Information on Contraception & Emergency Contraception.
Information on Contraception
There are multiple types of contraception. Not all types are available in all areas, and it’s a good idea to speak with your doctor about which type is best for you.
Some contraceptive methods protect both against pregnancy and against STD/STIs, while others do not. It is important to make sure you pick a type that offers the level of protection that you need. Penile-Vaginal intercourse is the only method of sexual intercourse that can result in pregnancy. However, all types of intercourse can result in STD/STIs.
Abstinence – Abstinence is the avoidance of sexual intercourse. Some people define abstinence as the avoidance of all sexual contact beyond kissing and physical contact with clothing intact. Others have a more relaxed definition that allows sexual contact except for sexual intercourse. Abstinence is one of only 2 100% effective methods of avoiding pregnancy, and the only 100% effective method of avoiding STD/STIs
Withdrawal/Pull Out – This method involves the removal of the penis from the vagina prior to ejaculation. Because seamen can be present in pre-ejaculate this method is not reliable against pregnancy or STD/STIs.
Rhythm Method (Calendar Method) – This method has proven quite effective, although it is not 100% effective against pregnancy, and offers no protection against STD/STIs. This method can also be used to increase the chances of pregnancy occurring. A woman is most fertile during a several day window in her menstrual cycle. The rhythm method involves the woman keeping track of her cycle, and determining which days she is most fertile and avoiding sexual intercourse on these days, or using an alternative method of contraception. A popular way of tracking involves the use of Cycle Beads or a similar item. Some form of cycle tracking beads are available most countries either via online or family planning centers.
Condoms – Condoms are approximated to be 85%-90% effective against preventing pregnancy and STD/STIs under standard use. Under perfect conditions they can be up to 98% effective. Condoms can be used for vaginal intercourse, anal intercourse, and oral intercourse and different types of condoms are available for each method. In most places condoms can be bought over the counter without seeing a doctor.
Male Condoms – Male condoms are the most commonly used type of condom. They are placed on the erect penis of the male prior to penetration. For maximum effectiveness it is important that the condom is placed on the penis prior to any contact with the vagina, as pre-ejaculate can contain sperm.
Female condoms – Female condoms are roughly triangle shaped and placed inside the vagina of the woman with the “tip” in the opening of the cervix at the top of the vagina. The base of the female condom is wide and open and extends outside of the opening of the vagina. Depending on the brand of female condom they are held in place differently.
Note on Condoms – Most condoms are made of latex, which is a semi-common allergy. There are condoms made out of alternative materials such as polyurethane and lamb. Latex and polyurethane condoms are THE ONLY types of condoms that will block the transmission of the HIV virus. Condoms made of other materials will not, even if they block against other STDs.
Barrier Devices – There are multiple different methods of barrier devices, and effectiveness varies depending on the device. These 3 barrier devices are infrequently used for various reasons and their availability varies greatly depending on the country.
Dental Dam – A dental dam is a plastic sheet that is used during oral sex performed on a woman. It is a thin sheet that is placed against the woman’s vaginal area to provide a barrier between the vagina and the mouth of the partner. There is no risk of pregnancy during cunnilingus, so the dental dam is used to protect against STD transmission.
Cervical Cap – The cervical cap is placed inside the vagina over the opening of the cervix. It looks somewhat like a small cup with a round bottom, and blocks sperm from entering the cervix where it would become fertilized. The cervical cap doesn’t protect against STDs and it’s effectiveness against pregnancy vary between 55% and 85% depending on the brand of cervical cap and the number of children the woman has had. The cap must be properly fitted by a trained medical provider as it comes in multiple sizes.
Diaphragm – The diaphragm is similar to the cervical cap, although it doesn’t fit over the opening of the cervix, it covers the opening by causing the plastic device to. The diaphragm blocks sperm from entering into the cervix where it is fertilized, and can also hold spermicidal gel for additional protection. It doesn’t protect against STDs and its effectiveness against pregnancy varies from 60% to 90% depending on a variety of factors. The diaphragm must be fitted by a health care professional, and must be refitted after weight changes more than 10lbs or 2/3 Stone, and after pregnancy of any duration.
The Sponge - The sponge is inserted into the vagina over the opening of the cervix. Most sponges come pre-saturated with a spermicidal solution which is what provides the majority of their effectiveness. They do not protect against STDs and their effectiveness varies from 70% to 90% depending on the brand and whether the woman has been pregnant or not. Many women experience significant vaginal irritation from spermicidal gels which has prevented the sponge from gaining widespread use.
Hormonal - Hormonal contraception is one of the most popular forms of contraception, and it comes in many varieties allowing for a wide range of women to use it. Different hormonal contraceptives are available in different areas, and all generally require a prescription from a doctor to obtain. Hormonal contraceptives work by preventing the woman from releasing an egg (ovulation). Hormonal contraception is well tolerated in some women, while other experience side effects that prevent their continued use. With a wide variety of types of hormonal contraceptives available one may not work well for one woman, but another will.
