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Abstinence

What Is It?

Abstinence is not having sex. A person who decides to practice abstinence has decided not to have sex.

How Does It Work?

If two people don't have sex, then sperm can't fertilize an egg and there's no possibility of a pregnancy. Some forms of birth control depend on barriers that prevent the sperm from reaching the egg (such as condoms or diaphragms). Others interfere with the menstrual cycle (as birth control pills do). With abstinence, no barriers or pills are necessary because the person is not having sex.

You don't have to be a virgin to practice abstinence. Sometimes people who have been having sex decide not to continue having sex. Even if a person has been having sex, he or she can still choose abstinence to prevent pregnancy and sexually transmitted diseases (STDs) in the future.

How Well Does It Work?

Abstinence is 100% effective in preventing pregnancy. Although many birth control methods can have high rates of success if used properly, they can fail occasionally. Practicing abstinence ensures that a girl won't become pregnant because there's no opportunity for sperm to fertilize an egg.

Protection Against STDs

Abstinence protects people against STDs. Some STDs spread through oral-genital sex, anal sex, or even intimate skin-to-skin contact without actual penetration (genital warts and herpes can be spread this way). So only avoiding all types of intimate genital contact can prevent STDs. Avoiding all types of intimate genital contact — including anal and oral sex — is complete abstinence.

Only complete and consistent abstinence can totally prevent pregnancy and protect against STDs. Because a person does not have any type of intimate sexual contact when he or she practices complete abstinence, there is no risk of passing on a sexually transmitted infection.

Consistent abstinence means that someone practices abstinence all the time. Having sex even once means that the person risks getting an infection.

Abstinence does not prevent AIDS, hepatitis B, and hepatitis C infections that come from nonsexual activities like using contaminated needles for doing drugs, tattooing, or taking steroids.

How Do You Do It?

Not having sex may seem easy because it's not doing anything. But peer pressure and things you see on TV and in the movies can make the decision to practice abstinence more difficult.

If it seems like everybody else is having sex, some people may feel they have to do it, too, just to be accepted. Don't let kidding or pressure from friends, a girlfriend, a boyfriend, or even the media push you into something that's not right for you. The truth is that most teens are not having sex.

A couple can still have a relationship without having sex. If you've made a decision not to have sex, it's an important personal choice and the people who care about you should respect that.

You may have questions about making this choice or about other methods of birth control. Your doctor or nurse — or an adult you trust, such as a parent, teacher, or counselor — can help provide some answers.

Reviewed by: Larissa Hirsch, MD

Date reviewed: September 2009

Originally reviewed by: George A. Macones, MD

BIRTH CONTROL PATCH

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What Is It?

The birth control patch is a thin, beige, 1¾-inch (4½-centimeter) square patch that sticks to the skin. It releases hormones through the skin into the bloodstream to prevent pregnancy. Hormones are chemical substances that control the functioning of the body's organs.

How Does It Work?

The combination of the hormones progesterone and estrogen in the patch prevents ovulation (the release of an egg from the ovaries during a girl's monthly cycle). If an egg isn't released, a girl can't get pregnant because there's nothing for a guy's sperm to fertilize.

The hormones in the patch also thicken the mucus produced in the cervix, making it difficult for sperm to enter and reach any eggs that may have been released. The hormones can also sometimes affect the lining of the uterus so that if the egg is fertilized it will have a hard time attaching to the wall of the uterus.

Like other birth control methods that use hormones, such as the birth control pill or ring, a girl uses the birth control patch based on her monthly menstrual cycle. She puts on the patch on the first day of her menstrual cycle or the first Sunday after her menstrual cycle begins. She will change the patch on her skin once a week for 3 weeks in a row. (The patch should be applied to one of four areas: the abdomen, buttocks, upper arm, or upper torso — except for the breasts.) On the fourth week, no patch is worn, and a girl's period should start during this time.

Using The Patch

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It's important to apply a new patch on the same day every week to ensure that it keeps working effectively. For example, a girl who applies her first patch on a Monday should always apply her patches on a Monday. When it's time to change the patch, pull the old one off first, before applying a new patch. Place the new patch on a different area from the old patch (but still on one of the four recommended areas listed above) to avoid skin irritation. Don't apply the patch to skin that is red, irritated, or cut.

For the first 7 days on the patch, use an additional form of contraception as well to prevent pregnancy.

If you forget to apply a new patch on the right day, or if the patch becomes loose and falls off, read the instructions that come in the package or call your doctor. If this happens you may need to use a backup method of birth control (such as condoms) or stop having sex for a while to protect against pregnancy. Also, if you stop using the patch for any reason, you will need to begin using another method of birth control, usually after 24 hours of removing your last patch.

It's OK to participate in normal activities like swimming and exercise while wearing the patch. You can also get it wet in the shower or in the bath. However, the patch should not be moved or removed until the week is up (pulling the patch off to reposition or move it may cause it to lose some of its stickiness and it might fall off easily). Don't try to decorate the patch, change the size of a patch by trimming it, or try to attach it with tape. Talk to your doctor if the patch falls off.

The patch should not be applied over makeup, creams, lotions, powder, or other skin products as these may prevent it from sticking well. (Skin products may also affect how hormones are absorbed by the skin.)

How Well Does It Work?

Ongoing studies suggest the birth control patch is as effective as the birth control pill. That means that about 8 out of 100 couples will have an unintended pregnancy during the first year of use. Of course, the chance of getting pregnant depends on whether you use the patch correctly. Delaying or missing a weekly application or removing a patch too early reduces its effectiveness and increases the chance a girl will become pregnant.

For girls who weigh more than 198 pounds (90 kilograms), the contraceptive patch may be less effective in preventing pregnancy.

In general, how well each type of birth control method works depends on a lot of things. These include whether a person has any health conditions or is taking any medications that might interfere with the patch. How effective the patch is at preventing pregnancy also depends on whether the method chosen is convenient — and whether the person remembers to use it correctly all the time.

Protection Against STDs

The birth control patch does not protect against sexually transmitted diseases (STDs). Couples having sex must always use condoms along with the birth control patch to protect against STDs.

Abstinence (the decision to not have sex) is the only method that always prevents pregnancy and STDs.

Possible Side Effects

The birth control patch is a safe and effective method of birth control. Most young women who use the patch have no side effects. Smoking cigarettes while using the patch can increase a girl's risk of certain side effects, which is why health professionals advise women who use the patch not to smoke.

The side effects that some women have while using the patch are similar to those experienced with the birth control pill. These may include:

• irregular menstrual bleeding

• nausea, headaches, dizziness, and breast tenderness

• mood changes

• blood clots (these are rare in women under 35 who do not smoke, but there may be a higher risk with the patch than with the Pill)

Other possible side effects seen in patch users include:

• skin reactions at the site of application of the patch

• problems with contact lens use — a change in vision or inability to wear the lenses

• menstrual cramps

Many of these side effects are mild and tend to disappear after 2 or 3 months.

Who Uses It?

