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!

Why choose risky sex when safe sex is so easy??

It absolutely horrifies me how little most teenagers and young adults know about contraceptives and safe sex practices.  Every once in awhile I encounter someone who naively believes that basically everyone knows how to have safe sex, they just choose not to.  The people that believe this are very lucky - they clearly had someone in their life (possibly a parent, doctor, or health teacher) who was willing and able to educate them.  While I realize that many people do choose not to have safe sex, there are so many others that do it because they truly do not know how to have safe sex.  According to several studies almost 40% of the teenagers in our country have never been taught about the different types of contraceptives or how to properly use them.  Many teenagers are unaware of how to properly put on a condom.  There are both teenagers and adults that falsely believe that they should wear more than one condom at a time to avoid pregnancy and STIs.  Wearing more than one condom at a time is incredibly risky because the friction between them often results in the condoms ripping.  There are also a lot of people who are also unaware that they need to take their birth control at the same time daily.  Women often do not use a second form of contraceptive when they start taking the pill or switch to a different type of pill, which might result in pregnancy.  It is not uncommon for people to have never heard of alternate forms of contraceptives such as IUDs.  I recently learned that a number of students in my graduate health education class had never heard of birth control shots before taking our class.  Although I am familiar with them, I have never known of anyone (that I know of) using a female condom.  How is it possible that there are so many products out there and yet so many people are either unaware of their options, or actually choosing to have unprotected sex?

FYI: Don't ever use a condom with a staple stuck through it :)

I think the most disturbing fact is that a significant portion of sexually active teens and young adults admit that they will most likely be having unprotected sex in the near future.  What has happened in our society that makes us think that this is acceptable behavior?  How is it possible that the risk of pregnancy, STIs and STDs such as HIV does not scare the crap out of our generation?  Are the current teens and young adults in our country really so arrogant that they truly do not believe it can happen to them?  I find that hard to believe.  I know so many people that have had unplanned pregnancies, and I know the STI rates for my age group... clearly it is happening to us.  So why is there so little concern over these possibly life threatening consequences?  No matter how hard I try I simply cannot wrap my mind around the choices that people make...  When it is so easy to purchase contraceptives why do people still choose to engage in risky sexual activities?  I continue to hope that with a stronger emphasis on the importance of sex education in combination with great health educators, maybe the next generation will make better, safer choices than ours.

Is teen pregnancy still an issue?

A sexually active teen who does not use contraceptives has a 90% chance 

of becoming pregnant within a year.

Often when I discuss teen pregnancy with people I am surprised with their negative reactions.  I often hear comments about how teen mothers are uneducated and mainly found in small, impoverished towns. Although I am from a small town and do remember a number of people I went to high school with having children before graduation, I do not believe that this is an accurate assumption.  I am appalled by how often pregnant teens and mothers are viewed as "trailer trash".  Don't get me wrong, I am by no means condoning teenage pregnancy.  I just do not believe that looking down on teen mothers or judging them is appropriate.  Considering the fact that the majority of high school students are having sex and the majority of those students are not always having safe sex - I think it's amazing that more high school students do not become pregnant.  I think that the real problem here is a lack of education and that so many boys and girls have false beliefs about sex and conception.  Some teens believe that you have to be having regular intercourse to get pregnant and many teens believe that the withdrawal method will protect them from pregnancy.  Teens often account their unplanned pregnancies to simply getting "carried away."  They had not planned on having sex, so they did not have any contraceptives... which lead to them having unprotected sex.  This is why education is so important.  Good health educators, who have the trust and respect of their students, can make them understand why it is necessary to have safe sex every time and how they can be safe.  The only way for us to dramatically reduce the number of teen pregnancies in our country is for parents and educators to work together, informing students about safe sex practices, making safe sex the norm for all people, and creating an environment where it is not only acceptable, but also expected to talk about sex.  

Facts:

In the U.S., in 2006, the teen pregnancy rate increased for the first time in more than a decade.  We currently have a higher teen birth rate than any other industrialized nation.  10% of all U.S. births are to teen mothers; 1 in 5 teen births is to a teen who already has a baby.  There are numerous negative consequences for teen mothers, such as: decreased level of education, poverty, and increased dependence on public assistance.  The children of teen mothers also face serious health issues such as being born prematurely and having lower birth weights.  

How does this affect you??  Teen childbearing cost taxpayers more than $9 billion per year!

Why are teens getting pregnant?  Lack of an adequate, comprehensive health education, false information about safe sex practices, language barriers, and problems at home are just a few of the reasons why some teenagers become pregnant.  

* The National Campaign to Prevent Teen and Unplanned Pregnancy has an amazing website, full of statistics, studies, and what you can do to help prevent teen pregnancy.

Should condoms be distributed in high schools?

