Contraception: Methods and Practices

Nancy Coiro, sexuality educator

What kind of birth control should you use? If you don't know the answer to this question, you're in luck -- MyPleasure's contraception section can help you find the right form of birth control for you.

Quick Facts

Our contraception fact sheets include quick information on all the different forms of birth control available, including descriptions, instructions for use, information on effectiveness and STD prevention, and advantages and disadvantages to each method.

Cervical Cap

Birth Control Method
Barrier

Description
Slightly smaller than a diaphragm, the cervical cap is a small, soft rubber cap that fits snugly over a woman's cervix, providing a physical barrier to semen trying to enter the uterus, and killing sperm before they can enter the uterus and fertilize an egg.

How It Works
Fill the cap with spermicidal jelly, foam or cream and then insert into your vagina, placing it over your cervix, which is the opening of your uterus or womb. Suction keeps the cap in place, blocking sperm from entering the uterus; the spermicide kills live sperm and prevents them from fertilizing an egg if they should happen to make it past the cap barrier.

You can have intercourse multiple times while wearing the cervical cap -- you don't need to reapply spermicide, but you should check to make sure the cap is still in place. The cap is effective for up to 48 hours, and must be left in place for at least six hours after intercourse.

Should You Use It?
Women who have intercourse infrequently, or whose fertility is low because of age, will find the cervical cap a good choice for contraception. Couples who have intercourse frequently (more than three times weekly) may find the cervical cap less effective than those who have sex sporadically, mostly due to inconsistent and incorrect use. The cervical cap is also very effective for women who have not had children, but higher failure rates apply for women who wait to begin using the cap until after they have given birth.

Effectiveness
With consistent and correct use, the cap is 91% effective; however, most couples will find the cap to be, on average, 75% effective at preventing pregnancy.

STI Protection
Barrier methods may provide considerable protection from sexually transmitted infections (STIs) such as gonorrhea, chlamydia and certain pre-cancerous conditions of the cervix; however the cap does not prevent the transmission of many other STIs, including herpes, HPV or HIV. Women who experience irritation and/or an allergic reaction to spermicides may be at increased risk for STIs, if exposed.

Advantages
Small and portable.
Can be inserted up to an hour before sex.
Effective for 48 hours.
Wearer can have intercourse an unlimited number of times with each wearing.
Confidential -- your partner doesn't have to know you're using it.
Teaches women more about their anatomy.
Reliable form of contraception when used correctly and consistently.
Caps can usually be used for up to a year before they need to be replaced.

Disadvantages
Must be fitted by a clinician.
Some women cannot be fitted for a cervical cap or cannot easily reach their cervix.
Can be difficult to insert properly and can slip out of place during intercourse.
May increase the risk for allergic reaction to latex or rubber, urinary tract infection, vaginal infection or inflammation of the cervix. Women who frequently use spermicides may experience disruption in the vaginal skin, increasing the risk of STIs and abnormal pap results.
There is a risk of toxic shock syndrome, a rare but serious infection, if the cervical cap is kept in place longer than recommended.
Must be left in for at least six to eight hours after intercourse, but no longer than 48 hours.
Cannot be used with oils, lubricants or gels unless the product packaging specifically states it is safe to use with latex or rubber.
A new fitting may be necessary after pregnancy, miscarriage, abortion or weight gain of over 15 pounds.

Where to Buy It
A clinician must fit you for a cervical cap; most health departments, family-planning clinics and gynecologists can help you. During your appointment, make sure you fully understand how to insert and remove the cap. If you have any questions, don't be afraid to ask! Once your doctor has fitted you, you can buy the cap and spermicide at most clinics, drugstores or pharmacies.

Follow Up
Because cervical caps can cause certain types of infections or inflammations in the vaginal area, you'll want to have a Pap test taken within a few months after you begin using this method, just to make sure you're still in good health. After each use, wash the cap thoroughly with hot water and mild soap, or as directed by your physician. Each time you use the cap, check it for cracks or tears and replace it if it shows any signs of deterioration. Have your cap's fit rechecked annually and after a pregnancy.

