that’s paternalism but with a parent molesting the child.

  8. 8

    I got the same thing from my doctor. I think after awhile I understood that he was used to talking to dumb people. I didn’t want to have to tell him that my husband and I weren’t sexually active. I was pretty embarrassed about it. Finally I blurted it out and he’s been leaving me alone–for now. I think he gets it that I’m not an idiot. I’ve already told him that I’ve been in menopause for two years now. But I suppose many people are misinformed about that, too. I for one know my body pretty well.

  9. 10

    There is one birth control method that nobody ever includes this warning with. Abstinence. Even Planned Parenthood says it’s 100% effective. It’s not, by the way. Not even close.

    Condoms are made out of latex. Abstinence is made out of good intentions. Condoms have to contain a small amount of fluid. Abstinence has to contain intense desires that stem from either 1200 million years of evolution or the Devil himself. Whichever you believe, it’s absolutely dishonest to tell schoolchildren that they can count on successfully remaining celibate.

    Abstinence isn’t a method, it’s an outcome. It’s 100% effective in the same way barriers are 100% effective. Sure condoms break, but the moment they do they stop being barriers. We would never accept that kind of semantic nonsense when it comes to condoms, but for some reason we do when it comes to abstinence.

    1. 10.1

      Agreed. Ironically, many of the proponents of abstinence-only education believe that abstinence failed at least once – when Mary was impregnated by God. In health class they rarely warn you about the risk of immaculate conception…

      I wonder if Heina’s doctor would have warned her about the risk of pregnancy had she said her contraceptive method was abstinence.

    2. 10.3

      This. One of the big things that drives me up the wall is when proponents of abstinence-only education try to cite the failure rate of condoms or birth control pills “with typical use” in order to lower the effectiveness rates. However, they never make that same qualifier for abstinence.

      Since the biggest reason for condom and birth control failure is, in fact, non-use (ie, deciding to have sex without a condom “this time”, or forgetting/being unable to take the pill and still going ahead with intercourse), then any “abstinent” couple who decides to have sex because hormones/booze/good jazz should be considered “typical” use of abstinence, and counted as part of that subset’s “failure rate”.

  10. Tim

    “badly fatally injured”

    You’re kidding? Do you mean “poorly injured” as if by an novice samurai who nearly missed his sword thrust? Why did you include the word “badly”?

  11. 12

    Ok, here’s the thing. Women’s bodies, men’s sperm and contraceptives are highly unpredictable. Two particular people could have completely unprotected sex every day for two years and never get pregnant. Either one of them might have sex with a different partner and fall pregnant that one time. A different couple could use 3 different types of contraceptives, at the same time, correctly, and still manage to get pregnant. I know a woman with 5 kids, 3 of whom were conceived while she was correctly using bc. Your doctor doesn’t know you, sexually. He doesn’t have any direct experience with how careful you are at putting your bc to use. It’s his job to make sure you understand that if you take that medicine, and get pg, your baby will have birth defects. And you need to understand that every time you have sex, pregnancy is a possible outcome. Period. No matter what you do to prevent it, pregnancy is still a possibility. The ONLY way to be 100% sure you cannot get pregnant is by keeping sperm far away from your vagina.

    When I was trying to conceive, it was very frustrating to me that nobody had ever told me how difficult it can be–how unpredictable our bodies are. I’m sure my friend was quite put out by the fact that people had assured her that on birth control she wouldn’t get pregnant, but she did–three times. The point is–unpredictability. Don’t get mad at your doctor. He’s trying to help you avoid a horrible outcome.

    And yes, my friend and her husband took permanent steps after the third oops.

    1. 12.1

      He isn’t my gyno. He isn’t even my G.P. He already had warned me of the dangers that the drug presented to any embryo/fetus I might inadvertently create. It was certainly not his job to condescendingly lecture me about how my use of both physical barriers and the Paraguard might, just might, lead to pregnancy. The IUD is not a method that relies on perfect use — it’s simply there and does its job beautifully most of the time.

      A patient who uses two methods, one of which does not require much action at all, and rattles off information about them is not one unaware of pregnancy risk. The way he talked about it, I might as well not use the methods at all — and there lies the danger. We overhype the potential danger of even protected sex to the point where we undervalue the incredible ways we have of making it significantly safer.

