It may surprise many to know that methods of birth control have been around for thousands of years. There are many reasons why it may be considered desirable to prevent conception and these may include the desire to engage in enjoyable coitus for its own sake without consequences, the wish to have no more children for health or economic reasons or perhaps the desire not to produce offspring who may be defective in some way. In this article we shall concern ourselves with the various methods used throughout history and their efficacy. We shall not discuss the religious and ethical rights and wrongs of the matter , which would obviously require a book to themselves!

We shall start with a few facts about sperm. The ejaculate of a healthy man contains between one and six hundred million live motile spermatozoa, any one of which can produce a child by uniting with a fertile human egg. These were first seen wriggling about in their inimitable fashion in 1677 by the Dutch microscopist Anthony van Leeuwenhoek. Although mankind has been interested in conception and its prevention since Egyptian times if not before, the true scientific facts of the matter have only relatively recently become known. Therefore early methods were often based on superstition and magic and were of limited efficacy. According to the ancient historian Diodorus Siculus - The Egyptian holds his father alone to be the Author of generation and the mother only to provide nourishment of the foetus.' The implication here is that the sperm contains the homunculus or complete being in miniature. This itself contains its own offspring and so on ad infinitum. But an ignorance of the true facts makes no difference to the basic principle that in practice all contraceptive methods seek to prevent the union of sperm and egg . To eliminate the result of that union, however few cells it has in its early stages, cannot strictly be called contraception.

At this point COITUS INTERRUPTUS should be mentioned. This very primitive method of contraception is nothing more than physical withdrawal by the male of his erect penis from his partner before ejaculation occurs, so that, as in the Biblical - Sin of Onan - his 'seed is spilled upon the ground.' Despite the best of intentions and the most steely mental attempts at control this method is arbitrary at best. It is also unsatisfactory for both partners from an enjoyable point of view. The physiological nature of arousal and ejaculation is such that after the so called - plateau phase ' there comes a point when ejaculation is completely inevitable and unstoppable. Only seconds of time can be involved. It is not to be expected that complete withdrawal of the penis from the vagina during the 'vinegar strokes' of immediate pre-ejaculation can be relied upon. In addition at these moments, even before full ejaculation, fluids containing sperm may be released, involuntary and unnoticed, with undesirable consequences should the penis remain within any part of the vagina.

The oldest method of prevention of the consequences of actual union and ejaculation is the PESSARY This is a soft ball containing various substances which is inserted into the vagina prior to intercourse. Its efficacy derives from the fact that it acts as a physical barrier or plug and in addition to this it may be that some of its ingredients have a spermicidal effect as well. The first recipe we have for a pessary is from the Petri Papyrus of 1850 B.C.. It was composed of fresh crocodile dung and honey. This would certainly be quite sticky. Variations on this theme are found in India and Africa where they use elephant dung. There is certainly a magical element involved in the use of dung from such powerful beasts and doubtless various prayers and incantations would be used in addition to the pessary itself which would be prepared at times corresponding to the astrological conjunction of the planets. There were many other recipes. For instance Pliny the Elder, a Roman writing in A.D.57, suggests that to prevent conception - 'there is nothing better than to anoint the natural parts of a woman with ox gall incorporated in the fat of serpents, verdigris and honey mixed therewith, before that she meddleth with a man in the act of generation.' The pessaries would be rolled by hand, incorporating a piece of thin string for easy removal after use. Rhazes of Baghdad, writing in A.D.882 has the following; Occasionally it is very important that the semen should not enter the womb. There are several ways of preventing its entrance, one of which is to apply to the uterus before receiving the man some drug which expels the semen and prevents conception. Such would be a pessary made of cabbage, colocynth pulp, the inner skin of pomegranate, aminals ear wax, elephants dung and whitewash. These may be used alone or in combination.

Much of the efficacy of a pessary is derived from its spermicidal action, which is now understood and tested by modern scientific methods. In earlier times trial and error was the most that could be expected but even so good results were achieved. Salt is an excellent spermicide, as the Arabs discovered. Alum is also very good and has the additional benefit of making the mucous membrane of the vagina contract, which can result in more intense sensations during intercourse. Tannic acid was and indeed may still be used in Sumatra.

Perhaps the best known brand of pessary made in recent times is Rendells. These were created in London by W.J.Rendell, a chemist who discovered that quinine was an excellent spermicide. Later improvements to the formula replaced quinine with Alkylaryl Polyalkyeane Ether Alcohol among other things. The modern pessary is soluble and is inserted into the highest vault of the vagina, as close as possible to the cervix so that it will dissolve and distribute a film of spermicide over the upper portion of the vaginal passage. The basic principal is that an active spermicide is contained in a low melting point non greasy base.

Plenty of other jellies and creams can also be used which have spermicidal and lubricating qualities. These provide extra protection when used in conjunction with a condom or sheath or with other barrier methods.

