4. Abstinence
What Is Abstinence?
You may have heard people talk about abstinence in
different ways. Some people think of abstinence as not
having vaginal intercourse. They may enjoy other kinds of
sex play that don't lead to pregnancy. This is better
described as outercourse.
Some people define abstinence as not having vaginal
intercourse when a woman might get pregnant. This is
better described as periodic abstinence, which is one of the
fertility awareness-based methods of birth control.
And some people define abstinence as not having any kind
of sex play with a partner. This is the definition we use on
these pages.
Being continuously abstinent is the only way to be
absolutely sure that you won't have an unintended
pregnancy or get a sexually transmitted disease (STD).
5. Abstinence
How Does Abstinence Prevent Pregnancy? Abstinence
prevents pregnancy by keeping sperm out of the vagina.
How Effective Is Abstinence? Used continuously,
abstinence is 100 percent effective in preventing
pregnancy. It also prevents STDs.
How Safe Is Abstinence? Abstinence is one of the
safest ways to prevent pregnancy — there are no side
effects.
6. Abstinence
What Are the Benefits of Abstinence?
has no medical or hormonal side effects
Is free
Women and men abstain from sex play for many reasons — even after they've
been sexually active. A couple may even choose to be abstinent after having had
sex play with each other. The reasons people choose to be abstinent may change
throughout life.
People choose abstinence to
prevent pregnancy
prevent STDs
wait until they're ready for a sexual relationship
wait to find the right partner
have fun with romantic partners without sexual involvement
focus on school, career, or extracurricular activities
support personal, moral, or religious beliefs and values
get over a breakup
heal from the death of a partner
follow medical advice during an illness or infection
7. Abstinence
What Are the Disadvantages of Abstinence?
There are few disadvantages to abstinence.
People may find it difficult to abstain for long periods of
time and may end their period of abstinence without
being prepared to protect themselves against
pregnancy or infection.
8. Abstinence
How Do I Talk with My Partner About Being Abstinent?
Talking with your partner about your decision to abstain from sex
play is important — whether or not you've had sex play before.
Partners need to be honest with each other and make sexual
decisions together. These are some of the best ways to keep a
relationship happy. Even so, it may not be easy to do. You may
feel awkward or embarrassed.
It's best to talk about your feelings before things get sexual. For
many people it's hard to be clear about what they want if they get
aroused. It is helpful to think — ahead of time — about how you
can say "no" to sex play. What behavior will be clear? What words
will be best? You can practice saying the words out loud. Then
think about how someone might respond to you.
Take the time to consider fully what being abstinent will mean for
you. It is important to know what you are thinking and feeling and
what you need. Then you can tell your partner about it.
Be straightforward about the limits you want to set.
10. Implanon
What Is Implanon?
Implanon is a thin, flexible plastic implant
about the size of a cardboard matchstick. It is
inserted under the skin of the upper arm. It
protects against pregnancy for up to three
years
11. Implanon
How Does Implanon Work?
Like several other methods of birth control, such as the birth
control shot, Implanon releases a hormone — progestin.
Hormones are chemicals made in our bodies. They control
how different parts of our bodies work.
The progestin in Implanon works by keeping a woman's
ovaries from releasing eggs — ovulation. Pregnancy cannot
happen if there is no egg to join with sperm. The hormone in
the implant also prevents pregnancy by thickening a
woman's cervical mucus. The mucus blocks sperm and
keeps it from joining with an egg.
The hormone also thins the lining of the uterus. In theory, this
could prevent pregnancy by keeping a fertilized egg from
attaching to the uterus.
12. Implanon
How Effective Is Implanon?
Effectiveness is an important and common concern when
choosing a birth control method. Implanon is very effective. Less
than 1 out of 100 women a year will become pregnant using
Implanon. It lasts up to three years.
Certain medicines and supplements may make Implanon less
effective. These include
the antibiotic rifampin — other antibiotics do not make Implanon
less effective
certain medicines that are taken by mouth for yeast infections
certain HIV medicines
certain anti-seizure medicines
St. John's wort
Keep in mind Implanon doesn't protect against sexually
transmitted diseases. Use a latex or female condom to reduce the
risk of infection.
13. Implanon
How Safe Is Implanon?
Most women can use Implanon safely. But all
medications have some risks, so safety is a concern
when choosing a birth control method. Talk with your
health care provider about your health and whether
Implanon is likely to be safe for you. You should not
use Implanon if you are pregnant or have breast
cancer.
There are many other methods of birth control that may
be safe for you if you cannot use Implanon. Read about
other methods to find one that may be right for you.
14. Implanon
What Are the Benefits of Implanon?
Using Implanon is safe, simple, and convenient. Women
like the implant because
The ability to become pregnant returns quickly when you
stop using Implanon.
It can be used while breastfeeding.
It can be used by women who cannot take estrogen.
It gives continuous long-lasting birth control without
sterilization.
There is no medicine to take every day.
Nothing needs to be put in place before vaginal
intercourse.