The birth control patch may be a good choice for sexually active young women who weigh less than 198 pounds (90 kilograms) and find it difficult to remember to take a pill every day or who have difficulty swallowing pills.

Not all women can — or should — use the birth control patch. In some cases, medical or other conditions make the use of the patch less effective or more risky. For example, it is not recommended for women who have had blood clots, severe high blood pressure, certain types of cancers, certain types of migraine headaches, or diabetes with certain problems. It's recommended that girls who have had unexplained vaginal bleeding (bleeding that is not during their periods) or who suspect they may be pregnant should talk to their doctors, discontinue using the patch, and use another form of birth control in the meantime.

Girls who are interested in learning more about the possible health benefits and risks of different types of birth control, including the patch, should talk to a doctor or other health professional.

How Do You Get It?

A doctor or a nurse practitioner must prescribe the patch. He or she will ask questions about health and family medical history, and may also do a complete physical exam, including a blood pressure measurement and a pelvic exam. If recommending the patch, the doctor or nurse practitioner will write a prescription and provide instructions on how to use it.

Those who start using the patch may be asked to return within a few months for a blood pressure measurement and to ensure that there are no problems. After that, a doctor may recommend routine exams once or twice a year or as needed.

How Much Does It Cost?

The patch usually costs between $15 and $50 a month, although health and family planning clinics (such as Planned Parenthood) might sell them for less. In addition, the birth control patch and doctor's visits are covered by many health insurance plans.

Reviewed by: Larissa Hirsch, MD

Date reviewed: August 2009

BIRTH CONTROL PILL

What Is It?

The birth control pill (also called "the Pill") is a daily pill that contains hormones to change the way the body works and prevent pregnancy. Hormones are chemical substances that control the functioning of the body's organs. In this case, the hormones in the Pill control the ovaries and the uterus.

How Does It Work?

Most birth control pills are "combination pills" containing a combination of the hormones estrogen and progesterone to prevent ovulation (the release of an egg during the monthly cycle). A woman cannot get pregnant if she doesn't ovulate because there is no egg to be fertilized. The Pill also works by thickening the mucus around the cervix, which makes it difficult for sperm to enter the uterus and reach any eggs that may have been released. The hormones in the Pill can also sometimes affect the lining of the uterus, making it difficult for an egg to attach to the wall of the uterus.

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Most combination pills come in either a 21-day pack or a 28-day pack. One hormone pill is taken each day at about the same time for 21 days. Depending on your pack, you will either stop taking birth control pills for 7 days (as in the 21-day pack) or you will take a pill that contains no hormones for 7 days (the 28-day pack). A woman has her period when she stops taking the pills that contain hormones. Some women prefer the 28-day pack because it helps them stay in the habit of taking a pill every day.

There is also a type of combination pill that decreases the frequency of a woman's period by supplying a hormone pill for 12 weeks and then inactive pills for 7 days. This decreases the number of periods to one every 3 months instead of one every month.

Another kind of pill that may change the number of monthly periods is the low-dose progesterone pill, sometimes called the mini-pill. This type of birth control pill differs from the other pills in that it only contains one type of hormone — progesterone — rather than a combination of estrogen and progesterone. It works by changing the cervical mucus and the lining of the uterus, and sometimes by affecting ovulation as well. The mini-pill may be slightly less effective at preventing pregnancy than combination pills.

The mini-pill is taken every day without a break. A girl who is taking the mini-pill may have no period at all or she may have irregular periods. For the minipill to work, it must be taken at the same time every day, without missing any doses.

Any type of birth control pill works best when it is taken every single day at the same time of day, regardless of whether a girl is going to have sex. This is especially important with progesterone-only pills.

For the first 7 days of taking the Pill, a girl should use an additional form of contraception, such as condoms, to prevent pregnancy. After 7 days, the Pill should work alone to prevent pregnancy. But continuing to use condoms will protect against sexually transmitted diseases (STDs).

If pills are skipped or forgotten, a girl is not protected against pregnancy and she will need a backup form of birth control, such as condoms. Or she will need to stop having sex for a while. Do not take a friend's or relative's pills.

How Well Does It Work?

Over the course of 1 year, about 8 out of 100 typical couples who rely on the Pill to prevent pregnancy will have an accidental pregnancy. Of course, this is an average figure and the chance of getting pregnant depends on whether you take your birth control pills every day. The Pill is an effective form of birth control, but even missing 1 day increases the chance of getting pregnant.

In general, how well each type of birth control method works depends on a lot of things. These include whether a person has any health conditions or is taking any medications or herbal supplements that might interfere with its use. For example, antibiotics or an herb like St. John's wort can interfere with the effectiveness of the Pill.

How well a particular method of birth control works also depends on whether the method chosen is convenient — and whether the person remembers to use it correctly all the time.

Protection Against STDs

The birth control pill does not protect against STDs. Couples having sex must always use condoms along with the Pill to protect against STDs.

Abstinence (the decision to not have sex) is the only method that always prevents pregnancy and STDs.

Possible Side Effects

The birth control pill is a safe and effective method of birth control. Most young women who take the Pill have none to very few side effects. The side effects that some women have while on the Pill include:

• irregular menstrual bleeding

• nausea, headaches, dizziness, and breast tenderness

• mood changes

• blood clots (rare in women under 35 who do not smoke)

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Some of these side effects improve over the first 3 months on the Pill. When a girl has side effects, a doctor will sometimes prescribe a different brand of the Pill.

The Pill also has some side effects that most girls are happy about. It usually makes periods lighter, reduces cramps, and is often prescribed for women who have menstrual problems. Taking the Pill often improves acne, and some doctors prescribe it for this purpose. Birth control pills have also been found to protect against some forms of breast disease, anemia, ovarian cysts, and ovarian and endometrial cancers.

Who Uses It?

Young women who can remember to take a pill each day and who want excellent protection from pregnancy use birth control pills.

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Not all women can — or should — use the Pill. In some cases, medical or other conditions make the use of the Pill less effective or more risky. For example, it is not recommended for women who have had blood clots, certain types of cancers, or certain types of migraine headaches. It's recommended that girls who have had unexplained vaginal bleeding (bleeding that is not during their periods) or who suspect they may be pregnant should talk to their doctor.

Girls who are interested in learning more about different types of birth control, including the Pill, should talk to their doctors or other health professionals.

How Do You Get It?

A doctor or a nurse practitioner must prescribe the Pill. He or she will ask about a girl's health and family medical history, and do a complete physical exam, which may include a pelvic exam. If the doctor or nurse prescribes birth control pills, he or she will explain when to begin taking the Pill and what to do if pills are missed.

The doctor or nurse will usually ask the girl to come back in a few months to have her blood pressure checked and to see if she is having any problems.

After that, girls who are having sex should get routine exams every 6 months to a year, or as recommended by the doctor.

How Much Does It Cost?

The Pill usually costs between $15 and $50 a month, depending on the type. Many health and family planning clinics (such as Planned Parenthood) sell birth control pills for less. In addition, birth control pills and doctor visits are covered by many health insurance plans.

