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Birth Control Methods

Abstinence
Abstinence means that you do not engage in any sexual activity at all. “Outercourse” is a term that describes a method of abstaining from vaginal intercourse only, permitting other types of sex play.

Effectiveness:
As a method of birth control, abstinence is 100% effective in preventing pregnancy. Outercourse is over 99% effective.

Advantages to Abstinence:
• No medications or devices required.
• Prevents sexually transmitted diseases.
• 100% effective in preventing pregnancy.
Disadvantages to Abstinence:
Continuous abstinence for long periods of time can be difficult for many people to maintain.

Advantages to Outercourse:
• No medications or devices required.
• Allows other types of sex play while decreasing the risk of pregnancy and STDs.

Disadvantages to Outercourse:
• It may be difficult for many people to abstain from vaginal intercourse for long periods.
• Exposure to the temptation to “go all the way.”

If you are considering Abstinence/Outercourse:
• Remember to have methods and resources available to protect yourself

against pregnancy or sexually transmitted diseases in case you stop practicing abstinence/outercourse.

• Talk with your partner about the boundaries you have established and how to maintain them.

The Cervical Cap, available commercially since 1988, is a latex barrier method of birth control. It is a thimble-shaped cup, which fits inside the vagina over the cervix. It adheres to the cervix by suction. Spermicide is placed inside the cup before it is placed over the cervix. The cervical cap may be inserted even hours before intercourse.

Effectiveness: For women who have never had a vaginal birth, the cervical cap is 82-92% effective. For women who have had a vaginal delivery, the cervical cap is 60-74% effective.

Advantages:
• It can remain in place up to 48 hours at a time before it needs to be removed.
• There are no hormonal side effects.
• Sex may be more spontaneous than when using a diaphragm or condom.
• Only one initial application of spermicide is needed, even if intercourse is repeated.

Disadvantages:
• It is not a good method for women who have cervical abnormalities.
• It may be difficult to insert and/or remove.
• It may possibly cause cervical irritation.
• It does not prevent transmission of sexually transmitted diseases.
For more information:
Cervical Cap Ltd. is the distributor of the cervical cap in the United States. More information can be found on their website: www.cervcap.com

A condom is a thin sheath, which provides a physical barrier to sperm during intercourse. Male condoms are made out of latex, polyurethane, or lambskin and fit over the erect penis. Female condoms are made out of polyurethane and fit inside the vagina and over its outside lips (labia).

Male Condoms:
Latex Condoms: Latex condoms are the most common type of condoms and are available in many stores and clinics. There are many different brands, sizes, and styles of latex condoms available from ultra thin to textured to extra large. Latex condoms can be purchased with or without spermicide or lubricant.

• Polyurethane Condoms: Polyurethane condoms, made of a thin and flexible soft
plastic material, are an excellent alternative for people who have latex allergies and cannot use latex condoms.
• Lambskin Condoms: Natural lambskin condoms are made out of lamb caecum (lamb intestines). Although they are just as effective in preventing pregnancy as latex condoms, they do not provide protection against HIV.

Female Condoms:
The Reality® Female Condom is a sheath made of polyurethane with a ring at both ends. The female condom is more expensive than the male condom, but it can be inserted up to 8 hours before intercourse. It also provides protection against sexually transmitted diseases. The Reality Female Condom is manufactured by The Female Health Company and more information can be found on their website: www.femalehealth.com

Effectiveness of Condoms: Condoms are 88-98% effective. If used consistently and properly every time, the risk of pregnancy is very small.

Benefits of Condoms:
• Condoms provide protection against pregnancy and sexually transmitted diseases (like gonorrhea, chlamydia, and HIV).
• Since condoms are available without a prescription, they are good for people who need protection right away.
• There are no medicine side effects, and no interference with a woman’s hormonal cycle.

Disadvantages of Condoms:
• Condoms must be used every time throughout intercourse.
• Women are at risk for pregnancy and infection if the condom is placed on the penis after the first penetration, even if the condom is used before ejaculation.
• Condoms can break, tear, or fall off during sex.

