Birth control

Exploring all the options

While there are many forms of birth control available, not all of them may be right for you. It's important that you get complete, accurate information—from a doctor, birth control clinic, sex educator, or community health nurse—so you can make the right decision for you.

It's also important that you know how effective each of these methods is. If you are female, your choice will depend on your overall health since some health conditions prohibit the use of some methods. Your choice will also depend on the type and stability of your relationship, cost, your values, your beliefs, and your willingness to comply with a particular method. For instance, you need to consider whether you can remember to take a pill at the same time every day. You may need to ask yourself how open your partner is to using condoms.

Abstinence

Abstinence means not having any kind of sexual intercourse. Abstinence is the most effective protection against pregnancy and sexually transmitted infections. It is 100% effective.

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Outercourse

Outercourse involves alternative forms of lovemaking which do not involve vaginal intercourse. These alternative forms include oral sex (such as cunnilingus, anilingus, and fellatio) and mutual masturbation. Outercourse can be very effective in preventing pregnancy as long as partners ensure sperm and pre-ejaculatory fluid ("pre-cum") stay far away from the vaginal area: because sperm can still enter her body, a female can become pregnant if her partner ejactulates close to her vaginal area. Outercourse, however, is not without risk: you can still contract a sexually transmitted infection from oral or anal sex. (Refer to How risky is oral sex? and How risky is anal sex? for more information.)

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Oral contraceptives

(Birth control pills or "The Pill")

Birth control pills must be taken every day. Oral contraceptives contain small amounts of hormones that prevent a woman's ovaries from releasing eggs. Naturally, if an egg isn't released, it cannot become fertilized and pregnancy cannot occur. In addition, birth control pills also cause other physical changes in a woman's body that make it difficult for male sperm to reach an unfertilized egg. For instance, the Pill thickens the mucus of the cervix, thereby making it more difficult for sperm to travel into the uterus and up into the fallopian tubes. Oral contraceptives also alter the lining of the uterus, making it thinner and therefore more difficult for an egg to implant itself in the endometrium.

While highly effective in preventing pregnancy if taken properly, (efficacy is between 95% and 99%) the Pill does not protect against sexually transmitted infections. You should still use a condom (see below) if you engage in vaginal, anal, or oral sex. (Refer to How risky is oral sex? and How risky is anal sex? for more information.)

Before deciding whether he or she can safely prescribe the Pill for you, your doctor will want to ask you some questions about your general health and examine you to ensure taking the Pill won't pose any health risks. Some women's bodies don't cope well with hormones. Your doctor may also want to perform a pelvic exam, a Pap test and possibly a test for sexually transmitted infections.

The Pill cannot protect against sexually transmitted infections. It's important to use both condoms and the Pill in order to safeguard against pregnancy and sexually transmitted infections. Knowing your partner or believing you're in a monogamous relationship is not enough. You may have chosen to have sex only with your partner, but do not assume your partner feels the same way. Do not assume you're in a monogamous relationship. If you wish to stop using condoms, be sure to see your doctor for regular HIV testing and tests for sexually transmitted infections. Following that, talk with your partner and make sure you both agree to be strictly monogamous.

The Pill is available through prescription.

Refer to Oral contraceptives: The Pill for more information.

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Birth control patch

Evra® or "The Patch"

A new form of birth control, the birth control patch has been available in Canada since January 2004. A 4-centimetre (1 1/2-inch) square that sticks to a woman's skin (usually on the buttocks, stomach, back, or upper arms but never on the breasts), the patch continuously releases the hormones estrogen and progestin into a woman's bloodstream. When used properly, the Patch is more than 99% effective in preventing pregnancy. For women who have trouble remembering to take their pill every day, the Patch may be more effective than the Pill. It may, however, be less effective in women weighing more than 90 kilograms (198 pounds).

The Patch works in a manner very similar to the Pill: hormones prevent a woman's ovaries from releasing eggs. Naturally, if an egg isn't released, it cannot become fertilized and pregnancy cannot occur. In addition, the patch also causes other physical changes in a woman's body that make it difficult for male sperm to reach an unfertilized egg.

Both the Patch and the Pill thicken the mucus of the cervix, thereby making it more difficult for sperm to travel into the uterus and up into the fallopian tubes.

The only main difference between the Patch and the Pill is that the Pill is taken by mouth whereas the Patch provides hormones through the skin.

If you cannot take estrogen because of an underlying medical condition, you should not use the Patch. Only your doctor can determine whether the Patch is right for you.

The Patch cannot protect against sexually transmitted infections. It's important to use both condoms and the Patch in order to safeguard against pregnancy and sexually transmitted infections. Knowing your partner or believing you're in a monogamous relationship is not enough. You may have chosen to have sex only with your partner, but do not assume your partner feels the same way. Do not assume you're in a monogamous relationship. If you wish to stop using condoms, be sure to see your doctor for regular HIV testing and tests for sexually transmitted infections. Following that, talk with your partner and make sure you both agree to be strictly monogamous.

