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Perfect contraception – a complete guide

Safe sex in the XXI century is no longer just about preventing unwanted pregnancy. It is about safety in the literal sense of the word – proper contraception can save your health and even life.

About contraception

Contraception is a set of measures that help to avoid pregnancy and sexually transmitted diseases (STDs). This article will help you choose the most convenient and reliable method of protection, provide useful information that will help you discuss your options with your doctor and determine the one that right for you. The choice of contraceptive method depends on a number of aspects: your age, medical and family history, medications you are taking, and your smoking habits.

Barrier contraception

Condoms

This is the only way to prevent both pregnancy and STDs, except not having sex at all. Condom put properly (and on time) can protect you from sexually transmitted diseases and even HIV.

A few facts from the World Health Organization.

  • Every day, more than 1 million people worldwide contract sexually transmitted infections (STIs), most of which are asymptomatic.
  • Each year, approximately 374 million people are infected with one of four curable STIs: chlamydia, gonorrhea, syphilis or trichomoniasis.
  • An estimated 500 million people aged 15-49 have a genital infection caused by the herpes simplex virus (HSV).
  • Human papillomavirus (HPV) infection is associated with more than 311,000 deaths from cervical cancer each year.

And also from UNAIDS:

  • Approximately 1.5 million people became newly infected with HIV in 2021.
  • Approximately 650,000 people died from AIDS-related illnesses in 2021.

Hope we have convinced you.

There are two types of condoms:
  • Male condoms, placed on the penis, give 98% protection against pregnancy
  • Female condoms, placed in the vagina, give 95% protection against pregnancy
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Male and female condoms

Condoms are made of very thin latex, male condoms may also be made of polyisoprene or polyurethane. They are designed to prevent contact of semen or vaginal secretions with the genitals of the sexual partner.

It is important to use only certified condoms, with a valid expiration date, and of course, only once. If necessary, you can use lubricant, but only water-based! Oil-based products, such as moisturizer, lotion or petroleum jelly, can damage latex and polyisoprene condoms, but they are safe to use with polyurethane condoms.

There are condoms with spermicides, but their additional effectiveness has not been proven, and they are more expensive.

Sometimes men refuse to use a condom, saying that the senses are not the same, and the erection decreases. However, it is about your safety, and the answers to these “excuses” are collected for you here.

Contraceptive diaphragms and caps

It’s a silicone dome that covers the cervix, and therefore prevents the partner’s sperm from entering the uterus. It must be inserted into the vagina before sexual intercourse.

These devices should be used together with spermicides – a gel or cream that kills sperm. Their effectiveness against pregnancy is 92-96%, for which the diaphragm or cap should remain in the vagina for at least six hours after sex. Could be longer (30 hours for diaphragms and 48 hours for caps), but not less.

Diaphragm and cap

It is important to choose your size and learn how to place the diaphragm or cap correctly. Your doctor can help you with this. If your weight has changed by at least 7 pounds, or after childbirth, miscarriage or abortion, you should reconsider the size. Moreover, it is not recommended to use this product within six weeks after the birth of a child, as well as during menstruation, due to the high risk of toxic shock syndrome.

The diaphragm and cap are contraceptives that do not protect against sexually transmitted infections. Moreover, spermicides containing the chemical nonoxynol-9 may even increase the risk of infection, including HIV.

As with condoms, oil-based lubricants should not be used, only water-based ones. Other contraindications include an atypical shape or position of the cervix, weak vaginal muscles, allergies to diaphragm/cap materials or spermicides, and inflammation.

Additionally, these products can provoke cystitis.

Hormonal contraception

We at the School of Women’s Health always emphasize that all drugs should be prescribed by a doctor. When it comes to hormonal contraceptives, let us emphasize once again. They are sold without a prescription, but have a significant impact on the functioning of the female body and a number of contraindications. Therefore, a specialist consultation is mandatory.

Oral contraceptives (OC)

Commonly known as birth control pills. They contain artificial versions of female hormones that are naturally produced in the ovaries. There are two main types: combined oral contraceptives with estrogen and progesterone and pills that contain only progesterone, called mini-pills.

