Barrier Methods

Condoms

Use - There are multiple kinds of condoms - male condoms, female condoms, lubricated or unlubricated, with or without spermicide, large and small, ribbed for her pleasure, and so on. The three main materials for condoms - latex, polyeurethane and lambskin - all help prevent pregnancy. However lambskin DOES NOT protect against sexually transmissable infections (STI).

Specific directions for using condoms are included with the package. Read them carefully and follow them. One extra hint they don't tell you is to put a drop of lubrication in the tip of the condom before you roll it on. This eases application, decreases the risk of air pockets that can cause condoms to break, and feels more pleasurable to many men.

Effectiveness - Used correctly, male condoms offer up to 98% effectiveness against pregnancy. With typical use, male condoms are about 85% effective against pregnancy. The female condom is about 95% effective at prevening pregnancy when used correctly, and about 79% effective with typical use. They also offer a reduced risk of some STIs such as chlaymida, gonorrhea and HIV; others (like herpes, HPV and syphillis) can still be transmitted even if a condom is used correctly.

Side Effects - There are no long term side effects with condom use. If you are allergic to latex, use polyeurethane condoms instead. If you are sensitive or allergic to the lubricants used with many condoms, use an unlubricated condom and add your own lubricant to it (some lubricants such as Just Like Me by pureromance.com or Pink or Sliquid, available at condomania.com have been formulated to reduce the risk of irritation).

Cost - Condoms can cost from 50 cents to $4 a piece, depending on what kind you get. You can get them free lots of places, or for 10 cents at the health center. You can have condoms delivered to your door by ordering them online at condomamia or rubbermania, among other places.

Diaphragm

Use - You need to get a diaphragm that fits you. Your gynecologist will measure your cervix and order one in your size. Then you fill it with spermicide and insert the diaphragm before sexual intercourse. Read the IU Health Center's Diaphragm Information for details.

Effectiveness - 94% effective with perfect use, 82% effective with typical use. Improper fitting, removing it too soon after sex, or deterioration of the diaphragm by oil-based lubricants can hinder effectiveness.

Side Effects - Allergic reaction to latex (plastic ones are available), bladder infection, or vaginal soreness from the pressure of the rim, and, in a few women, Toxic Shock Syndrome. It also doesn't offer any protection against STIs.

Cost - The diaphragm itself will be about $10-$35, and you also pay the cost of the doctor's visit and you buy spermicide to use with it.

Cervical Cap

Use - Like the diaphragm, you must have a cervical cap fitted to your body. Your gynecologist will fit you and order one your size. Once you have it, you insert it, along with spermicide. For details, read the IU Health Center's Cervical Cap Information.

Effectiveness - With perfect use, the cap is 91% effective, and with typical use, it is 82% effective. Removing it too early, erosion by oil-based lubes, and incorrect insertion can inhibit effectiveness. It can also be knocked out of place during intercourse.

Side Effects - Allergic reaction to the latex, infection, and, in some women, TSS. It also doesn't offer any protection against STIs.

Cost - the cervical cap itself costs about $30 and it can last for years. You also pay for the doctor's appointment(s) and the spermicide that you use with it.

Chemical Methods

The Pill

Use - Obtain a prescription from your gynecologist, and take one pill every day (at about the same time of day, if possible).

Effectiveness - With perfect use, 99.9% effective with "combination pill" (estrogen and progestin), and 99.5% effective with minipill (progestin only). With typical use, the pill is about 92% effective.

Side Effects - Irregular bleeding, particularly with missed pills, weight gain, acne, nausea, headaches, mood changes, and gastrointestinal disorders. Side effects often subside after the first few cycles, and they vary greatly from woman to woman. rare but more serious side effects include blood clots, stroke or heart attacks and are increased if you smoke cigarettes. Women who use hormonal methods of birth control (such as the Pill, Patch, Depo Provera or Lunelle) are strongly advised not to smoke. It also doesn't offer any protection against STIs.

Cost - It varies by brand, but you can expect about $10-$35 a month.

The Patch (Ortho-Evra)

Use - Obtain a prescription from your healthcare provider (nurse practitioner or doctor). Wear a patch for a week, then another patch for the 2nd week, then a third patch for the 3rd week and then go "patch-free" the fourth week. The hormones are delivered through the skin and into the bloodstream.

Effectiveness - The Patch is believed to be as effective as the Pill. Like the Pill, it works by preventing ovulation (the release of an egg). It also causes changes to a woman's cervical mucus, making it more difficult for a man's sperm to enter into the uterus.

Side Effects - Potential side effects include "breast symptoms, headache, application site reaction, nausea, upper respiratory infection, menstrual cramps and abdominal pain" according to Othro-Evra's web site. Like the Pill, rare but more serious side effects include blood clots, stroke or heart attacks and are increased if you smoke cigarettes. Women who use hormonal methods of birth control (such as the Pill, Patch, Depo Provera or Lunelle) are strongly advised not to smoke. It also doesn't offer any protection against STIs.

