August 2014

Contraception

Contraception

 

Protecting Yourself From Unwanted Pregnancy

Pregnancy and contraception are a very personal matter. Whether you chose to prevent pregnancy or become pregnant is entirely up to you. It might seem obvious to suggest that if your do desire to become pregnant there is nothing you need to do about it but live life normally and have sex. However, it may be less than obvious that if you should chose not to become pregnant you often have to do something, if you are sexually active, to protect against becoming pregnant.

Certainly, without question, one of the best methods of preventing pregnancy is not to be sexually active, however, for many women this is an option that they may not wish to take advantage of. Many women desire to be sexually active but still do not wish to become pregnant. For these women other options then abstinence must be sought. But what methods are available and what are their potential risks and benefits, how does one chose and what is most effective? These are questions that all can be answered but clearly the answers will be different for every woman and every couple.

In this paper we will briefly look at each of the methods available for prevention of unwanted pregnancy and we will discuss the questions asked above. This is meant only to be a brief overview and not meant to direct you, as a patient, to pick anyone method. In fact it has been my experience that most women over their life time use more than one method, often all or many of them, at different times of their life and for reasons that make sense to them in context of what their immediate needs are and what is best for them considering their partner, financial status, insurance and how important it is not to become pregnant.

 

History of Contraception

Contraception is not a new phenomenon. The first prescription for a contraceptive was apparently written on papyrus around 1550 B.C. It apparently called for crocodile dung to be inserted into the vagina, this was the preferred method of the ancient Egyptians. For ancient Arabians, elephant dung mixed with honey was the method of choice. The women in Northern Canada drank a potion of dried beaver testicles mixed with alcohol to avoid pregnancy.

Fortunately, modern technology has advanced to a place where we no longer have to rely on such primitive methods of contraception. Modern science allows us to convert natural as well as synthetic chemicals into remarkably simple methods of contraception. Contraception now comes in many forms including hormonal tablets, implants which are inserted under the skin, injections, barriers such as diaphragms that fit into the vagina and block entrance of sperm cell into the woman's cervix and uterus, condoms and simple methods of sterilization for men and women. Pregnancy is likely to occur in 85 out of every 100 normal, healthy women who use nothing for contraception. See our handout Contraceptive Methods and Statistics for each of the methods listed below.

 

Contraceptive Methods and Statistics

How well do the various methods of contraception actually work? Click here and find out.

For more information click here. Contraceptive Methods and Statistics

 

Abstinence

Pregnancy can be prevented if men and women do not have vaginal sex. If the male does not deposit his sperm cells in the vagina then pregnancy cannot occur. This method is preferred by many women for it is also an excellent way to prevent sexually transmitted diseases. It is a valued for women for religious purposes, for maintain a sense of morality and before marriage. Its main down fall is that it only works if the woman is consistent. If a women has great resolve but for any reason allows sexual intercourse to occur at the wrong time of month and no other protection method is used pregnancy can occur.

For more information click here. Abstinence

Withdrawal

Withdrawal relies on the man (or woman) pulling out (or away) from each other just before the male ejaculates and releases sperm into the vagina. This methods is used by many couples. It affords between 96% and 81% protection against unwanted pregnancy. For couples where pregnancy is not a problem, where possibly not entirely unwanted but where there may only be limited desire for delay, withdrawal is a reasonable method. Its main advantage is that there is no cost or risks, no devices or preparation. Its main disadvantage is that it often breaks up the mood and diminishes the total enjoyment of the sexual act itself. Where this is not a problem and pregnancy would not be very unwelcome withdrawal is an excellent method. Where pregnancy is definitely undesired withdrawal is a not likely a method of choice.

Breast Feeding as a Means of Contraception

Breastfeeding can protect against pregnancy. This is ancient inborn mechanism for protecting nursing mothers from pregnancy before their current baby has a chance to fully survive. Learn more about how and when to use this method of protection.

For more information click here. Breast Feeding as a Means of Contraception

 

Safe Sex (Basal Body Temperature)

We know that just before ovulation the average body temperature, often called the Basal Body Temperature, drops 1 to 2 degrees. Using a special thermometer (Basal Body Thermometer) one can monitor the basal body temperature and determine when ovulation is about to occur. Since pregnancy can only occur in a short period of time just after ovulation knowing when ovulation occurs, the Unsafe Days, allows the woman to either use abstains or a secondary method of contraception, condoms, foam, diaphragm to prevent pregnancy or to protect against pregnancy. The period of time before and after the unsafe days is referred to as the Safe Days. The unsafe days begin just before ovulation when the temperature drops and last for approximately 7 days (see Figure 1). The safe days are one week before the temperature drop and 2 weeks after the unsafe days are over. The protection rates for all methods of periodic abstinence is between 99% and 80% effectiveness.

bbt-1b

Figure 1.

 

For more information click here.  Safe Sex (Basal Body Temperature)


Male Condoms with or without Spermicidal Foam, Creams or Gels

Male condoms, spermicidal crams, gels and foam are all forms of barrier methods of contraception. The male condom is used to trap sperm cells and prevent them from entering into the vagina, cervix or uterus to cause pregnancy. Condoms must be put on over the penis prior to intercourse. Lone it at best 97% effective but in practice its efficiency in protecting against pregnancy is more like only 88% effective. Compared to other methods of birth control this is rather low. It has the advantage of being an easy, portable method which can be used with only a little need for forethought. It also has the advantage of protecting on a limited basis against STD's such as gonorrhea, syphilis, AID's and others.

When used alone condoms do provide moderate protection but when used in combination with spermicidal agents not only does the their ability to protect increase dramatically but also their ability to protect against STD's also dramatically increases. The disadvantage of spermicidal agents is also the disadvantage of this combination. Spermicidal agents must be inserted in the vagina 20 to 30 minutes prior to intercourse for maximum protection. While some condoms already come with spermicidal agents within and on them extra spermicide assures a higher rate of protection for both protection against pregnancy and STD's.