Reviewed by: Larissa Hirsch, MD

Date reviewed: September 2009

BIRTH CONTROL RING

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What Is It?

The birth control ring is a soft, flexible, doughnut-shaped ring about 2 inches (5 centimeters) in diameter. It is inserted into the vagina, where it slowly releases hormones — the chemicals the body makes to control organ function — through the vaginal wall into the bloodstream. The hormones in the ring affect the ovaries and the uterus in order to prevent pregnancy.

How Does It Work?

The combination of the hormones progesterone and estrogen in the birth control ring prevent ovulation (the release of an egg from the ovaries during a girl's monthly cycle). If an egg isn't released, a girl can't get pregnant because there's no egg for a guy's sperm to fertilize.

The hormones in the ring also thicken the cervical mucus, making it difficult for sperm to enter the uterus and reach any eggs that may have been released. The hormones in the ring can also sometimes affect the lining of the uterus so that an egg will have a hard time attaching to the wall of the uterus.

Like the birth control pill or the patch, a girl uses the birth control ring based on her monthly menstrual cycle. She inserts it into the vagina (similar to the insertion of a tampon) on the first day of her menstrual cycle or before day 5 of her menstrual cycle. It remains in place for 3 weeks in a row. At the end of the third week, on the same day of the week it was inserted, about the same time of day, she removes it. Within a few days, her menstrual period should start. At the end of the fourth week, on the same day of the week the last ring was inserted, she inserts a new ring and the process begins again. The new ring should be placed on that day, even if a girl still has her period.

Because the hormones in the ring don't take effect immediately, another form of birth control (such as a condom) should be used for 7 days when a girl first starts using the ring. After 7 days, the ring should work alone to prevent pregnancy. But continuing to use condoms will protect against sexually transmitted diseases (STDs).

The exact position of the ring in the vagina is not critical as long as it feels comfortable. This is because the ring does not work as a barrier method of birth control. If it doesn't feel comfortable, a girl can push it further back or remove and reinsert it. Most girls do not feel the ring once it is in place. It can be left in place during swimming, bathing, and exercise. It can also remain in place during intercourse.

The ring is held in place by the vaginal muscles, so it's unlikely that it will fall out. If it does, it can be rinsed under cool water (not hot!) and reinserted within 3 hours. If more than 3 hours pass without the ring in the vagina, there's a chance a girl can become pregnant and she'll need to use an additional form of birth control until the ring has been in place for 7 days. If the ring is out for more than 3 hours during your third week wearing it, call your doctor to see what to do. He or she may have you put a new ring in, or tell you not to replace it, so you get your period early. Either way, an additional form of birth control should be used.

How Well Does It Work?

The effectiveness of the vaginal ring seems to be similar to other hormonal methods of birth control, like the patch or the Pill. Results show that over the course of 1 year, about 8 out of 100 typical couples who rely on the ring to prevent pregnancy will have an accidental pregnancy. Of course, the chance of getting pregnant depends on whether a girl uses the ring correctly. Delaying or missing a monthly insertion or removing a ring too early reduces its effectiveness.

In general, how well each type of birth control method works depends on a lot of things. These include whether a person has any health conditions or is taking any medications that might interfere with its use. It's important for a doctor to be aware of all medications and herbal supplements that a girl might be taking. Although using the ring means a girl does not have to remember to take a pill every day or replace a patch, it still needs to be removed after 3 weeks and then replaced a week later. If it is not replaced on time, the ring loses its effectiveness.

Protection Against STDs

The vaginal ring does not protect against STDs. Couples having sex must always use condoms along with the vaginal ring to protect against STDs.

Abstinence (not having sex) is the only method that always prevents pregnancy and STDs.

Possible Side Effects

The vaginal ring is a safe and effective method of birth control. Most young women who use the ring have no side effects. Smoking cigarettes and using the ring can increase a girl's risk of certain side effects, which is why health professionals advise girls who use the ring not to smoke.

The side effects that some women have while using the ring are similar to those experienced with the birth control pill. These may include:

• irregular menstrual bleeding

• nausea, headaches, dizziness, and breast tenderness

• mood changes

• blood clots (rare in women under 35 who do not smoke)

Other possible side effects seen in ring users include:

• vaginal irritation or infections

• vaginal discharge

• problems with contact lens use, such as a change in vision or inability to wear the lenses

Many of these side effects are mild and tend to disappear after 2 or 3 months.

Who Uses It?

The vaginal ring may be a good choice for young women who find it difficult to remember to take a pill every day or who have difficulty swallowing pills. They must feel comfortable enough with their bodies to be able to insert a device into the vagina.

Not all women can — or should — use the vaginal ring. In some cases, medical or other conditions make the use of the ring less effective or more risky. For example, it is not recommended for women who have had blood clots, severe high blood pressure, certain types of cancers, certain types of migraine headaches, or diabetes with certain complications.

Girls who have had unexplained vaginal bleeding (bleeding that is not during their periods) or who suspect they may be pregnant should talk to their doctors, stop using the ring, and use another form of birth control in the meantime.

Girls who are interested in learning more about the possible health benefits and risks of different types of birth control, including the ring, should talk to a doctor or other health professional.

How Do You Get It?

A doctor or a nurse practitioner must prescribe the ring. He or she will ask questions about health and family medical history, then do a complete physical exam, which may include a blood pressure measurement and a pelvic exam. If recommending the ring, the doctor or nurse practitioner will write a prescription and provide instructions on how to use it.

Girls who start using the ring may be asked to return within a few months for a blood pressure measurement and to ensure that there are no problems. After that, a doctor may recommend routine exams once or twice a year or as needed.

How Much Does It Cost?

The ring usually costs between $30 and $50 a month, although health and family planning clinics (such as Planned Parenthood) might sell them for less. In addition, the vaginal ring and doctor's visits are covered by many health insurance plans.

Reviewed by: Larissa Hirsch, MD

Date reviewed: September 2009

BIRTH CONTROL SHOT

What Is It?

The birth control shot is a long-acting form of progesterone, a hormone that is naturally manufactured in a girl's ovaries. The shot is given as an injection in the upper arm or in the buttocks once every 3 months to protect a girl from becoming pregnant.

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How Does It Work?

The hormone progesterone in the birth control shot primarily works by preventing ovulation (the release of an egg during the monthly cycle). If a girl doesn't ovulate, she cannot get pregnant because there is no egg to be fertilized.

How Well Does It Work?

The birth control shot is a very effective method of birth control. Over the course of 1 year, fewer than 3 out of 100 typical couples who use the birth control shot every 3 months will have an accidental pregnancy. The chance of getting pregnant increases if you wait longer than 3 months to receive your next shot.

In general, how well each type of birth control method works depends on a lot of things. These include whether a person has any health conditions or is taking any medications that might interfere with its use. It also depends on whether the method chosen is convenient — and whether the person remembers to use it correctly all of the time.