Refer to The birth control patch for more information.

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Vaginal ring (NuvaRing™)

Now available in Canada and at least as effective as the Pill (95% to 99% effective), the vaginal ring is a new method of birth control in which a soft, flexible, clear plastic ring is inserted into the vagina where it slowly releases estrogen and progestin over a three-week period. This 54-millimetre (2-inch) diameter ring prevents pregnancy in much the same way the Pill does: the release of hormones prevents a woman's ovaries from releasing eggs. Naturally, if an egg isn't released, it cannot become fertilized and pregnancy cannot occur. In addition, the ring also causes other physical changes in a woman's body that make it difficult for male sperm to reach an unfertilized egg. The ring, however, does not provide a physical barrier to sperm and it does not protect against sexually transmitted infections.

Available in only one size, the ring does not have to be in a particular position inside the vagina in order to be effective. This is because it's held in place by the vaginal walls. As such, it should not fall out. If by chance it does, it should be rinsed off and replaced as soon as possible.

If it's been less than 3 hours since the ring has fallen out, you should be protected against unwanted pregnancy. If, on the other hand, it has been more than 3 hours since the ring has been out, a backup method of birth control should be used for the next 7 days.

The ring must stay in for at least 7 more days if it's been out longer than 3 hours. This could mean that it's worn more than 21 days in a single month. A 7-day ring-free interval follows before the next ring is inserted.

Refer to The vaginal ring for more information.

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Emergency contraception

The "Morning After Pill" or an intrauterine device (IUD)

If you've had unprotected sex within the last 3 to 7 days, you can get emergency contraception so you don't become pregnant. Unprotected sex means that:

• you did not use any form of birth control
• if you did use a condom, the condom broke
• you missed two or more birth control pills in a row
• you were late for your birth control shot (Depo-Provera)

There are two main forms of emergency contraception: the "Morning After Pill" or a copper intrauterine device (IUD).

The "Morning After Pill" is more effective if you've had sex within the past 3 days. Some healthcare professionals may prescribe it if you've had sex within the past 5 days. If you've had unprotected sex within the past 5 days, he or she may prescribe a copper intrauterine device (IUD) instead.

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Male condom

Made of a thin material (usually latex) that is placed over an erect penis, the male condom prevents sperm and pre-ejaculatory fluid ("pre-cum") from entering a woman's body. If you use a condom every time you have sex and follow the package instructions each time, condoms are 97% effective in preventing pregnancy. If you use condoms only some of the time or if you do not carefully follow the package instructions each time, condoms are only 86% effective in preventing pregnancy.

Because male condoms are also effective in the prevention of certain sexually transmitted infections including HIV, chlamydia and gonorrhea, they should be used in combination with other forms of birth control. For instance, a woman may use oral contraceptives or a diaphragm to prevent against pregnancy, but her partner should also use a condom to protect against sexually transmitted infections.

It's important to know how to properly use a condom, particularly since they can tear or slip off. You and your partner may find intercourse more comfortable if you use a water-soluble lubricant such as KY Jelly. Avoid oil-based lubricants such as baby oil, petroleum jelly, cooking or vegetable oil, mineral oil, or any other lubricant derived from oil: these can erode the latex, causing small, even unnoticeable tears and holes through which sperm and sexually transmitted infections, including HIV, can pass. Never ever use a condom if it appears brittle: a condom should be pliable.

Refer to Use of the male condom for more information.

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Female condom

The female condom is a thin pouch a woman places in her vagina prior to having vaginal intercourse. There is a ring at each end of the condom: one covers the cervix while the other covers her external genitalia, thereby preventing sperm from entering her body. If a female condom is used every time you have sex and you carefully follow the package instructions each time, it is 95% effective in preventing pregnancy. If you use a female condom only some of the time, or you do not carefully follow the package instructions each time, it is only 79% effective in preventing pregancy.

When used during vaginal intercourse, female condoms protect against sexually transmitted infections. Using female condoms for anal intercourse may reduce the risk of contracting HIV and other sexually transmitted infections, but this has not been tested. Female condoms were not designed for anal intercourse and a latex male condom should be used instead. If you must use a female condom, note that the inner ring should be removed for use during anal sex. (Refer to How risky is anal sex? for more information.)

Refer to Use of a female condom for more information.

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Injectable contraceptives

Depo-Provera or "The Shot"

More than 99% effective, this method of birth control injects a type of progesterone into a woman's buttocks or arm every three months. The hormone begins to work as soon as a patient receives the injection. This shot, however, does not prevent against sexually transmitted infections. What's more, you may not be able to get pregnant for a year after you stop using it.

