Hormone Therapy?

Question Submitted: I was wondering if you know where I might find good information about the ethics of the medicinal use of hormonal therapies for a married woman. It looks like I will probably be having to wade into some murky waters here soon. Tomorrow, I’m going to make an appointment with my OB. I saw her nurse practitioner a week ago, and she was thinking I need either three months of birth control or 10 days of progesterone, but we decided to see if time would help. Well, after nearly doubling over with cramps in the middle of the church service on Sunday because of my 4th menses in 2 months, I think we need to do SOMETHING. I trust my doctor for the medical info, but I don’t think she will be able to help with the ethics. My husband and I would like to be as well informed as we can be before making any decisions, but, to be honest, other than doing a little research that led us to avoiding hormones for birth control, we don’t even know were to start. I was hoping you could point us in a general direction. Thank you so much.

I am so sorry to hear you are in such physical pain. That is awful. I had similar pain episodes a couple years ago. They were excruciating, debilitating, and socially embarrassing.

I do not know of any particular published resources which I 100% recommend on this topic. At this point, I suggest you ask your OB-gyn some very frank questions, listen to her answers, talk to your husband/pastor/father confessor, research all you can about your doctor’s suggested treatment plans on the internet (Lutherans for Life and LCMS Life and Health Ministries may be helpful resources with this), and then make decisions according to your conscience. Remember, you do not have to make a decision in the doctor’s office. You can go home, take your time researching and discussing your options, and come back at a later time with your decision.

If it helps, at the request of my own OB-gyn, I took the pill for a few months a year-and-a-half ago to help her diagnose what kind of masses were growing in my abdomen. Since some types of masses are known to be hormone responsive, my undergoing hormone therapy helped my doctor diagnose (without immediately, surgically opening me up) whether or not those masses were cancer, regular cysts, fibroids, or endometriomas. The results of the hormone therapy helped my doctor better treat me and, in the end, prepare for surgery.

I will admit that in order not to burden our own consciences, my husband and I abstained during that time.

I also bartered with my doctor. I acknowledged her need for me to take the pill for diagnostic purposes, but I also explained that I was only willing to take it for a limited season of time. She understood from the beginning that the pill was never going to be an acceptable, longterm treatment option for me. I think that information helped her make alternative treatment decisions for me before, during, and after my surgery. My surgery was successful, though my doctor had to leave some offensive tissue in my body so as not to destroy some of my organs. In an effort to get rid of that tissue, I then took Lupron Depot shots for six months in order to starve the tissue of my own hormones and, hopefully, kill it.

I am neither advocating nor discouraging you from taking hormone therapy for the purposes of healing medicine. I never thought I ever would, but, when the time came, the risks of vascular bleeding in undergoing immediate surgery and the risks of an ovarian torsion in doing nothing outweighed the longterm health risks of hormone therapy for me. My doctor was also reticent to perform a hysterectomy at the time unless she absolutely had to, as the consequences of depleting my body of its natural hormones in my early thirties also had longterm risks. Every woman is different, every diagnosis is different, and every treatment plan is different. Just be sure to ask your doctor detailed questions about the entire effects of any therapy which you engage. Let her know that you have religious concerns that could burden your conscience if you engage in any therapy which might potentially serve as contraception or an abortifacient. Whether your doctor agrees with you or not, she is a professional who wants the best for you and your health and most likely will respect your request with honest, forthright answers. She does not have to agree with you to be a good physician.

At this point, I do not plan on engaging in any more hormone therapy for long-term health reasons. My husband and I agreed to undergo such therapy once in an attempt to rectify the immediately dangerous situation. If I continue to have problems post-surgery, my husband and I are seriously considering alternative options, even a hysterectomy, for hormone therapy does have its own longterm consequences on the female body.

These are such hard decisions. I am sorry that they are also undefined and ethically murky in so many ways. I am serious about asking your doctor the hard questions. Listen to her, talk to your husband, make a decision you can live with, and trust in Christ always.