Spermicidal agents (foam, creams, jelly and vaginal suppositories) used alone are between 93% and 89% effective in protecting against unwanted pregnancy. Some women and men will feel that they are messy and can diminish the pleasure of intercourse, while others will have no problem with their use. Women occasionally complain of irritation, burning or discomfort from irritation of the sensitive skin of the vaginal and external genitals however, this is usually minimal, short lived and easily terminated by washing or douching.

For more information click here.  Male Condoms with or without Spermicidal Foam, Creams or Gels

The Cervical Cap and Female Condoms

The cervical cap is a device which the woman places over her cervix by inserting an reaching up to her cervix and placing a soft rubber cap over it. It is generally used in association with a spermicidal agent. Its rate of protection is one lower rates of protection. In previously nonpregnant women the rate is between 91% and 82% and in women who have had one or more pregnancy the rates drops to 73% to 64% protection. These are about the lowest of all methods of protection other then no contraceptive method at all.

The vaginal female condom is a sheath of rubber no unlike the male condom which is inserted into the vagina. It is used in association with a spermicidal cream. These two methods are rarely used as they have poor protection rates, require more preparation and are more difficult to use. The female condom has an overall protection rate of between 95% and 89% without concurrent use of a spermicidal agent.


The Diaphragm

This is a commonly used method of contraception. A rubber disc is placed into the vagina in front of the cervix and acts as a barrier to sperm. It is used in association with a spermicidal cream or jelly. It has the advantage of being a relatively easy method to use and the disadvantage of requiring forethought as the diaphragm must be inserted 20 to 30 minutes prior to intercourse and left in place 6 to 8 hours afterward. It is an excellent method for a settled couple who have relatively regular habits. Since its overall protection rate is between 94% and 82% it is best used by couples where pregnancy, if it occurs, is not a major problem.

For more information click here. The Diaphragm


The Intrauterine Device (IUD)

There are two commonly used IUD's. Bother are plastic devices that are inserted up into the uterus during menstruation. They both act to change the lining of the uterus so that a fertilized egg cannot implant. The three types of IUD devices are available, the copper impregnated IUD and the progesterone impregnated IUD and the plain plastic IUD (Lippes Loop). Each has a different use and value. The copper and plain IUD's can be left in place for up to 10 years, while the progesterone impregnated IUD must be replaced yearly. IUD's are generally safe when inserted by someone who knows what they are doing and when the patients checks on a monthly basis to feel the string that comes out of the cervix to be sure that the IUD is still in place. The advantage is that once inserted the woman does not have to do anything she can be her normal self and enjoy sex whenever she desires. The disadvantage is that women who have multiple partners may have a somewhat increased risk of pelvic infection or PID. Effectiveness for progesterone device is between 98.5% and 98.0% for copper device is about 99.4% reliability.

For more information click here. The Intrauterine Device (IUD) 


Birth Control Pills

Oral contraceptives pills (OCP's or often just OC's) have been used for contraception since the late 1960's. They have been proven to be safe and reliable. As with all of the methods listed above there are certain risks (see our handout on birth control pills) however they are generally between 99% and 99.5% effective in protecting against pregnancy. There are now two types of OCP's: Combined pills (a combination of the female hormones estrogen and progesterone) and progesterone only pills. There are then four types of combined pills the 21-day pills and the 28 day pills, the monophasic, 21 and 28-day pills, and the triphasic 21 and 28-day pills.. Monophasic pills provide the same dosage level of hormones all through the active cycle, whereas triphasic pills provide three different dosage levels one for each week of active cycle. Triphasic were originally designed to more closely follow a woman's natural hormonal pattern. Many experts say, however, that the fluctuations in dosage don't really matter and may even cause extra problems, such as increased "breakthrough" bleeding (sporadic menstruation) while on the pill, or an increase in pill-related headaches and other symptoms.

The progesterone only pills, also called minipills, lack the estrogen component. Since many women should not use estrogen for one reason or another, for example women who are afraid of estrogen, have history of medical problems which would contraindicate the use of estrogen, women who are breast-feeding, etc., minipills are often prescribed for these women. Minipills also have lower doses of progestin than combination pills making them a good choice for women worried about metabolic effects of the hormones. Minipills are however not as effective as a birth control method as compared to combination pills. They also require that the woman take them on a rigidly regular schedule and therefore are only best used in women who are very reliable, and have steady relations.

For more information click here.  Birth Control Pills


Depo-Provera

A concentrated form of progesterone is injected every three moths providing temporary contraception which can be continued for years or stopped at anytime. Its advantage it is 97% reliable and its disadvantage is that once given it is not reversible for three months.

For more information click here. Depo-Provera


Norplant Pellets*

 The Norplant system provides six pellets that are inserted directly under the skin in a minor surgical procedure. They release small doses of the female hormone progesterone which acts to prevent pregnancy. Its advantage is that it lasts 10 years and is highly effective , in fact the most reliable method allowing only 9 pregnancies per 10,000 women.

For more information click here. Norplant Pellets


Sterilization

There are procedures for both men and women to create permanent sterility. Tubal ligation in women and vasectomy in males. While this sounds wonderful for the couple who have completed their family there are certain disadvantages. The method is not fool proof and every year 4 out of every thousand women still become pregnant and between 1 and 1.5 out of every thousand me cause pregnancy.

For more information click here. Sterilization

 

Summary

There is no fool proof perfect method for protecting pregnancy. Each method has its values and these values will often depend on age, stage in life, desire for future pregnancies and the reliability of the couple in taking responsibility for the proper use of the selected method.