Fahamu Online: August 2014

CONTRACEPTIVES.

Choosing not to have sex

Choosing not to have sex provides 100 percent protection from HIV, STIs, and pregnancy. For some, this means avoiding vaginal, anal, and oral-genital intercourse altogether.

WHAT ARE THE ADVANTAGES OF ABSTINENCE?

Choosing not to have sex is free and available to all.

Not having sex is extremely effective at preventing both infection and pregnancy. It is the only 100% effective method of preventing sexually transmitted infections (STIs) and unintended pregnancy.

Not having sex can be practiced at any time in one's life.

Not having sex may encourage people to build relationships in other ways.

Not having sex may be the course of action which you feel is right for you and makes you feel good about yourself.

WHAT ARE THE DISADVANTAGES?

If you've made the choice not to have sex, and change your mind in the heat of the moment, you might not have birth control handy.

WHERE CAN I LEARN MORE?

What you do sexually is an important decision that you will want to think carefully about. You may want to discuss your decision with another person whom you respect. You may want talk it over with your partner. You might also check with your local family planning association, temple or church, or local health department for an organized support group or program for young people wanting to wait until they are ready before having intercourse.

Birth Control Pills

There are two types of Birth Control Pills:

1. Combined Oral Contraceptive Pills

2. Progestin-Only Pills.

WHAT ARE COMBINED BIRTH CONTROL PILLS?

Combined oral contraceptive pills contain two hormones, an estrogen and a progestin. They work by stopping ovulation (release of an egg) and by inhibiting the movement of sperm. Among typical couples who initiate use of combined pills about eight percent of women will experience an accidental pregnancy in the first year. But if pills are used consistently and correctly, just three in 1,000 women will become pregnant. For increased protection against sexually transmitted diseases, use condoms as well. Pills alone do not protect against STIs and HIV.

Complete information about this contraceptive method is available through a clinician or the package insert accompanying the specific pills you are taking.

WHAT ARE THE ADVANTAGES OF CHOOSING COMBINED ORAL CONTRACEPTIVE PILLS?

When properly prescribed for the individual, pills are safer than pregnancy and delivery.

Pills decrease a woman's risk for cancer of the ovaries and cancer of the lining of the uterus (endometrial cancer). Pills also lower a woman's chances of having benign breast masses.

Pills significantly decrease a woman's menstrual cramps and pain.

Pills reduce menstrual blood loss and anemia.

Pills reduced PMS symptoms.

Pills can reduce prevalence of acne by up to two-thirds.

Many women enjoy sex more when on pills because they know they won't get pregnant.

Some clinicians will provide pills without a pelvic exam.

Pills suppress endometriosis.

WHAT ARE THE DISADVANTAGES?

Pills do not protect from HIV/AIDS or other STIs. Use a condom for added protection.

A woman must remember to take the pill at the same time, every day.

Nausea and/or spotting are the two problems women may have the first month on pills.

Missed periods or very light periods. Pills tend to make periods very short and light.

A woman may see no blood at all. Most women like this when they understand it is to be expected.

Some women experience headaches, depression or decreased enjoyment of sex.

Serious complications such as blood clots are rare, but do occur.

Pills can be quite expensive and usually require a prescription.

Use of pills is associated with a statistically higher risk of developing cervical dysplasia. Pills users with dysplasia who also have HPV (human papillomavirus) have a three- to four-fold higher risk of developing cervical cancer.

Pill users who smoke or have hypertension are at significantly higher risk of suffering a stroke, compared to other pill users. Pill users who smoke are also at significantly higher risk of a heart attack, compared to pill users who do not smoke and to other women.

WHERE CAN I GET COMBINED ORAL CONTRACEPTIVE PILLS?

Pills are available with a prescription from a clinician, local health department, or family planning clinic.

WHAT ARE PROGESTIN-ONLY PILLS?

Progestin-only pills contain just one hormone, a progestin. They work by making cervical mucus thicker so sperm cannot get to the egg, and by making the lining of the uterus thinner. Sometimes they stop ovulation (release of an egg). Among typical couples who initiate the use of progestin-only pills about eight percent of women will experience accidental pregnancy in the first year. But if these pills are used consistently and correctly, just three in 1000 women will become pregnant. For protection from HIV and increased protection from pregnancy, use condoms as well. Pills alone do not protect from STIs and HIV.

