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	<title type="text">Charlotte Shane | The Verge</title>
	<subtitle type="text">The Verge is about technology and how it makes us feel. Founded in 2011, we offer our audience everything from breaking news to reviews to award-winning features and investigations, on our site, in video, and in podcasts.</subtitle>

	<updated>2016-05-10T14:53:05+00:00</updated>

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		<entry>
			
			<author>
				<name>Charlotte Shane</name>
			</author>
			
			<title type="html"><![CDATA[Wait, just how many types of orgasms are there?]]></title>
			<link rel="alternate" type="text/html" href="https://www.theverge.com/2016/5/10/11645658/female-orgasm-types-sigmund-freud-sex-education" />
			<id>https://www.theverge.com/2016/5/10/11645658/female-orgasm-types-sigmund-freud-sex-education</id>
			<updated>2016-05-10T10:53:05-04:00</updated>
			<published>2016-05-10T10:53:05-04:00</published>
			<category scheme="https://www.theverge.com" term="Health" /><category scheme="https://www.theverge.com" term="Report" /><category scheme="https://www.theverge.com" term="Science" /><category scheme="https://www.theverge.com" term="Sex" />
							<summary type="html"><![CDATA[According to mainstream women&#8217;s magazines, there are about as many types of female orgasms as there are brands of flattering workout pants. There&#8217;s the storied g-spot orgasm, the cutting edge &#8220;a-spot&#8221; (&#8220;anterior fornix&#8221;) orgasm, the even more obscure &#8220;u-spot&#8221; (urethra) orgasm, the cringe-y sounding cervical orgasm, and for boring underachievers, the basic and accessible clitoral [&#8230;]]]></summary>
			
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<p>According to mainstream women&rsquo;s magazines, there are about as many types of female orgasms as there are brands of flattering workout pants. There&rsquo;s the storied g-spot orgasm, the cutting edge &#8220;a-spot&#8221; (&#8220;anterior fornix&#8221;) orgasm, the even more obscure &#8220;u-spot&#8221; (urethra) orgasm, the cringe-y sounding cervical orgasm, and for boring underachievers, the basic and accessible clitoral orgasm. Scientifically speaking, though, just how many orgasms are there?</p>
<p><q class="right">&#8220;Orgasm is the sudden, involuntary release of sexual tension.&#8221;</q>There&rsquo;s no consensus yet from the medical community, in part because there&rsquo;s disagreement about how to define an orgasm in the first place. Some researchers and sexperts favor a definition like the one sex educator Emily Nagoski provided in last year&rsquo;s best-selling <em><a href="http://books.simonandschuster.com/Come-as-You-Are/Emily-Nagoski/9781476762098">Come As You Are</a></em>: &#8220;Orgasm is the sudden, involuntary release of sexual tension,&#8221; a description that carefully omits mention of concrete physical markers. For others, like neuroscientist and psychophysiologist <a href="http://www.span-lab.com/about/people.php">Nicole Prause</a>, identifying a physical response is key. Knowing what, exactly, an orgasm is seems like a reasonable basis for determining where it originates and ultimately manifests &mdash; the apparent mission of proselytizers of increasingly elaborate orgasm types. What else are they trying to put a name to?</p>
<p>In their efforts, they&rsquo;re honoring &mdash; you guessed it &mdash; good old Sigmund Freud, who popularized the bifurcation of women&rsquo;s sexual response into clitoral and vaginal over a century ago. Thanks to second-wave feminism, it&rsquo;s widely accepted that his theory left a legacy of collective psycho-sexual baggage we&rsquo;ve barely begun to slough off, but even he couldn&rsquo;t have anticipated the climax cottage industry that his dubious claims about &#8220;sexual maturity&#8221; ushered in. If you&rsquo;ve got the genitalia of a cis woman &mdash; meaning a vulva, a vagina, a clitoris, a cervix, and all the rest &mdash; you should, according to <a href="https://www.youtube.com/watch?v=tsdbPK2niKw">some experts</a>, be able to &#8220;achieve&#8221; up to 10 different varieties of sexual release through skillful manipulation of your myriad private parts. But the best evidence suggests bodies simply don&rsquo;t work like that.</p>