Female Condoms

Birth Control Method
Barrier

Description
The female condom is not made from latex or rubber, but from polyurethane, a strong, thin material that conducts heat well. A long sheath with two soft rings at each end, one ring of the female condom is covered with polyurethane and fits over the cervix, while the larger, open ring, stays outside the vagina, covering part of the perineum and labia during intercourse, forming a hollow lining to the walls of the vagina.

How it Works
After applying lubricant to both sides of the female condom, insert the end with the enclosed ring into the vagina and rest the ring against the cervix. Slowly unfurl the rest of the female condom down through the vagina, and pull the open end out of the vaginal opening. Because the female condom will block any natural female moisture, you will need to use additional lubricant during intercourse. Male and female condoms should not be used at the same time. The female condom can be inserted up to eight hours before intercourse, but should be removed immediately afterward and discarded.

Should You Use It?
As female condoms are relatively new, only one brand is in production, the Reality Female Condom^TM; some women may not enjoy not having more brands to choose from. While female condoms are a wonderful way to ensure your body is protected not only from contraception, but also from sexually transmitted infections (STIs), including HIV, and many women do not enjoy the bulkiness or "unsexiness" of the female condom. Also, some women find the outer ring uncomfortable or irritating during intercourse. However, the manufacturer reports that 50-75% of the male and female participants in studies done in numerous countries and cultures found the female condom to be "acceptable for use." Also, most couples reported that the female condom did not interfere with sexual pleasure or sensitivity.

Effectiveness
Among typical couples who use female condoms, about 20% will experience an accidental pregnancy in the first year. However, if female condoms are used consistently and correctly, only about 5% of users will become pregnant.

STI Protection
According to the manufacturer, when used consistently and correctly, the female condom is estimated to reduce the risk of HIV infection for each act of sexual intercourse by 97.1%. Furthermore, in-vitro studies have shown the female condom to be an effective barrier to microorganisms, including HIV and a bacteriophage smaller than hepatitis B, the smallest virus known to cause an STI. In other words, the female condom provides the same relatively safe barrier to STIs as male condoms -- only abstinence is more effective at preventing infection.

Advantages
Gives women more control over their bodies and a sense of freedom.
Protects a greater area of the female body.
Can purchase the female condom without seeing a clinician.
Can be inserted up to eight hours in advance of intercourse.
Safe and effective at preventing both pregnancy and infection.
Your partner can insert it and make it part of lovemaking.
Any lubricant, oil or gel can be used with the female condom.
Polyurethane transmits heat well, which might add a fun dimension to your love play.
Many couples say they like the way it feels.
Covered by Medicaid in many states.
Does not generally increase the risk of urinary tract infection, yeast infection, cervical irritation or vaginal infection.
Can be modified for use as a protective barrier for oral sex.

Disadvantages
Large, unattractive or odd-looking.
Must be used with lubricant.
May make distracting rustling noises prior to or during intercourse.
Some people complain it is difficult to use.
Not sold in as many stores as male condoms.
About three times more expensive than male condoms.

Where to Buy It
Female condoms are sold in packs of three or six; each condom costs $2 to $3. The package comes with a lubricant and a leaflet that explains how to use female condoms.
Female condoms are sold at most drugstores and some supermarkets, but not as many as male condoms -- call ahead to ensure the store carries them. You can also order
female condoms directly from The Female Health Company. To learn more about the female condom, speak with your clinician or call 1-800-274-6601.

Follow Up
Just like a male condom, the female condom can only be used one time. Once the man has ejaculated, you will need to insert a new female condom before your next sex act. To avoid messy spillage, remember to remove the female condom prior to standing up. After using the female condom, dispose of it in the trash can -- do not flush it down the toilet; polyurethane will clog most plumbing. If you experience irritation or discomfort after using the female condom, consult your physician immediately.

