Talk:Contraception (medical methods)/Draft

New Start

new start Nancy Sculerati 13:42, 3 May 2007 (CDT)

Ive made some major changes. I'd also like to fill in the history section, especially regarding the discovery of The Pill. BTW, N, same problems apply to my other recent starts, I'm working on it, but I could use your help just cleaning the closet, so to speak. Then we can add good content.--Peter A. Lipson 13:43, 3 May 2007 (CDT)

You might want to grab the old content about socio-religious issues and paste into a new article.--Peter A. Lipson 14:35, 3 May 2007 (CDT)

im not so sure that expanding into vet science helps the article, but i suppose we could add it and just break it off later if we want. I like the idea of a human contraception article that people can reference easily.--Peter A. Lipson 14:47, 3 May 2007 (CDT)

Is there somewhere we could include sterilization, as tubal ligation and vasectomy are very commonly used in the U.S.Peter A. Lipson 14:54, 3 May 2007 (CDT)

EDIT CONFLICT I would like to break off sterilization as well, now. I would also like to make it clear, in the article that discusses that Sterilization (surgical), that there are methods of stopping transport of germ cells, (tube tying, vasectomy) as well as removal of testes/ovaries that have larger repercussions. Please realize that by doing it this way we are able to have fair articles that are clear cut -medical/veterinary (health science) and contraception with a precise definition, I split off Control of Contraception, since that is not a health science article. Those people interested in exploring "natural birth control methods" such as abstinence and other means done behaviorally may do so in another article, also not health science - without this article having to try to cover what is already plenty- that being methods of contraception in people and animals, MEDICAL methods. I agree, if it gets to be too much even so, we can split off humans from animals, but let's get there first. Nancy Sculerati 14:56, 3 May 2007 (CDT)

I see your point, however I really think we need to include such common surgical methods here. Included elsewhere, or linked, should be discussions of forced sterilization, eugenics, etc.--Peter A. Lipson 15:00, 3 May 2007 (CDT)

Why do you insist on mixing politics and religion in, instead of giving those their own articles? If you would follow my lead we could have a whold series of articles that each would be neutral and fair. Why do we have to decide NOW what thge article needs to contain? I know I could write it in a way that would be really good, and that we could cover everything to everyone's satisfaction. But I am running out of steam just arguing about it. I'll hold off writing anything on these articles under the circumstances, it's a waste of my time. The surgical methods of sterilization can be mentioned as existing, it cxan be expalined how they differ from the definition of contraception that e are using, and they can be linked. I'm taking a break. This is the sort of stuff that maes me wonder why I even try.Nancy Sculerati 16:25, 3 May 2007 (CDT)

Nancy, I do not understand why surgery, as well as NFP, are not considered "medical methods". Stephen Ewen 16:40, 3 May 2007 (CDT)

Medical methods are just that-medical. They are not behavioral, and they are not surgical. They are medical. Is there not another article that is unqualified to be written called Contraception? Could that article not contain whatever you want to put in it? Could it not be a whole slew of workgroups? THIS article, I had hoped, back when I was busy writing it, would contain MEDICAL methods. It has a theme- normal conception would be described, and how medical methods are likely to either stop ovulation, fertilization, or implantation would be described. The hormonal stuff alone is worth paragraphs. Nancy Sculerati 16:46, 3 May 2007 (CDT)

lets keep on topic

It seems medical methods are not seen as such by some of the authors. May I remind all participants to keep within track of the meaning of this article, and if needed spin-off to another article (possibly create it) to elaborate on side steps. Thank you. Robert Tito |  Talk  17:41, 3 May 2007 (CDT)

Emergency contraception

Mittal S. Introduction of emergency contraception in India. Journal of the Indian Medical Association. 104(9):499-502, 504-5, 2006 Sep. Consortium on National Consensus for Emergency Contraception met in New Delhi in January 2001, to reach a consensus on strategies for introduction of emergency contraception in India.

Petersen R. Albright JB. Garrett JM. Curtis KM. Acceptance and use of emergency contraception with standardized counseling intervention: results of a randomized controlled trial. [Journal Article. Randomized Controlled Trial. Research Support, Non-U.S. Gov't. Research Support, U.S. Gov't, P.H.S.] Contraception. 75(2):119-25, 2007 Feb. UI: 17241841

Hansen LB. Saseen JJ. Teal SB. Levonorgestrel-only dosing strategies for emergency contraception. [Review] [34 refs] [Journal Article. Review] Pharmacotherapy. 27(2):278-84, 2007 Feb. UI: 17253917 ref added

IUD

Archer DF. Reversible contraception for the woman over 35 years of age. [Review] [23 refs] [Journal Article. Review] Current Opinion in Obstetrics & Gynecology. 4(6):891-6, 1992 Dec. UI: 1450355 ref added to article, if you wish to move it and need help, let me know

Condoms

Flannigan J. Promoting sexual health: practical guidance on male condom use. [Review] [30 refs] [Journal Article. Review] Nursing Standard. 21(19):51-7; quiz 58, 60, 2007 Jan 17-23. UI: 17288318

Gallo MF. Grimes DA. Lopez LM. Schulz KF. Non-latex versus latex male condoms for contraception.[update of Cochrane Database Syst Rev. 2003;(2):CD003550; PMID: 12804475]. [Review] [29 refs] [Journal Article. Meta-Analysis. Review] Cochrane Database of Systematic Reviews. (1):CD003550, 2006. UI: 16437459

Hormonal methods

Liu SL. Lebrun CM. Effect of oral contraceptives and hormone replacement therapy on bone mineral density in premenopausal and perimenopausal women: a systematic review. [Review] [104 refs] [Journal Article. Review] British Journal of Sports Medicine. 40(1):11-24, 2006 Jan. UI: 16371485

Bradley LD. Abnormal uterine bleeding. [Review] [23 refs] [Journal Article. Review] Nurse Practitioner. 30(10):38-42, 45-9; quiz 50-1, 2005 Oct. UI: 16217420

Ehrmann DA. Polycystic ovary syndrome.[see comment]. [Review] [144 refs] [Journal Article. Research Support, Non-U.S. Gov't. Research Support, U.S. Gov't, P.H.S.. Review] New England Journal of Medicine. 352(12):1223-36, 2005 Mar 24. UI: 15788499

Khoury-Collado F. Bombard AT. Hereditary breast and ovarian cancer: what the primary care physician should know. [Review] [45 refs] [Journal Article. Review] Obstetrical & Gynecological Survey. 59(7):537-42, 2004 Jul. UI: 15199272

Winkel CA. Evaluation and management of women with endometriosis. [Review] [54 refs] [Journal Article. Review] Obstetrics & Gynecology. 102(2):397-408, 2003 Aug. UI: 12907119

Olive DL. Pritts EA. Treatment of endometriosis. [Review] [94 refs] [Journal Article. Review] New England Journal of Medicine. 345(4):266-75, 2001 Jul 26. UI: 11474666

Moore J. Kennedy S. Prentice A. Modern combined oral contraceptives for pain associated with endometriosis. [Review] [1 refs] [Journal Article. Review] Cochrane Database of Systematic Reviews. (2):CD001019, 2000. UI: 10796731

DeCherney A. Bone-sparing properties of oral contraceptives. [Review] [25 refs] [Journal Article. Review] American Journal of Obstetrics & Gynecology. 174(1 Pt 1):15-20, 1996 Jan. UI: 8571999

Iyer V. Farquhar C. Jepson R. Oral contraceptive pills for heavy menstrual bleeding. [Review] [1 refs] [Journal Article. Review] Cochrane Database of Systematic Reviews. (2):CD000154, 2000. UI: 10796696

Burkman RT. Collins JA. Shulman LP. Williams JK. Current perspectives on oral contraceptive use. [Review] [72 refs] [Journal Article. Review] American Journal of Obstetrics & Gynecology. 185(2 Suppl):S4-12, 2001 Aug. UI: 11521117

Tyrer LB. Current controversies and future direction of oral contraception. [Review] [42 refs] [Journal Article. Review] Current Opinion in Obstetrics & Gynecology. 5(6):833-8, 1993 Dec. nice older summary of oral contraceptives after 30 years of use: in 1993-main questions of safety had to do with exogenous estrogen and posible increased risk of cervical and breast cancer. Oral contraceptves began being widely prescribed in about 1960. Reduction of doses of both estrogen and progesterin lowered clinical incidence of cardiovascular complications.The cardiovascular complications associated with OCP are specific:thromboembolic events, stroke, MI.As far as Breast cancer- the consensus in 1993 was that the overall incidence waqs not greater in women who used OCP, but the acceleration of the growth of early breast cancers (rather than their initiation) is a risk. The incidence of endometrial and ovarian cancer, however, is lower in women using birth control pills.Higher dose pills have some significant effects on CHO metabolism, especially in women who are "pre-diabetic" but do not cause diabetes.Health benefits of OCP : decreased iron deficiency anemia, less dysmennorhea, menometrorraghia, taken correctly combination pills about 100% effective in preventing pregnancy. UI: 8286698

Risk populations,complications etc

CARRIE ARMSTRONG:ACOG Releases Guidelines on Hormonal Contraceptives in Women with Coexisting Medical Conditions American Family Physician - Volume 75, Issue 8 (April 2007)

Bushnell, Cheryl D. MD, MHS; Hurn, Patricia PhD; Colton, Carol PhD; Miller, Virginia M. PhD; del Zoppo, Gregory MD, MS; Elkind, Mitchell S.V. MD; Stern, Barney MD; Herrington, David MD; Ford-Lynch, Gwendolyn MD; Gorelick, Philip MD, MPH; James, Andra MD, MPH; Brown, Candice M. PhD; Choi, Emily MD; Bray, Paul MD; Newby, L Kristin MD, MHS; Goldstein, Larry B. MD; Simpkins, James PhD Advancing the Study of Stroke in Women: Summary and Recommendations for Future Research From an NINDS-Sponsored Multidisciplinary Working Group. Stroke. 37(9):2387-2399, September 2006. "Women have poorer outcomes from stroke than men. Women also have risk factors that are unique, including pregnancy and hormone therapy. Hormone therapy for postmenopausal replacement increased the risk of ischemic stroke according to results of the Women’s Health Initiative clinical trials. Based on the current understanding of the mechanisms of action of estrogen, the reasons for this increased risk are uncertain."..."A multidisciplinary workshop was held in August 2005 to summarize the current evidence for estrogen and, more generally, stroke in women, and to provide recommendations for future basic, preclinical, and clinical research studies."