<p>Let&rsquo;s start with the fact that the vagina and clitoris are intimately connected to the point of near inextricability &mdash; and that&rsquo;s not news. In 1966,<a href="https://books.google.com/books/about/Human_Sexual_Response.html?id=N-xqAAAAMAAJ"> Masters and Johnson</a> excoriated the suggestion that they&rsquo;re distinct:</p>
<blockquote class="wp-block-quote has-text-align-none is-layout-flow wp-block-quote-is-layout-flow">
<p>Are clitoral and vaginal orgasms truly separate anatomic entities? From a biologic point of view, the answer to this question is an unequivocal No &hellip; [T]here is absolutely no difference in the response of the pelvic viscera to effective sexual stimulation, regardless of [where] the stimulation occurs.</p>
</blockquote><p><q class="left">Bodies are not assembled as cleanly as plumbing systems</q>Vaginal and clitoral orgasms are not separate because the vagina and the clitoris, as anatomical structures, are not separate. Bodies are not assembled as cleanly as plumbing systems, in spite of what common parlance for our reproductive systems suggests. As<a href="http://www.ncbi.nlm.nih.gov/pubmed/16145367"> one 2005 paper</a> notes, &#8220;The anatomy of the clitoris has not been stable with time &hellip; To a major extent, its study has been dominated by social factors.&#8221; By today&rsquo;s best evidence, derived from meticulous cadaveric dissection, it is an organ that extends deep into the body on multiple planes, and constitutes far more than the small glans and hood that most of us think of as &#8220;the clit.&#8221; When recognized in its complete, three-dimensional glory, it has something of a wishbone shape and comes into contact with the labia, urethra, mons, and vaginal walls.</p><img src="https://platform.theverge.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/6463291/Figure_28_02_02.0.jpg?quality=90&#038;strip=all&#038;crop=0,0,100,100" alt="diagram-clitoris-wikimedia" title="diagram-clitoris-wikimedia" data-has-syndication-rights="1" data-caption="" data-portal-copyright="" /><p class="article-caption">(<a href="https://commons.wikimedia.org/wiki/File:Figure_28_02_02.jpg">Anatomy &amp; Physiology, Connexions Web site/Wikimedia Commons</a>)</p>
<p>Because of its location against the top wall of the vagina, around the urethra, and along the labia, stimulation and pressure on any of these adjacent areas during sex necessarily applies pressure, friction, vibration, and so on, to the clitoris. &#8220;It is therefore problematic at best to define a &lsquo;clitoral orgasm&rsquo; as a phenomenon distinct from a &lsquo;vaginal orgasm,&rsquo;&#8221; declared <a href="http://onlinelibrary.wiley.com/doi/10.1002/ca.22524/abstract">one intensive medical review from 2015</a>.</p>
<p><q class="right">&#8220;An orgasm is an orgasm is an orgasm!&#8221;</q><a href="http://dodsonandross.com/blogs/betty-dodson/2014/10/womans-erection-needs-20-30-minutes-adequate-clitoral-stimulation">Legendary sex educator Betty Dodson</a> is particularly vehement on this point. &#8220;An orgasm is an orgasm is an orgasm!&#8221; she told me, while lamenting our continued preoccupation with &#8220;vaginal&#8221; orgasm. &#8220;The clitoral body is the primary source of orgasm whether it&rsquo;s stimulated externally, internally, or both.&#8221; When I spoke with Nicole Prause, she too emphasized, &#8220;If something is put into the vagina, the clitoris is always displaced.&#8221; In most cis women&rsquo;s bodies, you can&rsquo;t stimulate a vagina without stimulating the clitoris at the time.</p>
<p>Internal structure of the clitoris aside, the external, visible portion of the clitoris (the glans) is also influenced by penetration, as plenty of sex position manuals indicate. Women who come from penetration without targeted manipulation of their glans may experience external clitoral stimulation through penetration regardless, due to general friction in that same area. Furthermore, pulling on the skin at the vagina&rsquo;s vestibule results in some stretching of the glans and clitoral hood as well the vascular tissue of the urethra. (Our beloved u-spot!) The interwoven nature of these tissues is the cause of &#8220;<a href="http://www.tandfonline.com/doi/abs/10.1080/14681994.2011.649692">ambiguity problems</a>&#8221; when trying to identify the source of orgasm &mdash; but it&rsquo;s only a &#8220;problem&#8221; if ideological values demand the artificial deconstruction of a body&rsquo;s holistic, quirky functioning. The very structure of genitals renders orgasm parsing impossible.</p>