Oral Contraception – There are 2 main types of oral contraception, one using progesterone only, and the other using a mix of progesterone and estrogen. Both are taken once a day in pill form. They provide no protection against STDs and are 90% to 99% effective against pregnancy; however their effectiveness depends greatly on the woman’s ability to take the pill consistently.
The Patch – The contraceptive patch is similar to those used to stop smoking. The hormones are infused into a gel which is applied to a small patch and applied to the skin. Each patch lasts for a week, and then must be changed, with the woman not wearing a patch for a week to allow for her menstrual period. This is beneficial for women who may have difficult remembering to take a pill daily. The patch doesn’t protect against STDs and is about 98% effective. Effectiveness does depend on the woman remembering to change the patch when needed.
Depo Provera – Depo provera is an injection of hormones that lasts for 3 months. While taking Depo Provera a woman doesn’t generally have her menstrual period, although she must get the injection every 3 months within a specific window of time. Many women find this method beneficial due to the lack of menstrual period and because it only requires an injection every 3 months rather than taking daily or weekly hormones. However, this method does have a higher rate of side effects due to the high level of hormones the injection has. Depo Provera offers no STD protection and is about 97% effective against pregnancy.
Implanon – Implanon is a small rod, about the size of 3 grains of rice, which is filled with hormones which are slowly released over 3 years. It is injected into the skin of the upper arm and is left in place. A specially trained medical provider is needed to insert the Implanon, which limits it’s availability in some areas. It offers no protection against STDs and is 99% effective against pregnancy.
Norplant – Norplant is similar to the Implanon, although it has a 5 year life span. It has multiple arms and looks like a small fan. It is inserted into the upper arm and releases hormones slowly into the body. It does not protect against STDs and is about 99% effective against pregnancy. The Norplant is not available in the US, many other western countries, and has recently only been used in developing countries.
Nuvaring – The Nuvaring is a soft ring that is infused with hormones that are released slowly over a period of 3 weeks. The ring is inserted into the vagina and left for 3 weeks, at which time it is removed to allow menstruation. It does not protect against STDs and is about 97% effective against pregnancy.
Intra Uterine Device – The Intra Uterine Device or IUD is a small T shaped device that is placed just inside the opening of the cervix. IUDs prevent pregnancy a couple of ways by causing physical changes in the cervix to make it difficult for an egg to become implanted. There are two types of IUD. One that uses hormones that are released slowly, and can be used for up to 5 years, and another that is made out of copper and does not use hormones that can be used for up to 10 years. IUDs do not protect against STDs and are about 99% effective against pregnancy.
Surgical Sterilization – Surgical sterilization is a permanent form of birth control that can be performed on either a man or a woman. There are different methods depending on gender. Complete surgical removal of the uterus of a woman is one of only two ways to be 100% protected against pregnancy. Surgical sterilization generally involves multiple consultations with a health care provider to discuss the different types of surgery available, and to evaluate if you are healthy enough for surgery. Surgical sterilization is 98% to 100% effective depending on the type of surgery and does not protect against STDs.
Emergency contraception is contraception given after sexual intercourse where no contraception was used or the contraception fails. After a woman has sex the sperm and egg must both travel to the uterus where the egg can become fertilized, this can take between 2 and 5 days. Emergency contraception is taken during that time, and prevents the egg from becoming fertilized. It is NOT an abortion, as the egg has no become fertilized yet when the contraception is taken.
Hormone based emergency contraception, known as Plan B or the morning after pill is the most commonly used version of emergency contraception. It consists of 2 pills containing a high dose of hormones that are taken within 72 hours of sexual intercourse. In many areas it is available directly from a pharmacy to women over the age of 18 or 16 without a prescription. In other areas, and for some women under 18, a doctor’s prescription is required. The morning after pill is available in the UK, USA, Australia, Canada and most European countries directly from a pharmacy. Family planning clinics, Planned Parenthood, and GUM/Women’s Health clinics should also have it available and your regular family doctor should be able to write a prescription. Most ER/A&Es, minor injury units, walk-in clinics, and urgent care centers have the morning after pill available, but it is advisable to call ahead to these places to see if they do carry it because some places do not for various reasons.
Many Muslim, Eastern, and African countries strictly regulate all kinds of birth control so the morning after pill may not be as easily available there. However, it is always a good idea to speak with your doctor and see what your options are even if you do live in one of these areas.
A less used method of emergency contraception is the copper IUD, which can prevent pregnancy when inserted within 5 days of sexual intercourse. However, this is not commonly used because of the reduced availability of IUDs in some areas, and because doctors often require a consultation prior to inserting an IUD.