Periodic abstinence and fertility awareness methods (FAMs) are ways you can prevent pregnancy by using your fertility pattern. Understanding your fertility pattern helps you predict ovulation. You can also use this information to help you become pregnant.

If you choose periodic abstinence, you will not have vaginal intercourse during your “unsafe days.” These are the days during which your fertile phase is likely to occur. The fertile phase lasts for about nine days—approximately six days before and three days after the day of ovulation. If you use FAMs, you will use a barrier contraceptive during your “unsafe days.” (Sperm can live from two to seven days in a woman’s reproductive system. The egg can live from one to three days.)

How Periodic Abstinence and FAMs Work

There are several ways you can predict when to abstain or use birth control.

For the basal body temperature method: Take your temperature every morning before getting out of bed. Your temperature rises between 0.4°F and 0.8°F on the day of ovulation. It remains at that level until your next period. You are fertile during the six days preceding ovulation.

For the cervical mucus method: Observe the changes in your cervical mucus. You must do so all through the first part of your menstrual cycle, until you are sure you have ovulated. Normally cloudy, tacky mucus will become clear and slippery in the few days before ovulation, and it will stretch between the fingers. When this happens, you are in your most fertile phase. You must abstain from vaginal intercourse or use a barrier contraceptive during the six days before this time. This method is sometimes called the ovulation method.

For the calendar or “rhythm” method: Chart your menstrual cycles on a calendar. You may be able to predict ovulation if your periods are the same every month. You must abstain or use a barrier method during your “unsafe days.” It will be more difficult to predict the day of ovulation if your cycle length varies from month to month. In that case, you will have more “unsafe days.” (It is best not to rely on this method alone.)

It is best to combine the basal body temperature method, the cervical mucus method, and the calendar method. Combining these methods is called the symptothermal method.

For the post-ovulation method: Abstain or use a barrier method from the beginning of your period until the morning of the fourth day after your predicted ovulation—more than half of your menstrual cycle.

Effectiveness of Periodic Abstinence and FAMs

Of 100 women using periodic abstinence, about 20 will become pregnant during the first year of typical use. Perfect use can give better results. Nine women will become pregnant with perfect use of the calendar method. Perfect use of the post-ovulation method, the basal body temperature method, or the cervical mucus (ovulation) method results in only one to three pregnancies. Pregnancy rates are generally higher for single women who use these methods. Failure rates for FAMs are not available.

Periodic abstinence and FAMs provide no protection against sexually transmitted infections.

Advantages of Periodic Abstinence and FAMs

• There are no medical or hormonal side effects.

• Calendars, thermometers, and charts are easy to get.

• Most religious groups accept periodic abstinence.

Who Can Use Periodic Abstinence and FAMs

• women in good health who have had careful instruction

• women whose only sex partner is equally committed to the method

Women should not rely on this method if they have:

• irregular periods

• irregular body temperature patterns

• uncooperative partners

Possible Problems Using Periodic Abstinence and FAMs

• Care is needed in keeping records and interpreting signs.

• Illness or even lack of sleep can cause false temperature readings.

• Vaginal infections or use of vaginal products or medication may alter cervical mucus.

• You and your partner may be tempted to take risks during your fertile period.

Where to Learn about Periodic Abstinence and FAMS and How Much They Cost

Expert and professional guidance is essential for women to learn how to use these methods successfully. Classes are available at Planned Parenthood and other family health, family planning, and church-affiliated centers. Classes are often free of charge. Charts are carried by family planning clinics. Temperature kits can be bought at drugstores. Kits range from $5 to $8 and up. Charts cost little or nothing. The cost in clinics or when authorized by a private doctor is covered by Medicaid in some states.

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Performance anxiety

Performance anxiety is the fear of being unable to please a partner. In men, it is the fear of erectile dysfunction. It is also one of the causes of erectile dysfunction. Poor body image, lack of self-esteem, problems in relationships, and fear and anxiety about sex can contribute to performance anxiety. If a man can believe that occasional failure to become erect is common, he is more likely to break the vicious circle of inhibited erection leading to performance anxiety leading to inhibited erection.

