Your Contraceptive Choices

Your Contraceptive Choices

Abstinence What it is and How it works
Abstinence means choosing not to have sex But “What’s Your Definition”? Refraining from all sexual behavior, including masturbation Refraining from sexual behavior involving genital contact Refraining from penetrative sexual practices Many more definitions out there…its not enough to ask “Have you had sex before?” Saying No… It doesn’t work if you only practice abstinence occasionally! Cost: Free!!! Emotionally and financially! Its the only thing that is 100% effective for preventing pregnancy and STDs

Advantages & Disadvantages of ABSTINENCE
Effectiveness: 100% prevents sexually transmitted infections and pregnancy No medical or hormonal side effects Postpone emotional and physical risks Less likely to become infertile Free! ($0) Possible Problems Disadvantages May be difficult to abstain May not be prepared with back-up method if or when you choose to become sexually active

WITHDRAWAL What is it? How does it work?
The man pulls his penis out of the vagina before he ejaculates to keep the sperm from joining the egg

Advantages and Disadvantages of Withdrawal
Better than using no method at all Free Disadvantages Must rely totally on partner to pull out in time – woman has no control Partner may not be able to withdraw in time Pre-ejaculate -- possibility for sperm Only 78% effective

Spermicides What they are and how they work
A method that a woman inserts into the vagina before having sex Contain chemicals that kill sperm and/or block sperm from entering cervix Active ingredient: nonoxynol-9 Forms: Gel, foam, cream, film, suppository, or tablet Used alone OR as part of another barrier method Time sensitive – usually require 15 min wait before sex for spermicide to activate; must reapply/effective for only an hour

Advantages and Disadvantages of Spermicides
Full personal control over use No need for special procedure or exam Doesn’t contain hormones Side effects are uncommon; almost anyone can use them Available without a prescription and in most drug stores; relatively inexpensive Disadvantages Need to plan ahead – must have available when you have sex Must reinsert often (every hour) Doesn’t provide protection from STD’s Not as effective as other methods Some have allergic or chemical reaction to ingredients in it Side effects may include increase urinary tract infections or irritation

Effectiveness 74% effective with typical use
94% effective with perfect use

Approximately $.30 - $1.00 per act of sex
Cost Approximately $.30 - $1.00 per act of sex Film (12 sheets) – approx. $9.25 Foam (container) -- $12.00 Suppositories (12) -- $4.00 Gel or Cream (tube) -- $12.00

The Female Condom What is it and How does it Work
Thin, loose-fitting and flexible plastic (polyurethane) tube worn inside the vagina A soft ring at the closed end covers the cervix and keeps sperm from entering the vagina (fits like diaphram) Outer ring covers the labia on the outside of the vagina One time use only – thrown away after you use it and replaced with a new one before your next act of sex.

Advantages and Disadvantages of the Female Condom
Available without a prescription No hormonal side effects Can be used for people with latex sensitivities Prevents STDs: chlamydia, gonorrhea, herpes, HPV, and HIV Stays in place regardless of penis hardness – cannot fall off Disadvantages Difficult to use Can break or leak More expensive then the male condom Does not contain spermicide

Side Effects There are no physical side effects
There is a chance though that it will break or slip during intercourse DO NOT USE WITH MALE CONDOM!!! (The friction will cause both to break)

Effectiveness 79% with typical use 95% with perfect use

About $2.50 per package/condom
Cost About $2.50 per package/condom

The Male Condom What is it and How does it work?
Keep sperm from entering the vagina during intercourse It is a thin layer of latex (plastic) that covers the penis; polyurethane and tactylon (plastic) are available as well. Rolled onto an erect penis Once man ejaculates, must hold on to base of condom and remove himself from woman; gently pull off condom and discard Removal must be done immediately before penis becomes soft (flaccid) to prevent spilling of semen. A new one must be used before next sex act.