Combined oral contraceptives (COC)

The mechanism is primarily to suppress ovulation, namely the production of follicle-stimulating and luteinizing hormones of the pituitary gland. At the same time, COCs thicken cervical mucus, which prevents the penetration of sperm, inhibit the growth of the endometrium (uterine mucosa), thereby making it impossible to attach a fertilized egg and at the same time slow sperm motility. 

“Oh, I forgot to take the pill” is what causes pregnancy. The big disadvantage of COCs is the importance of taking them every day without forgetting.

Natalia Silina, founder of the School of Women’s Health and Lior Medical Center

However, if taken correctly, such contraception has more than 99% protection against pregnancy.

The pill does not protect against sexually transmitted infections!

The rules are simple: take one pill every day at the same time for 21 days, then pause for a week (7 days). It’s going to be the time you have your period. You will not only know when you have your period, but also be able to adjust this process a little (after consulting your doctor, of course).

There are such schemes for taking monophasic COCs:

  • 1 pill daily for 24 days, then a pause of 4 days
  • 1 pill daily continuously from three packages, then a pause for 7 days
  • just take them every day without pauses

If you start taking the pills from the first to the fifth day of your period, you are already protected from pregnancy. If you start taking COCs on other days of the cycle, you should take care of additional contraceptive methods until your next period.

COCs are different and can help with certain health problems, including:

Among the disadvantages of the combined pill is an increased risk of breast and cervical cancer. However, the impact is considered insignificant, and it is significantly less than, for example, obesity. In addition, COCs are associated with an increased risk of thrombosis.

Combined oral contraceptives are not suitable for you if:

  • You smoke or have recently quit smoking and are over 35 years old
  • Have blood clots or someone in your family had blood clots before the age of 45
  • Have problems with blood vessels or have had a stroke
  • You are very overweight (more than 200 pounds)
  • Have a severe form of diabetes
  • Have liver or gallbladder disease
  • Have cardiovascular problems, including high blood pressure
  • Experience severe migraines, especially with the so-called “aura” in front of your eyes
  • You are taking certain medications that reduce the effectiveness of COC

There are still prejudices that COC is a guarantee of getting fat. It’s a myth.

Oral contraceptives that contain only progesterone – mini pills 

Their contraceptive effect is in thickening the cervical mucus so that the sperm cannot meet the egg. Some drugs also suppress ovulation. When taken correctly, they provide 99% protection against pregnancy.

Like combined contraceptives, progesterone-only pills can only be prescribed by your doctor!

These pills are good for you if:

  • You can’t take estrogen pills;
  • You are over 35 years old and you smoke;
  • You have just given birth – progesterone contraceptives are suitable for breastfeeding;
  • You are disciplined – it is important to take progesterone pills at the same time every day;
  • You are not afraid of changes in the nature and frequency of your periods. Sometimes mini pills make menstruation smearing and irregular

The rest of the factors pro and against this method of contraception coincide with those of COC.

Birth control injection

The doctor will give you an injection with progesterone and, depending on the drug, you will be protected from pregnancy for a period of 8 to 13 weeks.

The advantages, disadvantages and contraindications for the injection are the same as those for oral contraceptives containing progesterone. Additionally, this method is not good for you if you plan to get pregnant in the next year, since ovulation takes about 12 months to recover.

Birth control implant

Under local anesthesia, a small plastic stick will be placed under your skin. It will release progesterone for 3 years and provides more than 99% protection against pregnancy.

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Birth control implant

Just like the contraceptive injection, the implant is suitable for women who have just given birth and during lactation. Unlike injections, fertility returns swiftly after the implant is removed, so you can plan pregnancy soon. At the same time, this type of contraception due to the high concentration of progesterone can give the feeling of “permanent pregnancy”, namely swelling, sometimes acne, irritation. 

If there is access to more modern contraceptive methods, I would advise using the implant as a last option. Rather as an exception. When other modern methods are not available, but contraception is needed.

Founder of the School of Women’s Health and Lior Medical Center Natalia Silina

Contraceptive patch

It’s a sticker that contains the same hormones as combined oral contraceptives, namely estrogen and progesterone. The principle of action is the same, the effectiveness is more than 99%.

