CONTRACEPTION (BIRTH CONTROL)

What are the various methods of contraception and their effectiveness rates?

Contraceptive Methods: Failure Rates, Advantages, Causes of Failure, and Side Effects

Method Theoretical or Perfect Use Failure Rate Typical Use Failure Rate in Typical Users Potential Negative Side Effects Potential Advantages to Users Possible Causes of Failure That Could Result in Pregnancy
Abstinence 0% ? Sexual frustration. Avoiding planning for eventual use of contraception. No cost or health risks. Freedom from worry about pregnancy. Inability to continue abstaining.
Withdrawal (coitus interruptus) 4% 19% Inability to fully relax during sexual intercourse and not be on guard. Frustration created by inability to ejaculate in the vagina. No cost or preparation involved. No risks to health (if sexually transmitted diseases are absent). Available even if no other methods are. Lack of ejaculatory control, causing ejaculation in vagina. Ejaculating semen too close to vaginal opening after withdrawing. Sperm present in pre-ejaculatory fluid from the penis (even more likely if intercourse is repeated within a few hours).
Natural Family Planning/Fertility Awareness (Rhythm Method) 1-9% 20% Sexual frustration during periods of abstinence. Accepted by Roman Catholic Church. May be used to increase chances of pregnancy if that choice is made. No health risks. Inadequate time devoted to charting female's menstrual cycle or misunderstanding of method. Ovulation at an unexpected time in the cycle. Deciding to have intercourse during the unsafe period of the cycle, without other contraception.
Combined Oral Contraceptive (birth control pill containingestrogen and progestin) 0.1% 3% Nausea, weight gain, fluid retention, breast tenderness, headaches, missed menstrual periods, acne. Mood changes, depression, anxiety, fatigue, decreased sex drive. Circulatory diseases. Gastrointestinal disorders. Reliable; offers protection all the time. Brings increased regularity to menstrual cycle. Tends to reduce menstrual cramping. Not taking pills as directed or skipping a pill. Impropersupervision by clinician. Ceasing taking the pills for any reason.
Minipill (progestin only) 0.5% 3% Irregular menstrual periods are a common side effect. Bleeding between menstrual periods. Appearance of ovarian cysts. Safer for older women. Reliable; offers protection all the time. Brings increased regularity to menstrual cycle. Tends to reduce menstrual Not taking pills as directed or skipping a pill. Impropersupervision by clinician. Ceasing taking the pills for any reason.
Norplant implants 0.09% 0.09% Slight visibility of implants. Menstrual cycle irregularities. Improper insertion or difficult removal. May have risks similar to pills, butresearch is incomplete. Long-term protection. Extremely reliable. Requires no attention after initial treatment. Use beyond a 5-year period. Gaining a significant amount of weight (less effective in women over 155 lbs.).
Depo-Provera injections 0.3% 0.3% Weight gain. Excessive bleeding. Menstrual cycle irregularities. Increased depression. Decrease in sex drive. May be associated with slight increase in breast cancer risk for younger women, but research is incomplete. 3-month protection. Extremely reliable. Neglecting to get reinjected after 3 months.
Sponge (contains spermicide) Note: Manufacture of this method was discontinued in 1995 9-20% 18-36% Increased risk of toxic shock syndrome. Allergic reactionto polyurethane or spermicide. Vaginal dryness. Increased risk of vaginal yeast infections. Ease of use. Relatively inexpensive. Protection over 24 hours, several acts of intercourse. No odor or taste. Difficulty in proper insertion and placement. Internal anatomical abnormalities that interfere with placement or retention.
Cervical cap with Spermicide 6% 18% Possible risk of toxic shock syndrome. Allergic reaction to rubber or spermicide. Abrasions or irritation to vagina or cervix. Can be left in place for long periods of time. Improper fitting or insertion/placement. Deterioration byoil-based lubricants or vaginal medications.
Spermicidal Foam, Cream, Jelly, Suppositories, or Film 6% 21% Allergic reactions to chemical. Unpleasant taste of chemical during oral-genital sex. Available without prescription. Minimal health risks. Easy to carry and use. s, Does not require partner Slippage of outer rim into vagina during intercourse. Twisting of pouch during intercourse.
Male Condom 3% 12% Allergic reactions to latex (natural "skin" condoms are also available and nonlatex rubber condoms will soon be available as well). Some reduction in sensation on the penis. Available without prescription. Offers protection from sexually transmitted diseases. A method for which the man can take full responsibility. Easy to carry and use. Breakage of condom. Not leaving space at tip of condom tocollect sperm. Lubrication with petroleum jelly, or presence of some vaginal medications, weakening rubber condom. Seepage of semen around opening of condom or condom slipping off in the vagina after coitus. Storing of condom for more than 2 years or in temperature extremes. Not placing condom on penis at beginning of intercourse.
Female Condom (Vaginal Pouch) 5% 21-26% Some reduction in sensations of intercourse. Relatively high rate of contraceptive failure. Sometimes makes noises. Allows woman to choose protection from disease, along with contraception. Available without prescription. Slippage of outer rim into vagina during intercourse. Twisting of pouch during intercourse.
Diaphragm 6% 18% Allergic reaction to the rubber (plastic diaphragms are also available) or spermicide. Increased risk of toxic shock syndrome. Bladder infection or vaginal soreness because of pressure from rim. Negative side effects are rare. Inexpensive; can be re-used. Improper fitting or insertion of the diaphragm. Removal of diaphragm too soon (within 6-8 hours of coitus). Not using sufficient amount of spermicidal jelly with the diaphragm. Leakage in or around diaphragm or slippage of of diaphragm. Deterioration by oil-based lubricants or vaginal medications.
Intrauterine Device (IUD): Progesterone T (Progestasert) Copper T 380A Levonorgestrel 1.5% 0.6% 0.1% 2% 0.8% 0.1% Uterine cramping, abnormal bleeding, and heavy menstrual flow. Pelvic inflammatory disease or perforation of the uterus during insertion of the IUD; also violent allergic reaction; infection of the ovaries. Reliable. Can be left in place, so that nothing must be remembered or Failure to notice that IUD has been expelled by uterus.
Vasectomy 0.1% 0.15% Psychological implications of being infertile can sometimes lead to some sexual problems. Permanent; no other preparations. Very reliable. Minimal health risks. Having unprotected intercourse before reproductive tract is fully cleared of sperm following vasectomy (may be several months). Healing together of the two cut ends of the vas deferens.
Contributed by Sam Hulick
shulick@indiana.edu


