Doctor's Review: Medicine on the Move

November 18, 2017
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Contraception: silly to sensational

The long evolution from lemon-soaked pessaries to the Pill

Apart from survival, the biological drive to procreate is the strongest instinct in the animal kingdom -- fueled by everything from spectacular flauntings of feathers and antlers to awe-inspiring displays of red Porsches and push-up bras. But what sets us humans apart from the rest of our furry and feathered friends is the ability – and perhaps more tellingly, the desire – to manipulate so many aspects of our reproduction.

Of course, the desire to mess with Mother Nature was there long before we had the science to back it up. The oldest method of birth control of all, the withdrawal method, is right there in the pages of Genesis. Onan, who was slain by God for his crime of coitus interruptus, at least survived in the sense that he gave the act – and its partner in seed-spilling, masturbation – his name. Judging by the large family sizes also recounted in the Bible, onanism was about as effective then as it is now.

Sweet and sour

Birth control forced lovers of the past to get creative. The Talmud, the ancient Jewish how-to guide to life, recommended lemon-juice soaked sponges inserted just prior to intercourse. Speaking of citrus and sex, Giacomo Casanova (1725-1798), that notorious Italian lover and leaver of legend, was known to use a half-lemon as a cervical cap to prevent pregnancy in his many partners.

The always crafty ancient Egyptians had methods of their own. The Ebers Papyrus (circa 1550 BCE) describes a virtual plethora of pessaries, with ingredients as varied and sweet-sounding as acacia root and honey, to more stomach-churning inserts soaked in donkey’s milk or crocodile dung. Onion juice applied to the foreskin was also recommended. These last few were likely quite effective forms of birth control in that they also served to repel one’s partner so completely that sex was nearly impossible. The lovers in ancient China fared even worse -- women sometimes drank hot mercury as their birth control method of choice. Presumably, this worked well too -- if maternal death can be considered a way to prevent pregnancy.

Crazy condoms

The centuries marched on but time did little to solve the problem of family planning. The Japanese devised a glans cover made of animal horn as early as the 1400s. European methods were even more creative and equally ineffective. In medieval times, drinking sheep’s urine or rabbit’s blood were celebrated as sure-fire ways to prevent conception; alternately, weasel testicles could be strapped to one’s thigh during sex to achieve the same effect. Nettle-leaf pessaries were favoured in Elizabethan England, while around the same time in Africa, women were advised to collect and drink the frothy spittle from camels’ mouths.

Some strides were made around 1500 when Italian anatomist Gabriele Falloppio (1523-1562) contributed the first academic description of the condom to the literature. Inspired by a nasty syphilis epidemic in Italy at the time, this condom was unlikely very effective seeing as how it was made of very fine linen and tied on the base of the penis with a pretty ribbon.

Slightly less porous were the leather condoms to come out of Denmark, and those made from animals’ intestines. Ones made from fish entrails were found in the cesspit of an English castle in Dudley, dating from the mid 1600s. It wasn't until Charles Goodyear came up with the vulcanization of rubber in 1839 that condoms actually became a viable form of birth control, with rubber remaining the shield material of choice until latex came along a century or so later.

Those Virile Victorians

During Victorian times, freedom from the corset was at least one reason to look forward to pregnancy, but that didn’t stop women from trying to fend off the stork on their own. Aside from condoms, the delightfully named “womb veils” – mail-order cervical caps made of rubber – were originally devised to correct prolapsed uteri, though their effectiveness as birth control was questionable. Stateside, the Comstock laws of 1873 made the dissemination of immoral material (i.e., pornography and contraception) illegal, so women ordering douches and clysters and caps from adverts in the backs of magazines were once again left to their own devices -- the US Postal Service refused to deliver any orders.

The beginning of the 20th century saw definite improvement in fertility awareness and family planning, although there were still some pretty big gaps in terms of both the understanding and the execution. One low point for women during the 1920s and ’30s was the inexplicably popular Lysol douche; despite its miserable and often quite serious side effects, there seemed to be a common belief that chemical disinfectants could be used pre- or post-coitally as an effective form of birth control. Many of these so-called “Feminine Hygiene” products contained poisonous ingredients, often causing burns and other irreparable damage. Alternately, women willing to endure the embarrassment could get diaphragms from their doctors, but condoms still remained the most popular form of birth control during the first half of the 20th century.

Rhythm Method

More good news was that the rhythm method was finally up and running in more or less the right way by the 1930s. Previously, physicians from the first-century like Greek doctor Soranus of Ephesus (one of the first physicians to really specialize in gynecology) and the Roman-Christian MD Augustine of Hippo, a.k.a. Saint Augustin (354-430), wrote that the days immediately preceding and following a woman's menstrual flow were when she was most fertile.

