Introduction to Contraceptive

Contraceptives are deliberate prevention of pregnancy using any of several methods.

Birth control prevents a female sex cell (egg) from being fertilized by a male sex cell (sperm)

and implanting in the uterus. In the United States, about 64 percent of women aged 15 to 44

years practice some form of birth control. When no birth control is used, about 85 percent of

sexually active couples experience a pregnancy within one year.

There are a variety of birth control methods to choose from, although most options are for

women. Selecting a method is a personal decision that involves consideration of many factors,

including convenience, reliability, side effects, and reversibility (whether the method is

temporary or permanent). For instance, some people may prefer a birth control option that

provides continuous protection against pregnancy, while others may prefer a method that only

prevents pregnancy during a single act of sexual intercourse. Some people might have past

illnesses or medical conditions that prevent them from using certain types of birth control

methods. Some women may find that certain birth control methods cause uncomfortable side

effects, such as irregular menstrual bleeding, weight gain, or mood changes. A person with

multiple sexual partners may prefer a birth control method that also offers protection from

sexually transmitted infections (STIs). Another important consideration is whether a person ever

plans to have children. Most birth control methods are reversible—they do not affect a person’s

ability to reproduce once the method is halted. But surgical birth control methods cannot, in most

cases, be reversed; once a man or woman undergoes the surgery, he or she can no longer

reproduce.
 Effectiveness of Contraceptives

No birth control method, other than abstinence from sex, is 100 percent effective in

preventing pregnancy. Some methods are more effective than others, and scientists use two types

of pregnancy rates when describing effectiveness. Method effectiveness, or perfect use, is the

percentage of pregnancies that occur when a particular method is used correctly and consistently

with each act of sexual intercourse. User effectiveness, or typical use, is the percentage of

pregnancies that result from average use of the method, which accounts for improper or

inconsistent use. This article provides typical use statistics in its overview of birth control

methods.
 Types of Contraceptive

Male condom

This is a latex (or polyurethane) sheath that covers the erect penis and prevents semen entering

the vagina. This is an effective form of contraception when used properly (95–98% effective).

This means using a condom every time you have sex and putting it on before there is any contact

between the penis and vagina. Male condoms are relatively cheap and are available over the

counter from supermarkets, pharmacies and sexual health clinics.

Female condom

This is a loose polyurethane sheath with a flexible ring at each end that sits in the vagina and

collects semen. It can be inserted many hours before intercourse and is stronger than the male

latex condom, but may take some practice with insertion and use. Female condoms are available

through mail order from Family Planning Victoria. They may also be available in some retail

outlets and sexual health clinics.

Diaphragm

This is a soft, shallow rubber dome that fits in the vagina, covers the cervix and stops sperm from

entering the uterus. The diaphragm must stay in place for at least six hours after intercourse and

is 85–95 per cent effective if used, fitted and positioned correctly. Diaphragms must be fitted by

a suitably trained doctor or nurse. They may decrease the risk of STIs, but should not be relied

on for this.

Intrauterine devices (IUD)

An IUD, sometimes known as a coil, is a small plastic device with either added copper or

hormones (Mirena). It is inserted into your uterus by a doctor. It can stay in the uterus for five to
eight years, depending on the type used, and can easily be removed before that if you would like

to fall pregnant or are having problems. Both types are 99 per cent effective and work by

changing the lining and environment of the uterus, effectively killing off sperm. If any sperm

survive and fertilise an egg, the egg is unable to stick to the wall of the uterus, so a pregnancy

can’t continue. The Mirena IUD also slowly and continuously releases a small amount of

progestogen, and can thicken the mucus made by the cervix to further block sperm. This may

also cause minor effects on the hormones controlling your menstrual cycle. The Mirena is

occasionally removed because of hormonal symptoms such as headache, breast tenderness, acne

and increased appetite. However it generally gives very light periods. The copper IUD tends to

make periods heavier, but doesn’t cause hormonal side effects.

Hormonal contraceptives – pills and vaginal rings

Hormonal contraception for women is available in the form of either a pill (oral contraceptive) or

a vaginal ring. Both are available by prescription. Hormonal contraceptives are highly effective

(94–99%) if used correctly. However, they may produce side effects and don’t protect against

STIs.

