Contraceptive Options

Birth Control Pills | Condoms | Depo-Provera | Emergency Contraception | More Info

Abstinence

Do you love me? If you answer "Yes," does that mean you must have sexual intercourse? Many students at Geneseo--more than you think--answer the second question "No" for a variety of reasons. Despite common perceptions, not everyone is "doing it" at Geneseo. Not everyone is ready or willing to have sex. If you are thinking about having sex for the first time, some factors to consider are described below.

Do You Have a Healthy Relationship?

Are you in a new relationship, or one that has lasted for a long period of time? Even if you are not currently in one, have you thought about what a "healthy and loving" relationship would require? Here are some questions to help you enhance your expectations of such a relationship:

  • Do you and your partner have a mutual understanding of the following terms: romance, intimacy, respect, monogamy, trust, commitment? How do these terms apply to your relationship? Have you talked about these issues with each other recently?
  • Can you be assertive and communicate honestly with your partner, especially about personal issues (such as expectations, past and current sexual history, and various forms of contraception including abstinence)?
  • Are alcohol and/or other drugs used to reduce inhibitions or lessen honest communication about desires, expectations, or emotional support between you and your partner?
  • Do you accept yourself, your strengths and weaknesses, your feelings, and do you tell them to your partner?
  • Do you measure your self-worth by what you believe and do, and not by what your partner measures your?
  • Do you have realistic expectations about the relationship?
  • How do you go about making effective decisions concerning aspects of your relationship?

After personally answering these questions, we encourage you to communicate your responses with your partner. Your personal commitment to communicate is an essential factor in establishing a healthy, loving relationship.

Are You Ready for Sex?

The first step in taking on the responsibilities required in a sexual relationship is making sure you have established and understand your sexual values and beliefs as well as those of your partner. The following questions may help you evaluate whether you are ready for sexual intercourse.

  • Do you feel comfortable with your present level of involvement with your partner?
  • What do you imagine as a possible result of having sexual intercourse with your partner? How will you feel about yourself? How will you feel about your partner?
  • How do you feel about your partner? Do you respect and trust your partner?
  • Can you discuss prevention of pregnancy and sexually transmitted infections (STIs)? Do you feel comfortable taking the responsibility to prevent pregnancy and STIs? Have you discussed what both of you will do if pregnancy occurs?
  • Do you feel pressured to have sexual intercourse?
  • Are you comfortable talking to your partner about your decisions?

Decide yourself what level of sexual intimacy is right for you before getting into a sexual situation. You have control over your sexuality and have the right to do only that for which you feel ready. Even if you have had sex in the past, you can decide to abstain if that is what you want to do now.

Abstinence...A Change of Thought

If you decide on abstinence, it does not mean you must abstain from sexual intimacy. There are many forms of sexual expression other than sexual intercourse. Some people choose not to have sexual intercourse (vaginal, anal or oral) for a variety of reasons. They:

  • prefer to wait for religious or moral reasons
  • want to wait until there is a commitment in the relationship such as marriage
  • do not feel physically or emotionally ready
  • do not want to risk pregnancy
  • do not want to risk getting a sexually transmitted infection
  • do not feel that they have the time or energy to establish a sexual relationship

The advantages of abstaining from sexual intercourse include:

  • no risk of pregnancy
  • decreased risk of STI transmission
  • no expense for contraception
  • opportunity to make a deliberate decision about when, where, and how to express your sexuality

The decision to say "no" is enhanced by a personal commitment and plan for how you will handle a situation in which intercourse is a possibility. An "insurance policy" of always having a back up method of contraception and condoms in case you decide to say "yes, just this once."

Non-penetrative safer sex or abstinence can be fun and intimate. See "101 Ways To Make Love Without Having Sex" (available in the Reproductive Health Center waiting room) for some ideas. Be creative and use your imagination; sex can be pleasurable and safe at the same time. For more information on abstinence, including a discussion of oral sex and masturbation, check out the SmarterSex.org web site.

 

Birth Control Pills

This section reviews use of birth control pills. Wait until you get your period to start taking the pills. Take your first pill the Sunday following the onset of your period. However, if you start your period on a Sunday, take your pill that day. Continue to take one pill a day approximately the same time every day; the evening is the best time. You will have your period while you are taking the last seven pills.

Plan to take the pill about the same time everyday to keep a steady level of hormone in your body. If the pills are taken after a meal or at bedtime, the possibility of nausea lessens for many women. After all the pills are gone in the pack, start taking the next pack regardless of whether your period has stopped or not. If you miss one period, continue taking the pill and call the your provider.

If you forget one pill, take that pill as soon as you remember it. If you forget two pills, take two pills each day for the next two days, complete the rest of the pill cycle, and use another method of birth control (such as foam and condoms) during the rest of the cycle.

