Germany: Difference between revisions

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[[File:Flag of Germany (unoff).svg.png|300px | thumb|right|alt=Image provided by Creative Commons.|]]

'''OVERVIEW'''

Germany is renowned for its sexual openness and LGBT community. However, there are some roadblocks to certain health care options. To obtain contraception, you must first receive a prescription. Since March 2015, you can purchase some emergency contraception (the morning after pill) in Germany without a prescription. While abortion is permitted, there is a mandatory "counseling" session, which has made some women feel guilty, ashamed or incredibly uncomfortable (see "Abortion" section for details). On the positive side, there are some absolutely fantastic hospitals and doctors, as well as a wealth of resources specifically geared toward the LGBT community. The transportation system is rather efficient and English is spoken by most locals.  

'''General Note:''' There are many types of contraceptives, also known as "birth control," including IUDs, oral contraceptives, patches, shots, and condoms, etc. If you would like to view a full list, click [https://www.plannedparenthood.org/learn/birth-control here].

In Germany, you need a prescription to obtain hormonal contraceptives ("verhütungsmittel" in German), such as the pill, IUDs, etc. So you will need to arrange an appointment with a gynecologist ("frauenarzt" in German) to obtain the prescription. If you a prescription from another country, there is a good chance that the pharmacy will accept the prescription and issue you the medication.

The majority of women (of reproductive age) in Germany are using some form of contraception. In the 1990s, it was calculated that 74.7% of German women were using contraception with 58.60% of these women on the pill.

Condoms are available in nearly all drug stores or pharmacies.

* For a comprehensive list of contraceptive options available in Germany, click [http://contraceptive.ippf.org/search?search.searchtext=&search.component=&search.countrycode=DE here].

* If you already have a prescription for '''birth control pills''', you can visit a pharmacy ("apotheke"), which is typically open from 9:00-18:00, Monday to Friday, and 9:00-12:00 on Saturdays. If you do not yet have a prescription, you'll need to arrange an appointment with a doctor. In Germany, there are over 70 brands of birth control available. For a full list, click [http://contraceptive.ippf.org/search?search.searchtext=&search.component=&search.countrycode=DE here].

* If you want an '''IUD''', you can find Mirena in Germany.

For women under 18 years, birth control pills are free or can be purchased with a 5 euro copay (as of 2015). For women over 18, they will need to pay the full price, which will vary based on the brand. But a one month supply of Desofemine cost 15 euro in 2015.

'''Important Notes:''' Emergency contraception may prevent pregnancy for three days (72 hours) and sometimes five days (120 hours) after unprotected sex. Take EC '''as soon as possible''' after unprotected sex. If you don't have access to dedicated EC, oral contraceptives can be used as replacement EC, but remember the following: 1) Only some contraceptives work as EC 2) Different contraceptives require different dosages and time schedules to work as EC 3) You must only use the first 21 pills in 28-day packs and 4) They may be less effective than dedicated EC. For general information on emergency contraceptives, click [https://www.plannedparenthood.org/learn/morning-after-pill-emergency-contraception here] and [http://ec.princeton.edu/info/ecp.html here].

In Germany, you can get emergency contraception (the morning after pill) without a prescription. Until March 2015, it was by prescription only. Now you can purchase Levonorgestrel and Ulipristal pills over-the-counter and, if you're over 14 years old, you don't parental consent.<ref>[https://en.wikipedia.org/wiki/Emergency_contraceptive_availability_by_country#Germany Contraceptive Availability by Country: Germany]</ref>

'''Note:''' The longest-lasting EC is currently [http://www.ellaone.com/ ellaOne]. It lasts up to 5 days (120 hours) after unprotected sex, and it's available in Germany.  

