Birth Control

There are several different, reversible methods of contraception currently available. These include spermicides, male and female condoms, diaphragm + spermicide, cervical cap, oral contraceptives, progestin-only oral contraceptives, implanted progestin contraceptive, and depo-provera (injection). All of these have risks and benefits associated with them and none of them provide 100% guaranteed contraception. Only condoms, the diaphragm + spermicide, and the cervical cap have the potential to protect against sexually transmitted diseases — but this protection is NOT 100% guaranteed — the only absolute 100% protection from STDs is abstinence. All forms of birth control have a failure rate–the only foolproof way to avoid pregnancy during childbearing reproductive years is abstinence.

Spermicide

Foams, creams, suppositories, or jellys containing chemical agents to kill the sperm may be applied within the vagina prior to sexual intercourse. Spermicide alone is 37 times less effective than oral contraceptives in preventing pregnancy.

Diaphragm

These dome shaped plastic devices act as a physical barrier to fertilization.  They are available in several sizes and are inserted into the vagina to cover the cervix. They are used most effectively with a spermicide that is applied prior to insertion of the diaphragm. The use of a diaphragm is about 6 times less effective than oral contraceptives in preventing pregnancy.

Condom

This flexible tube shaped barrier is placed over the erect penis so that the ejaculate is retained within the tube. Condoms come in various, materials, colors and styles. It should be noted that all condoms do not protect equally against STD’s. Those made of animal skin allow the passage of infectious viruses, and should be avoided.  Condoms have a breakage rate of 1-5%. The use of a condom is about 11 times less effective than oral contraceptives in preventing pregnancy.

Oral Contraceptives

Oral contraceptives  are one of the most popular forms of contraception. They do not provide protection against STDs. The majority of oral contraceptives are a combination of a progestin component and an estrogen component. The progestin component works in two ways: 1) it prevents implantation of the fertilized egg and 2) it inhibits ovulation. The estrogen component does several things. First, it suppresses the development of a mature follicle in the ovary. Estrogen also potentiates (increases) the action of the progestin component to prevent ovulation. Finally, estrogen also serves to regulate the monthly menstrual flow.

When an oral contraceptive is started, it takes three cycles (approximately 3 months) to match the oral contraceptive’s hormones with the body’s hormones. During these three months, the oral contraceptive may not provide full protection from pregnancy; therefore, a secondary form of birth control may be beneficial during the initial three months.

There are several side effects assiociated with taking an oral contraceptive. These side effects can be remembered by the following acronym: ACHES. If any of these side effects are noticed, contact a doctor immediately.
A- Severe Abdominal pain — a rare complication of the estrogen component.
C- Severe Chest pain, shortness of breath, coughing up blood
H- Headaches
E- Eye problems: blurred vision, flashing lights, blindness
S- Severe leg pain (calf or thigh)

Another little known side effect of oral contraceptives is that they can change the shape of the cornea. Therefore, oral contraceptives can affect the fit of contacts. This change is permanent for as long as the oral contraceptive is taken.

It is very important to inform all health care providers that the pill is being taken. The reason for this is that there are a number of drug interactions with that can affect how effective the oral contraceptive is in preventing pregnancy. For example, nearly all antibiotics, will increase the metabolism of  the oral contraceptive thereby decreasing protection against pregnancy.  Failure rates for combination oral contraceptives are approximately 0.3 failures per 100 woman-years. Progestin alone has a failure rate 3-4 times that of estrogen/progestin contraceptives.

Progestin Implants

These are being used increasingly in some parts of the world. They are surgically inserted under the skin and can prevent pregnancy for up to 5 years. They appear to be effective and well tolerated although they may cause ammenorrhea or irregular bleeding.

IUD

Intrauterine contraceptive devices are plastic or metal objects placed within the uterus by a clinician. It also must be removed by a clinician. Occasionally the uterus may expel the IUD spontaneously. They act by preventing the implantation of the fertilized egg, possibly by speeding the passage of the zygote through the uterus. They also cause changes in the uterine lining during the menstrual cycle. IUD’s are associated with an increased incidence of uterine infections and painful menstruation. Their effectiveness is 4-5 times less than oral contraceptives. Copper containing IUDs may also have a spermicidal effect. This method might be perceived by some as an early stage (post-zygotic) abortive measure.

Rhythm Method

Rhythm method is an alternative to medical intervention. Abstinence is practiced during the portion of the menstrual cycle closest to the expected dates of ovulation. It is only marginally effective.

Surgical Methods

Tubal Ligation (female)

This surgical procedure consists of cutting the Fallopian tubes and ligating the ends to make it impossible for the sperm and egg to meet. This procedure does not interfere with sexual intercourse or ovulation. The procedure is virtually irreversible.

Vasectomy (male)

Surgically cutting the sperm-carrying vas deferens tubes does not interfere with sexual intercourse. The procedure must be done for both testes. When two successive tests for sperm in the ejaculate have been negative the procedure can be said to be successful. Vasectomies have been reversed with some success. Vasectomies are usually performed by urologists.