Male Condom

Birth Control Method
Barrier

Description
Condoms, also known as rubbers, are made of latex, plastic or natural membranes and, when unrolled, look like long, thin, deflated balloons. Condoms are stretched or rolled over a man's penis prior to intercourse to prevent body fluids from mixing when two people have sex.

How It Works
Remove the condom from its package. It will look like a flat coin with a ring on top. Do not unroll the condom! Instead, place it onto the end of an erect penis, ring side up, and slowly unroll it down the length of the penis. Some people enjoy putting a condom on their lover's penis as a prelude to sex; others prefer the wearer to take care of things. If you have difficulties putting on a condom, practice on a banana!

Remember: penises and condoms come in different sizes and shapes, so find a condom that fits well; most condoms cover the glans and at least half the shaft. If you use a water-based lubricant such as Passion or Aqua Water by Wicked it may decrease the chance of your condom breaking. To decrease the chance of the condom slipping down the penis or falling off in the vagina or anus, pull the penis out of the vagina or anus right after ejaculation. Don't continue thrusting until the penis becomes soft. Hold the rim of the condom against the penis during withdrawal.

Should You Use It?
Condoms, one of the most effective forms of birth control and sexually transmitted infection (STI) prevention, are inexpensive and easy to use. You can find them just about everywhere, including drugstores, grocery stores, pharmacies and corner markets. The downside: they can take some of the romance and sensation out of intercourse. Many people use condoms until they are married or in a monogamous relationship, and then after testing negative for STIs, they switch to a different form of birth control. If you are not in a long-term, monogamous relationship, it's important that you continue to use condoms during sex -- if don't like them, learn how to incorporate them as a ritual part of your lovemaking.

Effectiveness
With consistent and correct use, condoms are 97% effective; however, most couples will find condoms to be 89% effective at preventing pregnancy.

STI Protection
When used consistently and correctly, condoms are one of the safest and most effective forms of STI protection, bested only by abstinence.

Advantages
Very effective at preventing pregnancy when used correctly and consistently.
The best method of preventing infection, except for abstaining from sex.
Condoms are inexpensive and widely available.
Many men "last longer" when they use condoms.
Condoms come in many colors, sizes, flavors, and styles -- for example, with and without ribbing, with and without studs, with and without lubrication or spermicide.
Condoms can make sex less messy -- after a man ejaculates, his semen stays inside the condom.
Putting on the condom can be a fun, erotic experience if your partner puts the condom on your penis, or you put it on your partner's penis.

Disadvantages
Unless the partner puts it on as a part of foreplay, the condom interrupts sex.
Condoms easily tear with fingernails, a ring, teeth or anything sharp.
Oil-based lubricants, such as Vaseline, suntan oil, whipped cream or Crisco, cause latex to disintegrate and cannot be used with latex condoms.
While rare, some men cannot maintain an erection while wearing a condom.
Animal membrane condoms are not as effective at protecting against infection as latex or polyurethane condoms.
The man must pull out soon after ejaculation. If he becomes soft, the condom can fall off and be left in the vagina or anus without the couple knowing that this has happened.
Some people may experience an allergic reaction to latex/rubber condoms.

Where to Buy It
You can buy condoms from almost any drugstore, grocery store, convenience store or gas station. Some health departments and family planning clinics such as Planned
Parenthood give away condoms for free. If you are uncomfortable with purchasing condoms in person, try buying them online.

Follow Up
If a condom tears or breaks during intercourse, it's imperative that you consult a clinician to ensure an unwanted pregnancy did not occur. You will also want to get tested for STIs, including HIV. If you experience an allergic reaction to a condom, try a different brand or try condoms that don't have spermicide. If the irritation persists, you may be allergic to latex. People who are sensitive or allergic to latex or who find the smell of latex very unpleasant may choose natural membrane condoms (skin condoms), which are slightly less effective at preventing pregnancy and more expensive than latex condoms. However, skin condoms do not prevent the transmission of STIs. A better alternative to using skin condoms may be to use polyurethane condoms, since these prevent infection as well as pregnancy.

