Many forms of birth control are available to couples. However, an ideal method—one that is 100% effective, completely safe, with no side effects, reversible, separate from sexual activity, inexpensive, easy to obtain, usable by either sex, and not dependent on the user’s memory—is unavailable now and in the foreseeable future. Each current method has advantages and disadvantages with regard to effectiveness, side effects, cost, and convenience (as summarized in ■ Tables 10.1 and 10.2). It is a good idea to be familiar with the various meth­ods available because most people will use several of them during their active sex lives. In addition, a woman who is satisfied with her contraceptive method is more likely to use it consistently and, hence, improve its effectiveness (Frost & Darroch, 2008).

At a Glance

■ TABLE 10.1

Factors to Consider When Choosing a Birth Control Method

Method

Cost per Year for 100 Occurrences of Intercourse

Advantages

Disadvantages

Outercourse

0

No medical side effects; helps develop non­intercourse sexual intimacy.

Risk of unplanned intercourse; no protection from STIs.

Hormone-based methods

Estrogen-pro­gestin pills, including Seasonale

$384-$516 ($32- $43 per cycle)

Very effective. No interruption of sexual experience. Reduces PMS and premen­strual dysphoric disorder, menstrual cramps, and flow. Improves acne. May reduce migraine headaches associated with menstrual cycle fluctuations. Reduced risk of ovarian, endometrial, and colon cancer. No increased risk of stroke in healthy, non­smoking women under age 35.

No protection from STIs. Slightly increased risk of blood clot, especially in first 2 years of use. Increased risk of cervical cancer. May increase migraine headaches. May suppress some degree of normal bone mineral devel­opment when used during adolescence. Possible side effects of nausea, fluid reten­tion, irregular bleeding, decreased sexual interest.

Progestin – only pills

$384-$456($32- $38 per cycle)

Very effective. No interruption of sexual experience. No estrogen-related side effects. Can be used during breast-feeding.

No protection from STIs. Breakthrough bleeding. May worsen acne. Must be taken same time each day to be effective.

Vaginal ring (NuvaRing)

$580

Do not have to remember to take daily pill. Consistent, low-dose release of hormone. No interruption of sexual experience.

No protection from STIs. Increased vaginal discharge. Expulsion of ring. Not effective for women over 198 pounds.

Skin patch (Ortho Evra)

$580

Same as vaginal ring.

Higher incidence of blood clots than with pill or ring. Slightly higher breakthrough bleeding than with oral contraceptives. Skin irritation. No protection from STIs.

Depo-Provera

injection

$132-$300 for 4 injections each year

Very effective. No interruption of sexual experience. Do not have to remember to take on daily basis. No estrogen-related side effects. Good choice during breast-feeding.

No protection from STIs. Breakthrough bleeding. Weight gain. Headaches. Mood change. Clinic visit and injection every 3 months.

Lunelle

$420 for 12 injec­tions per year

Same as for Depo-Provera. May have estrogen-related side effects. No break­through bleeding.

Same as for Depo-Provera, but clinic visit and injection required monthly.

Implanon

$130-$270 (initial cost $400-$800, but lasts for 3 years)

Offers longer protection than any other hor­monal contraceptive. Highly effective. No need to remember to use daily or monthly method. No estrogen-related side effects. No increased cardiovascular risks.

No protection from STIs. May cause amen­orrhea, irregular bleeding, spotting, and headaches. Risks of progestin-related side effects.

Progestin IUD

Mirena

$35-$100 per each of 5 years (initial cost $175-$500)

Very effective. No interruption of sexual activity. Don’t have to remember to use. Can be used during breast-feeding.

No protection from STIs. Increased risk of pelvic inflammatory disease for women with multiple partners. Cramps. May be expelled. Rare incidence of perforating the uterine wall.

Barrier and spermicide methods

Male

condoms

$100 ($1.00 each)

Some protection from STIs. Available with­out a prescription.

Interruption of sexual experience. Reduces sensation.

Female

condoms

$400 ($4.00 each); 2nd generation $200 ($2.00 each)

Same as male condoms.

Same as male condoms. Higher cost than male condoms. Difficulty inserting.

Vaginal

spermicides

$85 (850 per application)

No prescription necessary.

Interruption of sexual experience. Skin irrita­tion. No protection from STIs. Not effective enough to be used without a condom.

CHAPTER 10

At a Glance

■ TABLE 10.1

Factors to Consider When Choosing a Birth Control Method (continued)

Method

Cost per Year for 100 Occurrences of Intercourse

Advantages

Disadvantages

Cervical barrier methods with spermicide

Diaphragm

$15-$75 ($750- $38.00 if used for 2 years); $85 for spermicide

Some protection from bacterial STIs. Can be put in before sexual experience. No side effects. Decreased incidence of cervical cancer.

Limited protection from STIs. Increased urinary tract infections. Requires practice to use correctly. Can cause vaginal or cervical irritation.

Cervical cap

Same as diaphragm

Same as diaphragm. No increase in urinary tract infections.

Same as diaphragm.

Sponge

$400 ($4 each)

Same as diaphragm. No increase in urinary tract infections.

Same as diaphragm.