Advantages & Disadvantages of Male Condoms
Easy to buy Inexpensive Full personal control over use; no special procedures or exams Side effects uncommon Helps prevent pregnancy and most STDs Can be used with other methods Disadvantages Can sometimes break Need to plan ahead; have available when you have sex Latex and/or Spermicide Allergies – other brands or types of plastic available for those who suffer Loss of sensation

Effectiveness 86% – typical use 97% - perfect use
Nearly 100% if used with withdrawal

Condom Not Recommended For:
Women or Men who are uncomfortable touching the penis Those who have an allergy to latex (rubber) or spermicide. Avanti and Trojan Supra brands have a polyurethane male condom (best) or natural membrane condoms (lamb skin) Only 1-2% of women and men have such allergies

Family Planning Centers may give them away or charge very little
$$ Cost $$ $.30 - $1.00 each Family Planning Centers may give them away or charge very little

Depo-Provera What it is and how does it work?
A shot of the hormone progestin Stops ovulation and/or thickens cervical mucus to keep sperm from joining egg Must receive shot every 12 weeks (3 months)

Advantages and Disadvantages of Depo-Provera
Stops monthly periods or have extremely light periods Contains no estrogen Safe, highly effective, long-lasting protection – no need for action before, during or after sex Reduces menstrual cramps and pain Can be used right after birth and while breast feeding Alternative to women who are over 35 and smoke Decreased risk of endometrial and ovarian cancer, and PID Disadvantages Must receive shot every 3 months Irregular or late periods, spotting may occur. After a year most stop having periods; safe – most welcome it. Bloating, weight gain, headaches, depression, loss of interest in sex, hair loss, and abdominal pain Side effects can’t be reversed until wears off May cause delay in pregnancy after shot is stopped Does not protect against STDs

Depo-Provera Not Recommended for Women who are:
Are uncomfortable with needles/injections Plan to get pregnant within 5 years Have impaired liver function or liver tumors Have known or suspected breast cancer Have abnormal vaginal bleeding Have depression in their medical history Don’t have access to health care provider – requires a prescription and must be injected by a health care provider

Effectiveness 99.7% effective Does NOT protect against STD’s

Cost $35.00 for each injection $35-$125 for an exam

IUD What is it and How does it work?
A small plastic device inserted into (and/or removed from) the uterus by a health care provider Contains copper or hormone progestin that keep the sperm from joining the egg Prevents a fertilized egg from implanting in the uterus

Advantages and Disadvantages of IUD
Immediately effective Longest lasting of any method Easily removed by provider at any time Requires no daily attention Convenient: no action needed before, during or after sex Only safe for those not at risk for STDs Disadvantages Doesn’t prevent against STDs Requires health care provider visits for insertion and removal Possible risk to future fertility For some, insertion can be painful May increase cramps and bleeding during monthly periods

IUD Not Recommended For Women Who:
Plan to get pregnant within 5 years Have an active cervical infection, abnormal vaginal bleeding, pelvic infection, ectopic pregnancy, frequent fainting, severe anemia, heavy menstrual bleeding or cramping, or have uterine fibroid tumors in their medical history Have been pregnant in the last 6 weeks Have had an abnormal Pap smear that has not yet been resolved Do not have access to a health care provider – requires a prescription and must be inserted and/or removed by provider

Effectiveness 98%-99.9% EFFECTIVE

COST $173-$400 (including exam) Approx. $150-$200

Emergency Contraceptives What it is and How it Works
Regimen of combined oral contraceptive pills (ECPs – emergency contraceptive pills) taken within 72 hours of unprotected sex Other options: Progestin-only Mini-Pills taken within hours Insertion of copper-releasing IUD within 5 days of unprotected sex

Effectiveness 74-89% pills 99% IUD insertion

Advantages and Disadvantages of Emergency Contraceptives
Only methods a couple can use to prevent pregnancy after unprotected sex or after an “accident” Provides emergency treatment for victims of sexual assault who were not protected by an effective method at the time Disadvantages Not as effective at preventing pregnancy as other birth control methods Possibility of short term side effects like nausea, vomiting, and mentrual changes at next period Does not protect against STDs

Cost Approximately $25 for pills
Approximately $150-$200 for IUD insertion $170-$400 (including exam)