Performance anxiety can lead to a habit of thinking about, comparing, grading, and monitoring our sexual performance while we are having sex with a partner. This is called spectatoring. We can become so preoccupied spectatoring that we inhibit our sexual arousal. Spectatoring, like performance anxiety, seems to be more common in men than women, but it may be that a man’s failure to become erect is more obvious than a woman’s failure to become aroused.

Most of us will experience inhibited sexual arousal from time b time. It is important that we accept this as a normal part of our se lives and not let ourselves become so anxious that we make sex less pleasurable for us than it might be.

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The term “sexual behavior” covers a great variety of distinct behavioral variables, including covert behavior such as sexual dreams and fantasies; measures of psychophysiological arousal such as acid phosphatase excretion; autosexual behavior such as self-stimulation and genital masturbation; and overt sociosexual behavior such as dating, kissing, or sexual intercourse. Animal-behavior research has provided a useful classification scheme for observable patterns of hormone-influenced sociosexual interaction: attractivity, proceptive behavior, and receptive behavior. Attractivity denotes those aspects of the sexually mature individual—in lower mammals mainly odor cues, in nonhuman primates both odor and visual cues— which elicit the sexual approach or proceptive behavior of a potential mating partner. Receptive behavior is a term used for postural compliance with a partner who initiates the copulatory sequence. Although originally defined for female mammals, these terms seem applicable to male mammals as well. It is fairly easy to point out analogous patterns of sociosexual interaction for humans. Any human study, however, also has to take into consideration covert and autosexual behavior, since they constitute major aspects of human sexual behavior.

To what extent the various aspects of sexual behavior are intercorrelated in development and influenced by somatic-endocrine factors has not been sufficiently investigated. Heterosexual attractivity seems to be brought about primarily by the development of the secondary sex characteristics in puberty. Evidence for this conclusion comes from ample but undocumented sex-clinical experience, from systematic rating studies of sexual attractivity and from studies of men’s arousal response, measured by penile plethysmography, to pictures or films of nude females of varying degrees of sexual maturation (Freund and others, although longitudinal studies of attractivity changes in early adolescence have not been done. Flirting, dating, and related proceptive behaviors also are of major importance in adolescence and play only a minor role in childhood.

Particularly detailed data are available on genital sexuality. The reports by Kinsey and others have documented that many aspects of sexual behavior, including orgasm, can occur well before puberty, but sexual activity in childhood usually is only sporadic and lacks the regularity of adolescent and adult life (for a summary of the Kinsey data on childhood, see Meyer-Bahlburg). It is in most cases not before puberty that sexual concerns and behavior in its various aspects become a major part of everyday life.

Using orgasm as the behavioral criterion, Kinsey and others demonstrated striking differences between the sexes during puberty. Boys showed a sudden upsurge in sexual activity which could begin a year or more before the onset of puberty was noticeable; they usually reached their life peak in terms of orgasmic frequency within a year or two after the onset of puberty. Most of this early activity was masturbation. For two-thirds (68%) of the boys in the Kinsey sample, masturbation provided the first ejaculation; for the remaining ones, nocturnal emissions and heterosexual coitus provided the first ejaculation. By age fifteen, 82% of the boys were experienced in masturbation to orgasm.

In girls, by contrast, the gradual and steady increase in the accumulative incidence of erotic arousal and orgasmic response which was observed before puberty continued into puberty and beyond; typically, women did not reach their maximum rate of orgasm until their middle twenties to thirties. Of the relatively small percentage of girls in the Kinsey sample who experienced orgasm during puberty (20% by age fifteen), the majority (84%) used masturbation as the most important outlet. For the average male, adolescence was the age of highest orgasmic frequency, with 3.4 outlets per week, whereas the corresponding figure for sexually active females (including masturbation) was around 0.5 orgasms per week.

The occurrence of the first ejaculation—Levin introduced the appropriate term thorarche (from Greek thor?s, sperm, and arch?, beginning)—is brought about by masturbation in the majority of North American males. Asayama has demonstrated the same for Japanese males. Thus, there appears to be a relatively close relationship of puberty, thorarche, and autosexual activity for most males, while masturbation to orgasm by females is a relatively late event. In both Kinsey and others’ and Asayama’s reports, masturbation was practiced by only a minority of female adolescents; it developed later than the somatic markers of puberty in the majority of those who ever practiced it.

