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Author Topic: Birth Control Probability
Kaspyn
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Hello. You have a great site here and I thank Heather and the rest of the staff for the years of effort that has gone into this site.
I've read many of your articles, comments by your staff and even reviewed your Birth Control Bingo piece. I had an encounter recently and I'm trying to attain further information as to how much of a risk of pregnancy there could possibly be. I had sex with a woman who, a year ago, had tubal ligation and endometrial ablation. During our encounter I did not wear a condom but did enter vaginally. I did not ejaculate inside her or anywhere near her. I would consider this to be perfect withdrawal according to your website. In addition, it was 4 days before I ejaculated- meaning I've gone to the bathroom many times to flush out any residual sperm. Also, knowing my body, I've never witness myself precum. I likely do precum but probably stays within until it comes out with the ejaculation. 17 hours after the encounter, the girl took a plan-b pill for an extra layer of protection. Overkill, maybe? More for the peace of mind I guess.
So looking at your website and other credible websites on the Internet, how much of a risk is there for a possible pregnancy? Doing probability and statistics, am I in the ballpark of roughly 8,000,000 to 1 shot that the girl is pregnant based purely on statistics?
Tubal ligation is said to be 99.5% effective. The pill taken within the first 24 hours is either 95 or 99% effective depending on your past articles. Perfect withdrawal is 96% effective-which of course I may never had any precum to begin with. These statistics are based on a year in which couples average sex 80 times a year. In my case, it was a one-time deal. Again, being analytical, is the probability this low? Do the numbers make sense?
Would Heather, Robin or other members say the proverbial, you had a very very LOW risk and have nothing to worry about? Like finding the hundreds of dollars on the sidewalk, winning the lottery or being struck by lightning?
After reading your articles and Birth Control Bingo, I hope my calculations make sense- knowing all well that these are just statistics and not real life.
Thank you for reading and will be happy to hear from a member of the staff.

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Heather
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Welcome to the boards, Kaspyn. [Smile]

If this person had a successful tubal (and that's something checked at a follow-up after one), there is no risk of pregnancy whatsover. There was certainly also no need for Plan B, because there was nothing for it to do, and I'm pretty perplexed as to why this woman took it in the first place?

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Kaspyn
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Heather, thank you for the fast response.
I agree tubals are 100% successful if done correctly, but I've read the body can repair themselves which maybe the 0.5% failure rate. Of course going online some claimed to have gotten them and still gotten pregnant. I don't know if she returned to her Doctor for a check-up. Thanks for the suggestion, I will ask her.
The Plan B she had extra and didn't mind taking. Again, it was more of extra assurance in the event that the tubal wasn't completely successful. If the tubal was successful, I agree, it wouldn't have any benefit. Likely it was overkill but more the peace of mind.
As for my own personal Bingo that I did, do the numbers make sense? You didn't have vasectomy or tubal ligation as an option, therefore I did my own calculations from reading the articles on your site. Ultimately, am I looking at a millions to one shot (a fluke) if a pregnancy happened with all that I described? And then on top of that a likely miscarriage since she had a uterus ablation?

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Heather
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To my knowledge, the fallopian tubes repairing themselves is something theoretical, not something documented. The failure rate with tubals, as I understand it, is about them not being done properly, not about them not being permanent when done, unless someone has the surgery to try and reverse it.

As well, I don't know how someone who actually had a tubal one year ago would be in doubt if it was successful.

I most certainly can't make any estimates about what impact the endometrial ablation would have had on a pregnancy. (Many people who have had that done cannot become pregnant afterwards, others can. That's information she'd have to get from her physician.) But I don't need to, since if she had a tubal, there won't be a pregnancy.

Ultimately, it sounds like the real issue here, the way to move forward productively, since all if this is about a choice you already made, is to talk about what might be better for you moving forward. It sounds like you very much want to prevent pregnancies, so why not do what you can and, sparing vasectomy, use the most effective method of contraception available to you, condoms? You can pair them with any other method or methods a partner is using.

Of course, I have to say, if you're asking a partner to use Plan B after she has had a tubal, that suggests to me something else might be going on here, with you simply not feeling comfortable with this kind of sex at all right now?