You may experience side effects during the first one or two months you are on the pill. They are: occasional spotting, mild nausea, breast tenderness and/or enlargement, and a slight weight gain. These side effects should diminish as your body adjusts to the pill. If such side effects are troublesome for several months, be sure to tell your provider when you pick up your next cycle of pills. Mid-cycle spotting or bleeding ("breakthrough bleeding") sometimes occurs during the first one or two months. If bleeding is heavy and troublesome for more than one day, please call your provider but DON'T STOP TAKING THE PILLS. If you take each day's pill on schedule, you are not risking pregnancy.

If any of the following symptoms occur, please call your presribing provider immediately:

  1. Persistent pain or numbness or weakness in the arms or legs.
  2. Pain in the chest or shortness of breath.
  3. Sudden severe headaches, with or without nausea or vomiting.
  4. Dizziness.
  5. Fainting.
  6. Disturbance of vision or speech.
  7. Severe depression.
  8. Yellowing of the skin or eyes.

If any other medication is prescribed for you, please tell the medical provider that you are taking birth control pills. It has been discovered that some medications can lower the effectiveness of oral contraceptives and that oral contraceptives can lower the effectiveness of some medications. Cigarette smoking while using oral contraceptives is strongly discouraged. The nicotine and estrogen combine to increase the risks of cardiovascular problems such as stroke, heart attack and blood clots.

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Condoms and Spermicides

What are Condoms and Spermicides?

A condom, also called a prophylactic or rubber, is a thin sheath that fit snugly over an erect penis to act as a barrier. The closed end of the condom catches the semen, so that it cannot pass into your partner at the time of ejaculation. There are many types of condoms available: latex rubber, polyurethane, lambskin, lubricated, and spermicidal. Most condoms sold in the U.S. are latex condoms which come in a variety of textures and colors. Latex and polyurethane condoms are the only condoms which prevent transmission of HIV.

A spermicide is a chemical that is inserted into the vagina prior to intercourse to kill sperm and act as a barrier to the cervix. Spermicides are available in the form of foam (most effective), films, creams, jellies, and suppositories.

How Effective are Condoms and Spermicides?

 
Theoretical
Effectiveness*
Actual Effectiveness**
Condom without Spermicide
97%
86%
Condom with Spermicide
94%
74%

*Theoretical effectiveness rates are based on studies that have been done to determine how effective a method itself can be, apart from user behaviors.
**Actual effectiveness rates reflect what happens to the pregnancy rate in a group of people who do not use this method correctly some of the time and who do not use this method every time they have intercourse.

Using latex condoms and a separate vaginal spermicide is more effective in preventing pregnancy than using a spermicidal condom, which does not contain as high a concentration of spermicide as a vaginal foams or film.

How to Use Condoms

 Condoms must be used correctly in order to be effective. Condoms are packaged individually. In order to maintain their effectiveness, they must be protected from heat, so avoid storing condoms in car glove compartments and similar areas.

Putting It On

Before any sexual contact, when the penis is erect:

  • Pinch the condom at the tip and squeeze out any air.
  • Place the rolled-up condom against the end of the erect penis.
  • Unroll the condom to cover the entire penis.
  • If you put it on backwards and it does not unroll easily, don't flip it over; there may be semen on it. Use another condom.

Taking It Off

Right after ejaculation (coming):

  • Hold on tight to the condom at the rim (at the base of the penis) and pull out slowly while the penis is still erect. This will keep the condom from slipping off inside your partner or any semen from being spilled.

Increasing Comfort

Insufficient lubrication can cause discomfort and chafing or condom breakage. Place a small amount of the water-based lubricant (e.g., KY Jelly) on the inside of the condom tip before unrolling it. This can increase sensation for the condom wearer. After unrolling the condom over the erect penis, place some of the water-based lubricant on the outside of the condom.

Extra Protection (for pregnancy prevention)

For vaginal sex, also use an applicator filled with spermicide inside the vagina for extra protection in the event of breakage. If the condom breaks, spermicidal jelly or foam should be inserted immediately into your partner.
Condoms are available in many varieties: colors, flavors, shapes, textures, lubricated, non-lubricated, with or without spermicide--almost any type to meet different needs. You may want to experiment with the type of condom that is most satisfactory to you and your partner.

How to Use Female Condoms

For vaginal sex, another option is to use a female condom to prevent pregnancy, HIV/AIDS and other sexually transmitted infections.  Women can insert the female condom ahead of time which allows for more spontaneity and doesn't require an erection to insert.  To insert the female condom, find a comfortable position.  Try standing with one foot up on a chair or sit with knees apart or squat down.  Ensure the inner ring is at the bottom (closed) end of the pouch.  Hold the pouch with the open end hanging down. While holding the outside of the pouch, squeeze the inner ring between your thumb and middle finger. With your other hand, spread the labia of the vagina open and insert the squeezed end of the condom into opening.  Now push the inner ring and the pouch the rest of the way up past the pubic bone.  Its also important that the outside ring lies against the outer labia.  To remove, squeeze and twist the outer ring to keep the sperm inside the pouch. Gently pull out the pouch and discard in the trash; do not flush down the toilet.

