Contraception

Methods of Contraception: Summary

What is contraception?

Contraception (birth control) is the term used for the prevention of pregnancy. There are many ways to try to prevent pregnancy when you are having sexual intercourse. Some are much more effective than others. They include the use of hormone medications, contraceptive devices (barriers), periods of avoiding sex, and surgery. What follows is basic information on these various methods. This will help you decide which method is right for you and your lifestyle.

Remember that you need to consider whether the method you choose will also protect you from getting sexually transmitted infections. Sometimes you may need to use more than one method to prevent pregnancy AND disease. The latex male condom and the polyurethane female condom are the best protection currently available against sexually transmitted infections. They are the only ways to reduce your risk of being infected during sex with HIV, the virus that causes AIDS. The birth control methods using hormones, natural family planning, and withdrawal do not give any protection against disease.

What are the different methods of contraception?

Hormone Medications

Birth control pills (oral contraceptives); Depo-Provera and Lunelle (injections); Evra (patch); Norplant (placed under the skin); and Nuvaring (a vaginal ring) all contain manufactured forms of the hormones progesterone and/or estrogen. The hormones stop a woman's ovaries from releasing an egg each month. They also cause the cervical mucus to thicken, which then acts as a barrier to sperm. A woman takes birth control pills according to a daily schedule prescribed by her health care provider. Depo-Provera is given by injection and prevents pregnancy for 3 months. Lunelle is used monthly.  The Evra skin patch needs to be replaced every week.  Nuvaring is inserted into the vagina and needs to be changed monthly.  Norplant is a set of small, thin, flexible capsules that are placed under the skin of a woman's arm. Norplant prevents pregnancy for up to 5 years, the length of time recommended for leaving the implants in place.

All of these hormonal forms of birth control require visiting a health care provider for a prescription, shot, or placement of the capsules.

Contraceptive Devices

Most contraceptive devices form physical or chemical barriers that stop sperm from entering a woman's uterus. 

The male condom is a tube of thin material (latex rubber is best) that is rolled over the erect penis just before any contact of the penis with a woman's genitals. The male condom provides the best protection against sexually transmitted diseases, including HIV.

The female condom is a 7-inch-long pouch of polyurethane with two flexible rings. It is inserted into the vagina before intercourse. It covers the cervix, vagina, and area around the vagina. Like the latex male condom, the female condom provides protection against some sexually transmitted infections, including HIV.

Spermicides are sperm-killing chemicals that are available as foam, jelly, foaming tablets, vaginal suppositories, or cream. They are inserted into the vagina no earlier than 30 minutes before intercourse. Spermicides should NOT be used alone. They should be used with another contraceptive, such as a condom, for increased effectiveness.  Spermicides do not significantly protect against sexually transmitted diseases.

Contreceptol is a form of nonoxynol-9, which is a spermicide.  When used in conjunction with a condom, and both are used properly, they are approximately 98.2% effective (therefore very unlikely that you would become pregnant).   A wise choice is using a spermicide together with condoms (this is more effective than using condoms by themselves).

As far as how to use correctly, the spermicide (which may be a gel, foam, or contraceptive film) needs to be inserted into the vagina prior to any heterosexual intercourse.  The condom, preferably with a reservoir tip, needs to be checked to make sure it is not past its expiration date, and that it has not spent most of its life in a wallet or exposed to excessive heat.   Roll the condom onto the erect penis prior to any penile vaginal (or anal) intercourse, and check periodically during intercourse to ensure it hasn't slipped off.  After ejaculation, the man needs to withdraw from the vagina (or anus) before he loses his erection.  While withdrawing he needs to hold onto the condom to assure that it doesn't slip off.

Condoms and spermicides can be purchased at drug and grocery stores without a prescription.

The diaphragm is a soft rubber dome stretched over a flexible ring. No more than 3 hours before intercourse, the diaphragm is filled with a spermicidal jelly or cream and inserted into the vagina and over the cervix. (The cervix is the opening of the uterus).

The cervical cap is made of latex rubber or plastic and is shaped like a cup. It is smaller and more rigid than a diaphragm. No more than 24 hours before intercourse, the cap is filled with a spermicidal jelly or cream and inserted into the vagina and over the cervix.

The intrauterine device (IUD) is a small plastic device containing copper or hormones. Instead of stopping sperm from entering the uterus, the IUD changes the physical environment of the reproductive tract, which prevents the egg from being fertilized or implanting and growing in the uterus. An IUD is inserted into the uterus by a medical professional. Depending on the type, it may be worn from 1 to 10 years before it must be replaced.

The diaphragm and cervical cap require a health care visit for a fitting. The IUD requires a health care provider visit for insertion and removal.

Natural Family Planning and the Withdrawal Method

The natural family planning methods of birth control do not depend on any devices or drugs. To prevent pregnancy you cannot have sex for about 7 to 10 days during each menstrual cycle. To know when it is safest to have sex, you record body temperature and changes in cervical mucus daily.

The withdrawal method involves removing the penis from the vagina just before semen starts coming out (ejaculation). Often sperm are deposited in the vagina before or during withdrawal, making this method unreliable. 

Sterilization

Sterilization is the surgical closing of the tubes that normally carry the sperm or eggs. A woman or man who undergoes sterilization should no longer be able to conceive children.

In a vasectomy a surgeon cuts and seals off the tubes that carry sperm in a man. When a woman is sterilized, her fallopian tubes, which carry the eggs from the ovaries to the uterus, are sealed off. A vasectomy is a more minor surgical procedure than female sterilization.

How well do the various methods prevent pregnancy?

The following chart shows the typical failure rates of birth control methods discussed in this handout. The failure rate is the number of pregnancies expected per 100 women during 1 year of using the method. The rates vary, depending on how correctly and consistently each method is followed. If a method is used perfectly, the failure rate is lower than the typical rate shown here. Use of more than one method (for example, birth control pills and condoms) can decrease the chances of failure.

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Study results provided by:

Hatcher, R.; Trussel, J.; Stewart, F.; Stewart, G.; Kowal,
D.; Guest, F.; Cates, W., Jr.; Policar, M. Contraceptive
Technology.  (New York: Irvington Publishers, Inc., 1994).
Table 5-2.  Adapted with permission.
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As you can see, other than sterilization, the hormone medications and the IUD are the most effective methods of birth control. However, the diaphragm and cervical cap can be nearly as reliable if they are used properly. The least reliable methods are spermicide alone, natural family planning, withdrawal method, and female condom.

Remember to consider always using a condom in addition to other methods of birth control to prevent sexually transmitted infections.