TeenHealthFX - Answers - Updated Birth Control Information

Other Birth Control Method Questions And Concerns / Question
Published: March 14, 2006

Dear TeenHealthFX,

TeenHealthFX needs to update their birth control information. Your original question and answer was written in 2001. Don’t things change?

Signed: Updated Birth Control Information

Dear Updated Birth Control Information,

Some information about birth control methods stays the same and some information does change. Here is the most current information when it comes to sex and birth control!

Having sex is all about making choices – choosing what you are comfortable with and what you are ready for when it comes to being physically intimate with someone else.

Here are some of those choices…

Making a choice about whether or not you feel ready to have sex or if you want to wait.
Making good choices about who your sex partners will be in terms of your own emotional and physical well-being.
Making choices about what you are comfortable doing and what you do not want to do with your sex partners.
If you plan on having sex, making responsible choices that allow you to do so in the safest ways possible!

Once someone makes the choice to start having sex, there are some things to consider in terms of choosing a sex partner.

BOTH of you must agree on any and all types of sexual activities - Never use any kind of pressure, threats or intimidation to get consent.
Be open and honest with one another – especially about what types of sexual activities you are ready or not ready to do.
Treat each other with respect and as equals.
Be aware and attentive to each other’s pleasure and feelings.
Protect each other from any physical or emotional harm.
Discuss and make plans for preventing unwanted pregnancies and STD’s
Respect if your partner is not yet ready for something
If you are planning on having sex – think before you act, and be prepared to take responsibility for any of the consequences that result from your actions!

Be informed about the various types of birth control available, and talk with your partner and your physician to find out which method is best for you. The following is a general overview of various methods of birth control.

Reversible Methods of Birth Control

Behavioral Methods

Continuous Abstinence:
Continuous abstinence is not having sex (vaginal, anal and oral).

Advantages of Abstinence

No physical side effects
Can be used anytime
Nothing to purchase
The best guarantee in preventing unwanted pregnancies and STD’s.

Disadvantages of Abstinence

Requires a great deal of commitment and self control by both partners.
Social pressure to engage in intercourse may make this a difficult method.
Many people fail to use protection when abstinence ends

Effectiveness of Abstinence
Perfect Use: 100% If used correctly and consistently
Typical Use: Unknown; depends on the user

Outercourse
Outercourse is sex play without vaginal intercourse. Many people who use this method of birth control believe that any kind of penetrative sex is too risky to be called “safer sex,” so there is no penetration at all – oral, anal, or vaginal. Instead of allowing penetration to occur, the focus is more on kissing, massaging, masturbating or body-to-body rubbing (frottage).

Advantages of Outercourse

No medical or hormonal side effects

Can be used as safer sex if semen and vaginal fluids are not exchanged

May make sex play last longer, enhance orgasm, and increase intimacy between partners

Can be used when no other birth control methods are available

Disadvantages of Outercourse

Women and men may let outercourse lead to intercourse without being ready to protect themselves from pregnancy and infection.

Some people may become too excited through outercourse and then find it difficult to abstain from intercourse.

Sperm may come into contact with the vagina, increasing chance of pregnancy.

Effectiveness of Outercourse
100% effective against pregnancy unless pre-ejaculate or semen gets onto the vulva or into the vagina. Effective against STDs, reducing the risk of HIV and various STDs unless body fluids are exchanged through oral or anal sex. Some infections, like herpes and HPV, can be passed if there is skin-to-skin contact.

Periodic Abstinence and Fertility Awareness Methods
Periodic Abstinence and Fertility Awareness methods of birth control use a females own body to determine ovulation and pregnancy risk. Periodic Abstinence and Fertility Awareness methods of birth control are NOT recommended for teenagers!!!!!!

Disadvantages of Periodic Abstinence and Fertility Awareness Methods

Provide a very low rate of protection against pregnancy due to a female teen's irregular menstrual cycle. In order for these methods to be even slightly effective, you must be incredibly diligent and very predictable in your cycle.

Will not be able to have intercourse for much of the menstrual cycle.

Withdrawal Method
The Withdrawal method (sometimes referred to as “pulling out”) is when a male takes his penis out of the vagina before ejaculation. The Withdrawal method of birth control is NOT recommended for teenagers or adults as a method of birth control!!!!

Disadvantages of Withdrawal Method

Males tend to ejaculate a little semen in the beginning of a sex act (known as pre-cum). This semen contains sperm and can get a female pregnant or transmit an STD.
Some men have trouble "pulling out" in time.

Please be safe and choose an alternative method.