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Contraceptive patch

The patch releases hormones for a week, then you need to replace it with a new one, and so on for 3 weeks. Then you have a week of pause, during which menstruation should begin, although this does not always happen. After seven days, you need to stick the patch again, and the cycle starts again.

Vaginal ring

This is a small flexible plastic ring that is placed in the vagina in front of the cervix. It works for a month, releasing estrogen and progesterone, so it works the same way as the combined pill and patch and has the same advantages, disadvantages and contraindications.

The effectiveness is 99%. Minus: it has low doses of estrogen, which is not suitable for all women. If you have frequent “thrush” or dryness in the vagina while using the hormonal contraceptive ring, then immediately consult your doctor to choose another options of contraception.

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Vaginal ring

The advantage of the patch, ring, injection and implant is that unlike the COCs: if you have diarrhea or vomiting, your contraception is still effective. These methods also free you from the worrying about taking pills on time every day.

Emergency hormonal contraception

This method has a high probability of side effects and is not suitable for regular contraception! Use it as a last option and better no more than once in your life, ideally – never. Although, of course, there are situations when it is the only possible way to avoid even worse consequences for life and health. For example – after rape.

Also called the “morning pill”. You should take one dose of medicine containing high amount of estrogen and progesterone, or only progesterone, as early as possible (but no later than after 72 hours). Take a second dose 12 hours later. Better to consult your doctor about your choice of a drug.

The sooner you take the pill, the more effective it is, but there is a 25% chance that you will still get pregnant. About 50% of women feel nauseous after using emergency contraception, and vomiting complicates the life of another 20%. Your menstrual cycle may also change. Be sure to visit your doctor to assess your health after the morning pill. And take a pregnancy test, even if you are at least one day late.

Another, safer method of emergency contraception is the copper intrauterine device (IUD). More about it in the next section.

Intrauterine devices

There are two types of intrauterine devices: the copper IUD and the intrauterine system (IUS). Both should be prescribed and inserted by a specialist.

Intrauterine hormonal system and copper coil

Intrauterine copper coil

This is a small T-shaped device that the doctor inserts into the uterus. It releases copper, which changes the cervical mucus and makes it much harder for sperm to reach the egg. In addition, an already fertilized egg will not be able to attach in the uterus. Depending on the type, it is effective for 5 or 10 years and gives more than 99% protection against pregnancy. If you are over 40 years old and do not plan to become pregnant, the spiral can remain until menopause. Convenient, right?

Specialists of the World Health Organization define the copper coil as the most effective method of emergency contraception.

You can install a copper IUD on any day of the cycle, and you are immediately protected from pregnancy. This method has no side effects of hormonal drugs, so you may use it while breastfeeding. After removing the UID, you can get pregnant immediately.

Disadvantages

Quite an unpleasant application procedure, but you can ask your doctor for a local anesthetic. You may feel pain for some time after insertion, but it should pass in a few days. You may also have some bloody, smearing discharge for a while, and your period may become heavier and/or longer and/or more painful. This should pass within a few months.

The latter is the main reason for abandoning the IUD, although unpleasant feelings during menstruation after the adaptation period is a rather rare complication.

Sometimes you might get pelvic infection within 20 days after the installation of the IUD. If you have a fever, feel pain in the lower abdomen, or unusual discharge with an unpleasant odor, consult a doctor.

Rarely, pregnancy might still occur, then it is important to make sure that it is uterine. IUDs increase the risk of ectopic pregnancy.

Intrauterine system (IUS)

It also has a T-shape, but is made of plastic and the active substance is progesterone. It protects against pregnancy for 3 or 5 years, depending on the type, with 99% effectiveness. The hormonal IUS also thickens cervical mucus, which prevents sperm from reaching the egg. In addition, it thins the uterine epithelium, making it harder for a fertilized egg to attach. Some women may stop ovulating, but this is extremely rare.

The main advantage of hormonal coils is the relief of heavy menstruation, so they are often prescribed as a treatment for painful and heavy periods. Additionally, the symptoms of endometriosis are reduced or disappear altogether due to thinning of the uterine epithelium.

The hormonal IUS can also be installed on any day of the menstrual cycle, and you can get pregnant immediately after removal. If you are over 45 years old, you can leave it in until the onset of menopause.