+ Mrs. Jeanne Korby +

Mother’s Day 2009 was particularly gruesome. I was living in that tortured season of hope that is a barren woman’s early thirties, and every month brought a fresh wave of pain, guilt, anger, and confusion. Mother’s Day was a fat, juicy lemon whose acid was being mercilessly squeezed into my open wound.

To make matters worse, I was without my husband that day. I can’t remember why – perhaps he was guest preaching out of town or on some seminary trip – but I walked into the church all by my lonesome that morning.

I had to walk past the table where corsages were being handed out to mothers in the congregation. The dreaded walk of shame. My cheeks burned red with humiliation.

A be-flowered friend stepped up to me in the narthex. She fingered her corsage while she spoke. I can’t remember what she said, but I remember the tightness in my throat as I willed the tears not to spill. If I could just make it into the church. Someone special was waiting for me there.

I slid onto a cold pew in the side wing of the nave. Next to the wheelchair.

“You can be my daughter today, and I’ll be your mother.”

“Thank you, Jeanne,” I whispered, the tears falling freely, now. I didn’t need to hide them from Jeanne. She already knew. Still, I wiped at them, not wanting anyone else to know.

We sat by each other through the whole service. I probably even leaned on her, she with the fragile back and weak cartilage. She was always stronger than she looked.

We took and ate the Body and Blood of our Lord together in the side chapel reserved for those who have trouble making it up to the altar. As we knelt at the rail, I whispered in her ear, “Jeanne, what do you think about when you take the Lord’s Supper?”

She didn’t balk at my imprudence. She and I always talked like this. Forthright. Familiar. Honest.

“I think,” she whispered back, “‘Lord, I am a sinner. Give me all.'”

Thank you, Jeanne, for being a mother to me in my grief, for mentoring me as a pastor’s wife, and for teaching me the prayer I still pray at the altar today. I rejoice in knowing that Christ Jesus has, indeed, given you all. I wait with you for the resurrection day, dear friend. +

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Shepherds Who Point Us to the Lamb

There is no better time to talk about suffering than Good Friday, and our church body is blessed to have so many learned, compassionate, and insightful shepherds who know that the life of the Christian is one of taking up our crosses and following Christ, the Lamb of God, who takes away the sin of the world. Take some time this weekend to watch, listen, and read the following as we focus on the suffering and death of our Lord:

Rev. Bryan Wolfmueller’s comments on Issues, Etc. about Sanctification and Suffering

Synodical President Rev. Dr. Matthew Harrison’s video, “Suffering is Purposeful through Repentance”

and Rev. Dr. Gifford Grobien’s comments specifically to you, the barren:

When couples experience barrenness, with Job we should want to worship God and to say, “The LORD gave, and the LORD has taken away; blessed be the name of the LORD” (Job 1:21). But in the midst of the devil’s temptations such faithful action and confession seem out of reach. We are distraught. There really isn’t any reason we can hear that will ease the questioning and the sadness. Once again, suffering has overshadowed the way things ought to be. Suffering overtakes even the faithful person. The cross looms and gives no reason.

Instead, the cross calls the church faithfully to follow. Faithfully. That is, even without seeing. Even without perceiving or understanding. The cross beckons us to see suffering and to see deliverance through suffering. It does not explain suffering; but it promises deliverance from suffering. More than this, the cross of Jesus Christ promises deliverance through suffering to fellowship with the one who suffered ultimately. The church is a fellowship of suffering; a fellowship with the passionate One; a fellowship with God of the universe who nevertheless stooped to suffer not just with you, but for you.

Suffering, by its very nature, takes time. We, on the one hand, desire immediate results. We have our food through the drive-through, our information at the touch of a screen, our friends at the click of a mouse. Even our sins are forgiven in a moment, at the Word of absolution. That much is true. Yet suffering connotes experience. It implies time. Deliverance comes after a time of suffering, and this time is not in vain. During this time we are sanctified. We grow in the love of God through the Spirit of God. We are sustained by this same Spirit through God’s indomitable gifts, so that no temptation overtakes us that is beyond our ability. God is faithful, and with the temptation he will also provide the way of escape.