Over-the-Counter Barrier Methods

Condoms are ideal for teens to use because they are widely available and can be used on a situational basis. Many doctors recommend that condoms be used in conjunction with the pill or Depo-Provera, as well as with spermicide (preferably non-nonoxyol 9). Keep in mind that while there is already spermicide on the condom, this does not provide adequate protection and additional spermicide is needed. Using a combination of these birth control methods offers protection against STDs and double protection against pregnancy. There are currently two types of condoms available: male condoms and female condoms.

Male Condoms
Condoms are made of latex (often called “rubbers”), polyurethane (plastic), or natural membranes (often called "skins" and made from the intestine of sheep). Polyurethane condoms may be used by couples when either partner is allergic to latex. Condoms act as a mechanical barrier, preventing pregnancy by stopping sperm from going into the vagina. The condom is put onto the penis before the penis comes into direct contact with the vagina. Among typical couples who initiate use of latex condoms for men, about 15% will experience an accidental pregnancy in the first year. If condoms are used consistently and correctly, about 2% will become pregnant over the course of an entire year.

Advantages of Male Condoms

No hormones or hormonal side effects.
Very safe and effective at preventing pregnancy and infection if used perfectly.
Sexual intercourse may be enjoyed more because there is less fear of STDs, HIV, and pregnancy.
Condoms may reduce the risk of cervical cancer because there's less risk of HPV infection.
Condoms come in many colors, sizes and varieties.
Condoms make sex less messy by catching the semen.
If the woman puts the condom on the man, it can be fun for both partners.
Condoms come in different sizes to ensure a good fit.
Use a water based lubricant, such as KY Jelly, to decrease breakage.
To decrease the chance of the condom slipping down the penis or falling off in the vagina, pull the penis out of the vagina right after ejaculation. Don’t continue thrusting until the penis becomes soft.
Practice putting a condom onto a banana - this will make it easier to use condoms during sex.
With condoms, the risk of infertility for partners is decreased.
Condoms are fairly easy to get and usually do not cost a lot.
A good contraceptive option during breast-feeding or with other methods as a backup.

Disadvantages of Male Condoms

Unless the woman puts it on as a part of foreplay, the condom may interrupt sex.
Condoms require some practice to learn how to use.
When putting the condom on the penis you must avoid tearing the condom or putting a hole in it with fingernails, a ring or anything sharp. This includes anything sharp in the mouth!
YOU CAN’T USE OIL BASED LUBRICANTS such as Vaseline or sun tan oil with latex condoms! These products can put a hole in a latex condom in a matter of seconds.
Some men cannot maintain an erection with a condom on.
The man must pull out soon after ejaculation. If the man looses his erection, the condom can fall off and be left in the vagina without the couple knowing that this has happened.
Some people are sensitive (or allergic) to latex or find the smell very unpleasant. They must use polyurethane condoms: Durex-Avanti, Trojan-Supra or Reality Female Condom
Buying, negotiating use, putting on, and getting rid of condoms may be embarrassing.
Condoms may decrease enjoyment of sex for some couples by causing decreased sensation for either partner.

Effectiveness of Male Condoms
Perfect Use: 98% IF used correctly and consistently
Typical Use: 85%

Female Condoms
Female condoms are made of a thin plastic called polyurethane. This is NOT latex or rubber. The condom is placed into the woman’s vagina. It is open at one end and closed at the other. Both ends have a flexible ring used to keep the condom in the vagina. The female condom comes in only one size: 15 centimeters in length and 7 centimeters wide. The flexible and removable inner ring at the closed end is inserted into the vagina as far as possible; the inner ring may be removed or left in place in vagina; the larger outer ring remains outside the vagina. Among typical couples who initiate use of female condoms, about 21% will experience an accidental pregnancy in the first year. If these condoms are used consistently and correctly, about 5% will become pregnant in the course of an entire year.

Advantages of Female Condoms

Female condoms give women a new option in as a safe and fairly effective method of preventing both pregnancy and infection (especially against herpes and HIV, since it covers more of the external genitalia).
No hormones or hormonal side effects.
Female condoms give women more control and a sense of freedom when it comes to birth control.
Women don’t need to see a clinician to get it. No prescription or fitting is needed.
The female condom can be put in up to 8 hours in advance.
Your partner can insert it and make it part of lovemaking.
Condom is pre-lubricated inside and out. Any additional lubricant may be used inside and out - this even includes oil-based lubricants since this condom is NOT made of latex
The female condom can be used if either partner is allergic to latex.
The female condom is a good option during breastfeeding.
Breakage is rare.