Tozer, Beverly S. MD; Boatwright, Elizabeth A. MD; David, Paru S. MD; Verma, Deepa P. MD; Blair, Janis E. MD; Mayer, Anita P. MD; Files, Julia A. MD Prevention of Migraine in Women Throughout the Life Span. Mayo Clinic Proceedings. 81(8):1086-1092, August 2006. "Migraine is a common disorder in women. The 1-year prevalence of migraine is 18% in women compared with 6% in men. Migraine most commonly occurs during the reproductive years, affecting 27% of women 30 to 49 years of age. " "During the reproductive years, headaches in women are commonly associated with menses, pregnancy, and use of combined oral contraceptives (COCs).".."Oral Contraceptives: Many women with MM also take COCs, which can unpredictably induce, alter, or alleviate migraines. The normal decline in endogenous estradiol concentration in the late luteal phase of the natural menstrual cycle is equivalent to a 20- to 25-µg decline in synthetic ethinyl estradiol (EE).13 Thus, no COC will prevent MM in a woman who has headaches during her natural cycle because even the lowest-dose medication produces a decline equivalent to 20 µg of EE premenstrually. If use of COCs exacerbates migraines throughout the cycle, the initial strategy should be to lower the estrogen content to 20 µg of EE. Persistent headaches despite this intervention may necessitate discontinuing COCs in these patients.20 When a woman experiences prolonged aura, focal neurologic symptoms different from those of her typical aura, or a sudden prolonged headache, use of COCs should be discontinued, and possible secondary causes of headache should be explored.16"

Vaginal ring

Teal SB. Craven WM. Inadvertent vesicular placement of a vaginal contraceptive ring presenting as persistent cystitis. [Case Reports. Journal Article] Obstetrics & Gynecology. 107(2 Pt 2):470-2, 2006 Feb. UI: 16449153

Miller L. Verhoeven CH. Hout J. Extended regimens of the contraceptive vaginal ring: a randomized trial. [Clinical Trial. Comparative Study. Journal Article. Multicenter Study. Randomized Controlled Trial] Obstetrics & Gynecology. 106(3):473-82, 2005 Sep. UI: 16135576:Objective: To compare the bleeding patterns and tolerability of 3 different extended ring regimens with those of the standard 28-day cycle with 21 days of contraceptive vaginal ring use followed by 7 ring-free days.Methods: Following a run-in 28-day ring cycle, women were randomized to 1 of 4 regimens: monthly (28-day cycle), every other month (49-day cycle), every third month (91-day cycle), or continuous (364-day cycle). Treatment duration was 1 year. Daily bleeding diary, interval visit questionnaire, and examination data were collected.Results: A total of 561 women were enrolled, 429 were subsequently randomized, and 289 (67.4%) women completed the entire year. All schedules were well tolerated and acceptable to women, but study completion rates were higher for the shorter cycles. Bleeding days were reduced with postponement of the withdrawal bleeding (ring-free) week, but spotting days increased. For example, women using the continuous or 364-day ring cycle reported a median of zero bleeding days but 10–12 days of spotting during the first 3 months of extended use. Unscheduled bleeding during ring use was the lowest with the traditional 28-day cycle. Adverse events, blood pressure, body weight, and laboratory findings were comparable over the 4 treatment groups.Conclusion: The combination vaginal contraceptive ring can be used for extended cycles to alter the bleeding schedule. Women willing to tolerate some spotting might choose the longer extensions to have fewer menstrual periods.

New start

Nancy and Peter, what is the goal of writing this article as opposed to the more general one on contraception? Where does this new start fit into the big picture? Is abstinance to be a separate article or part of the more general contraception article? Chris Day (talk) 15:28, 4 May 2007 (CDT)

Just looking in here, I think that there is an important role for an article that essentially aims to explain exactly how different methods of contraception work. Such an article can really avoid the moral/religious issues altogether. I think it is important to get across a clear account of the principles underlying hormonal use, in a way that will lead to an understanding of the limits of effectiveness and the potential hazards too. Hormonal contraception in men is also physiologically a very interesting (and illuminating) story.

I guess I see that there are potential problems in having an article that covers both the reproductive cience aspects and the ethical/societal aspects. For the moment it seems a good idea to develop these separately, though perhaps later they can be merged or linked.Gareth Leng 11:55, 5 May 2007 (CDT)

disclaimer font

It may just be my macbook pro, but I can't read the font/type-size/font-color/letter spacing of the disclaimer. Changing just one of those variables would make it easier to read. -Tom Kelly (Talk) 18:17, 5 May 2007 (CDT)

it's your browser settings- make the text bigger. I'll put the font up 1, bit it will probably be too big, It's not a disclaimer- it's a guide. Nancy Sculerati 19:19, 5 May 2007 (CDT)

I think in general it's better to let the user's browser choose the font. Html tags such as <big>, <small> etc. can be used to gently suggest what type of font to use without forcing it on the user. I would just use italics and not make the font smaller. Remember that people might have to read this stuff on various types of devices: devices for blind people; tiny handheld devices with limited screen size and resolution, etc. --Catherine Woodgold 19:30, 7 May 2007 (CDT)

Contraception versus birth control

My understanding of the word "contraception" is that it means methods that prevent conception, and that conception is the joining of egg and sperm. Therefore methods that prevent implantation are not contraception, except euphemistically. If such methods are to be discussed, perhaps "birth control" would be a better name for the article. --Catherine Woodgold 19:25, 7 May 2007 (CDT)

---

That understanding is not a physician's understanding, and one reason that certain articles, including this one have been broken off from the main article Contraception is exactly to prevent conflicts in approaches and understanding from rendering all the articles useless. For example, for some religious views- contraception does not include prevention of implantation, but only of conception- but that is not a health science view:

According to the Medline-Mirriam Webster on line Medical dictionary:Main Entry: con·tra·cep·tion Pronunciation: kän-tr-sep-shn Function: noun

deliberate prevention of conception or impregnation

- con·tra·cep·tive /-sep-tiv/ adjective or noun

Contraception includes the deliberate prevention of pregnancy. This is also how the topic is treated in every OB-GYN textbook I have ever read, and all the ones that are referenced here. However, it would be absolutely inaccurate to use this definition for groups who are not health scientists and do not agree with it, and we will strive to make this health science definition clearer in the article.

Since it makes a great deal of difference to many patients EXACTLY how contraceptives work, that information is being provided in this article- to the best of the current health science information.

A discussion of contraception from a different perspective than health sciences, as well as health sciences, is the main focus of Contraception, an article that needs authors. The different ways contraception are defined and the implications seem to belong there, as a full an unabbreviated discussion. Nancy Sculerati 11:16, 8 May 2007 (CDT)

Comments on the introduction

Re link to natural family planning: "abstinence methods" is too narrow; for example, the withdrawal method is also a method of natural family planning (depending on the definition of natural family planning). How about "natural methods"? Re "failure rate": I prefer the term "pregnancy rate" for two reasons. For one thing, "failure rate" can be interpreted to mean a number of things, such as the rate of breakage of condoms, for example, whether or not anyone becomes pregnant as a result. (When something other than pregnancy rate is actually meant, some other less ambiguous term can be used.) For another thing, "pregnancy rate" is more polite, in my opinion, especially when the article is read by a person who knows that their own existence resulted even though their parents were using a birth control method. Re of the group of women who were supposedly using it. I suggest changing to "group of women" to "couples" to avoid seeming to support the idea that contraception is women's sole responsibility. Other methods have a rate of effectiveness that is independent of compliance. They can't be completely independent of compliance, or else the people could be not using the method at all and still achieve the effectiveness. (Unless possibly you mean something like the lactation amennhorea method.) Oh, wait, it could be getting shots every few months. Still, one has to comply insofar as getting the shot in the first place. I haven't thought of a better wording yet, though. --Catherine Woodgold 20:05, 5 May 2007 (CDT)