It was an erroneous notion held until well into the 20th century, when gynecologists Kyusaku Ogino of Japan (1882-1975) and Hermann Knaus of Austria (1892-1970) pinpointed ovulation. The discovery quickly led to the development of manuals, hand-held devices and even an entire clinic devoted to spreading the word. The eponymously named "O.K." method was great in theory but -- as legions of "surprise" babies can attest -- just because a woman knows about the rhythm method doesn't mean she can keep a beat.

Mother of the Pill

It was these laws that inspired one New York nurse, Margaret Sanger (1879-1966) to fight for women’s right to birth control. Repulsed by the reproductive misery she witnessed in her work in the slums of the city, from the perils of frequent childbirth and miscarriage to the dangers of STDs and self-induced abortions, she began to advocate for women’s right to good birth control.

In 1915, both she and her husband, the architect William Sanger, were charged with the crime of disseminating information about birth control and sending diaphragms by post, but they ultimately won their appeal on the grounds that it could also prevent disease.

In 1921, Ms Sanger founded what would one day become Planned Parenthood of America. Her dream – a magical little pill that could prevent pregnancy – was 40 years in the making but eventually, after plenty of legal battles and scientific research, she found a team who made it happen.

The road from idea to drugstore shelves was a rocky one. Sanger enlisted the medical genius of reproductive biologist Gregory Pincus (1903-67) and as much as $2 million in funding from her friend, International Harvester heiress Katharine McCormick (1875-1967). A key piece in the puzzle was the ability to create synthetic progesterone, a feat accomplish in the early ‘50s by chemists Frank Colton and Carl Djerassi. At last, the holy grail of family planning – approved by the FDA following extensive testing and marketed by Searle under the name Enovid – hit the North American scene in1960.

The world would really never be the same.

Fertility fall-out

Yes, the year 1960 was a seminal one (in more ways than one). Socially, the impact of the Pill was enormous. Although social mores of the time dictated that the Pill be prescribed and marketed only to married women, it didn’t take long before it was widely available. Almost overnight, single women everywhere were free from fear of unwanted pregnancies something that undoubtedly helped engender the “free-love” movement in the latter half of the decade. The freedom of being able to plan one’s family was equally thrilling for married women, and provided mothers the chance to not only limit their number of children, but also to space their kids out and plan their careers freely.

Of course, there were unanticipated social side effects as well. Almost instantly, the skyrocketing birth rates in North America courtesy of the post-WWII baby boom came to a screeching halt. As the 1960s unfolded, the debate over who controlled women’s fertility came to the fore. Margaret Sanger and other women’s health advocates insisted that since the burden of childbirth and child-rearing fell almost exclusively to women, that they alone had the right to control over this extremely important domain. And yet men were the ones in control of the Pill in many ways.

Banned by the Pope

A backlash against the Pill came in the form of safety hearings before the U.S. Senate in 1970. For a brief moment, religious interests – and there were many groups who opposed its use, especially after the Pope “banned” the Pill and all forms of artificial family planning in 1968 – suddenly aligned with a new generation of feminists who asked if perhaps the Pill might not be the greatest thing since sliced bread. Was it safe? Could it be safer? Was it yet another way to control women's bodies? Shouldn’t birth control be equally the man’s responsibility as well?

In what was seen as a patients’-rights victory for Pill users – as well as the radical feminists who disrupted the meetings – the FDA approved its continued sale provided each packet contained patient information outlining the risks associated with its use. In addition, the renewed interest in the Pill’s safety resulted in better formulations with lower doses of hormones to lessen the risk of blood clots. After a brief decline in sales, the Pill became more popular than ever, with more than 10 million women in North America counted among its loyal fans by 1973.

The debate surrounding this and indeed all forms of family planning rages on. But today, some 55 years after the Pill first hit the market, women who want to be in charge of the ifs and whens of having babies turn to the Pill more than any other kind of birth control, it being the method of choice among close to half of North American women of childbearing age. Internationally, the number is quite astounding – roughly 100 million women around the globe use the Pill regularly.

Unlike the first- or even second-generation formulations, today’s Pill delivers highly effective birth control and cycle regulation at the lowest hormonal doses possible. This translates into a level of safety and efficacy that our ancient ancestors – and even our mothers – could really only dream of.

This article was accurate when it was published. Please confirm rates and details directly with the companies in question.

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