Tips for successful condom use:
• Involve your partner in the decision to use condoms. Make a commitment together to use condoms every time.
• Always put the condom on the penis before any genital-to-genital contact. The fluid in the tip of the penis contains sperm and may also carry infection.
• Use enough water-based lubricant to decrease risk of tearing. Live by the motto: “You can never have enough lube.” Even when your own lubrication seems like enough, the condom may cause drying more quickly than usual.
• Use a vaginal spermicide while using condoms to increase protection against
pregnancy.
• After intercourse, check the condom for any leaks before throwing it away.
• Remember that emergency contraception is available if the condom breaks, tears,
or falls off.
• Do not reuse condoms.
• Before you stop using condoms in a relationship, make sure that you have another birth control method, and both you and your partner get tested for sexually transmitted diseases.

Purchasing Condoms:
Condoms are readily available in drug stores, grocery stores and convenience stores. Many public bathrooms have vending machines. Condoms can also be ordered via the Internet. An excellent source is the Rubber Tree, a non-profit organization that has a wide selection of condoms, lubricant, and spermicide at very affordable prices. Their website is: www.rubbertree.org

Depo-Provera is an injectable, long acting, hormonal contraceptive. Depo-Provera is a form of the hormone progesterone. There is no estrogen in Depo-Provera, unlike most birth control pills which contain both estrogen and progesterone. It is, therefore, medically safer for some women than birth control pills. It is often referred to as “depo” or “the shot.”

Effectiveness:
Depo-Provera is over 99% effective when given every 12 weeks.

How Depo-Provera Works:
Depo-Provera prevents ovulation (the release of an egg from a woman’s ovaries). Without an egg to be fertilized, pregnancy cannot occur.

How and When Depo-Provera is Given:
Depo-Provera is given by injection once every 12 weeks. The first injection is often given within five days of the onset of a normal period. A back-up birth control method must be used for two weeks after the first injection.

Advantages:
Excellent protection from pregnancy (almost 100% effective) and convenience (freedom from remembering to take a pill every day, and no interruption of sexual activity to use a barrier method) are the two biggest advantages of Depo-Provera. Since women often stop menstruating while using Depo-Provera, it improves or stops PMS and prevents light spotting outside of period time. It reduces the risk of ovarian cancer, and uterine cancer, and it does not appear to affect the breast cancer risk at all.

Risks & Side Effects:
The primary side effect is irregular bleeding. Initially, many women will experience irregular bleeding or spotting. This may last for 3-6 months, after which periods often stop altogether. Other side effects include weight loss or weight gain, mood changes, and occasional heavy periods. Rare, but possible, side effects include breast discharge, increased acne, decreased sex drive, marked weight loss or gain, or depression.

Depo-Provera does not offer protection against sexually transmitted diseases.

There is no risk to future fertility with Depo-Provera. Pregnancy can occur immediately after discontinuing Depo-Provera even if normal periods have not returned. Most women will resume regular periods within 6 months, although some women will not have normal menstrual cycles for 24 months.

Contraindications:
Women should not use Depo-Provera if they have a suspected or confirmed pregnancy, undiagnosed vaginal bleeding, a history of diabetes or vascular problems, abnormal liver function, or malignancy of the reproductive tract.

Recommendations:
Since the years between the ages of 18-25 are critical for bone density formation, and there is growing scientific evidence that Depo-Provera may slow that process, we recommend a daily calcium supplement of three (3) Tums® or Rolaids®.

If you have additional questions about Depo-Provera as a birth control method, call the office Monday-Friday, 9:00am-5:00pm or visit the following website: www.depo-provera.com

Diaphragm
The diaphragm is a rounded, disc-shaped barrier method of birth control made out of soft rubber latex. It is placed inside the vagina behind the pubic bone and over the cervix. Spermicidal jelly is placed in the diaphragm and it must be inserted before intercourse begins. Additional vaginal spermicide (either jelly or cream) must be used if intercourse is repeated. The diaphragm must be left in place for six hours following the last act of intercourse before being removed.

Effectiveness:
Diaphragms are 82-94% effective.

Advantages:
• No hormonal side effects.
• May be inserted up to six hours before intercourse.
• Does not affect sensation during intercourse when properly sized.

