1. Choices in Contraception
Planned Parenthood of Central and Greater Northern New Jersey

2. Guidelines Be respectful One person speak at a time
Avoid side-conversations
Right to pass
Ask questions
Stay focused
Have fun

3. Planned Parenthood www.plannedparenthood.org
Affordable & Confidential Services:
HIV/STI Testing and Treatment
Pregnancy Testing
Pregnancy Options Counseling
Abortion Services
Gynecological Exams
Birth Control
Condoms
Health Education

4. Discussing Birth Control
The How, Why, and What of Contraception.
What patients want/need to know?

5. What Does “Birth Control” Mean to You?
What should people know about Contraception?
What comes to mind when you think about Birth Control?
Why contraception?
Someday- most human beings will become sexually active!
Why is it important for both men and women to know about birth control?

6. You live in ancient times. Your STI/Pregnancy Prevention options are:
Crocodile dung, mixed into a paste and inserted in the vagina
A magical folk belief: rocking & jumping after sexual activity
Abstinence
Doing nothing to prevent STIs or pregnancy

7. Things to consider when choosing Birth Control
Will you be comfortable using it?
Will you remember to use it?
Do you know how to use it the right way?
Do you know how effective it is?
Are you ok with that level pf protection?
Will using the method embarrass you or your partner?
Can you afford it?
Will you enjoy sex with it?
Has your doctor said it’s ok for you to use?
Does it fit in with your religion/values?

8. How Pregnancy Happens

9. Factors for Choosing the Right Method for You!
Lifestyle factors
How often it is taken
Being able to get supplies
Being able to get to a doctor or clinic
Money
Other behaviors (smoking, etc.)
Age
Relationship status/ communication with Partner
Antibiotics can counter act with birth control and make it ineffective.
There are so many different options- different folks for different strokes, there is a method out there for everyone! It is similar to choosing a favorite color!
Talking to your partner can not only help you decide the best method for you, but also known that when both partners understand how the method works, there is a better chance of that user becoming a perfect user vs. typical user.

10. Effectiveness Sometimes even the most perfect user can beat the odds.
Correct and consistent use is key to effective birth control.
Typical vs. Perfect user
Technology fails people just as people fail technology.
Sometimes even the most perfect user can beat the odds.
Using two different methods is more effective than one.
Not two Condoms (WHY?) but Condom with other method (pill, patch, ring, etc.)
Longer term methods have lower pregnancy rates.
IUD, implants, and long term injectable smaller chance of user error.
Typical vs. perfect user greatly impacts the effective rates on these methods.
Technology can fail even to the most perfect user. The only 100% way to prevent pregnancy is abstinence.

11. What are these Contraceptive Methods?
(And why are there so many to choose from?!)

12. Different Strokes for Different Folks!
There are many categories of contraception
Behavior
Barrier
Hormonal
Chemical
I.U.C/ I.U.D
Permanent

13. Different Strokes for Different Folks!
There are many categories of contraception
Behavior
Barrier
Hormonal
Long Acting
Permanent

14. BEHAVIORAL
Abstinence
Pulling Out

15. Behavioral Methods
Abstinence
Withdrawal
Outercourse

16. Abstinence What does Abstinence mean to you?
Abstinence works 100% of the time when preventing a pregnancy and also an STI. However, two partners need to be on the same page in order for it to work.
You can not get pregnant by waving at someone across the room or by kissing your partner, but when we start talking about Abstinence- are we referring to sexual intercourse or sexual activity? It can be either or- and mean something different to everybody.
Be clear in your conversation so that there is no confusion. Abstinence means different things to different people.
In my profession we would say abstinence is refraining from vaginal, anal, or oral sex. This was we know a person can not create a pregnancy or get an STI.

17. Abstinence What does Abstinence mean to you?
Abstaining from sexual intercourse until a goal is met such as marriage, finishing school, etc.
Communication is necessary!
Abstinence works 100% of the time when preventing a pregnancy and also an STI. However, two partners need to be on the same page in order for it to work.
You can not get pregnant by waving at someone across the room or by kissing your partner, but when we start talking about Abstinence- are we referring to sexual intercourse or sexual activity? It can be either or- and mean something different to everybody.
Be clear in your conversation so that there is no confusion. Abstinence means different things to different people.
In my profession we would say abstinence is refraining from vaginal, anal, or oral sex. This was we know a person can not create a pregnancy or get an STI.