From Sexuality Today, by Gary F. Kelly

Associated Risk statistics with Contraception

Activity                        Chance of Death in a Year

Risks for men and women of all ages who participate in:
     Motorcycling                       1 in 1,000
     Automobile driving                 1 in 6,000
     Power boating                      1 in 6,000
     Rock climbing                      1 in 7,500
     Playing football                   1 in 25,000
     Canoeing                           1 in 100,000

Risks for women aged 15 to 44 years:
     Using Tampons                      1 in 350,000
     Having sexual intercourse (PID)    1 in 50,000

Preventing pregnancy:
     Using birth control pills
          nonsmoker                     1 in 63,000
          smoker                        1 in 16,000
     Using IUDs                         1 in 100,000
     Using diaphragm, condom or spermicide   NONE
     Using fertility awareness methods       NONE
     Undergoing sterilization:
          Laparoscopic tubal ligation   1 in 67,000
          Hysterectomy                  1 in 1,600
          Vasectomy                     1 in 300,000

Continuing pregnancy                    1 in 14,300

Terminating Pregnancy:
     Illegal abortion                   1 in 3,000
     Legal abortion
          Before 9 weeks                1 in 500,000
          Between 9-12 weeks            1 in 67,000
          Between 13-15 weeks           1 in 23,000
          After 15 weeks                1 in 8,700

The source is the 1990-1992, 15th Revised Edition of Contraceptive Technology. Authored by too many doctors to cite. However, this book is used by millions of doctors around theworld as an authority on contraception. Its authors gather their sources from data published by several different statistic gathering organizations (such as the Centres for Disease Control) and then compile and interpret it in their book. Happy Reading.


