Contraception

How to decide

• Do you need to protect against STIs?

• How important is convenience?

• What about effectiveness? Only abstinence is100% effective, but other methods come close.

Review this slideshow, then ask your doctor,nurse, or family planning specialist which optionsare best for you.

With so many options, choosinga form of contraception can bedaunting. Begin with a fewquestions:

Fertility awareness

Fertility awareness - Also called natural familyplanning, fertility awareness means avoidingsex when the woman is most fertile.

The most reliable way to do this is to watchfor changes in cervical mucous and bodytemperature. To use this method correctly,it's best to get training from a health careprofessional.

Pros: No medications or devices.

Cons: Limits spontaneous sex, less reliablethan pill or sterilisation.

Spermicide

Frequent use may cause tissue irritation,increasing the risk of infections and STIs.

Spermicides are most often used along withother contraceptive methods

Pros: Easy to use.

Cons: May increase the risk of STIs, best usedwith backup method.

Spermicide contains a chemical that kills sperm. It comes in theform of foam, jelly, cream, film, sponge or pessary that isplaced inside the vagina before sex. Some types must be put inplace 30 minutes ahead of time.

Male condom

The latex condom is the classic barriermethod. It prevents sperm fromentering the woman's bodyprotecting against pregnancy andagainst STIs.

Condoms are about 85% effective butcan be up to 99% effective with properuse.

Pros: Widely available, protectsagainst STIs.

Cons: Only effective if used correctlyevery time. Can’t be reused.

Female condom

The female condom is a thin plastic pouch thatlines the vagina and can be put in place anytime before sex but before the penis comesinto contact with the vagina or genital area.

Users grasp a flexible, plastic ring at theclosed end to guide it into position. It'ssomewhat less effective than the malecondom.

Pros: Widely available, some protectionagainst STIs, conducts body heat better than amale condom.

Cons: Can be noisy, five out of 100 users getpregnant, not reusable. Should not be usedwith a male condom, to avoid breakage.

Diaphragm

The diaphragm is a rubber dome that isplaced over the cervix before sex. It isused with a spermicide.

If used correctly, they are estimated to be92-96% effective in preventing pregnancy.

Pros: One device can last two years.

Cons: Must be fitted by a doctor, no STIprotection. Can't be used during yourperiod due to a risk of toxic shocksyndrome.

Cervical cap

A cervical cap is similar to a diaphragm,but smaller.

The cap slips into place over the cervix,blocking entry into the uterus. It is usedwith spermicide. The success rate issimilar to that of the diaphragm.

Pros: Can stay in place for up to 48hours.

Cons: Initially must be fitted by adoctor, no protection against STIs. Can’tbe used during your period.

Contraceptive sponge

The contraceptive sponge is made of foamand contains spermicide. It is placedagainst the cervix up to 24 hours beforesex. The sponge is around 90% effective,but unlike the diaphragm or cervical cap,no fitting by a doctor is required.

Pros: No prescription, effectiveimmediately.

Cons: Difficult to insert correctly, no STIprotection. Can't be used during yourperiod.

Contraceptive pill

The most common type of contraceptive pill(combined pill) uses the hormones oestrogenand progestogen to prevent ovulation.

The other type of pill is the progestogen-onlypill (POP). When taken on schedule, the pill isover 99% effective at preventing pregnancy.

Pros: More regular, lighter periods or noperiods, depending on the type of pill. Lessperiod pain.

Cons: No STI protection. May cause sideeffects, including breast tenderness, spotting,serious blood clots and raised blood pressure.Some women should not use contraceptivepills.

Contraceptive patch

Women who have trouble remembering a dailypill could consider the contraceptive patch.

The patch is worn on the skin and changed onlyonce a week for three weeks with a fourthweek that is patch-free.

The patch releases the same types of hormonesasthe contraceptive pill and is just as effective.

Pros: More regular, lighter periods with lessperiod pain, no need to remember a daily pill.

Cons: May cause skin irritation or other sideeffects similar to contraceptive pills. Doesn'tprotect against STIs.