Combined pill

This is made up of the synthetic forms of the hormones oestrogen and progesterone. The

combined pill prevents ovulation, thickens cervical mucus to make it harder for sperm to enter

the uterus and changes the lining of the uterus to make it less suitable for a fertilised egg to stick.

There are many types of combined pills with different dose and hormone combinations.

Generally this form of contraception is not recommended for women who are at risk of heart

disease, such as smokers aged over 35 years.

Vaginal ring

This contains similar hormones to the combined pill and works in the same way. A ‘one size fits

all’ ring is inserted into the vagina and stays there for three weeks. During that time, it slowly

releases hormones that pass from the vagina into the bloodstream. It is then removed and a new

ring is inserted a week later. It is low dose and saves remembering to take a pill every day. It is

as easy to insert as a tampon and, like the combined pill, is 99 per cent effective if used correctly.

Mini pill

This contains only the synthetic form of progesterone. It makes the cervical mucus thicker,

which prevents sperm from entering the uterus. This pill must be taken every day at the same

time and is not as effective as the combined pill. It is usually suitable for women who either

experience side effects from oestrogen or shouldn’t take it for health reasons.

Hormonal contraceptives – implants and injections

Hormonal contraceptives for women are also available as implants and injections. These

methods are more effective than other hormonal methods, but may produce side effects and don’t

protect against STIs. Male injectable contraceptives are currently being trialled.

Implantation

This is a hormone implant that is inserted under the skin at the inner side of the upper arm. It

contains etonogestrel, a progesterone-like hormone that prevents ovulation and hinders sperm

from entering the cervix (by changing cervical mucus).

Implantation lasts for three years, is close to 100 per cent effective and is suitable for most

women who can’t tolerate synthetic oestrogens. The device is inserted by a doctor under local

anaesthetic.
DPMA injections (Depo-Provera/Depo-Ralovera)

These are long-acting (12 to 14 weeks) injectable contraceptives containing the hormone

progestogen. They prevent ovulation, block sperm by thickening the mucus made by the cervix

and cause changes in the lining of the uterus so it is unsuitable for a fertilised egg to stick.

DPMA injections are highly effective and provide a very private method of contraception.

Sterilisation

Sterilisation is a permanent surgical procedure that requires referral to a specialist. Female and

male sterilisations are highly effective methods of contraception but do not provide protection

against STIs.

Female sterilisation

This procedure blocks the fallopian tubes, preventing an egg from passing down the tube and

being fertilised. The two common surgical methods used are:

 Tubal ligation (having your tubes tied)– performed under general anaesthetic.

 Essure micro-inserts – doesn’t require a general anaesthetic.

Vasectomy (male sterilisation)

This involves blocking sperm by cutting the tubes they pass through from the testes to the penis.

Emergency contraception-Postinor 2

Sometimes it is necessary to prevent pregnancy after sex rather than before: for example, when a

pill is forgotten or a condom breaks, or in the case of rape. Emergency contraception is a

hormonal method of contraception that prevents or delays ovulation in that cycle. It may also

stop a fertilised egg from sticking to the wall of the uterus. It is 85 per cent effective. Emergency

contraception was previously known as the ‘morning after’ pill. There are different types of

emergency pills available. The most commonly used form – two tablets of progestogen hormone
– can be prescribed by a doctor or is available over the counter at most pharmacies. These pills

should be taken as soon as possible after sex and must be started within 120 hours of unprotected

sex.

Natural methods

Natural family planning is based on an understanding of the menstrual cycle. Monitoring cervical

mucus changes, body temperature changes and rhythm or cycle calculations are different

methods used to help determine when a woman is most likely to be fertile each month. The

effectiveness of natural family planning varies in relation to whether one or a combination of

methods is used. Confidence, correct use and effectiveness improve the longer the method is

used. Natural family planning methods do not protect against STIs.

