MY EARLIER POST ABOUT THE RETURN OF “THE SPONGE” produced this email from Dr. Wendy Kroi:

Dear Professor Reynolds,

In response to your comment “Somebody needs to work on that.”–oh, but I am!

I have put together a book listing ALL the contraceptive options available. At the very least, American women deserve to know how few methods they have access to. Here is a link to the Table of Contents (Link. ) For more background on the lack of options see (Link).

Here are just a few of the facts:

1) the U.S. is one of the few countries in the world where women don’t have access to hormonal implants or combination injections

2) the only hormonal Intrauterine device (IUD) available in the U.S. is Mirena, an older type of IUD (more prone to causing side effects)

3) although a step in the right direction, the Today sponge is the only brand which contains the highest amount of the spermicide Nonoxynol 9 (N-9). N-9 has been clearly linked to an increased risk of HIV transmission (relevant articles: http://www.g-h-o.co.uk/id49.htm)

4) between 2000 and 2002 only 3 birth control books aimed at a general audience have been published in the U.S. None cover all the available contraceptive options. Any book published before 2000 is obsolete because new methods have become available and because of the N-9 research.

And just one quick example to personalize all the statistics: there are 199,613 active duty women in the military. For these women, avoiding an unintended pregnancy and maintaining top physical form are essential work requirements. However, a survey* of 158 female freshman cadets at the U.S. Military Academy in West Point, found that 60% of respondents experienced premenstrual and menstrual symptoms (various birth control methods can be used to control these symptoms) that interfered with their activities–physical more than academic. If the West Point cadets experience these problems, imagine what those brave women soldiers have to put up with in the middle of the desert!

*Schneider MB, Fisher M, Friedman SB, et al. Menstrual and premenstrual issues in female military cadets: a unique population with significant concerns. J Pediatr Adolesc Gynecol.1999;12:195-201.

Sorry for the lengthy post, but I am quite passionate about this subject. And, after all, you did bring it up :-).

Once the book is published, I plan to use blog ads. . . . Oh, and in the interest of full disclosure: I am an Ob/Gyn, I am the medical advisor for the Global Health Options site ( http://www.g-h-o.co.uk/index.htm) and I have no connections (financial or otherwise) with any of the pharmaceutical companies that manufacture contraceptives.

Best Regards,

Wendy Kroi

Well, it really is a problem, and I’m glad somebody’s addressing it. I suspect, however, that the fallout from the Dalkon Shield litigation, coupled with political opposition from “social” conservatives, has chilled pharmaceutical companies’ interest in investing in this area, which is unfortunate.

UPDATE: Dr. Mark Littlehale emails:

I too am an OB/gyn. Here are a couple of points worth adding about birth control.

1) Norplant an implantable contraceptive is primarily off the market because of a large number of lawsuits associated with its use….too hard to get out too many side effects etc. It is widely available around the world but here we are too lawsuit happy…

2) Lunelle, a monthly injectable combination hormone, is available in the U.S.

3) Mirena is actually associated with fewer side effects than the Copper T IUD. Less bleeding, less cramping and less pelvic pain particularly in people with endometriosis

4) “Contraceptive technology” by Dr. Robert Hatcher (Emory U) is updated every couple of years and is available to the general public.

Interesting.

ANOTHER UPDATE: Medpundit Sydney Smith has further observations and corrections.