Sunday, June 2, 2013

We're Moving!

We are MOVING to a new site!

Because Blogger has become a near occasion for sin (it frequently makes me want to take the Lord's in vain and think malicious thoughts about those who designed it) this site is being moved to a Wordpress site.

One of the nice things about the move is that we have our own domain.

The posts and comments have been moved, but it's still very much "default Wordpress". Hopefully, we should have a new look soon.

-  James

Wednesday, May 29, 2013

Wild Wednesday: Incorporating Play into Your Relationship

Wild Wednesday posts are totally non-theological posts that are designed to help your love life and your marriage. Enjoy.  - James

Last week's Wild Wednesday column was about the importance of play in a relationship. If you're single, play can help you develop the solid intimate friendships that can lead to a relationship. If you're in a relationship or are currently married, play can deepen the bond between you.

This week's post is about how to incorporate "play" into a relationship.

Kinds of Play

The National Institute for Play describes seven different types of play:

  1. Attunement — Play that establishes connection with another person.
  2. Body — Physical play.
  3. Object — Playing with toys or other objects.
  4. Social — Playing with groups of people or teams.
  5. Imaginative — Role playing, pretend, fantasy.
  6. Narrative — Storytelling.
  7. Transformative— Playing to learn or discover new knowledge. Explorative play.
An activity might involve several types of play.

Dancing may involve attunement play and body play.

Playing a team sport may involve body, object, and social play—perhaps even a bit of transformative play, if the game involves finding creative ways to win or score points.

Ideas for Play

The previous column suggested that couples schedule "play time". But what should you do? Sometimes as adults, we forget how to play.

Don't think that "play" has to be limited to just the two of you to build a relationship. Any kind of playing that you do together is going to bring a relaxed sense of fun into your relationship that will bring you closer together.

Take up a hobby or activity that you both enjoy. Not only can this introduce you to fun experiences, but it can also introduce you to fun people who enjoy the same things you do. After all, you're all in the activity to have fun.

If you have children, your kids are experts at play.  Playing with kids helps us experience the magic of play through their perspective. Let yourself be a kid again and join in the fun. (Just don't join in so much that your kids don't have time to play as kids. They need that.)

Schedule game night. Game night can be a great way to have fun with friends. It can be a great way to connect with the kids. Or it can be something fun for just the two of you to do together.

Overcoming Barriers to Play

Many adults find that they have forgotten how to play. Naomi Brower of Utah State University writes about how to overcome common barriers to play:

So how do we add more play into our relationships? Consider some of the following suggestions on how to overcome common barriers to play:

1. Schedule some fun. Many couples intend to play but never actually make it happen (Parrott & Parrott, 2006). Agree on a date and time and put it on the calendar (Markman, et al., 2004). When we schedule time for fun, we are more likely to make it happen.

2. Get active. Lack of energy and unhealthy living habits can often leave us feeling drained even when we find time in our busy schedules for fun (Braff & Schwarz, 2004). Make a plan to help each other eat right and participate in physical activities. You can make physical activity fun!

3. Give yourself permission to be a kid again.
Because we spend so much time acting like adults, we may feel it is childish to play and instead want to act serious to maintain our dignity (Markman, et al., 2004). Let your partner know your fears and trust him or her to help you overcome them. Do fun things that you feel comfortable with (Braff & Schwarz, 2004).

4. Be open to trying new things. Sometimes our idea of fun is different than our partner’s idea of fun. Find out why your partner enjoys what they do by asking questions and trying it yourself. Be open minded and willing to compromise. You might like it much more than you thought you would!

5. Protect fun from conflict and resentment. Sometimes negative feelings for our partner or conflicts may threaten to ruin a fun activity. Agree ahead of time to focus on having fun during the activity and to discuss important issues and conflicts at another time (Markman, et al., 2004). It may be hard to do this at first, but spending this important time together will strengthen your relationship and your ability to resolve conflicts in the long run.

6. Focus on teamwork. Some people are very competitive and may avoid playing games because they know they will become too competitive and want to win, even at his or her partner’s expense. In this case, learn a new game together, or find an activity where you can play or work as a team (Braff & Schwarz, 2004).

7. Budget for some fun. For many, money is tight, but there are often ways to find a small amount of money in a budget for some fun activities or for a special occasion. Just remember, having fun does not require a lot of money, and there are lots of fun activities that are free!

