Avoiding intercourse

Abstinence. If you play, you pay; if you don't, you won't. If the sperm never reaches the egg, the chances of getting pregnant are nil.

Pros:

• No risk of acquiring a sexually transmitted disease.
• No cost.

Cons:

• Difficult for many people to abstain from sex all together.
• A person who resumes sexual relations may not be prepared, or may forget to use birth control.

Medical risks/side effects:

• None

Effectiveness:

100% effective

Outercourse.The opposite of intercourse, outercourse involves sex play without vaginal penetration to prevent sperm from joining the egg.

Pros:

• Effective against HIV and other serious sexually transmitted infections, unless body fluids are exchanged through oral or anal intercourse.
• Can be used when no other methods are available.
• May prolong sex play and enhance orgasm.
• No cost.

Cons:

• Once you get started, you may want more. May prove difficult for many to abstain from going on to vaginal intercourse, with or without protection.

Medical risks/side effects:

• None
• Sexually transmitted diseases can be transmitted when body fluids are exchanged through oral or anal intercourse.

Effectiveness:

Nearly 100% effective. However, pregnancy is possible if semen or pre-ejaculate is spilled on the vulva.

Barrier methods

Female Birth Control Methods

Sponge. The vaginal contraceptive sponge, Today®, has not been available in stores since the sole manufacturer voluntarily stopped selling it in 1995. It remains an approved product, however, and representatives from Allendale Pharmaceutical Co. say the Today Sponge product should become available again in the very near future, pending FDA approval. Some Internet suppliers sell various versions of the contraceptive sponge manufactured abroad.

Pros:

• Readily available in drugstores.
• Can be inserted as part of sex play.
• Can be used with other methods to prevent sexually transmitted infections.

Cons:

• Some women complain of a loss of sensation when wearing condoms.
• Condoms can, and do break, allowing sperm to spill into the vagina. That's why it's recommended that condoms be used together with a spermicide to disable the sperm before fertilization occurs.
• May slip off during intercourse.

Medical risks/side effects:

• Latex allergies

Effectiveness:

79%-95%

Diaphragm. A rubber disk that must be filled with spermicide, then placed deep in the vagina to cover the cervix. The diaphragm holds the spermicide in place over the cervix to block entry of sperm into the vagina.

The diaphragm protects for one act of intercourse over a period of six hours. For repeated intercourse, or for intercourse that takes place six hours or more following insertion, leave the diaphragm in place! Inject fresh spermicide into the vagina for additional protection.

The diaphragm should be left in place for at least six hours after the last intercourse, but not for longer than a total of 24 hours.

Pros:

• No major health concerns.
• Can last several years.
• Offer some protection against pelvic inflammatory disease (PID).
• Can be inserted before or during sex.
• Usually cannot be felt by either partner.

Cons:

• Sometimes messy.
• Cannot use during vaginal bleeding or infection.
• May be difficult for some women to insert.
• May interfere with spontaneity-intercourse must be anticipated so that a woman can insert the diaphragm ahead of time.
• Diaphragms require refitting every year or two.
• Diaphragms may become dislodged if the woman is on top during intercourse.

Medical risks/side effects:

• Increased risk of bladder infection; not recommended for women who have recurring infections.
• Latex or spermicide allergies.
• Rare cases of toxic shock syndrome (TSS) have been reported with diaphragm use. The symptoms of TSS include: sudden high fever; diarrhea, vomiting; sore throat, aching muscles and joints; dizziness, faintness, weakness; a sunburn-type rash.

Effectiveness:

80%-94%

How to get a diaphragm. Visit a private doctor or a family planning clinic for an examination and prescription. May be purchased at a drugstore or clinic. An examination costs from $50 to $120, but often costs less at family planning clinics. Diaphragm costs range from about $13 to $25. Spermicide cream or jelly costs range from about $4 to $12.