18. Withdrawal
Unprotected intercourse in which a man withdraws his penis from the vagina before ejaculation.
Provides no protection from STIs.
Premature ejaculation can happen to even the most trained or experienced male. So though this method is often times recommended for men who know their bodies well, accidents can happen to anyone!
Sometimes this is referred to as Pull and Pray
Here I often get the question of “pre-cum” and pregnancy. Urine and Sperm come out of the same tube in guys. That urethra cannot have sperm living in there for long, since urine also passes through. In pre-cum there is no sperm, however the way that it can get inside a woman is if there is still some hanging out inside that urethra and a male ejaculates.

19. * Name two methods that protects against both Pregnancy and STI’s?*

20. Outercourse
Outercourse is sexual activity/play that does not lead to vaginal intercourse.
These increase risk for STIs. WHY?
Outercourse can offer protection against unintended pregnancy as well as STI’s…
Some examples of Outercourse???
Examples would be dry humping, grinding, phone sex, dirty skyping, mutual masturbation etc.
The legal definition that constitutes something as sex is the fact that it turns someone on.
The issue here is that often times, Outercourse leads to intercourse.

21. Talk Around
Why would some people not be willing to use behavioral methods as a form of birth control?
They are married and they have no need to.
They are seeking pregnancy.
It is risky.
No fun.
There are other options

22. BARRIER (prevents the sperm from joining the egg)
Female Condom
Male Condom
The Sponge
Spermicide
Diaphragm
Cervical Cap

23. Barrier Methods
Condoms
Male and Female
Diaphragm/ Cap
Sponge

24. Male Condoms
The male condom is a thin, waterproof sheath which is placed over an erect penis before sex.
A condom prevents pregnancy by keeping semen from entering the vagina. They also help in preventing STI.
Fun Fact! How fast does ejaculate leave the body???
Condom Demo!
Steps to putting on a condom.
Two things to check before opening the pack? If there is an air bubble and the expiration date.
If you have a condom old enough to go to kindergarten you might want to get rid of it before you make someone who goes to kindergarten.
Another example of expired condoms would be comparing them to an old rubber band and trying to shoot that at someone.
Make sure the condom is right side up. You can tell by testing it between your thumbs and fingertips, and also by the outer ring of the condom.
Next step, pinch the tip and twist to avoid air inside and to give a space for the ejaculate.
Roll the condom down the tip of the penis and smooth out any air bubbles. Make sure that resivuior tip is still at the top. You never want to stretch it over the head of the penis- can cause the condom to break!

25. Fun Facts about Male Condoms
A condom should be placed over a fully erect penis.
Condoms can’t be reused!
Most condoms are made of latex. Condoms made of polyurethane are available for people with latex sensitivity.
The effective rate of condoms in couples that use them consistently and correctly is about 98%.
Can you put a condom on a flacid or soft penis? It won’t go on right, it will fall off.
Why can’t you reuse a condom?
They make Sheepskin condoms, which some people consider a luxury item, but it used to be one of the only methods they had. The problem is that they are pores, and may let sperm and germs through more likely than a latex or polyurethane.

26. Fun Facts about Male Condoms Continued…
Condoms are affordable and you do not need a prescription.
Condoms also offer excellent protection against STI’s.
Condoms are useful in preventing the transmission of disease during oral sex.
-Flavored Condoms/ Dental Dams
Condoms should fit good and feel good- just like methods of birth control, there are plenty of different types (flavors, sizes, and style) to choose from when picking out the right condom.
You might hear your friends talking about “the best” condoms- but they are talking about the best one for them.

27. Do’s and Don'ts… Condom Style!
Don’t lubricate condoms with oils.
Oil based lubricants destroy latex!!!
Do use water based personal lubricants .
Do check the expiration date and condition of the package.
Do have more than one condom on hand at a time.
Do hold the condom when removing penis after sex is finished.
Don’t keep condoms in hot or cold environments.
Do keep condoms at the same temperatures that people are comfortable.
No food products b/c food has oil! No baby oil, no conditioner, no crisco, no butter!!!
Never keep condoms in your car.
Never in your wallet or back pocket (due to hear and pressure)- front and side pockets are good.
Women who store them in their purse, get a condom case, or an altoids case to protect them from stab wounds from a pen or pencil!
Why have more than one condom? What if it flips out onto the floor? What if you want to have a time two or time three?
Someone should pull out of their partner holding the base of the condom while the penis is still erect after ejaculation to avouid anything slipping out the back or the condom falling off.