8. Make having fun more of a priority. Some people feel they are too busy to have fun or that it’s unproductive and unnecessary (Braff & Schwarz, 2004). Play really can help us to strengthen our relationships with others; just try it and see just how much more enjoyable your relationship can be! Take advantage of the simple and seemingly mundane moments you have every day to add a little fun. Try a silly twist to saying hello or goodbye, add something fun to meal time or take time to just stop and watch the sunset on the way back from running errands. It doesn’t have to take a lot of time to add a little fun into your routine, and it can create many lasting memories

There are even "Play Workshops" to help grown-ups remember how to play.

Play: Not Just Fun, It's Vital!

A pioneer in research on play, Dr. Stuart Brown says humor, games, roughhousing, flirtation and fantasy are more than just fun.

Any time you think play is a waste, remember that it offers some serious benefits for both you and others. As Brown says in his book, “Play is the purest expression of love.”

Readers: Any other ideas for incorporating play into your relationship?

Next week's column will be about ways that married couples can incorporate play into their intimate relationship. No reason why play has to stop at the bedroom door. ;-)

Tuesday, May 28, 2013

NFP: How Much Abstinence?

A reader asks the following about Natural Family Planning:

I have heard the average of Phase II being 12 to 14 (at least, on the NFP forums I am involved in).

I think 10 days is quite unusual, and quite "lucky" in the NFP world. Or, you are just more "open" to children than others. :)

When I read West or Popcak say "7 to 10", I just shake my head.

How much abstinence?

A common question about Natural Family Planning is how much abstinence should couples expect. Some couples ask "What's so hard about a week off?", while others reply "A week? Try two or more!"

It is also a question that few NFP advocates address. 


This post deals with Phase II abstinence only. Some couples may abstain more during Phase I, but such abstinence is too variable and personal to address in a post. Some couples may be comfortable with sex during menstruation, others may not be. The decision to abstain during menstruation is a personal choice, not one required to avoid pregnancy or follow Church teaching. (Yes, I know the Billings/Creighton rule, but it remains low risk.) Some couples may be strict about the "every other day" rule, while others may feel confident enough about their observations to use every day.

This post only deals with non-postpartum cycles in a healthy, cycling woman. Some cycle disorders, such as PCOS, can cause the fertile period to seem unusually long. In reality, a woman with PCOS is subfertile and these days are simply false-positives. Also, cycles may be unusual postpartum. Extended abstinence is not uncommon in these situations.

Finally, every woman is different and every cycle is different. "Normal" for one woman may not be "normal" for another. Even if a woman usually has "normal" cycles, this is no guarantee that every cycle will be "normal"

The Fertile Window

The actual "fertile window" where sex can lead to conception is only a maximum of 6 days.

Among healthy women trying to conceive, nearly all pregnancies can be attributed to intercourse during a six-day period ending on the day of ovulation.
Ovulation = Day 0

Sperm live for a maximum of five days (in good cervical fluid) and the egg lives for no more than one day. 5 + 1 = 6 days of fertility. Conception is most likely on the day of ovulation and the two days before.

Method Days of Possible Fertility

Every method adds in some "margin of error" to make sure couples trying to avoid don't get pregnant. Additionally, methods must be able to predict ovulation from five days out and sometimes fertile symptoms last for longer than five days.

How many days do each NFP method mark as fertile, on average?

Symptothermal Method
According to one study of the Symptothermal Method, it's 13 days, less when you get more experience.
However, one has to realize that the median fertile time determined by the STM is 13 days a cycle (less days after the first year). The potential fertile time is in fact longer than the actual physiological fertile time.
This particular Symptothermal Method did not have a basic infertile pattern (Yellow Stamp) instruction, instead, it considered the "Last Dry Day" to be the end of Phase I. Common sense says that it may take more time for two fertility signs to coincide than only one. (Our own experience is that the temp shift tends to be later than the mucus dry-up.)

Many couples were aware that the method was conservative and used days of possible fertility at the beginning and end of Phase II without getting pregnant.

Billings Ovulation Method

Another study found an average of 10 days of possible fertility with the Billings Method.

Billings has generally has a higher overall pregnancy rate than STM, which makes sense. (Less abstinence=less margin of error.)

Billings instructor Kristin Putnam claims 6-8 days of possible fertility is normal and anything MORE than this is a sign something may be wrong, such as a hormonal or nutritional issue.

We ended up taking classes from her and were able to reduce our abstinence as a result. We were very pleased with this, but, as always, YMMV.

