CONTRACEPTION

CONTRACEPTION

Contraception simply means the process of avoiding pregnancy ie the development of an embryo (conceptus) in the womb. It can be achieved through the following ways:

ABSTINENCE (Choosing not to have sex)

Choosing not to have sex provides 100 percent protection from HIV, STIs, and pregnancy. For some, this means avoiding vaginal, anal, and oral-genital intercourse altogether. Others may choose to avoid any type of sexual or intimate contact, including hugging and kissing. Choosing not to have sex is often referred to as “abstinence.”

What are the advantages of choosing not to have sex (abstinence)?

• Choosing not to have sex is free and available to all.
• Not having sex is extremely effective at preventing both infection and pregnancy. It is the only 100% effective method of preventing sexually transmitted infections (STIs) and unintended pregnancy.
• Not having sex can be practiced at any time in one's life.
• Not having sex may encourage people to build relationships in other ways.
• Not having sex may be the course of action which you feel is right for you and makes you feel good about yourself.

What are the disadvantages?

If you've made the choice not to have sex, and change your mind in the heat of the moment, you might not have birth control handy.

Where can I learn more?

What you do sexually is an important decision that you will want to think carefully about. You may want to discuss your decision with another person whom you respect. You may want talk it over with your partner. You might also check with your local family planning association, temple or church, or local health department for an organized support group or program for young people wanting to wait until they are ready before having intercourse.

Birth Control Pills

Also known as: The Pill

There are two types of Birth Control Pills: Combined Oral Contraceptive Pills and Progestin-Only Pills.

Combined birth control pills?

Combined oral contraceptive pills contain two hormones, an estrogen and a progestin. They work by stopping ovulation (release of an egg) and by inhibiting the movement of sperm. Among typical couples who initiate use of combined pills about eight percent of women will experience an accidental pregnancy in the first year. But if pills are used consistently and correctly, just three in 1,000 women will become pregnant. For increased protection against sexually transmitted diseases, use condoms as well. Pills alone do not protect against STIs and HIV.

Complete information about this contraceptive method is available through a clinician or the package insert accompanying the specific pills you are taking.

What are the advantages of choosing combined oral contraceptive pills?

• When properly prescribed for the individual, pills are safer than pregnancy and delivery.
• Pills decrease a woman's risk for cancer of the ovaries and cancer of the lining of the uterus (endometrial cancer). Pills also lower a woman's chances of having benign breast masses.
• Pills significantly decrease a woman's menstrual cramps and pain.
• Pills reduce menstrual blood loss and anemia.
• Pills reduced PMS symptoms.
• Pills can reduce prevalence of acne by up to two-thirds.
• Many women enjoy sex more when on pills because they know they won't get pregnant.
• Some clinicians will provide pills without a pelvic exam.
• Pills suppress endometriosis.

What are the disadvantages?

• Pills do not protect from HIV/AIDS or other STIs. Use a condom for added protection.
• A woman must remember to take the pill at the same time, every day.
• Nausea and/or spotting are the two problems women may have the first month on pills.
• Missed periods or very light periods. Pills tend to make periods very short and light.
• A woman may see no blood at all. Most women like this when they understand it is to be expected.
• Some women experience headaches, depression or decreased enjoyment of sex.
• Serious complications such as blood clots are rare, but do occur.
• Pills can be quite expensive and usually require a prescription.
• Use of pills is associated with a statistically higher risk of developing cervical dysplasia. Pills users with dysplasia who also have HPV (human papillomavirus) have a three- to four-fold higher risk of developing cervical cancer.
• Pill users who smoke or have hypertension are at significantly higher risk of suffering a stroke, compared to other pill users. Pill users who smoke are also at significantly higher risk of a heart attack, compared to pill users who do not smoke and to other women.

Where can I get combined oral contraceptive pills?

Pills are available with a prescription from a clinician, local health department, or family planning clinic.

What are progestin-only pills?

Progestin-only pills contain just one hormone, a progestin. They work by making cervical mucus thicker so sperm cannot get to the egg, and by making the lining of the uterus thinner. Sometimes they stop ovulation (release of an egg). Among typical couples who initiate the use of progestin-only pills about eight percent of women will experience accidental pregnancy in the first year. But if these pills are used consistently and correctly, just three in 1000 women will become pregnant. For protection from HIV and increased protection from pregnancy, use condoms as well. Pills alone do not protect from STIs and HIV.

Complete information about this contraceptive is available through a clinician or the package insert accompanying the specific pills you or your partner are taking.

What are the advantages of choosing progestin-only pills?

• Minipills do not have estrogen related side effects and can be taken by women who have had side effects or complications using estrogen-containing pills.
• The amount of the progestin in minipills is LESS than in combined pills.
• Nursing mothers can take progestin-only pills (preferably after the baby is six weeks old).
• Minipills cause light menstrual flow and less anemia.
• Minipills reduce menstrual cramps, pain, headaches, mood swings, and breast tenderness.
• Minipills are associated with reduced risk of endometrial cancer, ovarian cancer, and pelvic inflammatory disease (PID).
• Minipills can help manage the pain associated with endometriosis.

What are the disadvantages?

• Minipills do not protect from HIV/AIDS or other STIs. Use a condom for added protection.
• Menstrual irregularity is the big problem with minipills. While the amount of blood lost is less, bleeding may be at irregular intervals and there may be spotting between periods.
• Minipills tend to make periods very short and scanty. A woman may go several months with no bleeding at all, and some women do not like this.
• A woman must remember to take a pill every single day.
• Some women using minipills gain weight or complain of feeling bloated. Regular exercise and attention to a nutritious diet can minimize or control weight gain.
• Some women using minipills experience increased symptoms of depression.

