The Facts of Life: Examining Reproductive Health

Methods of Contraception

Choosing to abstain from sex does not mean a person will never have a sexual relationship. It means that either one or both partners are not ready. The decision to abstain may or may not be right for you. Some who have chosen abstinence feel it is a positive experience; others' reactions have been more mixed. Many who abstain do so until they meet someone they really care for. Abstinence is a choice you can make at any point in your life, even if you have already been sexually active.

Cervical Cap
A cervical cap is a small rubber barrier that fits over the cervix (the opening to the womb). Used with contraceptive cream or jelly, it stops and kills sperm. Women with a cervical erosion or laceration should not use the cap, because it doesn't allow the free flow of cervical secretions, which may be a cause of irritation. Also, a woman with a history of toxic shock syndrome should not use the cap.

The initial fitting of a cervical cap to the cervix must be done by a health care provider. For regular use, it may be inserted 6 to 40 hours before intercourse and left in for 48 hours. It is always used with a contraceptive cream or jelly, and to be effective, must be used every time a couple has intercourse. If a woman is menstruating, contraceptive foam and a condom are recommended instead of the cervical cap. A woman will need to be refitted once she has had a full-term pregnancy, a miscarriage or an abortion past the first three months of pregnancy, pelvic surgery, and/or a weight gain or loss of more than ten pounds.

If the cervical cap is used correctly with each act of intercourse, it is 97% effective. Effectiveness is increased if the cervical cap is used in combination with a condom.

Advantages

• Easy to use, once technique is learned
• Used only when needed
• Few health problems associated with use
• May help protect against STDs

Disadvantages

• May lead to bladder infections
• Difficult for some women to use
• Women with short fingers may have difficulty inserting
• Possible reaction to rubber, cream or jelly (both partners)
• Can be pushed out of place during sex
• Must be checked for holes and cracks
• Doesnotprotect against AIDS

Warning Signs: Consult your physician

• Doesn't stay in place
• Irritation or itching in the genital area
• Frequent bladder infections
• Unusual vaginal discharge

Depo-Provera
Depo-Provera is an artificial hormone that prevents the ovaries from producing eggs. The hormone also produces changes in the mucus of the cervix and lining of the uterus to decrease the chance of pregnancy. It is injected into either the buttock or upper arm and is effective at once. One shot lasts for 12 weeks and reduces the risk of pregnancy by 99%. Depo-Provera is not recommended to women who have had unexplained vaginal bleeding, breast or uterine cancer, a stroke, blood clots in the legs, or liver disease.

Advantages

• Longer lasting protection
• Contains no estrogen, so no side effects from that hormone
• Does not interfere with lovemaking
• Convenient and private

Disadvantages

• May have irregular or no menstrual periods at all
• Immediate discontinuation of this birth control method is not possible
• May experience weight gain and headaches
• Must wait out the side effects
• Doesnotprotect against AIDS and STDs.

Warning Signs: Seek immediate medical attention

• Sharp chest pain
• Coughing of blood
• Severe headache
• Vomiting
• Blurred vision
• Severe pain or swelling in calf
• Pain, pus, or bleeding near site of injection

Diaphragm
A diaphragm is a small rubber barrier that fits into the vagina, over the cervix (the opening to the womb). Contraceptive cream or jelly is applied to the diaphragm to kill sperm. The diaphragm is a little larger than the cervical cap and is more pliable.

Diaphragms come in different sizes and must be fitted by a health care provider. It is always used with contraceptive cream or jelly, and is only effective if used each time a couple has sex. The diaphragm may be inserted 6 hours before intercourse and left in place at least six hours after intercourse. If a woman is menstruating, it is recommended that she use contraceptive foam and a condom instead. After a full-term pregnancy, a miscarriage or an abortion past the first three months of pregnancy, pelvic surgery, or a weight gain or loss of more than ten pounds, a woman should be refitted for a diaphragm.

If a woman uses the diaphragm correctly each time she has sex, it is 97% effective. However, if the diaphragm is used in combination with a condom, effectiveness is increased.

Advantages

• Easy to use, once method is learned
• Used only when needed
• Few health problems associated with use
• May help protect against STDs

Disadvantages

• May lead to bladder infections
• Difficult for some women to use
• Possible reaction to rubber, cream or jelly (both partners)
• Can be pushed out of place during sex
• Must be checked for holes and cracks
• Doesnotprotect against AIDS

Warning Signs: Consult your physician

• Doesn't stay in place
• Irritation or itching in genital area
• Frequent bladder infections
• Unusual vaginal discharge

Female Condom
A female condom is a loose-fitting sheath that fits into the vagina, covering the cervix. It catches semen from an ejaculation, preventing sperm from entering the vagina and protecting against AIDS and STDs.

The sheath has an inner and an outer ring. To insert, the inner ring is squeezed and then pushed into the vagina with the index finger as far as it can go. Care must be taken to ensure the penis enters the opening of the condom or no protection will be provided. Once it is removed, it is discarded. A new condom is used each time a couple has intercourse.

If the condom is used correctly, it is 98% effective. Effectiveness is increased if it is used along with contraceptive foam, creams, and jells.

Advantages

• Used only when needed
• No side effects
• One size fits all
• Inexpensive and can be purchased at drugstores and clinics
• Effective against AIDS and STDs

Disadvantages

• Outer ring hangs out
• If used incorrectly, will not provide protection
• Must be used with each sex act

Fertility Awareness Method
Fertility awareness is used to determine the days on which ovulation takes place. Changes in body temperature, vaginal mucus and menstrual periods are observed and recorded. These changes will indicate when pregnancy is likeliest to occur. This method works best for a woman who is in good health, has regular menstrual cycles, and has a supportive sexual partner.