Rae of No Wealth But Life/Vita Catholic claims a minimum of 9 days of abstinence for women of normal fertility and anything LESS than this is a sign of possible sub-fertility. Many of the commentators had similar experiences.

Rae also notes that fertility declines with age. While it may seem like abstinence lasts forever and an amorous look during Phase II can get you pregnant when you are in your mid 20s, when you are in your 30s, the observed fertile period may be shorter and the likelihood of pregnancy may be reduced.

Creighton Model Fertility Care

I have not been able to find any studies of Creighton Model (please provide studies in the comments if you have them), but because Creighton is a derivative of Billings (the rules are similar, but the observation techniques are different) then they should have about the same amount of abstinence. Anecdotally, this seems to be the case for most women.

A small number of women can use Billings, but not Creighton and a small number can use Creighton, but not Billings. Obviously, for these women, the methods will provide very different results.

Marquette Method

I am not aware of any studies on the length of the fertile window under the Marquette Method. (Please provide studies in the comments if you have them.)

The materials provided on Marquette's website note that the actual fertile window is 6 days.

In the charts provided in the user manual, however, the fertile window appears to be closer to 13 days. This is unsurprising because the official rules of the Marquette Method are very similar to the rules of Symptothermal in the Frank-Herrmann study cited above.

That being said, the fertility monitor gives many couples the confidence to days marked as fertile by the method, but not by the monitor, although this does increase the risk of pregnancy.


A recent study from Poland compared the Billings Method, Creighton Model, the Two-Day Method, various Symptothermal Methods, Rhythm, and Phase III BBT only. (Marquette Method was not included.) They also proposed a new symptothermal method (DBN) with the beginning of Phase II calculated by a computer algorithm.

They looked for the number of days available in a cycle and the number of "false negatives", that is, days in the 6-day fertile window that were marked as infertile. The results were as follows:

Not surprisingly, Billings (BO) and Creighton (CM) had the most available days and the highest percentage of false negatives (highest risk). Billings and Creighton supporters would counter that pregnancies resulting from intercourse on a day marked infertile within 6 days of ovulation are rare due to poor quality cervical fluid or poor follicular development, although they are certainly possible.

The various Symptothermal methods all had fewer false negatives, but fewer available days (more false positives).

To demonstrate the differences between methods, the following charts are for the same woman on the same cycle. (Intercourse markings have been removed):

Billings Ovulation Method = 8 days (CD 8-15)

Symptothermal Method (Fertility Awareness Method) = 13 days (CD 5-17)


Multiple studies have shown that the "fertile window" during which intercourse may lead to pregnancy is no more than six days long. Due to the difficulty in predicting and detecting ovulation,  methods of Natural Family Planning often consider days beyond those in the fertile window to be potentially fertile. Different methods take different approaches to calculating the potentially fertile window. Generally, methods that mark the least number of days as potentially fertile expose couples to the greatest amount of risk of possible pregnancy. Although all methods claim a low perfect-use failure rate when used to avoid pregnancy, the "actual use" pregnancy rate can vary widely. Methods with a shorter average abstinence period leave couples who want to avoid pregnancy with less of a margin of error.

In choosing a method of Natural Family Planning, couples should weigh their need to avoid pregnancy against the strain that extended abstinence will put on their marriage. A couple who does not have a very serious reasons to avoid pregnancy would be well-served by choosing a method with less abstinence or by using a more conservative method, like Marquette, less strictly. A couple who has a very serious need to avoid pregnancy can gain peace of mind by choosing a method designed for maximum security.

Monday, May 27, 2013

The Hard Cases - When Pregnancy is Dangerous

Every so often people wonder why couples cannot choose sterilization or contraception in the "hard cases"—cases where a pregnancy is dangerous to the mother. The following hypothetical arose on an internet discussion board:

Everywhere authoritative I've seen -- the Catechism, Humanae Vitae, Casti Connubii, etc. -- is 100% clear with no wiggle room that contraception use is always and everywhere a mortal sin. Which kind of removes grace from the equation, doesn't it? If you are committing a mortal sin *without a sincere desire to repent* you are turning away from God and by definition rejecting grace; that's the very thing that differentiates mortal sin from venial sin. It might be a matter in which the Church ought to give couples support, but the official doctrine really *is* "thou shalt not--or else."