Where can I geT progestin-only pills?

Pills are available with a prescription from a clinician, local health department, or family planning clinic.

Cervical Cap

What is a cervical cap?

The cervical cap is a small cap made of soft latex. A doctor or nurse practitioner "fits" a woman for a cervical cap. The woman puts spermicide (which destroys the sperm) in the cap and then places the cap up into her vagina and onto her cervix (the opening of the womb). Suction keeps the cap in place so sperm cannot enter the uterus (the womb). Women should obtain a new cap yearly. Among typical couples who initiate use of the cap before having a child, about 16 percent of women will experience an accidental pregnancy in the first year. If the cervical cap is used consistently and correctly, about nine percent of women will become pregnant. Failure rates are significantly higher if the cervical cap is used after a woman has had a child. Use a condom for additional protection against HIV and other STIs.

What are the advantages of choosing a cervical cap?

• The cervical cap is small and easy to carry. May be put in up to one hour before sex.
• It will work continuously for 48 hours.
• It does not matter how many times a couple has sex as long as you leave it in at least six to eight hours after the last time you have sex.
• Your partner doesn't have to know you are using it.

What are the disadvantages?

• Is not the best protection against HIV and other STIs.
• The cervical cap must be fitted by a clinician.
• You must wash your hands with soap and water before putting in the cap.
• It may interrupt sex.
• A woman has to take it with her on vacations or trips.
• It increases a woman's risk for inflammation of the surface of the cervix.
• It is difficult for some women to insert a cervical cap properly even after being taught.
• If left in too long, increases slightly a woman's risk for a very serious infection called toxic shock syndrome. Don't leave your cervical cap in for more than 48 hours.
• It may accidentally be placed onto the cervix improperly or may slip out of place during sex.
• After putting it in, a woman must check to be sure it is covering the opening of the uterus, called the cervix.
• New fitting may be necessary after a baby, abortion, miscarriage, or gaining 15 pounds.
• Latex may cause irritation or a woman may be allergic to it.
• A woman should have a new cap each year.
• You need fresh spermicidal cream or jelly each time you use your cap.
• It is not recommended that you use a cervical cap during menstruation.*

Where can I get a cervical caP?

Cervical caps may be obtained from clinicians in health departments and local family planning clinics.

Condoms

Effective condoms are made of latex or polyurethane. Unrolled, condoms look like long, thin balloons. They prevent body fluids from mixing when two people have sex. The condom is put onto the penis before the penis comes into contact with the vagina, mouth, or anus.

Latex condoms, when used consistently and correctly during vaginal, oral, or anal intercourse, are highly effective in preventing the sexual transmission of HIV. They are also effective in preventing most sexually transmitted infections (STIs). Gonorrhea, chlamydia, and trichomoniasis are transmitted when infected semen or vaginal or other body fluids contact mucosal surfaces. Condoms provide a great level of protection against these STIs because they protect both partners against exposure to the other's body fluids. Condoms also provide some protection against STIs—such as genital herpes, syphilis, chancroid, and human papillomavirus (HPV)—which are transmitted primarily through contact with infected skin or with mucosal surfaces. Because these STIs may be transmitted by contact with surfaces not covered or protected by the condom, condoms provide a lesser degree of protection against them.

General Tips for Those Who Are Sexually Active:   

• Use a water based lubricant such as Astroglide or KY Jelly to decrease the chance of the condom breaking.
• To decrease the chance of the condom slipping down the penis or falling off inside the vagina, pull the penis out of the vagina right after ejaculation.
• Hold the rim of the condom onto the shaft of the penis during withdrawal.
• Never use more than one condom at a time.
• Never re-use a condom.
• For more information, check out Using a Condom.

What are the advantages of choosing condoms?

• Condoms are safe and effective at preventing both pregnancy and some infections when used at each act of sex.
• Using condoms is the best method of preventing infection if two people are going to have sex.
• No prescription is needed to get condoms.

What are the disadvantages?

• Condoms do not provide complete protection against genital herpes, syphilis, chancroid, or HPV because the STIs can be transmitted across infected skin surfaces not covered by the condom.
• When putting the condom on the penis you must avoid tearing the condom or putting a hole in it with fingernails, a ring, or anything sharp.
• YOU CAN'T USE OIL BASED LUBRICANTS, such as Vaseline or sun tan oil. These products can cause a hole in a condom.
• The man must pull out soon after ejaculation or the condom could fall off and spill or be left in the vagina.
• Some people are sensitive or allergic to latex.

Where do I get condoms?

From family planning clinics, pharmacies or drugstores, supermarkets, and gas stations. Many campus health centers, family planning clinics, or health departments give away free condoms. They are also available from a wide variety of online retailers.

NEW RESOURCE:  Check out Condomology, a new initiative from the American Sexual Health Association aimed at ensuring that people have fact-based information in plain, understandable speak that we can all use and share. You’ll find videos, slideshows, charts and other information covering the “ins and outs” of condoms and sexual health. Visit Condomology today!

Some great Condomology resources

• Condom Effectiveness FAQ
• Making Informed Decisions: Facts About Condoms
• The Scientific Case for Condoms
• Great videos about condoms

Contraceptive Film

What is vaginal contraceptive film?

