Dutch Methods of Birth Control

by Margaret Sanger

MEANS THAT MAY BE USED BY THE WIFE.

The wife may prevent conception by passing into the vagina the occlusive pessary of Dr. Mensinga; if this do not remain in its place, she may rather use that named Matrisalus, which is more curved. If this also does not remain in its place, the husband should use the French Letter or condom. If, finally, the husband will not use these means, the wife may use the tubular pessary, or, for want of a better, the sponge. (This is the only method available in countries where there are no medical practitioners or other persons who know the business, and can choose and teach women how to place the pessaries.)

These instruments, designed to cover the mouth of the womb, are not worn in the daytime. The wife may introduce them every evening (and by preference before the return of her husband). During the night they all may remain untouched, unless there be danger of the instrument being ill-placed. On the morrow, or in uncertain cases immediately after connection, a small injection should first be made, in order to cleanse away the greater part of the sperm, then the instrument should be withdrawn standing upright or kneeling; finally a full injection should be made use of to clear out thoroughly every corner of the organ. The pessary must then be cleaned carefully, and inspected to see that it is in good condition, wiped gently and put away in a drawer without wrapping it up.

During menstruation the woman should entirely abstain from sexual relations. When, however, it should chance that, withdrawing the instrument she sees that the flow appears, it will be necessary for her to use energetic injections if she had sexual relation.

The method which we mention for the use of women has the great advantage of permitting her to be free from care during the night; and it is also an essential point that the husband need not be consulted in the matter.

If these instruments are well placed, the husband cannot perceive their employment by the wife. It is also requisite that the method does not at all annoy the wife; if they produce the slightest pain, it is because they are either ill-chosen or misplaced.

Should the wife have any special disease of her organs, she should refrain from all connection until cure is effected; when there is doubt, she ought to consult a physician before employing such methods.

The first instruction and choice of the instrument should be pointed out to the wife by a practitioner or by a midwife or by any other person acquainted with the matter. If such assistance be unobtainable, she may herself try to act under the following directions:—

The pessary Mensinga (price 50 cents) is a simple ring closed by an indiarubber membrane curved like a hemisphere; it is but of little importance whether the convex side be directed upwards or downwards. These instruments are made of different sizes, and are numbered corresponding to their diameters in centimeters. The greatest number that can be introduced without discomfort gives the most security. (We advise engaged women to choose their pessary some weeks before marriage, in order that the discomfort which results for the first moment may have passed away on the marriage day; 6¾ or 7 will generally be suitable; soon after marriage they should choose higher numbers. The external orifice of the genitals may be very narrow, and yet the vagina rather large). It is good to commence by trying No. 7¾.

Generally the pessary is moistened with the same liquid which is used as an injection; but on the first occasion, and always when the pessary is introduced with difficulty, the genital parts may be moistened with white soap to render them slippery. When a wife is measured for a pessary she should be at her ease, undressed, without her stays, in the stooping or cowering posture, and thighs apart. She should have been to the watercloset before.

To place the pessary, it is pushed vertically into the longitudinal opening of the vulva. The ring may be slightly pressed into a figure of 8, but not forcibly so as to break the spring which is in its walls. The part first introduced ought to be directed backwards; the last inserted part should disappear behind the os pubis which is felt in front. By hooking the finger behind this bone, the pessary may be pushed up as far as it will go.

It is necessary to choose the pessary with care. The essential conditions are: (1) that there should be no space between the pessary and the os pubis, nor that any should remain when it is pushed as far as possible backwards. (A very small space may perhaps be left, on condition that the husband take care not to enlarge it during connection.) (2) We should feel the inferior tip of the womb covered by the membrane of the pessary when the finger is introduced as far as possible. As a rule, we should try the largest number that can enter, and then higher numbers, until the pessary is found which satisfies these conditions.

If the membrane of the pessary does not cover the mouth of the womb, the pessary must be introduced not in the direction of the abdomen, but backwards towards the anus (bottom); this method of operating may fail if the woman is stooping; it will succeed better if she is lying down.

When a pessary is found which realises the conditions above described, care must be taken that the instrument remains in its place when the woman is standing up with the thighs apart, and making at the same time pressure of the abdomen. If in such conditions the pessary descends so that a space is left between the pessary and the os pubis, a larger number must be tried. If no number of the Mensinga pessary fits, recourse must be had to the pessary Matrisalus (price 75 cents), which is more difficult of application, for with this instrument care must be taken that the convex side is placed above, and the curved part in front, in correspondence with the curved part of the os pubis. This pessary has the great advantage that it does not descend so easily. Besides, this pessary is treated like the others.

If this pessary does not suit either, the husband must make use of the French Letter, and if he objects, the wife might use the tubular pessary (price 25 cents), which, not serving as an obturator of the vagina, covers the end of the womb like a cap. The wife at first introduces her finger to find out the tip of the womb, she then slides the tubular pessary up until it adheres like a sucker to its tip. The higher part of the pessary should enter first, and the instrument should be placed so that during connection the husband should scarcely touch the bottom of the pessary. After the first connection, the wife should see that the pessary remained in its place.

Injections should be used as in former cases. If none of these methods are applicable, the wife may make use of a fine sponge. This sponge ought to be as large as an infant’s fist, and be rather too large than too small, so as to block up the vagina.

A thin ribbon is attached to the sponge, in order to withdraw it easily. The sponge must be renewed after a time, as it loses its elasticity with use. It should, before it is introduced, be moistened with the same solution as the fluid injection, and then pushed up so that the womb is well covered. Injections should be used with the sponge before it is introduced and immediately after connection, before and after removing the sponge. It is not as certain a preventive as the pessaries.

Yet this sponge is preferable to certain plans spoken of in the newspapers, and which cost a good deal, such as soluble pessaries, containing quinine or some acid substance. These are pushed up five or ten minutes before connection, and as near as possible to the mouth of the womb, with the hope that they may melt at the right moment and at the right place to destroy the vitality of the male fluid.

The Atokos or other syringes with powder. They contain an acid powder which is blown up into the vagina. If either of these methods be used, energetic injections should be taken immediately after connection.

Injections, made immediately after connection, even with the most splendid syringes, are not of themselves sufficient; they always can come too late.

Dr. Hinz has invented a small syringe with an indiarubber ball at each end of a tube, recommended by Dr. Fischer-Duckelmann, to inject a spermicide liquid, which is warmed, at the moment of the emission. This syringe is called Facilitas, but it is neither easy nor secure.

With these syringes the liquids mentioned in the following chapter may also be used.

For the success of any of these methods, it is indispensable that the wife should be acquainted with the position of the mouth of the womb.