Cervical cap.Like a diaphragm but smaller, fitting snugly around the cervix. Used with spermicide, the cervical cap protects for 48 hours and for multiple acts of intercourse within this time. Must stay in place for eight hours following intercourse.

Pros:

• Does not require repeated applications of spermicide.
• Can be left in place longer than the diaphragm.
• Less risk of urinary tract infections.

Cons:

• Difficult for some women to use.
• Only four sizes. Difficult to fit some women.

Medical risks/side effects:

• Latex or spermicide allergies.
• Rare cases of toxic shock syndrome (TSS) have been reported with diaphragm use. The symptoms of TSS include: sudden high fever; diarrhea, vomiting; sore throat, aching muscles and joints; dizziness, faintness, weakness; a sunburn-type rash.

Effectiveness:

80%-90%- for women who have not had a child

60%-80%- for women who have had a child

Sponge. The vaginal contraceptive sponge, Today®, has not been available in stores since the sole manufacturer voluntarily stopped selling it in 1995. It remains an approved product, however, and industry sources report that Today will be back on the market in the fall of 1999. Some Internet suppliers sell various versions of the contraceptive sponge manufactured abroad.

The sponge, a disposable, donut-shaped polyurethane device, contains spermicide that is inserted into the vagina to cover the cervix. It protects for up to 24 hours and for multiple acts of intercourse. Like the diaphragm, it should be left in place for at least six hours after intercourse.

Pros:

• Less messy than the diaphragm.
• Disposable, requiring no care.
• Does not require a doctor's visit.

Cons:

• More expensive to use than the diaphragm or condoms.
• May feel bulky inside the vagina.
• High rate of failure.
• Can increase the risks of HIV transmission.

Medical risks/side effects:

None noted.

Effectiveness:

According to the FDA, when used correctly, the sponge is 91% effective for women who have not borne children; 80% effective for women who have borne children.

Spermicides. Available in foam, cream, jelly, film, suppository, or tablet forms, spermicides are inserted deep into the vagina and contain a chemical that destroys sperm. Package instructions must be carefully followed because some products require a 10- minute wait before having sex. One dose is usually effective for one hour. For repeated intercourse, additional spermicide must be applied. Following intercourse, the spermicide must remain in place for at least six to eight hours.

Pros:

• Easy to buy in drugstores, supermarkets, etc.
• Insertion may be part of sex play.

Cons:

• Can be messy.
• May irritate vagina or penis; may set off allergies.
• Broad variation in effectiveness.

Effectiveness:

According to the Food and Drug Administration, studies have not produced definitive data on the efficacy of spermicides alone. The authors of Contraceptive Technology suggest the failure rate for typical users may be 21% a year. Planned Parenthood lists the effectiveness at 72%-94%.

Contraceptives

The pill.Highly effective, the pill is the most popular form of reversible birth control in the United States. It uses the hormones estrogen and progestin to suppress ovulation. Recent studies indicate that many women are reluctant to take the pill because of fear of medical risks. However, current low-dose pills have fewer risks associated with them than earlier versions. In fact, the Food and Drug Administration suggests that for most women, birth control pills are safer even than delivering a baby.

Pros:

• Nothing to put in place before intercourse.
• Makes a monthly period more regular, with less blood flow and cramps.
• Studies suggest the pill helps protect against cancer of the ovaries and womb and infections of the tubes and ovaries.

Cons:

• May be difficult for women to remember daily pill and timely refills.
• Does not protect against sexually transmitted diseases, including AIDS.
• Available only by prescription.
• Too costly for some women.

Medical risks/side effects:

• Side effects may include nausea, breast tenderness, spotting, weight gain, mood changes, and headaches.
• Some women cannot use (e.g., those with medical conditions such as high blood pressure, or those over age 35 who smoke.
• Long-term safety well studied, according to the Association of Reproductive Health Professionals (ARHP).
• Women who smoke--especially those over 35--and women with certain medical conditions, such as a history of blood clots or breast or endometrial cancer, may be advised against taking the pill.
• The pill may contribute to cardiovascular disease, including high blood pressure and blood clots.
• Protects against ovarian and endometrial cancers, pelvic inflammatory disease, non-cancerous growths of the breast, ovarian cysts, and osteoporosis (thinning of the bones), according to Planned Parenthood.