<p>So what is an orgasm then, this experience that can&rsquo;t be pinned to a specific hodgepodge of genital triggers? Anatomically, &#8220;an orgasm consists of highly stereotyped contractions, which means they always occur in the same type of pattern,&#8221; says Prause. &#8220;It&rsquo;s 8 to 12 contractions, that start about 0.8 seconds apart and increase in latency until they stop.&#8221; It&rsquo;s a pretty straightforward take that&rsquo;s easy for researchers to verify in a subject &mdash; which can&rsquo;t be said for Nagoski&rsquo;s definition, mentioned above. (&#8220;Orgasm is the sudden, involuntary release of sexual tension.&#8221;)</p>
<p><q class="left">An orgasm is not guaranteed bliss; quality varies</q>Nagoski&rsquo;s stance prioritizes self-reporting over observable and quantifiable physical indicators, and doesn&rsquo;t even mention genitals. Given how commonly women evince <a href="https://medium.com/@enagoski/unwanted-arousal-it-happens-29679a156b92#.u7fgl0mmo">arousal noncordance</a> &mdash; how often their bodies indicate arousal without being accompanied by a subjective sense of feeling turned-on, or vice versa &mdash; it&rsquo;s understandable that this approach is generally positioned as the more feminist or otherwise women-friendly option. (Men also <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811244/">experience discordant arousal</a> pretty frequently, but not as regularly women do.)</p>
<p>But like Nagoski, Prause&rsquo;s framing leaves plenty of room for subjective experience. An orgasm can fit both or either set of criteria yet be disappointing, unsatisfying, or not particularly powerful &mdash; something magazine articles rarely address when they&rsquo;re exhorting their audience to go O wild. An orgasm is not guaranteed bliss; quality varies. But it&rsquo;s hard to psych readers up for digging around in their anterior vaginal walls for 30 minutes, chasing an elusive experience that may prove underwhelming once obtained. Better to promise &#8220;new heights&#8221; of pleasure. If you can find the right spot, and leave it at that, any experience less than sheer ecstasy will seem like the fault of the body in question.</p>

<p>Nagoski and Prause share something else in common in spite of divergent approaches to climax: both believe that orgasm is, essentially, a singular experience &mdash; meaning there is no &#8220;kind&#8221; or &#8220;type&#8221; of orgasm, only different ways of inducing it.</p>
<p><q class="right">Both researchers think there is no &#8216;kind&#8217; or &#8216;type&#8217; of orgasm</q>&#8220;Some people base it on where the stimulation comes from,&#8221; explains Prause, which is why articles about &#8220;nipple orgasms&#8221; and &#8220;anal orgasms&#8221; exist, but &#8220;there&rsquo;s no physical evidence that supports the idea of different types of orgasm.&#8221; No matter how they&rsquo;re induced or what part of the body seems to be receiving the most stimulation, orgasms result in those stereotypical contractions. For a researcher like Prause, a so-called g-spot orgasm is indistinguishable from a so-called clitoral orgasm.</p>
<p>We can glare back at Freud when looking to understand why our culture is so obsessed with detailing something that doesn&rsquo;t exist (i.e., sexual climaxes that stem from different sources). The preoccupation with orgasm through vaginal penetration alone &mdash; and the quest to induce it in every woman &mdash; opened a Pandora&rsquo;s box of possibilities for segmenting women&rsquo;s genitals into discrete components with separate sensations and capacities. Lady privates, notoriously complicated as they are, have become regarded as a collection of parts before &mdash; if not altogether instead of &mdash; a cohesive whole. Our culture already sends women on a fruitless chase for pleasure in an area of their body not as fully primed to provide it as others, so why not add new zones to the list? If you&rsquo;re diligently trying to engage a vagina without any clitoral side effect, why not try <a href="http://www.mensxp.com/sexuality/better-bedroom-performance/626-arouse-the-secret-u-spot-.html">stroking the urethral opening</a> (without touching the clitoris, because that&rsquo;s sensible) while you&rsquo;re at it? As an aside: how hell-bent are you people on getting or giving a UTI?</p>