Withdrawal

Withdrawal is the deliberate removal of the penis from the vagina before ejaculation so that

sperm is not deposited in or near the vagina. This method of contraception is not recommended,

because drops of fluid secreted by the penis when it first becomes erect can contain enough

sperm to cause pregnancy. In addition, a man may not withdraw in time. With typical use,

withdrawal is effective in preventing pregnancy 81 percent of the time. Withdrawal does not

protect against STIs.

Abstinence

Abstinence is the avoidance of any sexual activity that could cause pregnancy. This includes

intercourse and other sexual activities in which semen may come in contact with the vulva

(external female genitals) or vagina. Abstinence is completely effective in preventing pregnancy

as well as STIs, and it poses no health risks.

 Summary
A number of birth control methods are available that work in different ways to prevent
pregnancy. This table provides an overview of each method, how it works, its effectiveness in
preventing pregnancy, and its benefits and drawbacks.

Birth Control Effectiveness in Preventing Benefit Risks or Possible

Method Description Pregnancy s Problems
Birth Control Prescription drug 95% • More regular • Not effective
Pill containing female sex periods, reduced against
hormones; a woman cramping, and less transmission of
takes one pill daily for severe symptoms of sexually
21 days; prevents premenstrual transmitted
ovaries from releasing syndrome (PMS), infections (STIs)
an egg, thickens such as headache, • Rare but
cervical mucus to keep fatigue, and dangerous
sperm from reaching an irritability complications,
egg, and/or prevents the • No action required including blood
lining of the uterus from prior to sexual clotting and
thickening so that a intercourse, permits hypertension,
fertilized egg cannot sexual spontaneity particularly in
implant. • Some protection women over 35
against ovarian and years who smoke
endometrial cancer, • Must be taken
noncancerous breast daily
tumors, ovarian cysts
Cervical Cap Thimble-shaped latex 80% in women • Reusable • Not effective
cap inserted into a who have not • Can last for one to against STI
woman's vagina over given birth; two years transmission
cervix to prevent sperm 60% in women • Needs to be
from entering uterus; who have given fitted by a health-
used with spermicide. birth. care professional
• Difficult to fit
women with an
unusual cervix
size
• Difficult for
some women to
insert
Contraceptive Hormonal injection 99% • No action required • Not effective
Injection given by a health-care prior to sexual against STI
professional in a intercourse, permits transmission
woman's arm or sexual spontaneity • Requires regular
buttock; prevents • Effective for one to visits to a health-
ovaries from releasing three months, care professional
 an egg, thickens depending on type to administer the
cervical mucus to keep used injection
sperm from reaching an • May cause
egg, and/or prevents the irregular bleeding,
lining of the uterus from weight gain, sore
thickening so that a breasts, nausea,
fertilized egg cannot and acne
implant.
Contraceptive Skin patch worn by a 95% to 99% • No action required • Not effective
Patch woman for 21 days on prior to sexual against STI
the buttocks, stomach, intercourse, permits transmission
upper arm, or upper sexual spontaneity • Rare but
torso; releases low • Regular use may dangerous
doses of female sex result in shorter, more complications,
hormones; prevents regular menstrual including blood
ovaries from releasing periods, while also clotting and
an egg, thickens decreasing hypertension,
cervical mucus to keep premenstrual particularly in
sperm from reaching an cramping and women over 35
egg, and/or prevents the menstrual-related years who smoke
lining of the uterus from iron deficiency and • Some
thickening so that a acne. medications,
fertilized egg cannot including
implant. antibiotics and
anti-seizure,
tuberculosis, and
migraine drugs,
can interfere with
effectiveness
Contraceptive Flexible ring inserted in 95% to 99% • No action required • Not effective
Ring a woman's vagina for 21 prior to sexual against STI
days; releases low doses intercourse, permits transmission
of female sex sexual spontaneity • May cause
hormones; prevents • Regular use may vaginal irritation
ovaries from releasing result in shorter, more and discharge
an egg, thickens regular menstrual • May cause
cervical mucus to keep periods, while also irregular bleeding,
sperm from reaching an decreasing weight gain or
egg, and/or prevents the premenstrual loss, breast
lining of the uterus from cramping and tenderness,