In other words, if someone was telling me they only felt safe driving when they had eight seatbelts on, drove with a certified driving instructor, etc., I'd not want to talk with them about how many more seatbelts would help, but about if they might need to do something around their fear of driving were they wanting to add so many things to make it safer than after one or two of those things, they weren't even adding anything extra. When we're so freaked out by something we're trying to add safeties that really won't even do anything -- and also choosing not to add things, like condoms, that do -- and endlessly picking apart our choices after the fact, that tells me something is underneath it all the person should probably focus on before doing that thing again.

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Heather Corinna, Executive Director & Founder, Scarleteen
About Me Get our book!
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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Heather
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Btw, I don't mean to blow you off about the numbers. It's just that once we get past two methods of contraception used properly, not only is pregnancy so incredibly unlikely we can safely just say it's not going to happen, but even with just two, we're reaching. The figures for effectiveness come from broad studies, done in a year's worth of use, so I just don't think it's sound to try and do the math on this, nor to suggest we really can with any accuracy.

This decision was already made on your part, and unless something is amiss here, I need to leave it at saying I do not see even the remotest risk of pregnancy here. And then, if you like, talk about making choices you feel better about, which I think is far more productive than trying to analyze these things in ways that really aren't even sound after the fact.

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Heather Corinna, Executive Director & Founder, Scarleteen
About Me Get our book!
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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Kaspyn
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Heather, thank you for your advice.
A few questions.
1) From all that I stated, would there be any reason to suspect there is a pregnancy?
2) For reference, what is the effective rate of plan B taken within 24 hours? Online sites have it as 95% whereas I see you stated on your website as 99%.
3) Knowing myself, I've never witnessed myself producing precum whether during sex or during masturbation. It's probably there but doesn't come out until I ejaculate. If this is so, does it add to a safer withdrawal procedure? Because if nothing comes out, then withdrawal would be safe correct? I understand that condoms would reduce any risk, but wanted to ask.
Along the same lines for precum, I've seen many of this site's experts still state that if you haven't ejaculated in quite sometime or have recently used the restroom, then sperm in precum is non-existent. Does that still hold true as there are many theories on this?
Thank your for your time.

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Heather
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If you look right back to my first (and second) response to you, you'll see me saying, already, I do not see any remote risk of pregnancy here. My answer to the same information isn't going to change.

As well, since you've already read our piece on Plan B, content written by me, you know what I'm going to say about that, no? [Smile] The sooner Plan B is used, the more effective it is, and it is well-documented that when taken within the first 24 hours, it is at its most effective.

Because pre-ejaculate isn't something people usually see, and it often occurs while the penis is inside another body (and, if you ejaculate and become erect, you can be certain you do, in fact, have pre-ejaculatory fluid, you just haven't seen it), I can't possibly guess about that, nor do I know of any studies to give us that answer (or how we'd even do them). For the other information you're asking about, a site search will easily answer that question, as it's something we and I have addressed many, many times.

And now I need to restate and hold that limit I just tried to set with you in my last response.

I'm happy to talk with you about making choices, moving forward, you feel better about.

But at this point, I need to let all the numbers and figures and estimates about pregnancy with a choice you've already taken rest -- as I've given what sound information about that I can, and it's on you now to either accept those answers or not -- and stick to talking about things you can actually do something about.