      1. This, I think, is the crux of the issue. If you use both a Paragard and condoms, you are clearly a patient who is very educated about her reproductive health. You don’t need a lecture on failure rates.

        The physician should give detailed info on the teratogenic effects of any medication prescribed to women of child bearing age (not just nullips) but there’s no need to lecture. This is information that can be given succinctly and in a straight forward fashion. It sounds like you need a dr who will appreciate your intellect.

  12. 13

    > However, it is rarely if ever assumed that people will drive more recklessly due to the use of automotive safety devices.

    People driving more recklessly when they have safety devices installed is a well documented phenomenon, specifically ABS systems. I don’t know if there is research looking into whether this generalizes to other types of risk but I wouldn’t be surprised if it does.

  13. 14

    However, it is rarely if ever assumed that people will drive more recklessly due to the use of automotive safety devices.

    That’s untrue. It’s not uncommon for people to tend to normalize their risk when increased safety measures are available by engaging in riskier behavior or the same risky behavior more often. This is called Risk Compensation.

    One example that has been in the news recently is the risk of head injury in football. Some doctors have hypothesized that the risk of head injury has increased dramatically due to a change in play style that has resulted in part from the increased effectiveness of padding and helmets. Players who are not well protected are more likely to play defensively. But because players are armored, a playing style has been developed and widely adopted which encourages the players to collide with each other as hard as possible. While the risk of any individual collision has been minimized thanks to the padding, the vastly increased number of collisions means that players are actually virtually guaranteed to suffer a concussion at least once.

    Another documented example is the use of sunscreen making people more likely to expose their skin to sun for longer periods of time. (The SGU talked about this one not too long ago.)

    In the case of cars, the increasing safety of cars has been cited has one of the reasons that Texas has raised the speed limit on some highways to 85 mph. The reality is that seatbelt or no, a collision at 85 mph is very likely to be deadly, and that risk only increases at higher speeds which drivers are very likely to attain in an 85 mph zone.

    If not having a seat belt means that you are more likely to drive defensively, and much less likely to push yourself to higher speeds, then it is very possible that having a seatbelt and the illusion of safety that it provides will cause people to take risks they otherwise would not. If you would never drive 80 mph without a seatbelt but you would with one, you’re normalizing your risk and possibly even increasing it, especially if several other drivers on the road feel the same way.

    For example, the admonishment to always wear a seat belt is never accompanied with the admonishment that they don’t work 100% of the time.

    That’s BS. If you have never been told that seatbelts don’t work 100% the time then your driver’s ed instructor should be fired immediately. The professionals responsible for educating the public about seat belts should absolutely be emphasizing that a seatbelt is not a substitute for safe driving, just as those responsible for educating the public about pregnancy and STIs (which would include doctors in my opinion, even if they are not your OB/GYN) should emphasize that all preventative methods do have a chance of failure. The alternative would be highly irresponsible.

    Indeed, a relative of mine was fatally injured by her seat belt.

    From this and the rest of your post, the message seems to be that the risks of seatbelts are underrepresented, not that the risks of birth control are overemphasized. If your experience is representative, then we need to immediately launch a campaign to properly educate people on seatbelts, how they work, what they do, and what kind of protection drivers and passengers should expect. It sounds to me like the big problem is that you were never properly lectured on the effectiveness of seatbelts, not that you have been overlectured on the effectiveness of birth control.

    condoms can never actually cause STIs or pregnancy.


    For the sake of simplicity I’m going to plug in some numbers that are not accurate. Let’s say condoms are 99% effective. That is, when used correctly, they reduce your chance of getting pregnant from (let’s say) 60% from a single sexual encounter to 0.6%. That’s fantastic, and clearly you should use condoms. However, if you then have sex many more times than you would if you did not have access to condoms, and due to your access to condoms you neglect other helpful though less effective methods that you would probably employ in their absence (such as avoiding sex when you are most fertile and requiring your partner to pull out before ejaculating), you could very possibly counteract the increased safety of condoms by engaging in risky behavior with much greater frequency. (And that is before we even consider the possibility that all of those extra sex sessions might mean that you are having sex with more partners than you would otherwise.) So no, the condom is not “causing” STIs or pregnancy, but it is changing your behavior such that STIs and pregnancy may actually be more likely.