Injectable contraceptives have been known to cause irregular bleeding, lighter or heavier menstrual periods, shorter or longer periods, or no periods at all. They are also associated with weight gain and bone loss. For women prone to forgetting to take the Pill each day, Depo-Provera may be a viable alternative. On the other hand, it is not recommended for women who suffer from certain medical conditions. Research has also shown that long-term use of Depo-Provera can lead to a decrease bone mineral density. Therefore, Depo-Provera may not be the best option for teenage girls under the age of 15 as their bones are still developing and, as such, these girls have yet to reach their peak bone mass.

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Diaphragm

A soft rubber dome placed inside a woman's vagina and over her cervix prior to vaginal intercourse, a diaphragm stops sperm from entering a woman's body. If you use a diaphragm every time you have sex and carefully follow the package instructions each time, it is 94% effective in preventing pregnancy. If you use it only some of the time, or if you do not carefully follow the instructions each time, a diaphragm is only 80% effective.

A diaphragm may be inserted up to two hours prior to having vaginal sex. Many women like this because it means they do not have to interrupt sex to put in a diaphragm. However, women using diaphragms must also use a spermicidal cream or jelly and they cannot remove the diaphragm for 6 hours after having sex. Some women claim diaphragms are messy and hard to place. Only a doctor or nurse can properly fit you for a diaphragm.

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Cervical cap

Similar to a diaphragm, a cervical cap is a small rubber dome with a firm rim that fits over the cervix, thereby preventing sperm from entering a woman's body. If you use a cervical cap each time you have vaginal sex and you carefully follow the package instructions each time, a cervical cap is 94% effective in preventing pregnancy. If you use it only some of the time, or if you do not carefully follow the instructions each time, a cervical cap is only 82% effective. The cervical cap, however, does not provide any protection against sexually transmitted infections. As with a diaphragm, a cervical cap can be inserted ahead of time so it doesn't interrupt sex and it can be left in for up to 48 hours. Because it is available in a number of different sizes, only a doctor or a nurse can fit you for a cervical cap.

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Contraceptive sponge

A donut-shaped foam sponge containing spermicide, a contraceptive sponge is inserted into the vagina before sex. It covers the cervix and prevents sperm from entering a woman's body. The sponge absorbs sperm while the spermicide kills them. Proven 87% effective for 12 hours, the sponge must stay in for 6 hours before it can be removed. The sponge carries one advantage over the diaphragm and the cervical cap: you don't have to be fitted for it. One drawback, however, is that the sponge offers no protection against sexually transmitted infections.

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Intrauterine device (IUD)

Proven 99% effective in preventing pregnancy, an intrauterine device is a small T-shaped piece of plastic or copper that only a doctor can place in a woman's uterus. Depending on the type, an IUD can stay in place between 1 and 10 years and can be removed at any time. If placed within 5 days of having unprotected sex, an IUD may also be used as an emergency contraceptive device.

An IUD may lead to heavier bleeding during menstrual periods.

The major disadvantage of using an IUD is that it can increase a woman's chance of developing an infection or pelvic inflammatory disease, a condition that can result in infertility. Therefore, an IUD may not be a viable option for women involved in a long-term, steady relationship.

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Vasectomy

A minor surgical procedure performed in a doctor's office, a vasectomy involves cutting and tying the tubes in which sperm travel. This procedure should not be performed unless a male is completely sure he will not want children in the future. Because a vasectomy is a permanent, irreversible procedure, it may not be the best choice for adolescent males since in the future, they may decide they want children. Although 99.9% effective in preventing pregnancy, a vasectomy does not protect against sexually transmitted infections.

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Tubal ligation (having one's tubes tied)

Performed in a hospital, a tubal ligation is a surgical procedure in which a woman's fallopian tubes (the tubes that carry the fertilized egg to the uterus) are cut and tied. Because a tubal ligation is a permanent, irreversible procedure, it may not be the best choice for adolescent girls since in the future, they may decide they want children. Although 99.6% effective in preventing pregnancy, a tubal ligation does not protect against sexually transmitted infections.

Refer to Tubal ligation for more information.

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Rhythm method (natural family planning)

Approved by many of the world's religions, natural family planning (also sometimes called the "rhythm method") implies that a couple will abstain from sex during a woman's fertile period—that is, the period during which she is ovulating. The ovulation period is the time in a woman's menstrual cycle during which the ovaries release a egg to be fertilized. It is during this time that a woman is most likely to become pregnant. In fact, a woman may become pregnant anytime from a few days leading up to ovulation and a few days after she ovulates. This is because an unfertilized egg can live up to 24 hours and sperm can live up to 5 days. Couples practicing the rhythm method typically abstain from sex for a period beginning 5 days before a woman ovulates and ending 5 days after ovulation.

In order for this method to be effective, a couple must determine when ovulation happens. A doctor or nurse can teach you. This method is not very effective in cases where a woman's periods are irregular (as in the case of adolescent girls or young adults) or if she is suffering from an illness since each of these factors can make it difficult to predict when she will ovulate. What's more, this method's effectiveness differs from one woman to the next. As a result, the effectiveness of natural family planning can vary from 70% to 90%. The rhythm method offers no protection from sexually transmitted infections.