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Heather Corinna, Executive Director & Founder, Scarleteen
About Me Get our book!
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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Kaspyn
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Heather, thanks again for the replies. Earlier, you sent me a second reply when I was replying back. In essence you answered my question, but it appeared I was asking for a follow-up. Sorry, wasn't trying to question again on the subject.
You mentioned that you don't see ANY remote risk of pregnancy at all based on the three methods of protection used properly. That is very reassuring and I appreciate you expertise. When you say remote...would the chances of your Cubs winning the World Series be what you had in mind? Just joking. [Smile] When you say remote, would not even being struck by lightening be comparable? I'm just trying to find something to relate it too, if there is anything at all.
You mentioned I need to look forward from this. I've read more or your articles and looked over my options. Again one option that is out there (that I used) is the perfect withdrawal. Another being condoms that you have also suggested. When doing the research on your site about perfect withdrawal I'm still confused. Will I use it in the future in lieu of condoms? Probably not. However, I would like to be more educated of my choice.
When reading your site, I get conflicting statements and facts from your experts as to how safe and effective perfect withdrawal is. On a cornucopia of...you mention more research needs to be done. You made this statement, "Sperm is less likely to be present in pre-ejaculate when a person with a penis has urinated after a previous ejaculation, or has not ejaculated in some time. Go ask Alice states, "Urinating in between ejaculations flushes the urethra of stray sperm and makes the way clear for the sperm-less pre-ejaculate fluid." I've also found some comments that you and OWL Dan have made on some other people's messages that sperm would be cleared out after urination. Some of the other writers on this site state there's no way of knowing.
In essence, I'm trying to understand better. I know this question has been brought up numerous times (and widely debated on the Internet) but I'm confused on what is the conventional thought on this site.
I know going forward condoms would be better to avoid this all together. I am trying to educate myself and understand if I was safe with using perfect withdrawal when it was 4 days from my previous ejaculation and having gone to the bathroom a lot during that time. Or was the risk the same as the 4%?
I look forward to hearing from you and better choices I will feel comfortable with.
Thanks.

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Heather
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I think anyone has more of a chance of pregnancy, in any situation, than the Cubs winning the World Series. [Frown] But then, I'd also say there is more of a chance of their actually being leprachauns standing at the end of rainbows passing out gold than that, too.

But with a successful tubal, yes, I think saying a pregnancy is about as likely as being struck by lightning is comparable.

The trouble with withdrawal around this is that we basically have NO clinical trials: we have no studies, at all yet (unless that's changed in the last year) where we can say, with any certainty what the perfect use rate is, only estimates. And obviously, that's a problem. We also know that in typical use, it's less effective than any other method. And that's not about pre-ejaculate so much as it is about people ejaculating while inside the vagina before they realized that was happening, which is going to happen sometimes with most people. Orgasms can tend to sneak up on us like that.

You know, in this withdrawal vs. condoms setup, we don't actually have to go there. With someone SO worried about pregnancy they're getting Plan B after a partner has had a tubal, again, I'd really find out what that's about, and if that's a kind of sex you even feel okay having, honestly.

If you figure it is, then you DO have the option of using BOTH non-permanent methods of contraception available to you, personally, which is using condoms and withdrawal. That way, too, you also get protection against STIs, which are no less of a risk than pregnancy. What do you think about that?

(Of course, noting your age, vasectomy is also an option for you if a pregnancy is something you feel you never want.)

[ 07-22-2013, 11:13 AM: Message edited by: Heather ]

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Heather Corinna, Executive Director & Founder, Scarleteen
About Me Get our book!
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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Kaspyn
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Heather,
I asked and she said a follow-up check-up was done and everything was fine following the tubal. I guess my fear is reading credible websites stating that there is still a 0.5-1% failure rate as the body can repair itself. Taking a Plan-B because it was readily available was an option and was taken within 24 hours just in case there was a tubal failure. Plan B, I saw on one of your posts to another user, is 99% effective within 24 hours. I'm curious about that one because most websites list it as 95% effective within 24 hours.
As for perfect withdrawal, I go by your 96% even if that's an estimate on your part.
The one piece of information I am still caught up on is, does precum contain sperm if you didn't ejaculate recently or have gone to the bathroom since that time? On this website I've seen it stated as possible but then seen many posts by you and OWL Dan stating no. I'm just trying to better understand more than making a case for using that method alone in the future. In my situation, was there even a risk if just by chance precum did come out since it was 4 days before last ejaculation and gone to the bathroom many times?
In the future condoms and withdrawal is an option for both pregnancy and STIs. I don't want to consider vasectomy just yet.
I do agree with your assessment about the Cubs. [Smile] And if by chance I get struck by lightening I guess I'll know that a successful tubal wasn't 100%.

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Heather
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I really, really need you to hear my limit around some of this. Did you do that search on the site for the pieces that talk about pre-ejaculate? If so, you should have easily found at least a few pieces, from me, no less, talking about what we know about sperm and pre-ejaculate.

