Ask Isadora: No More Children

 No More Children

* While there are many others, sterilization is the most effective permanent form of birth control. I am 42, married, with a child.  My family is complete.  I really don’t want to deal with birth control for ten more years or so and my husband refuses to have a vasectomy. Do I have any other choices?

Cutting or tying off the tubes is much easier for a man than for a woman, less expensive and less invasive as well.  But there is a  less invasive and expensive form of sterilization for a woman in Essure, a birth control insert that helps to develop a scar tissue barrier in the fallopian tubes.  While both this and a vasectomy may be reversible in some cases, you have to go into it assuming that it will not be. You and your husband need to have further discussion on this.  Whatever either if you do needs to be a mutual decision.

* I am a 40 year old married woman who has  completely lost my libido. The last I remember feeling any sexual drive towards anyone, at all, husband included, is 10-15 years ago. Sex is just not important to me but I want to want  to have sex  because it makes my husband happy. What can I do?

You can see your gynecologist to discuss taking hormones.  You can think of relations between you and your husband as expressions of affection, love, gratitude, family bonding, and other positive feelings for him rather than lust and act sexually on those premises, or you could consider seeing a sex therapist to find out  what’s going on and what other arrangements are possible. Lastly, there is always the resort suggested to  Victorian brides, “Lie down, close your eyes, and think of England.”

* How do I know whether my partner or even I myself have HPV if there are no visible symptoms?

Those with visible genital warts would be likely to know, but there are approximately 40 types of genital HPV and most of the time most people do not know they have it. Some types can cause cervical cancer in women and  other kinds of cancer in both men and women. If you are going to be sexual without using condoms I recommend a full screening for this and other potentially hidden STDs like herpes, chlamydia and HIV for both parties.  If you have an 11-13 year old daughter discuss with her doctor the advisability of the new preventive HPV vaccine given in three doses.

*In a recent column, you had a letter regarding Testicular Cancer.  I have had it  twice in the last 14 years.  There is a terrific resource on line – both a support group and a forum for the latest ideas, treatments and thoughts on this cancer.  I would appreciate it if you would pass on to your readers the link to the Testicular Cancer Resource Center –  The site is at least 12 years old and has an excellent mail list, a good resource for the patient and caregivers.

 Thank you for that helpful resource.  Some other sexual health related general resources for readers are The  Center for Disease Control and Prevention ( , His and Her Health ( and Sexual Health (  Although these are all reputable information sites please do not let shyness about such personal issues prevent you from seeing a doctor with your concerns.  Nothing on the Internet will take the place of hands on examination and face to face discussion.