Disadvantages of Female Condoms

The female condom is large and some feel it is unattractive or odd-looking. Although it looks different and may appear unusual at first, its size and shape allow it to protect a greater area. Many of the couples who have used it like the way it feels.
Some women do not like to, or may have difficulty with, placing the condom into their vagina.
It will not work if the man’s penis enters the vagina outside of the female condom. The penis must be directed into the condom.
It can make rustling noises prior to or during intercourse. A lubricant may decrease noises.
The female condom is not available in as many stores as the male condom. It may be hard to find, so call the store in advance.
Female condoms are about three times more expensive than male condoms.
The inner ring may cause discomfort; if it does, it should be removed.
The female condom is less effective than latex male condoms in preventing both pregnancy and STDs.
They cost about $3 or more per condom. Because of the cost, some couples have been tempted to wash and reuse female condoms. Apparently, this does NOT damage the female condom.

Effectiveness of Female Condoms
Perfect Use: 95% IF used correctly and consistently
Typical Use: 79%

Contraceptive Sponge
A soft, foam device that contains spermicide and covers the cervix. It prevents pregnancy by killing sperm in the vagina and blocking the cervix to hinder the progress of sperm into the uterus.

Advantages of Contraceptive Sponge

Available over the counter

Can be inserted before intercourse

Allows for multiple acts of intercourse

Disadvantages of Contraceptive Sponge

Effectiveness is lower for women who have already given birth

Requires a high level of comfort with one’s body

Possible difficulty with removal

Limited STD protection; possible irritation by spermicide that could facilitate STD transmission

Effectiveness of Contraceptive Sponge
Perfect Use: 91% IF used correctly and consistently
Typical Use: 84%

Spermicides
A spermicide kills or disables sperm so that it cannot cause pregnancy. Spermicides come in many different forms: foam, jelly, cream, film, and suppositories. Most use the chemical nonoxynol-9 against sperm. Spermicides provide lubrication and can be used with other methods of birth control. They are most effective when used consistently and correctly with a barrier method of birth control, like a condom

Advantages of Spermicides

Available over the counter in a variety of forms (creams, films, foams, gels, suppositories)

Adds lubrication

Disadvantages of Spermicides

Timing: must insert close to each intercourse

May cause allergic reaction

Possibility of irritation that could facilitate STI transmission

Effectiveness of Spermicides
Perfect Use: 91% IF used correctly and consistently
Typical Use: 84%

Prescription Barrier Methods

Diaphragm or Cervical Cap
The diaphragm is a soft rubber disk or bowl that fits over the cervix (the opening to the uterus) that blocks the man’s semen from entering the cervix. In terms of sizing, your doctor will specifically fit the diaphragm to your body. The cervical cap is a more snug-fitting form of a diaphragm, which forms a cap over the cervix.

Advantages of a Diaphram or Cervical Cap

No hormones or hormonal side effects
Can insert within 6 hours of initiation of intercourse
Gives the woman the control over the contraception
The penis can remain inside the vagina after ejaculation
Sex is less messy during a woman’s period as the diaphragm holds back some of the menstrual blood
May slightly reduce the risk for cervical infections, including gonorrhea, Chlamydia, HPV (human papilloma virus) and PID (pelvic inflammatory disease)
May be used during breastfeeding after the vagina and the cervix have returned to non-pregnancy shape

Disadvantages of a Diaphram or Cervical Cap

Spermicide must be applied before intercourse
Not effective against STD’s, including HIV
Can be tricky to insert; should wash hands with soap and water before inserting
Relatively high failure rates (16% of women have accidental pregnancies within the first year of use)
Must be fitted by a clinician
Higher risk for urinary tract infections (UTI)
Some find it unattractive and dislike having to insert something into the vagina.
If left in for too long, slightly increases risk for TSS (Toxic Shock Syndrome); the diaphragm should not leave in for more than 24 hours, the cervical cap should not be left in for more than 48 hours.
May slip out of place during sex; might need to check when changing sexual positions
New fitting may be needed after having a baby, abortion, miscarriage or gaining 15+ pounds.
Must be left in place 6 hours after last act of intercourse

Effectiveness of a Diaphram or Cervical Cap
Perfect Use: 91% (cap) and 94% (diaphragm) IF used correctly and consistently
Typical Use: 84%

Prescription Hormone Methods

Birth Control Pill
It can be a combination of one or two hormones, Progestin and Estrogen. Your doctor, gynecologist, adolescent medicine physician or teen health center must prescribe this method. The pill works by preventing the release of an egg from the ovary and by thinning the lining of the uterine wall. It also thickens the cervical mucus in order to keep the sperm from joining with the egg.

