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Comment by Resident_Geek | Hacker News Reader

I don't see how this title trivializes birth control. Good birth control comes from controlling birth. I don't believe any other method can claim 10+ years of effectiveness, with practically no side effects and high reversibility.

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Intrauterine devices (IUDs) fit exactly that bill. But one of my points is that one form of birth control, only for men or only for women, shouldn't wear the title "best."

Have you ever had sex with someone who has an IUD. Or talked to a woman with an IUD to see her opinion on it? Because it's not all you make it out to be.

I'm not sure how that would inform my awareness of the fact that IUDs provide effective birth control for women for 10 years after insertion. But I'm in medical school, so you can make a guess as to how many of the women that I know happily use IUDs (hint: many).

When you say you know these women, do you mean in the biblical sense?

> rudiger: When you say you know these women, do you mean in the biblical sense?

This crass garbage has no place on HN.

I'm curious what problems you have in mind. Of my friends who I know use an IUD, 4 out of 4 say some variation of "how could you consider using anything else?" The only complaint that I heard from this admittedly small sample is a day's worth of discomfort following insertion.

As far as IUD's, let's not forget there are two types: paragaurd (copper) IUD and Mirena (levonorgestrel eg hormonal) IUD. There are different side-effects associated with both although I have anecdotally heard that paragaurd's side effects are mild compared to oral contraceptives. Should someone not wish to use hormonal BC or if they cannot for various medical reasons-->paragaurd is what you are stuck with. And its great in many ways (no babies, no babies and no babies), but many women experience periods that last over a week and spotting in between as well as extremely painful cramps. I was on it for 6 years and I'm so happy I finally got it removed. In summary, IUD's are of course a great form of BC, but that doesn't mean we shouldn't pursue more options. I don't think I'm stating anything earth shattering when I say, women wouldn't mind more non-hormonal based BC options.

As always, it depends on the woman; I know one who swears by them, though I've never had sex with her so I wouldn't know for sure.

You only believe what women say when you've had sex with them? What?

The OP mentioned a change in sensation for men. He's suggesting that he is not qualified to comment on that.

"Have you ever had sex with someone who has an IUD. Or talked to a woman with an IUD to see her opinion on it? Because it's not all you make it out to be."

Where does the OP say anything about a change of sensation in men?

Yes; I was conceding that I've never had sex with someone who has an IUD, only talked to them. You'd have to ask nekitamo what exactly one should learn from having sex with someone who has an IUD.

As someone who has sex on a regular basis with (one) woman who has an IUD, my experience has been that it has no impact whatsoever if installed properly. The uterus (where an IUD lives, naturally) is not typically involved in the act of sex.

I figured as much. You'll have to ask nekitamo what he was on about.

I've never noticed the IUD, but I did notice the NuvaRing (it wasn't bad or obtrusive, just "uh, wtf is that?")

Um, read the comment I was replying to for context.

And I disagree with that. If it's the best at controlling birth, it's the best birth control. Since all sex acts involve two people, and I have a really hard time picturing a form of birth control which targets both parties equally, which party benefits/is responsible for it/controls it is neutral for judging which form is best.

Both parties are responsible, so there can and ought not be a single "best". "Best" is not any single method, but instead requires something from both parties.

All right, I see what you mean. I'll explain why I think there is a best method.

For a single person considering the question on their own, the best choice is limited to what's available to them. Since there are (approximately) equal numbers of men and women considering this, neither population affects the universal rankings.

But for a couple considering their birth control options, it doesn't matter on which of them the responsibility and direct benefit fall. What matters is the effectiveness and side effects. So they can agree on which is best without worrying about who holds the responsibility, etc.

So, for example, the pill is better than condoms, because it has a lower failure rate and doesn't have the side effect of severely reduced pleasure. The fact that a single woman can't depend on condoms and a single man can't take the pill cancels out, because there's one of each of them, and the couple is making the choice for both of them.

What you have described is not a "best method;" it's a compromise due to limited resources. Using multiple complementary methods will always result in a lower risk than deciding on any one of the options.

What I've described is why, in my opinion, birth control methods that target opposite genders are still mutually comparable.

By that standard, an IUD is better than this because of the battery of Stage III and postmarketing trials supporting its effectiveness. But I disagree with your standard and find it to create a false dichotomy where there need be none.

The dichotomy exists regardless of your not acknowledging it, though. I have _had_ these conversations and made these comparisons. My current girlfriend and I switched from condoms to the pill, despite the extra responsibility for her and the definite potential for side effects, because it's a better form of contraception, period. The very instant we can switch to RISUG we will, because all available data indicates that it's better in an absolute sense.

The dichotomy is still false. Adding RISUG to what you are currently using (OCP) will be more effective than merely switching from one to the other.

IUDs have side effects. Copper ones can make periods unbearable for some women. Hormonal ones come with the same risks as hormonal birth control. You also have to open the woman's cervix which is a painful procedure, especially for women who haven't given birth before.

IUDs can also make the cervix more sensitive to pain in general. IUDs also can slip out.

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