DOUCHES have been used for thousands of years. This is principally a hygienic measure to ensure that the vaginal passage is maintained in a healthy condition, but it can also be used as an emergency contraceptive measure when other precautions have not been taken. However, it is important to note that if douching is done after intercourse when, say, a diaphragm or pessary has been used, the douching fluid may wash away the contraceptive chemicals before they have completed their job of rendering the sperm inactive. In all such cases several hours should elapse before a douche is used. It is applied through a special vaginal douche or tube ( also sometimes called a speculum ) or by means of a whirling spray - of which more later .

Where no other contraceptive precautions have been taken douching with a spermicidal douching fluid is certainly better than no protection at all, since there is a fair chance that all the sperm will be washed away or rendered inactive by the fluid, especially if the douching is carried out as quickly as possible after intercourse but as a contraceptive measure in itself it is unreliable.

Historically douches too go back at least to Egyptian times and smoke or steam fumigations have also been used. Smoke fumigations of the vagina by means of a special kettle with a long thin spout were especially popular in India as early as the 1st. century B.C. A modern version of this ancient practice consists of foaming tablets which release a spermicidal gas. For many years Lloyds of Portsmouth supplied Foaming Chemical Contraceptive Tablets which were inserted into the vagina in the same way as a pessary. They were dissolved by the vaginal secretions to produce a foaming action which in turn liberated tiny bubbles of gas with strong germicidal and antiseptic properties. The foam spread rapidly over the folds of the vagina and the cervix, thus barring the entrance to the womb and any sperm which came into contact with it were instantly rendered inactive. Other more modern methods have included aerosols with special applicators to produce the same effect.

Substances used in the douching fluid include salt or brine, alum, sodium bicarbonate, lemon juice which contains citric acid. More recently sulphocarbonate of zinc has been used. Applicators in former times even included the bill or beak of the ibis, a kind of stork common in Egypt, but more commonly the horns of animals were used. More recently squeezable nozzled rubber bottles have been employed and these are known as whirling sprays. Alternatively an enema syringe can be employed.

Because sperm can move quite rapidly from the vagina to the womb it must be said that the douche is not a particularly reliable contraceptive method and although it had its adherents many years ago it has now largely gone out of fashion, there being better alternatives available.

An interesting variant on the chemical / spermicidal method is a 1970's product called C-FILM. This was advertised as the first 'His or Hers' method of contraception and was a square of soft pliable spermicidal plastic film that dissolved in the vagina. It did not seep or leave anything to be disposed of. It was discreet. It did not interfere with spontaneity, was claimed to be virtually unnoticed and was available without a prescription. It could be placed high in the vagina with a dry finger or placed upon the tip of the erect penis with slight moistening. It could be inserted up to an hour before intercourse. Like most purely chemical methods it was not necessarily perfectly reliable in itself, but a useful second precaution when other barrier methods were also used.

Various barrier methods to physically prevent the passage of sperm to the womb have been tried over the centuries. These have included small SAFETY SPONGES impregnated with a spermicidal jelly and inserted into the vagina prior to intercourse. They are covered with a fine mesh net and have a cord for easy removal. Natural marine sponges are generally favoured over synthetic ones. Small balls or wads of feathers have also been used in a similar way. The Arabs in about 1200 A.D. have the following remarkable advice; Take the testicle of a wolf, and it must be the right testicle. Rub it with oil, wrap it in wool and insert it into the vagina. This would cause her to lose desire and lessen the chance of conception.

Probably one of the most effective of these inserted barriers has been the DUTCH CAP . This occlusive method was invented in Germany in 1838 by a Dr. Mensinger who made the caps from rubber. Its use spread to Holland and from there to England, hence the name. It is designed to fit over the cervix or entrance to the womb. It is used in conjunction with a spermicidal cream. It is perhaps more properly known as a DIAPHRAGM and is very reliable as an occlusive method. It has the disadvantage that it must first be fitted by an expert for there are far too many sizes for a woman to judge for herself which size she will require. The appliance itself consists of a metal spring rim covered by a simple hemisphere of rubber. It is important for safety reasons to allow a minimum of 8 hours to elapse after intercourse before removing the cap so that any sperm remaining in the vagina are killed by the spermicidal cream. New fittings may be required after childbirth and at regular intervals because the size required can alter.

further mechanical barrier used by the woman is a CHECK PESSARY or OCCLUSIVE CAP. This is a small thimble-shaped appliance which fits on to the cervix and is held in place by suction. Like the diaphragm it must be used with a spermicidal cream and remain in place for some hours after intercourse.. It also requires correct initial fitting to ensure the correct size.

Perhaps the best known of all mechanical barrier instruments to prevent conception and to protect from disease is the CONDOM. This has been around since prehistoric times and in its earliest days, as perhaps now, it was used as a prophylactic,or disease preventer. The Chinese made theirs from oiled silk paper but in the West the caecum or appendix of a lamb or sheep was commonly used. Linen was also employed. Sometimes only the tip or glans of the penis would be covered, as with the Japanese Kabuta-Gata, which was made of leather or tortoiseshell. More recently rubber 'American Tips' do the same but have a tendency to slip off in use and are not recommended as an effective barrier. The name condom may be derived from the French town of that name, but it is commonly believed that a Doctor or Colonel Condom resident at the Court of Charles II perfected their preparation and encouraged their use as a way of cutting down the numbers of the King's illegitimate offspring.

