RESUMO
PIP: The contraceptive revolution, in separating sexuality from fertility, has brought into sharper focus some of the problems of normal human sexuality. Animal sexuality is purely biologic, but the nature of human sexuality is qualitatively distinct; sexuality is not solely driven by instinct or need, and is not invariably followed by the birth of young. The contraceptive consultation transcends the mere technologic aspects of method choice and is an occasion for communication. Contraception 20 years ago when the pill appeared was accepted initially by mature couples who had reflected on their situation, but it has become increasingly the concern of single women and physicians, resulting in an increasing failure of men to accept responsibility for their sexuality or paternity. The role of the mother should be assessed in contraceptive consultations with adolescents: mothers who propose that their daughters receive pill prescriptions on the pretext of worry about unmarried pregnancy may actually have an unconscious desire to relive their own adolescence free of the taboos they encountered. When the adolescent secretly seeks contraception against the wishes of her mother, the physician is faced with the task of making the consultation an act in favor of the patient instead of an act against the parent s. The physician who takes the trouble to listen to his patient recognizes her capacity for autonomy. A contraception failure is sometimes the expression of an unconscious desire, even if the pregnancy itself is refused. While women who are now middle aged or older were troubled by recurring pregnancies and may have longed for the menopause, younger women are likely to complain of the side effects and discomforts of contraception. The availability of effective contraception has probably produced changes in attitudes toward fertility and sexuality. The IUD may appeal to women who are disturbed by the complete dissociation of sexuality and fertility of the pill. Contraception that doesn't fail may be perceived by women as castration of their power of fertility, a power that is at present entirely in the hands of women because the most effective contraceptive methods are female. Whether or not men desire children, they are now dependent on their partners' contraceptive use, which appears to be increasingly the concern of the woman and her doctor rather than of the partners together. The contraceptive revolution has changed the experience of sexuality, sometimes for the better but sometimes, perhaps, by seeming to oblige wives in particular to have intercourse more frequently than they mighter prefer, an example being postpartum women who are counseled about contraception despite a notable lack of enthusiasm.^ieng
