The real problem seems
to surface after marriage, as studies show that this can increase
a couple’s risk for divorce. People often don’t realize
that marriage is quite different from living together. A newly married
couple generally makes a conscious effort to accommodate each other
because they know their relationship is supposed to last a lifetime.
They want to build compatibility, not test it.
On the other hand, when a couple lives together
before marriage, they are testing each other to see if they are compatible.
They're not sure if they want to be with each other for life, so they
are usually not willing to make the all-out commitment. It’s
not that they can’t commit themselves as though they were married,
they just tend not to because their situation doesn’t demand
it. A lot of times, these couples end up getting married because the
living arrangement has worked out well, but unfortunately they don’t
change their mentality. They continue to live together as they did
before marriage, believing that their behavior has passed the test,
so any further accommodation isn’t really necessary. As a result,
they don’t end up nurturing their marriage the way they should
in order for it to be successful.
Every couple is different, and you may very well
have a successful marriage even if you choose to live together first.
You should think carefully about what's right for you, weighing your
desire to see if you're compatible and remembering that when you do
get married, both of you will still need to work on your relationship
and help it grow.
QUESTION
Do I have to already have had a child to use an IUD? (I thought that
was the case but I have a friend who uses one and hasn't had any kids.)
ANSWER by Manjit K. Risam, M.D.,
M.R.C.O.G, F.A.C.O.G.
Great question! The short answer is no, you do not have to have had
a child to use an intrauterine device (IUD). But as with all forms
of contraception, it’s best to consult your doctor about whether
an IUD is the right choice for you.
You might be surprised to learn that rudimentary
IUDs have been used since the early 1900s. Currently, in the United
States, copper-based (Paraguard) and hormone-based (Mirena) IUDs are
available. Generally, an IUD can be easily inserted into the uterine
cavity by an OBGYN in his or her office and must be removed by the
doctor as well. A small string attached to the device extends into
the vagina. Despite the long history of IUDs, it’s not entirely
clear how they work. From what we know, IUDs interfere with sperm’s
ability to move, lowering the chance of fertilization, and change
the transport speed of the ovum (egg). Also, the progesterone released
from the hormonal device causes changes to the lining of the uterus.
Although IUDs are widely used in other parts of the
world, particularly in Europe and Asia, you might find doctors in
the United States more reluctant to advise an IUD for nulliparous
women—women who have not had children. There are several reasons
for their caution. In the 1970s, an IUD known as the Dalkon Shield
was linked with at least 12 deaths from infections related to miscarriages.
Most IUDs were taken off the market during the mid-1970s as a result.
In the mid-1980s, there was much concern over the risk of tubal infertility
associated with certain IUDs, and hence, many physicians were reluctant
to insert IUDs for women who had not had any children. With the availability
of newer IUDs, including Paraguard in the late 1980s and Mirena in
the early 1990s, IUDs have gained some popularity in the United States.
Although there remains a small risk of pelvic inflammatory
disease (PID) with IUD use, it’s not the IUD itself that causes
PID, but bacteria resulting from unsterile conditions during insertion
or, more likely, from sexually transmitted diseases (STDs). In fact,
although IUDs have risen in popularity again in the United States
as a long-term reversible form of contraception—the copper IUD
can be left in place for ten years and the hormonal IUD can be left
in for five years—the fact remains that IUDs do not prevent
STDs. And it’s the STDs that can cause PID and, therefore, infertility.
While you do not have to have had a child to use
an IUD, women who have not had children are good candidates for IUDs
only if they are at low risk for contracting an STD. This, in my opinion,
is the main issue. If women are not in monogamous relationships or
are likely to have multiple sexual partners, I counsel them to use
other forms of contraception because of the risk of STDs and, as a
result, PID and infertility. For women with low risks of contracting
STDs, IUDs are a good option with a less than two percent failure
rate. Additionally, for women with a history of breast cancer or liver
disease, who cannot use hormonal contraception, the copper IUD is
a good choice. As with any such decision, I advise you to consult
your OBGYN and let him or her know about your contraceptive concerns.
Together, you will be able to make the right decision for your contraceptive
needs.
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