The film is a little two inch by two inch thin sheet with a chemical that kills sperm (a chemical called nonoxynol-9). It is placed on or near the cervix (the opening of the womb). It dissolves in seconds. Among typical couples who initiate use of vaginal spermicide, 29 percent of women will experience an accidental pregnancy in the first year. If vaginal spermicide is used consistently and correctly, about 18 percent of women will become pregnant. This method is most effective when used in combination with condoms. Complete information about film is available through your clinic, your clinician, or the package insert accompanying vaginal contraceptive film.

What are the advantages of vaginal contraceptive film?

• Film is simple to use.
• It is not messy; there is no discharge. It is virtually undetectable and discreet. You can't tell it is there.
• Vaginal contraceptive film can be bought at most drug stores; no prescription is needed.
• Film may be used alone or with a diaphragm or a condom.
• It reduces the risk of getting some sexually transmitted diseases.

What are the disadvantages?

• Contraceptive film does not adequately protect from the HIV/AIDS virus or other STIs. Use a condom if you or your partner may be at risk.
• Frequent use of nonoxynol-9 can cause irritation which may increase susceptibility to HIV and other STIs.
• It must be inserted no longer than one hour before sex. Inserting it may interrupt sex.
• A woman must use a new film each time she has intercourse.
• The film must make contact with the cervix in order to be effective.
• A woman must wash hands with soap and water before putting the contraceptive film in. She must also dry hands carefully to keep the film from sticking to her fingers.
• Some people may be sensitive to film or find it causes irritation.
• It is not as effective as some other contraceptives.

Where can I go to get vaginal contraceptive film?

Vaginal contraceptive film can be found at many pharmacies, drug stores, and family planning clinics. It is also available at a number of online drugstores.

Contraceptive Foam

What is contraceptive foam?

Foam is placed into the woman's vagina using an applicator and has two effects. It kills or destroys sperm and blocks the man's fluids from entering the cervical canal. Foam stops sperm from getting to the egg. Among typical couples who initiate use of vaginal spermicide, 29 percent will experience an accidental pregnancy in the first year. If vaginal spermicide is used consistently and correctly, about 18 percent will become pregnant. Foam is most is effective when used in combination with condoms. Complete information about this contraceptive is available through a family planning association or clinic, a clinician or the package insert accompanying the foam.

General Tips

• A woman should practice putting foam into her vagina in advance. This will make it easier at the time of intercourse.
• You can't be sure if there is enough foam in the can to protect against the next act of intercourse. It may help to keep an extra handy.

What are the advantages of contraceptive foam?

• Foam gives the woman control over use of a contraceptive.
• It is available over the counter without a visit to a clinician.
• It can be put into the vagina up to 20 minutes before sexual intercourse, but it is also effective immediately.
• Foam is safe and has no hormones.
• The man's penis can remain inside the vagina after ejaculation.

What are the disadvantages?

• It may not be protective against HIV/AIDS. To increase effectiveness, use condoms.
• Foam can be irritating to the vagina, and some people feel that it is messy.
• Some women do not like placing an applicator up into the vagina.
• The taste of foam is unpleasant.
• The container carrying the foam is large and some may find it embarrassing to carry around.

Where can I get contraceptive foam?

At your local pharmacy, drug store, clinic or at a number of online drugstores.

Contraceptive Implants

What are contraceptive implants?

The contraceptive implant (Implanon) is a single implant inserted into the upper arm. After a woman is given a local anesthetic, insertion takes only a few minutes. Usually it does not hurt. Implants give off very small amounts of a hormone much like the progesterone a woman's body produces during the last two weeks of each monthly cycle. Among typical couples who initiate use of implants, five women in 1,000 will experience an accidental pregnancy in the first year. Complete information about this contraceptive is available through a clinician or the package insert accompanying the implant.

What are the advantages of contraceptive implants?

• Implanon is effective for three years. In a recent study, no pregnancies occurred among the first 70,000 cycles of Implanon users. That's great protection!
• There is nothing to do on a daily basis or at the time of intercourse.
• Women lose less blood during menstruation. They also have less cramping, headaches, and breast tenderness.
• Depression and premenstrual symptoms may improve.

What are the disadvantages?

• Implants do not protect from HIV/AIDS or other STIs. Use a condom, if you or your partner may be at risk.
• Implants are quite likely to cause irregular periods in some women. If bothersome to you, contact your clinician. There are drugs that a woman may take to have a more acceptable pattern of bleeding. As time goes on a woman's periods may become more regular.
• You may gain weight, lose hair, develop headaches or note darkening of the skin over your implants. Implants may cause some arm discomfort.
• Depression and premenstrual symptoms may become worse.
• A woman may have trouble finding a clinician who will remove her implants.

Where do I go to get contraceptive implants?

A woman can get implants from a doctor, nurse practitioner, nurse midwife, health department, or family planning clinic. Not all clinicians insert implants. It is a good idea to check on this in advance. Be sure the clinician is also experienced at removing implants and will remove them regardless of ability to pay to have them removed.
What is the routine after a woman has implants inserted?

A woman will probably be given a date to return about one month after insertion to check out the insertion site and to answer any questions she may have. After this, return to your clinician just once a year for your regular checkup.

Contraceptive Sponge

What is the contraceptive sponge?

The vaginal sponge is a barrier method of preventing pregnancy. That is, the sponge acts as a barrier to prevent semen from entering the cervix. The sponge is more effective with women who have never given birth than with women who have. With typical use of the sponge, about 16 percent of women will experience pregnancy within one year. With consistent and correct use of the sponge, about nine percent of women will experience pregnancy within one year.