Depo-Provera

Birth Control Method
Hormonal

Description

Depo-Provera, also known as "the birth control shot," is a hormone much like the progesterone a woman produces during the last two weeks of her monthly cycle, after her body has determined it does not contain a fertilized egg. Progesterone causes the cervical mucus to become thicker, so sperm cannot reach the egg, and also changes the lining of the uterus so implantation of a fertilized egg cannot occur. Depo-Provera mimics these conditions, preventing pregnancy from occurring.

How It Works
You must see a health-care professional to get a Depo-Provera injection, and return every three months for a new injection. Most clinics provide the first shot when a woman has her period or within seven days of the start of her period. If you are late for your shot, be sure to use condoms or another method until you see your doctor again.

Should You Use It?
Depo-Provera is one of the most effective methods of contraception, but it does not protect against the transmission of sexually transmitted infections (STIs). Also, some women have experienced severe reactions to the hormonal shot. If you have a monogamous partner who has tested negative for STIs, you might want to try Depo-Provera. If you experience unpleasant side effects, see your doctor or clinician who may be able to prescribe additional medications to help alleviate the symptoms.

Effectiveness
Among typical couples who initiate use of Depo-Provera, about 3 in 1000 will experience an accidental pregnancy in the first year.

STI Protection
Depo-Provera does not prevent the transmission of sexually transmitted infections, including HIV.

Advantages
Nothing must to be taken daily or used at the time of sexual intercourse.
An extremely effective form of birth control.
Women lose less blood using Depo-Provera and have less menstrual cramping.
Often after three injections women stop having periods.
Completely confidential -- no one has to know you are using this method.
Nursing mothers can receive Depo-Provera injections once the baby is 6 weeks old. Depo-Provera may improve PMS, depression and symptoms from endometriosis.

Disadvantages
Can lead to very irregular periods and spot bleeding.
Can cause weight gain, headaches and breast tenderness.
Does not offer protection from HIV or other infections.
A new injection is required every three months.
May make symptoms of depression and PMS worse.
May lower your estrogen level and cause bone loss, although this is has not yet been proven.
A few women are allergic to Depo-Provera.

Where to Buy It
You can get Depo-Provera injections from your clinician, health department or family planning clinic.

Follow Up
Complete information about this contraceptive is available from your clinician or from the package insert that is provided when you are given Depo-Provera injections.

Diaphragm

Birth Control Method
Barrier

Description
Slightly larger than a cervical cap, the diaphragm is a soft rubber or latex cup that fits over a woman's cervix, providing a physical barrier to semen trying to enter the uterus and killing sperm before they can fertilize an egg.

How It Works
Fill the diaphragm with spermicidal jelly or cream and then insert into your vagina, placing it over your cervix, which is the opening of your uterus or womb. The pubic bone and rear wall of the vagina keep the diaphragm in place, blocking sperm from entering the uterus; the spermicide kills live sperm and prevents them from fertilizing an egg if they should happen to make it past the barrier. You can have intercourse multiple times while wearing the diaphragm, but you'll need to reapply spermicide each time. You can leave the diaphragm in place and insert fresh spermicidal cream or jelly by using a special applicator. The diaphragm is effective for up to 48 hours, and must be left in place for at least six hours after intercourse.

Should You Use It?
Women who have intercourse infrequently, or whose fertility is low because of age, will find the diaphragm a good choice for contraception. Couples who have intercourse frequently (more than three times weekly) may find the diaphragm less effective than those who have sex sporadically, mostly due to inconsistent and incorrect use. The diaphragm is also very effective for women who have not had children, but higher failure rates apply for women who wait to begin using the diaphragm until after they have given birth.

