The Dartmouth Review
January 15, 2001

"I Want You Guys to Have All the Sex You Want"

Editor's Note: A student went to Dick's House and met with Physician Assistant Anne Michaels. The student reported that she had not been taking her birth control pills regularly, but that she had been in a fight with her boyfriend and wasn't having sex, anyway. The night before, however, they reconciled--and had unprotected sex. She is concerned that she might be pregnant, the student told Michaels. The student did not ask for the morning-after pill; she just sought advice. After relating her problem, the conversation proceeded as follows:

Anne Michaels: Let's look at this calendar. Tell me--here's today's date--when was the first day of your last period?

Student: Umm... I think it was Wednesday, the 22nd...

Michaels: And you had a normal period?

Student: Yes.

Michaels: And since you started your new pack of pills, how many days have you skipped them altogether? Have you taken them late?

Student: No. I missed the last two days, and before that, I took a pill but I missed the day before that also.

Michaels: OK. And since your last period, this is the only time you've had sex?

Student: Yes.

Michaels: This is the only time you've had sex without any other protection?

Student: Yes.

Michaels: And what were you guys using before your last period in addition to the pill, condoms?

Student: Yes.

Michaels: One of the things we can do--I can feel how nervous you are. One of the options that we have is, if you had sex last night without a condom and you missed your pill, we can give you what's called the morning-after pill or emergency contraception, called Plan B. And what that does is that it's a hormone to try to stop you from ovulating. Okay?

So if, you know, if you were to ovulate during--this medication is used, it can be used up to 72 hours after you had sex without protection or a condom breaks or anything like that. This hopefully will prevent you from ovulating. It's not an abortion pill; it's not going, you know, it's not going to get rid of a pregnancy. It's going to hopefully prevent you from--it makes everything kind of a hostile environment. That's what I recommend that we do.

Student: So, I don't understand. It's not an abortion?

Michaels: Yes. If you have a pregnancy there, it doesn't get rid of the pregnancy. It just stops you from ovulating, so that you don't have any eggs there, so that the sperm and the egg don't get together, if that makes sense. But it's not, you know-- Let's say, if you were pregnant now, it's not going to terminate a pregnancy, if that makes sense. But hopefully, because this happened last night, we're going to prevent you from getting pregnant. Does that make sense?

Student: Yes.

Michaels: I would say that's what we need to do. Doing a urine test right now on you is not going to show us anything. But this is what I recommend: that you do Plan B now. Restart your pills--you know, start your pills again. You need to use condoms or abstain--no sex until your next period. If anything is different in your next period, you have to come back.

Student: OK.

Michaels: I'll go get it. We have it right here. But I want you--you need to read this--we can talk about it when I get back. You can have a seat right here. You will have to initial it, we'll go over it when I come back.

[Michaels gave the student a form entitled "Informed Consent for Emergency Contraception." See picture in print edition.]

Michaels: I'm going to have to give you a prescription. The pharmacy is closed but I'm going to give it to you now so you can take it today.

Student: OK. Great.

[Michaels read the form aloud and both signed at the bottom.]

Michaels: Any questions?

Student: No.

Michaels: Listen, you're doing everything right. I totally understand why you're concerned. And my goal is that you get out of college and not have to worry about, you know. I want you guys to have all the sex you want.

The prescription is going to cost four dollars. You can come back and pay for it tomorrow so it doesn't go on your student account, but all it says is "pharmacy charge," anyway.

What time do you get up in the morning?

Student: 8:30.

Michaels: OK. This is how this goes: you take one now, and you take one twelve hours from now--you'll have to set your alarm clock for about 5:00.

And remember don't have sex, or have sex with a condom and keep taking your pills, don't stop your pills, keep taking them and then come back and see us if you don't get a normal period. Even at anything the least bit strange, come back. Alright? You feeling a little better? If you have any questions you can e-mail me.

I have a little cup of water here if you'd like to take the first pill here so you don't forget.

Student: I'd rather take it at home because I like to take any medications with food so that it won't upset my stomach.