How to Use Spermicides

Spermicide is inserted close to the cervix within 30 minutes of intercourse. Use a new application for each act of intercourse or if there is a delay of intercourse for more than 30 minutes after application. Because spermicides are not very effective in preventing pregnancy they should only be used with another form of contraception such as a condom.

Advantages and Disadvantages of Condoms and Spermicides

Advantages include:

  • readily available over the counter, no exam necessary
  • allow the man to take an active role and shared responsibility in preventing pregnancy
  • causes no serious health risk
  • may increase ability to maintain erection longer
  • provide lubrication
  • inexpensive
Disadvantages may include:
  • may interrupt lovemaking because the condom must be placed on erect penis and the spermicide must be inserted into the vagina prior to intercourse
  • ineffective if used incorrectly or if the condom breaks
  • may reduce sensitivity and pleasure
  • may cause allergic reactions to latex, spermicide, or lubricant used with the condom
  • may be messy or inconvenient
  • necessitates prompt withdrawal to keep the condom from slipping off
  • may result in less energetic lovemaking from fear that condom may slip off or break
  • may taste bad (scented condoms such as mint are not spermicidally lubricated)
  • may not protect against transmission of STIs transmitted through direct skin-to-skin contact (e.g. HPV, herpes)

Condoms and STIs

Although not 100% effective, for sexually active people condoms provide the best means of protection available today for Sexually Transmitted Infections (STIs). Condoms cannot prevent STI transmission, but they can help reduce the risk. However, animal membrane condoms (lambskin) do not give protection against HIV infection and other sexually transmitted diseases. Therefore, the use of latex and polyurethane condoms with nonoxynol-9 is highly recommended.

The Condom Comeback

Here are some suggestions for how to encourage a partner to use condoms:

Condom excuse: "It doesn't feel good."
Condom comebacks:
"If you're uncomfortable using condoms then let's try something other than intercourse."
"Neither does sleeping alone."

Condom excuse: "It spoils the mood."
Condom comebacks:
"The mood will come back."
"So does your attitude."

Condom excuse: "It takes too long."
Condom comebacks:
"Then you need practice and there's no time like the present."
"Let me help you put it on."
"A condom can make sex last longer."
"We have all night. What's the rush?"
"It's worth the wait."

Condom excuse: "You won't catch anything from me."
Condom comebacks:
"Yes, but you might catch something from me."
"I know I won't, because either we use a condom or we are not having intercourse."
"Then you won't get anything from me."

Condom excuse: "Just this once won't matter."
Condom comebacks:
"It only takes once."
"Then just this once I'll have to say no."

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Depo-Provera

What is Depo-Provera?

Depo-Provera is an injectable progestin (hormone) that acts similarly to other progestin-only contraceptives. Depo-Provera works by preventing the development of the egg and by changing the cervical mucus, thus helping to prevent the sperm from reaching the egg. One injection provides 12 weeks of protection so you must return to your health care provider every 12 weeks for another injection. Depo-Provera can be used safely and effectively as a contraceptive by most women. Depo-Provera does not protect against STIs, so always use a condom.  You must return to your health care provider every 12 weeks for another injection. Depo-Provera tends to make a woman's periods less regular, and spotting between periods is fairly common. Some women stop having periods completely. If your pattern of bleeding concerns you, return to your health care provider for follow-up.  Furthermore, you should contact your provider if you develop any of the following:  weight gain, depression, headaches, frequent urination, or heavy bleeding.

Benefits and Disadvantages

Depo-Provera is greater than 99% effective in preventing pregnancy in both theory and actual use.

The specific benefits include:

  • causes no serious complications such as those occasionally associated with estrogen-containing pills (contains no estrogen)
  • provides highly effective, long acting protection against pregnancy
  • convenient, does not interfere with intercourse
  • decreases menstrual cramps in some cases
  • reduced risk of Pelvic Inflammatory Disease, endometrial and ovarian cancers

Some of the disadvantages may include:

  • causes menstrual cycle irregularities for most users
  • may decrease bone density
  • may experience weight gain, water retention, breast tenderness
  • long term lipid effects are unknown
  • requires an injection
  • provides no protection against sexually transmitted diseases (STIs)
  • Depo-Provera is not a good choice if you want to be pregnant in the next year or two, as it may take from nine to twenty-four months after you stop taking Depo-Provera to regain your fertility

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Emergency Contraception

Emergency Contraceptive Pills, or ECPs, are not a true form of contraception. Rather, ECP is a means to protect yourself against pregnancy after an unexpected incident of unprotected sex, whether consensual or non-consensual. Additional information about ECP can be found on our Other Sexual Health Issues page.

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More Information

Method Match helps you to select the contraceptive that best meets your needs--you can compare up to four methods based on effectiveness or frequency of use to detemine which is right for you.

Family Practice notebook.com contains an excellent section on Contraception Management which includes detailed information concerning various contraceptive methods. The site also provides particularly useful information about oral contraceptives, including guidelines for managing possible side effects.

Some of the above information was adapted from the
Duke University Student Health Center.

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