Complete information about this contraceptive is available through a clinician or the package insert accompanying the specific pills you or your partner are taking.

WHAT ARE THE ADVANTAGES OF CHOOSING PROGESTIN-ONLY PILLS?

Minipills do not have estrogen related side effects and can be taken by women who have had side effects or complications using estrogen-containing pills.

The amount of the progestin in minipills is LESS than in combined pills.

Nursing mothers can take progestin-only pills (preferably after the baby is six weeks old).

Minipills cause light menstrual flow and less anemia.

Minipills reduce menstrual cramps, pain, headaches, mood swings, and breast tenderness.

Minipills are associated with reduced risk of endometrial cancer, ovarian cancer, and pelvic inflammatory disease (PID).

Minipills can help manage the pain associated with endometriosis.

WHAT ARE THE DISADVANTAGES?

Minipills do not protect from HIV/AIDS or other STIs. Use a condom for added protection.

Menstrual irregularity is the big problem with minipills. While the amount of blood lost is less, bleeding may be at irregular intervals and there may be spotting between periods.

Minipills tend to make periods very short and scanty. A woman may go several months with no bleeding at all, and some women do not like this.

A woman must remember to take a pill every single day.

Some women using minipills gain weight or complain of feeling bloated. Regular exercise and attention to a nutritious diet can minimize or control weight gain.

Some women using minipills experience increased symptoms of depression.

WHERE CAN I GET PROGESTIN-ONLY PILLS?

Pills are available with a prescription from a clinician, local health department, or family planning clinic.

Cervical Cap

WHAT IS A CERVICAL CAP?

The cervical cap is a small cap made of soft latex. A doctor or nurse practitioner "fits" a woman for a cervical cap. The woman puts spermicide (which destroys the sperm) in the cap and then places the cap up into her vagina and onto her cervix (the opening of the womb). Suction keeps the cap in place so sperm cannot enter the uterus (the womb). Women should obtain a new cap yearly. Among typical couples who initiate use of the cap before having a child, about 16 percent of women will experience an accidental pregnancy in the first year. If the cervical cap is used consistently and correctly, about nine percent of women will become pregnant. Failure rates are significantly higher if the cervical cap is used after a woman has had a child. Use a condom for additional protection against HIV and other STIs.

WHAT ARE THE ADVANTAGES OF CHOOSING A CERVICAL CAP?

The cervical cap is small and easy to carry. May be put in up to one hour before sex.

It will work continuously for 48 hours.

It does not matter how many times a couple has sex as long as you leave it in at least six to eight hours after the last time you have sex.

Your partner doesn't have to know you are using it.

WHAT ARE THE DISADVANTAGES?

Is not the best protection against HIV and other STIs.

The cervical cap must be fitted by a clinician.

You must wash your hands with soap and water before putting in the cap.

It may interrupt sex.

A woman has to take it with her on vacations or trips.

It increases a woman's risk for inflammation of the surface of the cervix.

It is difficult for some women to insert a cervical cap properly even after being taught.

If left in too long, increases slightly a woman's risk for a very serious infection called toxic shock syndrome. Don't leave your cervical cap in for more than 48 hours.

It may accidentally be placed onto the cervix improperly or may slip out of place during sex.

After putting it in, a woman must check to be sure it is covering the opening of the uterus, called the cervix.

New fitting may be necessary after a baby, abortion, miscarriage, or gaining 15 pounds.

Latex may cause irritation or a woman may be allergic to it.

A woman should have a new cap each year.

You need fresh spermicidal cream or jelly each time you use your cap.

It is not recommended that you use a cervical cap during menstruation.*

WHERE CAN I GET A CERVICAL CAP?

Cervical caps may be obtained from clinicians in health departments and local family planning clinics.

Condoms

Effective condoms are made of latex or polyurethane. Unrolled, condoms look like long, thin balloons. They prevent body fluids from mixing when two people have sex. The condom is put onto the penis before the penis comes into contact with the vagina, mouth, or anus.