In this health science article the rate of pregnancy is referred to in the standard manner as in the published medical literature- when discussing any method of contraception, the "failure rate" is ordinarily reported as as the percentage of women in a group that reports using a particular contraceptive method that become pregnant in the course of one year. Because of how the statistics are done for large studies, individuals placed in a group- such as "condoms" are counted in that group's results- EVEN if they are admittedly non-compliant most (or all) of the time. Similarly, if a woman had an IUD placed, and the IUD came out the next day (expelled) her one-year results would be reported in the IUD results, generally speaking. That's where the "supposedly" comes from- and it will have have more development. The "withdrawal method" is NOT a recognized form of medical contraception, nor a recognized "health science" method of effective birth control, but instead is a "traditional" or "alternative medical" method that is sometimes used as a control when reporting health science statistics. In fact, the use of condoms in a medically advised manner (see article here) unequivically states that the condom must be applied before contact such that it contains any pre-ejaculate. Should you wish to discuss traditional or alternative medical methods of reducing or influencing the pregnancy rate , there are other articles to do so Natural Family Planning, and Contraception- including any new articles that you (or others) might like to start. This article legitimately focuses on medical methods only. Nancy Sculerati 11:24, 8 May 2007 (CDT)

The note about the link to the natural family planning article need not use medical terminology. I see no reason not to change the wording "abstinence methods" to "natural methods" in that note at the top of the page. The withdrawal method is not the only problem with the phrase "abstinence methods". Another problem is that some people consider "abstinence" to mean abstinence from sexual activity (not just abstinence from vaginal intercourse); and some people consider "abstinence" to mean abstinence all month, not periodic abstinence.

Citizendium articles are supposed to be written from a neutral point of view, not divided into one article on contraception written from a medical point of view using medical terminology in a way that is in conflict with common understanding, and another article on the same topic written in common terms in a way that is in conflict with medical understanding. This article may be about medical methods of contraception, but it must present them with a neutral point of view. See CZ:Neutrality Policy. --Catherine Woodgold 15:55, 13 May 2007 (CDT)

minor formatting point

Editors may wish to paraphrase quotes, unless the particular quote is of such uniqueness that it should be left intact. Just a suggestion.--Peter A. Lipson 08:38, 10 May 2007 (CDT)

One reason that I like to quote is because it leads readers to the references. But that's short quotes- some of the long ones are sort of placeholders here, that way we can develop the sections, know the references. Nancy Sculerati 12:04, 10 May 2007 (CDT)

Effectiveness of condoms

We probably should mention the compliance rate, i.e., in what percentage of sexual encounters in which the partners intend to use condoms, do they actually remember to do so before it's "too late"?

With 'the pill', the crucial moment is a matter of routine. Every day the girl takes a pill (or recalls that it's a "no pill" day), and probably always at the some time - like after getting up or before going to bed.

With condoms, the crucial moment is typically part of a sexual encounter. It requires additional discipline to interrupt foreplay, for example. It's easier for the girl to remember to take a pill in the bathroom by herself every day, than to remember to say, "No glove, no love" at just the right moment. (Not to mention issues of self-esteem, will he/she reject me, etc.) --Ed Poor 11:36, 10 May 2007 (CDT)

I agree with you. This is really in a rough draft form, and the whole compliance issue has to be well written. It isn't now- I've ben reading the medical literature, and taking notes, and working on the various articles that relate to the references as I can. That's one reason that I started Contraception (veterinary), oddly enough, because I came across these papers in the talk page there as I was researching various methods. Anyway- I'm continuing to work, and happy to have help. The hormonal stuff- from a physiological point of view, is another area that is really unfinished, and Ovulatory cycle is getting written, too. Nancy Sculerati 12:02, 10 May 2007 (CDT)

The main advantage of latex condoms is not their utility in pregnancy prophylaxis, although the stats could be better, could be worse, but currently they are the only method of having sex while being protected against STDs. A little hard to figure out how to make the point, but I prefer to do it here on the discussion page and see how others integrate it. I think Ed already knows how I feel about this one : ) Peter A. Lipson 17:35, 10 May 2007 (CDT)

That point is already made in the text, but the other point -not yet made- is that, like for contraception, these devices are NOT 100% effective, even when remembered to be placed before any actual contact. The other point not yet made, is that the very group of people who are most at risk for HIV etc, generally, promiscuous, impulsive younger people- are the very people who have the worst stats in using these effectively for birth control. Nancy Sculerati 17:41, 10 May 2007 (CDT)

The point almost leads into a point about HPV vaccine, but I'll leave that for later. Thanks, Nancy.Peter A. Lipson 17:44, 10 May 2007 (CDT)

Nancy, that's a good point: impulsiveness is a risk factor in itself. It's not just a medical issue, but a social (sociological?) one. --Ed Poor 18:03, 10 May 2007 (CDT)

It's a medical issue in that every OB-GYN article and textbook chapter- when discussing contraception, talks about: a sort of "best match" strategy of patient ("client") and method. So, the obese woman who is hypertensive is likely to do best with something that is not going to further raise her blood pressure, the person at high risk for catching a STD is better off (in one sense) with latex condoms incorporated into the method- and worst off with an IUD. etc. There are several published references discussing the fact that latex condoms are fairly ineffective in preventing pregnancy in young women, and much more effective in older women. That reason- impulsiveness greater in young people, is implied as one of the underlying issues. Also -female condoms, that I don't know much about- I'm just reading about them now, may offer protection, some protection anyway, against sexually transmitted disease as well as male condoms. I feel strongly that these articles have to be factual, encyclopedic articles that do not push a political or religious view. On the other hand, all health science articles should be "doctorly" in that they are a service to the public that give clear information in a kind and helpful manner. That's sort of an extension of "family friendly", human friendly, in other words, humane. Anyway- there's a long way to go here, yet- but progress is being made. Nancy Sculerati 18:20, 10 May 2007 (CDT)

In that case, the fettility awareness methods should also be included under "medical methods", for the same reason. --Catherine Woodgold 07:35, 14 May 2007 (CDT)

Question

I am still perplexed at why NFP would be barred from inclusion on an article about "medical methods of contraception", especially when condoms are included (how is a condom "medical" and NFP not??). The AMA medical encyclopedias I have make no distinction and consider the topic of NFP as within the purvey of the field of medicine and medical practitioners within a "best match" strategy. Stephen Ewen 20:02, 13 May 2007 (CDT)

Good point! Having one article that talks about almost all the methods and then a different article for the natural methods gives a certain impression -- it gives the impression to doctors and patients, for example, not to expect discussion of natural methods in the doctor's office, which is unfortunate. --Catherine Woodgold 21:02, 13 May 2007 (CDT)

Well, IMHO, I do think a unified contraception article should include all methods, including the abysmal success rates of certain methods, like withdrawal, rhythm, etc. Peter A. Lipson 21:31, 13 May 2007 (CDT)

Why don't you all write one? Contraception remains blank. Nancy Sculerati 21:45, 13 May 2007 (CDT)

Nancy, I am not trying to be difficult here, please understand. Contraception, as I understand it, would include a brief history of contraception and coverage of key social issues such as ethics, population control, women's rights, etc. In Contraception (medical methods), this article, it seems to me, and in medical encyclopedias, it seems that they all have a "natural methods" section. I cannot understand why condoms would be considered a medical method while NFP would not be. Can you, or someone, kindly explain the rationale that would differentiate these two?

Also, I have a question. What about Essure? Would that be considered any more surgical than IUD placement?

Stephen Ewen 22:25, 13 May 2007 (CDT)

An IUD placement is not a surgical procedure. An IUD is a medical device, which is why you'll find it in this article. Ths article, by the way, is already fairly robust and yet it does not yet include the different types of IUDs, and does not yet give a proper description of the medical complications of hormonal contraceptives. This is an additional reason why I, personally, have no interest in expanding the topic for this article to include birth control in general. To do even minimal justice to the medical methods of contraception it's going to be long as it is. If you have read it and still think an IUD is placed surgically, it may be because I did not describe how IUDs are placed, and-come to think of it- that really should be in here. I haven't written the fallopian tube obstruction part of Sterilization (surgical), but glancing quickly at the site you reference, Essure is a non-reversible surgical sterilization procedure which is some variation of that. Thanks for the reference. I'll check it out as I slowly continue doing the library research, and may inc orporate it in the sterilization article. I myself stick to medical textbooks and peer reviewed articles in medical journals, and I'll see what I can find. Give me time, please. Nancy Sculerati 22:36, 13 May 2007 (CDT)

Sorry-this article has simply collected the various medical devices and drugs that are used for contraception as medical methods. NFP does not use drugs or devices, it's strictly behavioral. It is not routinely mentioned as a contraceptive, but it conceivably (sorry for that pun) could be - and for that matter, tube tying and vasectomy might be mentioned as well, even though they are not ordinarily reversible and are not really contraceptives but are sterilization procedures. Still, various "medical" books and articles might mention all these birth control methods in the same breath. That doesn't mean that they are all "medical contraceptives". I don't "own"these articles but I am committed to writing well referenced prose that completely covers all the topics. NFP is missing a lot of stuff- the recent work on temperature, for example, and the explanation for why lactation inhibits ovulation, as well as other things I am aware of. The sterilization article is barely started. I urge you to write or work with someone to write an overall article on Birth Control. I have a very clear idea iof what I am doing and all I can say is that I can demonstrate it better than justify it in advance. I assure you, by all our precedents of acceptable lengths of articles, I cannot cover these topics in proper detail and expand the topics. I would like to continue working, and learning. I'll help you with a general article on Birth Control, but I myself am not interested in starting it at this time. Start it, work on it- I'll fill in where I know something.Nancy Sculerati 22:54, 13 May 2007 (CDT)

Steve, you seem to have your hands on some medical encyclopedias. Maybe you could explain in more detail the title of the article in an encyclopedia (this matters quite a bit), how abstinence is covered, and whether and to what extent this is treated as a "medical method" like others. --Larry Sanger 23:30, 13 May 2007 (CDT)

By the way, can't this problem above be finessed by having strictly medical methods in the present article, and other methods (along with medical ones) listed in birth control? We should have an article called "birth control," shouldn't we? If not, why not? --Larry Sanger 23:32, 13 May 2007 (CDT)

Reply

Here's a synopsis from American Medical Association Home Medical Encyclopedia (in two volumes), Random House, 1989.