Cost - The price is comparable to the Pill, at around $10-$35 a month.

Depo-Provera

Use - Injection of hormones, typically in the buttocks but sometimes in the arm, every 13 weeks (three months). Shot must be administered by a medically trained person at a medical facility.

Effectiveness - 99.7% effective. Nothing to forget or do wrong, except not get a shot every three months.

Side Effects - Some women gain weight, some have irregular, excessive, or painful menstruation. Other women report having no period at all. Decreased sex drive in some women. It also doesn't offer any protection against STIs.

Cost - From $35-$75 per shot, plus any other expenses for the doctor visit.

Norplant

Use - Small rubber matchstick-size implants which release a slow, steady stream of hormones are placed just below the skin of the arm. When it was available, you needed a prescription and a doctor to implant them. Implants may be left in for up to 5 years and removed at any time.

Effectiveness - 99.01% effective, extremely reliable, and foolproof because there is nothing to forget or do wrong.

Side Effects - Sometimes the implants are slightly visible. Also Norplant was found to be less effective in women who weigh over 155 pounds. It also doesn't offer any protection against STIs.

Cost - was $500-$800, and roughly $150 to have removed, which averages to about $20 a month if left in for all 5 years; currently not available on the market.

Lunelle

Use - A once-a-month hormonal injection. The first injection is given during the first day of menstrual flow, and then again once every 28-30 days/

Effectiveness - +99% effective, very reliable as long as injections are repeated at regular intervals.

Side Effects - In clinical trials of this new drug, users gained an average of 4 pounds. Other side effects include breast tenderness and dizziness. This method of contraception was not available on the market for very long (it is currently unavailable) and its side effects are less well studied than others.

Cost - was about $33 per injection, one injection per month; currently not available on the market.

You can find more information about Lunelle at the KISISS Lunelle Page.

NuvaRing

Use - A prescription from your healthcare provider is required. A woman inserts the NuvaRing in her vagina and leaves it there for three weeks. Then she removes it and goes "ring-free" during the fourth week. This method works by releasing hormones (a combination of estrogen and progestin) into a woman's body and stopping ovulation (the release of an egg) from occurring.

Effectiveness - NuvaRing is thought to be as effectiveness and the Pill when used correctly (about 99% effective).

Side Effects - Potential side effects include vaginal infections and irritation, vaginal discharge (leukorrhea), headache, weight gain and nausea. Like other hormonal methods of birth control, rare but more serious potential risks include blood clots, heart attacks and strokes, high blood pressure and heart disease, breast cancer, liver tumors and gallbladder disease. Women who use hormonal contraceptives are typically strongly advised NOT to smoke. It also doesn't offer any protection against STIs.

Cost - Comparable to the Pill and the Patch, at about $10 - $35 per month.

You can find more information about NuvaRing here.

Behavioral

Abstinence

Use - No sexual intercourse, not even any semen on the vulva. Pretty straightforward.

Effectiveness - Abstinence is the only absolutely certain contraceptive method. You're 100% with this one, as long as you do it right.

Side Effects - Well, you don't get to have sex. For some people that's a burden, for other it's a relief or a welcome respite. The risk of STIs varies depending on what you're doing. If you are having genital contact with a partner (e.g. oral sex, anal sex, rubbing genitals together), then you are still at risk for STIs.

Cost - Free, except for what you spend on alternative methods of play.

Natural Family Planning (NFP)

Use - There are a variety of NFP methods available (temperature method, cervical mucus method, calendar method, cycle beads); some use a combination of these. Planned Parenthood has an excellent description of this delicate process here. It takes practice, but it's one of the few birth control methods condoned by the Catholic Church.

Effectiveness - Done correctly, this method is 97% effective. With typical use, it has been estimated to be about 80% effective at preventing pregnancy.

Side Effects - Relationship stress is possible. This method requires open, honest communication between partners and a strong commitment to follow the schedule. It also doesn't offer any protection against STIs.

Cost - The method itself is free. A NFP thermometer can cost upwards of $100; it offers considerable certainty and can be worth the investment to couples willing to invest the time and effort necessary to use it correctly. You can make an appointment with your healthcare provider or a health educator at IU Health and Wellness (855-7338) for information and/or detailed instructions on using NFP methods.

Withdrawal

Use - The man withdraws the penis from the woman's vagina before he ejaculates, thus mimimizing the amount of sperm launched into the cervix. Because sperm may be present on the head of the penis or in the urethra, it may be transported to the vagina via pre-ejaculate. This method requires excellent ejaculatory control in the male partner, and typically calls for excellent communication skills in the couple.

Effectiveness - Theoretical effectiveness is 94% and typical use effectiveness is 81%.

Side Effects - Planning on this method may leave you unprepared to use another method, and the risks of pregnancy, particularly for inexperienced couples, is relatively high. It also doesn't offer any protection against STIs.