We've been talking about whether the prohibition against contraception is based in natural law and universal moral principles. Which means it *must* apply to "the least of these." To people in the most dire straits medically or financially. That's where I think it fails, and if it fails there it *can't* be universal.

This is the absolute most problematic scenario I can imagine, and it is indeed unusual, but I think it gets to the issues with this teaching. Consider a couple in which the wife has severe pulmonary hypertension -- among the most dangerous conditions one can have with respect to maternal survival during pregnancy. The husband is career military and is often deployed for months at a time. They have adopted three small children with special needs who are quite attached to their mother.
If they use NFP for the express purpose of trying to conceive a child, they are not committing any sort of sin. Nor are they sinning if they are providentialists and use no family planning whatsoever. Indeed, in either of those situations their faith in God to not give them more than they can handle would be viewed as praiseworthy. (At no point in any official Catholic document I am aware of does a couple undertaking a risky pregnancy come under any censure no matter the circumstances. I am no theologian, of course, so I may well be missing something.)

Suppose, on the other hand, they assiduously use NFP to avoid the wife's fertile period, and because they are aware that a pregnancy would likely orphan their needy children they take the further precaution of a vasectomy. They do not wish to "have their cake and eat it too" by enjoying marital relations when they would otherwise be abstaining, but at the same time they believe they have made the decision that is in the best interests of their family and they are in agreement that the vasectomy was the prudent thing to do, and they feel no remorse whatsoever. This couple is in a state of mortal sin.

How is that possibly moral?

This is an excellent question. 

Life threatening or otherwise dangerous pregnancies are a very difficult situations that many couples face. They may want more children, but have obligations to take care of the children they have. Some may be concerned about passing on a life-threatening genetic disorder.

What Should the Couple Do?

First, a vasectomy is not 100% effective at preventing pregnancy. Nor is a tubal ligation or Essure procedure. The only methods of birth control that are 100% effective are hysterectomy, oophrectomy (female castration), male castration—and complete abstinence.

Second, many modern methods of Natural Family Planning are highly effective. The Marquette Method works by measuring hormone levels in the urine, giving couples a high level of security even with irregular or difficult to read cycles. Add cervical mucus readings and BBT cross-checking and couples should have at least a few days where the chance of conception is virtually zero. If used very conservatively (e.g. Phase 3 only, multiple cross-checked signs) it can be as effective at preventing pregnancy as a vasectomy.

Nevertheless, if a couple needs 100% effectiveness at preventing pregnancy, the Church teaches that complete abstinence (until menopause) is the only moral option.

The Church acknowledges that this is extremely difficult for couples. Pope Pius XII, in his address to the Italian Midwives explains why the Church requires couples to go to such difficulties.

It will be objected that such an abstention is impossible, that such a heroism is asking too much. You will hear this objection raised; you will read it everywhere. Even those who should be in a position to judge very differently, either by reason of their duties or qualifications, are ever ready to bring forward the following argument: "No one is obliged to do what is impossible, and it may be presumed that no reasonable legislator can will his law to oblige to the point of impossibility. But for husbands and wives long periods of abstention are impossible. Therefore they are not obliged to abstain; divine law cannot have this meaning."
In such a manner, from partially true premises, one arrives at a false conclusion. To convince oneself of this it suffices to invert the terms of the argument: "God does not oblige anyone to do what is impossible. But God obliges husband and wife to abstinence if their union cannot be completed according to the laws of nature. Therefore in this case abstinence is possible." To confirm this argument, there can be brought forward the doctrine of the Council of Trent, which, in the chapter on the observance necessary and possible of referring to a passage of St. Augustine, teaches: "God does not command the impossible but while He commands, He warns you to do what you can and to ask for the grace for what you cannot do and He helps you so that you may be able".
Do not be disturbed, therefore, in the practice of your profession and apostolate, by this great talk of impossibility. Do not be disturbed in your internal judgment nor in your external conduct. Never lend yourselves to anything which is contrary to the law of God and to your Christian conscience! It would be a wrong towards men and women of our age to judge them incapable of continuous heroism. Nowadays, for many a reason,—perhaps constrained by dire necessity or even at times oppressed by injustice—heroism is exercised to a degree and to an extent that in the past would have been thought impossible. Why, then, if circumstances truly demand it, should this heroism stop at the limits prescribed by the passions and the inclinations of nature? It is clear: he who does not want to master himself is not able to do so, and he who wishes to master himself relying only upon his own powers, without sincerely and perseveringly seeking divine help, will be miserably deceived.
The Church acknowledges such abstinence is difficult—it would require heroic virtue—but the Church also recognizes that it is not impossible. Priests and religious abstain for life. Denying that such heroic virtue is possible denies the possibility for couples to attain such heroic virtue. It also denies the power of God's grace to give couples this virtue.