Advantages of the Birth Control Pill

Effective against pregnancy when used correctly.
Decreases risks of certain cancers, such as ovarian cancer and endometrial cancer (cancer of the lining of the uterus)
Decreases chance of getting benign breast masses, ovarian cysts, ectopic pregnancies and pelvic inflammatory disease (PID)
Can relieve or eliminate cramps
Decreases blood loss during menstruation and risk for anemia
Periods are often shorter in length and tend to occur more regularly
The cycle can be controlled so that you do not have your period at certain times (i.e., vacations)
The number of cycles can be decreased by using a type of the pill called Seasonale

Disadvantages of the Birth Control Pill

No protection against STDs, including HIV
Should be taken same time every day - sometimes a person with a bad memory will opt for another method of birth control if they cannot remember to take the pill every day.
A back-up contraception method is needed for the first 7 days of the first pill pack; and back-up is needed for 7 days if you think you’ve missed one or more pills.
Possible side effects include weight gain, mood swings, breast tenderness, nausea, spotting – however, most are minor and can go away after a few months
The pill can be expensive and you will need a prescription; the pill generally costs $25-30 a pack but you can usually get them at a reduced cost at Planned Parenthood or teen health center
Should not smoke or should try to reduce smoking while taking the birth control pill due to the possibility of increased risk of serious health concerns.
Some serious adverse side effects include risk of blood clots and heart attacks – although these are rare in young, healthy women.
Some women may not get their period for 1-3 months after stopping the pill, however this is rare.
Some women may experience headaches, depression, anxiety, and fatigue and mood changes.

Effectiveness of the Birth Control Pill
Perfect Use: 99+% IF used correctly and consistently
Typical Use: 92%

The Patch
One Ortho Evra patch is worn each week for 3 consecutive weeks, usually on the lower abdomen or buttocks. The fourth week is patch-free to permit withdrawal bleeding. The 4.5 cm square patch delivers both estrogen and a progestin and this stops ovulation. Used correctly and consistently the patch leads to only 3 pregnancies among 1,000 women using patches for a year! You do not need a back-up method during the 7 patch-free days.

Advantages of The Patch

You don't have to take a pill daily or interrupt sex to use a barrier contraceptive.
Patches may decrease a woman's menstrual cramps and pain.
Patches may decrease the amount of menstrual bleeding and a woman's risk for anemia.
Acne may improve and facial hair is diminished.
You can use patches for an extended period of time or continuously (with no hormone-free intervals).
Each patch has enough hormones to suppress ovulation for up to 9 days, so you can be a day or so late putting on the next patch. (Not recommended).

Disadvantages of The Patch

Patches do not protect you from HIV or other STD’s. You must use condoms if you may be at risk.
You may have spotting (mostly during the first few cycles).
Using patches may cause headaches, depression, mood changes, or decreased enjoyment of sex (infrequent).
Serious complications such as blood clots may occur. While these types of complications are rare, the risk may be higher than for those on birth control pills.
Patches tend to be slightly more expensive than birth control pills. In early 2005 the cost of patches for one 28 day cycle is $38 to $45 in most pharmacies. This works out to $494 to $585 per year!
Partial detachment of patches (2.8%) complete detachment (1.8%) and skin irritation may occur. Even less common (under 1%) is increased pigmentation of the skin under the patch. This hyperpigmentation may last for a number of months.
A back-up contraceptive for 7 days is recommended if there is any question about starting use of a new patch late or if there is a question about the attachment of the patch.
You will need a prescription from your nurse practitioner, physician, nurse midwife or physician's associate.

Effectiveness of The Patch
Perfect Use: 99+% IF used correctly and consistently
Typical Use: 92%

Vaginal Ring
A thin, transparent, flexible ring that you insert into the vagina yourself to provide contraception protection. Leaving the Vaginal Ring in for 3 weeks, it slowly releases estrogen and progestin hormones into the body. These hormones stop ovulation and thicken the cervical mucus, creating a barrier to prevent sperm from fertilizing an egg. Worn continuously for three weeks followed by a week off, each Vaginal Ring provides one month of birth control.

Advantages of the Vaginal Ring

Continuous protection against pregnancy for 1 month

No precise placement necessary

Nothing to apply or insert at time of intercourse

Disadvantages of the Vaginal Ring

Must remember to remove for the week of menstruation, and then insert a new ring for the next three weeks

Requires a high level of comfort with one’s body

No protection against STD’s, including HIV

Effectiveness of the Vaginal Ring
Perfect Use: 99+% IF used correctly and consistently
Typical Use: 92%

Depo-Provera (the Shot)
This is a shot of Progestin in your arm or butt every 12 weeks. Depo-Provera works by preventing the release of an egg. A woman can get Depo-Provera shots from a physician, nurse practitioner, physician’s assistant or local Planned Parenthood.

