Dutch Methods of Birth Control

by Margaret Sanger

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injection should first be made, in order to cleanse away the greater part of the sperm, then the instrument should be withdrawn standing upright or kneeling; finally a full injection should be made use of to clear out thoroughly every corner of the organ.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.