The Alpha Center of Sioux City: Contraception

Contraceptive Considerations

Below is some basic information about the most commonly used methods of birth control, with considerations for teens, single adults, and married couples. This is intended as an overview, not medical advice or an endorsement of any particular method. Only abstinence is 100% effective in preventing pregnancy. If you are interested in discussing your sexual and contraceptive decisions with someone, please contact our center for an appointment with a knowledgeable counselor. If you have technical questions about birth control drugs or side-effects, you are advised to consult your physician or pharmacist. The Alpha Center encourages you consult your pastor, priest, or rabbi for moral questions about reproductive decisions.

Condoms

About Condoms: Condoms--made of latex, polyurethane, or natural skin--are used by the male partner to prevent pregnancy by acting as a barrier against sperm. Among couples with average fertility, condoms have about a 14% failure rate annually. On a per usage basis, 2-6% break or fall off during intercourse. Latex and polyurethane condoms are popular because they are inexpensive, help prevent some STDs, and can be found in drug stores and vending machines.

Considerations for Teens: Condoms are far less effective when used by teens. One study reported a failure rate of 18% when used by people under the age of 18. And although condoms will help reduce your risk of contracting diseases like HIV, condoms can break, leak, or slip, which means you are still at risk if your partner is infected. One study found that among sexually active teen girls, 30% contracted an STD over a six month period, even when condoms were used consistently. Condoms are not effective in preventing all STDs.

Considerations for Single Adults: Among fertile couples, only abstinence is 100% effective in preventing pregnancy. And if you or your partner had sexual contact with any one else, he or she could be infected with an STD without knowing it, putting you at risk. Although condoms will help reduce the risk of both pregnancy and many STDs, there is still a significant risk because condoms can and do break, and couples do not always use them properly. Condoms are not effective in preventing all STDs.

Considerations for Married Couples: Compared to hormonal methods, condoms pose few health risks, and they are relatively easy to use. But keep in mind that with a 14% annual failure rate, the odds are that after using condoms continuously for several years, you will eventually experience a surprise pregnancy. Talk to your mate about this possibility ahead of time. If you choose condoms, have a plan for what to do when a condom breaks.

Spermicide WARNING!

Spermicides containing nonoxynol-9 were once thought to help prevent HIV infection, but newer studies show an increased risk because the chemical can irritate the vagina, facilitating infection. Consequently, spermicides are no longer being recommended for HIV prevention. (more)

Barrier Methods for Women

About Barrier Methods for Women: These include the diaphragm, cervical cap, female condom, and contraceptive sponge (not available in the US). These methods are used by women and work by acting as a barrier to sperm. The diaphragm and cervical cap are used with spermicide; contraceptive sponge comes with spermicide already applied. These methods have variable failure rates averaging 21-26% per year, and as high as 40% for women who have had children.

Considerations for Teens: These may not be good methods for teens. All these are more difficult to use correctly than condoms as proper placement is essential. Both the cap and diaphragm require a visit to the doctor for fitting. Teens are more fertile than older adults, which also increases the failure rate of these methods among this age group. Teen and young adult use of the diaphragm indicates a failure rate of 32% per year. The diaphragm, cervical cap, and contraceptive sponge offer only modest protection from STDs.

Considerations for Single Adults: The diaphragm, cervical cap, and contraceptive sponge offer only modest protection from STDs. In fact, the spermicide used with these methods has been shown to possibly facilitate HIV infection (see warning above).

Considerations for Married Couples: These methods are most effective when used by couples who have sex less frequently and are committed to using them properly. Due to compromised reliability, neither the cap nor sponge should be used if you have given birth. Keep in mind that with a 21-26% annual failure rate, the odds are that after using any of these methods continuously for several years, you will eventually experience a surprise pregnancy. Talk to your mate about this possibility ahead of time.

Hormonal Methods

About Hormonal Methods: These include combined oral contraceptives (the Pill), progestin-only pills (the mini-pill or POPs), Depo-Provera (the Shot), Norplant, and Emergency Contraceptive Pills (ECP or Morning-After Pills). These methods involve hormones which change the way a woman's reproductive system works. These methods primarily work by preventing ovulation and thinning the lining of the uterus to prevent implantation should fertilization occur (see box below). Typical failure rates for these methods range from 1-13% per year.

Considerations for Teens: Oral contraceptives and Depo-Provera are popular methods for teens due to their ease of use. However, all hormonal methods have many possible side-effects, such as weight gain and skin problems. Some side effects can be quite serious, such as prolonged bleeding with Depo-Provera, which is why you should always let your health care providers (and parents) know if you are using any of these methods. All hormonal methods, especially Depo-Provera, are associated with loss in bone density for teens. Additionally none of these methods offers any protection from STDs like the AIDS virus.

Considerations for Single Adults: All hormonal methods typically have some unpleasant side-effects, such as weight gain, depression, and loss of sex drive. Older women who smoke should not use combined oral contraceptives. These methods offer no protection from STDs. Although these are some of the more effective methods of pregnancy prevention, many women do get pregnant despite proper use. Others get pregnant when they forget a pill or take antibiotics (which can compromise the effectiveness of the Pill). Hormonal methods offer no protection from STDs.