Vaginal ring

The vaginal ring is a soft plastic ring that isworn inside the vagina.

The ring releases the same hormones asthe pill and patch and is just as effective Itis removed every 21 days and replaced aweek later following a "ring-free" week.

Pros: Lighter, more regular periods, onlyreplaced every month.

Cons: May cause vaginal irritation or otherside effects similar to pills and the patch.Doesn’t protect against STIs.

Contraceptive injection

The contraceptive injections, known as Depo-Provera and Noristerat, are hormonal injections.

Depo-Provera protect against pregnancy for up to 12 weeks, and Noristerat protects against pregnancy for up to eight weeks. Both Noristerat and Depo-Provera are 99% effective in preventing pregnancy.

Pros: Only injected a few times a year, highly effective.

Cons: May cause spotting and other side effects. Doesn't protect against STIs. Prolonged use of Depo-provera may increase risk of osteoporosis.

Contraceptive implant

The contraceptive implant is a matchstick-sized rod that is placed under the skin of theupper arm.

It releases the same hormone that’s in thecontraceptive injection, but the implantprotects against pregnancy for three years.It is highly effective.

Pros: Lasts three years, highly effective.

Cons: May cause side effects, includingirregular bleeding. Doesn't protect againstSTIs.

IUDs and IUSs

IUD stands for intrauterine device, a T-shaped piece of plastic that is placed insidethe uterus by a doctor.

IUDs contain copper and can remain in theuterus for five to 10 years. An IUS, orinteruterine system, is a similar T-shapeddevice that contains the hormoneprogestogen. It can remain in place for up tofive years. Both types make it more difficultfor sperm to fertilise the egg and are 99%effective.

Pros: Long-lasting, low-maintenance.

Cons: Side effects can include painful orheavy periods.

Sterilisation - Tubal ligation

If you're sure you won't want biologicalchildren in the future, you may be readyfor permanent sterilisation.

The traditional method for women iscalled tubal ligation or "having yourtubes tied." A surgeon closes off thefallopian tubes, preventing eggsfrom making their journey out of theovaries. (The banding method is shownhere.)

Pros: Permanent, nearly 100% effective.

Cons: Requires surgery, may not bereversible. Doesn't protect against STIs.

Sterilisation - Tubal implants

A newer procedure makes it possible toblock the fallopian tubes without surgery.

Small implants of metal or silicone areplaced inside each tube. Scar tissueeventually grows around the implantsand blocks the tubes. Once an X-rayconfirms the tubes are blocked, no otherform of birth control is needed.

Pros: Permanent, no surgery, almost 100%effective.

Cons: Takes a few months to becomeeffective. May increase the risk of pelvicinfections, irreversible.

Vasectomy

Besides condoms, a vasectomy is theonly birth control option available tomen.

It involves surgically closing thevasdeferens – the tubes that carry spermfrom the testes, through thereproductive system. This prevents therelease of sperm but doesn't interferewith ejaculation.

Pros: Permanent, almost 100% effective.

Cons: Requires surgery, not effectiveimmediately, may not be reversible.

Emergency contraception

Emergency contraception works afterunprotected sex to help avoid pregnancy.This is an option if a woman has hadunprotected sex or suspects her usualmethod failed.

Though it is often called the "morningafter pill", the Levonelle (prescription-only) or Levonelle One Step (over thecounter levonorgestrel) pill can be takenup to 72 hours (up to three days) and theellaOne pill (prescription –only) up to 120hours (up to 5 days) after unprotected sexor contraception method failure.

The IUD (coil) can be fitted up to five daysafter unprotected sex or contraceptionmethod failure as emergencycontraception.

Withdrawal

Pulling out before the man ejaculates,known as the withdrawal method, is nota foolproof method of birth control.

Some ejaculate (fluid that containssperm) may be released before the manactually begins to climax.

In addition, some men may not have thewillpower to withdraw in time.

Pros: Free, no need for devices orhormones.

Cons: Hard to do correctly. No protectionagainst STIs.