Dear Doctor, 

I am aged 26 with children. I have never used any family planning method apart from condoms. However, my husband recently told me he is tired of using condoms. I would not be comfortable using any other family planning method apart from safe days. Please teach me how.

Ritah

Dear Ritah,

Some men think that condoms reduce sexual pleasure or virility in some way. This may be perceived by some subjectively but in most cases it is based on stories from other men.

Although condoms carry some risk of failure, they can still protect against unwanted pregnancy and sexually transmitted diseases as long as they are used correctly and are of good quality.

Use of hormonal contraceptives is highly effective and it does not interfere with sexual activity in any way. But in case of pills one has to be regular with it. Long term use of hormonal contraceptives can cause adverse effects like increase in fats in the blood, swelling of feet, increased risk of heart problems, increased risk of clotting, etc.

Safe days is the period when a woman does not ovulate. This is the period excluding the 14th to the 21st day of a menstrual cycle beginning from the first day of the cycle when bleeding occurs. But this is not hard and fast and varies much from one woman to another. Even the duration of a menstrual cycle is highly variable among individuals. It is said that a woman can have ovulation as early as the 5th to 7th day of the cycle, if she is sexually aroused. Therefore it is difficult to assess a 100% safe period effectively.

Dr Rachna Pande  is a specialist in internal medicine at Ruhengeri Hospital

Premature withdrawal is another way of avoiding pregnancy. In this the man withdraws before ejaculation so that semen is not deposited in the vagina. This can be adopted if both partners agree to it. It also needs self discipline and cooperation on the part of both because one moment’s delay in withdrawing can lead to pregnancy. But if practiced correctly with determination, it successfully prevents pregnancy.

The best way of family planning, if one has achieved the desired family size is to undergo sterilization. Male sterilization, i.e. vasectomy is faster to perform and recovery after the procedure also occurs faster than as after tubectomy (sterilization of a woman). Male sterilization does not interfere with a man’s ability to have sex in any way. Rather with no fear of pregnancy occurring, it can be more enjoyable for both partners. Sterilization is the only surest method of avoiding pregnancy. Done in a proper center with proper aseptic precautions and with skilled hands it is very safe both for men as well as women.

However before taking the decision to undergo sterilization there are certain pre requisite conditions. It should be a consensus decision taken by both partners after discussion so that no disputes arise later. Pregnancy should be excluded before a woman undergoes tubectomy. The last born should be at least 5 years or more of age.