Effectiveness
With consistent and correct use, the diaphragm is 91% effective; however, most couples will find the diaphragm to be, on average, 80% effective at preventing pregnancy.

STI Protection
Barrier methods may provide considerable protection from sexually transmitted infections (STIs) such as gonorrhea, chlamydia and certain pre-cancerous conditions of the cervix; however, the diaphragm does not prevent the transmission of many other STIs, including herpes, HPV or HIV. Women who frequently use spermicides may experience disruption in the vaginal skin, increasing the risk of STIs and abnormal pap results.

Advantages
Small and portable.
Can be inserted up to an hour before sex.
Effective for 48 hours.
Wearer can have intercourse an unlimited number of times with each wearing.
Confidential -- your partner doesn't have to know you're using it.
Reliable form of contraception when used correctly and consistently.
Can usually be used for up to two years before they need to be replaced.

Disadvantages
Must be fitted by a clinician.
Some women cannot be fitted for a diaphragm or cannot easily reach their cervixes.
Can be difficult to insert properly and can slip out of place during intercourse.
May increase the risk for yeast infection, allergic reaction to latex or rubber, urinary tract infection, toxic shock syndrome, vaginal infection or inflammation of the cervix.
Must be left in for at least six to eight hours after intercourse, but no longer than 48 hours.
Cannot be used with oils, lubricants or gels unless the lubricant packaging specifically states it is safe to use with latex or rubber.
A new fitting may be necessary after pregnancy, miscarriage, abortion or weight gain of over 15 pounds.

Where to Buy It
A clinician must fit you for a diaphragm; most health departments, family-planning clinics and gynecologists can help you. During your appointment, make sure you fully understand how to insert and remove the diaphragm. If you have any questions, don't be afraid to ask! Once your doctor has fitted you, you can buy the diaphragm and spermicide at most clinics, drugstores or pharmacies.

Follow Up
After each use, wash the diaphragm thoroughly with hot water and mild soap, or as directed by your physician. Because diaphragms can increase your risk for certain types of infections or inflammations in the vaginal area, you'll want to have a Pap test taken within a few months after you begin using this method. Each time you use the diaphragm, check it for cracks or tears and replace it if it shows any signs of deterioration. Have your diaphragm's fit rechecked annually and after a pregnancy.

Emergency Contraceptive

Birth Control Method

There are two methods of emergency contraception; hormonal, post-coital contraceptives or emergency intra-uterine device insertion. The pill form is also called the "morning after" pill. Currently marketed pill forms of emergency contraception include Preven ® and Plan B ® .

Description
Emergency contraceptive pills contain either progestin or progestin and estrogen. Insertion of an IUD after unprotected sex is also an effective method of birth control.

How It Works
Emergency contraception works by stopping the release or fertilization of an egg, or by blocking implantation of an egg. It will not cause an abortion. Taking pills or having an IUD inserted needs to be done as soon as possible after unprotected sex (usually within 72 hours), to increase the chances of preventing pregnancy.

Regular birth control pills may be used as emergency contraception under the guidance of your health care provider.

Should You Use It?
Emergency contraception can be used after unprotected vaginal intercourse. It is usually provided by public hospitals after cases of rape. It is used only in women who are not pregnant from a previous act of intercourse. It is the most effective way to avoid an unplanned pregnancy after the failure of condoms or after unprotected sex.

Effectiveness
According to the Food and Drug Administration, there is an almost 80% reduction in the risk of pregnancy after a single act of unprotected sex when correctly using the pill forms of emergency contraception. Only 1 out of 1000 women will become pregnant after an emergency IUD insertion.

STI Protection
The use of emergency contraception does not prevent the transmission of sexually transmitted infections (STIs), including HIV.

Advantages
This is the best way to prevent unintended pregnancy after condom failure or when no birth control method was used.
Most symptoms of taking emergency contraception pills clear up within two days.
Emergency contraception will not affect an existing pregnancy.