Effectiveness:

95%-99.9%

How to get the pill. Visit a private doctor or a family planning clinic for an examination and prescription. May be purchased at a drugstore or clinic. An examination costs from $50 to $125, but may cost less at family planning clinics. One month's supply of pills costs $15-$25 at drugstores.

Implants. Implants (brand name Norplant®) are match-sized sticks placed under the skin of a woman's upper arm. These capsules constantly release small amounts of hormone that suppress ovulation.

Pros:

• Protects against pregnancy for 5 years.
• Once implanted, requires no additional action before, during or after sex.
• Can use while breastfeeding starting six weeks after delivery.
• Can be used by some women who cannot take the pill.
• One of the most effective reversible methods of birth control available in the U.S.

Cons:

• Higher upfront cost than other forms of birth control.
• Not covered by all insurance plans.
• Placing and removing implants requires a small cut in the skin.
• Monthly periods may be less regular; spotting may occur.
• Does not protect against STDs.

Medical risks/side effects:

• Irregular bleeding, headaches, nausea, depression, nervousness, dizziness, weight gain or loss, hair loss.
• Possible scarring and/or discoloration of the skin at insertions site.
• Rarely, infection at insertion site.

Effectiveness:

99.95%

How to get implants. You must see a healthcare provider to find out if you can use Norplant. Not recommended for women who have blood clots or inflammation of the veins, have had breast cancer or growths of the liver, and women with certain forms of high blood pressure.

Norplant costs between $500 and $600 for the medical exam, the implants and insertion. Over a five-year period, this comes to a little more than $100 a year. Clinicians will charge from $100-$200 to remove the implant. Medicaid covers the cost in all states. In addition, the Norplant Foundation awards financial assistance for women in need (phone 1-800-760-9030).

Injectable hormones.Depo-Provera is a progestin that is injected into the buttocks or arm muscle every three months by a healthcare provider to suppress ovulation.

Pros:

• Highly private-no supplies to be stored or detected by anyone
• Requires no action before, during or after sex

Cons:

• Requires regular follow up and maintenance
• Does not protect against STDs

Medical risks/side effects:

• Irregularities in periods-longer, shorter, or none at all
• Spotting
• Weight gain
• Fertility may be delayed by as much as 9-24 months after receiving the last injection
• Headache, nausea, depression, dizziness, change in sex drive, change of appetite, hair loss or increased body hair

Many studies have questioned the possible risks and long-term effects on women who use Depo-Provera. Although studies in the 1960s and 1970s performed in the U.S. on dogs and monkeys linked this drug to cancer of the breast and uterus, more recent studies on rats and mice show no such association. Abroad, studies of the risk of cancer in women using Depo-Provera have identified an increase in the risk of breast cancer in women less than 35 years old. Risks identified varied from study to study, depending on the age of the women evaluated and length of use.

Effectiveness:

More than 99%

Intrauterine Devices (IUD). An IUD is a T-shaped device inserted into the uterus by a healthcare provider. It provides protection from pregnancy for 10 years.

It's not entirely clear how IUDs prevent pregnancy. Research suggests that they prevent sperm and eggs from meeting by either immobilizing the sperm on their way to the fallopian tubes or changing the uterine lining so the fertilized egg cannot implant in it. Although earlier models of the IUD were taken off the market due to associations with pelvic infections and infertility, today serious complications from IUDs are rare.

Pros:

• Requires no action before, during or after sex.
• Can be used during breastfeeding.
• Can be used by women who cannot take the pill.

Cons:

• Does not protect against STDs.
• Mild discomfort upon insertion.