Disadvantages:
• May increase the occurrence of urinary tract infections.
• Does not prevent transmission of sexually transmitted diseases.
• Needs to be re-fitted if you gain or lose 10 pounds or more.

For more information:
Diaphragms need to be fitted by a health care practitioner. If you are interested in using a diaphragm, contact your provider.

Fertility Awareness Method
The Fertility Awareness Method (FAM) is a natural method of contraception, which determines when a woman is most fertile by using cyclic indicators during her menstrual cycle. The time of highest fertility is determined by daily monitoring of three factors:
• Waking basal body temperature.
• Cervical mucous.
• Cervical position.

This information is recorded on monthly charts and women can either abstain from intercourse or use a barrier method of contraception during their fertile period to avoid pregnancy.

Effectiveness:
If used perfectly, fertility awareness method is 99% effective in preventing pregnancy. However, due to user error, FAM is typically 89-94% effective. Marking menstrual cycles only is not effective FAM.

Advantages:
• Non-hormonal.
• Non-allergenic.
• It is consistent with the more strict religious beliefs.

Disadvantages:
• It is time-consuming to learn.
• It requires a daily commitment to measuring and charting.
• It is not a good method for women who are not comfortable with finding
their own cervix with their fingers.
• There is an increased risk of pregnancy if charting is irregular.
• It does not protect against sexually transmitted diseases.
• Erratic sleep and/or travel schedules may alter charting and confuse cycles.

For more information go to www.tcoyf.com

Intrauterine Device (IUD)
IUDs are birth control methods that are placed inside the uterus. Both IUDs available in the United States are shaped like a “T” and made out of plastic. IUDs must be inserted by a health practitioner. IUDs prevents pregnancy by preventing fertilization. An IUD will effectively prevent pregnancy as soon as it is placed in the uterus.

Women can use the IUD if they:
• Have a normal uterus
• Do not have any genital tract infections or STDs now or within the past 3 months.
• Are a low risk for STDs (in a steady, faithful relationship with one partner who has no infection and no other partners).

What is it like to have an IUD inserted?
It takes only about 5-10 minutes to actually insert the device. Your clinician will perform a pelvic exam to measure the size, shape, and position of your uterus. A cleaning solution is applied to the cervix and the IUD is placed inside using a special inserter. The woman may feel some cramping at the time of the insertion, however, it is usually mild to moderate and goes away soon. After the device is placed, the string on the end is cut short enough so it does not bother your partner.
Most women have little discomfort wearing the IUD, however it may take some time for your body to adjust. Using an over-the-counter drug such as ibuprofen or naproxen, is usually enough to relieve any discomfort.

Side-effects:
• A slightly higher risk of infection exists during the first 3 weeks after the IUD is placed.
Call the clinic if you have fever or chills with pelvic pain or tenderness after insertion.
• Perforation of the uterus is rare but possible during insertion.
• Increased cramping and bleeding with periods is common in the first few cycles
after insertion. Call the clinic if you have unusual vaginal bleeding with IUD in place.
• It is possible, although rare, that the IUD can fall out of the uterus. Call the clinic if you or your partner can feel the plastic part of the device. Use latex condoms for back-up until your device is checked.

Mirena®:
Commonly called “Mirena”®, this is a contraceptive device that is placed into the uterus. It is approved by the US Food and Drug Administration. It is quite small (about 1 1/4” tall and wide), made of plastic, and shaped like the letter “T”. Inside, it contains a synthetic female hormone, levonorgestrel, which is released slowly into the uterus (womb), helping to prevent pregnancy. This hormone acts like the natural hormone progesterone and is often used in implants and oral contraceptive pills.

The levonorgestrel IUD has been available in Europe for more than 10 years. It is available in more than 50 other countries. Almost 2 million women have used this intrauterine contraceptive. It is a plastic T about one inche tall. For a more information about the Mirena go to: http://www.mirena-us.com/faq.html

How does the Levonorgestrel IUD work?
Scientists believe that the intrauterine contraceptives work in many ways, all of which are not fully understood. It works mainly by:
• interfering with the normal development of the egg
• interfering with the ability of the sperm to fertilize the egg
• preventing the woman from releasing an egg from the ovary
• making cervical mucus a thicker barrier for sperm to go through
It is a true contraceptive. It prevents pregnancy from occurring.

