Contraception

Facts & Myths about contraception

The Facts
A woman can still get pregnant:
• If it is the first time she has sex
• If she does not have an orgasm
• If a man pulls out of her vagina before he comes
• Whatever position the couple has sex in
• If she has sex when she has a period
• If she is not fully breastfeeding
• If she douches (squirts fluid into the vagina).

  Note: Douching changes the normal environment of the vagina and may introduce organisms higher into the reproductive system that normally don't belong there; it also disrupts the acid-base balance of the vagina, which weakens the defenses of the vagina and leaves women at higher risk for infections

Frequently Asked Questions (FAQ)

Can I get pregnant if I have unprotected sex during my period?
Yes, it is possible to become pregnant from vaginal intercourse during menstruation. This is especially likely when the menstrual cycle is brief (21-22 days). Because sperm can live up to 7 days, and in some cases up to 10 days, in the cervical mucus of a woman's vagina and, in a short cycle, ovulation can occur within a few days of the last day of a woman's period, it is very possible for pregnancy to happen.

It is also possible to get pregnant if a man spills sperm near the opening of the vagina, either through ejaculation or pre-ejaculate fluid, and just one sperm makes its way into the vagina to an egg.

Does a skipped period always indicate pregnancy?
Stress and other factors may cause a delayed period; however, if you have light spotting or no period AND other symptoms, take a pregnancy test ASAP--you may be pregnant. If the result is positive, or if you want to double-check a negative result, the next step is to visit a medical provider for a pregnancy test.

Will using birth control cause me to become sterile?
No.

There are many myths about contraception. Rumours and propaganda do not die easily. When people hear something often enough they tend to believe it is true even if there are no facts to support it. Being well-informed and seeking the facts is one way to stay healthy and safe.

Choosing and Using Contraception

This section provides a comprehensive guide to all methods of contraception and answers many of your frequently asked questions.

How effective is it?
Effectiveness of any contraceptive depends on several factors:

• Using contraception correctly
• How often you have sex
• Personal Fertility: as women approach menopausal age they tend to have decreasing fertility.

Note: If 100 sexually active women don’t use any contraception, 85 of them will become pregnant in a year.

Some methods of contraception do not depend on you remembering to take or use the method. Once you have been given one of these methods you don’t have to think about contraception for as long as the method lasts. They are:

• Contraceptive injection such as Depo (3 months)
• IUS Mirena (5 years)
• IUD Paraguard (10 years)
• Tubal Ligation - female sterilization (permanent)
• Vasectomy - male sterilization (permanent)

Other methods used are those that you have to think about each day, month or each time you have sex. For these methods to be effective you must use them according to the instructions given. These methods include:

• NuvaRing (3 weeks)
• Birth control pills (daily)
• Ortho Evra Patch (weekly)
• Diaphragm and cervical cap (each act of intercourse)
• Condoms (each act of intercourse)

Methods of Contraception

Condoms (male and female)

Male condoms are thin, disposable and usually made of latex, which protects you from most STDs. If you are allergic to latex, it is important that you use non-latex condoms. Condoms fit over an erect penis. Condoms must be put on as soon as a man has an erection for ideal protection from STDs and pregnancy. You can get condoms at most drugstores, grocery stores and clinics. You do not need a prescription.

NOTE: Condoms are currently no charge at Family Planning! For your convenience, we can mail up to 20 condoms per month, courtesy of our Male Involvement Project.

How to use a (male) condom:

• Use a new condom before each sex act.
• Squeeze tip of condom to remove air (Excess air could cause condom to break).
• As soon as erection occurs (before any sexual contact), place condom on tip and roll down all the way. It is important to note that most condoms will only roll one way. If it is placed on the penis incorrectly (won't roll down) then you must use a new condom, since seminal fluid may be present on the original condom and could result in pregnancy.
• After coming (ejaculating) withdraw penis while still hard.
• Hold on to rim of condom as you withdraw so nothing spills.
• Avoid further sexual contact with your partner until both of you wash your hands, sex organs, and any other areas that came in contact with body fluids.

Female condoms are made of thin plastic, and have a flexible ring at each end. The walls of the vagina are shielded from direct contact with the penis when the condom is in place.