Escape. Deliverance. God provides the way of deliverance from suffering. He conforms us to the cross so that we would die and live in Christ. God delivers from infertility. It takes time. It may take a lifetime. But there is deliverance in the cross.

One of the ways to endure suffering as we await deliverance is to hear God’s Word and to pray. When we pray the Psalms we do both. God knows what it is to suffer, for He gives us psalms to pray even in suffering–psalms of lament. Thus we pray the psalms of lament. Psalm 13: “How long, O LORD? Will you forget me forever?” Psalm 59: “For the cursing and lies that [my enemies] utter, consume them in wrath; consume them till they are no more, that they may know that God rules.”

Pray these psalms, knowing that the enemy spoken of is the devil, the tempter overcome by suffering. He is overcome by Christ’s suffering, indeed, but it is true that Satan is overcome in his work in our lives when we persevere through suffering. When we are afflicted, the root temptation is to curse God and turn away in unbelief. God is all powerful, so our affliction must be his fault! That is the temptation of Satan. That is the theology of glory. So, when we persevere in faith, in spite of affliction, the work of the devil in our particular circumstances is also overcome through the power of the Spirit in the Word.

nosh on this

The eyes of all look to you,
and you give them their food in due season.
You open your hand;
you satisfy the desire of every living thing. Psalm 145:15-16

Food serves manifold purposes, doesn’t it? As a health enthusiast I often ponder the efficacy (or lack thereof) of the food we eat. As common sense would have it, this is what I’ve come up with: Real food nourishes, sustains, it delights us and brings people, most especially our families, together.

Awhile back, host Kristi Leckband wrote a beautiful post found here. In a nutshell, she recounts how her family dynamics around the dinner table were more sullen and silent at times of sorrow over dashed adoption efforts. And now, the dinner conversation jags lively and joyful as they delight in their new daughter adopted from China.

From this post I began to think about the dinner table. It’s compelling how gathering around it with family in either joy and sorrow is so necessary. It strengthens us in that unit. While the food is often the impetus for the gathering, the dinner table can be the weigh station where rest, conversational refreshment and, perhaps, just silent presence is needed.

This certainly has spiritual implications within our church families, too. What about that first Maundy Thursday? Jesus and his disciples are gathered in the upper room. This was one of many occasions in which they’d dined together. While the bible doesn’t say, I’m not so sure laughter, unless it was nervous or out of ignorance, set the tone that particular night. No. That night was focused on just being in each other’s presence and with their Master. In fact, Jesus is doing most of the talking and doing. In spite of the feelings and thoughts around the room about the impending event, food is the one of the reasons they gather. But Jesus is nourishing his disciples on a new spiritual plane; uniting them to Him through bread and wine, reminding them they are forgiven through what He is about to do on the cross.

This must have been a terrifying “church family night.” But they were reminded of who they were in relation to Christ and each other. They gathered around that table to receive food, physical and spiritual, to nourish, sustain and bring them together.

Think back to your childhoods. Hopefully yours are filled with comforting and joyous memories. Did our families turn us away from the table if we had a heavy or anxious heart? Did they require us to have a contrived zeal to be there? No. Simply being born or adopted into our families granted us a seat. Sure, we might have had to munch on pureed veggies, small and soft foods until our bellies could digest the more solid stuff on the table. We also (for the most part) learned manners there, too. This private order of service is all part of what it means to grow into our families.

So too, our Lord’s Table does not turn away heavy hearts or require pietistic zeal. Simply being God’s child grants us a seat. Yes, there may be a time in which the Word and baptism are the primary sustenances until a proper examination of communion is confessed. But this is all part of the gifts of learning what it means to grow in God’s church. Jesus knew the right time to teach and administer this holy meal to his disciples, just as we with our pastors are examined in order that we may come to the Lord’s table to receive Christ’s body and blood at the right time, too.