<p>This is the inverse of how we generally think and talk about men. &#8220;Penis&#8221; indicates an area of widely varying sensitivity and nerve distribution, but somehow this fact doesn&rsquo;t inspire a mountain of articles on, say, how to get a guy off by stroking only the base of his shaft or petting his urethral opening. Mercifully, some academics are working to reverse this trend. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16536770">One 2012 study</a>, for instance, concluded that the &#8220;specialized tissues&#8221; of the vulva show a &#8220;unified response to sexual arousal.&#8221; (The paper opens with the endearing complaint that &#8220;the anatomy of the vulva is typically presented with no unifying theme.&#8221;) But the sanest voices in this discussion are drowned out by a sexist, sex-crazed pop culture with little to no interest in real anatomy.</p>

<p>There&rsquo;s nothing wrong with exploring one&rsquo;s body for different types and degrees of pressure, but the overbearing cultural imperative for women to do so, with its transparent sociopolitical agenda, is a problem. The next time a person, daytime TV segment, or magazine article tries to imply you&rsquo;re inferior because you don&rsquo;t experience 12 different types of orgasms, remind yourself that they&rsquo;re advocating the impossible, and looking pretty silly while they do it.</p>
<hr class="wp-block-separator" /><h3 class="wp-block-heading" id="what-is-the-future-of-sex">What is the future of sex?</h3><div class="video-container"><iframe src="https://volume.vox-cdn.com/embed/e9c4e0b9b?player_type=youtube&#038;loop=1&#038;placement=article&#038;tracking=article:rss" allowfullscreen frameborder="0" allow=""></iframe></div>
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					</entry>
			<entry>
			
			<author>
				<name>Charlotte Shane</name>
			</author>
			
			<title type="html"><![CDATA[The medical abortion works — so why aren&#8217;t more women using it?]]></title>
			<link rel="alternate" type="text/html" href="https://www.theverge.com/2015/8/25/9174769/abortion-pill-shot-surgery-medical-women-healthcare" />
			<id>https://www.theverge.com/2015/8/25/9174769/abortion-pill-shot-surgery-medical-women-healthcare</id>
			<updated>2015-08-25T10:53:39-04:00</updated>
			<published>2015-08-25T10:53:39-04:00</published>
			<category scheme="https://www.theverge.com" term="Report" /><category scheme="https://www.theverge.com" term="Science" />
							<summary type="html"><![CDATA[I found out I was pregnant during a routine gynecological exam after I mentioned my period was a few days late. My doctor told me she&#8217;d need to collect a urine sample anyway, so they&#8217;d test it just to be sure. I wasn&#8217;t worried. I&#8217;d only been off hormonal birth control for a little over [&#8230;]]]></summary>
			
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<p>I found out I was pregnant during a routine gynecological exam after I mentioned my period was a few days late. My doctor told me she&rsquo;d need to collect a urine sample anyway, so they&rsquo;d test it just to be sure. I wasn&rsquo;t worried. I&rsquo;d only been off hormonal birth control for a little over a month after staying on it for many years, and I&rsquo;d read it sometimes takes months to resume regular ovulation. My boyfriend and I had one slip up, but that single incident seemed like a long shot. So when the doctor came back into the room with a upbeat &#8220;yup, you&rsquo;re pregnant,&#8221; I was (perhaps stupidly) shocked.</p>
<p><q class="right">&#8220;Yup, you&#8217;re pregnant.&#8221;</q>I immediately asked if her office performed abortions. I was 26, working in the sex industry, and involved with a man I knew wasn&rsquo;t right for me in the long term. I was pretty sure I didn&rsquo;t want to have children at all &mdash; but particularly not now, not like this.</p>
<p>The doctor recoiled as if I&rsquo;d struck her. &#8220;We don&rsquo;t do that here,&#8221; she said. &#8220;You&rsquo;re not even going to think about keeping it?&#8221; I affirmed with complete certainty that I was not, and asked if she could recommend a facility that would help. &#8220;You can Google it,&#8221; she said as she opened the door to the examination room, indicating very clearly that I should leave.</p>

