Ways to Keep From Getting Pregnant

OVERVIEW
Methods of contraception include hormonal, barrier and sexual-practice approaches. Permanent sterilization for both men and women are also possibilities requiring surgical procedures. Each contraceptive technique has its pros and cons. In the U.S., birth-control pills are the most popular method, followed by condoms and then diaphragms. Spermicidal foams and sponges rank somewhere close to diaphragms, both in popularity and efficacy. Surgical sterilization becomes more popular in the later decades of life, after people have had children. Around 1/3 of U.S. couples opt for a permanent surgical method after having children. "Emergency contraception" prescriptions are available from some physicians. Emergency contraception is used to compensate for the suspected failure of a birth-control method, such as the dislodging of a diaphragm or condom during intercourse.

HISTORY
The first birth-control pills were developed in the 1960s, and while their quality and variety have improved, their dangers and side effects continue to emerge and be better understood. The IUD, or intrauterine device, has caused so many acute and chronic disorders, occasionally serious, that this method is no longer popular or recommended by physicians in the U.S. Although there has been talk of a male "Pill" for many years, no such product or medication yet exists. The barrier methods and fertility methods are less effective than the pill (or of course sterilization) especially for younger age groups.

TYPES
Hormonal birth control methods include birth-control pills and (less commonly) hormonal pellets placed under the skin. Emergency contraception prescriptions concentrate very high doses of hormones in a single pill that's taken within 24 hours of unprotected intercourse. The hormonal levels are so high that they are able to prevent pregnancy, but are unhealthy for the body and used only as an emergency measure.
The barrier methods include condoms (rubbers), diaphragms and cervical caps, as well as vaginal sponges and spermicidal foams and creams. Condoms are widely available and require no doctor's prescription, while diaphragms and cervical caps are available in a variety of sizes and must be properly fitted by a physician. Both diaphragms and cervical caps are to be used in tandem with spermicidal jelly to improve their efficacy.
Surgical approaches include male vasectomy or female tubal ligation, often referred to as "tying the tubes."
The so-called "rhythm method" involves remaining scrupulously aware of a woman's fertile and infertile days in the monthly cycle and being cautious to avoid intercourse during the fertile days.
Male vasectomy is performed as an outpatient procedure requiring no hospitalization, and has a short recovery time. Female tubal ligation is a major abdominal surgical procedure requiring general anesthesia, overnight hospitalization and a longer recovery time.

BENEFITS
Birth-control pills are close to 100 percent effective and very convenient; however, they are the method most associated with side effects, including blood clots, blood-vessel disease and liver damage. Birth control pills require a doctor's prescription and must be taken faithfully every day to work.
The barrier methods are around 80 to 90 percent effective when properly used, but are less convenient. Condoms have the benefit of not requiring a prescription, while diaphragms and cervical caps do require medical assessment and prescriptions. Some women may be allergic and react to the spermicidal jellies that are used with diaphragms and cervical caps. Some men may be allergic to condom latex. Diaphragms and cervical caps are similar, with diaphragms being larger and cervical caps smaller and dome-like, fitting directly over the cervix. Diaphragms must be left in place for 8 hours following intercourse, and should be removed and reinserted with fresh spermicidal jelly prior to all sexual continued activity. Cervical caps may be left in place for 72 hours without the need to remove and reinsert, which may be an advantage over diaphragms.
The surgical approaches are effective but permanent, so they are obviously only appropriate for people who do not wish to have children in the future. While some men have successfully reversed their vasectomies to restore fertility, this is not to be counted on, and vasectomies are considered permanent. A man will still be fertile for around 15 to 20 ejaculations following a vasectomy until the existing sperm are depleted.
The rhythm method or other techniques that involve male withdrawal prior to ejaculation are the least effective of all contraceptive methods. Successfully avoiding pregnancy requires that a woman have a regular, predictable menstrual cycle, chart the cycle carefully and stay mindful of fertile periods. Taking the woman's temperature with a special basal body thermometer can improve fertility awareness as the temperature rises slightly around ovulation. Cervical mucus also changes in quality during fertile days; some women also use this in addition to charting their temperature to gain better awareness of when they are ovulating. Over-the-counter urine and saliva tests for identifying fertile periods are also becoming available to eliminate the guesswork, and are often used to identify precisely when ovulation occurs by couples who are trying to get pregnant.

MISCONCEPTIONS
It is a misconception that birth-control pills are harmless and can be used indefinitely. The risk of side effects and blood-vessel damage goes up with long-term use; doctors recommend that usage continue for no longer than 4 years. Women who smoke should not use birth-control pills at all, nor should women with other vascular-disease risk factors, including diabetics or those with high blood pressure and cholesterol levels.

EXPERT INSIGHT
See your doctor or visit a Planned Parenthood professional to fully discuss your contraceptive options, be fitted for a diaphragm or cervical cap, or be educated on the physical signs of fertility.

RESOURCES
Plannedparenthood.org