Considerations for Married Couples: After discontinuing combined OCs or Depo-Provera, it may take several months to over a year for normal fertility to return. Keep in mind that with a 1-13% annual failure rate, the odds are that after using many of these methods continuously for several years, you may eventually experience a surprise pregnancy. Talk to your mate about this possibility ahead of time.

So how do hormonal contraceptives prevent pregnancy?

Think "oral contraceptives" prevent conception? Think again. Hormonal methods suppress ovulation much of the time, but scientists recognize that in many cases ovulation continues to occur. Some women who use hormonal methods ovulate every single cycle. So how do hormonal methods prevent conception? That depends on how you define "conception." Although most people think of conception as the joining of egg and sperm to form new life, in some circles the word "conception" has an alternate meaning--the implantation of the embryo into the uterus.[1] When fertilization is not prevented, hormonal birth control methods commonly cause the expulsion of an embryo prior to implantation by changing the lining of the uterus so that it will not accept an embryo and by changing the way the fertilized ovum travels down the fallopian tube.[2] This action has been termed by some as 'interceptive,' as opposed to contraceptive or abortive.[3] This is an important distinction, because any woman interested in preventing fertilization will want to avoid using these methods. Although there are legitimate medical uses for some of these drugs, clinicians tend not to explain the interceptive effects to their patients, some being unaware themselves. Pharmaceutical companies minimize this mechanism of hormonal methods to prevent women of conscience from rejecting their products, as had occurred with the IUD.[4]

1. The FDA and the American College of Obstetrics and Gynecology now define 'conception' to mean implantation instead of fertilization. Under this definition, all hormonal methods and IUDs would be contraceptive. JC Willke, Abortion: Questions and Answers, Revised 1990 Ed., Hayes Publishing Company Inc., Cincinnati, OH, 1990, p. 42-43.
2. RA Hatcher et al, Contraceptive Technology, 17th Ed., Ardent Media Inc., New York, 1998, p. 406, 468-9, Table 20-1.
3. RG Rahwan, "Pharmacological Approaches to Birth Control: Contraceptives, Interceptives, Abortifacients." U. S. Pharmacist, 1977, 10: 31-42. Course notes revisited 1995.
4. R Alcorn, see Section 10. "What do the Pill manufacturers say?" in "Does the birth control pill cause abortions?" 2nd ed., Eternal Perspective Ministries, Gresham, OR, 1998. Go there.

Source: Epigee Birth Control Guide, Hormonal Methods.

Natural Methods

About Natural Methods: These are methods which require no drugs or chemicals, therefore they tend to be free from side-effects. Most methods work by determining when a woman is fertile and then avoiding sex at that time (periodic abstinence). This may be accomplished through charting the woman's temperature and/or observing body signals (requires training), or through use of a fertility computer (which can be expensive). These methods have failure rates averaging 13-20% per year.

Considerations for Teens: The most popular natural method for teens is withdrawal (also called the "pull-out" method), which has a failure rate of about 21% for this age group. Effective use of this method requires self-control and practice, which teens are generally lacking, making this a poor choice. This method offers little protection from STDs like the AIDS virus.

Considerations for Single Adults: Natural methods tend to be most rewarding when both partners are involved, as they require the participation of both during the fertile period. This may be difficult if neither partner has made a long term commitment to the relationship. Like every other method of birth control, pregnancy is possible, especially if the method is not adhered to strictly. Natural methods offer no protection from STDs.

Considerations for Married Couples: Many couples appreciate a safe, natural, and mutual method of birth control. Natural methods are most effective when followed strictly. Keep in mind that with a 13-20% annual failure rate, the odds are that after using this method continuously for several years, you will eventually experience a surprise pregnancy. Talk to your mate about this possibility ahead of time.

Abstinence

About Abstinence: Abstinence means refraining from any type of sexual activity. This is the best way to prevent pregnancy and STD.

Considerations for Teens: Abstinence is the best method for teens. It is the only sure way to avoid pregnancy or sexually transmitted disease. Additionally, early sexual activity and having multiple sex partners is strongly linked to cervical cancer in women. Don't be fooled: oral sex, anal sex, and other similar activities do not count as abstinence. Some of these can still cause pregnancy and STD, and most eventually lead to plain old sexual intercourse.

Considerations for Single Adults: Considering the risk of pregnancy and death from STDs such as AIDS, refraining from sex is a sensible and popular alternative to sexual activity. More unplanned pregnancies and abortions occur among young adults than teens. Half of all women who begin having sex become pregnant within six months. Deciding to abstain is a positive though difficult choice, with many benefits.

Considerations for Married Couples: There are many times when abstinence within a marriage is necessary, such as after childbirth or surgery, or during natural family planning. Being able to spend some time not having sex can be a valuable experience for both partners, as it gives couples time to explore other aspects of their relationship. Prolonged abstinence, however, is not recommended.

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