<p>My best friend, a nurse, urged me to get an abortion shot. (A what? I thought.) She swore it would be the easiest and quickest option, and told me where I could find it. She even accompanied me on the visit &mdash; though I wasn&rsquo;t required to bring a second party for the procedure, which was a simple injection in the hip.</p>
<p><q class="center">The subsequent abortion felt mercifully easy</q>The subsequent abortion felt mercifully easy. It was quick and entailed almost no pain. Giddy with relief, I hugged the doctor on my follow-up visit, when successful termination was confirmed.</p>
<p>I&rsquo;ve been passionate about reproductive health for the entirety of my adult life, and surrounded myself with similarly engaged and educated women &mdash; how had I not heard of an abortion shot? Even today, when I talk to other women about terminating with an injection, they&rsquo;re entirely unfamiliar with this option. I wanted to know why it wasn&rsquo;t available and known to more women.</p>
<p><q class="left">Why wasn&#8217;t this available and known to more women?</q>Well, it was; <a href="http://www.cmaj.ca/content/186/1/13">in Canada</a>, anyway. Methotrexate, the chemotherapy drug used for my abortion, is one of three approved drug-based methods to end pregnancy, and an important one in environments <a href="http://www.researchgate.net/publication/6388209_Does_methotrexate_confer_a_significant_advantage_over_misoprostol_alone_for_early_medical_abortion_A_retrospective_analysis_of_8678_abortions">without better alternatives</a>; namely, countries with extremely restrictive abortion laws in which mifepristone (&#8220;the abortion pill&#8221;) is difficult to obtain. Methotrexate works by stopping fetal cell duplication as well as the ongoing implantation process. Though my experience was mild and physically undemanding &mdash; I had no downtime, nausea, or heavy bleeding &mdash; the drug itself is regarded as extremely toxic and can have <a href="http://www.womenonwaves.org/en/page/930/what-is-methotrexate">a host of ugly side effects</a>.</p>
<p>So the current preference <a href="http://www.ucsusa.org/our-work/center-science-and-democracy/promoting-scientific-integrity/mifepristone-and-misoprostol.html#.VdJvxngrnqs">among health experts around the world</a> is for the<a href="http://www.theglobeandmail.com/life/health-and-fitness/health/why-isnt-the-gold-standard-of-abortion-drugs-available-in-canada/article15690075/"> superior abortifacient</a> mifepristone, often called RU486 or the abortion pill, which was approved by the FDA in 2000. (Misoprostol, the third abortion medication, causes contractions of the uterus and is effective in inducing abortion<a href="http://www.womenonwaves.org/en/page/702/how-to-do-an-abortion-with-pills--misoprostol--cytotec"> 90 percent of the time</a>. Though it can be taken alone, it&#8217;s more commonly used in combination with either methotrexate or mifepristone.) Some American clinics still offer methotrexate abortions &mdash; and methotrexate can be taken orally instead of administered by injection &mdash; but since the FDA approved mifepristone in 2000, most provide that instead. Mifepristone has a higher rate of success and carries less risk of side effects.</p>
<p><q class="center">Medical abortion constitutes the majority of cases in many parts of Europe</q>Medical abortion &mdash; meaning any abortion induced by drugs as opposed to achieved through surgery &mdash; constitutes the majority of abortions in many parts of Europe: 70 percent in Switzerland, 83 percent in Sweden, and 94 percent in Finland. And for the majority of human history, ingestibles and herbs have been a highly <a href="http://www.who.int/reproductivehealth/publications/unsafe_abortion/ijgo_supplmt/en/">common method for inducing abortion</a>. The ancient equivalent of medical abortion even receives mention in the Bible. When the abortion pill became available in the States, the public response anticipated an abortion revolution. <em>Time</em> put the pill on their print issue&rsquo;s cover, and <a href="http://www.nytimes.com/2000/09/29/us/us-approves-abortion-pill-drug-offers-more-privacy-and-could-reshape-debate.html"><em>The</em> <em>New York Times</em>&rsquo; headline</a> suggested it would &#8220;reshape debate.&#8221; Gloria Feldt, president of Planned Parenthood at the time, called it &#8220;the most significant technological advance in women&rsquo;s reproductive health care since the birth control pill.&#8221;</p><img src="https://platform.theverge.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/3997330/2416744097_7ec6d4c270_o.0.jpg?quality=90&#038;strip=all&#038;crop=0,0,100,100" alt="abortion protest (flickr)" title="abortion protest (flickr)" data-has-syndication-rights="1" data-caption="" data-portal-copyright="" />
<p><em><em>An anti-choice protester (</em></em><a href="https://www.flickr.com/photos/daveynin/2416744097/in/photolist-4FyrPF-dVUK4v-p9fS4G-bsQVSj-bFKMuK-bFKFGK-bK6JE6-dt5z4p-dN3Evf-vPekBh-iBkmzr-bFKMcx-bFKLCz-bFKLoH-bFKKSk-bFKKrB-bsQTpG-bsQSSE-bFKJcc-bsQS4f-bFKGM4-bsQQCb-bsQP5d-bsQN9L-7gvJR5-7B9fTC-7gvLsC-8xHrAu-7grTp8-7wNPyE-c9xbo-bwddKJ-c9xbi-dAHtd-c9xbk-bK7YFr-bwddi7-c9xbm-bwdd1u-N6zod-bwdmVu-4UP1x7-4xF3BS-pXprdc-8T2S46-7SuhZ-5Hk9iW-bjvNxH-bjvNQx-7grRzD"><em><em>Daveynin</em></em></a><em><em>) </em></em></p>