Advantages:
• It is safe, effective, easy to use, and less expensive over time than most forms of contraception.
• You don’t need to remember to use it; it’s always working.
• It decreases menstrual flow and cramping
• It provides long-term effective birth control for 7 years.
• It can be taken out at any time.

Side-effects to the Levonorgestrel IUD:
• All of the side-effects listed above for IUDs in general.
• Severe cramping
• Unusual vaginal bleeding

Paragard®
Sometimes called the “Copper T”, the ParaGard T380® contraceptive device is placed into the uterus. It is approved by the US Food and Drug Administration and has been used as a birth control method both in the US and around the world for many years. It is quite small (about 1 1/2″ tall and wide), made of plastic with copper wrap, and shaped like the letter “T”. Millions of women have used this intrauterine contraceptive safely and effectively.

How does the Copper IUD work?
Scientists believe that the intrauterine contraceptives work in many ways, not all of which are fully understood. It works mainly by:
• interfering with the ability of the sperm to fertilize the egg
• possibly killing sperm cells
• interfering with the ability of the fertilized egg to implant in the uterus

Advantages of the ParaGard IUD:
• It is safe, effective, easy to use, and less expensive over time than most forms of contraception.
• It provides long-term effective birth control for 12 years.
• You don’t need to remember to use it; it’s always working.
• Can be taken out at any time.
• No side effects as with hormonal methods of birth control.

Disadvantages of the ParaGard IUD:
• Can increase cramps and bleeding during your period.
• Can be uncomfortable when it is being inserted into your uterus.
• Can increase your risk for uterine infections.
• Cannot be used if you are allergic to copper.

The Ring (NuvaRing™) is birth control that delivers the female sex hormones estrogen and progestin through a medicated ring placed in the vagina. The ring is placed in the vagina and left there for three weeks. At the beginning of the fourth week, the woman removes the ring and usually has a menstrual period during this time.

How the Ring Works: The Ring works by preventing ovulation (the release of an egg from a woman’s ovaries). Without an egg, fertilization and pregnancy cannot occur.

Effectiveness: When used exactly as directed, the Ring is 97-99% effective.

Advantages of the Ring:
• Excellent protection from pregnancy and no interruption of sexual activity.
• Lighter, shorter, less painful periods and less premenstrual tension (PMS).
• Protection from anemia, pelvic infections, and ovarian and uterine cancer.
• You only need to think about it once a week.

Risks: Using the Ring may increase your risk of complications such as heart attack, stroke, high blood pressure, and migraine headaches. The risk of complications increases if you are a smoker and over 35. At any time, your risk of any of these complications is 1/6th the risk of complications with pregnancy. The Ring does not offer protection against sexually transmitted diseases.

Side effects: Possible side effects include nausea, breast tenderness, weight gain/fluid retention, spotting/bleeding between periods, mood changes, and changes in your sex drive. Side effects, if experienced at all, are most frequent during the first few months and usually disappear as your body gets accustomed to the Ring.

Contraindications: Women who have heart disease, circulatory disease, a clotting disorder, liver disease, or cancer probably should not use the Ring.

If you have or have had a health problem such as migraine headaches, high blood pressure, diabetes, severe depression, sickle cell anemia or trait, are planning surgery in the next four weeks, or are a smoker, inform your physician. Further evaluation may be necessary to decide if it is safe for you to use the Ring.

Instructions for Ring Use: Place the ring in your vagina for 3 weeks, then take it out for one week. This is when you should have a period. One week after you removed the ring, begin again with a new ring. Read the instructions that come with the ring. Ask a staff member if you have any questions.

If You Forget to Remove your Ring: If the Ring was in for less than 6 weeks, you are still protected. Take it out as soon as you remember, and place a new ring immediately. If the ring has been in longer than 6 weeks, you are no longer protected. Remove the ring as soon as you remember and put a new one in immediately. You must use a back-up method of birth control, such as foam and condoms, for the next week to be sure you don’t get pregnant.