Protection Against STDs

The birth control shot does not protect against sexually transmitted diseases (STDs). In fact there are studies that show that the birth control shot may possibly increase the risk of getting certain STDs. Scientists do not understand why, however.

Couples having sex must always use condoms along with the birth control shot to protect against STDs.

Abstinence (not having sex) is the only method that always prevents pregnancy and STDs.

Possible Side Effects

Many young women who receive the birth control shot will notice a change in their periods. Other possible side effects include:

• irregular or no menstrual periods

• weight gain, headaches, and breast tenderness

• depression

The U.S. Food and Drug Administration (FDA) has issued a safety warning with regard to the use of the long-acting progesterone shot. Studies link this shot to a loss of bone density in women, although bone density may recover when a woman is no longer getting the shot.

Doctors are not sure how this type of shot may affect the bone density of adolescent girls in the future, though. So girls who are considering the shot as a method of birth control should talk to their doctors about it. Girls who are receiving the shot should make sure that they are getting enough calcium each day, either through their diet or by taking calcium supplements.

Girls who smoke should be sure to let their doctors know because smoking may be connected to this bone density loss. Smoking also increases a girl's chances of the other side effects of the shot.

Women may notice a decrease in fertility for up to a year after they stop getting the birth control shot. However, the shot does not cause permanent loss of fertility and most women can get pregnant once they stop getting the shot.

Who Uses It?

Every method of birth control should be considered in light of what works for the individual. Young women who have a hard time remembering to take birth control pills and who want extremely good protection against pregnancy use the birth control shot. Also, nursing mothers can use the birth control shot.

Not all women can — or should — use the birth control shot. In some cases, medical or other conditions make the use of the shot less effective or more risky. For example, it is not recommended for women who have had blood clots, certain types of cancers, or certain types of migraine headaches. Girls who have had unexplained vaginal bleeding (bleeding that is not during their periods) or who suspect they may be pregnant should talk to their doctors.

A girl who is interested in learning more about different types of birth control, including the shot, should talk to her doctor or other health professional.

How Do You Get It?

The shot must be prescribed and is given every 3 months in a doctor's office.

How Much Does It Cost?

Each injection (3 months' worth of birth control) costs about $60. Many health insurance plans cover the cost of birth control shots, as well as the cost of the doctor's visit. Family planning clinics (such as Planned Parenthood) may charge less.

Reviewed by: Larissa Hirsch, MD

Date reviewed: March 2009

Originally reviewed by: Neil Izenberg, MD, and George A. Macones, MD

CERVICAL CAP

What Is It?

A cervical cap is a small, thimble-shaped cup made of silicone, latex, or rubber that fits over the cervix (the part of the uterus that opens into the upper part of the vagina). It is considered one of the barrier methods of birth control because it provides a physical barrier between a male's sperm and a female's egg.

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How Does a Cervical Cap Work?

The cervical cap keeps sperm from entering the uterus by covering the cervix. For added protection, spermicide is put into the cap before inserting the cap snugly over the cervix.

The cap is inserted before having sex and can be left in place for up to 48 hours. Once in place, spermicide should be added every time a couple has sex. After sex, the cap must be left in place for at least 6 hours.

Follow the manufacturer's instructions for removing the cap. Removing a cervical cap involves placing a finger in the vagina to pull the cap out. Because the cap has to be placed properly, women who use one should be comfortable feeling for their cervix deep inside the vagina.

After each time it is used, the cap must be washed, rinsed, and dried, then stored in its case. It should not be dusted with baby powder and should never be used with oil-based lubricants such as mineral oil, petroleum jelly, or baby oil. These substances can cause the material in the cap to become brittle and crack. Other vaginal creams, such as medicines for yeast infection, also can damage the cap.

How Well Does It Work?

Over the course of 1 year, 16 to 20 out of 100 typical couples who rely on the cervical cap to prevent pregnancy will have an accidental pregnancy. For women who have had a baby, the cervical cap is less effective: 32 out of 100 typical couples who use the cervical cap after the woman has had a baby will have an accidental pregnancy. Of course, these are average figures and the chance of getting pregnant depends on whether you use this method of birth control correctly and every time you have sex.

In general, how well each type of birth control method works depends on a lot of things. These include whether a person has any health conditions or is taking any medications that might interfere with its use. It also depends on whether the method chosen is convenient — and whether the person remembers to use it correctly every time.

Protection Against STIs

The cervical cap does not protect against sexually transmitted infections (STIs). Couples having sex must always use condoms along with the cervical cap to protect against STIs.

Abstinence (not having sex) is the only method that always prevents pregnancy and STIs.

Possible Side Effects

Most females who use the cervical cap have no problems. The few side effects some women do have include:

• Spermicides may irritate the vagina and surrounding skin.

• Strong odors or vaginal discharge may appear if the cervical cap is left in too long.

• The material in the cervical cap may cause an allergic reaction (this is rare).

• Toxic shock syndrome (TSS) is a rare complication.

• The cap may lead to changes in the cervix because of irritation.

Who Uses It?

The cervical cap is not usually recommended for most young women since it can be very difficult to insert correctly. Inserting a cervical cap involves reaching all the way to the cervix with your fingers. It can sometimes also be knocked out of place during intercourse, which can result in pregnancy. The cervical cap cannot be used when a girl has her period.

A diaphragm works like the cervical cap, but many girls find the diaphragm easier to use.

How Do You Get It?

A doctor must fit a girl for a cervical cap. During a pelvic exam, the doctor will measure a girl's vagina and then determine which size cap is right for her. The doctor or nurse will then teach her how to insert and remove the cap.

How Much Does It Cost?

A cervical cap costs about $70 and should be replaced every year. In addition, there is also the cost of the doctor's visit and a fitting fee. Many health insurance plans cover these costs, and family planning clinics (such as Planned Parenthood) charge much less. In addition, the cost of spermicide is about $0.50 to $1.50 per use.

Reviewed by: Larissa Hirsch, MD

Date reviewed: April 2008

CONDOM

What Is It?

Condoms are a barrier method of contraception. There are male condoms and female condoms. A male condom is a thin sheath (usually made of latex, a type of rubber) that is worn on the penis. A female condom is a polyurethane sheath with a flexible ring at either end. One end is closed and inserted into the vagina; the other end is open and the ring sits outside the opening of the vagina. The male condom, sometimes called a "rubber" or "prophylactic," is far more commonly used.

How Does It Work?

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Condoms work by keeping semen (the fluid that contains sperm) from entering the vagina. The male condom is placed on a guy's penis when it becomes erect (and before any sexual contact). It is unrolled all the way to the base of the penis while holding the tip of the condom to leave some extra room at the end. This creates a space for semen after ejaculation and makes it less likely that the condom will break.

After the guy ejaculates, he should hold the condom at the base of the penis as he pulls out of the vagina. He must do this while the penis is still erect to prevent the condom from slipping off when he gets soft. If this happens, sperm could enter the vagina.