A new condom must be used each time you have sex. Sometimes condoms break or come off. Using water-soluble lubricant, such as Astroglide or Slippery Stuff, can make using condoms more comfortable. You cannot use the female and male condom at the same time.

• Suggested Resources

Global Protection Corp is an innovative condom manufacturer. Their interactive web site also provides education about condoms including a creative FAQ page called Myrtle's Lounge.

Interactive Questionnaire - Choosing a Birth Control Method
The Association of Reproductive Health Professionals (ARHP) is a non-profit membership association composed of highly qualified and committed experts in reproductive health.

Birth Control Pills
The pill contains hormones like those produced by your own body - estrogen and progesterone. It prevents pregnancy by stopping the release of an egg. Once you stop taking the pill, you can get pregnant right away. That is why it is important to take your pill about the same time every day. Less than 1% of women using the pill 'perfectly' will get pregnant within the first year of use.

Birth control pills are easy to use unless you have trouble remembering to take a pill every day. Other advantages of the pill include:

• Periods that are more regular, lighter, and less painful
• Reduced risk for uterine and ovarian cancer
• Treatment for ovarian cysts

If you give birth and decide to breastfeed your baby you can still use pills, however you would use a "mini-pill" with no estrogen until you are ready to wean the baby.

Plan B (emergency contraception)

Contraceptive injection (Depo Provera)
Depo is an injectable form of the hormone progesterone. Depo is slowly absorbed by the body, preventing pregnancy by stopping an egg's release. It is effective for three months. Depo is a highly effective and private method. Less than 1% women will get pregnant within the first year of use. Some women do not have periods with this method after being on Depo about 6 months. Most women will not have periods after about 1 year on Depo. It is important to talk to your provider about possible side effects before you decide whether it may be a good method for you. Once you have the shot you may not change methods until it wears itself out in three months time.

Contraceptive patch (Ortho Evra)
The birth control patch delivers steady levels of estrogen and progesterone through your skin to your bloodstream. The patch prevents pregnancy the same way birth control pills do, and is equally effective. A new patch is applied the same day every week for 3 weeks. The fourth week you do not wear a patch; it is your period week. The patch can be worn on the abdomen, upper torso (front or back, but not on your breasts) buttocks, or upper outer arm. Possible side effects should be discussed with your provider prior to use.

Contraceptive ring (NuvaRing)
The vaginal ring is soft, flexible and easy to use. It releases a steady, low dose of estrogen and progesterone into your body. You leave it in place in the vagina for 3 weeks. The ring is removed for the fourth week, which is when you will have your period. Most women do not feel the ring once it is inserted correctly. Its effectiveness is equal to birth control pills. Most women have no major side effects with the NuvaRing.

The Intrauterine Device (IUD - Paraguard)
The IUD is a T-shaped piece of plastic with a copper wire that provides very effective birth control for up to ten years. Less than 1% women get pregnant within the first year of use. Your medical provider must insert and remove the IUD. If you are allergic to copper, the IUD would not be a good method for you. The IUD is recommended only for women who are in a stable, faithful relationship and do not have a history of pelvic inflammatory disease (PID) or ecctopic (tubal) pregnancy. Prior to insertion, you should be screened for STDs, and talk to your provider about potential side effects. Some women have spotty bleeding, heavier menstrual periods, and cramps with the IUD.

The Intrauterine System (IUS - Mirena)
Mirena is a T-shaped IUD that provides very effective birth control for up to 5 years. It releases a small amount of the hormone, progesterone. Less than 1% women get pregnant within the first year of use. Your medical provider must insert and remove the IUS Mirena. Mirena is recommended only for women who are in a stable, faithful relationship and do not have a history of pelvic inflammatory disease or etopic (tubal) pregnancy. Mirena makes your periods lighter and less painful. During the first 3 to 6 months, spotting and bleeding can occur. Some women who use Mirena stop having periods. It is safe, and many women like not having periods. Your periods and your ability to get pregnant return soon after the Mirena IUS is removed.

Diaphragms and caps
The diaphragm is a small rubber cup that you fill with contraceptive jelly. You place it in your vagina, making sure your cervix is covered, before intercourse. It prevents sperm from entering your uterus. The cervical cap is like the diaphragm, but smaller. It uses suction to fit over your cervix and blocks sperm from entering your uterus.