The advantages, disadvantages and contraindications are the same as for progesterone and copper IUD, including the risk of pelvic infection.

Spermicides and contraceptive gels

Spermicides

These are non-hormonal ointments, creams, gels, foams or suppositories containing chemicals that, firstly, block the entrance to the cervix of the partner’s sperm. Secondly, they significantly slow down the speed of sperm, so they do not reach the egg.

The effectiveness of spermicides is the lowest among birth control drugs and is about 70%. However, they significantly increase the effect of using barrier contraception: condoms, caps and diaphragms.

They are usually well tolerated, but you may be allergic to certain components, so if you or your partner have any unpleasant feelings, avoid this method.

Contraceptive gels

This is a new local drug that appeared this year. Unlike spermicides, it does not contain the most common nonoxynol-9. Its effect provided by three active substances: lactic acid, citric acid and potassium bitartrate. These components increase the acidity in the vagina, which slows down sperm.

The effectiveness of protection against pregnancy is 86%.  As well as spermicides, the gel is best used together with barrier contraception.

Usually, the gel is better tolerated than spermicides, but you or your partner may feel itching and burning in the intimate area. Well, then this is not your method. Also, the change in vaginal pH can lead to vaginitis or urinary tract infections.

Natural family planning

If you have only one partner, and you’re sure in him, you may consider natural planning, basically, tracking your fertility. It is necessary to monitor daily, throughout the menstrual cycle, the signs of the body that indicate the approach and onset of ovulation and record them in a diary. The method is quite time-consuming, but natural. The effectiveness is from 91% to 99%, if you monitor the symptoms of ovulation daily. And that covers a bunch of procedures.

You need to track: the duration of the menstrual cycle, body temperature and the nature of your discharge. Better to consult a natural contraception specialist to learn how to interpret the indicators correctly. It may take you from 3 to 6 months to learn how to use this method right, and only then start using it.

Despite the attractiveness and zero cost of such contraception, the menstrual cycle can be affected by illness, stress, travel or some medications. In this case, it is worth considering other methods of contraception or combining the calendar method with barrier contraception.

Permanent method

It is a vasectomy for men and sterilization for women.

Vasectomy

During a small surgical operation, the doctor cuts or blocks the channels that supply sperm from the testicles to the penis. A man can still have sex and ejaculate, but his seminal fluid will not contain sperm. 

The effectiveness is almost 100%. However, the man has to use additional contraception from 8 to 12 weeks after the operation, since sperm can be stored in the canals leading to the penis.

Fertility after vasectomy is very difficult or impossible to restore. Therefore, a man should think good about his decision.

Female sterilization

This is blocking or removing part of the fallopian tubes that connect the ovaries to the uterus. In this way, eggs will no longer have a chance to meet sperm and therefore be fertilized. You keep ovulating and menstruating, you just don’t get pregnant anymore.

The effectiveness is almost 100%, but rarely the tubes may recover on their own. In this case, there is a risk of ectopic pregnancy. Depending on the type of sterilization, you need to use additional contraception until your next period or up to 3 months.

Types of sterilization
  • The small parts of the fallopian tubes are tied, cut and removed;
  • Special clips – the tubes are blocked with plastic or titanium clamps;
  • Silicone ring – a small loop is made of the fallopian tube, pulled through the ring and clamped shut.

This is an almost irreversible method. Sleep on it.

Whatever method you choose, we wish you to stay healthy! And of course, may you have only the desired pregnancy. We’ve got you with this, since a happy woman is healthy and educated!

You can learn about proper prepare for pregnancy from our course Preparing for Pregnancy. More about your health and body is in the courses: A girl becomes a woman, All about you. What it’s like to be a Woman, All about you 35+.

I’m eager to file all of these courses in English, just send me a request to dr.silinaeducation@gmail.com

You can always choose your doctor at the Lior Medical Center.

Issued by Dr. Silina School of Women’s Health, journalist Maria Zavialova

All materials published on the website “Dr. Silina School of Women’s Health” were reviewed by a gynecologist-endocrinologist, the founder of the educational project, candidate of medical sciences, Natalya Silina.

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