Contraception

A sheath, or cover, placed over an erect penis before intercourse. Designed for one-time use, a condom prevents pregnancy by blocking the passage of sperm into the vagina. The condom, which collects the semen, is removed from the penis after intercourse. Available without a prescription, male condoms can be made of latex rubber, polyurethane (a type of plastic) or lamb intestines (natural or lambskin condom). Using condoms with a lubricant will reduce the chance of breakage and subsequent leakage of sperm. Aside from abstinence (refraining from sexual intercourse), male condoms are the most effective contraceptive method of preventing sexually transmitted diseases. They can be used with all other forms of contraception, except for female condoms because breakage may occur. The U.S. Food and Drug Administration (FDA) estimates that the failure rate for this method is 11 percent.

Shaped similarly to the male condom, the female condom is a polyurethane sheath with an open and closed end. Before intercourse, the closed end is inserted into the vagina and the open end remains outside the body partially covering the labia. It is available without a prescription and is intended for one-time use. The female condom should never be used in combination with the male condom because breakage may occur. According to the FDA, the failure rate for this method is 21 percent.

A reusable dome-shaped rubber disk that covers the cervix to prevent sperm from reaching the uterus and fertilizing the egg. When used correctly, spermicide is placed in the device and around its edges. A diaphragm is available only with a prescription and women must be fitted for the device by a healthcare professional. A diaphragm may be used for multiple acts of intercourse, but additional spermicide must be added before each act. In addition, it must be left in place for at least six hours after the last act of intercourse. To prevent complications, the device should not remain in the body for longer than a total of 24 hours. The FDA estimates that the failure rate for this method is 17 percent when used with spermicide.

Like the diaphragm, a cervical cap is a reusable thimble-shaped latex cup used to cover the cervix and prevent sperm from reaching the uterus and fertilizing the egg. It should be used in combination with spermicide. It is available only by prescription and requires fitting by a healthcare professional. It may be used for multiple acts of intercourse, but it should not remain in the body for longer than a total of 48 hours. When used in combination with spermicide, the FDA estimates that the failure rate for this method is 17 to 23 percent, depending on the brand.

A reusable cup-shaped device with a valve and a loop. Made of silicone, it is used to cover the cervix and prevent sperm from entering the uterus. It is held in place by pelvic muscles and the vaginal wall. It should be used in combination with spermicide, and may be inserted up to eight hours before intercourse. It may be used for multiple acts of intercourse, but it should not remain in the body for longer than a total of 48 hours. Cervical shields come in one size and they are available only by prescription. The FDA estimates that the failure rate for this method is 15 percent.

A disk-shaped device made of soft polyurethane. It contains spermicide and has a woven polyester loop attached to it for easy removal. It is placed in the vagina and used to cover the cervix. It may be used for multiple acts of intercourse. However, it must remain in the body for at least six hours after the last act of intercourse. It should not sit in the body for longer than a total of 30 hours. The sponge was removed from the marketplace in the United States in 1995, but has recently been re-approved for sale. They are available without prescription in most pharmacies or drug stores. The FDA estimates that the failure rate for this method is 14 to 28 percent.

A chemical designed to destroy sperm when placed in the vagina. It is available in the form of a foam, cream, jelly, film, suppository or tablet. It may be used alone or in combination with other forms of contraception. The tablet, film and suppository forms must be inserted at least 15 minutes before intercourse. Typically, each dose is effective for one hour. For multiple acts of intercourse, additional spermicide must be used. Following intercourse, the spermicide must remain in the body for six to eight hours, therefore, women should not douche during this time. Spermicides are widely available without a prescription. According to the FDA, the failure rate of this method is between 20 and 50 percent.

Also known as an IUD, this small T-shaped device is inserted into a woman’s uterus by a healthcare professional, typically an obstetrician-gynecologist (ObGyn). It prevents pregnancy by stopping sperm and the egg from joining on their way to the fallopian tubes, or by altering the endometrium to prevent the fertilized egg from implanting. It can remain in place for up to 10 years, but requires monitoring by a healthcare professional. In some cases, an IUD may be placed in the uterus within seven days of unprotected sex as a form of emergency contraception. The FDA estimates that the failure rate for this method is less than 1 percent.

Also known as combined oral contraceptives, these drugs use synthetic hormones (estrogen and progestin) to prevent ovulation. One pill must be taken at the same time every day for 21, 28 or 91-day cycles. They are available only by prescription and are manufactured under several different brands. The U.S. Food and Drug Administration (FDA) estimates that the failure rate for this method is 1 to 2 percent.

Also known as progestin-only pills (POPs), this type of birth control pill contains only the hormone progestin. These pills prevent pregnancy by thickening the mucus in the cervix and preventing sperm from reaching the egg. They also prevent the endometrium (the lining of the uterus) from thickening, which makes it difficult for a fertilized egg to implant itself in the uterus. One pill must be taken at the same time every day for 28 days. They are available only by prescription. According to the FDA, the failure rate for this method is 2 percent.

A skin patch that releases progestin and estrogen into the bloodstream to prevent ovulation and to thicken the mucus in the cervix. It is worn on the abdomen, buttocks or upper torso or upper outer arm. A new patch is applied once a week for three weeks. During the fourth week (the week of menstruation), no patch is worn. It is available only by prescription. The FDA estimates that the failure rate for this method is 1 to 2 percent.

Inserted high into the vagina, this flexible ring releases progestin and estrogen to prevent ovulation and thicken the mucus in the cervix to keep sperm from reaching the egg. Measuring approximately 2 inches (5 centimeters) in diameter, the ring is worn for three weeks and removed for the week the woman is menstruating. After menstruation, a new ring is inserted. It is available only by prescription. The FDA estimates that the failure rate for this method is 1 to 2 percent.

