Birth Control

QUESTION: How can I prevent unintended pregnancies in the future?
ANSWER: If you never have intercourse again, you will never again get pregnant. However, once you have become sexually active, this is not a very realistic and may not be even a desirable goal. Nearly every young woman who tells us, “Oh, I won’t need anything for birth control because I’m not going to have sex again,” we see for a second and even sometimes a third abortion. It is much better to be prepared with contraceptive knowledge and methods and not need them, than to need them and not be prepared. However, when you have intercourse without proper preparation, you still can use the morning after pill, also called emergency contraception (emergency contraception, or EC, is not an emergency and I will be very grumpy if I am waked in the middle of the night for a non-emergency) if you get in touch with us within 72 hours after exposure. This can also be used if a condom slips off or breaks, but it is important that you call as soon as possible during clinic hours. EC is not a substitute for the regular use of an effective method of contraception and should not be used as such.

Birth control methods

1. Abstinence.
If you are very young, there is no doubt that this is the most desirable option for you. Also, one who is sexually abstinent does not get sexually transmitted diseases. But remember, just saying you’re going to be abstinent does not prevent pregnancy. You have to practice it.

2. Avoiding coitus.
Coitus is the act of sexual intercourse involving the penis making contact with the vagina. However, vaginal penetration is not necessary for pregnancy to occur if your partner ejaculates, or “cums,” in the vicinity of your vulva. If you avoid coitus while engaging in other forms of sexual activity – oral sex, mutual masturbation and other non-genital contact sexual relations, you will not get pregnant. However, these activities almost always lead to coitus and should probably be avoided unless you are using something for birth control, except for the very rare individual.

3. Hormonal and other methods.
A. The single most effective methods of birth control currently available are injectable or implantable progestins called Depo-Provera and Norplant. We no longer use Norplant in this clinic, and I am unsure where you might obtain this. We do use Depo-Provera which has a pregnancy rate of about 1 in 200 or so when it is properly used. Used in combination with condoms, the odds against an unintended pregnancy are about 1 in 2,000, and using a condom also helps prevent sexually transmitted diseases for you who are not married to, and living with, your partner.

B. There are now multiple routes by which the hormones in the birth control pill may be delivered. There is the pill itself - several different name brand and generic preparations - which is absorbed in the intestinal tract. Anything that interferes with the gut’s motility (that is, the speed that substances move through the bowel) or rate of absorption may alter the effectiveness of the pill. There are now two products available which deliver the hormones through the mucus membranes of the vagina or through the skin: one is a patch, sort of like a band-aid, the other a vaginal ring. These are touted as being as effective as the pill, but because of relatively steady absorption rates, they may prove to be even more effective. About 1 in 50 women who use the pill will get pregnant and this is improved to about one in 2-300 if your partner wears a condom every time.

C. The IUD. There are at least three IUDs on the market. At one time, it was assumed that wearing an IUD might increase the probability of pelvic infections. This may or may not be true according to the latest data. Using an IUD makes the rate of unwanted pregnancies about 1 in 50, and again, having a partner use a condom as well will reduce that probability to about 1 in 2-300.

D. Sterilization. Sterilization is a permanent method of insuring that you won’t become pregnant again. It should be considered only by mature women who are certain that they never want any more babies under any circumstances. The odds of a pregnancy after sterilization are about 1 in 200 or so.

E. Spermacides plus condoms. The odds are about 1 in 50 of becoming pregnant if you use both every time.

F. Spermacide or condom alone. About 1 in 8 pregnancy rate.

G. Diaphragm with a spermacide. About 1 in 5.

H. Rhythm method. About 1 in 2.

I. Douching. Probably not much better than using nothing.

J. No method. About 8 of 10 women will get pregnant in any one year.