If You Miss a Period: Occasionally women skip a period while using the Ring. If you have been using your ring exactly as directed, you are almost certainly not pregnant and should continue using the ring as directed. You may wish to get a pregnancy test two weeks after your period was due to reassure yourself. If you have pregnancy symptoms, do a pregnancy test as soon as possible.

Warning Signs: (ACHE)
Call the clinic immediately if you experience:
• (A) severe abdominal pain.
• (C) severe chest pain.
• (H) severe headaches.
• (E) severe extremities (leg/arm) pain.
• (S) changes in sight.

Any of these symptoms can be an early indication of a complication.

Additional Questions: Questions are always welcome. Feel free to call the clinic about any questions or concerns you may have regarding your birth control method. We are available Monday – Friday, 9:00 am – 5:00 pm.

Oral contraceptive pills are often referred to as “birth control pills” or “the Pill.” The Pill is a prescription drug containing the female sex hormones estrogen and progesterone. It is taken once a day for as long as you wish to prevent pregnancy.
How Pills Work: The Pill works by preventing ovulation (the release of an egg from a woman’s ovaries). Without an egg, fertilization and pregnancy cannot occur.

Effectiveness: When used exactly as directed, the Pill is 97-99% effective.

Advantages of the Pill:
• Excellent protection from pregnancy and no interruption of sexual activity.
• Lighter, shorter, less painful periods and less premenstrual tension (PMS).
• Protection from anemia, pelvic infections, and ovarian and uterine cancer.

Risks & Side Effects: Using the Pill may increase your risk of complications such as heart attack, stroke, high blood pressure, and migraine headaches. The risk of complications increase if you are a smoker and over 35. At any time, your risk of any of these complications is 1/6th the risk of complications with pregnancy. The Pill does not offer protection against sexually transmitted diseases.

Side effects: Possible side effects include nausea, breast tenderness, weight gain/fluid retention, spotting/bleeding between periods, mood changes, and changes in your sex drive. Side effects, if experienced at all, are most frequent during the first few months and usually disappear as your body gets accustomed to the pills.

To decrease side effects: Nausea can sometimes be avoided by taking your pills with a meal or before bed. Spotting/bleeding is less likely to occur if you take your pill at the same time every day. Mood changes can be prevented by supplementing your diet with 100 mg of vitamin B6 a day. If the side effects do not disappear or are too bothersome, they are often eliminated by changing to another kind of pill.

Contraindications: Women who have heart disease, circulatory disease, a clotting disorder, liver disease, or cancer probably should not take the Pill.
If you have or have had a health problem such as migraine headaches, high blood pressure, diabetes, severe depression, sickle cell anemia or trait, are planning surgery in the next four weeks, or are a smoker, inform your physician. Further evaluation may be necessary to decide if it is safe for you to take the Pill.

Instructions for Oral Contraceptive Pill Use: Begin the first package as directed on the package insert or as directed by your physician. Take the first pill whether or not you are still bleeding. From then on, take one pill at the same time every day. This is important since each pill lasts approximately 24 hours.

Have your blood pressure checked at three months, six months, and then yearly. There is no charge for this, just call to arrange an appointment.

If You Forget a Pill:
If you forget one pill: take it as soon as you remember and take your next pill on schedule even if that means you will be taking two pills in one day. You may wish to use a back-up method of birth control, such as foam and condoms, for the next week to be sure you don’t get pregnant.

If you forget two pills in a row: take two pills as soon as you remember and two pills the next day at your usual time. Continue to take the rest of your pills on schedule and use a back-up method of birth control, such as foam and condoms, for the rest of your cycle, since ovulation may have occurred.

If you forget three pills in a row: you are definitely not protected. Begin using a back-up method of birth control immediately. Finish the active pills in that package and then immediately start a new package of pills the following day. Continue to use a back-up method of birth control for at least a week.

If you are finding it very difficult to remember to take your birth control pills, you may wish to consider choosing a different method of contraception.

If You Miss a Period: Occasionally women skip a period while taking the Pill. If you have been taking your pills exactly as directed and have not missed any, you are almost certainly not pregnant and should continue taking your pills. You may wish to get a pregnancy test two weeks after your period was due to reassure yourself. If you miss two periods in a row or have pregnancy symptoms, continue taking your pills and get a pregnancy test as soon as possible.