Periodic Abstinence What it is and How it Works
Identifying days when pregnancy is most likely to result and abstaining from sex (also called Natural Family Planning or Rhythm Method) Includes measuring basal body temperature, charting cycle on calendar, cervical mucus, and symptothermal methods Called fertility awareness if using barriers or withdrawal method during fertile time

Effectiveness Calendar method – 87% - typical use 95% - perfect use
Basal body temperature – 80% - typical use 98% - perfect use Cervical mucus – 80% - typical use 97% - perfect use Symptothermal – 80% – typical use

Advantages and Disadvantages of Periodic Abstinence
Full personal control over use; no need for special medical procedures or examinations No side effects Free ($0) Disadvantages Does not protect against STDs, including HIV Not good for women who: Have irregular cycles or menstrual problems Inability to interpret fertility signs correctly Have persistent reproductive system tract infections that affect the signs of fertility Have partner unwilling to practice periodic abstinence

Cost Free $0 Suggest buying a basal (resting) body temperature thermometer (BBT)

Birth Control Pills What are they and How do they Work?
A combined oral contraceptive pill that releases the hormones estrogen and progestin The pill is taken once a day Helps to stop the release of the egg, stops sperm from entering cervix, and changes lining of the uterus to prevent egg from implanting.

Advantages and Disadvantages of Birth Control Pills
Studied for over 30 years – long-term safety well known Periods become more regular Less menstrual cramping, facial hair, acne, and menstrual flow Reduces risk of ovarian and womb cancer and infections of tubes and ovaries Strengthens bones by regulating hormones Some protection from PID Disadvantages Must be taken daily; hard to remember to take Side effects include irregular bleeding, weight gain or loss, changes in mood, nausea, breast tenderness and headaches Increased health risks when used with smoking Slight increase in the risk of blood clots Does not protect against STDs

Birth Control Not Recommended for Women who:
Cannot take estrogen due to current health status Smoke Over age 35 Have blood clots, impaired liver function or liver tumors, known or suspected breast cancer, vaginal bleeding, high blood pressure, gallbladder disease or severe headaches in their medical history Do not have access to health care provider – requires a prescription from the provider

Effectiveness 92% - typical use 99.7% - perfect use Increased
effectiveness if used with other barrier methods

Cost $17.00-$21.00 for monthly pill packs
$35-$ for exam, if needed

Mini Pills What are they and How do they Work?
A special kind of oral contraceptive pill Taken daily (one pill) Contains the hormone progestin which works to prevent pregnancy by stopping ovulation and/or thickening the cervical mucus to stop the sperm from passing through

Advantages and Disadvantages of Mini Pills
Studied for more than 30 years; long-term safety well known Stops monthly periods or causes extremely light periods Contains no estrogen Alternative for women over 35 who smoke Decreased menstrual cramps and pain; relief from acne and facial hair Decreased risk of endometrial cancer, ovarian cancer, and PID (pelvic inflammatory disease) Immediate reversibility Disadvantages Must take them every day at the same time Effectiveness is compromised easier if taken with other medications because dose is very low Does not protect against STDs, including HIV Not recommended for women who: Have impaired liver function Known or suspected breast cancer Abnormal vaginal bleeding in medical history Don’t have access to healthcare provider as they require a prescription

Cost $17.00 – $25.00 per monthly pill pack
$35.00-$ for exam, if needed

Implanon What it is and How it Works
Implanon is not yet widely available. As more health care providers are trained to insert and remove this newly-approved method, a greater number of Family Planning centers and other providers will be offering it. Implanon® is a thin, flexible plastic implant about the size of a cardboard matchstick. It is inserted under the skin of the upper arm. The implant contains progestin. It works in two ways. It keeps the ovaries from releasing eggs (ovulation). It also thickens the cervical mucus, preventing sperm from joining with an egg. In theory, it could prevent implantation of a fertilized egg, but it has not been proven that it does.

