Tuesday, April 23, 2019

The Pill And I: Tales From Both Ends of the Speculum

drawing by Suzanne Dunaway
Not long after the first-ever birth control pill came on the market, I lost my virginity. Grateful it hadn’t been the other way around, I headed off to the Harvard Student Health Service to score a prescription. Its chief, Dr. Curtis Prout, was willing to oblige, bucking Massachusetts law. That was in November 1964. To my dismay, when I came back in six months for a refill I was turned down. Only decades later did I learn that Dr. Prout was not deliberately humiliating me, but bowing to a change in school policy after some parentsprotested. Fortunately the good doctor was among the few who eventually resumed quietly writing those prescriptions (“Once you’ve started I guess you’re not going to stop,” he’d told me on our first encounter).
Back then the Pill, the only Pill, was named Enovid. It packed a hypercharge of estrogen, ten times stronger than is used nowadays. That hormonal overdrive made me mock-pregnant all through college: nauseated, jumpy, and – especially – perpetually hungry. I remember driving to the supermarket, buying a cake, and wolfing the whole thing down in my car before I reached home. I went from 116 pounds (53 kg) to 150 (68 kg), and from a barely B cup bra to a zaftig D. 
In 1964 the Pill had been already around for half a decade, but who knew? During my time in high school it wasn’t easy to obtain even if you were legit married grownups, and I doubt any of the girls in those Buick back seats had even heard the news. For us sex and pregnancy still went together like a horse and carriage. Girls who “went all the way” were likely to “get in trouble,” and every year a few were shipped “upstate,” to sit out their pregnancies in homes for wayward females where they’d whisk the baby away for adoption straight from the delivery room. 
As the first near-failsafe means of contraception, Enovid changed everything. Virginity was doomed, since there was no longer any serious reason for girls to hold out – gonorrhea could be cured with a shot in the butt, and herpes and HIV hadn’t yet hit. American weddings had never demanded the hanging of bloody sheets out the window, so with the threat of pregnancy no longer a deterrent the intactness of your hymen could remainea secret between you and your groom. 
My own Pill-popping ended in 1969 at the urging of my boss, psychiatrist Gideon Seaman, whose wife Barbara had just written a best-seller called The Doctor’s Case Against the Pill, warning about blood clots and strokes. But my relationship with the Pill remains intimate, in the form of the thousands of prescriptions I’ve written since graduating from medical school (by which time the dosage of the hormones had shrunk to safer levels).
In Italy, those scripts count as something of a one-woman crusade. The Vatican managed to keep the Pill out of the country for many years, and even now many Italian women are convinced it’s both unnatural and dangerous. In 2010, 17.4% of American women ages 15-49 were taking the Pill, but only 2.8% of Italians of the same age. Medically speaking the Pill is so innocuous that in several American states you can buy it without a prescription, but in Italy you’d think it were as risky as setting off to climb Mount Everest. Gynecologists play a major role in discouraging its use by refusing to write a prescription without first demanding a frighteningly long list of blood tests, supposedly to check whether you’re healthy enough to resist its presumed dangers. 
Even more barriers lurk. Sometimes a Catholic pharmacist claiming to be a Conscientious Objector will refuse point-blank to fill a prescription. This is, of course, illegal. Others like to play doctor; one patient who brought my prescription to renew her birth control pill was told, "The Pill you were taking is too strong – I'll give you a better one." And 3-weeks-out-of-4 oral contraceptives, the commonest kind, are sold without the week of sugar pills that are included in American packets. I’ve always suspected this invitation to messing up your timing of being a morsel of ecclesiastic sabotage.
But the proof of the pudding is in the eating. Italians’ approach to contraception, like their approach to so much else, may be muddled but it works: they have among the lowest birth rates in the world. How do they do it? Condoms, rhythm, and – mainly – pulling out. Yup. Time-honored, tech-free coitus interruptus may be a drag, but it turns out to be a lot more effective than most of us think – including my medical school teachers. 
P.S. Bonus factoid for you from Stethoscope On Rome: A wild plant named silphium was apparently such an effective oral contraceptive that it was over-harvested to extinction by the 4thcentury ce.
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  1. Thanks, Susan, for this fascinating story. It well illustrates how strongly religion affects sexual practices and how thoroughly Catholic dogma permeates medical practice here. It seems that it's at times easier to obtain antibiotics in Italy, often without a prescription, than it is to acquire birth control pills, perhaps even with a prescription.

    1. Absolutely - antibiotics no problem. Anything hormonal they're always at least, as the Italians say, "fiscale" in demanding a prescription. And, furthermore, you've given me an idea for another blog post - keep tuned!