Advantages of Depo Provera (the Shot)

Effective against pregnancy when used correctly.
Only need to remember to go to the doctor every 12 weeks to get the shot
Increased privacy - there are no pills that can be found
Decreases blood loss and menstrual cramping during periods
Nursing mothers can use this, although it is recommended to wait until the baby is at least 6 weeks old
Can improve PMS, depression and symptoms associated with endometriosis
Can help to prevent ectopic pregnancies
Unlike some other medications, this is not less effective when taken with meds that may effect the liver

Disadvantages of Depo Provera (the Shot)

Not good choice if you don't like needles
Must remember to make appointment for shot every 3 months
Side effects may include loss of period, discomfort, headaches and irregular bleeding
This can be a good choice for those teens that don’t like to or have trouble remembering to take a pill every day.
No STD protection, including HIV
Has been suggested that it can cause decreased bone mass; therefore, regular exercise and calcium supplements may be needed
Depression and PMS may become worse
Some women are allergic to Depo-Provera
Can be expensive
Can increase your LDL (“bad cholesterol”) and decrease your HDL (“good cholesterol”)
Some women experience weight gain
Periods may change and can become irregular
It may take up to 10 months for fertility to return or several months for the period cycle to return to normal

Effectiveness of Depo-Provera (the Shot)
Perfect Use: 99+% IF used correctly and consistently
Typical Use: 97%

Emergency Contraception
This method of birth control is important to know about if you have unprotected sex. Read this response specifically on Emergency Contraception to find out about it and when to use it.

Advantages of Emergency Contraception

Can be used up to 120 hours (5 days) after unprotected sex

Good for emergency situations

Disadvantages of Emergency Contraception

May cause nausea and vomiting

NOT intended for regular use

No protection against STD’s, including HIV

Effectiveness of Emergency Contraception
Depends on timing. The sooner it is taken after unprotected sex, the more effective it will be. EC will be most effective when used within 72 hours following intercourse. If begun within 12 hours of intercourse it is generally 99% effective; within 1-3 days of intercourse it is 96-97% effective.

IUDs – Intrauterine Devices

IUD
Small device put inside the uterus by a healthcare provider that prevents the sperm from fertilizing the egg. There are two types: Copper-T and Mirena, which thickens the mucus in the cervix (opening to the vagina), so it is hard for sperm to enter the vagina.

Advantages of the IUD

Always stays in place

Doesn’t interfere with sex

Lasts 5-10 years

Mirena may cause light periods or no periods at all.

Disadvantages of the IUD

This intrauterine device is generally not recommended for adolescents due to the increased risk of PID (pelvic inflammatory disease), a severe sexually transmitted infection in the uterus and tubes. PID is particularly dangerous to teens because the body is still maturing and developing.

Must be inserted and removed by a clinician

No protection against STD’s, including HIV

Copper-T may cause more bleeding and cramping during periods or spotting between periods.

If a woman gets pregnant, IUD may need to be taken out.

Effectiveness of the IUD
Generally more than 99%.

Future Birth Control Methods for Men

Potential oral contraception methods for men to reduce sperm count and lower the chance of impregnating a woman.
Potential contraceptive injections, implants and vaccines for men to reduce sperm count.
Potential methods for vasectomy, including procedures with a higher success rate of future reversal.

Permanent Methods of Birth Control - Sterilization

Tubal Sterilization (women)
A surgical procedure that closes off the fallopian tubes, where an egg is fertilized by a sperm. When the tubes are closed, sperm cannot reach the egg, and pregnancy cannot happen.

Vasectomy (men)
A surgical procedure that makes a man sterile by basically keeping sperm out of semen.

Disadvantages of Tubal Sterilization or Vasectomies

Permanent methods of birth control that do not give you the options or freedom to choose or change their mind about having children later in life.

There are reversal surgeries available; however, these have a relatively low success rate.

No protection against STD’s, including HIV

Recommendations for Teens

The following birth control methods tend to be the most common methods for teens. Keep in mind that there is no one best method and each person needs to discuss with their health care provider what method is most appropriate for them.

Abstinence
Condoms with spermicide
OCPs (Oral Contraceptive Pills)
Depo-provera
Vaginal Ring (i.e., NuvaRing)

The cost of various birth control methods will vary, and you can often get them at a reduced cost at teen health clinics.

TeenHealthFX knows that you have quite a lot of hard choices to make and hope that they work out for the best. Just remember to take care of your own physical and emotional health needs, and that of your partner, when making any decisions about sex and safe sex!

Signed: TeenHealthFX