An injection of the hormone progestin. It prevents pregnancy by preventing ovulation, thickening the cervical mucus to keep sperm from reaching the egg and preventing the fertilized egg from implanting itself in the uterus by thickening the endometrium. It is injected into the woman’s buttocks or arm muscle by a health professional. An injection is required once every three months. According to the FDA, the failure rate for this method is less than 1 percent.

Small T-shaped devices inserted into a woman’s uterus by a healthcare professional. They prevent pregnancy by stopping sperm and the egg from joining on their way to the fallopian tubes, or by altering the endometrium so the fertilized egg cannot become implanted. A levonorgestrel (a progestin) releasing version (Mirena), which must be replaced every five years, is available. According to the FDA, the failure rate for this method is less than 1 percent.

Also known as the emergency contraceptive pills or post-coital contraceptives, this drug is used to prevent pregnancy after intercourse when other contraceptive methods failed or no contraception was used. The product contains the same type of hormones as oral contraceptives but is a high-dose combination of progestin and estrogen or progestin alone. It prevents pregnancy by delaying or preventing ovulation, or by preventing a fertilized egg from implanting itself in the wall of the uterus. For maximum effectiveness, the first dose should be taken no more than 72 hours after intercourse. The second dose must be taken within 12 hours of the first. The FDA approved the sale of the emergency contraceptive drug levonorgestrel (Plan B) without prescription for women aged 18 and older in August 2006. The morning after pill should not be confused with the abortion pill (RU486), which can terminate a pregnancy up to nine weeks after conception.

This form of contraception uses synthetic hormones to prevent the ovaries from releasing eggs and to keep sperm from reaching the egg. The injection is given by a healthcare provider on a monthly basis in the arm, buttocks or thigh. The FDA reports a failure rate of less than 1 percent when Lunelle is used correctly.

This method uses capsules surgically implanted by a physician under the skin of the upper arm, where it gradually releases hormones to prevent pregnancy for years. An earlier type of implant called Norplant was removed from the U.S. market in 2002. Another implant, called Implanon, was approved in 2006.

Also known as behavioral methods, these methods do not require use of prescription or over-the-counter hormones or devices. The effectiveness of these methods is quite low. Examples include:

• Natural family planning. Also known as the rhythm method, fertility awareness or periodic abstinence, this method requires a woman to abstain from sexual intercourse or use a barrier method of contraception (e.g., male or female condom, diaphragm) on the days when she is most likely to become pregnant. The menstrual cycle, changes in cervical mucus and changes in body temperature are used to approximate the days the woman is fertile. This method requires long-term monitoring of the menstrual cycle and daily monitoring of temperature and body changes (e.g., cramps, sore breasts). Over-the-counter ovulation indicator testing kits are also available. These kits determine when a woman is most likely to ovulate by measuring the amount of luteinizing hormone (LH) in a woman’s urine. The U.S. Food and Drug Administration (FDA) estimates the failure rate for this method to be 20 percent or higher.
• Lactational amenorrhea. This method is based on the idea that women may not ovulate when they are breastfeeding for up to six months after childbirth. It requires that a woman does not substitute any other food for breast milk, suckles the baby on demand and at least six times a day on both breasts.
• Withdrawal. Also known as coitus interruptus, this method requires the man to remove his penis from his partner’s vagina before ejaculation. However, sperm are found in pre-ejaculate fluid, so pregnancy can occur without a man ejaculating. This method requires that a man recognize when he is going to ejaculate and have sufficient control to withdraw beforehand. According to the FDA, the failure rate for this method is between 4 and 19 percent.

These contraceptive options prevent pregnancy by surgically altering or blocking the reproductive organs to prevent sperm and eggs from meeting. They are considered permanent because reversal requires major surgery that is frequently unsuccessful.

• Tubal ligation. Surgically cutting or blocking the fallopian tubes to prevent the egg from traveling to the uterus. It is also known as a female sterilization. According to the FDA, the failure rate for this method is less than 1 percent.
• Vasectomy. Also known as a male sterilization, this procedure surgically seals, ties or cuts a man’s vas deferens to prevent sperm from traveling from the testicles to the penis. According to the FDA, the failure rate for this method is less than 1 percent.
• Sterilization implant (Essure). A tiny, spring-like device is thread through the vagina and uterus and into each fallopian tube. The device is temporarily anchored inside the fallopian tube with flexible coils. A mesh material embedded in the coils is used to irritate the lining of the fallopian tube, causing scar tissue to grow. As a result, the fallopian tubes become permanently plugged. This is also known as nonsurgical sterilization or a selective tubal occlusion procedure (STOP). According to the FDA, the failure rate for this method is less than 1 percent.

Not having sexual intercourse at any time. This is the only method of contraception that is 100 percent effective.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about contraceptives:

1. Based on my lifestyle and health, which method might be best for me?
2. Which form of hormone-based birth control is the most effective?
3. Which birth control method that does not use hormones is most effective?
4. Do I have any conditions that prevent me from using hormone-based birth control?
5. Am I a candidate for an intrauterine device (IUD)?
6. Which form of birth control has the greatest risk for serious medical conditions?
7. How does the pill affect my fertility?
8. When should I stop using the pill If I want to become pregnant?
9. Can an IUD create problems for becoming pregnant?
10. What should I do if I failed to use birth control during intercourse?
11. How can I obtain the morning after pill?
12. What can be done if I decide I want to become pregnant after surgical sterilization?
13. Which method should I use if I am breastfeeding?
14. Can you provide information about natural family planning?
15. Can you refer me to community resources for contraception assistance?