Latex condoms, when used consistently and correctly during vaginal, oral, or anal intercourse, are highly effective in preventing the sexual transmission of HIV. They are also effective in preventing most sexually transmitted infections (STIs). Gonorrhea, chlamydia, and trichomoniasis are transmitted when infected semen or vaginal or other body fluids contact mucosal surfaces. Condoms provide a great level of protection against these STIs because they protect both partners against exposure to the other's body fluids. Condoms also provide some protection against STIs—such as genital herpes, syphilis, chancroid, and human papillomavirus (HPV)—which are transmitted primarily through contact with infected skin or with mucosal surfaces. Because these STIs may be transmitted by contact with surfaces not covered or protected by the condom, condoms provide a lesser degree of protection against them.

GENERAL TIPS FOR THOSE WHO ARE SEXUALLY ACTIVE:

Use a water based lubricant such as Astroglide or KY Jelly to decrease the chance of the condom breaking.

To decrease the chance of the condom slipping down the penis or falling off inside the vagina, pull the penis out of the vagina right after ejaculation.

Hold the rim of the condom onto the shaft of the penis during withdrawal.

Never use more than one condom at a time.

Never re-use a condom.

For more information, check out Using a Condom.

WHAT ARE THE ADVANTAGES OF CHOOSING CONDOMS?

Condoms are safe and effective at preventing both pregnancy and some infections when used at each act of sex.

Using condoms is the best method of preventing infection if two people are going to have sex.

No prescription is needed to get condoms.

WHAT ARE THE DISADVANTAGES?

Condoms do not provide complete protection against genital herpes, syphilis, chancroid, or HPV because the STIs can be transmitted across infected skin surfaces not covered by the condom.

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.

YOU CAN'T USE OIL BASED LUBRICANTS, such as Vaseline or sun tan oil. These products can cause a hole in a condom.

The man must pull out soon after ejaculation or the condom could fall off and spill or be left in the vagina.

Some people are sensitive or allergic to latex.

WHERE DO I GET CONDOMS?

From family planning clinics, pharmacies or drugstores, supermarkets, and gas stations. Many campus health centers, family planning clinics, or health departments give away free condoms. They are also available from a wide variety of online retailers.

WHAT IS VAGINAL CONTRACEPTIVE FILM?

The film is a little two inch by two inch thin sheet with a chemical that kills sperm (a chemical called nonoxynol-9). It is placed on or near the cervix (the opening of the womb). It dissolves in seconds. Among typical couples who initiate use of vaginal spermicide, 29 percent of women will experience an accidental pregnancy in the first year. If vaginal spermicide is used consistently and correctly, about 18 percent of women will become pregnant. This method is most effective when used in combination with condoms. Complete information about film is available through your clinic, your clinician, or the package insert accompanying vaginal contraceptive film.

WHAT ARE THE ADVANTAGES OF VAGINAL CONTRACEPTIVE FILM?

Film is simple to use.

It is not messy; there is no discharge. It is virtually undetectable and discreet. You can't tell it is there.

Vaginal contraceptive film can be bought at most drug stores; no prescription is needed.

Film may be used alone or with a diaphragm or a condom.

It reduces the risk of getting some sexually transmitted diseases.

WHAT ARE THE DISADVANTAGES?

Contraceptive film does not adequately protect from the HIV/AIDS virus or other STIs. Use a condom if you or your partner may be at risk.

Frequent use of nonoxynol-9 can cause irritation which may increase susceptibility to HIV and other STIs.

It must be inserted no longer than one hour before sex. Inserting it may interrupt sex.

A woman must use a new film each time she has intercourse.

The film must make contact with the cervix in order to be effective.

A woman must wash hands with soap and water before putting the contraceptive film in. She must also dry hands carefully to keep the film from sticking to her fingers.

Some people may be sensitive to film or find it causes irritation.

It is not as effective as some other contraceptives.

WHERE CAN I GO TO GET VAGINAL CONTRACEPTIVE FILM?

Vaginal contraceptive film can be found at many pharmacies, drug stores, and family planning clinics. It is also available at a number of online drugstores.

Contraceptive Foam

WHAT IS CONTRACEPTIVE FOAM?