By the 18th. century condoms were in common use and sold in brothels. The French called them 'little English riding coats' ( les redingotes anglaise ) and the English called them 'French letters' and they were used to prevent venereal diseases. Syphilis and gonorrhea were particularly rife in large cities at this time. The condoms themselves were, according to Dunglinson's Dictionary of 1839 - the intestinal caecum of a sheep, soaked for some hours in water, turned inside out, macerated again in weak alkaline lye, changed every twelve hours, scraped carefully to remove the mucous membrane, leaving the peritoneal and muscular coats exposed to the vapour of burning sulphur and afterwards washed with soap and water. It was then blown up, dried, cut to the length of seven or eight inches and bordered at the open end with a ribbon to tie it on. For some reason these were traditionally red or green. The best condoms were made in London and people came from all over Europe to buy them. Until recently condoms made from animal membranes could still be obtained, their devotees claiming that they were less perceptible in use than rubber because the skin did not act as an insulation in the same way as rubber does. However they were always extremely expensive. Nowadays the same advantages are claimed for condoms made of a kind of polyurethane but most are still made of latex they have been for a hundred years.

Back in the 1950's condoms were supplied with either plain or teat ends. They were either lubricated or dry. There was nothing like the enormous choice there is now. Washable condoms were also supplied which were guaranteed for 6 or even 12 months. These were supplied with little stands to dry them on after washing and French chalk was supplied as a dusting powder to maintain the sheath in the best condition. Unfortunately these condoms were rather thick and it was almost impossible to feel anything through them!

The largest manufacturer of sheaths in Europe must be S.S.L. International, perhaps better known by its previous appellation the London Rubber Company. They manufacture Durex Condoms, the U.K. brand leader for many years. The Company was first established in 1916 by a Mr. Jackson in one room at the back of a tobacconist's shop in High Holborn in the City of London. It was the introduction of vulcanised rubber that revolutionised the condom manufacturing process. This is a method of treating rubber to make it stronger and more elastic, originally by the use of sulphur at high temperatures, which was perfected in the late nineteenth century.

The process of manufacture is highly skilled and complicated. Naturally over the years and particularly recently there have been many technical advances and innovations and Durex condoms are now made in the Far East replacing their large factory on the outskirts of London. The manufacturing process starts with the rubber latex straight from the tree.. It is purified and adjusted to the correct viscosity in vast tanks. A continuous chain of formers, originally made of glass, is rotated through the tanks in a complicated way to ensure even coating with no bubbles or build ups of different latex thickness. Hot air dries the latex, and the process may be repeated. Then comes the vulcanisation. This is crucial, for it is this process which renders the latex capable of withstanding changes of temperature which would otherwise cause it to stiffen in the cold and soften in warmth. Lubrication and packing follows. At every stage the product is subjected to rigorous quality control by electronic methods. Rubber is a very poor conductor of electricity and it is this insulative effect that is utilised in the testing processs. Other random sampling tests involve the inflation of the condom with a specified amount of water and testing for leaks and the use of pressurised air.

Rubber is strange stuff. As well as being an electrical insulator it also prevents the transfer of heat. Modern lubricants go some way to mitigate this and condoms are now made thinner than formerly with no loss of strength and impermeability. Nevertheless expensive research has been done to find an alternative to rubber that does not have this property. In the 1970's there was a resurgence of interest in lambskin condoms due to revolutions in the manufacturing process. No longer did the sheaths have to be tied on with a ribbon. Nor did they need to be soaked in water before use. Although considerably more expensive than rubber they were less obtrusive, allowing extra sensitivity to the male. Skin conducts heat very well. Even so expense made these products luxury items beyond the pockets of many. Now Condoms have been manufactured of a sort of polyurethane. The Durex Avanti brand is an example of this type. It is thinner than a latex condom and can be used with oil based lubricants unlike rubber. They are more expensive, but not prohibitively so like those made from skin and they are claimed to be almost imperceptible in use.

Before the sexual revolution of the 1960's sexual matters and methods of contraception were little talked about. A man would purchase a packet of three from under the counter at his men only barbers. 'Something for the evening Sir?' With the invention of the Pill the popularity of condoms declined. It has been said that one of the reasons men grew their hair long in the Sixties was because they no longer had to go to the barbers to purchase their protectives! But with the advent of the scourge of AIDS the situation changed. Emphasis altered from contraception to protection and this has been encouraged by advertising, propaganda and government policy. Condoms are now available from a multiplicity of outlets and embarrassment at purchase is no longer prevalent. 'Safe Sex' is promoted as desirable and condoms are seen as the obvious method to achieve this by preventing direct contact. Extensive education in schools encourages condom use as the norm and many brands encourage the fun aspect. Thus now condoms are studded. ribbed, coloured, flavoured, scented and can even glow in the dark! No doubt further variations will be seen as innovation continues. Whether we like them or not condoms have become a necessity of modern life and are here to stay!