Disadvantages
A small number of women may experience upset stomach or may vomit after taking emergency contraception pills. Anti-nausea pills may be taken to reduce the likelihood of vomiting.
Some women may temporarily experience headaches, dizziness, irregular bleeding and breast tenderness.

Where to Buy It
In the United States, emergency contraceptive pills require a prescription. You can get pills from your doctor, nurse practitioner, nurse midwife, health department or family planning clinic. Use the emergency contraception hotline -- 1-888-NOT-2-LATE -- to locate emergency contraception in your area. If you choose emergency IUD insertion, contact your health care provider.

Follow Up
Consult your doctor for complete information on potential side effects, or to answer any questions.

Fertility Awareness

Birth Control Method
Natural Family Planning

Description
Fertility awareness, or natural family planning, is based on a woman's individual ovulation cycle. With a clinician's help, a woman charts out her menstrual, fertile and infertile days, avoiding intercourse during fertile times. Different forms of natural family planning include the Sympto-Thermal Method, the Ovulation Method, the Calendar Method (a.k.a., the rhythm method), the Lactational-Amenorrhea Method (breastfeeding) and withdrawal.

How It Works
Fertility awareness methods each have one thing in common: they rely on the physiology of a woman's body, rather than on drugs, hormones or barrier methods. However, each method is slightly different: the Sympto-Thermal Method involves charting a woman's body temperature to determine fertile and infertile days; the Ovulation Method requires a woman pay attention to her menstrual and ovulation cycle, using her body's moisture and dryness to determine infertile days; the Calendar Method, formerly known as "the rhythm method," relies on a woman counting backwards from the last day of her period to determine the most advantageous times to have intercourse; the Lactational-Amenorrhea Method, which involves prolonging breastfeeding as a means for preventing ovulation; and withdrawal, also known as coitus interruptus, the often-ineffective practice of withdrawing the penis prior to ejaculation.

Should You Use It?
Natural family planning (NFP) is the only completely natural form of contraception other than abstinence. While many people prefer this natural, mutual method of preventing pregnancy, couples who use this method improperly are more likely to get pregnant than those who misuse artificial methods. Couples who use this method seem to like it -- most users of these methods tend to be very loyal, continuing to practice NFP longer than users of any other method. If you want to use fertility awareness as a method of contraception, you should first confer with a trained counselor, clinician or family planning specialist.

Effectiveness
Failure rates for each natural family planning method are as follows: Sympto-Thermal Method, 15%; the Ovulation Method, 20%; the Calendar Method, 18%; the Lactational-Amenorrhea Method, 6%; and withdrawal, 20%.

STI Protection
The fertility awareness method does not prevent the transmission of sexually transmitted infections (STIs), including HIV.

Advantages
Very inexpensive.
No artificial devices or drugs required.
No harmful side effects.
Teaches women more about their bodies.

Disadvantages
Requires the participation and cooperation of both partners.
Most methods have a high failure rate when used incorrectly.
Couples should see a trained counselor before using NFP methods.

Where to Buy It
One of the biggest advantages to fertility awareness is that it doesn't require that you purchase anything prior to beginning it. Computerized fertility programs are available to
make temperature and ovulation charting easier, and you might want to pick up a Basal thermometer; otherwise, all you'll need to do is visit a family planning clinician for some good advice and training.

Follow Up
When you are ready, using fertility awareness methods is an excellent way to get pregnant. However, don't just "reverse" whatever you are doing to prevent pregnancy -- see your doctor again for a quick consultation.

Contraceptive Foam

Birth Control Method
Spermicide

Description
Contraceptive foam, a vaginal spermicide a woman places into her vagina with an applicator, has two contraceptive effects: it kills or destroys sperm and prevents sperm from reaching the egg by blocking the opening to the cervical canal.