Female Condom

The female condom is inserted into the vagina using the closed-end ring. The other ring creates the open end of the condom. The sheath then lines the walls of the vagina, creating a barrier between the sperm and the cervix. The female condom can be inserted up to 8 hours prior to intercourse. It should be removed immediately after sex.

The male and female condoms should not be used at the same time because they can get stuck together and cause one or the other to slip during intercourse, making them ineffective.

Condom Precautions

Once a condom is used, it cannot be reused. A new condom should be used each time you have sex — and it must be used from start to finish every time you have sex to prevent pregnancy and sexually transmitted diseases (STDs). Never use oil-based lubricants such as mineral oil, petroleum jelly, or baby oil with condoms because these substances can break down the rubber. A used condom should be thrown in the garbage, not down the toilet.

And if a condom ever seems dry, sticky, or stiff when it comes out of the package, or if it is past its expiration date, throw it away and use a new one. It's a good idea to have several condoms on hand in case there is a problem with one. It's best to store unused condoms in a cool, dry place.

How Well Does It Work?

Over the course of a year, 15 out of 100 typical couples who rely on male condoms alone to prevent pregnancy will have an accidental pregnancy. The use of the female condom is a little less reliable and 21 out of 100 couples will have an unintended pregnancy.

Of course, these are average figures and the chance of getting pregnant depends on whether you use condoms correctly every time you have sex.

The most common reason that condoms "fail" is that the couple fails to use one at all. Still, it is possible for a condom to break or slip during intercourse. Condoms can also be damaged by things like fingernails and body piercings. 

Experts used to think that using spermicide with a condom would decrease the pregnancy rate as well as help fight against STIs. However, more recent information indicates that this is not necessarily true and spermicide does not help make condoms more effective.

In general, how well each type of birth control method works depends on a lot of things. One factor is whether the method chosen is convenient — and whether the person remembers to use it correctly all the time.

Protection Against STIs

Most male condoms are made of latex. Those made of lambskin may offer less protection against some STIs, including HIV/AIDS, so use of latex condoms is recommended. For people who may have an allergic skin reaction to latex, both male and female condoms made of polyurethane are available.

When properly used, latex and polyurethane condoms are effective against most STIs. Condoms do not protect against infections spread from sores on the skin not covered by a condom (such as the base of the penis or scrotum). For those having sex, condoms must always be used to protect against STIs even when using another method of birth control.

Abstinence (not having sex) is the only method that always prevents pregnancy and STIs.

Possible Side Effects

Most men and women have no problems using condoms. Side effects that can occasionally occur include:

• allergy to latex condoms

• irritation of the penis or the vagina from spermicides or lubricants that some condoms are treated with

Who Uses It?

Couples who are responsible enough to stop and put a condom on each time before sex and people who want protection against STIs use condoms. Because condoms are the only method of birth control currently available for men, they allow the guy to take responsibility for birth control and STI protection. Condoms are also a good choice for people who do not have a lot of money to spend on birth control.

How Do You Get It?

Condoms are available without a prescription and are sold in drugstores, supermarkets, and even vending machines (in some stores, they're in the "Family Planning" aisle). Condoms come in different sizes, textures, and colors.

How Much Does It Cost?

Condoms are the least expensive and most available method of birth control — other than abstinence, of course. Male condoms cost about $0.50 to $1 each and are less expensive when they are bought in boxes that contain several condoms.

In addition, many health centers and family planning clinics (such as Planned Parenthood) and some schools distribute them free of charge. Female condoms are a little more expensive and cost about $2 to $4 per condom.

Reviewed by: Larissa Hirsch, MD

Date reviewed: September 2009

DIAPHRAGM

What Is It?

The diaphragm is a dome-shaped bowl made of thin, flexible rubber that sits over the cervix.

[pic]

How Does It Work?

The diaphragm keeps sperm from entering the uterus by blocking the cervix. For added protection, spermicide is put into the bowl of the diaphragm and along its edges before inserting the diaphragm high into the vagina so it covers the cervix.

The diaphragm is inserted up to 6 hours before having sex. More spermicide must be used each time a girl has sex while wearing the diaphragm. Additional spermicide should also be used if a girl is going to have sex more than 3 hours after she inserted the diaphragm. After sex, the diaphragm must be left in for at least 6 hours, but no longer than 24 hours. The diaphragm can be removed by placing a finger into the vagina to pull it out.

Each time the diaphragm is removed, it must be washed (with mild soap and water), rinsed, and air dried, then stored in its case. It should not be dusted with baby powder and should never be used with oil-based lubricants such as mineral oil, petroleum jelly, or baby oil. These substances can cause the rubber to become brittle and crack. Other vaginal creams, such as yeast medicines, can also damage the rubber.

A diaphragm should be replaced at least every 2 years. It should be examined regularly for holes or weak spots, and replaced as needed.

How Well Does It Work?

Over the course of 1 year, 16 out of 100 typical couples who rely on the diaphragm with spermicide to prevent pregnancy will have an accidental pregnancy. In general, how well each type of birth control method works depends on a lot of things. In the case of a diaphragm, some of the most important things to be sure of are that it fits correctly, that is used every time a couple has sexual intercourse, and that spermicide is used appropriately.

Protection Against STIs

The diaphragm does not protect against sexually transmitted diseases (STDs). Couples having sex must always use condoms along with the diaphragm to protect against STDs.

Abstinence (not having sex) is the only method that always prevents pregnancy and STDs.

Possible Side Effects

Most women who use a diaphragm have no problems with it. The side effects that some women have include:

• Spermicides may irritate the vagina and surrounding skin or cause an allergic reaction.

• Strong odors or vaginal discharge may appear if the diaphragm is left in too long.

• The rubber or latex in the diaphragm may cause an allergic reaction (this is rare).

• Diaphragms and spermicides may make urinary tract infections more likely.

• Toxic shock syndrome (TSS) is a rare complication if the diaphragm is left in too long.

Who Uses It?

Girls who can take responsibility for sex in advance use diaphragms. If a girl chooses to use a diaphragm, she must also always have a supply of spermicide.

The diaphragm isn't good for anyone who is uncomfortable or uneasy with the thought of reaching into her vagina. And it may not be a good choice for girls with certain medical conditions, such as frequent urinary tract infections (UTIs). The diaphragm should not be used when a girl has her period.

How Do You Get It?

A doctor must fit a girl with a diaphragm. During a pelvic exam the doctor will measure a girl's vagina and then determine which size of diaphragm is right for her. The doctor or nurse will then teach her how to insert and remove the diaphragm. Some doctors may even ask a girl to practice at home and then come in while wearing the diaphragm to check that she has done it right. A diaphragm that's inserted incorrectly or does not fit properly can result in pregnancy.

During the annual exam, the doctor will check that the diaphragm still fits correctly. The diaphragm may not fit correctly if a girl has gained or lost 10 pounds, had a baby, had an abortion, or was fitted when she was a virgin and she is now having sex. If any of these things have changed since her last exam, a girl should see her doctor to have the fit of the diaphragm checked rather than waiting until her annual exam.

