[Two Pronged] Please help and also please don’t judge

Rappler’s Life and Style section runs an advice column by couple Jeremy Baer and clinical psychologist Dr Margarita Holmes. Jeremy has a master’s degree in law from Oxford University. A banker of 37 years who worked in 3 continents, he enrolled in and subsequently gave workshops in work-life balance and gender sensitivity training. He has been training with Dr Holmes for the last 10 years, as co-lecturer and occasionally as co-therapist, especially with clients whose financial concerns intrude into their daily lives. Dr Holmes needs no further introduction.

Dear Dr Holmes and Mr Baer:

Hi, I was just wondering if I will get pregnant even if we’re using condoms from start to finish of the intercourse? Also the condoms didn’t break? Will I still be pregnant? Also, may I ask what kind of birth control pill should I take? Btw, I’m only 17 years old. – Ina

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Dear Ina:

Thank you for your letter. Your decision to use condoms is very sensible, as is your wish to know how safe they are likely to be. Safety is directly related to proper and consistent usage and it may be helpful to mention a few important factors which will reduce, or totally eliminate, condom effectiveness:

1. Late application
2. Early removal
3. Unrolling a condom before putting it on
4. No space at the tip
5. Failing to remove air
6. Inside-out condoms
7. Failing to unroll all the way
8. Exposure to sharp objects 
9. Not checking for damage
10. No lubrication
11. Wrong lubrication: oil-based lubrications with latex can degrade the condom
12. Incorrect withdrawal
13. Condom reuse
14. Incorrect storage
15. Not checking the condom’s expiration date

The World Health Organization published a paper last year, based on over 15 years of research and 50 studies, which showed that the success rate for condoms, when used properly, was 98% and that actual, i.e. imperfect, use reduced that to 85%. This of course means that even if you have perfected your use of a condom there is a 2% chance of an unintended pregnancy, while on average that rate is likely to be much higher, but only because the condom was not used properly or consistently.

As for choice of birth control pills, you would be best advised to consult a doctor, preferably a gynecologist, since different pills suit different women at different ages. However, it is also worthwhile mentioning that in addition to birth control pills, there are other methods such as injectables and implants. Again, a doctor would be best placed to advise you on which alternatives would be most appropriate for you.   

Jeremy

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Dear Ina: 

First, using a condom is a very good idea, and, frankly, one I would recommend my daughter to use if she were your age. To make it even safer, I would recommend her using a spermicidal jelly (foam?) in addition to using a condom which, to my mind, would make lovemaking about 100% effective. 

If, during all those times, your partner’s condom hasn’t broken and you have avoided all the pitfalls above that Jeremy mentioned, then I would say you were 100% safe so far. 

Keep up the good work and please write to us again if there is any other way we can help you. All the best – Margie

Dear Dr Holmes and Mr Baer:

Thank you so much for the help. Btw, how much is the “spermicidal jelly (foam)” and where can we buy it? Hope you’ll reply soon. It will be a big help. 

I can’t go to a gynecologist because I think all of them are just going to judge me. :(.

Ina

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Dear Ina:

As for your reluctance to consult a gynecologist for fear of being judged, it is a sad fact of life that we are all surrounded by people who are ready to judge us at the drop of a hat. Prejudice – religious, racial, sexual etc. – is ubiquitous and simply has to be faced. 

Despite the utopian provisions of the Hippocratic oath, there are plenty of doctors around whose own agendas, most frequently of a religious nature, take precedence over the health and wellbeing of their patients. I am all for freedom of religion but it should never be interpreted to include imposing one’s beliefs, however sincerely held, on others who do not share them.

Such imposition is all the more heinous when the imposer is taking advantage of an imbalance of power (for example, nurses in hospitals withholding painkillers from unwed mothers “to teach them the error of their ways”). 

Fortunately however there are also doctors whose approach to their patients is simply to treat them, not to judge them. Let’s hope you are able to find one of these. All the best – Jeremy

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Dear Ina: 

Thank you very much for this, your second letter, which shows how serious you are about your sexual health. First, let me just add a few factoids that you might want to consider and then move on to something just as important, though perhaps not as quickly and easily observed as an unwanted pregnancy.

Factoid 1: Make sure the spermicidal jelly you use is NOT oil-based. They are available at Mercury and other reputable drugstores, like South Drug. I am so sorry I don’t have any idea how much they cost right now, but that should be easy enough to find out.

Factoid 2: Below are two links; the first to CDC (Center for Disease Control) and the second to Planned Parenthood condom effectiveness for pregnancy prevention:

LINK 1  and LINK 2

Factoid 3: To quote Mina Tenorio, my go-to person at Likhaan, a wonderful NGO truly committed to help us, and predictably, none of the senators’ PDAF went to, “Yes, it’s sad that medical professionals tend to be judgmental when dealing with young people needing contraception. But there are still many who are not. There’s the Adolescent Medicine Unit at the Philippine Children’s Medical Center (Quezon Ave cor Agham Road).”  Please check it out, Ina. If it passes muster, perhaps you can also let other friends in similar predicaments know of its existence? 

Factoid 4: They say (myself included) that “a little knowledge is a dangerous thing,” and that’s why asking an expert is better. Alas, Jeremy and I are not true-blue, cutting edge experts in contraceptive health, so it is best you go to any doctor, preferably a gynecologist, who is…or should be.  Such experts might give you the option of injectables or implants in addition to the pill. 

You are a brave woman, daring to go where others don’t. Not many would be as relentless in getting the help they need, and I salute you for being such a person. If we don’t do what we can do ourselves to get what we need, who else will? Who else will even know? 

And yet, despite your relentlessness, you too are afraid of being judged. I don’t blame you either. Even I, 47 years older than you, am scared of being looked upon with a sneer. I doubt anyone is entirely immune from wanting to be liked and accepted. Evolutionary psychologists say that one reason social anxiety is so common is that we needed it for survival in the past. 

Thank God we no longer live in those times. Yes, being judged feels terrible, but you know what? Big deal. Those judgers/haters don’t know a thing about you and that’s why they have the arrogance to judge you.

You don’t have to fight with them, just pick up your stuff and go, should they have the nerve to taas kilay (look down on) you. Then go to someone else who has the brains and the heart to listen to you.

It is 17-year-old women like you, who are brave enough to look after themselves, who can later (but not necessarily) become: first, braver 18-, 20-, even 22- and 23-year-old women who will no longer shirk, but will, in fact, insist on being given the straightforward service they need when they need it; to 24-, 37-, 56-, 73-, 88-year-old warriors who will fight for every woman’s right to contraceptive and other services it should be the duty of every government to provide.

Mabuhay ka, Ina.    

Margie

– Rappler.com

Need advice from our Two Pronged duo? Email twopronged@rappler.com with subject heading TWO PRONGED.