Food conjures up so many thoughts in our minds …the things we crave, what makes us feel good and how we share it with others. How interesting that God uses food and is the food for the strengthening of our faith. This faith craves and confesses Christ crucified for our sins. It desires to be united to Him and to share it with others. And with the substances we see before us: a pastor, the Word, bread and wine, Jesus is the Host, Servant and Meal of this fine dining reality. Blessed Maundy Thursday as we remember our Lord’s death until He comes.

Oh, taste and see that the Lord is good! Blessed is the man who takes refuge in him! Psalm 34:8

It Should Have Been Me

“Did you hear? Alyssa is pregnant!”

“Guess what. My neighbor is expecting twins!”

“Has anybody told you? The Greenbergs are adopting!”

I’m certain we have all been privy to such conversations. In those moments, I have done my best to show genuine excitement for the couple. However, I am falling apart on the inside. That good news should be mine. I should be buying maternity clothing. I should be shopping for a double-stroller. I’ve been eating well, exercising faithfully, attending church on a regular basis. We submitted all of our paperwork to the adoption agency. Birthmothers should be choosing my spouse and me to adopt her child.

If left up to us, our wishes would be fulfilled. The pregnancy test would be positive. The twins would have matching cribs. The adoption process would be smooth as silk. It should be me! I should be the one shouting out such good news. But, no, I’m on the receiving end of good baby news once again.

There’s something else that should have happened to me. I should have been the one who was scourged, spit upon, mocked, pierced, and crucified. Yes, I’m the sinner who has broken every single one of the Ten Commandments. It really should be me who’s dead. I really don’t deserve any of the goodness that has been bestowed upon me, for I am a conceited, selfish sinner, who deserves death.

Thanks be to God that He gave His Son to take that punishment for me. Jesus Christ endured the scorn, the pain, and even the death you and I deserved. During this Holy Week, I humbly bow before the Lord God and thank Him for taking away the death that should have been mine.

Ouch

I admit that I neglect the topic of physical pain on this site. It is a selfish decision on my part. I don’t like to dwell on it. Physical pain simply is, and I can’t do a whole lot about it. It is something to be managed and endured for the long run, and I am the queen of self-numbing when it comes to long runs. Deep breath, chin up, eyes ahead, slow and steady.

However, I do not mean to neglect or ignore your own physical pain, dear reader. I know you are weary. I know you have to stay home two days a month from your job because of the searing pain. I know your menses are more than inconvenient; they are debilitating and socially impossible. I know you can neither stand nor sit nor lie down when the pain hits, and I know you vomit and writhe and pass out from the experience. I know the injections, therapies, surgeries, and crazy dietary restrictions are giant feet kicking your already dead horse. I know you shake your head at heaven every time a cyst bursts and ask “Really, Lord? Isn’t my childlessness alone already painful enough?”

Yet, physical pain is a symptom, not the root, of the problem of barrenness. Sin is the culprit which leaves our bodies twisted in pain, and only Christ’s atonement for that Sin will do. His blessed exchange on the cross, His loving sacrifice of Himself for the Sin of the world, is the reason we have hope in the midst of our pain. For, we know that our Redeemer did not stay dead but lives, and though fibroids and cysts and scar tissue and cancer and worms may destroy our bodies, yet in our flesh will we see God.

So, by all means, consult your doctors, your naturopaths, and your pharmacists for help in managing your physical pain, for they are God’s good gifts to us in this life; but, when the pain cannot be managed and simply must be endured, remember your suffering Savior on the cross and cry out, “Lord, have mercy!” and know that He does.

One More Thing

Speaking of our tendency to seek purpose in everything, our dear Joanna just brought the following quote to my attention:

“The natural view of God, which we construct by our own powers, is one in which we try to fit everything into the concept of the One, the True, the Good, and the Beautiful. For the theologian of the cross, however, this view has been shattered by painful disillusionment. Therefore, the death of the old nature means the end of…all attempts to anticipate [meaning] by postulating it hypothetically.” (Theology the Lutheran Way by Oswald Bayer, 26).

Exactly.

A Mother of Mothers

You’ve probably noticed by now that I rarely blog about the specifics of my vocations in life. It’s not because I don’t have them, and it’s not because I don’t rejoice in them. It’s simply that I am wary of suggesting that your barren life should look anything like mine. God gives each of us different neighbors to serve in life, and there is no sense in comparing.