FemCap

$65 ($32.50 if used for 2 years); $85 for spermicide

Same as diaphragm. Does not need to be fitted by health-care practitioner. Has a loop to assist removal.

Same as diaphragm.

Lea’s Shield

$145 ($60 each, replaced every year); $85 for spermicide

Same as diaphragm. Does not need to be fitted by health-care practitioner. Has a loop to assist removal.

Same as diaphragm.

Nonhormonal IUD

Copper-T

(ParaGard)

$15-$42 per each of 12 years; initial cost $175-$500

Can be kept for 12 years. Don’t have to remember to use. Also used for emer­gency contraception. Can be used during breast-feeding.

No protection from STIs. Increased men­strual flow and cramps. May be expelled. Increased risk of pelvic inflammatory dis­ease for women with multiple partners. Rare incidence of perforating the uterine wall.

Sterilization

Tubal

sterilization

$1,500 – $6,000

Highly effective and permanent. Reduces risk of ovarian cancer. Transcervical ster­ilization is safest and least expensive of female sterilization procedures.

No protection from STIs. Not easy to reverse for fertility. Discomfort after procedure.

Vasectomy

$350-$1,000

Easier procedure, less expensive, and lower failure rate than female sterilization.

No protection from STIs. Not easy to reverse for fertility. Discomfort after procedure.

Fertility awareness

Standard days method

0

Most effective of fertility awareness meth­ods. Acceptable to Catholic Church.

No protection from STIs. Uncertainty of safe times. periods of abstinence from inter­course or use of other methods. Requires careful observation and tracking.

Rhythm, calendar, basal temperature, and cervi­cal mucus methods

0

Acceptable to Catholic Church. No medical side effects.

No protection from STIs. Uncertainty of safe times. periods of abstinence from inter­course or use of other methods.

Withdrawal

0

No medical side effects.

No protection from STIs. Interruption of intercourse.

No method

0

Acceptable only if pregnancy desired.

No protection from STIs.

SOURCES: Berenson et al. (2008), Berenson & Rahman (2009), Blumenthal et al. (2008), Halbreich et al. (2012), Hannaford et al. (2007), International Collaboration of epidemiological Studies of Cervical Cancer (2007), Jensen et al. (2008), Lurie et al. (2008), Mansour (2008), Merki-Feld et al. (2008), Nanda et al. (2011), panzer et al. (2006), pikkarainen et al. (2008), pitts & Emans (2008), planned parenthood Federation of America (2008), and Speroff & Fritz (2005).

Contraception

■ TABLE 10.2 Effectiveness of Various Birth Control Methods

Method

Failure Ratea if Used Correctly and Consistently

Typical Number1 Who Become Pregnant Accidentally

Outercourse

0

0

Hormone-based methods

Estrogen-progestin pills, including Seasonale

0.3

8

progestin-only pills

0.5

3

Vaginal ring (NuvaRing)

0.3

8

Skin patch (Ortho Evra)

0.3

8

Depo-provera injection

0.3

0.7

Lunelle

0.05

0.2

Implanon

0.05

0.1

progestin IUD

0.1

0.1

Mirena

0.5

0.1

Barrier and spermicide methods

Male condoms

2

17.4

Female condoms

5

27

Vaginal spermicides

18

29

Cervical barrier methods with spermicide

Diaphragm with spermicide

6

16

Cervical cap

Woman has been pregnant

20

40

Woman has never been pregnant

9

20

Sponge

Woman has been pregnant

26

32

Woman has never been pregnant

9

16

FemCap

4

15

Lea’s Shield

6

18

Nonhormonal IUD

paraGard

0.5

0.8

Sterilization

Tubal sterilization

0.5

0.7

Vasectomy

0.1

0.2

Fertility awareness

Standard days method

5

12

Rhythm, calendar, basal temperature, and cervical mucus methods

9

20

Withdrawal

4

27

No method

85

85

aNumber of women out of 100 who become pregnant by the end of the first year of using a particular method.

SOURCES: Graesslin & Korver (2008), Guttmacher Institute (2008a), Hutti (2003), planned parenthood Federation of America (2008), and Speroff & Fritz (2005).

Effectiveness

Contraceptive effectiveness is best evaluated by looking at the failure rate (the number of women out of 100 who become pregnant by the end of the first year of using a par­ticular method). Table 10.2 shows the failure rate when contraceptive methods are used correctly and consistently; it also shows the rate of accidental pregnancies resulting from improper or inconsistent use. The most important variable of method effectiveness is

chapter 10

human error. Ignorance of the correct use of a method, negative beliefs about using a method, lack of partner involvement, forgetfulness, or deciding that "this one time won’t matter" all greatly reduce effectiveness and increase the chances of pregnancy. Some individuals eroticize or romanticize the risk of pregnancy (Higgins et al., 2008). In addition, people who feel guilty about sex may be less likely to use contraception effec­tively. Men and women who are uncomfortable with their sexuality are likely to take a passive role in contraceptive decision making, leaving themselves vulnerable to whatever their partners do, or do not do, about birth control. A woman may also be concerned about whether her partner sees her as a "nice girl" or as "easy." A simple way to appear as a "nice girl" is to be unprepared with birth control (Angier, 1999). Unfortunately, that’s also a simple way to have an unwanted pregnancy or contract an unwanted STI.