That being said, couples who believe that their situation requires them to completely abstain should not do so without pastoral counseling and spiritual guidance. Remember, Pope Pius XII spoke before the discovery of modern NFP. Today, a couple should be able to avoid complete abstinence with a very low risk of pregnancy. A good spiritual adviser should be able to help couples balance the risk of a dangerous pregnancy against the risks of complete abstinence.

Is the Couple in a State of Mortal Sin for Getting a Vasectomy?

Sterilization, even when the pregnancy endangers the wife, is still a very serious sin. The correct course of action is complete or periodic abstinence, as described above. Strictly speaking, there is no need for sterilization.

But is is a mortal sin?

A common misunderstanding about Church teaching is on mortal sin is that mortal sin is a matter of "break a rule, go to hell".

Fortunately, this is NOT Church teaching.

Mortal sin requires serious matter (objective), as well as full knowledge, and full consent (subjective). CCC § 1857. Unfortunately, many materials call any sin that is objectively serious matter "mortal sin", but that's not completely accurate.

Saying without a doubt that this couple is in a state of mortal sin ignores the circumstances of the act. Let's look at what the Church teaches about circumstances.
The circumstances, including the consequences, are secondary elements of a moral act. They contribute to increasing or diminishing the moral goodness or evil of human acts (for example, the amount of a theft). They can also diminish or increase the agent's responsibility (such as acting out of a fear of death). Circumstances of themselves cannot change the moral quality of acts themselves; they can make neither good nor right an action that is in itself evil. CCC § 1754
Bad circumstances cannot turn a bad act into a good one, they can diminish responsibility for the act. Circumstances are why the Church never teaches that any particular person is in hell, even if they committed a serious sin right before they died.

While the reasons why a couple would choose sterilization are something personal and subjective, a couple facing serious health problems from pregnancy is making that decision under duress from the health problems. A decision made under duress is generally not one made with full consent of the will. It also seems that this particular couple may not have a full understanding of why the vasectomy is sinful, meaning that this sin may not have been committed with "full knowledge", either. Although it is possible that the couple has committed a mortal sin due to the objectively serious nature of the sin, it is unlikely that that the couple has the subjective state of mind for it to be a mortal sin.
Even though the couple may not be going to hell for being sterilized, they have still committed a very serious sin. Such sin damages the couple's relationship with God and the Church. Therefore, anyone who has been sterilized or has approved of their spouse being sterilized should make a full confession and be reconciled to the Church.

Do they have to regret the vasectomy to be granted absolution? 

Not specifically.  

As Catholics, we believe in the forgiveness of sins. To be forgiven, one must first recognize their sinfulness and be sorry for what they have done (contrition). Nevertheless, the Church does not require people to fully regret the wrongness of their actions to be forgiven. For example, someone could be sorry for violating the laws of the Church or even afraid of the consequences of sin and be forgiven, even if they do not regret the act itself. This is called "imperfect contrition". While perfect contrition—where we regret our sins because we recognize what we have done is wrong and offensive to God— is best, imperfect contrition is sufficient for forgiveness of sins and absolution.
Moral development is a lifelong process. A couple who feels completely justified in being sterilized and is simply "sorry for the consequences" may eventually come to understand why what they did was wrong and regret their decision, even when pregnancy causes debilitating health problems.

The Church does not require couples to reverse sterilizations, although some couples have felt compelled by the Holy Spirit to pursue reversal and have found spiritual and relational healing in doing so.

So why not just be sterilized and go to confession?

That's not how confession works. In confession, you receive God's grace, mercy, and forgiveness, but the consequences of the action remain, which may include guilt and regret over what you have done.

In this clip from 30 Rock, Jack (Alec Baldwin) explains to Tracy (Tracy Morgan) how confession isn't just a "free pass".

Sterilization is the deliberate permanent destruction of a person's fertility. It does have real physical, psychological, and spiritual consequences.