Because vaginal barrier methods, including the sponge, protect the cervix, they may help in preventing some sexually transmitted infections, including gonorrhea, chlamydia, and trichomoniasis. Studies about the protective effect of vaginal barrier methods are not consistent, however, so women should also use condoms to prevent sexually transmitted infections.

What are the advantages of the contraceptive sponge?

• Sponges are easy to use, relatively inexpensive, and available without prescription.
• Because you may insert the sponge when your sex partner is not present, they offer a good measure of contraceptive privacy.

What are the disadvantages?

• Unlike hormonal methods, the sponge does not provide constant protection. You need a new one for each occasion of sex.
• You need to wash your hands with soap and water before you insert the sponge.
• The sponge must be inserted into the vagina and up against the cervix prior to the penis entering the vagina.
• Some women find it difficult to place the sponge correctly.
• Some women have difficulty removing the sponge.
• If left within the vagina for more than 30 hours, the sponge slightly increases your risk for a very serious infection called toxic shock syndrome. Don’t leave your sponge in for more than 30 hours.
• The sponge may accidentally be placed onto the cervix improperly or may slip out of place during sex.
• Sponges must be stored in a clean, cool, dark place—not in the glove compartment of a car or in a purse.

Where can I get the contraceptive sponge?

You can purchase the sponge in local pharmacies and other stores that sell condoms and personal hygiene products, including online stores.

Contraceptive Suppositories

What are contraceptive suppositories?

Contraceptive suppositories are barrier methods of birth control that are inserted deep into the vagina before sexual intercourse. The suppository melts, releasing spermicide. The spermicide prevents sperm from moving toward the egg and also protects the cervix. Of 100 women who use contraceptive suppositories less than perfectly, 29 will accidentally get pregnant during the first year. With perfect use, 15 women will get pregnant. Suppositories provide no protection against sexually transmitted infections. In fact, you should not use this method over and over in a single day because frequent daily use of any barrier method that contains the spermicide nonoxynol-9 can increase your risk of HIV and other STIs. For protection against STIs, use condoms.

What are the advantages of suppositories?

• Are inexpensive and available without prescription;
• Can be used by any woman who wants to use them; and
• Remain effective for about one hour after insertion.

What are the disadvantages?

• Suppositories do not protect from HIV or other STIs. Use condoms as well.
• Some brands of spermicide may irritate the penis or vagina. Try different brands if this happens.
• Suppositories cannot safely be used many times in one day.
• A new suppository must be inserted deep into the vagina prior to each act of sex.
• If not used exactly as directed, the suppository may not form a good barrier over the cervix.
• Suppositories can be messy.

Where can I get contraceptive suppositories?

Contraceptive suppositories are available at most drugstores and some convenience stores, supermarkets, family planning clinics, and local health department clinics. You can get more information about this contraceptive method from your regular doctor or nurse practitioner, family planning clinic, and/or the patient insert accompanying the suppositories.

Diaphragm

What is a diaphragm?

A diaphragm is a latex disc a woman places into her vagina. It should be left in the vagina at least 6 hours but no more than 24 hours after intercourse. The diaphragm blocks a man's semen from entering the cervix (the opening to the womb). A spermicide placed onto the diaphragm kills sperm. A diaphragm and the spermicide keep sperm from getting to the egg. Among typical couples who initiate use of the diaphragm, about 16 percent of women will experience an accidental pregnancy in the first year. If the diaphragm is used consistently and correctly, about 6 percent of women will experience pregnancy. Use condoms as well as the diaphragm for the most effective protection. Complete information about this contraceptive is available through a family planning association or clinician or through the package insert accompanying a diaphragm.

What are the advantages of choosing a diaphragm?

• A diaphragm gives a woman fairly good control over contraception.
• When used perfectly, only six women in 100 become pregnant the first year using a diaphragm.
• It can be put in up to several hours in advance of sexual intercourse.
• Diaphragms are safe; there are no hormones and no side effects from hormones.
• The penis can remain inside the vagina after ejaculation.

What are the disadvantages?

• A diaphragm does not provide adequate protection from HIV. Use condoms as well.
• The diaphragm must be fitted by a clinician.
• You must wash your hands with soap and water before putting a diaphragm in.
• Inserting the diaphragm may interrupt sex.
• A woman has to take it with her on vacations or trips.
• A diaphragm increases a woman's risk for urinary tract infections.
• It is difficult for some women to insert a diaphragm properly even after being taught.
• If left in too long, it slightly increases a woman's risk for a very serious infection called toxic shock syndrome. Don't leave a diaphragm in for more than 24 hours after intercourse.
• It may slip out of place during sex. If you change who is on top, you may want to check to see that the diaphragm is still covering the cervix.
• After putting it in, a woman should check to be sure it is covering the opening of the cervix.
• A new fitting may be necessary after having a baby, abortion or miscarriage, or gaining 15 pounds.
• It is not recommended that you use a diaphragm during menstruation.*

Where can I get a diaphragm?

A woman must be fitted in a clinician's office for a diaphragm. Be sure to be shown how to insert and remove a diaphragm. Then a woman must be given a prescription for the specific type of diaphragm she will use. The actual diaphragm and the spermicide used with the diaphragm are located at the local pharmacy or a drugstore.

Emergency Contraception

Emergency Contraception – also called EC, the Morning After Pill, or Plan B – can prevent pregnancy up to five days (120 hours) after unprotected sex. Emergency Contraception is a stronger dose of the same hormones used in regular birth control pills and is more effective the sooner you take it. EC works best if you take it within 24 hours of sex.

Plan B® is the only product specifically approved and marketed in the United States as an emergency contraceptive pill.