Foam is placed into the woman's vagina using an applicator and has two effects. It kills or destroys sperm and blocks the man's fluids from entering the cervical canal. Foam stops sperm from getting to the egg. Among typical couples who initiate use of vaginal spermicide, 29 percent will experience an accidental pregnancy in the first year. If vaginal spermicide is used consistently and correctly, about 18 percent will become pregnant. Foam is most is effective when used in combination with condoms. Complete information about this contraceptive is available through a family planning association or clinic, a clinician or the package insert accompanying the foam.

GENERAL TIPS

A woman should practice putting foam into her vagina in advance. This will make it easier at the time of intercourse.

You can't be sure if there is enough foam in the can to protect against the next act of intercourse. It may help to keep an extra handy.

WHAT ARE THE ADVANTAGES OF CONTRACEPTIVE FOAM?

Foam gives the woman control over use of a contraceptive.

It is available over the counter without a visit to a clinician.

It can be put into the vagina up to 20 minutes before sexual intercourse, but it is also effective immediately.

Foam is safe and has no hormones.

The man's penis can remain inside the vagina after ejaculation.

WHAT ARE THE DISADVANTAGES?

It may not be protective against HIV/AIDS. To increase effectiveness, use condoms.

Foam can be irritating to the vagina, and some people feel that it is messy.

Some women do not like placing an applicator up into the vagina.

The taste of foam is unpleasant.

The container carrying the foam is large and some may find it embarrassing to carry around.

WHERE CAN I GET CONTRACEPTIVE FOAM?

At your local pharmacy, drug store, clinic or at a number of online drugstores.

Contraceptive Implants

WHAT ARE CONTRACEPTIVE IMPLANTS?

The contraceptive implant (Implanon) is a single implant inserted into the upper arm. After a woman is given a local anesthetic, insertion takes only a few minutes. Usually it does not hurt. Implants give off very small amounts of a hormone much like the progesterone a woman's body produces during the last two weeks of each monthly cycle. Among typical couples who initiate use of implants, five women in 1,000 will experience an accidental pregnancy in the first year. Complete information about this contraceptive is available through a clinician or the package insert accompanying the implant.

WHAT ARE THE ADVANTAGES OF CONTRACEPTIVE IMPLANTS?

Implanon is effective for three years. In a recent study, no pregnancies occurred among the first 70,000 cycles of Implanon users. That's great protection!

There is nothing to do on a daily basis or at the time of intercourse.

Women lose less blood during menstruation. They also have less cramping, headaches, and breast tenderness.

Depression and premenstrual symptoms may improve.

WHAT ARE THE DISADVANTAGES?

Implants do not protect from HIV/AIDS or other STIs. Use a condom, if you or your partner may be at risk.

Implants are quite likely to cause irregular periods in some women. If bothersome to you, contact your clinician. There are drugs that a woman may take to have a more acceptable pattern of bleeding. As time goes on a woman's periods may become more regular.

You may gain weight, lose hair, develop headaches or note darkening of the skin over your implants. Implants may cause some arm discomfort.

Depression and premenstrual symptoms may become worse.

A woman may have trouble finding a clinician who will remove her implants.

WHERE DO I GO TO GET CONTRACEPTIVE IMPLANTS?

A woman can get implants from a doctor, nurse practitioner, nurse midwife, health department, or family planning clinic. Not all clinicians insert implants. It is a good idea to check on this in advance. Be sure the clinician is also experienced at removing implants and will remove them regardless of ability to pay to have them removed.
What is the routine after a woman has implants inserted?

A woman will probably be given a date to return about one month after insertion to check out the insertion site and to answer any questions she may have. After this, return to your clinician just once a year for your regular checkup.

Contraceptive Sponge

WHAT IS THE CONTRACEPTIVE SPONGE?

The vaginal sponge is a barrier method of preventing pregnancy. That is, the sponge acts as a barrier to prevent semen from entering the cervix. The sponge is more effective with women who have never given birth than with women who have. With typical use of the sponge, about 16 percent of women will experience pregnancy within one year. With consistent and correct use of the sponge, about nine percent of women will experience pregnancy within one year.