One blogger writes about her two pregnancies marred by debilitating Hyperemesis Gravidarum. She was sterilized after the second pregnancy. Despite the severity of her condition, she regrets the procedure, even after going to confession and being forgiven.
I know there are people who say the teaching of the Church is hard. But I’ve gone the other way. It’s harder. . . . [T]he guilt I carry to this day is a much more difficult burden than the fear.
Popular blogger Jennifer Fulwiler of Conversion Diary has a blood clotting disorder that makes pregnancy life-threatening. During her most recent (sixth) pregnancy, she was hospitalized after developing multiple blood clots in her lungs. After reflecting on her situation, she addresses the issue of sterilization.
All that said, I do think there’s enough risk in my own situation that I should chill on the pregnancy front for now, maybe forever. In that case, then, wouldn’t contraception or sterilization make everything easier? To put it concisely:



Like so many other people who have made the switch to NFP, I simply couldn’t be okay with any form of sterilization anymore, whether temporary or permanent. I don’t know how to articulate it other than to say I just couldn’t do it. On a purely visceral level, in that place deep in the heart where the most important truths about our humanity reside, I know as surely as I know anything else that those Catholic teachings about human sexuality are true and good.

The entire blog post is excellent, especially for those facing serious health problems during pregnancy. Jennifer writes about whether they were "done" having children and why, despite the risks to her health, they would continue to follow the teachings of the Church.

What about Pursuing a Risky Pregnancy?

As for the matter of pursuing a risky pregnancy, there is nothing objectively wrong with a married couple pursuing pregnancy. The Church teaches that spouses have a duty to responsible parenthood, but such issues are between the couple and God. New life is good. Pursuing new life when it is dangerous to do so could be an act of faith or an act of foolishness.

But then again, many acts of faith look a lot like acts of foolishness. Couples in this situation should pray for the wisdom to know the difference—to act prudently, but not fearfully. 

When pregnancy is dangerous to the mother's health, this is a difficult situation for couples and for families. Nevertheless, the Church's teaching, though difficult, is what is good and true. Church teaching respects the true meaning of sexuality, while sterilization does not.

While it is understandable why couples would want to resort to sterilization in such a difficult situation, this is still a sin. All sin, not just mortal sin, separates us from God. Those couples who have been sterilized should avoid the temptation to justify their action nor should they keep themselves away from the Church out of guilt and shame for "failing" at Catholic sexual teaching. Instead, they should confess their sins; receive God's mercy, forgiveness, and healing; and be reconciled to the Church.

Edit: Contraception/Sterilization for Medical Reasons

Some people have wondered about what a couple should do if the woman needs birth control pills as hormonal therapy to treat a medical condition or a hysterectomy. This is a separate issue. This post is about sterilization for the exclusive purpose of preventing pregnancy, where the only medical issues are due to the pregnancy.

Moral Theologian Fr. John A. Hardon, S.J. addresses the use of birth control pills for medical reasons. (See Specialized Problems.)

Clearly [birth control pills] could be licitly administered for curing these [menstrual] disorders, even though temporary sterilization were caused. An undesirable side-effect is permitted for the sake of a great good.

One guideline about whether any medical treatment involving fertility is allowable is what I call the "nun rule": If a religious sister (i.e. non-sexually active woman) in the same condition would undergo the same treatment, it is probably OK for a married woman to do so. Treatment of medical issues should not be seen as a "loophole" to use contraception in your marriage.

Some may be concerned about a possible abortifacient effect of birth control pills. When use of the pills is for hormonal therapy and not for pregnancy prevention, any pregnancy loss would be a unintentional miscarriage, not a deliberate abortion. The risks of miscarriage vs. the benefits to the woman from such therapy should be weighed in the same way as any other treatment or no treatment. (Because the primary mechanism of the pill is prevention of ovulation and women with menstrual disorders are likely to have trouble carrying a pregnancy to term without intervention, often the risk of miscarriage for these women is less while on the pill than while trying to conceive.)

Finally, any form of treatment that shuts down the reproductive system (either hormonally or surgically) is a very serious option—much more so than our society that thinks this is "healthy" is willing to recognize. Women who believe they need birth control pills or a hysterectomy to treat a medical condition would be well advised to seek a second opinion or look for alternative forms of treatment, such as NaProTechnology or the Billings Center for Fertility and Reproductive Medicine.

Even if a woman does need birth control pills for medical reasons or if she has to have a hysterectomy, the couple can still develop the virtue of marital chastity. The article "Using Contraception with an NFP Mentality" by a married Catholic woman who was using birth control pills to treat the symptoms of some severe medical problems addresses many of these issues.