How Does Emergency Contraception Work?

Emergency Contraception is a stronger dose of the same hormones found in regular birth control pills. When taken after unprotected sex, these hormones can greatly reduce the chance of pregnancy and are most effective if taken within 12 hours after sex.

Preventing Pregnancy After Sex

Plan B® – the only form of prescription EC currently available in the United States – is a set of two pills. The Food and Drug Administration has approved the use of certain brands of regular birth control pills as EC, though the number of pills and dosage varies by brand. (To find out more, click here.)

EC works by delaying ovulation (or the release of an egg from an ovary). It may also prevent the egg from being fertilized. It’s possible, although unproven, that EC may inhibit implantation (that is, prevent a fertilized egg from attaching to the wall of the uterus).

EC Does Not Cause An Abortion

Using emergency contraception is not the same as having an abortion, and emergency contraceptive pills do not cause abortion. The U.S. Department of Health & Human Services, the American College of Obstetricians & Gynecologists, and almost all mainstream professional medical groups define pregnancy as beginning when a fertilized egg has finished implanting in the uterus. Emergency contraceptive pills will not harm an egg that has finished implanting; therefore, they can’t cause an abortion.

If a woman takes EC when she is already pregnant, it won’t have any effect whatsoever. It will not end the pregnancy or cause any birth defects. Emergency contraceptive pills are not the same as RU486 (the “abortion pill”) – the two are entirely different drugs.

Most Women Experience Mild or No Side Effects

While some women experience no side effects at all, taking EC may make you nauseous, dizzy, or tired. You may also vomit, develop a headache, and/or have sore breasts. If you do experience side effects, they will be temporary and should last less than a day or two.

It's normal for your next period to be a few days late or early. It may be heavier, lighter, or more spotty than usual. If your period doesn't come, you should take a pregnancy test.

Helpful Hints When Taking Emergency Contraception

• Take motion sickness pills, like Dramamine II before taking the emergency contraceptive pills.
• Take the pills with food.
• Take your first dose mid-morning and your second dose (12 hours later) right about bedtime.

Getting EC When You Need It

If you have recently had unprotected sex, chances are you’re worried – maybe even panicked – about the possibility of getting pregnant. When taken within five days (120 hours) after unprotected sex, Emergency Contraception can greatly reduce the chance of getting pregnant. But it’s important to act quickly – EC is more effective the sooner you take it.

In August 2006, the FDA determined that Emergency Contraception, packaged as Plan B®, would be made available without a prescription only for women ages 18 and older. Young women under age 18 still need a prescription.

Emergency contraceptive pills cost between $35 and $75. If you need to visit a doctor for a prescription, you may also have to pay for an appointment. Fortunately, most family planning clinics offer discounts or free services to teens. (To find a clinic near you call: 1-888-NOT-2-LATE  English (1-866-EN-TRES-DIAS (Spanish))

If You Are Age 18 or Older

You can ask your pharmacist for a pill called Plan B®. You can buy this pill in the drug store. You do not need a doctor’s prescription, but you may need to show ID.

If you can’t get to the drug store right away, you can have a friend or family member pick up Plan B® for you – as long as she/he is age 18 or older. Both men and women can buy Plan B®.

If You Are Under Age 18

Update: On March 23, 2009, the U.S. District Court for the Eastern District of New York ordered the FDA to extend over-the-counter access to Plan B to 17 year olds within 30 days and to reconsider making it available without a prescription for those younger.

If you are under age 18, you need a prescription from a health care provider to get Plan B®. Call or visit a health clinic, Planned Parenthood, or your regular doctor to find out if they provide Emergency Contraception. Many doctors and health clinics provide confidential services to women under age 18, but you may want to ask about their confidentiality policy to make sure.
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You do not need a pelvic exam and/or pregnancy test before getting a prescription for these pills. However, some doctors may insist on doing a pelvic exam and/or pregnancy test before providing a prescription.

Using Regular Birth Control Pills As EC

If you are unable to find a clinic or doctor to help you, don't forget that EC is just a high dose of regular birth control pills. If you have a package of birth control pills, or can get one, you may be able to use it as EC.

How many regular birth control pills a woman should use when she can’t get PlanB® depends on the type or brand of regular birth control pills she has. Some don’t work as emergency birth control at all – so women should be sure to check whether the brand they have can be used and exactly how to use it.

Once a woman uses her regular birth control pills as emergency birth control, the pack of regular birth control pills will no longer have enough pills to protect her from pregnancy for the rest of the month. She must use condoms every time she has sex until her next period, and then start a new pack of regular birth control pills as she normally would after her period.

Female Condom

What is the female condom?

Female condoms (previously known as Reality Condoms) are made of a thin plastic called polyurethane – NOT latex. The condom is placed into the woman's vagina. It is open at one end and closed at the other. Both ends have a flexible ring used to keep the condom in the vagina. Among typical women use of FC condoms, about 21 percent will experience an accidental pregnancy in the first year. If these condoms are used consistently and correctly, about 5 percent of women will experience pregnancy. Complete information about this contraceptive is available through a clinician or through the package insert.

What are the advantages of the female condom?

• Female condoms give women more control and a sense of freedom.
• A woman doesn't need to see a clinician to get it. No prescription or fitting is needed.
• The condom can be put in several hours in advance of sexual intimacy.
• It is safe and fairly effective at preventing both pregnancy and infection.
• The inside of the condom is lubricated.
• It can be used by individuals who are allergic or sensitive to latex.
• Polyurethane transmits heat well. This may make sex more fun.