How It Works
Follow the package instructions for filling the applicator. Gently insert the applicator completely into the vagina, and then withdraw it about one-half inch. Depress the plunger fully, and then withdraw it. Complete information about this contraceptive, including how much to use, is available from your clinician or from the package insert accompanying the foam.

Should You Use It?
If you have a regular partner who has tested negative for HIV, contraceptive foam may be a great contraceptive choice for you. However, be aware that the foam doesn't taste very good, so if you enjoy having oral sex performed, you may want to postpone inserting the foam until just prior to intercourse, which can interrupt sex.

Effectiveness
With consistent and correct use, contraceptive foam is 94% effective; however, most couples will find contraceptive foam to be 50 to 80% effective at preventing pregnancy. Foam is more effective in preventing pregnancy when used with condoms.

STI Protection
Contraceptive foam may prevent the transmission of some sexually transmitted infections (STIs) in some women, but it may not be an effective form of protection against HIV. Women who frequently use spermicides may experience disruption in the vaginal skin, increasing the risk of sexually transmitted infections and abnormal pap results.

Advantages
Gives the woman control over contraception.
Available over the counter without a visit to a clinician.
Can be inserted up to 20 minutes before sexual intercourse and is effective immediately.
An extremely safe and flexible form of birth control -- there are no hormones involved.
The man's penis can remain inside the vagina after ejaculation.
Foam adds lubrication and moisture.
Foam reduces the risk of getting some STIs.

Disadvantages
Can be irritating to the vagina and some people feel that it is messy. Use of spermicide may increase the risk of irritation and allergic reactions, and may increase the risk of urinary tract infection.
Some women do not like putting an applicator into the vagina.
Not an effective form of protection against HIV.
The taste of foam can be unpleasant.

Where to Buy It
Foam is sold at most drugstores and some supermarkets. Call ahead to make sure the store sells it.

Follow Up
After intercourse, use a mini-pad or a panty-liner to catch any foam that might drip out. If you decide to douche, wait at least eight hours after intercourse before doing so.

IUD

Birth Control Method
Intra-uterine Device

Description
An IUD is a T-shaped plastic device about 3.5 cm long that is placed into the uterine cavity to prevent pregnancy. Small amounts of copper or a hormone are released into the uterus, blocking sperm from entering the Fallopian tubes and thus preventing fertilization. If fertilization were to occur, the IUD would prevent the fertilized egg from successfully implanting in the lining of the uterus. IUDs begin working immediately upon insertion and stop affecting fertility immediately upon removal.

How It Works
The FDA has approved two kinds of IUDs: the Copper T (Paragard ® ) IUD, which contains copper and can be used for up to 12 years; and the Progestin (Progestasert ® or Mirena ® ) IUD, which uses the hormone progesterone, the same as the hormone produced by a woman's ovaries during each monthly cycle. The progesterone causes the cervical mucus to become thicker so sperm cannot reach the egg. It also changes the lining of the uterus so implantation of a fertilized egg cannot occur. Progestasert ® can be used for up to one year. Mirena ® can be used for up to five years. The IUD can also be used as an effective method of emergency contraception (EC). While hormonal EC taken orally can be used for 72 hours after intercourse, an IUD can be inserted up to five days after unprotected intercourse for emergency pregnancy prevention.

Should You Use It?
You might want to use an IUD if you have had at least one baby (pregnancy stretches the uterus and reduces the chance that your body will expel the device), you are in a mutually monogamous relationship or are otherwise not at risk of contracting sexually transmitted infections (STIs), you have no history of pelvic inflammatory disease (PID), or you cannot use hormonal contraceptives. You should not use an IUD if you have an STI; IUD use increases the possibility that an STI (such as gonorrhea or chlamydia) will lead to PID, which can cause infertility, increased risk of ectopic pregnancy, and even death, if it goes untreated. You also shouldn't use an IUD if you might be pregnant or if you have certain cervical and uterine abnormalities as defined by your doctor.