<p>But the abortion pill amounts to<a href="http://www.guttmacher.org/pubs/journals/psrh.46e0414.pdf"> only 36 percent of domestic abortions</a> within the first nine weeks of pregnancy, at least in 2011, the most recent statistic available. That same year brought a slew of restrictive regulation which impacted medical abortion availability &mdash; and, consequently, its use. &#8220;The dream of Mifeprex was that all doctors are going to prescribe it, and that would greatly reduce stigma because it&rsquo;s going to be available everywhere,&#8221; says Tammi Kromenaker, MS, of Red River Women&rsquo;s Clinic in North Dakota. But it proved to be a technological advancement that didn&rsquo;t fulfill the invested parties&rsquo; anticipations of widespread change &mdash; at least, not here in the US.</p>
<p><q class="right">Theoretically, medical practitioners could dispense a pill in private without calling attention to themselves</q> Reproductive rights activists hoped that abortion medications would appeal to doctors who didn&rsquo;t want anti-abortion protesters at their clinic doors, but who did want to help patients obtain abortions. Theoretically, medical practitioners could now dispense a pill in private without calling attention to themselves and inviting the inevitable cascade of protest, harassment, and threats. But stigma is not so easily sidestepped. As the Guttmacher Institute&rsquo;s Rachel Jones points out, &#8220;if you&rsquo;re [a doctor] in a fundamentalist, born-again community and you offer a patient an abortion option, it could be the death of your practice.&#8221; That fear among practitioners places an onus on patients to ask for options they might not even know exist &mdash; and from someone who may not be sympathetic to the idea at that. As Jones says, &#8220;If you&rsquo;re not advertising [that you offer medical abortion], how do patients know?&#8221; There&rsquo;s always the possibility that if you venture a request for help, you might be told to &#8220;Google it,&#8221; and shown the door.</p>
<p>Furthermore, the abortion pill is not available in pharmacies; doctors willing to provide it must work with the manufacturer directly to be personally approved. If a woman approaches her general practitioner with a request for medication and the doctor agrees, it&rsquo;s possible too much time may pass before she can actually obtain the drugs. (Danco Laboratories, maker of Mifeprex, the only FDA abortion pill, did not reply to a request regarding how long the average application process takes.)</p>
<p><q class="left">A medical abortion is a process, not an instant fix</q> And then there are the side effects. A medical abortion is a process, not an instant fix, and it can entail heavy bleeding, intense cramping, and the passage of large clots. According to Kromenaker, pregnant women who intend to request abortion medications are sometimes dissuaded after finding out what the side effects entail.</p>
<p>This last point is crucial for understanding why abortion by pill didn&rsquo;t sweep the nation in the way some media coverage suggested it would. Enthusiasm about abortion medication has less to do with its intrinsic advantages, which are highly subjective, and more to do with its ability to work around circumstantial limitations that make surgical abortions challenging to obtain. Its rise in popularity <a href="https://www.guttmacher.org/pubs/Abortion-Worldwide.pdf">on the international stage</a>, for instance, is the result of increasing abortion access for rural women with scant other options, rather than women with ready access to surgical options choosing medication instead. And while some European countries have policies favoring abortion through medication and may subsidize the cost entirely, <a href="http://www.fundabortionnow.org/learn/hyde">the Hyde Amendment</a> prevents US federal funding from playing a role in citizens&rsquo; abortions in any aspect. <a href="http://www.nwlc.org/resource/state-bans-insurance-coverage-abortion-endanger-women%E2%80%99s-health-and-take-health-benefits-awa">Twenty-five states</a> have even passed laws prohibiting or inhibiting privately purchased insurance plans from covering it.</p>