What are the disadvantages?

• This condom is large and some call it unattractive or odd looking. Its size and unattractiveness may decrease enjoyment of sex.
• The condom will not work if the man's penis slides in outside of the female condom.
• It can make rustling noises prior to or during intercourse. A lubricant may decrease noises.
• The condom takes practice to use it right. Some people complain that it is hard to use.
• It is not available in as many stores as the male condom and may be hard to find.
• The female condom is about three times more expensive than male condoms.

Where do I get  female condoms?

The condom is sold at many drugstores, including online stores. To learn more about the female condom, call your local family planning clinic or health department.

Fertility Awareness Method

Also known as: The Rhythm Method

What is the fertility awareness method?

Fertility awareness is a means of understanding a woman's reproductive cycle by observing and writing down fertility signs. These signs determine whether or not she can become pregnant on a given day. A woman is actually fertile during only about a fourth of her cycle. This method is a great way for a woman to learn more about her body, but it is not recommended for teens.

What are the three primary fertility signs? They are a woman's temperature when she first wakes up; her cervical fluid (the fluid at the mouth of a woman's womb); and the position of her cervix. The fertility awareness method permits a woman to use this information so that she may abstain from intercourse when she is most fertile. The failure rate among women who use this method perfectly is two to three percent; while the failure rate among most women who use this method is 13 to 20 percent.

Before Ovulation

• Waking temperatures remain low.
• Cervical fluid looks similar to raw egg white and becomes wet and then dry.
• Cervix rises and becomes softer and open.

After Ovulation

• Waking temperatures rise for 12 to 16 days.
• Cervical fluid quickly dries up after ovulation.
• Cervix quickly drops and becomes firm and closed after ovulation.

What are the advantages of the fertility awareness method?

• The fertility awareness or symptothermal method helps a woman track and improve PMS (premenstrual syndrome) symptoms.
• It empowers women with practical knowledge.
• The method helps a woman know when during her cycle to have sex to become pregnant or to avoid pregnancy, depending on her goal.
• It is useful in conjunction with other contraceptive methods, such as barrier contraceptives (such as condoms) and withdrawal.

What are the disadvantages?

• This method provides no protection against HIV and other sexually transmitted infections.
• The method involves daily charting of fertility signs.
• It requires discipline for a number of days in the cycle if a woman chooses to avoid sex rather than use a barrier contraceptive during her fertile days.
• As a contraceptive, this method is unforgiving of improper use. If a woman has sex when this method tells her to abstain, she is very likely to become pregnant.
• Abstinence is required at the time in a woman's cycle when her sexual urge is usually at its peak.

Where do I go to learn about the fertility awareness method?

Some clinicians and some family planning clinics can help you. An excellent book which has marvelous graphics is called Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control and Pregnancy Achievement, by Toni Weschler; HarperPereniel a division of HarperCollins Publishers. Another excellent book is the Fertility Awareness Handbook by Barbara Kass-Anesse.

Injectable contraceptives

Also known as: The Shot

What are injectable contraceptives?

The type of shot most used is called Depo-Provera. It is a shot given every three months. It is a hormone, much like the progesterone a woman produces during the last two weeks of each monthly cycle. Injectables stop the woman's ovaries from releasing an egg and have other contraceptive effects. Among typical couples who initiate use of injectables, about three percent of women will experience an accidental pregnancy in the first year. For the most effective protection against sexually transmitted infections, use condoms as well. Complete information about this contraceptive is available through a family planning clinic, local health department, or clinician.

What are the advantages of injectable contraceptives?

• Nothing needs to be taken daily or at the time of sexual intercourse.
• Injectables are extremely effective.
• Women lose less blood during menstruation when they are using injectables and have less menstrual cramps.
• Privacy is a major advantage. No one has to know a woman is using this method.
• Nursing mothers can receive injections; it is best to receive after the baby is six weeks old.
• It is okay for a woman to start another contraceptive method if it is less than 13 weeks since the last shot.
• Injectables may lead to improvement in PMS (premenstrual symptoms), depression or symptoms from endometriosis.

What are the disadvantages?

• Injectables do not protect you from HIV infection or other STIs. Use condoms to reduce risk.
• Injections can lead to very irregular periods. If a woman's bleeding pattern is bothersome, there are medications which can be given to help have a more acceptable pattern of bleeding.
• Some women gain weight. To avoid weight gain, women should watch their calorie intake and get lots of exercise.
• A woman has to return every three months for her injection.
• Depression and premenstrual symptoms may become worse.
• It may be a number of months before a woman's periods return to normal after her last shot.
• Injectables may cause bone loss, especially in smokers. Women should get regular exercise and consider taking extra calcium to protect their bones from osteoporosis.
• Some women are allergic to injectables.

Where can I go to get started using injectable contraceptives?

You can get injectable contraceptives from your clinician, health department, or family planning clinic. Most clinics provide the first shot when a woman is on her period or within seven days of the start of the period.

What if I am late for my shot and have sex?

Be sure to use condoms or another method for added protection. Also, emergency contraception is an option that can prevent pregnancy after unprotected sex—but it does not prevent against sexually transmitted infections.

Intrauterine Contraception

What is intrauterine contraception?

An intrauterine device (IUD) is a small device which is placed into the uterine cavity. There are two highly effective intrauterine contraceptives available in the United States: the Copper T IUD and the LNG-IUS.

IUDs are safe, relatively inexpensive, and provide extremely effective long-term contraception. Complete information about this contraceptive is available through your clinician or the package insert accompanying the IUD. Recent analysis shows that use of IUDs carries no increased risk of reproductive tract infections.