28. The Reasons Condoms Break
Improper storage.
No room for ejaculate.
Air inside the reservoir tip.
Wrong kind or not enough lube.

29. Female Condom
The female condom is a polyurethane or latex sheath that fits inside the vagina covering the cervix.
At the store, these are usually available but not usually easy to find so someone might have to ask.
They go for about 4 bucks a piece, but sometimes we have them at Planned Parenthood.
Has anyone ever seen one of these before?
The ring inside anchors the condom inside the vagina so that it doesn’t fall out

30. Cervical Cap
The cervical cap is a soft latex cup that fits over the cervix. It is used with spermicide.
It is smaller than a diaphragm and must be fitted by a health care professional.
Can be inserted up to 8 hours before sex and can remain in place no more than 48 hours.

31. Diaphragm
The diaphragm is a shallow latex cup with a springy steel rim that fits over the cervix.
Diaphragms must be fitted by a health care provider. All vaginas are the same size, but all cervix's are not.
Latex diaphragms are a durable birth control method, usable for up to 10 years.
Spermicide is applied to the cup before insertion, and must be inserted no more than 3 hours before sex.
It can be used for 6 hours, and then must be taken out no sooner than 6 hours, no longer than 24 hours after sex.

32. Vaginal Sponge
The sponge is a spongy foam cervical cap that is saturated with spermicide. The foam absorbs semen and the spermicide kills sperm.
It is available without prescription and can be bought at the store.
After sex the sponge should be left in place for at least 6 hours but no more than 30.
In order to activate the spermicide, a woman would need to wet the sponge lightly and insert it into the vagina.
The company who makes these is no longer making them, but they are still available on the shelf.
The future for sponges is yet to be determined.

33. Chemical Methods Spermicide
A foam, cream, jelly, suppository or film that contains sperm killing chemicals.

34. Facts for Use
Depending on the product directions spermicide can be inserted in the vagina between 5 and 90 minutes before intercourse.
Spermicide improves the effectiveness of barrier methods.
Spermicide improves use of condoms!
Though spermicide improves effectiveness of barrier methods, recent research is showing that it can put women at a higher risk for contracting STI’s. It can decrease the number of skin cells in a woman's vagina making her more susceptible to disease.

35. Spermicide
Depending on the product directions spermicide can be inserted in the vagina between 5 and 90 minutes before intercourse.
Spermicide improves the effectiveness of barrier methods.
Spermicide improves use of condoms!
Though spermicide improves effectiveness of barrier methods, recent research is showing that it can put women at a higher risk for contracting STI’s. It can decrease the number of skin cells in a woman's vagina making her more susceptible to disease.

36. HORMONAL (stops the egg from being released – and thicken cervical mucus)
The Pill
The Patch
The Ring
The Shot
The Implant

37. Hormonal Birth Control Methods
Pill
Patch
Ring
Shot
Implants
Hormonal Birth Control Methods

38. How Hormonal Methods Work
3 Ways All Hormonal Methods Work
They thicken cervical mucus making it harder for the sperm to meet the egg.
They send a signal to the ovary saying not to release an egg.
If sperm and egg do meet, hormonal methods do not allow the implantation in the uterus to create a pregnancy.

39. Facts about Hormonal Methods
Available by prescription only.
Provides no protection against STIs.

40. Taken once a day at the same time every day.
The Pill
Taken once a day at the same time every day.
Pill

41. Must be taken on daily schedule, regardless of sexual activity.
Facts about the Pill
Must be taken on daily schedule, regardless of sexual activity.
Certain Medications can make the pill less effective, so it is important to talk to your doctor.
The idea of taking the pill at the same time every day is based on flow of hormones. If the pill is taken correctly and consistently the hormone levels are balanced, if not they become unbalanced and turn someone into a typical user.
Talk to your doctor about medicines!
The antibiotic rifampin. Other antibiotics do not make the pill less effective.
Certain anti-fungals that are taken orally for yeast infections
Certain anti-HIV protease inhibitors
Certain anti-seizure medications
St. John's Wort

42. Possible Benefits of the Pill
Preventing Acne, Cancer of the lining of the uterus and ovaries, Ectopic pregnancy, Noncancerous breast growths, Osteoporosis, Ovarian cysts, PMS, Vaginal dryness related to menopause
Why would someone want to skip their period?
Vacation, sex, why wouldn’t someone?
Medically there is nothing wrong with skipping a period or not getting a period on purpose. This triggers some peoples attitudes, values, and beliefs about getting a menstrual.
A common misconception is that this effects future fertility and that isn’t true.