Birth control

Just a two paragraph entry. Defines it simply, then says it can refer to what it calls "the narrow area" of both "natural or artificial" means to prevent pregnancy and then the "broader" areas of "family planning" and "population control". It uses "birth control" as an umbrella term for 1) family planning; 2) contraception (defined as the means for #1); 3) Elective abortion; 4) Sterilization; and, 5) population control. It mentions human rights issues when States pressure citizenries in population control efforts. In point of fact, birth control is actually "the lead article", in that it is the umbrella for all related topics.

Contraception

Total coverage is several pages long. It includes an Intro that briefly discusses all methods, from "avoidance of intercourse" (a nicely neutral term for the politically charged "abstinence", don't you think?) to surgical sterilization. Discusses effectiveness measuring; risks of usage; and, future possibilities, e.g., vaccines.

It then gives detailed separate entries for 1) barrier methods (mechanical and chemical); 2) hormonal; 3) periodic abstinence (temp, mucous, symptothermal); and, 4) postcoital methods.

Sterilization

Has a brief intro article and then separate entries for male and female.

This all is, of course, simply how they chose to do it.

But here is what I think would prove very useful. I think it would be very helpful to have a more fully settled and decided overall plan for this whole series of articles. That way, everyone who'd like to contribute to these topics can be doing so within a larger, articulated strategy.

Stephen Ewen 00:31, 14 May 2007 (CDT)

I am taking the liberty of moving the brainstorming on birth control below, by Stephen, to the Contraception talk page, which may be renamed birth control or stay contraception as you all like. Nancy Sculerati 05:53, 14 May 2007 (CDT)

"Contraception"--what does it mean?

I was asked to comment here. I don't want to do so in any greater detail without getting the matter more study and thought, which I don't have time to do. But I would like to say something. Suppose, first, that in fact medical doctors, in conceptualizing what they call contraception, consider only active methods of preventing impregnation after or during sex. IF that is the case, then it is not, strictly speaking, biased at all to omit discussion of abstinence. Speaking for myself, and bear in mind that I am very far from being an expert on this, I always thought "contraception" meant "methods of preventing sex from resulting in a pregnancy," and so by definition excludes abstinence, whereas "birth control" was a broader term that could of course include abstinence. It wouldn't surprise me if this is what doctors understood by the term. If so, then there is no need to mention abstinence in the article titled "contraception." Granted, there would be a systematic professional bias against abstinence as a method of birth control if we only had an article titled "contraception," and it did not mention abstinence; but we should have a broader article, something like birth control, that lays out all the options, including abstinence. These two articles will have overlapping content, no doubt, but I suppose that's all right. Besides, the "birth control" article could cover ethical and religious aspects, which it would be strictly inappropriate to include in an article that is focused on medical practices. (I hope it is not controversial to say the latter. Obviously, some people do, on ethical or religious grounds, advocate against certain medical practices. But surely it is useful knowledge to such people to have a clear explanation of the exact practices they are advocating against. That's what the present article is for, as I understand it.)

I think it would be worthwhile cataloging the different related concepts here, and deciding explicitly which we want to have articles about:

• Contraception
• Birth control
• Family planning
• Others?

I ask the disputants here whether, perhaps, it would be more productive to use birth control as a locus for all the different methods of preventing pregnancy (which methods may or may not actually involve sex).

I don't mean to hand down a decision, here. I'm just on all points stating my opinion here, and I think that the relevant decisions here belong in the hands of the Health Science Workgroup. --Larry Sanger 21:47, 13 May 2007 (CDT)

Anyway, a single article called "Contraception (medical methods)" is likely to get too long. It could be split into "Contraception (hormonal methods)", "Contraception (barrier methods)", "Contraception (fertility awareness methods)", etc.

We would have to decide where a description of combined barrier/fertility awareness methods would fit in. --Catherine Woodgold 07:41, 14 May 2007 (CDT)

Catherine, you might be right--I have no idea--but this is a decision that must be left with the Health Sciences workgroup editors, of which Dr. Sculerati is one. Recall that part of the purpose of having expert editors at all in CZ is precisely the sort of issue we are facing here: where there is a dispute between an editor and others, the others are expected to give input, but then defer. I trust Dr. Sculerati's judgment, and that of the other doctors involved in the project. I encourage you to do the same. --Larry Sanger 10:15, 14 May 2007 (CDT)

I a member of the Healing Arts workgroup and I have to agree with Nancy. Contraception would include methods that prevent pregnancy as a result of sexual activity. Anything else could be listed under "See also", but there is no reason why (medical methods) can't remain a separate article with a (surgical methods) having another domain. This would be a workgroup decision. Some of the other methods could even share the Religious Workgroup and those editors can certainly have some proprietory control over those articles, but contraception would be Health Sciences or Healing Arts. --Matt Innis (Talk) 20:15, 14 May 2007 (CDT)

copy edits

I made a couple of copy edits, hopefully helpful, but feel free to remove them if they don't fit into the scheme of things. --Matt Innis (Talk) 20:58, 14 May 2007 (CDT)

Editorial Guidance

I'm happy to act as editor for this and help guide it to Approval, unless there are any objections. I think my only contributions have been copy edits.

It seems to me that this is a very well developed article with already a broad scope, so I would not wsh to suggest extending it - there is clearly scope for a future article on male contraceptive agents, as there has been a lot of work towards developing a male 'pill'.

On a first reading I think the general conception is clear and the content good. I think some thought needs to be given to the question of exactly what the reader is expected to know and then exactly what the article should tell in the way of preparing the foundations. Terms like estrogen, progestin, zygote, gamete, motility, slip so easily from our tongues that we forget that others may look blankly on. I do think that a brief account of the ovarian cycle, the surge of estrogen that is a prerequisite for ovulation, the subsequent progesterone domination that is essential for pregnancy - is important to understand that there is a solid physiological rationale for steroid contraception - it's not just something that happens to work, we know exactly why it works. A section like this could also introduce the key terms that are used subsequently.

I think there are some questions that we might anticipate - if a spermicide kills sperm cells, why doesn't it kill other cells too? How did IUDs come to be used in the first place? Isn't it harmful to have a continual source of inflammation like this? Why do women have to take a pill every day, why can't we have a once-a month pill, or a once a year pill? (Why do women menstruate anyway, most animals don't? - maybe an aside). Finally I think that compliance is an important jargon term that needs to be explained clearly early on.

Just some suggestions to consider.Gareth Leng 07:52, 15 May 2007 (CDT)

Thanks Gareth, please also look at Ovulatory cycle, but I do think a section on human reproduction is needed and I'll try to keep your points in mind.Nancy Sculerati 09:27, 15 May 2007 (CDT)

Maybe something like this is needed to expand on one of the quotes given. "In women, ovulation is triggered in mid cycle by a surge of secretion of luteinizing hormone from the anterior pituitary gland. Progestin prevents ovulation by suppressing this secretion of luteinizing hormone. Progestins also thicken cervical mucus, thereby retarding the passage of sperm, and they make the endometrium unfavorable to implantation. Estrogen on the other hand prevents ovulation by suppressing the secretion of follicle-stimulating hormone, which is necessary to begin the ovarian cycle. A second effect is to stabilize the endometrium, and this prevents breakthrough bleeding."Gareth Leng 09:36, 15 May 2007 (CDT)

Thank you so much. Nancy Sculerati 10:04, 15 May 2007 (CDT)

Hey Gareth, there is nothing to keep you from formatting those references really nicely. Nancy asked me, but you are sooo much better at it;-) --Matt Innis (Talk) 14:08, 15 May 2007 (CDT)

I made the recommended changes, and-on my own volition- I added a short section on ethics. The reason why is in the section. Nancy Sculerati 14:30, 15 May 2007 (CDT)

Approval

I've nominated the article for approval, believing that I am legitimately able to do so - I have edited the article quite extensively but only for copy editing and formatting purposes, I am not the source of any of the actual content.Gareth Leng 04:59, 17 May 2007 (CDT)

