Couples Ask about Sex, Kids and Contraceptives

For the last several years my wife and I have been teaching a class to engaged couples on romance and sex in the context of a healthy marriage. We cover the essentials of male and female physiology and reproduction, and also respond to written questions on a variety of topics. I thought the following would be of interest to my readers.

Birth Control Still Required for 40-Somethings
Q: I am just over 40 years old and about to be married. I am still having regular menstrual cycles that have changed little over the past several years. I’m aware that fertility in women declines rapidly with aging and as a result, wondered if I need to use any form of contraception?

A: In a word, yes. Women in their 40s comprise the second largest contingent of those electing to abort an unwanted pregnancy, second only to women in their 20’s. The fact that you continue to have regular periods is a good indication that you are still ovulating. If you want to be sure, you can pursue one of two options.

You can purchase a special thermometer at your pharmacy with instructions to measure your “basal body temperature” each morning before getting out of bed. There is a characteristic temperature increase before ovulation and you can graph this on the chart that comes with the thermometer. The other option is to purchase an over-the-counter kit that tests one’s urine for an increase in hormone production consistent with ovulation.

Contraceptive choices for you will be dependent on your current health status. If you have high blood pressure or are a smoker, birth control pills or other hormonally based methods could be risky, leading you to consider barrier methods along with a spermicide as your safest option. I would strongly recommend a visit to your physician with your fiancé to select the best and safest method.

Do Contraceptives Affect Libido?
Q: Is there any evidence to indicate that oral contraceptives affect a woman’s libido or desire to engage in sexual intercourse?

A: I was able to find one source that suggested that for some women, oral contraceptives could have an unspecified, but negative, effect on a woman’s sexual drive. If you think that this might be the source of difficulties, select a non-chemical form of contraception for a three- to four-month trial period to see if there is a measurable difference in desire. If so, you could have the solution to your problem.

On the other hand, the issue of sexual drive is complex. As one sage said, the largest sex organ in the human body is the brain. Past emotional and physical trauma, guilt, embarrassment, poor information, or partners with an inadequate understanding of how to build intimacy and trust are just a few of the barriers to establishing a mutually satisfying sexual component in your marriage.

Creating a healthy sex life is an important task to achieve early on in your partnership. If for whatever reason that is not the case, I would recommend seeking help – sooner rather than later – and in that process, resist the temptation to assign blame or guilt.

Vasectomy Reversal Not the Only Issue
Q: I’m a male in my mid-forties about to get married to a younger woman who wants to have children. However, I have had a vasectomy. I’m interested in having it reversed and would like some information on that process and its likelihood of succeeding.

A: Despite the method used to perform your vasectomy and as long as the two ends of your vas deferens can be identified, the success rate of reversal as measured by sperm production can be as high as 95%. That does not mean that pregnancy will be achieved as those rates range from 40-50% and may have a variety of differing causes. Just as fertility declines with age for women, the same can be true for men with consequent lower sperm counts and a higher production of abnormal and ineffective sperm.

I would recommend that you locate a urologist with a specific interest in this procedure and ask him/her what their individual success rates are as measured by both sperm production and subsequent pregnancy. This may require some shopping for both competence and price as this is often not a covered insurance benefit.

As an aside, before you start a new family, do just a little bit of math. If your first child is born when you are 45, you will be 63 when he or she graduates from high school. As there is a considerable body of literature on children of older parents that addresses issues of abandonment through illness or death and their adverse effects, I think it incumbent on you to have a thorough physical that identifies and addresses your personal health risks. I would suggest that if not already in place, that you institute a health regimen that will allow you to remain a vigorous parent throughout your child’s life.

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