What is the Copper T IUD?

In the horizontal arms of the Copper T 380A IUD there is some copper. The IUD slowly gives off copper into the uterine cavity. This does several things. Most importantly, it stops sperm from making their way up through the uterus. Among typical couples who initiate use of this IUD, just less than 1% will experience an accidental pregnancy in the first year.

What are the advantages of the Copper T IUD?

• The Copper T IUD is the second most effective reversible method, rivaling surgical sterilization in preventing pregnancy.
• The IUD is effective for at least 10 years.
• Only 2 of 100 women using a Copper T for 10 years will become pregnant.
• Prevents ectopic pregnancies.
• Far more readily reversible than tubal sterilization or vasectomy.
• Protects against endometrial cancer.
• Very low cost over time. Convenient. Safe. Private.

What are the disadvantages?

• No protection against sexually transmitted infections. Use condoms if there is any risk.
• There may be cramping, pain or spotting after insertion.
• The number of bleeding days is slightly higher than normal and you could have somewhat increased menstrual cramping. If your bleeding pattern is bothersome to you, contact your clinician. There are medications which may make you have a more acceptable pattern of bleeding.
• High initial cost of insertion.
• Must be inserted by a doctor, nurse practitioner, nurse midwife or physician's assistant.
• A small percentage of women are allergic to copper.

What is the LNG-IUS?

The LNG-IUS contains some levonorgestrel in its vertical arm. This hormone is a progestin much like the progesterone a woman's ovaries produce each monthly cycle. Each week the LNG-IUS gives off about the same amount of levonorgestrel as a woman gets when she takes one or two of the minipills called Ovrette. The levonorgestrel causes the cervical mucus to become thicker so sperm cannot get to the egg. Among typical couples who initiate use of the LNG-IUS, just one in 1,000 women will experience an accidental pregnancy in the first year.

What are the advantages of the LNG-IUS?

• The LNG-IUS is the most effective reversible method, rivaling surgical sterilization in preventing pregnancy.
• It prevents ectopic pregnancies and pelvic inflammatory disease, decreases menstrual cramping and dramatically decreases menstrual blood loss (up to a 97 percent reduction in menstrual blood loss in one study).
• It may be left in place for up to seven years.
• It is safe, inexpensive over time, and provides extremely effective long-term contraception from a single decision.
• One of the costs of any contraceptive is the cost to you should your contraceptive fail. Given the extremely low failure rate of the LNG-IUS, a person using this method is far less likely to have either the emotional and financial expenses associated with an unintended pregnancy.
• Prevents ectopic pregnancies.

What are the disadvantages?

• It often changes the menstrual cycle. A woman has more bleeding days than normal for the first few months and less than normal after six to eight months. If a woman finds that her bleeding pattern is bothersome, she should contact a clinician. Some medications may improve the pattern of bleeding.
• This method provides no protection against sexually transmitted infections. Use condoms improve protection against sexually transmitted infections.
• It has a high initial cost of insertion.

Where can I go to get intrauterine contraception?

You can get intrauterine contraception from your clinician, health department, or family planning clinic. But not all clinicians insert intrauterine contraception. You might want to check on this in advance. Most clinics insert intrauterine contraception when a woman is on her period or within 7 days of the start of the period.

The Patch

What is the contraceptive patch?

The contraceptive patch is a lightweight, thin, flexible, beige-colored patch. It has three layers: the outer, protective, polyester layer; the medicated, adhesive layer; and a protective liner which is removed prior to applying the patch. The patch can be applied to the skin of the buttock, abdomen, upper torso (but not the breasts), or the outside of the upper arm. Each patch lasts seven days. Women replace the patch each week for three weeks, then have a seven-day patch-free week, during which time they begin their menstrual bleeding. During a year of typical use, eight women will experience pregnancy; with perfect use, only three in 1,000 women will experience pregnancy. For protection against sexually transmitted diseases, use condoms as well.

Complete information about the patch is available through a clinician or the package insert accompanying this contraceptive method.

What are the advantages of choosing the contraceptive patch?

• Used properly and consistently, the patch is highly effective at preventing unintended pregnancy.
• It is easy to use, since it needs to be applied only once a week. In addition, the user can easily verify that her patch is still in place.
• It is rapidly reversible, should you decide that you wish to conceive a child.
• Because the hormonal mechanisms of action are similar to that of birth control pills, experts believe the patch may provide many of the same advantages and non-contraceptive health benefits of contraceptive pills, although hard data about long-term health benefits may not be available for decades.

What are the disadvantages?

• The patch provides no protection against HIV or sexually transmitted infections. For protection against HIV or STIs, a woman should use condoms.
• Women must remember to change the patch once a week for three weeks and then to resume the patch after seven patch-free days.
• It is difficult to hide and thus offers less privacy than many other contraceptive methods.
• The patch is expensive.
• The patch must be stored carefully in a clean, cool, dark place—not in a purse or the glove compartment of a car.
• If a patch becomes dislodged and cannot be firmly reattached with ten seconds of continuous pressure, then it must be removed and replaced.
• Women who use the patch are vulnerable to the same health issues that arise with birth control pills, including increased risk of heart attack and stroke. Women who smoke should not use the patch.
• The patch can cause skin irritation, redness, or rash.
• The patch can cause breast tenderness, vaginal spotting, and/or temporary interruption of menses. These side effects usually disappear within the first two cycles of patch use.
• The patch is less effective in preventing pregnancy among women who weigh more than 198 pounds.

