Newsletter #27 (Spring 2001)

The Use of the Pessary

The Selected Papers of Margaret Sanger will be published in four volumes by the University of Illinois Press. The first volume, The Woman Rebel, 1900-1928, will be published later this year. Approximately 250 letters, diary entries, speeches and articles have been transcribed and annotated. Here's one example, an address by Sanger given at a roundtable meeting for members of the medical profession at the First American Birth Control Conference. The meeting, which took place two days before the Town Hall raid, gave doctors an opportunity to compare notes on the effectiveness and safety of diaphragms and other available contraceptives.

The First American Birth Control Conference, held in New York City from Nov. 11-13, brought together leading scientists, physicians, economists and social workers, and other movement supporters and activists to undertake a "wider investigation of the subject of birth control." Sessions were offered on health, social problems, population and war, as well as the legal aspects of birth control in America. At the conference, Sanger launched the American Birth Control League (ABCL) and announced plans for the opening of a clinic. The following is an extract from an invitation-only roundtable meeting for members of the medical profession on contraceptive techniques and devices. Prior to MS's comments, chairman Lydia Allen DeVilbiss introduced the session and the four topics under discussion: surgical methods; sterilization; mechanical and chemical contraceptives; and miscellaneous methods. Discussants included doctors Edward W. Lee, William F. Martin, S. Adolphus Knopf, Alice Butler and Isabelle McMillan. (Mistranscriptions by Sanger's staff have been corrected by the editors, in brackets.) (MS to Friends, Sept. 28, 1921 [MSM S67:740]; First American Birth Control Conference, Program, Nov. 11-13, 1921 [MSM S67:794].)

[New York, NY, November 11, 1921]

MRS. MARGARET SANGER: Madam chairman, and friends. In Holland the particular method that is recommended there is the [occlusive] pessary. More than thirty five years ago at the medical congress of Amsterdam, the physicians decided that this subject of birth control was one that must be [taught] to their people if they would remain within their borders. (1) At once the medical profession began to test out the use of a pessary. They have from that time on used and recommended what is called the [Mensinga] pessary, which has, I believe, seven sizes. It is a little different from the one used in England and also the one used in the United States. This is made of different material and different sizes. Altogether I have seen as many as fourteen different pessaries devised and effected in Holland. Now, the physicians soon came to recognize that it was quite necessary to take their time, to find a way to teach the woman who was normal the use of a pessary, and so Dr. Rutgers, who was most interested in this subject at that time, has instructed the nurses how to fit the pessary upon a normal woman who is not suffering from disease. It is most interesting to see these women come to these clinics and to be there and to witness the instruction. They are first taught to douche. A small syringe is used, and they are taught the use of this syringe. Next this pessary is inserted with soapsuds and is fitted. The nurse does this until she gets the correct size. When this round one does not fit, there is another kind which does fit almost always. You see what that does? It covers the whole wall. (2) It is not like the small American pessary which I will show you later. That is the kind of pessary that is used in Germany, and in Austria, and in Holland.

This small pessary is the one that is used in France and now has been taken on in England.

My personal experience from women whose records I have is that this is the kind of pessary that accidents happen from. This can be pushed aside. (3) It does not seem to have the same skin, and it does not seem to fit so well over the cervix as that other kind which is called here the ["mizpah"]. The top comes off and seems to be a more practical kind. (4)

This kind, the little one, the French pessary, has been used in France for many years, and of course there have been no records kept so you cannot tell how many times this has failed.

In England today this is the method being used there in the so-called mother clinics. (5) In America we have the records of the 1250 families who have used methods successfully for at least one year; the pessary, 335 families have used the pessary followed by a douche, of which 265 have used the douche following the use of the pessary; the condom–355 people have used the condom successfully, and 171 of these people have followed the use of it by a douche; next on record is the suppository, 181 families have used suppositories, and 108 have followed it by a douche. The other methods that are here, an antiseptic douche, only 264 people. Most of us know that an antiseptic douche is not a preventative, but is a hygienic measure. Coitus [interruptus], 175 families have used that method, 61 have followed by a douche. (6)

This is recent information we have had of people in the United States who have used those methods and have been willing to give us the information.

As far as pessaries are concerned, I think that the kind used in Holland is the best. The records there for five years show that there were only 1% failure, and five years previously 3% were failure. (7) But they claim that if a woman is normal, if her organs are normal, and if she is taught and knows how to insert a pessary, that this practice cannot fail.

