Contraceptives... so many options!

In my last post I talked about the number of people who are having unprotected sex.  While some people do choose to have unprotected sex, lots of people are simply unaware of their options.  So, this post is for anyone who is wondering what type of contraceptives are available and which ones would work best for you.
The main methods of contraception are as follows:
Condoms

Condoms serve as a barrier, preventing the passage of sperm and (in some cases) prevent the spread of STIs!  They are the only contraceptive device worn by men.  They are typically made out of either latex rubber or the intestinal membranes of lambs.  Latex condoms protect against STIs.  The latter is more expensive and the pores are large enough that HIV and other viruses can slip through (so they do not protect against STIs).  Unfortunately condoms often fail because they are not used correctly (I will soon post on proper condom usage).  The failure rate for typical use of condoms is 12%.
Advantages to condoms:

• Protects against pregnancy AND STIs!
• Does not rely solely on the woman to provide birth control.
• Cheaper than many other forms of contraceptives, no prescription necessary.  
• No side effects.

Disadvantages:

• They are often not used properly.
• Some people feel they make sex less spontaneous.
• Lessen sexual sensations for men.  

Hormonal Methods 
Oral Contraceptives (the pill): There are many kinds of birth control pills which vary in the type and dosage they contain.  There are two major categories: combination pills and mini-pills.

1. Combination pills contain synthetic forms of the hormones estrogen and progesterone.  Since women cannot conceive once they are pregnant, the combination pill tricks the brain into acting as though the woman is already pregnant, so that no ova mature or are released.  Since ovulation does not happen, she cannot become pregnant.  
2. Mini-pills contain synthetic progesterone only.  The mini-pill thickens the cervical mucus (it sounds gross, I know) so that the sperm cannot pass through, while also making the uterine lining less receptive to potentially fertilized eggs.  

Advantages to the pill: 

• Almost 100% effective when used properly!  The failure rate is incredibly low (0.5% or less)
• Easy to take, just set your phone alarm to remind you every day!
• Empowers women by letting them control their contraceptives (unlike condoms)

Disadvantages: 

• The pill should be taken at the same time daily.  (Missing days can = a baby) 
• Backup contraceptives must be used when starting the pill/ changing pills (again = baby)
• Since a lot of women do not always remember to take the pill daily or around the same time, the fail rate of typical use is higher, at 3%.
• No protection against STIs.
• Expensive. 
• Exposure to hormones (some people - like myself, but hey I'm a crazy worrier - worry about future health risk from the long-term exposure to estrogen.  This is very controversial though, do some research and decide how you feel about the issue!

The Contraceptive Patch: like the combination pill it also contains estrogen and progesterone.  The patch can be worn on your stomach, butt, upper arms, or back.  They are worn for a week (so you need four a month) and it slowly releases the hormones into your bloodstream.

Advantages to the patch:

• Like the pill it is more than 99% effective.
• Women do not need to remember to take it daily!  Put it on once a week and you are done!

Disadvantages (same as the pill):

• Cost.
• No protection against STIs.
• Exposure to hormones.  

Injectable Contraceptives: The seond-most popular method of contraceptives, after the pill.  There are two types - Lunelle and Depo-Provera.

1. Lunelle contains both estrogen and progesterone, and prevents ovulation.  It is injected monthly and has a failure rate of less than 1% when used properly.
2. Depo-Provera contains progesterone only and (according to the American Academy of Family Physicians) is as effective as female sterilization!!  It is injected every three months.  

Advantages to injectables:

• Highly effective.
• Not taken daily.

Disadvantages:

• Side effects (similar to the pill/patch, but possibly more intense): vaginal bleeding, headaches, breasts tenderness, irregular periods, vomiting, etc. 
• Exposure to hormones.
• Do NOT take if you smoke, have breast or uterine cancer, elevated blood pressure, or a history of heart disease, blood clots, or stroke.  