Where can I get the contraceptive patch?

The patch is available with a prescription from a clinician, local health department, or family planning clinic.

The Ring

What is the ring?

The ring (NuvaRing) is a small, flexible device that a woman inserts into her vagina once a month. She leaves it in place for three weeks and takes it out for the remaining week of her menstrual cycle. The ring releases combined hormones (estrogen and progestin) to protect against pregnancy. Although no studies have yet been published, experts believe that the ring will be as effective as the combined pill: out of 100 typical couples who rely on the ring for contraception, eight percent of women may accidentally get pregnant. Among women who use the ring perfectly, fewer than one percent should get pregnancy.

What are the advantages of the ring?

• Must be inserted only once each month;
• Means you don’t have to do anything at the time of sexual intercourse;
• Does not require fitting;
• Frequently causes more regular, lighter, and shorter periods;
• Helps prevent menstrual cramping and premenstrual symptoms as well as headaches and depression;
• May protect against medical problems such as ectopic pregnancy, pelvic inflammatory disease (PID), cysts, and cancer of the ovaries and of the uterus)

What are the disadvantages?    

• The ring does not provide any protection from STIs, including HIV. If there is any risk of infection, always use a condom as well.
• You must remember to keep the ring in place for three weeks and then to remove it three weeks to the day after you inserted it.
• You must remember to insert a new ring on the same day one week after you removed the old ring.
• You must wash your hands with soap and water prior to inserting the ring.
• The ring could slip out. If it does, you must replace it within three hours.
• You must wrap the ring in foil and throw it in the trash. It may not be flushed.
• The ring may cause increased spotting, breast tenderness, nausea and vomiting, and mood swings. These usually clear up within about three months after beginning use of the ring.
• The ring may cause vaginal irritation or infection and increased vaginal discharge.
• As with other forms of combined hormonal contraception, the ring slightly increases your risk of blood clots, especially if you are 35 or older and smoke.

How do I get the ring?

The ring is available by prescription only. You can get more information about this contraceptive method from your regular doctor or nurse practitioner, family planning clinic, and/or the patient insert accompanying the ring.

The Shield

What is the shield?

The shield is a soft silicone cup with a loop to aid in its removal. It fits snugly over the cervix and is used with spermicidal jelly or cream. The shield and the spermicide work together. The shield keeps sperm from moving past the cervix; the spermicide prevents sperm from moving toward the egg. Among 100 typical couples who use the shield, 15 women will accidentally get pregnant within a year. [There are no rates for perfect use.] Users can increase the effectiveness of the shield by making sure the cervix is covered and by using spermicide. For protection against STIs, couples should also use condoms.

What are the advantages of the shield?

• Can be used by women who are breastfeeding;
• Can be easily carried in a pocket or a purse;
• Cannot usually be felt by either partner;
• Is immediately effective;
• Is immediately reversible;
• Has no effect on your natural hormones;
• Can be inserted several hours ahead of time.

What are the disadvantages?

• It provides no protection against HIV and other STIs. Frequent daily use of spermicides containing nonoxynol-9 can irritate the vagina, increasing your risk for HIV and some other STIs. Use a latex condom to reduce the risk of infection.
• You must visit a clinician or clinic to get a prescription for a shield.
• It can be difficult to insert properly and may sometimes be difficult to remove.
• It may be pushed out of place during sexual activity.
• It causes some women pain or discomfort.
• Some women are allergic to silicone. Some women or their partners are allergic to spermicide.
• You may not be able to use the shield if you have frequent urinary tract infections or if you have a reproductive tract infection.
• You must not use the shield during your period.

How do I get the shield?

You can get the shield, or a prescription for it, from a clinician or family planning or local health department clinic. You can get more information about this contraceptive method from your regular doctor or nurse practitioner, family planning clinic, and/or the patient insert accompanying the shield.

Withdrawal

What is withdrawal?

When a man senses that he is about to ejaculate (come), he pulls his penis out of the vagina or anus. He then ejaculates outside of his partner. It works best if the couple has talked about it and has agreed in advance to use this method.  It also should be practiced if no other contraceptive method is available.  However, withdrawal does not provide adequate protection against HIV and STIs, so use condoms if there is even a slight chance of HIV or STI transmission.

Among typical heterosexual couples who initiate use of withdrawal, about 18 percent of women will experience an accidental pregnancy in the first year. If withdrawal is used consistently and correctly, about 4 percent of women will become pregnant. 

Using condoms during anal intercourse is strongly recommended to reduce the chance of transmitting HIV or other STIs. If condoms are not used during anal sex, withdrawal before orgasm may reduce the risk of HIV transmission. Withdrawal does not offer protection from STIs that can be transmitted by skin-to-skin contact.

Advantages of withdrawal?

• When used consistently and correctly, withdrawal can be effective at reducing the risk of pregnancy.
• No fluid or much less fluid is deposited in the vagina or anus. This means that there is somewhat less chance of HIV or other STI infection spreading from partner to partner.
• Withdrawal has no medical complications, no hormones, no supplies, and is free.
• It is always available.

Disadvantages?

• It provides poor to no protection against STIs, including HIV.
• It can be difficult to pull out in time.
• For withdrawal to be effective against pregnancy, the man must ejaculate far from the woman’s vagina.

Where can I get this method?

All you need to do is to pull out in time – each and every time. But, two methods are always better than one, so consider using withdrawal in addition to another method such as a condom to increase protection against HIV and other STIs. Also, learn more about emergency contraception in case plans change and the man comes inside the woman during heterosexual vaginal intercourse.