Sexual Relationships 
Sexual Health 
Hormonal birth control. It has been around for a little more than a half-century and in that time it has revolutionized sex. You can argue that it caused the sexual revolution, the spread of HIV, the feminist movement, and other things that have changed society forever. But there’s something you don’t often read about, and that is the trust issue involved, and that is what I’m writing about here.
The trust is a multi-faceted issue. First, does the woman trust her birth control? Second, and more touchy is this issue: does the man trust that the woman is using her birth control correctly, or even using it at all?
The reason that these are issues is the flip side of what makes hormonal birth control so popular. Hormonal birth control, particularly the Pill, the implant, and the Depo shot, is invisible. (The Nuvaring is practically invisible, and the patch is unobtrusive). Neither the woman nor the man has to do anything, wear anything, put anything on or in during a sexual episode. Intercourse can take place at any time, at any place, without any preparation, completely spontaneously. There is nothing present to cut down the skin-to-skin sensation of “completely naked” sex. And at one of the most important, exciting moments of intercourse, the man may stay inside the wet warmth of his woman’s vagina to have his climax. In short, having sex on hormonal birth control—if the woman handles the hormones well—is indistinguishable from, and as carefree as, having sex without any birth control at all, with one exception: the woman doesn’t get pregnant.
But it is this very invisibility that raises the trust issues. Because it can’t be seen, or felt, there’ always that nagging fear that maybe it isn’t there at all, or that it isn’t working as it should. And that can have a big impact on sexuality and on the mutual trust that relationships need.
First, the woman’s perspective. There is no 100% effective birth control except abstinence (or a total hysterectomy). Condoms fail. Diaphragms fail. And yes, the Pill fails. It fails more often if the woman uses it in the wrong way, but even with perfect use it still fails.
On the one hand, this makes hormonal birth control no different from any other method, so if the woman is afraid her pill isn’t working right, she will (or at any rate should) be afraid that the condom may break, or has a microscopic hole in it, or whatever. But somehow it’s different. A condom is there, physically. It seems substantial, and if it breaks, common sense says that she’ll see it break and can take the morning-after pill. With hormonal birth control, she doesn’t have that sense of substantiality. In fact it is even more counter-intuitive, because with the implant, unlike with condoms, there isn’t even a chance that the woman can somehow mess things up. Yet some women still feel more comfortable with a fallible condom than with an invisible, much less fallible hormonal implant.
Take me, for instance. I have been on the Pill for several years. I got a lot of experience taking it (for health issues) before I ever trusted it for birth control. But now my boyfriend and I do use it as our only method of contraception. I am careful taking it; I use the LadyPill reminder on my phone to help me make sure I take it right. I have never been late, much less missed a period. And yet, every month, as I come down to the last active pill or two in the pack, I always have a twinge of nerves in the back of my mind: what if it doesn’t work this time? What will I do? What will my boyfriend do?
In my case, my boyfriend and I have discussed this at length. We do have a plan in place. It isn’t like we haven’t prepared a fallback, so we won’t be taken by surprise. (If you don’t want to know, skip down a few lines. If you really want to know, neither of us ever wants kids, so I will have an abortion.) But even with the plans in place, I still get nervous.
But what about my boyfriend’s perspective? What about the trust there? Whenever we make love, I am there in bed with him, a completely naked woman, with absolutely nothing physical between him and me. Yet he willingly places his penis inside my vagina and lets me do the things to him that he knows will cause him to ejaculate there, with nothing at all to show that I am contracepting except for a pack of birth control pills in my makeup kit in my bathroom next door. He has my word that I’m actually taking the pills (and taking them properly); he has my word that I will have an abortion if the worst happens and I get pregnant. But these are only words, and in the heat of the moment words become secondary. An unscrupulous woman who understands that can certainly trap a man, even if most of us think that that would be stupid and playing with fire. Yes, I could trap him. As intercourse begins, then continues, and I move my hips and whisper sweet dirty nothings and sluttily push him inexorably over the edge and into a moment that cannot be undone (maybe even wrapping my legs around him to make sure he stays put during his ejaculation), how does he KNOW? How can he let himself be brought to this situation in the first place? It’s like he’s signing a blank check, and the only reason he’s doing it is because he’s hot for my body. How does he know, truly, really, that I have made myself sterile for him?
The simple answer is that he does not and cannot. Even if he watched me take the pill every night, how does he know I’m not making myself throw it up once he leaves? I know, it’s extreme, but my point is that what he’s doing takes a massive amount of trust.
In my case, with our relationship, it’s easy to trust; we’ve been together enough years that we both know the score, and he’s confident that I’m not one of the horribly confused (dare I say sick?) women that are out to trap their men. But what about couples whose relationship is still young? How does one develop the trust? Does the Pill increase the trust, or throw a barrier of suspicion between women and men?
I really don’t know, and would like hearing about that from you. This isn’t my first sexual relationship, but it IS the first one in which I have relied only on the Pill for contraception (and once again, two years in and not a sign of an “oops”). As for my boyfriend: he was a virgin before meeting me, and a shy one at that. He wanted to take things slowly. I don’t know if it was naivety on his part, pressure on mine, or just that he is a naturally trusting soul, and neither does he—we have discussed it a lot since then. But we were together for months, with growing emotional closeness coupled with increasingly intimate sexual activity, before the night arrived when he permitted me to take his virginity. By that time he knew I was on the Pill, and I had explained to him how it works and how I take it, and he had occasionally watched me take it. I wanted his first time—and our first time together—to be special, so when the time came we didn’t use condoms, and he came inside me. We picked a night shortly before I was due so he would know in a matter of just a few days that I hadn’t gotten pregnant. It was scary for him nevertheless, but as the months and the pill packs came and went (and no baby came), he relaxed more (as did I) and his trust levels grew (as did mine). In our case the Pill has done nothing but strengthen the trust that a man and woman should have, and at the same time it has allowed spontenaity and incredible intimacy that you just can’t get from condoms.
But what about other couples? Is there this degree of trust? Or is there doubt, suspicion, insistence on pulling out, and the like? In short, is hormonal birth control a blessing or curse for trust in relationships?
What’s your take?
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