thickening so that a menstrual-related nausea, vomiting,
fertilized egg cannot iron deficiency and headache, and
implant. acne mood change
Diaphragm Shallow rubber cup 80% • Reusable • Not effective
with flexible rim • Can last for one to against STI
 inserted into a woman's two years transmission
vagina over cervix to • Needs to be
prevent sperm from fitted by a health-
entering uterus; used care professional
with spermicide. • Must be inserted
before each act of
sexual intercourse
Emergency Methods used by a • Emergency • Prevents pregnancy • Not effective
Contraception woman after contraceptive when primary birth against STI
unprotected intercourse pills: 79% to control fails during transmission
to prevent fertilization 85% if taken sex (for instance, if • Needs to be
of the egg or within 72 hours condom breaks or prescribed by a
implantation of the after diaphragm or cervical health-care
fertilized egg in the unprotected cap dislodges); one or professional
uterus. Two methods intercourse more birth control
are available: • IUD: 99% if pills are skipped; or a
emergency inserted within woman is forced to
contraceptive pills or 7 days of have unprotected
emergency insertion of unprotected vaginal intercourse
an intrauterine device intercourse against her will
(IUD).
Female Polyurethane sac 79% • Reduces the risk of • Lessens
Condom inserted into a woman's many STIs sensation
vagina over cervix to • Available over-the- • May break
prevent sperm from counter during intercourse
entering uterus; may be • Inexpensive
used with a spermicide.
Fertility Collection of techniques 80% • No medical or • Not effective
Awareness used by a woman, hormonal side effects against STI
Methods including checking • Inexpensive transmission
body temperature or • Requires
cervical mucus daily or commitment to
recording menstrual consistently and
cycles on a calendar, to accurately
determine the days monitor fertility
when body is most • More than one
fertile; abstinence or the fertility awareness
use of a barrier method method should be
during this fertile period used to improve
can prevent pregnancy. effectiveness
Hormonal Six small capsules 99.9% • Most effective form • Not effective
Implant inserted by a health- of birth control after against STI
care professional under continuous transmission
the skin of a woman's abstinence and • Possible scarring
upper arm; delivers sterilization surgery or, rarely,
 small amounts of sex • Protects against infection at
hormones to prevent pregnancy for up to insertion site
ovaries from releasing five years • May cause
egg. • No action required irregular bleeding,
prior to sexual headache, nausea,
intercourse, permits depression
sexual spontaneity
Intrauterine Small device inserted 96% • Effective one to ten • Not effective
Device (IUD) by a health-care years, depending on against STI
professional into a type used transmission
woman's uterus; • No action required • May cause
prevents eggs from prior to sexual spotting between
being fertilized and/or intercourse, permits periods, longer,
implanting in uterus. sexual spontaneity heavier periods,
and cramping
• Rare risk of
uterine
perforation or
ectopic pregnancy
Male Condom Sheath of latex, 86% • Reduces the risk of • Lessens
polyurethane, or animal many STIs sensation
tissue placed on erect • Available over-the- • May break
penis; may be used with counter during intercourse
a spermicide. • Inexpensive
Spermicide Sperm-killing 74% • Available over the • Only partially
chemicals in the form of counter effective against
foams, creams, jellies, • Can be used with STI transmission
films, or suppositories other methods to • Possible
that are inserted into a improve effectiveness allergies or
woman's vagina to irritation
block the cervix,
preventing sperm from
fertilizing an egg.
Tubal Surgical procedure to 99.9% • Permanently • Not effective
Sterilization permanently block a prevents pregnancy against STI
woman's fallopian tubes • No action required transmission
to prevent eggs from prior to sexual • Reactions to
reaching sperm. intercourse, permits surgery may
sexual spontaneity include infection,
bleeding, injury to
intestine, reaction
to anaesthesia
• Increased
chance of ectopic
pregnancy
 • Generally
irreversible
Vasectomy Surgical procedure to 99.9% • Permanently • Not effective
permanently block a prevents pregnancy against STI
male's vas deferens • No action required transmission
(sperm duct) to prevent prior to sexual • Reactions to
sperm from reaching intercourse, permits surgery may
eggs. sexual spontaneity include infection,
blood clot near
testes, bruising,
swelling, or
tenderness of
scrotum
• Generally
irreversible