    Hell, if condoms are 99% effective and a million couples use them once, that still means that they will fail 10,000 of those couples. Multiply that times the number of times each couple has sex and you’re going to end up with enough failures that somebody will notice and complain.

    As I said, these are not accurate numbers. Condoms, properly used, are more effective than 99% and the chances that you would have enough extra sex to counteract their benefit is unlikely unless you are the luckiest person in the world (or it’s your job). Of course condoms are not always properly used, and can fail for other reasons as well. The equation is messy but most likely comes out in favor of condoms.

    Even if you do manage to have enough sex to normalize your risk I think most people, given two equally risky options, would choose the one that comes with lots of extra bonus sex.

    Although it is probably true that the risk of failure of birth control and condoms is overemphasized proportional to its occurrence, we are talking about a situation where failure comes at a pretty high cost to at least one individual, probably two, as well as the possible introduction of a whole new person into the equation, and that’s before we factor the impact on family and society from unintended pregnancies. It doesn’t seem like a bad idea to err on the side of overemphasizing the risks in this case. The chances that you’ll need a life preserver on a jumbo jet are pretty small, but they still play that safety video every single time. (Hell, they tell you how to buckle your seatbelt every single time, just in case you haven’t been in a car since 1975.)

    Safety warnings can definitely get ridiculous, in the sense that if you need the warning you are probably not sensible enough to use the product in the first place. This does not seem like one of those cases to me.

    1. 14.1

      This entire argument is missing the point.

      A professional speaking in a professional context about seatbelts should be explaining that seatbelts are not a replacement for safe operation of a vehicle.

      However, the OVERALL MESSAGE should never be that you cannot TRUST seatbelts because they are never 100% effective.

      This is a problem of the message of safe sex practices. It presumes that sex outside of a very specific context (makin’ babies) is bad. It doesn’t allow for the responsible use of sex for other reasons. It’s kind of like if a driver’s ed teacher was admonishing a race car driver for driving too fast because seatbelts are not 100% effective – the admonisher here is missing an important piece of data.

      The point of the devices is to be able to have sex without pregnancy. Of course they’re not 100% effective but that constant, unrelenting message teaches people that the devices don’t matter because of the lack of effectiveness. People need to be able to trust their condoms and random people with medical training shouldn’t be reminding everyone at all times that they’re not entirely effective since it undermines that trust.

  14. 15

    I think it comes down to the fact that while a doctor may feel required to warn you of the risks associated with pregnancy while on certain medication that differs from this “pregnancy could get you at any time” line that I know I (a fellow Paragard & condom) user have gotten often. Every instrument of the medical community has a failure rate but I’m hard-pressed to cite something else whose failure gets played up as much as that of BC. It’s interesting that someone brought up the “whenever you have sex you’re at risk, the only guarantee is abstinence” conversation in response to this topic because, to me at least, it’s the same kind of fear-mongering, slut-shaming designed to scare people out of educated sex. Now yes, my condom could break and at that exact moment my IUD (with its failure rate of less than one percent) could fail and I could happen to be ready to be fertiliized, as it were, and end up pregnant- it could happen. A lot of things could conceivably happen. But as the author states in another comment, the risk here is almost zero and to tell women that there is no way to engage in a healthy, happy sex life without constant fear of pregnancy just reeks of “that’s what you get for having sex” It all feels like people find it necessary to let women know, “you express yourself sexually, this could happen… no it could still happen!” because on some level, they think women deserve to face consequences.

    1. 15.1


      Guys, she’s not pissed that he warned her about the possible negative effects SHOULD she become pregnant. She’s pissed because he used scare tactics at her about birth control efficacy.

  15. 16

    I don’t really follow the point your making. Driving is really dangerious…

    I think it’s all about cost/benefit analysis. A drug should make things better for you or there’s no point right. So that increases the burden of proving no harm by a magnitude. So the doctor is telling you the risks of this drug even if they are rather insignificant and it’s perfectly OK for the doctor to be serious about it.