Implanon What it is and How it Works (cont.)
Implanon is not yet widely available. As more health care providers are trained to insert and remove this newly-approved method, a greater number of Family Planning centers and other providers will be offering it. After taking your medical history and giving you a physical exam, the clinician will numb a small area of your arm with a painkiller. The implant is inserted under the skin. Insertion takes only a few minutes. Otherwise, use an additional method of contraception for the first seven days.

Results of long-term studies will not be available for some time, but…
Effectiveness Results of long-term studies will not be available for some time, but… Researchers estimate that Implanon will be up to 99.9 percent effective for up to three years.

Advantages and Disadvantages of Implanon
Protection against pregnancy is immediate if you get the implant during the first five days of your period. Ability to become pregnant returns quickly when use is stopped Can be used while breastfeeding Can be used by women who cannot take estrogen Gives continuous long-lasting birth control without sterilization No medicine to take every day Nothing needs to be put in place before vaginal intercourse Disadvantages Does not protect against STDs Irregular bleeding may occur Periods become fewer and lighter for most women — in time, they may stop altogether. Some women will have longer and heavier periods. Some may have increased light spotting and breakthrough bleeding. Side effects include increased acne, change in appetite and sex drive, depression, dizziness, hair loss, headache, nausea, nervousness, sore breasts Increased risk of cysts on the ovaries Discoloring or scarring of the skin over the implant Pain at the insertion site

Implanon was approved for use in the United States in July 2006.
Cost Implanon was approved for use in the United States in July 2006. It is not yet known how much it will cost to have Implanon inserted or removed.

Sponge What it is and How it Works
Made of a soft, disposable polyurethane foam that feels like natural vaginal tissue Contains the spermicide nonoxynol-9. It is soft, round, and about two inches in diameter. It has a nylon loop attached to the bottom for removal. After it is moistened with water and inserted into the vagina, it is effective immediately and protects against pregnancy for the next 24 hours without the need to add spermicide – even with repeated sex acts. Do not leave in for more than 30 hours.

Effectiveness 84% - typical use 91% - perfect use

Advantages and Disadvantages of the Sponge
It is effective immediately Protects for 24 hours without the need to add spermicide – even with repeated sex acts. Can be used during breast-feeding Can easily be carried in pocket or purse Does not have an effect on a woman's natural hormones Can be inserted hours ahead of time and can be worn for up to 30 hours after insertion. Disadvantages Does not protect against STDs Cannot use during period or reproductive tract infection Insertion or removal could be difficult for some Some experience vaginal dryness and irritation Could be messy

A package of three sponges costs
$7.50-$9.00

CONTRACEPTIVE PATCH What it is and How it works
Applied to the abdomen, upper arm, upper torso, or buttocks Releases estrogen and progestin hormones through the skin Prevents ovulation Worn for 3 weeks at a time, not worn for 4th week

Advantages and Disadvantages of Ortho-Evra (Contraceptive patch)
Easy to use Can be worn for 3 weeks Effects fertility one month at a time Many same as pill Disadvantages Doesn’t protect against STDs Raised risk of heart attack and stroke Requires a prescription Many of same as pill

EFFECTIVENESS and COST
99% effective with perfect use 92% effective for women weighing 198 pounds or more Costs between $30-$40 a month

NuvaRing What it is and How it works
It is 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 releases the hormone estrogen and progestin to protect against pregnancy for one month. The combination of hormones works in two ways. Usually, it keeps the ovaries from releasing an egg (ovulation). Less often it thickens the cervical mucus, which prevents sperm from joining with an egg. The hormones also thin the lining of the uterus.

Warning! NuvaRing won’t work if:
If the unopened package is exposed to very high temperatures or direct sunlight It slips out of the vagina and is not replaced within three hours It does not stay in the vagina for three weeks in a row It is left in the vagina for more than three weeks

Advantages and Disadvantages of the NuvaRing
The ring protects against pregnancy for one month. It does not involve taking a daily pill, require the use of spermicide, or require a "fitting" by a clinician. Using the ring is simple, safe, and convenient. Many women have more regular, lighter, and shorter periods. A woman's ability to become pregnant returns quickly when use of the ring is stopped. Researchers assume that the ring advantages are similar to those known to be associated with the pill. Disadvantages Doesn’t protect against STDs Requires a prescription Certain medicines, drugs, anti-fungals, and protease inhibitors may make the ring less effective. Bleeding between periods Weight gain or loss Breast tenderness Nausea — rarely, vomiting Changes in mood Increased vaginal discharge Vaginal irritation or infection

