Throughout my time as a sex therapist, I have had dozens of conversations related to contraception patterns in people’s sex lives. The most common answers, as you might expect, tend to include condoms, “the pill,” and the most frequent response (unfortunately)–“the pull out method.” These answers, combined with a reported lack of satisfaction with the sex-ed provided throughout their lives, shows the importance of creating a conversation around contraception. Contraception is a cornerstone of sexual health, empowerment, and autonomy. It provides people the ability to make informed choices while also promoting overall well-being. It also serves as a primary component of Dr. Braun-Harvey’s protection principle of sexual health, showing the importance it plays in broader health outcomes. Throughout history, contraception has provided more than just protection against pregnancy. From resourceful ancient herbal medicine to modern medical innovations, the history of contraception reflects the human need for reproductive and sexual health care, as well as showcasing the burden of sexual health that is far too often placed on vulva-owners. Awareness of contraception history sheds light on sexual health evolution and fosters healthy, informed, and satisfying sexual experiences.

The Principles of Sexual Health

The inclusion of contraception in the six components of sexual health, as created by Dr. Douglas Braun-Harvey, demonstrates its importance to overarching sexual health outcomes. You might be asking, what are these components and why do they matter? The principles of sexual health provide a framework to maintain healthy and autonomous sexual experiences. These six principles include consent, non-exploitation, honesty, shared values, pleasure, and protection from HIV, STIs, and unwanted pregnancies (including contraception). In addition to contraception, the protection principle includes access to STI testing and treatment, ability to participate in family planning, and access to medically accurate education on the prevention of STIs and unwanted pregnancy. The specific six principles of sexual health provide a reminder that all humans have the right to safe and pleasurable sex, as well as furthering the dialogue regarding the role contraception plays in maintaining this right.

History of Contraception and Various Methods

I’m sure we can all remember sitting in history class as students wondering why we were spending our time learning about things from such a long time ago. However, we now know as professionals that history is deeply connected to modern-day outcomes based on the way past events (both positive and negative) shape current systems. Contraception is no exception. Studying the evolution of contraception methods over time illustrates the intersection of cultural, medical, religious, and societal influences on sexual health. Taking a closer look at contraception methods throughout history provides a lens for understanding the broader context of sexual health care. It also demonstrates the disproportionate historical burden, including emotional and mental responsibility, placed on vulva-owners when it comes to sexual health and pregnancy. In this timeline, a closer look is taken to provide this context and help inform the way we approach conversations about contraception and pregnancy in the context of sex therapy.

It is to be noted that due to a systemic lack of research, most contraceptive history is focused exclusively on European and North American historical perspectives. Additionally, the majority of harm caused by various historical forms of contraception disproportionately affected vulva-owners, contributing to disparities in reproductive health care which are still being unraveled today.

1. Ancient Approaches (from Pre-Common Era-500 A.D.)

As long as people have been having sex, people have been creating inventive forms of contraception. The beginning of contraception history thus begins with the beginning of humans. The very first historical form of contraception is the “withdrawal” method, meaning that a penis-owner withdraws from the vagina prior to ejaculation. In modern language, the famous and very popular pull-out method. The ways in which “pulling out” is entrenched in our deep history informs the importance of addressing the potential risks associated with it in current conversations and relationships. Most notably, this method does not prevent sexually transmitted infections in any way, and is not consistently effective in preventing pregnancy. There is always a possibility that pre-ejaculate, known as “pre-cum,” can lead to pregnancy. The changes of pregnancy from pre-cum are indeed lower compared to ejaculate during an orgasm, but additional forms of contraception are recommended for effective pregnancy prevention.

The first physical forms of contraception are recorded as far back as 1850 BC when Egyptian vulva-owners combined acacia leaves and honey, or animal dung due to resource accessibility, to create a cervical barrier thought to have spermicidal properties. North American indigenous communities consumed herbs to prevent pregnancy, marking the first use of an oral contraception until the modern invention of the birth control pill. The use of uncomfortable, potentially dangerous, and laborious contraceptive methods by vulva-owners is a clear example of how sexual burdens often land on vulva-owners. This disproportionate emotional and sexual burden often placed on vulva-owners when it comes to contraception is often still present in relationships and its presence throughout history is an important reminder to address its deep-rooted impact.

2. Medieval Methods (500-1500 AD) and Renaissance Revelations (14th-17th Century)

The approach to contraception throughout the medieval period sheds light on the impact cultural and social contexts play on overarching sexual health. In Western culture, the Catholic Church held a great deal of cultural influence and power during this time period and advocated for an abstinence approach to contraception. Any efforts to halt or prevent pregnancy was seen as immoral by the Church due to its indication of sexual interactions for non-reproductive purposes. Because of the lack of mainstream methods, vulva-owners utilized creative spiritual and herbal approaches to contraception during this period. A historical shift to the Renaissance era brought the first official condom. These inventions were predominantly made from animal intestines or bladders. Although not as modern or effective as later contraception, the methods used during this era paved the way for future improvements to increase access to safe and empowered sex and continue the dialogue around sexual autonomy.