Warning Signs: (ACHE)
Call the clinic immediately if you experience:
• (A) severe abdominal pain.
• (C) severe chest pain.
• (H) severe headaches.
• (E) severe extremities (leg/arm) pain.
• (S) changes in sight.

Any of these symptoms can be an early indication of a complication.

Additional Questions: Questions are always welcome. Feel free to call the clinic about any questions or concerns you may have regarding your birth control method. We are available Monday – Friday, 9:00 am – 5:00 pm.

The Patch (Ortho Evra™) is birth control that delivers the female sex hormones estrogen and progestin through a medicated patch applied to the skin. The adhesive patch is applied once a week for three weeks. No patch is used the fourth week and the woman usually has a menstrual period during this time.

How the Patch Works: The Patch works by preventing ovulation (the release of an egg from a woman’s ovaries). Without an egg, fertilization and pregnancy cannot occur.

Effectiveness: When used exactly as directed, the Patch is 97-99% effective.

Advantages of the Patch:
• Excellent protection from pregnancy and no interruption of sexual activity.
• Lighter, shorter, less painful periods and less premenstrual tension (PMS).
• Protection from anemia, pelvic infections, and ovarian and uterine cancer.
• You only need to think about it once a week.

Risks: Using the Patch may increase your risk of complications such as heart attack, stroke, high blood pressure, and migraine headaches. The risk of complications increases if you are a smoker and over 35. At any time, your risk of any of these complications is 1/6th the risk of complications with pregnancy. The Patch does not offer protection against sexually transmitted diseases.

Side effects: Possible side effects include nausea, breast tenderness, weight gain/fluid retention, spotting/bleeding between periods, mood changes, and changes in your sex drive. Side effects, if experienced at all, are most frequent during the first few months and usually disappear as your body gets accustomed to the patch.

Contraindications: Women who have heart disease, circulatory disease, a clotting disorder, liver disease, or cancer probably should not use the Patch.

If you have or have had a health problem such as migraine headaches, high blood pressure, diabetes, severe depression, sickle cell anemia or trait, are planning surgery in the next four weeks, or are a smoker, inform your physician. Further evaluation may be necessary to decide if it is safe for you to use the Patch.

Instructions for Patch Use: Place the first patch as directed on the package insert or as directed by your practitioner. Apply 1 patch each week for 3 weeks, then leave the patch off for one week. This is when you should have a period. One week after you took the last patch off, begin again. The patch can be applied on your back, your abdomen or your upper arm.

If You Forget to Change your Patch: change it as soon as you remember. You may wish to use a back-up method of birth control, such as foam and condoms, for the next week to be sure you don’t get pregnant.

If You Miss a Period: Occasionally women skip a period while using the Patch. If you have been using your patch exactly as directed and have not been late in changing your patch, you are almost certainly not pregnant and should continue using the patch as directed. You may wish to get a pregnancy test two weeks after your period was due to reassure yourself. If you were more than two days late in changing your patch during the past month or two, or if you have pregnancy symptoms, leave your patch on and get a pregnancy test as soon as possible.

Warning Signs: (ACHES)
Call the clinic immediately if you experience:
• (A) severe abdominal pain.
• (C) severe chest pain.
• (H) severe headaches.
• (E) severe extremities (leg/arm) pain.
• (S) changes in sight.

Any of these symptoms can be an early indication of a complication.

Additional Questions: Questions are always welcome. Feel free to call the clinic about any questions or concerns you may have regarding your birth control method. We are available Monday – Friday, 9:00 am – 5:00 pm.

Spermicide
Spermicide is a chemical that kills sperm. It is offered in various forms. The spermicide available in the United States is nonoxynol-9. Spermicide is placed in the vagina before sexual intercourse. Many spermicides require that it be placed at least 15 minutes, but no more than an hour, before intercourse. Spermicide is best used along with other birth control methods, like condoms, to increase their effectiveness.

Effectiveness:
Depending on how it is used, spermicide is about 74-94% effective in preventing pregnancy.