(That, and the temptation to over-define God-given vocation as purpose can be too overwhelming.)

Yet, there are moments when my joy in my barrenness is such that I have trouble not waxing on all things vocational with you, so if you would indulge me for a few sentences…

Do you know what I love about being barren? I get to be a mother of mothers. God keeps putting more and more of them in my life. These beautiful, hard-working, self-sacrificing, sleepless women keep showing up on my humble path, and I get to serve them. I get to listen to them, nurture them, encourage them, comfort them, cook for them, clothe them, offer them hospitality, render them retreats, take them out for dinner, sing with them, dry their tears, watch their children, do their laundry, clean their bathrooms and floors, invite them over for coffee or tea, play with them, and commend them to my Father in Heaven in prayer.

What a beautiful thing it is to be barren of children but a mother of mothers!

The Purpose Driven Barren Life

pur-pose
noun
1. the reason for which something is done or created or for which something exists

We are obsessed with purpose these days. We seek purpose in everything we do to give our very lives meaning. It comforts us, even puffs us up.

We even seek purpose in the things that happen to us. Take barrenness. If we can determine some reason as to why God is making us barren, then our suffering suddenly has a meaning, an objective, maybe even merit. If there is a purpose to our barrenness, then we are somehow elevated from miserable victim to blessed martyr. We suddenly have a life worthy of the interest of Oprah, Joel Osteen, and Rick Warren, and the prominence of this self-ascribed, higher purpose makes our wretched barrenness not sting so much.

But barrenness should sting. It is a result of Sin in the world, a devolution of the way God created things to be, and no amount of purpose changes that terrible truth.

The danger in trying to assign a particular purpose to our barrenness is that we are actually attempting to define the hidden will of God. We are trying to explain something that has not been explained to us in Holy Writ. We are trying to reveal that which has not been clearly revealed, and we should be wary of putting our hope, trust, and comfort in something that God has not made known to us in His Word. For, most likely, that self-assigned purpose will fail us in the face of the devil, Sin, and our flesh.

This is why it pains me so much when other people try assigning purpose to my own barren state:

“God made you barren so that you could write a book to help other people.”

“God made you barren so that you can be a better mother to all of the youth in your church.”

“God made you barren so that you will have more compassion for orphans and embryos.”

“God made you barren so that you will better appreciate having children when He gives them to you.”

Is any of this true? I certainly don’t know, because God has not revealed any of this to me in His Word, and, I suspect, neither has He revealed it to you.

Then, what true purpose is there in my barrenness? Outside of knowing that my womb is unfruitful because of Sin in the world and that God is allowing my womb to stay unfruitful, I don’t know from God’s Word why I am barren.

Here’s what I do know from God’s Word: Whatever purpose my barrenness serves, God is working it for the good of me and my neighbor; and, because God’s good grace is sufficient for me, I am free to serve the neighbors He has given me in abundance. Yes, that even includes the youth in my church, orphans, embryos, and you.

But, dear church, that is my vocation, not my purpose. Let’s not confuse the two.

What You’ve Always Wondered But Were Afraid to Ask

WARNING: The following post contains information of a “delicate” nature. We hate to be considered an explicit blog, but sometimes you have to talk about the topics that no one else will. Many thanks to our guest responder, Rev. Dr. Gifford Grobien, assistant professor of systematic theology at Concordia Theological Seminary, Fort Wayne, Ind., for being willing to address such a sensitive topic from a pastoral perspective.

Question submitted: My doctor says that in order to find out the cause of our infertility, my husband should really be tested as well. I guess this requires that he submit a sample of sperm. To my knowledge, this is typically collected outside of intercourse. Although I have heard that there are special prophylactics that could be used to collect it during intercourse but I have no idea where one would obtain these. I know of several other couples where the husband has been tested, but now that we’re in this situation and I have to think about how this is really done, I’m wondering if it’s really OK to do. I know that our end goal is good, and that we’re just trying to give the doctor as much information as he can so he can help us, but something just doesn’t feel right about what he has to do in order to get this sample. Any advice?