3. 18th Century Innovations (1700s) and 20th Century Breakthroughs (1900s)

The transition from the Renaissance era to the early 1700s unfortunately saw an increased presence of toxic and harmful contraception methods. This occurred in an attempt to create effective chemical contraceptives but use of mercury and lead caused physical, psychological, and sexual harm. This harm mostly impacted vulva-owners, again showcasing the importance of mitigating deeply-rooted sexism within sexual health care systems.These methods also created a sense of distrust related to contraception use, which is still being fought today.
Margaret Sanger, a well-known women’s and reproductive rights activist, played a large role in the creation of birth control in the 20th century. She coined the term “birth control” while conceptualizing a “magic pill” that could be used for contraception. Research surrounding a birth control pill was fervid throughout the 1950s, and the first oral contraceptive was approved by the FDA in 1960. According to the American Medical Association, over 1.2 million vulva-owners were using “the pill” within two years of its initial distribution. This widespread and immediate prevalence speaks to the need and desire for accessible sexual health care and family planning. Being able to facilitate dialogues surrounding effective and equitable contraception is key to breaking down generational barriers to positive sexual health outcomes.

4. Modern Contraception Marvels (21st Century)

With the technological boom of the 21st century also came a medical boom, including research surrounding a variety of new contraceptive methods. Research was most notable for long-acting reversible contraceptives (LARCs) such as intrauterine devices or implants, emergency contraception, and hormonal contraceptives. There has also been increasing research into male contraception and potential non-hormonal approaches to contraception. Digital technology has also created an ability to track menstruation and fertility windows, creating flexibility and autonomy for family planning. Decreased stigma, combined with a cultural shift that prioritizes sexual health, allows for greater access and education surrounding contraception and reproductive health care. These tools also provided greater levels of empowerment for vulva-owners. The immense amount of research and effort that contributed to the creation of contraception is a key reminder to maintain an equitable dialogue on this subject in modern relationships.

Importance of Contraception to Sexual Health

Now that the background of contraception has been discussed, it is important to also identify why this background matters. Learning this extensive history allows us to understand and further advance modern sexual health outcomes. Being able to appreciate past innovation is a motivating factor to continuing positive progress in contraceptive research Additionally, understanding the evolution and past preferences (as well as harms) of contraception helps individuals and health care providers shape present and future sexual health access. Education is empowerment, and contraception is no exception to this.
In addition to its history, there are several reasons why contraception is a key component of sexual health. Not only does contraction empower individuals and relationships to make choices about their reproductive lives, but it also allows them to plan pregnancies with life circumstances in mind. Contraception encourages communication between partners about values and future goals, which can ultimately increase relationship satisfaction. Contraception also contributes to increased patterns of pleasure, doubly increasing its impact on relationship satisfaction. When people are able to have sex without the pressure or anxiety of pregnancy or STIs, pleasure is greatly enhanced and sexual dysfunction concerns often decrease. There is no question that contraception is a critical component of sexual health, and therefore sex therapy values, due to its connection to long-term sexual health outcomes. Outcomes of all kinds, including financial, relational, physical, emotional/psychological, and logistical, are impacted by contraception. By increasing knowledge into the complex history of contraception, sex therapists and individuals can promote more informed choices and ultimately more fulfilling sexual experiences.

If you feel like you did not receive sufficient sexual health, or are struggling with current relationships, you are not alone. Clinicians at Hey Emma are here to support you.

Resources to Learn More

Books

    1. Contraception: A History by Robert Jütte
    2. Devices and Desires: A History of Contraceptives in America by Andrea Tone
    3. The Condom: A History by Peter F. Morgan:
    4. The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution by Jonathan Eig
    5. Reproducing the Future: Essays on Anthropology, Kinship, and the New Reproductive Technologies by Marilyn Strathern
    6. Handbook of Contraception and Reproductive Health Care by Johannes Bitzer

Articles

  1. “Birth Control before the Pill” on PBS News
  2. “The Story of How the Birth Control Pill was Invented and Tested” by NPR News
  3. “Birth Control in Antiquity” by M. Bujalkova
  4. “An Evidence-Based Update on Contraception” by Laura Britton PhD., Amy Alspaugh MSN, Madelyne Z. Greene PhD, and Monica McLemore PhD
  5. “The Importance of Access to Contraception” by American Academy of Pediatrics