How Much Does It Cost?

A diaphragm usually costs about $15 to $75. It should be replaced every 2 years. There is also the cost of the doctor's visit and a fitting fee. Many health insurance plans cover these costs and family planning clinics (such as Planned Parenthood) charge much less. In addition, the cost of spermicide is about $0.50 to $1.50 per use.

Reviewed by: Larissa Hirsch, MD

Date reviewed: April 2010

DOUCHING

Does douching after sex prevent a girl from getting pregnant?

– Clara*

Douching is when a girl rinses out her vagina with a solution, such as water and vinegar. Douching does not prevent pregnancy.

Douching should not be used as a method of birth control. Sperm are extremely fast swimmers — hundreds of thousands of them can reach the uterus by the time a girl even begins to douche. In addition, the pressure of the solution squirted into the vagina can even push sperm into the uterus.

Also, by douching, a girl may even increase her risk of contracting a sexually transmitted disease (STD). Most women douche in an attempt to cleanse the vaginal area. But even this is not a good idea. The vagina has its own natural cleaning system that flushes out bacteria. So not only do the chemicals and perfumes in feminine sprays and douches not help, they can actually cause problems like allergic reactions, irritation, or infections in the vagina.

Reviewed by: Larissa Hirsch, MD

Date reviewed: January 2010

EMERGENCY CONTRACEPTION

What Is It?

Emergency contraception is a way to prevent pregnancy after unprotected sex. Often called the morning-after pill, emergency contraceptive pills (ECPs) are hormone pills that can be taken up to 72 hours after having unprotected sex.

Most states require a doctor to prescribe emergency contraception; however, recently some states have allowed nonphysicians to provide ECPs. Either way it is important to seek medical help and guidance.

Emergency contraception is most effective when it is taken as soon as possible after intercourse. But some studies have shown that it can still work up to 120 hours after intercourse.

The intrauterine device (IUD) can sometimes be used as a form of emergency contraception. This is rarely prescribed for teens, though.

How Does It Work?

In high doses, the hormones estrogen and progesterone can prevent pregnancy. The number of pills taken depends on the type of pill being used. The first dose of pills should be taken within 72 hours of unprotected intercourse, usually followed by a second dose of pills 12 hours later.

The hormones may work in a number of ways to prevent pregnancy. They may delay ovulation (the release of an egg during a girl's monthly cycle), affect the movement and function of the sperm, affect the development of the uterine lining, and disrupt the actual fertilization process.

ECPs are less effective if fertilization has already occurred. If implantation has already occurred and a girl is pregnant, ECPs will not interrupt the pregnancy.

How Well Does It Work?

About 1 or 2 in every 100 women who use ECPs will become pregnant despite taking ECPs within 72 hours after having unprotected sex. The effectiveness of emergency contraception methods is calculated differently from the effectiveness of other contraceptives because of how they are used. Emergency contraception is the only type of contraception method that is used after unprotected sex.

Emergency contraception is most effective when taken as soon as possible after unprotected sex. Because of this, the name morning-after pill is somewhat misleading: Ideally the pill should be taken immediately after sex, without waiting for the next morning.

Emergency contraception will not prevent pregnancy if a girl has unprotected sex after taking the ECPs.

Because emergency contraception does not prevent all pregnancies, a woman should see her doctor if she doesn't get her next expected period after taking it.

Protection Against STDs

Emergency contraception does not protect against sexually transmitted diseases (STDs). Couples having sex must always use condoms to protect against STDs even when using another method of birth control. If a condom breaks (or a couple has unprotected sex), it's a good idea to get tested for STDs.

Abstinence (not having sex) is the only method that always prevents pregnancy and STDs. If a girl has been forced to have unwanted sex, she should see a doctor right away to be tested for STDs. That's because it's important to treat some STDs immediately before they develop into bigger problems.

Possible Side Effects

The larger-than-normal dose of hormone causes some side effects in many of the women receiving emergency contraception pills. These side effects include nausea, vomiting, breast tenderness, and headache. Such side effects are usually minor, and most improve within 1 to 2 days. A girl's menstrual period may be temporarily irregular after taking ECPs.

Who Uses It?

Emergency contraception is not recommended as a regular birth control method. Instead, it is used for emergencies only. If a couple is having sex and the condom breaks or slips off, if a diaphragm or cervical cap slips out of place, or if a girl forgot to take her birth control pills for 2 days in a row, a girl may want to consider using emergency contraception. It is also available to teens who are forced to have unprotected sex.

Emergency contraception is not recommended for girls who know they are pregnant.

How Do You Get It?

In most cases, teens need to get ECPs through a doctor or a health clinic. Some states allow pharmacists to sell ECPs over the counter (without a prescription) to people over 17, with proof of age. However, since laws change all the time and only some pharmacists are able to do this, call your pharmacy to find out if it is possible to get ECPs without a prescription.

ECPs need to be used as soon as possible after having unprotected sex. To find out who can provide or prescribe ECPs in your area, call the The Association of Reproductive Health Professionals hotline at (888) NOT 2 LATE.

How Much Does It Cost?

Depending on the types of pills that are prescribed, the emergency contraceptive pill costs between $8 and $35. Many health insurance plans cover the cost of emergency contraception and family planning clinics (such as Planned Parenthood) may charge much less.

Reviewed by: Larissa Hirsch, MD

Date reviewed: July 2009

FERTILITY AWARENESS

What Is It?

Fertility awareness is a way to prevent pregnancy by not having sex around the time of ovulation (the release of an egg during a girl's monthly cycle). Couples who do want to have a baby can also use this method to have sex during the time that they are most likely to conceive. Fertility awareness can include methods such as natural family planning, periodic abstinence, and the rhythm method.

How Does It Work?

If a couple doesn't have sex around the time of ovulation, the girl is less likely to get pregnant. The trick is knowing when ovulation happens. Couples use a calendar, a thermometer to measure body temperature, the thickness of cervical mucus, or a kit that tests for ovulation. The ovulation kits are more useful for couples who are trying to get pregnant. The fertile period around ovulation lasts 6 to 9 days and during this time the couple using only fertility awareness for birth control who does not want to get pregnant should not have sex.

How Well Does It Work?

Fertility awareness is not a reliable way to prevent pregnancy for most teens. Over the course of 1 year, as many as 25 out of 100 typical couples who rely on fertility awareness to prevent pregnancy will have an accidental pregnancy. Of course, this is an average figure, and the chance of getting pregnant depends on whether a couple uses one or more of the fertility awareness methods correctly and consistently and does not have unprotected sex during the fertile period.

In general, how well each type of birth control method works depends on a lot of things. These include whether a person has any health conditions, is taking any medications that might interfere with its use, whether the method chosen is convenient — and whether it is used correctly all the time. In the case of fertility awareness, it also depends on how consistent a woman's ovulatory cycle is, how accurately a couple keeps track of when she could be ovulating, and how reliably unprotected sex is avoided during the fertile period.