Thank you, Gareth. I have made some changes. Reading it over- for one thing I see that I have not mentioned thromboembolic events with birth control pills (hormonal preparations). I will announce this on the approval page and call for eyes, I know that since I am the primary author and also am approvals editor, that this is an odd situation. I know that you have copyedited, and -thank you- fixed up the references. That I am sure counts as editing, rather than authoring, but I will e-mail the physicians who have been active on the wiki and ask that they, especially, take a look here.Also invite comments, generally. Nancy Sculerati 05:45, 17 May 2007 (CDT)

I would like to second the article for approval. Further changes can go in the draft, at leisure! Supten 06:20, 17 May 2007 (CDT)

I would also like to second the article for approval, it is accessibly written. Walter van den Broek

It's good. It would be fine for approval. The WP article has more cultural aspects of contraception and some (corrected) misconceptions, which are not all that scientific, but fascinating. Consider adding to make a more well-rounded article.--Michael Benjamin 17:15, 17 May 2007 (CDT)

I found this article well-balanced, thorough, lucid, and highly informative. I too second the article for approval. --Anthony.Sebastian (Talk) 16:08, 18 May 2007 (CDT)

Suggested edit

I suggest changing this (2nd sentence of "human fertility") "Normally, fertilization occurs in the fallopian tube where the egg will begin dividing as it travels toward the uterus, and will implant itself." to this: " Normally, fertilization occurs in the fallopian tube, after which the embryo will begin dividing as it travels toward the uterus, where it will implant itself.". Reasons: After fertilization, "embryo" or "fertilized egg" would be less confusing than "egg", which will suggest at least to some readers an unfertilized egg. Secondly, the sentence as it now stands can easily be interpreted to mean "where ... it will implant itself," i.e. that implantation normally occurs in the fallopian tube. Thirdly, "and will implant itself" in the current version is too far removed from its subject, which is not the subject of the sentence as a whole, to make for smooth, easy reading. Fourthly, the current version says that the egg will implant itself. Even if it's considered correct to refer to a fertilized egg as an "egg" and to say that the egg divides, nevertheless by the time implantation occurs it's a multicellular entity to which the term "egg" no longer applies. --Catherine Woodgold 08:13, 19 May 2007 (CDT)

Your crticisms have some technical validity, but I prefer the sentence as it stands. Perhaps because of a laboratory background in embryology, the idea of a fertilized egg dividing seems normal. In some species, these first divisions can even be prompted by mechanical stimuli, and do not require fertilization (parthenogenesis). Referring to cleavages in an ovum is not outrageous, and sometimes scientists say ovum instead of zygote or certainly, will talk about developmental changes in the fertilized ovum. I realize that parthenogenes is not the case with human ova, and that a fertilized ovum that is dividing is called a zygote, but still, the text reads sensibly and the way that it is worded is not wrong. Nancy Sculerati 10:39, 19 May 2007 (CDT)

Anyway, after writing my above comment I realized that I may not have been using the word "embryo" correctly: perhaps it is not considered by everyone to apply at the unicellular stage. I have some other suggested versions of this sentence if anyone is interested. --Catherine Woodgold 16:18, 19 May 2007 (CDT)

Bravo + small suggestion

Firstly, I wandered into this page from Nancy Sculerati page. I'm not a subject expert, but I think this is a tremendous article and a wonderful addition to the library. Bravo to Nancy and to all of you who have put time and effort into this piece.

I have a small editorial suggestion. The last paragraph has no references and, on the face of it, appears a bit preachy. I think it might be more beneficial to quote sources to frame the same message. There's a part of me that thinks this is actually the stub of a whole new article, the Ethics of Contraception. (That article might already exist for all I know.)

I don't want this small criticism to diminish my overall praise for this article. This article is thorough yet concise. It is both fair and factual and both informational and readable. Overall this article is a model for what a good article should be at Citizendium. Thanks! Will Nesbitt 12:25, 19 May 2007 (CDT)

Comments

I suggest changing this "when women of child-bearing age have sexual intercourse with fertile men" (First sentence of last paragraph of "Human fertility" section) to this "when a woman of child-bearing age and a fertile man have sexual intercourse", to imply equal social responsibility of both parties.

Re "the overall risk ... and implanted IUDs, is quite low". (Near end of 3rd paragraph under "Human fertility) Because in the next section it talks of a "high" risk of implanting IUD's under certain circumstances, I wonder whether this is intended to mean that the risk of using the IUD is low once it's been implanted but that the risk of implanting it is not necessarily low. If so, this can be made clearer by saying "and already-implanted IUDs" or "and IUDs, once they are already implanted" etc. Also: whether the risk of the various methods is "low" is based on a value judgement concerning the relative value of sexual activity versus health, a value which varies considerably from one person to another.

"The article Natural Family Planning includes information that may help (somewhat) to accomplish, or avoid, conception." (Under "Surgical and "natural" ways of preventing pregnancy") I suggest deleting "somewhat", since some methods of Natural Family Planning have higher effectiveness rates than some medical methods of contraception. (See studies discussed at this website Couple to Couple League: click on "Basics" at the left, then click on "Effectiveness" at the left under "Basics".) For the same reason I also suggest changing "may help" to "can be used to". Also, in the section heading I suggest removing the quotation marks from "natural" or substituting a different term which it is felt can be used without quotation marks: perhaps "fertility awareness", "periodic abstinence" etc. The quotation marks suggest a value judgement about the methods.

Re "Some couples who use barrier methods of contraception combine these with abstinence on a woman's most fertile days, as predicted using a natural family planning method." (Last sentence of that section.) I suggest adding here that other couples use barrier methods on days of suspected fertility and have unprotected intercourse on days when a natural family planning method indicates infertility; (by the way, note that such a combined method doesn't necessarily require any abstinence).

"Condoms are a thin, strong, non-porous tube of material ..." (First sentence of "Condoms for men") I suggest changing the beginning of this to the singular "A condom is ..." to match the singularity of what it is being equated with.

"When a male condom is placed over an erect penis, semen and pre-ejaculate is prevented from entering the vagina, stopping pregnancy from occurring; a condom will also prevent transmission of some STIs and HIV (the virus that causes AIDS)."(Second sentence of 3rd paragraph of "Condoms for men" section.) Just placing the condom over the penis does not necessarily prevent semen from entering the vagina as seems to be claimed here. Other precautions must also be taken, as discussed later in the article. One possibility is to change this sentence to "By placing a male condom over an erect penis, semen and pre-ejaculate can be prevented from entering the vagina, stopping pregnancy from occurring..." Similarly, I suggest replacing "will" with "can" in the second half of the sentence.

"Even when condoms are of high quality, contain spermicide, and are used appropriately, pregnancy (and venereal disease including AIDS) occur(s) in some women." (last sentence of introduction of "Condoms for men" section): I suggest also mentioning sexually transmitted disease occuring in men. Maybe something like "Even when condoms are of high quality, contain spermicide, and are used appropriately, pregnancy sometimes occurs and sexually transmitted disease, including AIDS, is sometimes transmitted."

"While condoms are said to be 98% effective in preventing both pregnancy and spread of venereal infections..." (First sentence of "Effectiveness of male condoms") I suggest inserting ", when used properly," after "condoms" or inserting it in parentheses after "98% effective".

"for all men and women" (Last sentence of first paragraph of "Effectiveness of male condoms) I suggest "for both men and women". Same sentence: "as part of the practice of 'safe sex'," Could be changed to "...safer sex". Same sentence again: "to increase chances of avoiding an unwanted pregnancy" I suggest changing "increase" to "improve" to increase chances of avoiding having it accidentally read as "increase chances of an unwanted pregnancy" -- probably only saving the reader a split-second double-take :-)

"In other circumstances, the failure rate of condoms is certainly not 2%." (Middle of 2nd paragraph under "Protection varies according to compliance: typical use is less effective than perfect use") This could be misinterpreted as meaning that the failure rate is less than 2%. I suggest "...is certainly not just 2%" or "is certainly not only 2%" or "is certainly not as low as 2%".

"If a man is allergic to latex, he cannot safely use a latex condom without a threat to his health. If his female mate is allergic to latex, and he is not, he cannot use a latex condom without a threat to her health. In either case, latex condoms are ruled out as a method of contraception." (2nd sentence under "Latex allergy) This can be shortened to "Latex condoms cannot be used safely if either partner is allergic to latex." --Catherine Woodgold 18:12, 19 May 2007 (CDT)

I would prefer not to make any of these changes. Nancy Sculerati 18:26, 19 May 2007 (CDT)

The first time "STI" is used, it should be expanded.

" Jellies or creams of spermicides" I would say "Spermicidal jellies or creams" or some other formulation. The whole sentence: "Jellies or creams of spermicides are placed on the device before it is inserted, on the side that will face the cervix." I would re-arrange to make the meaning clearer, perhaps to "Before it is inserted, spermicial jellies or creams are placed on the side of the device that will face the cervix." --Catherine Woodgold 18:34, 19 May 2007 (CDT)

Nancy Sculerati said in an edit summary: "your copyedit changed the meaning, which is if all 100 had every single episode of coitus that they had over a year's time only with men shedding virus..." I didn't understand this point in the original sentence, which you've changed it back to: "...similarly, if over a year's course a hundred HIV-negative women had all intercourse with men who were not only HIV-positive, but..." I thought it was a typo intended to say "all had intercourse". I now suggest changing it from "had all intercourse" to "had intercourse only" or "had all their intercourse". --Catherine Woodgold 18:42, 19 May 2007 (CDT)

I would prefer not to make such changes.Nancy Sculerati 04:52, 20 May 2007 (CDT)

Moving to approve

With five editors now supporting approval I think we can close this today. I have made a few copy edits after reviewing the discussion above.