Advantages:
• Available without prescription.
• No hormonal side effects.
• May provide additional lubrication during intercourse.
• When used together, spermicides increase the effectiveness of other methods.
• May provide some protection against gonorrhea and chlamydia.

Disadvantages:
• Nonoxynol-9 may cause an allergic reaction in some people.
• Does not provide protection against HIV and other sexually transmitted diseases.
Recent studies indicate spermicides may increase risk of HIV and other sexually transmitted diseases, by causing small, microscopic tears in the vaginal lining, if used repeatedly in one day.
• May be difficult to learn how to use spermicide properly.
• May increase risk for vaginal infections (yeast or bacterial vaginosis)

Types of Spermicides:
Vaginal Contraceptive Film (VCF)™: VCF is an approximately 2 inch square, thin, clear, flexible film, which is placed high in the vagina where it dissolves. It has the highest percentage of nonoxynol-9 (28%) of the spermicides available in the U.S.

Suppositories™: Suppositories are almond-shaped tablets that are placed in the vagina and dissolve. Some of the common brands of suppositories are: Encare, Semicid, Conceptrol, and Koromex.

Gel/Jelly: Contraceptive gel or jelly requires an applicator to place a measured amount of spermicide in the vagina. It is usually clear and thick. Some gels/jellies are only indicated for use with diaphragms or cervical caps.

Foam: Contraceptive foam is also placed in the vagina by using an applicator.

Lubrication with Spermicide: Most lubricants do not contain a sufficient percentage of spermicide to significantly increase pregnancy prevention.

Spermicidal Condoms: Spermicidal condoms do not appear to be any more effective in preventing pregnancy than condoms without spermicide. To increase the effectiveness of condoms, use them with a regular spermicide such as film, suppositories, foam or jelly.

Sterilization
Sterilization is permanent birth control for women and men. It requires surgery. The procedure for women is called bilateral tubal ligation. For men, this procedure is called a vasectomy. Sterilization is a good option for people to consider only if they do not want to have any more children.

How sterilization works:
For women: The fallopian tubes are cut and tied or burned. This prevents sperm from being able to reach the eggs, so pregnancy cannot occur. Women still have normal cycles.
For Men: The vas deferens are cut and burned. This prevents ejaculation of sperm. Instead, the sperm gets reabsorbed into the body. Men will still ejaculate semen.

Effectiveness:
Both methods are over 99% effective in preventing pregnancy, although vasectomy is slightly more effective than bilateral tubal ligation.

Advantages once the surgery is performed:
• No medicines or devices required.
• No hormonal side affects.
• Safe and effective permanent birth control.
• Convenient.

Disadvantages:
• Reversals are expensive, difficult and unreliable.
• Initial cost is high.
• Does not protect against sexually transmitted diseases.

Withdrawal
Withdrawal, also referred to as coitus interruptus (or affectionately as “pull and pray”), requires that vaginal intercourse is discontinued prior to orgasm and the male ejaculates outside of the vagina and away from external genitalia. Due to the high failure rate and that sperm may be present in pre-ejaculation fluid, withdrawal is not recommended as a birth control method unless no other method is available.

Effectiveness:
Withdrawal is about 80% effective if used correctly.

Advantages:
• No medications or devices required.
• No cost.
• It is always available.

Disadvantages:
• High failure rate.
• Success is dependent on the ability of the male partner to anticipate ejaculation.
• Does not protect against sexually transmitted diseases.
• Inconsistent or incorrect use increases risk of pregnancy.

Instructions for Increasing the Effectiveness of the Withdrawal Technique:
• Prior to intercourse, the man should urinate, then wipe any fluid from the tip of the penis.
• Prior to orgasm, withdraw the penis from the vagina.
• Ejaculate well away from vaginal genitalia.

Important Points to Remember about Withdrawal:
• Do not use withdrawal as a birth control method unless no other method is available.
• Use emergency contraception (post-coital contraception) as a back-up method if ejaculation occurs in or around the vagina.

• The risk of pregnancy increases if the man cannot withdraw before ejaculation and with repeated acts of intercourse.

• Pre-ejaculate fluid may contains sperm.
• Withdrawal does not protect against sexually transmitted diseases.