<p>Here in the States, where many people are left to cover the cost themselves, surgical abortion can be the cheaper option &mdash; another mark in its favor. The Guttmacher Institute<a href="http://www.guttmacher.org/in-the-know/abortion-costs.html"> averages the cost of surgical abortion</a> to be about $450, while medication is $483. Thirty dollars is not an insignificant amount to those for whom the procedure is already a considerable expense.</p>
<p><q class="center">Rates of medical abortion have consistently risen every year since the pill&#8217;s approval &mdash; even as abortion rates have dropped</q></p>
<p>Still, rates of medical abortion have consistently risen every year since the abortion pill&rsquo;s approval 15 years ago, even as abortion rates themselves have gone down, and Dr. Beverly Winikoff of<a href="http://gynuity.org/about/"> Gynuity</a>,<a href="http://gynuity.org/about/"> an organization that promotes expanding affordable reproductive options worldwide</a>, expects that trend to continue. &#8220;I think [medical abortion] is amazingly popular here given how hard the government has made it to get,&#8221; she says. Since awareness of and comfort with choosing the abortion pill rests largely on word of mouth &mdash; women telling friends what their personal experience with the drugs was like &mdash; any frustrations about its popularity are a reflection of &#8220;inflated expectations about how transitions between medical technologies happen without commercial involvement,&#8221; as opposed to an accurate indication of the method&rsquo;s appeal and usefulness.</p>
<img src="https://platform.theverge.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/3997342/2566700164_7c38338b65_o.0.jpg?quality=90&#038;strip=all&#038;crop=0,0,100,100" alt="bad surprise (flickr)" title="bad surprise (flickr)" data-has-syndication-rights="1" data-caption="" data-portal-copyright="" />
<p><em><em> (</em></em><a href="https://www.flickr.com/photos/pinkmoose/2566700164/in/photolist-4UP1x7-4xF3BS-pXprdc-8T2S46-7SuhZ-5Hk9iW-bjvNxH-bjvNQx-7grRzD-7grQM2-7gvLRA-7gvKgS-7gvJmf-7grLYH-7grLBp-3cWbo3-6acKBo-bjvNMK-r2AtB-abuuhp-bjvNSD-oBC4vt-bum2wz-CXW6T-8T5Xzf-7mGpPo-6tbN69-8T5Xxj-8T5Xx5-8T5Xwy-8T5XvL-8T2S6n-8T5Xuq-8T5XtJ-4neiFz-8JZTJR-abueVV-6vkK9r-8DA2Ad-pXprEV-7Z53w8-wbjcui-mCmhJa-43d1ua-aNqxbR-ayFzuD-6t7yh2-5KsZxa-4TFgQ7-dW1kdy"><em><em>Anthony Easton</em></em></a><em><em>)</em></em></p>

