Methods of Contraception

What is Contraception?

Contraception is birth control by the use of devices (diaphragm or intrauterine device or condom) or drugs or surgery. The principle of contraception is to prevent the union of a sperm and a egg cells.

Your choice of a contraceptive method depends on several factors such as efficacy, safety, personal preference, cost and noncontraceptive benefits. The methods are divided into two categories: hormonal contraceptives and nonhormonal contraceptives.

Hormonal Contraceptives

Oral contraceptives contain synthetic hormones and there are two types, combination pills and progestin-only pills. Combination pills contain both estrogen and progestin and mainly work by preventing the ovaries from releasing eggs (ovulation) and by making the lining of the uterus thinner. They also thicken the cervical mucus, which helps to prevent the entry of sperm into the uterus. Progestin-only pills primarily work by thickening the cervical mucus and less often they prevent ovulation. Taking birth control pills daily maintains the level of hormones that is needed to prevent pregnancy.

The NuvaRing is a small, flexible ring that is inserted into the vagina once a month. The ring releases a low-dose combination of progestin and estrogen to provide month long contraception. The hormones prevent the ovaries from releasing an egg (ovulation) and the progestin thickens the cervical mucus, which helps to prevent the entry of sperm into the uterus. The NuvaRing can be removed for up to 3 hours but if it has been out for more than 3 hours, it should be reinserted and a backup method (such as condoms) should be used until ring has been in for 7 consecutive days.

The IUD is a small T-shaped plastic device. Two types of IUDs are now available in the U.S. The ParaGard IUD contains copper and can be left in place for up to 12 years and the Mirena IUD contains the hormone progestin and can be left in place for up to 5 years. The IUD appears to work primarily by preventing fertilization of the egg. IUDs seem to affect the way the sperm or egg move. The progestin in the Mirena also thickens the cervical mucus. The copper in the ParaGard impairs sperm function.
A health care provider inserts the IUD in the office. Usually there is some cramping with insertion. This method is completely reversible at any time and it is effective immediately after insertion.

The Ortho Evra Patch is a combined estrogen/progestin adhesive patch worn on the skin. The patch is placed in one of four locations-buttocks, abdomen, upper torso or upper outer arm once a week for three weeks in a row, followed by a 7-day patch free week. The combination of hormones works by keeping the ovaries from releasing an egg (ovulation) and less often by thickening the cervical mucus, which prevents the sperm entering the uterus.

Non Hormonal Methods

The condom, or rubber, is a latex, polyurethane, poluisophrene or natural skin sheath that covers the erect penis and catches semen before it enters the vagina. All kinds of condoms are effective contraceptives. Only latex, polyisophrene or polyurethane condoms, however, can help to prevent the transmission of sexually transmitted infections. Some people consider it inconvenient to have to interrupt lovemaking to put on a condom before intercourse. Breaking off sexual pleasuring to put on a condom is not necessary, however. Putting on a condom can be incorporated into a couple's sexual activities.

The female condom is a soft, loosely-fitting polyurethane sheath with two flexible polyurethane rings designed to hold the condom in place. One ring at the closed end is inserted into the upper end of the vagina (past the pubic bone) and around the cervix. The second ring forms the external outer edge of the device and remains outside the vagina after insertion. In this way, the outer ring and device material provide some protection to the woman's labia and the base of a male partner's penis. The sheath is coated on the inside with a silicone-based lubricant and additional lubricant is provided with the product. The female condom may be inserted up to 8 hours before intercourse, and should be removed shortly after intercourse and before standing up. It should only be used once.

The withdrawal method of birth control, also known as coitus interruptus, involves the man withdrawing his penis from the vagina before ejaculation. In theory, this prevents sperm from being deposited in the vagina and subsequently fertilizing an ovum. Typically, a couple has penile-vaginal intercourse until the man withdraws his penis from the vagina when ejaculation is impending. The man must rely on his own sense of forthcoming ejaculation in order to practice this method. While some men do have ejaculatory control, others do not which can lead to not practicing this method consistently. Even though ejaculation may not occur in the vagina the release of pre-ejaculate which is typically released just before ejaculation goes unnoticed by the man and the woman. Pre-ejaculate is unlikely to release viable sperm for a single act of intercourse, but may contain STI.