43. No patch is used in the fourth week. Period then occurs.
The Ortho Evra Patch
The patch releases synthetic estrogen and progestin to protect against pregnancy for one week.
A new patch is placed on the skin of the buttocks, stomach, upper outer arm, or upper torso once a week for three weeks in a row.
No patch is used in the fourth week. Period then occurs.
Patch is once a week method.
Can’t be placed in the same spot every week, but can not be placed just anywhere on the body either.
Three patches in a box.

44. A small, flexible ring that is inserted into the vagina once a month.
The Ring - Nuva Ring
A small, flexible ring that is inserted into the vagina once a month.
It is left in place for three weeks and taken out for the remaining week.
The ring responds to body heat and releases synthetic estrogen and progestin
Once a month.
A woman must be comfortable with her body in order to insert and remove.
Hormones activated by body heat so if it is out of the body you should store it in a fridge, or if you have to re insert it, make sure it is rinsed with cold water not warm.
Someone can leave this in for 21 days or 28 days depending if they want a period or not.

45. Emergency Contraception
Also known as “The Morning After Pill”, EC is high doses of birth control hormones. Taken correctly within 3 days after unprotected sex ,it reduces the chances of conception by as much as 85%. Within 5 days - 75%.
Emergency Contraception is not a controlled substance.
Available over the counter in New Jersey for anyone over the age of 17. Available by prescription to those under 17.
You can keep it in your medicine cabinet, or someone else can buy it for you. If you are under 17 you can get it at Planned Parenthood.
Can be taken up to 5 days after unprotected sex.
Side effects include moodiness, nausea, diarrhea.

46. Depo Shot Implanon I.U.C/I.U.D
Long Acting Reversible Contraceptives (LARC)
Depo Shot
Implanon
I.U.C/I.U.D

47. Long Acting Reversible Contraceptives (LARC)
These methods of birth control provide effective contraception for a long period of time. LARC methods are more effective in preventing pregnancy with typical use. More cost-effective than other methods.
Up front, these methods cost more money, but over time they turn out to be much more cost affordable. ParaGard for example could be $200, but over 12 years of preventing pregnancy, that is $1.39 a month. Planned Parenthood sometimes has opportunities to make these methods even more affordable.
Going back to that typical vs. perfect user- a clinician distributes these methods. I like to call them “set it and forget it” and less room for user error!

48. Depo Provera
An injectable progestin-only method of reversible birth control.
A single Depo Provera shot can prevent pregnancy for 12 weeks.
Depo Provera is the shortest acting LARC method.
Failure rate is 3 in 1000 with perfect use.
This is also a hormonal method so it works the same way as the Pill Patch and Ring, but is injected by a doctor every 3 months. Less user error.

49. Implanon
Implanon is a flexible plastic rod that is inserted under the skin of the inner arm.
It is about the size of a matchstick and requires a health care provider to insert it.
Contains synthetic progesterone and provides contraception for up to three years.

50. IUC- Intra Uterine Contraception
Implanted birth control device which is inserted in the uterus. May be left in place for 5-12 years depending on the device.
The Mirena contain hormones to increase effectiveness.
Prevent fertilization by affecting the movement of eggs and sperm and by changing the lining of the uterus.
ParaGard and Mirena
(this is an adjusted slide with photos added on top of the originals. I have tried to delete the original pictures but can’t figure out how)

51. Some IUDs contain hormones to increase effectiveness.
IUDs prevent fertilization by affecting the movement of eggs and sperm and by changing the lining of the uterus.
Some IUDs contain hormones to increase effectiveness.
IUDs are % effective as birth control.
May be left in place for 5-12 years depending on the device.

52. Permanent
Tubal Ligation & Vasectomy
Essure

53. Questions