We get our figures for contraceptive effectiveness from three or four combined and very credible sources: Contraceptive Technology (which is the reference book that's effectively the bible of contraception for anyone working in reproductive healthcare), Our Bodies, Ourselves, Planned Parenthood, and the FWHC, a clinic I used to work for with very extensive health information. We do have to continually update a lot of this, since EC is still relaitvely new, so by all means, this week I'll double-check all the stats again to make sure what we have is most current.

However, again, in this instance? It truly was not even needed because this person, who had a successful tubal, lacked the ability to become pregnant in the first place.

So, last time here: I'm happy to move forward and talk about what you can do in the future. But this, this choice you already made, it's done. And digging into minutae with it is something we know, over many years of doing this work, isn't productive or helpful. It also simply isn't a sound use of our limited time or resources.

[ 07-22-2013, 12:26 PM: Message edited by: Heather ]

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Heather Corinna, Executive Director & Founder, Scarleteen
About Me Get our book!
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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Heather
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One thing I'd add to this, btw, if it helps you to get over it, is to remember that this woman made choices, too. Choices that really are WAY more about her, and her life, than you. She's the one, after all, who could become pregnant, and she's the one who, ultimately, would be far more responsible for managing that.

So, perhaps it can help you to calm down to bear in mind that a person who would have WAY more to deal with with a pregnancy than you possibly could made these choices with you that she did. If she felt safe making them, and she is not concerned, that perspective can perhaps help you put your own lingering fears and anxieties in perspective.

--------------------
Heather Corinna, Executive Director & Founder, Scarleteen
About Me Get our book!
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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Kaspyn
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Heather,
Thank you for your time and understanding. I know your time with this site is valuable. I appreciate all of your advice.
Could you send me the links on the few pieces that you have concerning pre-ejaculate and sperm so that I know I'm reading the correct information.
Thanks.

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Heather
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Honestly, this is kind of a "let me Google that for you" moment.

Our main site has a search bar, right at the top. If you put "sperm" and "pre-ejaculate" into it and click, you're going to get a whole bunch of good links on the site to this information, like this: http://www.scarleteen.com/article/advice/can_pre_ejaculate_cause_pregnancy

--------------------
Heather Corinna, Executive Director & Founder, Scarleteen
About Me Get our book!
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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Heather
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Btw, I just figured out where you were getting confused, I think, by that 99% figure.

Were you looking here?

http://www.scarleteen.com/birth_control_bingo_emergency_contraception

If so, that up to 99%, as (I think) is made pretty clear in the first two lines of that piece isn't just about Plan B, which is referred to right up top in bold. that 99% accounts for use of the IUD as an emergency contraceptive, which is more effective than Plan B.

--------------------
Heather Corinna, Executive Director & Founder, Scarleteen
About Me Get our book!
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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Kaspyn
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Heather,
I found these 2 responses. One has 98% and the other 99%. http://www.scarleteen.com/forum/ultimatebb.php?/ubb/get_topic/f/21/t/002218.html
http://www.scarleteen.com/forum/ultimatebb.php?/ubb/get_topic/f/28/t/007020.html

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Heather
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The latter would be an error on my part.

Really, know that the very best way to search for all of the most current information is on the main site, not the boards.

We keep those pages updated, but can't possibly go back and recheck, correct or update every board post, given the volume.

--------------------
Heather Corinna, Executive Director & Founder, Scarleteen
About Me Get our book!
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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Kaspyn
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Heather, I do look at the main site but did come across this also on a board post from less than a month ago that you know of resources that you use that attain 98%. Looks like the user and I had about the same question.
http://www.scarleteen.com/forum/ultimatebb.php?/ubb/get_topic/f/27/t/028650.html

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Heather
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I really, really need to be done with this now. especially since this remains about a situation/topic with you where I have set firm limits, and I feel like you are continuing to try and wiggle around them, which I really don't appreciate.

Yes, that is true: some of those same resources I listed for you earlier, taking into account certain brands of the MAP, like EllaOne, for instance, which has a higher efficacy rate than others.

If you want more on this specifically, I ask that you please look elsewhere. You can start with resources like this clinical information sheet -- http://www.ok.gov/health2/documents/Emergency%20Contraception.pdf -- or by speaking with a sexual healthcare provider or pharmacist in-person.

--------------------
Heather Corinna, Executive Director & Founder, Scarleteen
About Me Get our book!
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. - Margaret Mead

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