You can find emergency contraception in public sector clinics, private clinics, pharmacies and emergency rooms. Some Catholic hospitals may refuse to prescribe or issue EC, but this is not very common. For dedicated EC products, there's ellaOne, an anti-progestin, and you should take 1 pill within 120 hours after unprotected sex. There's also PiDaNa, a progestin, and you also should take 1 pill within 120 hours after unprotected sex.<ref>[http://ec.princeton.edu/worldwide/ Princeton EC Website]</ref> As for contraceptives used as EC, there are a variety of contraceptives in Germany, and instructions for how many to take will vary according to the pills. For more details, visit the [http://ec.princeton.edu/worldwide/ Princeton EC website], where you can find all possible combinations accessible in Germany.

Further Reading:

* [http://www.indieberlin.de/indiesex/banging-berlin-emergency-contraception-free-in-berlin.html Interesting Article On Getting EC in Berlin] (IndieBerlin, May 2015)

LNG: € 17, as of 2013; UPA: € 35, as of 2013.

'''Important Notes - Learn about PEP and PrEP:''' If you think that you've been recently exposed to HIV (i.e. within 72 hours), seek out PEP (Post-Exposure Prophylaxis). It's a month-long treatment to prevent HIV infection after exposure, and it may be available in your city. Take PEP as soon as possible. For more information, click [https://www.aids.gov/hiv-aids-basics/prevention/reduce-your-risk/post-exposure-prophylaxis/ here]. If you are at risk of HIV exposure, seek out PrEP (Pre-Exposure Prophylaxis). It's a daily oral pill that can prevent HIV infection before exposure. To learn more about PrEP, click [http://www.whatisprep.org/ here].

If you are interested in long-term residency or citizenship in Germany, some regions (for example, Bavaria) require an HIV test before your approval. Furthermore, if an insurance claim is filed in Europe, the test results aren't necessarily protected/confidential. So it is advised to seek anonymous testing, if you would like to keep this information truly private.

There are many STD testing facilities in Berlin, though many of them are exclusively or almost exclusively for MSM (men who have sex with men). For this reason, it is best to confirm that a facility can test you in advance. We have provided a list below of facilities that test women (either all the time or on specific days).

* Check city pages, like the [[Berlin]] page, for local recommendations.

* AIDS-Hilfe Dortmund e.V.

* AIDS-Hilfe Dresden e.V. - Dresden organization providing HIV/AIDS information and many social programs and counseling for people with HIV.

* Telefonberatung der Bundeszentrale für gesundheitliche Aufklärung - AIDS and STD Hotline run by German government's health information center, also provides some information online regarding HIV.

All Germans and legal residents are required to have health insurance, so they may be covered through their insurance. For those who are uninsured, STD tests can vary from 200 euro (for consultation to testing and lab results) to 10 euro (for budget options). If you're looking for the cheapest option, go to Center for Sexual Health and Family Planning, which is run by the city and keeps costs low.

The HPV vaccine was introduced to Germany in 2007. There's no PreP availability in Germany, as of 2015.

'''Note:''' In addition to pads and tampons, you can also use menstrual cups and menstrual underwear for your period. To learn more about menstrual cups, click [https://en.wikipedia.org/wiki/Menstrual_cup here]. To learn more about menstrual underwear, click [http://menstrualcupreviews.net/best-period-panties-reviews/ here].

You can easily find pads and OB tampons. Tampons with applicators can be found in select shops but it's much more difficult. For DivaCup, visit the Berlin location of Globetrotter (Schloßstraße  78-82, 12165  Berlin, Phone: 030/85 08 92 0, Website: www.globetrotter.de/). You can also buy online on German websites like Biogarten (http://www.biogarten.de/), MEDintim (https://www.medintim.de/), Washbaer (https://www.waschbaer.de/shop/), etc. The Mooncup is sold in Berlin the following locations: Lifelines (Bundesallee 117, 12161 Berlin, e-mail@Lifelines-berlin.de, Telephone: +49 30 85401548), Lebensfluss (Boxhagener Straße 13,10245 Berlin Phone: 030-60982382, www.lebensfluss.de) and Vielfalter (Brunnenstraße 147, 10115 Berlin Phone: 1787 610663).