Effectiveness
The most effective reversible method of contraception currently available, IUDs are 99% effective at preventing accidental pregnancy.

STI Protection
The IUD does not prevent the transmission of sexually transmitted infections, including HIV.

Advantages
The most effective reversible method of birth control currently available in the United States.
Copper T IUDs are effective for at least 12 years, Mirena ® for five years and Progestasert ® for one.
An extremely safe, effective and failsafe method of contraception.
IUDs are in place until removed by the health care provider. Many women report that they are more spontaneous about having sex, because the risk of pregnancy is so low.
The ability to get pregnant returns immediately after removal of an IUD.
Prevents ectopic pregnancies, life-threatening pregnancies that occur in the Fallopian tubes.
Cost-effective over time.
Can be used by women who cannot use estrogen-containing birth control pills.
May be used by breastfeeding women.
May be inserted immediately following the delivery of a baby or immediately after an abortion.

Disadvantages
Some women may experience cramping, pain or spotting after insertion.
Some women may experience longer menstrual periods or stronger cramps.
Rarely, IUD use may cause pelvic infection or perforation of the uterus.
Provides no protection against STIs.
The initial cost of insertion is high
Must be inserted by a doctor, nurse practitioner, nurse midwife or physician's assistant.
Your partner may feel the strings during intercourse.

Where to Buy It
You can get an IUD from your doctor, nurse practitioner, nurse midwife, Planned Parenthood or the health department. Not all clinicians insert IUDs, so check in advance. To avoid inserting an IUD into a woman who might be pregnant, most clinics insert IUDs when a woman has her period or within seven days after her last period began. If the risk of pregnancy can be excluded, it may be possible to insert an IUD at other times.

Follow Up
One of the biggest advantages to the IUD is that there isn't much follow-up after the insertion. All you have to do is check the strings once a month to ensure the device is still in place. However, one of the potential side effects of the Copper T IUD is a longer menstrual period and more intense cramps so you may want to visit your doctor for additional medications to regulate your period.

Lea's Shield

Birth Control Method
Prescription Barrier Method

Description
Lea's Shield is a dome-shaped disk with a valve and a loop made of silicone rubber. It is washable and reusable.

How It Works
To use the shield, apply spermicide and insert the shield according to package instructions. The shield is held in place by the vaginal walls, creating a physical barrier. It covers the cervix and upper vagina, blocking sperm from entering.

Should You Use It?
Lea's Shield can be used by women who can't take the Pill, nursing mothers, and women who do not want to use hormonal birth control methods. It may be used as a back-up method for women who forget to take a pill.

Effectiveness
There is a failure rate of 15 pregnancies per year for every 100 women using this device.

STI Protection
Barrier methods may provide some protection from sexually transmitted infections (STIs) such as Gonorrhea, chlamydia and certain pre-cancerous conditions of the cervix; however the shield does not prevent the transmission of many other STIs, including herpes, HPV or HIV. Women who Frequently use spermicides may experience disruption in the vaginal skin, increasing the risk of STIs and abnormal pap results.

Advantages
Small, portable and inexpensive.
The shield is washable and reusable and does not need to be Custom fit.
Can be left in place for up to 48 hours, with additional spermicide used for subsequent acts of intercourse.
Confidential -- your partner doesn't have to know you're using it.
Teaches women more about their anatomy.
Reliable form of contraception when used correctly and consistently.

Disadvantages
Available by prescription only.
Some women experience skin irritation and spotting when using this method.
May increase the risk for urinary tract infection, toxic shock syndrome, vaginal infection or inflammation of the cervix.
The spermicide can make performing oral sex on the wearer unsavory.

Where to Buy It
Lea's Shield is Available in the United States by prescription only.

Follow Up
Remember to wash the shield thoroughly between uses, using mild soap and water. Once dry, the shield should be properly stored in its pouch. It should be replaced if it shows any signs of wear.

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