Protection Against STDs

Fertility awareness does not protect against sexually transmitted diseases (STDs). Couples having sex must always use condoms along with their chosen method of birth control to protect against STDs.

Abstinence (not having sex) is the only method that always prevents pregnancy and STDs.

Who Uses It?

Fertility awareness is not a reliable way to prevent pregnancy for most teens. It is often very difficult to tell when a girl is fertile. Because teens often have irregular menstrual cycles, it makes predicting ovulation much more difficult. Even people who have previously had regular cycles can have irregular timing of ovulation when factors such as stress or illness are involved. Fertility awareness also requires a commitment to monitoring body changes, keeping daily records, and above all not having sex during the fertile period.

How Do You Get It?

For couples interested in this method, it is best to talk to a doctor or counselor who is trained in fertility awareness. He or she can then teach the couple the skills they need to know to practice this birth control method accurately.

How Much Does It Cost?

The tools needed for fertility awareness — such as ovulation detection kits and thermometers, for example — are available in drugstores. But they can be expensive. Again, it's best to talk to a doctor for advice on using this method.

Reviewed by: Larissa Hirsch, MD

Date reviewed: April 2010

IUD

[pic]

What Is It?

The intrauterine device (IUD) is a T-shaped piece of plastic about the size of a quarter that is placed inside the uterus to prevent pregnancy. Two types of IUDs are available — one is covered with copper, the other releases the hormone progesterone.

How Does It Work?

The copper-coated IUD primarily prevents pregnancy by not allowing the sperm to fertilize the egg. It may also make it harder for a fertilized egg to implant in the uterus. When an IUD is coated with progesterone, it works in a similar way, but may also thicken the cervical mucus, which prevents sperm from entering the uterus and possibly prevent ovulation (the release of an egg during the monthly cycle).

How Well Does It Work?

Over the course of 1 year, fewer than 1 out of 100 typical couples using an IUD will have an accidental pregnancy. In fact, studies indicate that the IUD is one of the most effective and safest methods of birth control. Although the IUD is an effective method of birth control, it can come out of place and therefore should be checked regularly to be sure it is in place.

In general, how well each type of birth control method works depends on a lot of things. These include whether a person has any health conditions or is taking any medications or herbal supplements that might interfere with its use. The copper IUD allows some flexibility for girls who cannot use a hormonal method of birth control (such as the Pill, ring, or patch). The IUD can also provide a long-term form of birth control.

Protection Against STDs

The IUD does not protect against sexually transmitted diseases (STDs). For those having sex, condoms must always be used along with the IUD to protect against STDs. One of the concerns with the IUD is that girls who have multiple partners and do not use condoms can be at greater risk for STDs, and there's the possibility that these diseases could develop into a pelvic infection. This is true, though, for all methods of birth control.

Abstinence (not having sex) is the only method that always prevents pregnancy and STDs.

Possible Side Effects

The most common side effects of the IUD include:

• spotting in between periods

• heavier periods with more cramps with the copper IUD

• irregular or loss of periods with use of the hormonal IUD

• expulsion, or loss of the IUD. For some IUD users — particularly teens — the IUD can fall out or become displaced and not work properly.

• acne, breast tenderness, headaches, and nausea with the hormonal IUD

Rare problems include:

• perforation of the uterus — there's a very minimal risk of the device perforating the wall during its insertion

• an infection from bacteria getting into the uterus during insertion

In the past, one type of IUD increased a woman's risk of pelvic inflammatory disease (an infection in the upper part of a woman's reproductive system). That early type of IUD has been taken off the market and testing of the current IUDs indicate that the risk of infection is very small. Some doctors recommend testing for STDs before having an IUD inserted in order to help avoid a pelvic infection. And in order to help prevent future infections, condoms should always be used with IUDs.

The other concern that women have with IUDs is the possibility of ectopic pregnancies, which is when a fertilized egg implants somewhere other than in the uterus. However, doctors have found that girls with an IUD have a lower risk of having an ectopic pregnancy than girls who do not use any birth control.

Who Uses It?

IUDs are safe and effective for many teens. However, it is more common for IUDs to come out by mistake in women who haven't had a baby, as well as in teen girls. When an IUD comes out, a girl may not even know it, leaving her unprotected. So women with IUDs, especially teens, need to check them regularly.

IUDs sometimes need to be removed if a woman gets an STD. Having multiple sex partners can increase the risk of getting an STD. So, IUDs may not be right for girls who have multiple sex partners or who have sex with someone who has multiple partners.

If you're interested in using an IUD, talk to your doctor to see if it's a good birth control option for you.

How Do You Get It?

An IUD must be inserted into the uterus by a doctor. It is often easiest to insert during a girl's period. Copper IUDs need to be replaced by a doctor about every 10 years. IUDs with hormones must be replaced more frequently — up to every 5 years.

How Much Does It Cost?

An IUD costs about $200 to $400 plus the cost of having a doctor insert and remove it, as well as follow-up visits. Many health insurance plans cover these costs, and family planning clinics (such as Planned Parenthood) may charge much less, and the IUD is effective for several years.

Reviewed by: Larissa Hirsch, MD

Date reviewed: November 2009

IMPLANTABLE CONTRACEPTION

What Is It?

Implantable contraception is a small, flexible plastic tube containing hormones that doctors insert just under the skin of the upper arm. The hormones delivered in this way can help protect against pregnancy for several years.

One form of implantable contraception is currently available in the United States. It is a matchstick-sized flexible tube that can be left in place and protects against pregnancy for up to 3 years.

[pic]

How Does It Work?

The implanted tube slowly releases low levels of the hormone [pic][pic]progestin to prevent pregnancy. It primarily works by preventing ovulation (the release of an egg during the monthly cycle). If a girl doesn't ovulate, she cannot become pregnant because there is no egg to be fertilized. The progestin released by the device also thickens the mucus around the cervix. This helps prevent sperm from entering the uterus and also thins the lining of the uterus so if the egg is fertilized it may be less likely to attach to the wall of the uterus.

How Well Does It Work?

Experts believe the type of implantable contraception now available in the United States to be a very effective method of birth control. Over the course of 1 year, fewer than 1 out of 100 typical couples using implantable contraception will have an accidental pregnancy. The chance of getting pregnant will increase if a girl waits longer than 3 years to replace the tube. Because if this, it's important to keep a record of when tubes were inserted and switch to another method of contraception or get a new contraceptive implant.

In general, how well each type of birth control method works depends on a lot of things. These include whether a person has any health conditions or is taking medications or herbal supplements that might interfere with its use. For example, antibiotics or an herb like St. John's wort can interfere with the effectiveness of implantable contraception.

How well a particular method of birth control works also depends on whether the method chosen is convenient — and whether the person remembers to use it correctly all the time. This means the implant must be in a good position and working properly, and that a girl needs to remember to have it replaced on time. The only way to be 100% sure that you won't become pregnant or get an STD is to not have sex at all (called abstinence).