Because vaginal barrier methods, including the sponge, protect the cervix, they may help in preventing some sexually transmitted infections, including gonorrhea, chlamydia, and trichomoniasis. Studies about the protective effect of vaginal barrier methods are not consistent, however, so women should also use condoms to prevent sexually transmitted infections.

WHAT ARE THE ADVANTAGES OF THE CONTRACEPTIVE SPONGE?

Sponges are easy to use, relatively inexpensive, and available without prescription.

Because you may insert the sponge when your sex partner is not present, they offer a good measure of contraceptive privacy.

WHAT ARE THE DISADVANTAGES?

Unlike hormonal methods, the sponge does not provide constant protection. You need a new one for each occasion of sex.

You need to wash your hands with soap and water before you insert the sponge.

The sponge must be inserted into the vagina and up against the cervix prior to the penis entering the vagina.

Some women find it difficult to place the sponge correctly.

Some women have difficulty removing the sponge.

If left within the vagina for more than 30 hours, the sponge slightly increases your risk for a very serious infection called toxic shock syndrome. Don’t leave your sponge in for more than 30 hours.

The sponge may accidentally be placed onto the cervix improperly or may slip out of place during sex.

Sponges must be stored in a clean, cool, dark place—not in the glove compartment of a car or in a purse.

WHERE CAN I GET THE CONTRACEPTIVE SPONGE?

You can purchase the sponge in local pharmacies and other stores that sell condoms and personal hygiene products, including online stores.

Contraceptive Suppositories

WHAT ARE CONTRACEPTIVE SUPPOSITORIES?

Contraceptive suppositories are barrier methods of birth control that are inserted deep into the vagina before sexual intercourse. The suppository melts, releasing spermicide. The spermicide prevents sperm from moving toward the egg and also protects the cervix. Of 100 women who use contraceptive suppositories less than perfectly, 29 will accidentally get pregnant during the first year. With perfect use, 15 women will get pregnant. Suppositories provide no protection against sexually transmitted infections. In fact, you should not use this method over and over in a single day because frequent daily use of any barrier method that contains the spermicide nonoxynol-9 can increase your risk of HIV and other STIs. For protection against STIs, use condoms.

WHAT ARE THE ADVANTAGES OF SUPPOSITORIES?

Are inexpensive and available without prescription;

Can be used by any woman who wants to use them; and

Remain effective for about one hour after insertion.

WHAT ARE THE DISADVANTAGES?

Suppositories do not protect from HIV or other STIs. Use condoms as well.

Some brands of spermicide may irritate the penis or vagina. Try different brands if this happens.

Suppositories cannot safely be used many times in one day.

A new suppository must be inserted deep into the vagina prior to each act of sex.

If not used exactly as directed, the suppository may not form a good barrier over the cervix.

Suppositories can be messy.

WHERE CAN I GET CONTRACEPTIVE SUPPOSITORIES?

Contraceptive suppositories are available at most drugstores and some convenience stores, supermarkets, family planning clinics, and local health department clinics. You can get more information about this contraceptive method from your regular doctor or nurse practitioner, family planning clinic, and/or the patient insert accompanying the suppositories.

WHAT IS A DIAPHRAGM?

A diaphragm is a latex disc a woman places into her vagina. It should be left in the vagina at least 6 hours but no more than 24 hours after intercourse. The diaphragm blocks a man's semen from entering the cervix (the opening to the womb). A spermicide placed onto the diaphragm kills sperm. A diaphragm and the spermicide keep sperm from getting to the egg. Among typical couples who initiate use of the diaphragm, about 16 percent of women will experience an accidental pregnancy in the first year. If the diaphragm is used consistently and correctly, about 6 percent of women will experience pregnancy. Use condoms as well as the diaphragm for the most effective protection. Complete information about this contraceptive is available through a family planning association or clinician or through the package insert accompanying a diaphragm.

WHAT ARE THE ADVANTAGES OF CHOOSING A DIAPHRAGM?

A diaphragm gives a woman fairly good control over contraception.

When used perfectly, only six women in 100 become pregnant the first year using a diaphragm.

It can be put in up to several hours in advance of sexual intercourse.

Diaphragms are safe; there are no hormones and no side effects from hormones.

The penis can remain inside the vagina after ejaculation.

WHAT ARE THE DISADVANTAGES?