This is one of those questions that is extremely difficult both emotionally and morally. Emotionally, certainly, because of the good desire of the husband and wife for children. When this good desire is not fulfilled, a couple may feel shame, guilt, inadequacy or other difficult emotions. They may wonder what they have done wrong that they are unable to have children; if they pray long enough that God will end their infertility. Or they may develop hollow, cynical or withdrawn perspectives, with few or no companions to console and be with them.

The question is also difficult morally. It is easy to look at the goal of taking a sperm sample as being good–to try to have a child; to try to be fruitful. But goals are never isolated from action. The ends in themselves don’t justify the means because the means are not merely instrumental. Action is not merely instrumental. Action engages mind and body. Action commits a subject to a certain way of being, even if just for the moment of the action. Action familiarizes a mind and body with the action, so that the action becomes more familiar and easier. Action, even just once, is habit-forming. This is why we always learn through practice, even a one-time run-through. Reading something even once before presenting it publicly establishes comfort and familiarity. Taking a practice test does the same. Swinging the bat or shooting the basketball or walking through the steps of a recipe with the ingredients in front of you focus your mind and clarify the context. Action is inherently habit-forming.

So, should we encourage the act of masturbation, even if just once? Is masturbation as an act value-neutral? What about using a condom in marital intercourse? Is this better? Any kind of sexual climax outside of uncontracepted marital intercourse inherently separates the pleasure of the act from the sexual union of a husband and wife. Sexual intercourse means the use of the sexual organs, which is to ejaculate for the purpose of procreation. This is the basic meaning and purpose of sexuality and sexual organs. Sexual pleasure that is divorced from truly sexual (procreative-seeking) union separates two parts of an act that in creation were intended to remain together. Separating pleasure from marital, sexual union introduces a tolerance, an acceptability, a familiarity, a level of comfort with non-procreative sexual stimulation, whether with contraception, or as masturbation or sodomy.

In marital sexual relations the exciting and mysterious integrity of pleasure and procreation remain intact. With each union there is the pleasure combined with the joyous wonder and hope that this might bring forth a new creation. Even those who are scientifically sterile cannot deny that God may choose–in this act–to give life. Even those who are past childbearing age, by maintaining the physical integrity of the act, confess faithfulness to God’s design. They do not denigrate the act by turning it into mere pleasure, but they uphold that in this particular way of giving pleasure to each other, they conform to God’s design for bringing forth a new life, for deepening their own love beyond themselves, to embracing the love of children. They also bring to remembrance for themselves the joyous hope of years past, and excite in themselves an analogous kind of hope–perhaps not for themselves at that moment, but in thanksgiving for what God has given them, or in the joyous hope of life that God brings forth in others. Most basically, the act still submits to the created way of being.

How much more, then, for those who are of childbearing age, whether seemingly sterile or fruitful. The physical excitement and pleasure of sexual climax, because of its intensity, when separated from the possibility of procreation, is selfish. Physical pleasure is not wrong, of course, but God purposely brings it about in an act that is inherently selfless–the expectation of a third person and the expansion of love for that person. When the divinely designed integrity between pleasure and procreation is broken by human action, the outward-oriented aspect of the act is lost, so that only the inward-oriented aspect remains.

Is there no option for testing sperm of an infertile couple? Yes, if there is a way to do it without breaking the integrity of marital sexual relations. There is this possibility: either percutaneous epididymal sperm aspiration (PESA), or microsurgical epididymal sperm aspiration (MESA). The former uses a needle to collect sperm, while the latter is a minor surgical procedure to collect sperm. It appears that medical providers do not typically think of using these procedures unless a man’s vas deferens is blocked or deficient in some way. It’s also possible that health insurance would not cover them if there is no problem with the vas deferens. Nevertheless, it may be an option for those persistent in requesting it and who meet other medical criteria.

Rev. Dr. Gifford Grobien

He Remembers the Barren

God remembers you in Jesus