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Love and Sex Prescription

By Anju Mulchandani and Manjit K. Risam, M.D.

QUESTION
I am in my early 30s and have been dating someone for over a year. We get along so well that we have been informally living together for several months. We both have very busy schedules and have been able to eat the same food (cooking for two is easier and healthier) and spend more time together as a result. I want to know what the pros and cons of this are for me. Should I continue and adjust my lifestyle accordingly since it's going well, or should I forget about convenience and think about my long-term options, putting this living together aside for the future, since I already gave it a trial run and it seems good? Help!

ANSWER by Anju Mulchandani
The number of unmarried couples who live together has increased dramatically over the past few decades. Just as you have mentioned, there are many benefits that come with living together. The one on top of the list for most people is that you can find out each others’ annoying habits before you commit yourself! So it seems quite logical to test the relationship, and, in fact, many couples live together successfully and then go on to marriage.


Photo by Camilo Morales

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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Anju Mulchandani is a graduate of the Columbia School of Social Work. Her clinical experience has focused on providing counseling for individuals with a variety of emotional problems.

Manjit K. Risam, M.D., M.R.C.O.G, F.A.C.O.G. is an Obstetrician and Gynecologist with over 30 years of experience working with women in the United Kingdom and the United States. She is currently in private practice in the Washington, DC Metropolitan area and is an Assistant Clinical Professor at George Washington University in Washington, DC.

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