In Germany, every woman over the age of 20 is covered (either by private or public insurance) to receive a gynecological exam. These exams include a pap smear, pelvic exam, etc. If you go to a doctor in Germany and ask for an annual exam, they'll know what to do.

In German, "gynecologist" is "frauenarzt."

From InterNations: "It is important to note that ob/gyn care in Germany distinguishes clearly between gynecologists and obstetricians (Geburtshelfer). In case you are going to have a baby, you will have your pre-natal checkups at your usual gynecologist in Germany; but they will only be present during the birth if they happen to work as an obstetrician at your hospital of choice as well" (Source: [https://www.internations.org/germany-expats/guide/15986-health-insurance/women-s-health-in-germany-16004 Women's Health in Germany, Internations]).

'''Important Note:''' There are two main types of abortions: medical (also known as the "abortion pill") and surgical (also known as "in-clinic"). For medical abortions, you take a pill to induce abortion. For surgical abortions, a procedure is performed to induce abortion. For general information about medical and surgical abortions, click [https://www.plannedparenthood.org/learn/abortion here].

In Germany, abortion is permitted in Germany for the first trimester. But there's one hard restriction: a woman must first seek counseling before getting an abortion. The goal of counseling, according to German law, is to "protect the unborn life. The counseling should encourage the woman to continue the pregnancy, and should help her see the opportunities of bringing up a child." After the counseling, the woman must observe a three-day "consideration period" during which she must decide if she wants the abortion. If she does want the abortion, she can proceed to do so, and the counselor will typically refer her to a clinic or hospital.  

Despite these restrictions, abortion in Germany, especially in Berlin, is very common. In the first trimester, legal reasons for an abortion include: to save the life of the woman, to preserve physical health, to preserve mental health, rape or incest, fetal impairment, economic or social reasons, and available on request. After the first trimester, abortions can be performed if the woman has mental/health problems or if there is potential risk to the fetus. But this is an exception, not the standard, and a case must be made.  

Before German reunification, West and East Germany had very different abortion policies. In East Germany, abortion was legal and common. Under the socialist government, abortion was seen as part of women's socio-economic equality. In West Germany, abortion was only permitted in certain scenarios, such as when there was a serious threat to the woman's life or child's health, or in instances of rape or incest. In some cases, women were allowed abortion due to extreme socio-economic distress, but this determination could not be done by the woman; it was decided upon by a third party. When the country was reunified, a new abortion policy needed to be made to accommodate the country. The compromise between the laws of East Germany and West Germany brought the abortion laws of Germany today.  

While Berlin is a generally progressive city, some patients have reported unfriendly treatment at certain facilities. So, as always, it's important to research in advance. There are some Catholic hospitals that refuse to prescribe the abortion pill, even though it is legal, as well. However, Berlin has the most abortions out of any city in Germany each year, and it is reportedly much more tolerant toward abortion than more conservative regions of the country, such as Bavaria.

* For detailed recommendations, please check out city pages.

* ProFamiia Berlin - Can provide the necessary counseling (legally required) before an abortion. Need to confirm if they also provide abortion service or just referrals after the counseling. Details: "Pro Familia is the leading non-governmental service and consumer organization for sexual and reproductive health and rights in Germany. Founded in 1952, it is a charity with a Federal structure. As a founder member of the International Planned Parenthood Federation (IPPF) it is closely linked to international developments and activities in the field of sexual and reproductive health and rights." Address: Beratungsstelle Berlin, Kalckreuthstr. 4, 0777 Berlin, Phone: 030 39849898, Email: berlin@profamilia.de. Website: http://www.profamilia.de/index.php?id=909

In 2010, the average cost of a medical abortion was 300 euros. The average cost of a surgical abortion is 460 euros.

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