<p>As Dr. Winikoff observes, state laws ultimately play such a large role in women&rsquo;s ability to obtain abortions, medical or surgical, attempting to describe them as popular or unpopular indicates a level of personal preference most women simply can&rsquo;t exercise. The same women who struggle to obtain a surgical abortion will most likely struggle to obtain a medical one as well, thanks to purposefully restrictive regulations.</p>
<p><q class="right">17 states have banned telemedicine for medical abortion </q>For instance, telemedicine, which allows physicians to consult with nurses and patients <a href="http://www.postbulletin.com/news/politics/abortions-by-telemedicine/article_888d1c0a-f756-5424-ba3b-1be2e998734d.html">through video conferencing</a>, keeps patients from driving long distances to obtain mifepristone and misoprostol. That time saved can mean the difference between choosing an early, medical abortion, or being left with no choice but surgical after the window for early action has closed. But <a href="http://time.com/3207170/planned-parenthood-telehealth-abortions/">17 states have banned telemedicine</a> for medical abortion &mdash; and only medical abortion &mdash; which effectively means those who&rsquo;d benefit most from access to the pill (rural women without the time or financial resources for travel to the nearest surgical abortion clinic) are denied.</p>
<p>Other recent anti-choice legislation seized upon enforcing an outdated FDA-approved regimen for administering mifepristone, which requires patients make three or more office visits instead of only two. (Under the <a href="http://rhrealitycheck.org/article/2015/01/28/study-evidence-based-protocols-medication-abortion-safe-effective/">evidence-based alternative</a> regimen, women can bring home the misoprostol they&rsquo;re supposed to take two days after the mifepristone, while the FDA regimen requires an additional trip be made to take that misoprostol in front of a doctor.) In North Dakota, home to Kromenaker&rsquo;s clinic, this law is in effect. &#8220;We had to switch back to the FDA regimen, and our medication abortion numbers plummeted,&#8221; says Kromenaker. &#8220;Even for the most privileged of women, making four trips to a doctor&rsquo;s office to terminate one pregnancy is a huge burden.&#8221; <a href="https://www.guttmacher.org/pubs/gpr/16/1/gpr160118.html">Guttmacher Policy Review</a> described this legal maneuver as &#8220;threaten(ing) US trend toward early abortion.&#8221;</p>
<p><q class="left">Women prefer surgical abortion to medical</q>Dr. Winikoff is quick to point out that while only four states have passed laws requiring providers adhere to the FDA regimen, two of those states are Ohio and Texas. &#8220;Those are big states with a lot of people &mdash; and they&rsquo;re almost entirely unable to provide medical abortion because conforming to the FDA approval document makes provision so cumbersome. Medical abortion is very popular in California and New York, which are also states with a lot of people, but with more supportive regulation.&#8221;</p>
<p>In 2014, <a href="http://www.acog.org/Resources-And-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Gynecology/Medical-Management-of-First-Trimester-Abortion">the American College of Obstetricians and Gynecologists</a> found that while women are usually satisfied with whatever abortion method they choose, they prefer surgical abortion to medical. When presented with the breakdown of what each entails, it&rsquo;s easy to understand why: surgical abortion is quicker, more effective, and often entails only light bleeding, so it may remain the more popular choice in the US for the foreseeable future even if restrictive laws are overturned. And that&rsquo;s not a bad thing. In fact, it&rsquo;s a testament to how tenaciously activists have fought to ensure access and options to the pregnant people who need them.</p>

<p>For supporters of reproductive rights and comprehensive health care, the goal is for everyone to have the option of both methods: no more instances in which women can&rsquo;t obtain medication in time to avoid surgery, and no more instances in which women have to go with medical abortion (or else no abortion at all) because surgery is too costly an investment in terms of travel and time.</p>
<img src="https://platform.theverge.com/wp-content/uploads/sites/2/chorus/uploads/chorus_asset/file/3997366/5880678891_644a5f926c_o.0.jpg?quality=90&#038;strip=all&#038;crop=0,0,100,100" alt="reproductive rights rally" title="reproductive rights rally" data-has-syndication-rights="1" data-caption="" data-portal-copyright="" />
<p><em><em>A reproductive rights rally in Minnesota (</em></em><a href="https://www.flickr.com/photos/fibonacciblue/6977119874/"><em><em>Fibonacci Blue</em></em></a><em><em>) </em></em></p>
<p><q class="center">I&#8217;m not sure I would go with medication again if I needed an abortion and were given the option of surgery</q></p>
<p>Now that I know my medical abortion experience was somewhat anomalous, I&rsquo;m not sure I would go with medication again if I needed an abortion and were given the option of surgery. I admit I&rsquo;m daunted by the thought of intense cramps and heavy bleeding. But any number of circumstances could mean medical abortion would be the better method for me in the future, even if it isn&rsquo;t right now. In a perfect world, I &mdash; and all of us &mdash; would always have the choice.</p>
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