I recently had to debate this subject, and I had to debate against condom distribution. Although I felt condoms should be available in high schools, before this assignment I really didn't know much about either side of the argument. Here is what I knew: condoms help reduce the risk of Sexually Transmitted Infections (STIs) and reduce the risk of pregnancy. Condoms are used inconsistently among sexually active teenagers. In the United States 1 in 5 sexually active teens (ages 15-19) become pregnant every year. That adds up to almost 800,000 pregnancies a year, resulting in half a million births and a quarter of a million abortions. Also in the U.S., 1 in 4 teens will contract an STI. So as you can see I knew a few statistics (in my opinion very alarming statistics) and that was it. This is what I learned:

Among sexually active high school students who reported being sexually active in 2003:

• 14% used oral contraceptives only
• 49% used condoms only
• 6% used both oral contraceptives and condoms
• 11% relied on the withdrawal method
• 3% contraceptive injections
• 2% used both condoms and contraceptive injections
• 12% used no method
• (the remaining 3% did not give clear answers)

Condom use among adolescents decreases as they mature.  In the 9th grade self-reported condom use is at 62.9%, however, it drops down to 49.5% by senior year.  In schools where condoms are available - 98% of schools offer counseling to students and in 49% of schools counseling is mandatory for condom receipt.  Counseling typically includes: information on abstinence, instruction on proper storage and use of condoms, and demonstration of how to put a condom on and take it off.  

PROS

1. Teenagers are already having sex - make it safe sex
2. Distribution of condoms creates an environment in which safe sex is seen as normal
3. Stop the spread of STIs and STDs (such as HIV)
4. Each year an estimated 3 million adolescents are infected with STIs, accounting for 25% of the estimated 12 million new STIs occurring annually in the United States
5. AIDS is the 6th leading cause of death among 15-24 year olds
6. Condom availability does not increase sexual activity in teens
7. Make using condoms the norm for teenagers
8. Enforces responsibility 
9. Teens may not buy condoms because of the cost or embarrassment 
10. If you are teaching safe sex, students should have access to safe sex!

CONS

1. Not the school's responsibility
2. Classrooms disturbances
3. Condoms are not the answer - we should not promote teens having sex
4. Condoms are not 100% effective - there is no such thing as "safe" sex
5. Takes away from abstinence only education
6. Takes away from the rights of parents
7. Parents should be educated so they can be responsible for their children's sexual health
8. Offensive to some religious/moral/personal beliefs
9. Very expensive to the school and taxpayers
10. Free contraceptives can be found at many free health clinics

After preparing and presenting my side of the argument, the only con that I agreed with was the expense of distributing free condoms.  However, the research is overwhelmingly clear that teenagers are having sex.  It is also clear that many of them are not using condoms as contraceptives and those that do use them often do not use them properly or consistently.  This leads me to believe that in addition to sex education classes and demonstrations, and available counselors, condoms should be available in schools.  A study here in Massachusetts interviewed more than 4,000 high school students and found that condom distribution did not increase the percentage of sexually active students.  It did, however, lead to more consistent condom use among already sexually active teenagers.    

“In the fight against AIDS, condoms save lives. If you oppose the distribution of condoms, something is more important to you than saving lives." – Melinda Gates

Why is sex education so important?

There is a lot of controversy concerning sex education in our public schools. Honestly, I understand the argument - parents should be responsible for teaching their children about sex. I agree with that statement. In an ideal world children would learn everything they need to know about sex from their parents (and possibly their doctors, too). However, that is not the world we live in. It's easy to say that parents should be educating their children, the tough part is actually getting them to do it. The fact of the matter is that most parents are not talking to their children about sex. Whether it is because they are embarrassed, uncomfortable, or simply lacking information, it is not happening. According to a national survey, by the National Campaign to Prevent Teen Pregnancy, only 1/4 of adolescents had discussed sex with their parents. That means that 3/4 of teenagers were not learning about sex at home - knowing this, how can we say that children should only be learning about sex from their parents?

I think it's really tragic that parents are either not willing or able to discuss these important matters with their children. In another survey (also by the National Campaign) which interviewed thousands of teens, 88% of them claimed that they believed it would have been easier for them to postpone sex if their parents would have talked openly (and informatively) with them about the subject. By directly bringing up the topic and having open discussion about sex parents can have a major impact on their children's behaviors and views. Unfortunately in the majority of households this is not happening.

That is why sex education is necessary in every school. While it would be ideal for parents to educate their own children, it is not happening. In fact most teens learn about sex from their peers and the media, which means that the information they are receiving is often inaccurate and biased. In this day and age every child should be receiving comprehensive health education, including sex education. With teen pregnancies on the rise again, and the growing number of teenagers and young adults with Sexually Transmitted Infections it is vital for every student to be educated about sex, reproduction, and contraceptives. People who believe that sex education is simply teaching their children that it is okay to have sex (or how to have sex) are gravely mistaken. Sex education is about teaching students to understand their bodies and how they work. It is about teaching students what to do in difficult situations, how to handle peer pressure, and how to stand up for their personal beliefs. It is about giving students the confidence to respect themselves and the choices they make. Educating students gives them all of the necessary tools they need to make informed appropriate decisions. For all of these reasons and more sex education is essential in our schools.