Not Recommended for Women who:
Smoke cigarettes and are 35 or older Have had a heart attack or certain kinds of stroke, uncontrolled high blood pressure, a history of certain inherited blood clotting disorders, blood clots or vein inflammation Have a history of serious heart valve problems Have had an abnormal growth or cancer of the breast or uterus Have a severe liver disease or have had growths on the liver Are or think you might be pregnant Have migraine headaches with aura Have weak pelvic floor muscles Have chronic constipation Women cannot use a diaphragm, cap, or shield for a back-up method of birth control while they are using the ring.

Effectiveness The ring is a very effective reversible method of birth control. With typical use,* although no studies have yet been published, it is assumed that the ring will be more effective than the pill. 92% -- typical use 99% -- perfect use

Cost Ranges from about $35–$125 for first visit and exam In addition
The ring costs between $30 and $35 a month.

Male and Female Sterilization What it is and How it Works
A surgical procedure that prevents you from ever getting pregnant. Form of permanent birth control Woman: A tubal ligation blocks a woman’s reproductive tubes, preventing sperm from being able to fertilize an egg Man: A vasectomy blocks a man’s reproductive tubes, preventing sperm from leaving his body

Advantages and Disadvantages of Sterilization
Generally more reliable than other birth control methods Disadvantages Requires outpatient surgery Leaves small scars and may involve stitches. Can be expensive Does not protect against STDs

99.5% tubal ligation for women
Effectiveness 99.5% tubal ligation for women 99.85%-99.9% vasectomy for men

Not Recommended for Women who:
Plan to get pregnant in the future Want the choice of getting pregnant at some point in their lives Do not have access to a health care provider – sterilization requires outpatient surgery

Cost Approximately $1,200-$2,500 for tubal ligation
for vasectomy

Diaphragm or Cervical Cap What is it and How does it Work
Clinician fits you with a shallow latex cup (diaphragm) OR Thimble shaped latex cap Coat with spermicide Fits over the cervix and keeps sperm from entering the uterus. Place in before sex act – cervical cap min. before Left in place for at least 6 hours – no more than 24 hours Remove by inserting finger and breaking seal with fingertip and squeezing ring to take it out

Advantages and Disadvantages of Diaphragm and Cervical Cap
They don’t need to be replaced for mo. (cap) or several years (diaphram) Allow full personal control over their use Side effects are uncommon Diaphrams can be used during your period Provide some protection against bacterial STDs Reduce the risk of PID (pelvic inflammatory disease) Disadvantages Offers no protection against viral STDs You need to plan ahead – have products available whenever you have sex Difficult for some women to use Difficult to fit some (20%) of women (only 4 sizes in cervical caps) Can be messy Allergies to latex rubber or spermicide Increases risk of UTIs (urinary tract infections) Cervical cap cannot be used during period

Diaphragm and Cervical Cap NOT recommended for:
Women who are uncomfortable or not familiar with their vulva or vagina Have longer vaginas, tilted uterus, or short fingers – can make insertion and removal difficult Have allergies to latex (rubber) or spermicide Have a history or toxic shock syndrome or repeated UTIs (urinary tract infections) Don’t have access to health provider – they require a prescription and fitting by provider

Effectiveness and Cost
Diaphragm: 80% with typical use 94% with perfect use Cervical Cap: 60% with typical use 91% with perfect use $50-$150 for the fitting; (spermicide costs extra) $13-$25 for the diaphragm

MYTHS about birth control and contraceptives
A women will not get pregnant the first time she has sex A women can only get pregnant once a month A women will not get pregnant if her partner pulls out A women will not get pregnant if she urinates or douches after sexual activity.

Good Resources : www.metrokc.gov/health/famplan/birthcontrol/

Your Contraceptive Choices

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