We’ve come a long way since the pill was introduced in the 1950s. Today, there are many birth control options available—some of them over the counter (OTC), others prescribed by a medical practitioner (MP). Ask your health provider about which method might be best for you.
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BARRIER METHODS
Barriers block the sperm from reaching the egg. They can be either mechanical or chemical. All of these are nonhormonal methods and most of them (except condoms) do not protect against sexually transmitted infections.
The effectiveness is listed in parenthesis following each method as “(perfect use/typical use).” (2/15) means that with perfect use 2 percent of individuals using this method unintentionally get pregnant in a year, while with typical use (which includes occasionally forgetting to use it) 15 percent get pregnant. Different methods can be combined to increase effectiveness, e.g. condoms and diaphragm.
Mechanical barriers
Male Condom (2/15); OTC
Female Condom (5/21); OTC
Cervical Cap (9/16 no baby, 26/32 after childbirth); MP
Diaphragm (6/16); MP
Sponges (13/19); OTC
Chemical barriers
Spermicidal creams, films, foams, jellies, suppositories and tablets (15/29); OTC
Unlike the regular male condom, the female condom is designed to be worn by the woman. A small pouch with two flexible rings at each end, the ring at the dead end fits around the cervix of the uterus and the other ring stays outside the entrance to the vagina, lining the wall of the vagina all around.
Both the cervical cap and diaphragm are fitted by a health provider, since the size of a cervix varies and changes after delivery of a baby. They can be inserted up to a few hours before intercourse and must remain in place for at least 6 hours afterwards in order to be most effective. With good care (wash in mild soap and store in a cool, dry place), these devices can be reused for up to two years.
Sponges are technically both mechanical and chemical barriers, since they contain a spermicide, which is a substance that makes sperm unable to move. Just before insertion, wet the sponge with tap water to activate the spermicide.
HORMONE PILLS
Combination oral contraceptives (0.3/8); MP
Progestin-only oral contraceptives (0.3/8); MP
Combination oral contraceptives (the pill) contain various amounts of estrogen and progestin. To be most effective, they should be taken every day at the same time, as should the progestin-only pills (called minipills).
Birth control pills are not ideal for everyone, specifically women older than 45, who smoke, have high blood pressure, diabetes, high cholesterol, are obese or have frequent headaches.
HORMONE PATCH
Transdermal contraceptive patch (0.3/8); MP
The patch is a hormone-con-taining adhesive that sticks to the skin and has to be changed every week for three weeks. The fourth week is a “patch-free” week, to allow menstruation.
HORMONE INJECTION
Depo-Provera (0.3/3); MP
These are monthly injections into the buttock or upper arm.
INSERTABLE HORMONE METHODS
Vaginal ring (0.3/8); MP
Intrauterine system (IUS) (0.1/0.1); MP
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68 That’s the percentage of women who use condoms the first time they have sex with a new partner. |
The vaginal ring contains estrogen and progestin and is inserted once for three weeks. The fourth week is a “ring-free” week to allow menstruation. If you’re comfortable using tampons, inserting the ring shouldn’t be a problem. When inserted correctly, the ring cannot be felt by you or your partner.
NONHORMONAL INTRAUTERINE METHODS
Intrauterine Device (0.6/0.8); MP
As compared to the IUS (a small, plastic, T-shaped, pro-gestin-containing stem, which is inserted into the uterus), the IUD contains no hormone, but only copper. Both devices work by preventing the sperm from reaching the egg as well as by preventing the fertilized egg from implanting in the uterus. Both of these need to be inserted and removed by a trained health provider. You’ll feel a mild menstrual cramp during the quick procedure. You cannot feel the device in-side your uterus and it’s a good idea to periodically check whether the small string that is attached to the IUS/IUD remains at the opening of your cervix (at the end of your vagina) to make sure that you have not accidentally lost it.
Charlottesville’s Annette Owens, MD, Ph.D., is certified by the American Association of Sex-uality Educators, Counselors, and Therapists. She has co-edited the four-volume book, Sexual Health (Praeger).