I have removed the abbreviation STI in line with a general policy to minimise abbreviation use.

I have adopted a common copy editing convention with numbers, writing the numbers 1-10 in words except when followed by a scientific unit.

I may have missed some of these - please correct if you find any.

In think one place microgram is rendered as mcg - I think it would be better to use the greek here but sadly I dont know how - any help?

I intended my final changes to be uncontroversial copy edits; Nancy if you object to any please alter, no explanation will be needed.

I think with the balance strongly in favour lets close this and move on to use our energies elsewhere. It's an excellent article, as all I think agree.Gareth Leng 05:18, 20 May 2007 (CDT)

One way to represent microgram would be <math>\mu g</math> or <math>\scriptstyle\mu g</math> or <math>\textstyle\mu g</math> which displays as $\mu g$ or $\scriptstyle \mu g$ or $\textstyle \mu g$. --Catherine Woodgold 09:21, 20 May 2007 (CDT)

In the 2nd paragraph of "Oral contraceptive pills" I've changed "50 mcg" to "50 μg" by clicking on the Greek letter among the special symbols provided under the edit box. --Catherine Woodgold 11:34, 20 May 2007 (CDT)

I do not want to have to go through this article and revert anything. SEVEN editors have indicated that they approve it. At some point the comments made about copyedits are beyond what a reasonable individual would consider appropriate. STOP please. Nancy Sculerati 12:16, 20 May 2007 (CDT)

Further comments

"Barrier methods rely on consistent technically correct use to be effective, and so their typical failure rates in practice are higher than they would be given perfect compliance." (First sentence of "Intrauterine devices (IUD)" section) Since "be given" sounds like a compound verb, I would change "given" to "with".

"The inside of the uterus is an internal body cavity, and is not accessible. " (First sentence, 2nd paragraph of same section) I would add "not accessible except by a health care provider" or something to make the meaning clearer.

"With long-term placement, the annual incidence of side-effects like excessive bleeding or cramping also decreases." (Last sentence, 3rd paragraph of same section.) I would change "like" to "such as".

"However, there has been a correlation with Chlamydia trachomatis infections, fallopian tube blockage, infertility and copper containing IUDs" (4th sentence, 2nd paragraph of "Types of IUDs") When stating that there is a correlation among four things, it's not clear which pairs of things are correlated. I suggest "However, copper-containing IUDs have been found to be correlated with Chlamydia trachomatis infections, fallopian tube blockage and infertility."

I will probably have comments on the last one-third of the article shortly. --Catherine Woodgold 09:38, 20 May 2007 (CDT)

"The small risk of pelvic inflammatory disease associated with IUDs is limited to the first few weeks after insertion." (3rd sentence, "Side effects and complications" (of IUDs)) This might seem to contradict the "high" risk in certain circumstances mentioned under "Sex can cause other conditions besides pregnancy".

The first sentence of the section "Pregnancy rates after IUD removal" gives the reader the impression that what is being talked about has nothing to do with the subject heading, although the connection becomes clear at the second or third sentence. I suggest making the connection clear from the beginning, perhaps by switching the order of the 1st and 2nd sentence (and moving "however" to the other sentence).

The section "Pregnancy rates after IUD removal" could also mention the possibility of pregnancy if the IUD is removed within the 2 weeks following intercourse (for those IUDs that act by preventing implantation); perhaps this a reason for removing the IUD during the menstrual period, and that might be worth mentioning as well.

"ovulation is triggered in mid cycle" (2nd sentence of "Hormonal medications (systemic)") Perhaps it should be hyphenated as "mid-cycle"; I'm not sure.

In the section "Hormonal medications (systemic)" I suggest moving this sentence: "Systemic hormonal preparations are used for ordinary contraception in two basic forms: those that rely on progestin alone, and those that incorporate both estrogen and progestin." from the 2nd paragraph to immediately follow the first sentence of the first paragraph. Everything else can remain as it is. The reason is that the first paragraph talks about these two kinds of contraceptives, and this sentence nicely introduces them. What is currently the 2nd sentence of the 2nd paragraph, "Another variation in these..." will do nicely as a topic sentence of that paragraph.

In the 3rd sentence of the 2nd paragraph, perhaps "(time released)" should be hyphenated; I'm not sure.

In the 4th sentence, "Oral contraceptives are short acting preparations that are taken daily." I would add ", on the other hand," or ", in contrast," after "Oral contraceptives".

In the 5th sentence, "The difference between these medications is mainly the reduced number of acts of compliance over a given time period required in the longer acting forms." I would re-arrange "over a given time period required" to "required over a given time period" to make it clearer that it doesn't mean a reduced number of acts of compliance.

First sentence of 3rd paragraph: "Since hormonal contraceptives affect the menstrual cycle, these have been prescribed for women who have problems with excessive or irregular menstrual bleeding for several decades - even if the women are celibate." It is not clear whether this means that doctors have been prescribing these for several decades, or that they are only prescribed for this purpose to women who have had such bleeding continuing for several decades. If it means the former, (as seems most probable), this can be made clearer by moving "for several decades" to immediately after "prescribed". (I will probably continue to provide comments on the last sections of the article shortly.) --Catherine Woodgold 10:20, 20 May 2007 (CDT)

By the way, these suggested edits are only intended to make a small contribution towards improving what is generally a well-written and informative article.

Apparently there may be some reduction in effectiveness of hormonal contraceptives while taking certain antibiotics (e.g. see Weaver and Glasier (1999, Contraception 59 71-78). If so, I think this would be worth mentioning somewhere in the article.

In the section "Oral contraceptive pills", I would delete the first sentence of the 2nd paragraph "Birth control pills are available in combined form (estrogen and progestin), and in progestin-only forms." since it is a repeat of what has already been said in the previous section and has little or no connection with the following few sentences, especially if the connection between "progestin" and "progestagen" is not explained to the reader.

In the 2nd sentence of that paragraph, "Pregnancy while taking these pills is almost always because of a failure to remember to take them every day — failure of compliance." I would change the dash to a colon or use parentheses.

In the 3rd sentence, "...in particular at the beginning or at the end of the pack, so that the pill-free interval is more than 7 days" I would delete the comma after "pack" and(/or) change "so" to "such", to make it clearer that the "so that" is connected semantically to the immediately preceding phrase rather than to something earlier in the sentence.

In the 4th sentence, "Although the protection rate from unwanted pregnancy is similar in both types of pills if used correctly, the incidence and type of side effects are different." I would remove the italics and put "if used correctly" inside parentheses -- not because this information is not important (which it is), but because the contrasting information in the last part of the sentence has nothing to do with that information, which is not clear until one reaches the last few words of the sentence. Alternatively, it could be put inside parentheses but still left as italics to emphasize its importance. Another alternative would be to move the phrase "side effects" a few words earlier, ideally immediately after "correctly":, e.g.: ...pills if used correctly, the side effects are different in incidence and type."

In the next sentence, "...that is dose related." I might hyphenate "dose-related"; not sure.

In the next sentence, "50 mcg or less of the hormone" Perhaps "Fifty" or "Fifty micrograms" should be spelled out in words because it's at the beginning of the sentence; not sure if this would not be done because there's a scientific unit given. Reformulating the sentence is another alternative, e.g. insert "A dose of" at the beginnning.

Beginning of 1st sentence in 3rd paragraph: "The use of oral contraceptives (including newer agents) increases blood pressure (by as much as 8 mm Hg systolic and 6 mm Hg diastolic),..." I suggest replacing the first pair of parentheses with commas, and deleting the 2nd set of parentheses. If the purpose of the 2nd set of parentheses is to help less technically-minded readers (or even more technically-minded ones) skip over this information, putting the information in a footnote is another alternative.

First sentence in 4th paragraph: "The mechanism of action for combination pills (estrogen-progestin) and progestin-only pills are different." This sentence has a singular subject but plural verb. Other alternatives are: Change "is" to "are"; or begin with "The mechanism of action is different for..." or "...is different between...".

The rest of the 4th paragraph has an opening quotation mark but no closing quotation mark nor footnote, making it unclear how much is a quotation and who is being quoted. The material is also largely a repeat of what has already been said in the 1st paragraph of the section "Hormonal medications (systemic)".

The section "Regular oral contraceptive pills for other purposes" is largely a repeat of what has already been said in the last paragraph of the section "Hormonal medications (systemic)". I suggest deleting one of the two and moving any non-repeated information to the other one. (I will probably continue to provide comments on the last few sections of the article shortly.) --Catherine Woodgold 11:10, 20 May 2007 (CDT)

Section "Long-acting hormonal contraceptives", 2nd sentence: "In the long-acting contraceptives, it is mainly the method of administration that is different from these short acting hormonal preparations." I would insert "that of" after "different from".