Medical risks/side effects:

• Cramps, heavy bleeding during periods
• Possible increased risk of vaginal infections and pelvic inflammatory disease
• Rarely, infertility
• Perforation of uterus

Effectiveness:

98-99%

How to get an IUD. Requires a visit to a healthcare provider who will determine whether you can use an IUD, based on your medical history.

Before insertion, discuss with your clinician how to watch for possible side effects or other problems. Also be sure to read the material your provider gives you about the IUD and its risks/benefits.

The cost of the exam, insertion, and follow-up visit ranges from $250 to $450. These services are priced according to income at some family planning clinics and are covered by Medicaid and some medical insurance. Although the initial expense may seem high, if the IUD is used for a 10-year period, it actually costs less than most other forms of reversible birth control, including spermicides.

Natural methods

Natural or rhythm method. Requires abstaining from intercourse on the fertile days of a woman's cycle. The fertile days of a woman's cycle are the most likely days that she may become pregnant, which is approximately mid-cycle. However, a woman may ovulate any time of the month so this method of birth control is highly risky. A professional will teach you how to chart your menstrual cycle and to detect certain physical signs to help you predict "unsafe" days.

Here are brief descriptions of the changes you can chart to predict when you ovulate in order to plan or prevent pregnancy.

Temperature method. Take your temperature every morning before getting out of bed. Your temperature rises between 0.4°F and 0.8°F on the day of ovulation. It remains at that level until your next period.

Cervical mucus method. Observe the changes in your cervical mucus. You must do so all through the first part of your menstrual cycle, until you are sure you have ovulated. Normally cloudy, tacky mucus will become clear and slippery in the few days before ovulation. It also will stretch between the fingers. When this happens you are in your most fertile phase. You must abstain from vaginal intercourse or use a barrier contraceptive during this time.

Calendar method. Chart your menstrual cycles on a calendar. You may be able to predict ovulation if your periods are the same every month. You must abstain or use a barrier method during your "unsafe days." It will be more difficult to predict the day of ovulation if the length of your cycle varies from month to month. In that case, you will have more "unsafe days." It is best not to rely on this method alone.

It is best to combine the temperature method, the cervical mucus method, and the calendar method.

Pros:

• No medical or hormonal side effects.
• Calendars, thermometers, charts easy to get
• Acceptable to most religions

Cons:

• Uncooperative partners may make this method ineffective
• Taking risks during "unsafe" days can lead to pregnancy
• Requires ongoing, accurate record keeping
• Illness and lack of sleep affect body temperature
• Vaginal infections and douches change mucus
• Cannot use with irregular periods or temperature patterns.

Medical risks/side effects:

None.

Effectiveness:

75%-99%

Surgical methods

Female sterilization. If you feel absolutely certain that, under any circumstances, you do not want to have additional children, sterilization may be a birth control option. Sterilization is nearly impossible to reverse, although there is a three percent failure rate over a 10 year period.

Female sterilization is also referred to as tubal ligation. This surgery closes the fallopian tubes to prevent the passage of a woman's egg to her uterus. The surgery, usually performed on an outpatient basis, takes about 20-30 minutes. The physician administers general anesthesia, makes two small incisions, and then inserts an instrument that will cut, sew or burn the fallopian tubes. Production of female hormones remains the same and menstrual cycles continue as before.

Pros:

• Requires no action before, during or after sex
• No hormonal side effects
• May free you to enjoy sex more as there is no worry of becoming pregnant
• Cost-effective

Cons:

• Nearly impossible to reverse
• Requires surgery
• May regret the decision if your life circumstances change
• Does not protect against STDs

Medical risks/side effects:

• Mild bleeding or infection right after operation
• Reaction to anesthesia
• Bruising where the incision is made
• Very rare injury to blood vessels or bowel

How do I undergo sterilization?

Requires surgery, which costs $1,100-$2,500 for tubal ligation.

Effectiveness:

99.5%-99.9%