Now, they do not advise the woman to leave this in the body only over night. The next day when the husband is gone and the children are out at school, the woman is advised to take a cleansing douche and to wash the pessary and put it away. The reason they like it best is because it is not expensive; the only cost is its first outlay. And before the war they had the right kind of rubber and it was supposed to last from three to five years, and the charges were something like a gilder or a gilder and a half, which meant about sixty cents. Altogether the pessary is considered in Holland and in France the most successful method of birth control. (applause)

THE CHAIRMAN: I have asked Mrs. Sanger if this type of pessary was available in America. And she told me not this kind. In as much as this is the kind we are able to get in America, I would like to ask her if they use an ointment or something like it in connection with this.

MRS. SANGER: The idea is this. A little powder, any antiseptic dry powder in the cup before it is put on doubly secures against pregnancy, particularly if it is well fitted. (8) That is always one reason why I have stood so definitely for the principle of birth control being disseminated by the medical profession. As a nurse myself, I know that all women are not alike, that they are different. That it means individual examination or individual instruction. And with powder placed in the cup before it is inserted, and with the woman taught how to insert it, we have had a great deal of success, and very few failures with the right kind of pessary.

QUESTION. Will you kindly state what kind of powder?

MRS. SANGER: Boric powder, and even bicarbonate of soda. (9)

Notes:

1. The Sixth International Medical Congress was held Sept. 7-14, 1879, in Amsterdam. ("The Population Question in Amsterdam," The Malthusian [Oct. 1879], 66-71.)

2. German physician Wilhelm Mensinga (using the pseudonym Karl Hasse) designed the occlusive pessary in 1881. First used widely by Johannes Rutgers in his Dutch clinics, it was nicknamed the Dutch pessary or Dutch cap. Because the occlusive pessary covers the entire vaginal wall, rather than just the opening to the cervix, many American birth control reformers preferred it to the cervical cap. The Mensinga pessary, made of a flat watch spring covered with black opaque rubber, was produced in many sizes and required accurate fitting. But the Mensinga had a tendency not to return to its original shape after repeated use. As a result, Americans began using the Ramses, a slightly smaller version of the Mensinga pessary, which used a coiled watch spring to more effectively maintain its shape. Because of the slight possibility that some spermatozoa could pass round the edge of the cap, spermicidal cream or jellies were used to seal this off. (Cooper, Technique of Contraception, 135-137; Himes, Medical History of Contraception, 318-21.)

3. MS probably displayed a French cervical cap, which just covered the mouth of the cervix. (Cooper, 54-61.)

4. The Mizpah, an American variation of the French cervical cap, was constructed in two parts. In Family Limitation, MS cited it as one of the best</em>, but Marie Stopes attacked it on the mistaken assumption that the user was supposed to leave the rim inside the vagina between use. (Cooper, 57; Stopes, Contraception, 166.)</p>

5. Stopes's Mother's Clinic used the "Pro-Race" cap, a French cervical cap which she modified by adding a higher dome. (Cooper, 54-61.)

6. Using the letterhead of the "Margaret Sanger Research Bureau," MS sent out 31,000 questionnaires earlier that year to her client list asking for information about family size, reasons for using birth control and contraceptive methods employed. Compilations of the results, as well as transcriptions of nine responses, can be found on LCM 34:60-73.

7. MS probably got her figures on the efficacy of the Dutch pessary at the recent International Congress on Contraceptives in Amsterdam.

8. It was commonly held that neither pessaries or contraceptive ointments by themselves offered the desired level of protection, but in combination women could come close to 100% protection. As Dr. James Cooper noted, "the pessary prevents a 'direct hit' or ejaculation into the cervical canal, while the acid jelly kills all the sperms much more quickly than would otherwise be possible." (Cooper, 145.)

9. Following MS's remarks, more than a dozen doctors joined the discussion, debating the efficacy and safety of the pessary. The discussion then moved on to miscellaneous methods, including the safe period, withdrawal, various suppositories, x-ray sterilization, and the use of iodine drops in Russia. Several doctors interrupted to warn of the potentially harmful effects of chemical and mechanical contraceptives. A few doctors also broached the subject of how sexual positions and technique could improve the effectiveness of coitus interruptus. MS concluded with a statement on the legal aspects of dispensing birth control.