Protection Against STDs

Implantable contraception does not protect against sexually transmitted diseases (STDs). Couples having sex must always use condoms along with implantable contraception to protect against STDs.

Possible Side Effects

Many young women who get contraceptive implants will notice a change in their periods. Other side effects that some girls have include:

• irregular or no menstrual periods

• weight gain, headaches, acne, and breast tenderness

• irritation, infection, and possible scarring where the tubes are inserted

• depression

Some of these side effects may improve with time.

Smoking cigarettes while using implantable contraception can increase a girl's risk of certain side effects. This is why health professionals advise young women who use this type of birth control not to smoke.

Who Uses It?

Young women who have a hard time remembering to take birth control pills and who want long-term protection against pregnancy may be interested in implantable contraception.

Not all women can — or should — use implantable contraception. In some cases, health conditions make it less effective or more risky to use. For example, implantable contraception is not recommended for women who have had blood clots, liver disease, unexplained vaginal bleeding, or certain types of cancer. Talk to your doctor if you have diabetes, migraine headaches, depression, high cholesterol, high blood pressure, gallbladder problems, seizures, kidney disease, or other medical problems.

Anyone who thinks she might be pregnant should not have contraceptive implants inserted.

How Do You Get It?

Implantable contraception is only available through a doctor or other medical professional who has been trained in how to insert it. Some local health clinics may also be able to insert implantable contraception. A doctor may require two office visits: one to examine you and talk about implantable contraception and one to insert the tube itself. How soon the doctor is able to insert the implant depends on when a girl had her last period and what type of birth control she is currently using.

After numbing the inside of the upper arm, the doctor will use a small needle to insert the tube just under the surface. The whole process only takes a few minutes. After the tube is put in, a girl shouldn't do any heavy lifting for a few days.

A medical practitioner must remove the tube after 3 years — it cannot be left in a girl's arm, even after it is no longer working. To remove the tube, the medical practitioner numbs the area, makes a small cut in the arm and pulls out the tube. The tube can be removed any time after insertion — there's no need to wait the full 3 years, but you must go to the doctor to have it removed. To avoid an unplanned pregnancy, it's important to keep a record of when the implant was inserted and to either switch to another method of birth control or get a new implant inserted after 3 years.

How Much Does It Cost?

The cost of implantable contraception varies widely based on location and insurance coverage. It can range from several hundred dollars to over $1,000. Although there is a charge for removal, some doctors will remove the tube even if you cannot pay.

Reviewed by: Larissa Hirsch, MD

Date reviewed: March 2008

SPERMICIDE

Spermicide

What Is It?

Spermicides come in several different forms: cream, gel, foam, film, and suppositories. Most spermicides contain nonoxynol-9, a chemical that kills sperm. Spermicides can be used alone but are more effective when used with another method of birth control, such as a condom or diaphragm.

How Does It Work?

Spermicides immobilize and kill the sperm before they are able to swim into the uterus. To be effective, the spermicide must be placed deep in the vagina, close to the cervix. Creams, gels, and foams are squirted into the vagina using an applicator. Other types of spermicides include vaginal contraceptive film (VCF), a thin sheet placed in the back of vagina by hand, and vaginal suppositories.

Spermicides must be placed in the vagina before sexual intercourse. The instructions will say how long before sex the spermicide should be used. Some offer protection right away. But most must be placed in the vagina at least 15 minutes before sex so they have enough time to dissolve and spread.

All forms of spermicides are only effective for 1 hour after they are inserted. If more than 1 hour goes by before having sex, or if you have sex again, another application of spermicide is needed. When using spermicides, girls should not douche for at least 6 hours after having sex.

How Well Does It Work?

Over the course of 1 year, about 29 out of 100 typical couples who rely on spermicide alone to prevent pregnancy will have an accidental pregnancy. Of course, this is an average figure and the chance of getting pregnant depends on whether you use spermicides correctly and every time you have sex. Spermicides are most effective when used in combination with another form of birth control.

In general, how well each type of birth control method works depends on a lot of things. These include whether a person has any health conditions or is taking any medications that might interfere with its use. It also depends on whether the method chosen is convenient — and whether the person remembers to use it correctly every time. Spermicides are not as effective on their own as other forms of birth control. However, they are convenient, inexpensive, and easy to use.

Protection Against STDs

Spermicides alone are not effective against sexually transmitted diseases (STDs). For those having sex, condoms must always be used with spermicide to protect against STDs.

Abstinence (not having sex) is the only method that always prevents pregnancy and STDs.

Possible Side Effects

Spermicides may irritate the vagina and surrounding skin. This irritation may make it easier to be infected with STDs like HIV. Another possible side effect is recurrent urinary tract infections because the spermicide can disrupt the normal balance of bacteria in a girl's body.

Who Uses It?

People who can take responsibility for planning birth control in advance of having sex and couples using condoms or other barrier methods of contraception who want extra protection against pregnancy use spermicides.

How Do You Get It?

Spermicides are available without a prescription and are found in drugstores and some supermarkets (in some stores, they're in the "Family Planning" aisle). They're often found near the condoms and feminine hygiene products. But be careful when choosing a spermicide — the packages may look like those of some feminine hygiene products, such as douches or washes, which don't provide any birth control protection at all.

How Much Does It Cost?

Depending on the type of spermicide you choose (film is more expensive than gel), spermicide costs only about $0.50 to $1.50 per use.

Reviewed by: Larissa Hirsch, MD

Date reviewed: September 2009

WITHDRAWAL

What Is It?

Withdrawal is when a guy removes his penis from the vagina before he ejaculates (also called coitus interruptus or pulling out).

How Does It Work?

Withdrawal is an attempt to keep sperm from entering the vagina by having the guy ejaculate outside the vagina.

How Well Does It Work?

Over the course of 1 year, about 27 out of 100 typical couples who rely on withdrawal to prevent pregnancy will have an accidental pregnancy. Of course, this is an average figure and the chance of getting pregnant depends on whether you use this method correctly and every time you have sex.

Even for people who think they are doing it correctly, withdrawal is not an effective way to prevent pregnancy. Guys leak a bit of sperm out of the penis even before ejaculation, which means that even if a guy pulls out before he ejaculates, a girl can still become pregnant. Also, if a guy ejaculates close to the outside of the vagina, the sperm can swim up into the vagina. However, withdrawal is considered a better method of contraception than none at all.

Protection Against STDs

Withdrawal does not protect against sexually transmitted diseases (STDs). For those having sex, condoms must always be used to protect against STDs.

Abstinence (not having sex) is the only method that always prevents pregnancy and STDs.

Who Uses It?

Withdrawal is not a reliable way to prevent pregnancy. Most guys have a difficult time knowing exactly when they should withdraw the penis or don't have the willpower to pull out while they are having sex. And even if a guy does pull out, some sperm leak out of the penis before ejaculation, which can still get a girl pregnant.

Reviewed by: Larissa Hirsch, MD

Date reviewed: October 2009

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