A diaphragm does not provide adequate protection from HIV. Use condoms as well.

The diaphragm must be fitted by a clinician.

You must wash your hands with soap and water before putting a diaphragm in.

Inserting the diaphragm may interrupt sex.

A woman has to take it with her on vacations or trips.

A diaphragm increases a woman's risk for urinary tract infections.

It is difficult for some women to insert a diaphragm properly even after being taught.

If left in too long, it slightly increases a woman's risk for a very serious infection called toxic shock syndrome. Don't leave a diaphragm in for more than 24 hours after intercourse.

It may slip out of place during sex. If you change who is on top, you may want to check to see that the diaphragm is still covering the cervix.

After putting it in, a woman should check to be sure it is covering the opening of the cervix.

A new fitting may be necessary after having a baby, abortion or miscarriage, or gaining 15 pounds.

It is not recommended that you use a diaphragm during menstruation.*

WHERE CAN I GET A DIAPHRAGM?

A woman must be fitted in a clinician's office for a diaphragm. Be sure to be shown how to insert and remove a diaphragm. Then a woman must be given a prescription for the specific type of diaphragm she will use. The actual diaphragm and the spermicide used with the diaphragm are located at the local pharmacy or a drugstore.

Emergency Contraception

Emergency Contraception – also called EC, the Morning After Pill, or Plan B – can prevent pregnancy up to five days (120 hours) after unprotected sex. Emergency Contraception is a stronger dose of the same hormones used in regular birth control pills and is more effective the sooner you take it. EC works best if you take it within 24 hours of sex.

Plan B® is the only product specifically approved and marketed in the United States as an emergency contraceptive pill.

HOW DOES EMERGENCY CONTRACEPTION WORK?

Emergency Contraception is a stronger dose of the same hormones found in regular birth control pills. When taken after unprotected sex, these hormones can greatly reduce the chance of pregnancy and are most effective if taken within 12 hours after sex.

PREVENTING PREGNANCY AFTER SEX

Plan B® – the only form of prescription EC currently available in the United States – is a set of two pills. The Food and Drug Administration has approved the use of certain brands of regular birth control pills as EC, though the number of pills and dosage varies by brand. (To find out more, click here.)

EC works by delaying ovulation (or the release of an egg from an ovary). It may also prevent the egg from being fertilized. It’s possible, although unproven, that EC may inhibit implantation (that is, prevent a fertilized egg from attaching to the wall of the uterus).

EC DOES NOT CAUSE AN ABORTION

Using emergency contraception is not the same as having an abortion, and emergency contraceptive pills do not cause abortion. The U.S. Department of Health & Human Services, the American College of Obstetricians & Gynecologists, and almost all mainstream professional medical groups define pregnancy as beginning when a fertilized egg has finished implanting in the uterus. Emergency contraceptive pills will not harm an egg that has finished implanting; therefore, they can’t cause an abortion.

If a woman takes EC when she is already pregnant, it won’t have any effect whatsoever. It will not end the pregnancy or cause any birth defects. Emergency contraceptive pills are not the same as RU486 (the “abortion pill”) – the two are entirely different drugs.

MOST WOMEN EXPERIENCE MILD OR NO SIDE EFFECTS

While some women experience no side effects at all, taking EC may make you nauseous, dizzy, or tired. You may also vomit, develop a headache, and/or have sore breasts. If you do experience side effects, they will be temporary and should last less than a day or two.

It's normal for your next period to be a few days late or early. It may be heavier, lighter, or more spotty than usual. If your period doesn't come, you should take a pregnancy test.

HELPFUL HINTS WHEN TAKING EMERGENCY CONTRACEPTION

Take motion sickness pills, like Dramamine II before taking the emergency contraceptive pills.

Take the pills with food.

Take your first dose mid-morning and your second dose (12 hours later) right about bedtime.

GETTING EC WHEN YOU NEED IT

If you have recently had unprotected sex, chances are you’re worried – maybe even panicked – about the possibility of getting pregnant. When taken within five days (120 hours) after unprotected sex, Emergency Contraception can greatly reduce the chance of getting pregnant. But it’s important to act quickly – EC is more effective the sooner you take it.

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