There is a period of approximately eight days in the menstrual cycle when a woman is most likely to be fertile. During this time, vaginal mucus becomes clear and slippery and will stretch between the fingers, and the basal body temperature goes up. Intercourse is now to be avoided if pregnancy is not wanted.

Effectiveness of the method depends on how well a woman observes and records changes in her body, and her ability to understand what these changes mean. When this method is used correctly, it is 80% to 98% effective.

Advantages

• No side effects
• Acceptable to most religious beliefs
• Helpful when planning for pregnancy
• Thermometers and charts easy and inexpensive to obtain from drugstores and clinics

Disadvantages

• Must record temperature and vaginal mucus every day
• No sex during fertile time
• May not be effective for women with irregular periods
• Fevers and irregular sleeping patterns can change body temperature, and infections, medications and douches can change vaginal mucus making recording difficult
• Unreliable
• Doesnotprotect against AIDS or STDs

Foams, Suppositories, Creams, Jells, and Films
Foams, suppositories, creams, jells, and films contain chemicals called "spermicides" that kill sperm. The solid types melt, depositing the chemical at the cervix (the opening of the uterus). Foams create a barrier, blocking the cervix. Creams, jells, suppositories, and films melt into a thick liquid that coats the vagina.

Spermicides are inserted deep into the vagina no more than 20 minutes before intercourse. They must remain in the vagina for 6 hours after intercourse to ensure that the chemicals stop all the sperm.

The chemicals are 80% to 97% effective when they are used each time a couple has intercourse. When a condom is used along with one of these methods, effectiveness is increased.

Advantages

• Inexpensive and easy to buy - available at drugstores, supermarkets, clinics
• Easy to use and carry
• Used only when needed
• No prescription needed
• May protect against STDs

Disadvantages

• Chemicals may cause irritation of tissues (in men or women)
• Must be used with each sex act
• Doesnotprotect against AIDS

Warning Signs

• Itching or irritation

Intrauterine Device (IUD)
The IUD is a small plastic device which is inserted into the uterus. It prevents fertilization, and changes the chemistry of the lining of the uterus to prevent implantation of the embryo. Some types of IUDs may remain in place for up to 10 years; others may have to be changed each year.

This method of birth control is generally recommended to women who have already had a baby, have only one monogamous sex partner, and have never had pelvic inflammatory disease (PID). Women who are prone to reproductive tract infections, have a history of heart disease, or allergies to copper, abnormal vaginal bleeding, or a history of tubal pregnancies are advised to use another form of birth control.

The IUD is inserted into the uterus, usually during menstruation. The string should be checked monthly to make sure the IUD is in place. A medical examination is advisable three months after insertion; thereafter, an annual exam is recommended for IUD users. Both insertion and removal are performed by a health care provider.

The IUD is 95% to 98% effective. Most pregnancies that occur with use of an IUD do so during the first year. Effectiveness during the first year boosted by using other forms of contraception along with the IUD.

Advantages

• Always in place
• Woman does not have to think about birth control
• Does not affect woman's hormones
• Does not interfere with lovemaking

Disadvantages

• Cramping after insertion
• Bleeding or spotting between periods; heavier and longer periods
• May come out
• Must be taken out if pregnancy results
• Increased chance of tubal pregnancy
• Possibility of infection of tubes or ovaries, especially if history of problems, or multiple partners
• Infections may result in sterility or hysterectomy
• Untreated infection can be fatal
• Cases where IUD has punctured uterus
• Doesnotprotect against AIDS and STDs

Warnings Signs: Seek immediate medical attention

• Can't feel IUD string
• Severe cramping or pain in lower abdomen
• Pain or bleeding during sex
• Unexplained fever and/or chills
• Increased, or bad-smelling discharge from vagina
• Missed or light period

Male Condom
The male condom is a sheath made of either latex or animal tissue that is worn over the penis during intercourse. It catches the semen from an ejaculation so sperm are prevented from entering a woman's vagina. Condoms can provide protection against AIDS only if they are made from latex. They also protect against other sexually transmitted diseases.

To use a condom, the penis must be erect. The rolled condom is held at the tip to pinch any excess air out of the end, and rolled to the base of the penis. At least half an inch should be left at the tip to provide room for the semen and to prevent breakage. Only water-based lubricants are recommended because those that contain oil can weaken the condom, causing it to break. If a condom should break, contraceptive foam, cream, or jelly can quickly be inserted into the vagina to kill the sperm. A new condom is used each time a couple has intercourse.

After intercourse, the penis becomes flaccid and it is possible for the condom to slip off. At this point, sperm could enter the vagina. To prevent this from happening, the end of the condom is held onto as the penis is withdrawn from the vagina.

If the condom is used correctly, it is 98% effective. The use of contraceptive foams, creams, or jellies increases effectiveness. There is no guarantee of effectiveness if the manufacturer's date on the condom is more than two years old.

Advantages

• Inexpensive, and can be bought in drugstores, gas stations, supermarkets, clinics
• Easy to use and carry
• Used only when needed
• No side effects
• May prolong erection
• Protects against AIDS, and STDs

Disadvantages

• Condoms with spermicides may irritate vagina or penis
• Reaction if allergic to latex
• Must be used with each sex act
• Possibility of breakage
• Possible reduction of sensation