Common Methods of Contraception

Diaphragm

Has a failure rate of 2% (i.e. out of 100 women who primarily use the diaphragm, two become pregnant in any year). Always use spermicide; both partners must learn how to place it properly. It has few associated risks; it cannot become 'lost' because the vagina is only a few inches long. Can 'slip' and press against the rectum; this can be uncomfortable. Also, some men can feel the diaphragm during intercourse. Some women have recurrent yeast infections when using the diaphragm.

The average diaphragm costs about 20-30 dollars, but it must first be sized and fitted by a gynecologist, so there is the cost of a doctor's fee. Must be replaced every two years to ensure correct fit and product lifespan. A tube of Gynol II costs around 11 dollars and is good for 24 doses of spermicide.

The major disadvantage to the diaphragm is that it must be used one of two ways; either it is inserted before any sort of sexual play, in which case the taste of spermicide can become an issue if the couple wishes to engage in oral sex, or is inserted after oral sex but before intercourse, which can be considered a major interruption of play and may lead to not using it all.

(SOURCE: "The New Our Bodies, Ourselves" The Boston Women's Health Book Collective, 1984. Pgs 225-228.)


Reality, The Female Condom

[IMAGE]

The female condom is a soft, loose-fitting plastic pouch made of polyurethane (not latex) that lines the vagina. It has a semi-stiff plastic ring at each end. The inner ring is used to insert the device inside the vagina and hold it in place. The outer ring partly covers the labia area and holds the condom open. The female condom is market in the United States by Wisconson Pharmaceuticals under the name Reality. In the United Kingdom and Canada it is marketed under the name Femidom. Market acceptance testing has been going on for over a year, and on August 15, 1994, Wisconson Pharmaceuticals began widespread marketing of Reality.

In theory, the polyurethane construction of the female condom makes it viable to use with oil-based lubricants, and Wisconson Pharmaceutical's hotline states that this is safe. The female condom is also the best viable alternative available for those people who are allergic to latex. The female condom should notbe used for anal sex-- the anus has no upper end and the outer ring is not enough to prevent it from being pushed into the anus and become lost.

Inserting the female condom.

[IMAGE]

The female condom can be inserted up to 8 hours before sex. However, most women prefer to insert it between 2 and 20 minutes prior to sexual intercourse. The condom should be removed immediately after sex.

Squeeze the inner ring with your thumb and middle finger, placing your index finger down upon the plastic inside the inner ring. Still squeezing, spread the labia apart. With your hand positioned with your palm towards you, insert the female condom into the vagina. Push the inner ring and pouch the rest of the way into the vagina until the inner ring is up past the pubic bone. The outside ring should now lie against the vulva, covering the opening of the vagina.

The female condom after insertion

[IMAGE]

During intercourse, the female condom may move or shift. It should not be pushed into the vagina, and the outer ring is intended to prevent this. However, it may happen. If so, stop intercourse, fix the ring, and apply more lubricant to the penis or in the pouch.

After intercourse, the female condom should be disposed of in a trashcan. Do not flush the female condom in the toilet.

Effectiveness

The pregnancy rate for the female condom under normal use is expected to be comparable to that of the male condom (13%). However, because of a lack of familiarity with the device, initial results have been discouraging, with rates as high as double that (26%). The female condom requires the use of an external, water-soluble lubricant. A package of Reality, the brand available in the United States, comes with three female condoms and a small bottle of lubricant (1/2 oz). The lubricant is comparable in quality to Astroglide.

The female condom requires practice to use properly. Be prepared to take your time inserting it the first time. Those who have experience using a diaphragm will find the process familiar.

The female condom has not been tested in its efficiency to prevent disease. It is expected to be as effective as a male condom. However, the insertion process calls for two steps: inserting the ring, where the hand is outside the pouch and in contact with vaginal fluids, and then fitting the ring, where the fingers are inside the pouch, thus spreading those fluids about the pouch where the penis will go. While there are solutions to this problem (have each partner do one of these steps, wear gloves for half the process, or wash hands before the fitting stage), none of them are adequate for most people. The female condom should not be considered a viable protection for STDs in cases where the woman is suspected to have a mucosal infection such as herpes or HPV.