"If each is used properly, the side effects of long-acting hormonal preparations are potentially greater than those of the short-acting preparation, with some exceptions." (Last sentence of 1st paragraph of section " Long-acting hormonal contraceptives"): I would insert ", however," after "side effects", and make both instances of "preparation" plural.

Section "Hormonal patch": At the beginnings of the 3rd and 4th sentences, plural and singular pronouns are used apparently to refer to the same thing: "They" and "Its". I suggest changing "Its" to "Their".

The first sentence of the 2nd paragraph "The transdermal patch, Ortho Evra (Ortho McNeil), is a weekly combined contraceptive method that delivers 20 µg of EE and 150 µg of norelgestromin every day." is a repeat of information that was already given in the previous paragraph; the same product is mentioned but with fewer capital letters and the two drugs mentioned in a different order. I suggest deleting this sentence and combining the rest of the paragraph with the previous paragraph. (I still haven't read the whole article yet and will probably have more comments shortly) --Catherine Woodgold 11:47, 20 May 2007 (CDT)

Many thanks Catherine; I've only had time to look at some of these suggestions so far. On one of your copy editing points, by my guide mid cycle would not be hyphenated if used as a noun clause as here, but would be if used as an adjectival clause, so I left this unhyphenated but hyphenated time-released. I think you've spotted some very useful points by the way.Gareth Leng 12:16, 20 May 2007 (CDT)

I do not and I would prefer that, with the exception of microgram symbol and spelling out (always)sexually transmitted infections that the text be reverted. I have tried to do this myself, but am in tears at the moment becasue I have gotten so upset at all of this and cannot figure out how to do a reversion. Nancy Sculerati 12:21, 20 May 2007 (CDT)

If you wish to revert to an older version of an article, you can do it like this: (if this isn't what you want to know, I apologize, but possibly this information will help someone else.) View the article (not the talk page). Click "history" at the top. Find the version you want in the list of versions. To the left of the name of the person who edited it is the date as a blue link. Click on that date. You are then viewing the older version of the article. Click on "edit" at the top. It will warn you that you are editing an older version. Type in an edit summary at the bottom saying that you're reverting, explaining why etc. Click on the "save page" button at the bottom. I'm giving this information in an attempt to be helpful and hope it will be ignored if it isn't needed. --Catherine Woodgold 20:01, 20 May 2007 (CDT)

Comments on last part of article

(Edit conflict) I certainly did not intend to cause anyone any distress. My intention is only to make or suggest edits to the article and in some cases to provide explanations of my reasons for the changes or suggested changes.

In section "Ethics of using medical contraceptives", "Except for a minority of people, ... " (first sentence) I would change this to "For the majority of people, ..."

Third sentence, "...there are strongly held beliefs..." I would add "held by some people" after "beliefs"; otherwise it might give the impression that such beliefs are generally held by the medical community or by society in general. I would also remove the italics from "in any way" in this sentence, as they seem to reinfoce a particular point of view.

Fourth-last sentence of article: "The use of contraceptives by sexually active adolescents brings up another set of ethical issues, and in some countries, even legal issues — if parental consent is not obtained." I would replace the dash with a comma, or keep the dash and also have a dash instead of a comma before "and in some countries". Having the two dashes makes it clear that the "if" clause applies to both types of issues; otherwise it's not clear, especially with one comma and one dash; I'm not sure how important it is that it be clear or which was originally meant. If the parental consent is only supposed to apply to legal issues, one way to make this clear would be to put everything from "and in some countries" to "obtained" inside parentheses.

Third-last sentence: I would change "both" to "either" in "both withholding and providing".

Second-last sentence: "Overall, the ethics of using the methods of contraception described here is too large a topic to also be included. " I think a link should be provided from somewhere in this section to an article that will discuss the ethics: perhaps Contraception or Contraception (ethics) even if the article has not yet been written or finalized, so that the present article doesn't have to go through re-approval just to add the link in later. Alternative wording: "There is not enough room here to adequately cover the overall topic of the ethics of using the methods of contraception described in this article." and perhaps add "(See contraception (ethics) for more discussion of ethics)", if that's where the ethics will be discussed. Or a link to birth control. (I have now read the whole article and commented on it.) --Catherine Woodgold 12:32, 20 May 2007 (CDT)

If an author writes a phrase like "except for a minority" I think that it is reasonable that their style be respected if they have done the work rather than changed to similar wording preferred by others who are not experts in the field, and who have not provided the substance of the article. The need to read extensive posts after an article has been agreed by multiple editors to worthy of approval, especially when some of the changes made have affected the meaning, is very burdensome and at some point goes beyond being reasonable. This is particularly true when a point of view has previously been expressed that the article being commented on has all sorts of problems having to do with neutrality and the copyeditor has indicated a fundamental antipathy to the article. Nancy Sculerati 12:44, 20 May 2007 (CDT)

If you mean me, I feel that the above comments do not accurately represent my attitude towards this article nor what I've said about it, and that my overall attitude towards the article is better represented by the following comment that I posted above an hour or two before the above comment: "By the way, these suggested edits are only intended to make a small contribution towards improving what is generally a well-written and informative article." I realize that you've put a lot of work into this article, and the result has good content and is well-organized. I try to avoid "correcting" things that are aspects of the dialect of the writer. It's not always easy to know which things fall into that category, but that can be sorted out afterwards if I get it wrong. --Catherine Woodgold 18:25, 20 May 2007 (CDT)

Date of nominated version

The nominating editor Gareth Leng had changed the ToApprove template to point to the url of the version of 10:07, 20 May 2007 as the nominated version. I changed the "now" date in the template so that the displayed date of the nominated version would match the url. I hope I did it right. --Catherine Woodgold 17:26, 20 May 2007 (CDT)

I am sure you did so in the friendliest of spirits, and you are probably right in your choice, even so- only a nominating editor can change the template for any article.The approvals management editor contacts the nominating editor if there is any question. This is true for all articles. Nancy Sculerati 17:53, 20 May 2007 (CDT)

I'm sorry. I didn't realize that was the procedure. I also made a similar change at Talk:Bacteriophage. I hope these irregularities don't cause much trouble. --Catherine Woodgold 18:12, 20 May 2007 (CDT)

APPROVED Version 1.0

Congratulations Health Sciences! Another job well done! Notice that there are several changes that did not make it into the approved version as I did not see the necessary concurrence for the changes made. These changes remain on the Draft version and may be incorporated in future approved versions. --Matt Innis (Talk) 22:36, 20 May 2007 (CDT)

Discussion for Version 1.0 stopped here. Please continue further discussion under this break.

Typo

"One way to evaluate the risk of IUDs in this regard is to study the pregnancy rates of women who have had IUDs in place as a birth control method, after removall."

Firefox has a built in spellchecker that works in the wiki editing window. It would underline stuff like this as soon as it was misspelled, thus avoiding it. Stephen Ewen 23:00, 20 May 2007 (CDT)

Which version was approved?

Matt Innis' version of 03:44, 21 May 2007, with edit summary "(Save as Nominated Version)" is identical to the version of 17:39, 17 May 2007, but it is different from the version of 20:36, 16 May 2007, which is the most recent version before the date of "prior to 07:54, 17 May 2007" mentioned in the approval area. --Catherine Woodgold 09:21, 21 May 2007 (CDT)

Hi Catherine, good eye! I'll fix that.. hopefully. Check my work. --Matt Innis (Talk) 09:50, 21 May 2007 (CDT)

I picked the 07:54, 17 May 2007, which was the post just before the version I had. Let me know if there is something wrong with this thinking. --Matt Innis (Talk) 10:09, 21 May 2007 (CDT)

There is no version of 07:54, 17 May 2007. If I go to Contraception (medical methods) and click "history" (and display 250 lines) I see that there was a version at 20:36 16 May 2007, and the very next version is at 08:45 17 May 2007. The version you just put up now is identical to the version of 11:54 17 May 2007, which is, as you say, the version just before the version you had before, but it's not the version just before 07:54 17 May 2007: there are quite a lot of versions by more than one editor between 07:54 and 11:54 on 17 May. It would be helpful if you would put the date and time of the version you're reverting to in the edit summary. --Catherine Woodgold 10:45, 21 May 2007 (CDT)

Ahh, Catherine, I think I know what is happening, I have my preferences time set for Eastern time! I think the server automatically adjusts the times that I see (it subtracts 4 hours), but I don't know if they are the same times that you see (or Gareth for that matter). So we have to make sure the version that Gareth was pointing to was the version that mine states. Hmmm. See what version you come up with and I will see what I come up with and we will compare. --Matt Innis (Talk) 11:24, 21 May 2007 (CDT)

Ah! That explains a lot! Well, if I look in the history of this talk page, I see that in this edit:

1. N (cur) (last) 09:59, 17 May 2007 Gareth Leng (Talk | contribs) (→Editorial Guidance)

Gareth Leng put in the approval template. Actually, that was the last of 7 edits by him between 9:51 and 9:59; the next following edit was by Nancy Sculerati at 10:45. In the version of the talk page of 9:59, it says he nominated "this version", and if I click on "this version" it displays a version which it says at the top is Revision as of 09:48, 17 May 2007. It makes sense that he would have nominated that version, because it is the last of a string of about 28 edits by him of the article. However, that version is not the same as either one of the two that you put up as nominated versions. (Maybe it would help if you put in the edit summary the timezone as well as the date and time.) That was the first version nominated; I'm confused as to whether the version was later changed. --Catherine Woodgold 11:56, 21 May 2007 (CDT)