Intrauterine Devices (IUDs)

An IUD is an object that is inserted into the uterus and left in place to prevent conception.  They are used by over 100 million women in the world (they are used by nearly 1 in 3 women in China), however, they are used by only about 3% of women in the U.S.  In the 1960s IUDs became very popular in our country, they remained popular until the 80s when one popular brand became associated with high incidences of infertility and pelvic infections. Today IUDs are highly effective and a great option for women who do not want to worry about their birth control.  There are two types of IUDs: the Progestasert T and the Copper T 380A (otherwise known as ParaGard). They work by irritating the uterine lining, which leads to a mild inflammation.  The inflammation then causes the body to produce antibodies that are toxic to sperm and prevent the fertilized egg from becoming implanted.

1. The Progestasert T releases progesterone daily and must be replaced annually.  The failure rate is 2%.  Since insertations can possibly carry the risk of infection, health providers recommend the use of the ParaGard.
2. The Paragard is a copper based (T-shaped) devise, which has a failure rate of 0.8%, and it can be used for up to 8 years.  

Advantages to IUDs:

• Highly effective.
• Can last for years without replacing.  
• Paragard does not release any hormones into the body.  

Disadvantages:

• Insertion can be painful and there may be intense cramping and spotting for the first month or so.  
• Pelvic Inflammatory disease can occur after the insertion.
• Since they irritate the uterine wall there is a possibility that they could be expelled through the vagina.  Spontaneous expulsions occur in 2-10% of users within a year of use.
• Insertion can be expensive.
• No protection against STIs.

NOTE: IUD users are at a greater risk for ectopic pregnancies, during and after usage, and for miscarriages.  
Diaphragm

A rubber cup or dome that is fitted to the contour of the vagina.  It is coated with spermicide and inserted into the vagina before sex.  They are available by prescription, since they should be individually fitted to the woman.  Diaphragms can be inserted up to two hours before sex (any longer and the spermicide might start to lose its effectiveness).  They should be left in the vagina for at least six hours after sex - this ensures that the spermicide is able to kill any remaining sperm.  The failure rate of a diaphragm is 6%, however, in typical use the failure rate is 18!  This is often because it is not fitted properly or because they are removed too early.
Advantages to diaphragms:

• No side effects.
• No use of hormones.
• Can be used when needed, instead of daily (like the pill).

Disadvantages:

• High failure rate in typical use.
• Irritation may cause urinary tract infections or vaginal infections.
• No protection against STIs.

Spermicides
Spermicides are agents that kill sperm; they can come as jellies, creams, suppositories, foam, or a contraceptive film.  The failure rate of using spermicides alone is 21% - they are most effective when combined with other contraceptives.

NOTE: It is easy to find Spermicidal Condoms... if you choose condoms as your primary source of contraceptives USE SPERMICIDAL CONDOMS!  Double the protection :)
Advantages to spermicides:

• Great when used when other forms of contraceptives.

Disadvantages:

• Using them alone = too risky!  Always use them with another contraceptive!

The Contraceptive Sponge

The sponge is a soft, disposable device that provides a barrier that has built it spermicide.  It is placed in the vagina before sex and it absorbs sperm.
Advantages to the sponge:

• Can be inserted an hour or two before sex.
• Not as messy to remove as the diaphragm.  

Disadvantages: 

• Not as effective as other forms of birth control.
• There is a possibility (though rare) of developing toxic shock syndrome.  

The Cervical Cap

The cap is similar in shape to the diaphragm and must be fitted by a health provider.  However, it is smaller than a diaphragm and it fits over the cervical opening.  Before insertion the cap should be filled with spermicide and it should be left in place for 8 hours after sex.  The cap should be cleaned after each use and can last for up to three years.
Advantages to the cap:

• Can be inserted prior to sexual activity.
• Can be left in place, while offering continuous protection, for up to 48 hours!

Disadvantages:

• Failure rate ranges from 18%- 36%... scary!

Douching and the Withdrawal Method should not be considered viable methods of contraception.  Douching is ineffective, can cause vaginal infections, and may actually propel sperm toward the uterus.  The Cowper's gland releases pre-ejaculatory secretions of fluid, before ejaculation so the withdrawal method is unreliable and has an incredibly high failure rate!