In the United States, Reality has been available primarily through Planned Parenthood. Wisconson Pharmaceuticals has started shipping to drug stores and it should be available throughout the U.S. in the last quarter of 1994. Reality is somewhat pricey-- three condoms and a small bottle of lubricant cost approximately $7.00 US.

Personal observations.

My wife and I were part of a marketing test group for Reality. It's expensive, difficult to learn how to use, and not very effective at preventing STDs without extraordinary measures. However, I happen to like it. Without enough lubricant, it will stick to the skin of the penis and act just as a male condom. With enough lubricant it feels much better than a male condom-- the penis responds mostly to friction, and that's what Reality supplies. A friend of mine who is allergic to latex thinks they're a gift from heaven. Some gay men have tried using Reality for anal sex, with mixed but generally positive results. Wisconson Pharmaceutical has announced, rather loudly, that they have no intention of making the modification necessary to make Reality truly viable for anal sex.

Reality comes with an instruction booklet. The booklet is hilarious, mostly because of the name of the product. For example:

If you have the opportunity to purchase and try Reality, do so at least once. Get three condoms and a bottle of lubricant and try them out. Any new reproductive technology is worthwhile, and who knows-- you might like them.


Condoms

This is a posting of information about types of condoms which are significantly larger or smaller than average. I got it out of a book called "The Condom Book" or something similarly imaginative.

One thing that was apparent from reading through the descriptions was that advertising on size (or for that matter thickness or ribbing or whatever) is often misleading. A brand which is claimed to be smaller than average frequently isn't outside the normal variation. There may also be differences in size based on variations in manufacturing and these figures were probably based on single samples. Different size measurements for different styles of the same brand may indicate such variations or be an attempt to provide some size variation, in which case getting the precise style named is important. All measurements are flat and don't take into account elasticity, which might influence comfort when worn. Typical condom flat widths range from 2" to 2-1/8" (meaning two and one eighth, not two minus an eight). All the condoms listed here are both lubricated and reservoir ended. Company names are listed in parentheses. Extra words which may appear in the name on some packages are listed in square brackets. It is possible I've copied some numbers wrong (and other disclaimer noises).

SLIMMER CONDOMS

Mentor (Mentor):                        2" by 8", not smaller,
                                        but has adhesive inside

Bikini (Barnetts):                      slightly less than 2" by
                                        7-1/4", packaged in that
                                        frustrating plastic
                                        wrapper

[Sheik] Fetherlite (Schmid):            1-7/8" by 7-1/2"

Hugger (Circle):                        1-7/8" by 7-1/8"

Slims (Circle):                         1-7/8" by 7-3/4"
                                        to prevent slippage,
                                        rather expensive though

WIDER CONDOMS

Excita (Schmid):                        2-1/4" by 8-1/4", Excita
                                        Extra has spermicide

[Lifestyle] [Horizon] Nuda (Ansel):     2-5/8" head, 2-1/8"
                                        shaft, by 8-1/8"

[Ramses] NuForm (Schmid):               2-1/2" upper, 2+" lower,
                                        by 8-1/4, has benzocaine
                                        anaesthetic

Rough Rider (Ansel):                    2-1/2" by 8" thick but
                                        doesn't block sensations,
                                        raised studs

Sheik Ribbed (Schmid):                  2-1/4", forgot to note
                                        length

(Note wide variation in Sheik. Elite with spermicide and
Lubricated (with benzocaine?) are both 2-1/8". Fetherlite is
1-7/8".)

Trojan-Enz Lubricated (Carter-Wallace): 2-1/4" by 8"

LONGER CONDOMS

Man-form Lubricated (Protex):           2" by 8-3/4" long
                                        packaged in that
                                        frustrating plastic
                                        wrapper

[Trojan] Naturalube (Carter-Wallace):   2" by 8-5/8"

Elf Sternberg <elf@halcyon.com>

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