Hey, check this out on the talk page. This is when I was adding the new "multi-editor" ToApprove template. Notice the version number - (not the date) that Gareth placed. That number "1001054842" should be the one. That was at 7:54 my time or 9:54 Gareth's time. So if we use that version number, we should be alright, right? --Matt Innis (Talk) 12:21, 21 May 2007 (CDT)

Okay, Catherine, double check me again, but I think that is the version that we already have protected. The key then is the version number, that should be the same for everyone. --Matt Innis (Talk) 12:25, 21 May 2007 (CDT)

As far as confusion for whether the nomination date changed after, I have to see that three editors approved *after* the date was changed. The only editor that seems to approve of any subsequent changes was Gareth. The other option would have been to extend the date to allow the other editors to approve the new changes, but they are still on the draft and can be re-approved at any time. --Matt Innis (Talk) 12:29, 21 May 2007 (CDT)

OK, it's now correct. Gareth Leng originally nominated version 100105772 and then about three hours later changed the nomination to 100105842. Shortly afterwards, several editors seem to have approved, judging by the edit summaries. The version 100105842 (of 11:54 May 17 Universal Time) is identical to the current protected version. So everything is OK.

I guess I just assumed everybody would be using Universal Time. Maybe we shouldn't even be talking about dates and times, just version numbers. --Catherine Woodgold 13:58, 21 May 2007 (CDT)

Good news! Yes, I definitely agree. I am going to ask Chris Day to take a look at this since he makes a lot of the templates so he can have an idea for future situations. Thanks, Catherine, for hanging in there with me on that one till we got it right. --Matt Innis (Talk) 14:38, 21 May 2007 (CDT)

Some suggested edits not yet done

Note that I made a large number of suggested edits in the discussion area for the previous version. Some have been implemented; some of the others may still be of some value. --Catherine Woodgold 18:07, 2 June 2007 (CDT)

I made some changes to the draft that I thought would not be controversial (mostly grammar and spelling), a few of which should definitely have been made before approval. (If we are being scholarly with content in order to be taken seriously, we should not have basic subject-verb agreement issues.) Catherine, I'm pretty sure a few of my edits were addressing some of things you pointed out. But remember: the nature of the wiki is to "be bold" and make the changes yourself. When it comes to grammar and readability (as opposed to content issues outside your expertise), editing is more efficient than writing out an explanation of every edit and waiting for someone else to do it. If necessary, it can always be changed again. --Eric Winesett 21:48, 2 June 2007 (CDT)

I see that the currently approved article still has, for example, a subject-verb agreement issue in the sentence about "...mechanism of action...". --Catherine Woodgold 10:02, 11 August 2007 (CDT)

How long to get a simple typo fixed in the approved article?

The approved article says:

The mechanism of action for combination pills (estrogen-progestin) and progestin-only pills are different.

So "The mechanism are different."

Clearly it should say "The mechansisms are different."

Just a final "s" in "mechanisms" is needed.

Catherine Woodgold has been pointing this out for a long time. On Wikipedia this would take seconds to fix; here it's taking a long, long, long time. Michael Hardy 17:40, 14 September 2007 (CDT)

You are right Michael. I think it is time we need to use this article to develop policy on this. Let's go to the forum. --Matt Innis (Talk) 19:30, 14 September 2007 (CDT)

If an editor is contacted, will he or she decline to have an utterly clear typo fixed? Should we bother an editor with such trivialities? A mere typo is so trivial, and so plain common sense--something constables are clearly encouraged to use--that we should just fix it. I will do so now.  —Stephen Ewen (Talk) 20:10, 14 September 2007 (CDT)

(edit conflict) I think you are right that it needed fixing quickly. Are you saying you think that constables already have the right to fix it, or are you saying 'you' have the right to fix it because of something else. In other words, would you have been comfortable enugh for me to make the change? And anywhere else this is happening? --Matt Innis (Talk) 20:22, 14 September 2007 (CDT)

Looking at it in context now, and not as just the re-worded snippet here on the talk page ("The mechanism are different"), it is NOT utterly clear that this is just a simple typo. It may be worded the way it is to avoid confusion about each pill having multiple mechanisms of action. An editor should be contacted on the matter.  —Stephen Ewen (Talk) 20:20, 14 September 2007 (CDT)

Exactly my fear. --Matt Innis (Talk) 20:22, 14 September 2007 (CDT)

If the mechanisms are different, they are different right? Two mechanisms leading to the same result. So plural sounds right to me. Having said that I'd better go and read it in context. Chris Day (talk) 20:24, 14 September 2007 (CDT)

If this really were a sentence like "In other words, would you have been comfortable enugh for me to make the change?" I'd say it is just so common sense, something constables are encouraged to use, to just fix it to "enough".  :-)  —Stephen Ewen (Talk) 20:31, 14 September 2007 (CDT)

Ah, good point.. but are we talking about a mechanism or mechanisms? Can we fix one without fixing the other? --Matt Innis (Talk) 20:50, 14 September 2007 (CDT)

Though the bigger question is how do we assure that these articles don't sit here with errors. --Matt Innis (Talk) 20:51, 14 September 2007 (CDT)

Regardless of whether it's only an overlooked final "s" or a situation where the person writing the sentence forgot the beginning of the sentence before writing the end of the sentence, it is nonetheless impossible to view it except as a error of one kind or another. It's not grammatical by any stretch of the imagination as it stands. Michael Hardy 21:23, 14 September 2007 (CDT)

I agree that whether we change it to "The mechanisms are different" or "The mechanism is different", something needs to be changed. Two things are apparent: 1) Do we need to make the change on the draft (nobody has actually made that change on the Draft) 2) When and who can make these changes. Can we constables do it out of 'common sense' immediately? If so, we need to decide that now because we have other articles with the same problems. --Matt Innis (Talk) 21:49, 14 September 2007 (CDT)

On the latter, absolutely not in this case, as I explained above. It's not a mere commons sense matter of fixing something like "imediately" to "immediately".  —Stephen Ewen (Talk) 22:24, 14 September 2007 (CDT)

Okay, so if constables can't, what mechanism do we need to make 1) copyedit changes immediately and 2) re-approval of the draft that has copyedits. --Matt Innis (Talk) 22:35, 14 September 2007 (CDT)

If we don't have an effective mechanism for changing mere typos, then let's just go ahead and let constables change them, as a stopgap. Yes, three cheers for common sense! --Larry Sanger 23:14, 14 September 2007 (CDT)

That's just the rub. Both Matt and I's common sense says this might not be a mere typo!  —Stephen Ewen (Talk) 23:20, 14 September 2007 (CDT)

The other issue is that there are more copyedits in the draft that have been sitting there since May.. [1]. --Matt Innis (Talk) 23:31, 14 September 2007 (CDT)

I think trying to get User:Peter A. Lipson involved would be the ideal way to go.  —Stephen Ewen (Talk) 04:04, 15 September 2007 (CDT)

Agreed. You sending an email? --Matt Innis (Talk) 08:58, 15 September 2007 (CDT)

First time I've ever seen "I's" used as a possessive pronoun. "I's proposed edit to this page is very simple." You could say "Both Matt's and my common sense..." or "Both Matt's common sense and mine...". Anyway, I think it's perfectly clear that the singular doesn't make sense in the contemplated instance. Michael Hardy 20:53, 15 September 2007 (CDT)

Matt: no, I was hoping you would. Michael, on talk pages folk often write less formally, you'd agree.  —Stephen Ewen (Talk) 00:48, 16 September 2007 (CDT)

Steve, I see Michael has notified Gareth, that should work as well. I think he is allowed to make an individual editor nomination, though I see Derek considers that the three editor method may be necessary on the forum discussion that I started for this.

Michael, thanks for understanding that it is not a good odea for constables to write their own policies that they will be enforcing. That would be like the police writing their own laws. You are part of the process and have started this ball rolling. Stephen and I are trying to help push. Hopefully you see that we need editors and authors to give us the go ahead to make simple copyedit changes, which it looks like we will be able to do in the future. We do need someone to write it into policy! --Matt Innis (Talk) 09:11, 16 September 2007 (CDT)

I'd propose Nancy Sculerati to take the final decision as she has been the primary author for this page. Supten 01:03, 22 September 2007 (CDT)

Yellow button

Remember on approved article the yellow <> button will allow you to make a comparison between the approved version on the current draft version. [2] Given there are many changes, including the deletion of the whole "mechanism" paragraph, why doesn't this just get put up for re-approval in the standard way? Chris Day (talk) 15:40, 15 September 2007 (CDT)

Thanks Chris, I had forgotten that and it is a really great tool. --Matt Innis (Talk) 09:04, 16 September 2007 (CDT)

Note that the standard way is for an approving editor from the Health Sciences workgroup to fill in the ToApprove section of the metadata page. Chris Day (talk) 15:43, 15 September 2007 (CDT)