The diaphragm or cervical cap must always be inserted correctly before you have intercourse. It requires careful planning ahead. You can insert it a few hours before you have sex; it must stay in place for about 8 hours after intercourse, but no longer. Six percent of women who use the diaphragm 'perfectly' will get pregnant within the first year of use. Nine to twenty-six percent of women using the cervical cap 'perfectly' will get pregnant within the first year of use.

Your medical provider will fit you for a diaphragm or cervical cap. You and your partner will not be able to feel the diaphragm or cap if it fits well. You may need a different size diaphragm or cap after having a baby, or losing/gaining a lot of weight. Diaphragms and cervical caps do not interfere with breastfeeding.

Sterilization
Sterilization is a surgical method of birth control. It is considered permanent, so you need to be certain you do not want a child, or anymore children, under any circumstances before you choose sterilization. It is a personal choice; no one can require or force you to be sterilized. Consent forms must be signed 30 days before you have the operation. You can change your mind at any time prior to the operation.

Sterilization only needs to be done once. It is highly effective. Your sex drive is not effected by sterilization.

Female sterilization is called tubal Ligation. The two fallopian tubes are blocked to prevent the sperm and egg from uniting. Tubal ligation will not cause menopause. The woman still has monthly periods.

Male sterilization is called a vasectomy. It is cheaper and safer than tubal ligation. The two sperm tubes are blocked so sperm can not pass through the penis. The man still has an erection and ejaculates, but no sperm are in the fluid.

Natural family planning
Natural Family Planning (NFP) is a method that teaches a woman to recognize her own body's fertile time. You must not have intercourse near the time you ovulate. That is when you can get pregnant. There are no physical health risks associated with NFP. NFP can also be used to help you get pregnant.

In order for this method to work, you must record several body signs every day, and follow all the rules. It can be difficult for couples to avoid intercourse during fertile times.

CycleBeads are an easy way for a woman to track her cycle and clearly identify the days she could become pregnant and the days when pregnancy is most unlikely.

What If I Become Pregnant?

No method of contraception is perfect. If you think you could be pregnant you should see a medical provider as soon as possible to find out. They can talk to you about pregnancy care; such as taking folic acid and stopping smoking if you want to be pregnant; or talk to you about options if you do not want to be pregnant. For further information about planning a pregnancy, see our section on pregnancy options.

Contraception After Childbirth

Many unplanned pregnancies occur in the first few months after childbirth, so even if you are not currently interested in sex it is better to be prepared. Usually, you and your healthcare provider will discuss birth control methods the last month or so of your pregnancy.

How soon can I have sex after giving birth?
It is common to feel nervous about having sex again, but there is usually no reason why you shouldn't enjoy sex after childbirth. If you have any discomfort which might affect your enjoyment of sex, such as stitches which have not healed, discuss this with your doctor, midwife, or nurse. You may want to use a vaginal lubricant if you are uncomfortably dry. Use water-soluble lubricants such as Astroglide or Slippery Stuff. Products such as baby oil and Vaseline will damage latex condoms or diaphragms and are not made to be used in the vagina.

When will my periods start again?
If you are strictly breastfeeding your baby your periods may not come back until you stop breastfeeding. If you bottlefeed, or combine bottle and breastfeeding, your first period could start 5 to 8 weeks, sometimes longer, after the birth.

When do I need to start using contraception?
You can become pregnant again quickly after childbirth, so it is wise to think about which method you are going to use before you resume sexual activity. Don't wait for your periods to return, or until you have your postpartum check-up, because you could get pregnant before then. This is because ovulation can occur about two weeks before a period, so you can be fertile without realizing it even if you are breastfeeding.

You can use condoms as soon as you are ready to have sex. You can usually start a hormonal method around 6 weeks after childbirth. Remember to discuss your birth control options with your healthcare provider.

Contraception and Breastfeeding

Breastfeeding can act as a contraceptive method when you are fully breastfeeding a baby under six months of age and have not had a period postpartum. This method is called the Lactational Amenorrhea Method (LAM).

Note: If you are interested in the Lactational Amenorrhea Method it is highly recommended that you discuss this with your healthcare provider.

Contraception and Menopause

Contraception needs to be used until menopause. Contraception should continue to be used until a woman has not had a period or any bleeding for two years if aged under 50, and for one year if over 50.