  16. 17

    Another factor is that patients lie to their doctors quite often and a recent poll showed that one in ten doctors have lied to their patients. Many people lie about lifestyle habits to their friends, partners and doctors; and doctors know that their patients lie or often minimize their less than healthy choices. Ass covering, presumptions and assumptions’ are all part of the dance. However clearly, IMO, one of the problems is that a paternalistic or authoritarian doctor is more likely to have patients lie to them or try to avoid tedious lectures and cause gaps in the information gathering process that can and does place patients at higher risk.

  17. 19

    My wife was on accutane for a few years. She got the lecture every time from every one involved in dispensing the drug. Her ob/gyn even apologized in advance for going through the lecture again, but did it anyway. I’m not saying what this doctor did was right or wrong, but it is common.

    BTW: the drug itself is fantastic. The effects were dramatic and long-lasting.

  18. 20

    I get that this isn’t something to persuade anyone else to do but the first response that popped into my head was “well if the IUD and condoms then an abortion would clear that right up” hopefully straight faced enough to convince the doctor that I really view them that lightly.

    Then it changed a bit- “well then I’d get an abortion to find out if it was the second coming of Jesus or not.”
    …and I think I’ve met my quota of horrible abortion ideas for the month.

  19. 21

    After watching this, I just have one thing to say to DaeSung…”GET SOMEEE!“

    Also, if you missed SBS Big Show, you can rewatch the Tonight, What Is Right, and Cafe performances on Big Bang’s official Youtube channel.


    JT’s 4th Mini-album Big Bang VN
    big bang
    I’m really impressed with this mini-album. It shows how much BB has grown in 2 years they’ve been away. I have to say, this whole mini-album was very J-Pop influenced, well considering “Hands Up” and “Somebody to Love” were originally Japanese songs.

    Yes, Cafe deserves it’s own paragraph. Cafe is really an amazing song. It’s like there’s a bunch of upbeat J-Pop-ish K-pop then there’s this one chill song at the end. Just like on the “Stand Up” mini-album, all K-pop songs, then there’s “Oh My Friend.” It’s one song that completely stands out. Just like DaeSung said during SBS The Big Bang Show…

  20. 22

    I agree with Heina 100 %. A professional doctor should not lecture a patient that behaves responsible in this way. If you insist for legal reasons on saying something a statement like “For legal reasons I have to tell you that no method of contraception is 100 % reliable.” would have sufficed.

    This culture of constantly stressing that condoms are not 100 % safe is really horrific and damaging. Because the message that comes across is that condoms are not reliable and thus people think they can do completely without them because it does not really matter anyway. The result is the high rates of STIs and teen pregnancies compared to other countries that promote the use of condoms as part of public health programs.

  21. 23

    Maybe he just had a bad day or maybe he’s just one of those docs with an alien personality and took offense to her laughing about the chances of getting pregnant. So…he goes into the offensive rant and then she’s on the defensive, to which he wins because it’s his office, she stayed for the lecture and he gets the last word. Now it’s all over the blog and she gets the last word and yes he does sound like a jerk but, I’ve hardly known two docs in my life time that didn’t think of themselves as omnipotent all knowing bastards.

    Now I’m all in a dither thinking about all the fucktard righteous all knowing doctor bastards I know and how they really piss me off. Peanut butter or jelly, mounds or almond joy, doctor lectures or a new yellow pages search. Sucks having 1st world problems.

    1. 23.1

      “Now I’m all in a dither thinking about all the fucktard righteous all knowing doctor bastards I know and how they piss me off”

      That describes just about every day for me!

      Point of order: I would be sad to learn that the wonderful term “fucktard” is ablist – is it?

      And while I’m at it I want to apologise for using ablist language here in the past.

  22. 24

    I don’t subscribe to the whole “fight stupidity with fear” school of thinking, but I can understand it. The majority of people are either misinformed or in denial about the risks of having sex. The doctor is just trying to improve their odds of not getting pregnant/contracting an STD by stacking the deck. It reminds me of the scene in “Mean Girls” where the sex ed teacher was saying “Do not have sex, ever, you will get pregnant, AND DIE!” A dramatization of the situation, but accurate over all. Fighting fire with fire(or fear, in this case) never really works, but that doesn’t stop people from trying.

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