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The earliest encounters of infant and mother can hardly help but contribute to the sensory and affectional awakening of the infant, arousing sensitivity in the body and stimulating the growth of sexual consciousness. Evidence of a child’s capacity for sensory pleasure in the first year of life can be observed. From birth to one year of age the mouth is the chief pleasure zone of the infant, but infants also respond to total body contact (Renshaw). The chief pleasurable activity in the first year is sucking the mother’s breast or the thumb. The progressive development and orderly shift of sexuality from the mouth to other parts of the body (feet, thighs, abdomen) is evidenced in the activities of the infant when naked or when being bathed. Fingers wander searchingly over other parts of the body exploring the ears, the navel, the nipple region, and the genital area. Whether the infant is free to explore and stimulate its own body depends largely upon the parental acceptance of the infant’s nakedness and freedom of bodily activities.

Both before and after birth the human begins to develop a system of tensional outlets. These include changing positions in the womb, rocking to sleep in the crib, bed shaking, head banging, as well as handling the genitals and possibly some masturbating. Removal of clothes and attempts to run around naked occur between one and two years (Ilg and Ames). By two years the infant has already incorporated some of these impulses into forms of expression permitted by society, and although rocking, head banging, and some masturbating occur, much of the two-year-old’s release of tension is manifested by displays of strong affection toward parents, kissing, for example. Dolls and teddy bears also receive much attention. Being fed, taken to the toilet, dressed, and taken for rides are characteristic of things that occupy the two-year-old’s attention. The evidence of underlying sexual development is exhibited in the infant’s other achievements. Naming of the genitals with the use of a word for urination, distinguishing boys from girls even before the age of two, and differentiating adults by such words as “lady” or “man” are among these achievements.

At two and one-half years of age, the infant has still more understanding of the sociosexual scene. Differentiation of male and female roles has increased markedly. The child is aware of his or her gender and the fact that it is like the parent of the same gender and different from the other parent and his or her opposite-gender peers. The child can now differentiate the gender of children by the terms boy and girl. The two-and-a-half-year-old may well have incorporated a nonverbal generalization that boys and fathers have distinct genitalia and stand when they urinate, but girls and mothers do not. This age marks the beginning of interest in the physiological differences between sexes. The infant is very conscious of its own sex organs and may handle them when undressed. Inquiries concerning mothers’ breasts are common. All in all, the child has reached a point at which, because gender distinctions are possible, socialization into a male or female identity can and does occur.

In early childhood, erotic feelings become centered on the genitalia, and definite periods of sex play can be observed. Sex interest increases with age and varies in that some infants and children are much more interested than others in the subject of sex.

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The internal genitalia differentiate ahead of the external genitalia. Prenatal hormones, their presence or absence, control the differentiation of both.

The male and female internal genital structures differentiate from two separate primordia, the wolffian and mullerian ducts, respectively. In normal male development, the fetal testes first secrete their two hormones, androgen and mullerian inhibiting substance (MIS) at around the sixth week of gestation. Androgen ensures that the wolffian ducts proliferate into the vas deferens, seminal vesicles, and the ejaculatory ducts of the male internal genitalia. MIS ensures that the mullerian ducts vestigiate. In the absence of MIS, the mullerian ducts proliferate into a uterus, fallopian tubes, and the upper vagina of the female internal genitalia. In normal female development, the fetal ovaries do not, so far as is known, secrete hormones prenatally, and if maternal or placental hormones play a role in female differentiation, it has yet to be demonstrated.

Whereas the male and female internal genital structures differentiate from two separate primordia, the external genitalia develop from the same primordia. These structures remain undifferentiated until approximately the eighth week of fetal life, at which time androgen secreted from the fetal testes begins to masculinize them. It is possible that testosterone is converted to 5?-dihydrotestosterone (DHT) before masculinization of the external genitalia is effected. In any event, in the presence of androgen, the genital tubercle differentiates into a penis. The skin that becomes the hood of the clitoris and labia minora in the female wraps around the penis to cover it and to form the foreskin. The labioscrotal swellings fuse and form the scrotum. In the absence of androgen, the genital tubercle remains small and becomes the clitoris. What in the male is the foreskin and outer covering of the penis becomes the hood of the clitoris and the labia minora in the female. The labioscrotal swellings remain separate and form the labia majora.

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