15. Implanon
What Are the Disadvantages of Implanon?
Some women may have undesirable side effects while using
Implanon. But many women adjust to it with few or no problems.
Irregular bleeding is the most common side effect, especially in the
first 6–12 months of use.
For most women, periods become fewer and lighter. After one year,
1 out of 3 women who use Implanon will stop having periods
completely.
Some women have longer, heavier periods.
Some women have increased spotting and light bleeding between
periods.
These side effects are completely normal. Some woman may
worry that they are pregnant if they do not have a regular period.
But when Implanon is used correctly, it is very effective. If you are
concerned about a possible pregnancy, you can always take a
pregnancy test.
16. Implanon
Less common side effects of Implanon include
change in sex drive
discoloring or scarring of the skin over the implant
Headache
Nausea
pain at the insertion site
sore breasts
Serious Side Effects of Implanon
Many women have concerns about the possible risks of taking hormones
in birth control. Serious problems do not occur often.
Serious problems usually have warning signs. Tell your health care
provider immediately if
You have bleeding, pus, or increasing redness, or pain at insertion site.
You have a new lump in your breast.
You have no period after having a period every month.
You have unusually heavy or prolonged bleeding from your vagina.
The implant comes out or you have concerns about its location.
17. Implanon
How Is Implanon Inserted and Removed?
After taking your medical history and giving you a physical exam,
your health care provider will numb a small area of your arm with
a painkiller. Implanon is inserted under the skin. Insertion takes
only a few minutes.
After insertion, be sure to tell any health care provider you may
see that you are using Implanon.
The implant is effective for three years after it is inserted. After
that, it should be removed. Even though it stops working, it may
interfere with your period.
Implanon can be removed at any time. Your health care provider
will numb the area with a painkiller and will usually make one
small cut to remove the implant. Removal usually takes just a
few minutes, but it generally takes longer than insertion. A new
implant may be inserted at this time. Pregnancy can happen
anytime after the implant is removed.
19. Birth Control Pills
What Are Birth Control Pills?
Birth control pills are a kind of medication that women
can take daily to prevent pregnancy. They are also
sometimes called “the pill” or oral contraception.
20. Birth Control Pills
How Do Birth Control Pills Work?
It's pretty common for people to be confused about how birth control pills
work. Here’s what it boils down to: birth control pills are made of
hormones. Hormones are chemicals made in our bodies. They control
how different parts of our bodies work.
Some birth control pills contain two hormones — estrogen and progestin.
These are called combination pills. Some are progestin-only pills. Most
women on the pill take combination pills. The hormones in the pill work
by keeping a woman’s ovaries from releasing eggs — ovulation.
Pregnancy cannot happen if there is no egg to join with sperm. The
hormones in the pill also prevent pregnancy by thickening a woman’s
cervical mucus. The mucus blocks sperm and keeps it from joining with
an egg.
The hormones also thin the lining of the uterus. In theory, this could
prevent pregnancy by keeping a fertilized egg from attaching to the
uterus.
21. Birth Control Pills
How Effective Are Birth Control Pills?
Effectiveness is an important and common concern when choosing a birth control method.
Birth control pills are very effective. Combination pills work best when taken every day.
Progestin-only pills must be taken at the same time every day. That keeps the correct level of
hormone in a woman’s body.
Less than 1 out of 100 women will get pregnant each year if they always take the pill each
day as directed.
About 9 out of 100 women will get pregnant each year if they don’t always take the pill each
day as directed.
The pill may be slightly less effective for women who are very overweight. Talk with your
health care provider if you are concerned about how well the pill may work for you.
Certain medicines and supplements may make the pill less effective. These include
the antibiotic rifampin — other antibiotics do not make the pill less effective
certain medicines that are taken by mouth for yeast infections
certain HIV medicines
certain anti-seizure medicines
St. John's wort
Vomiting and diarrhea may also keep the pill from working. Ask your health care provider for
advice. Use a backup method of birth control — like a condom, female condom, diaphragm,
sponge, or emergency contraception (morning after pill) — until you find out you don’t need
to. Keep in mind the pill doesn’t protect against sexually transmitted infections. Use a latex
or female condom to reduce the risk of infection.
22. Birth Control Pills
How Safe Are Birth Control Pills?
Most women can use birth control pills safely. But all medications have some risks, so
safety is a concern when choosing a birth control method. Certain conditions increase the
risk of serious side effects. Some of these conditions may even rule out using the pill. Talk
with your health care provider to find out if the pill is likely to be safe for you. You should
not take any kind of birth control pill if you have had breast cancer or think you might be
pregnant. You should not take the progestin-only pill if you have blood clotting problems
that are not being treated successfully. You should not take the combination pill during
prolonged bed rest or if you • get migraine headaches with aura • have certain inherited
blood-clotting disorders • have or are being treated for blood clots or vein inflammation •
have had a heart attack, stroke, angina, or other serious heart problems • have had serious
heart valve problems • have lupus with certain conditions • have serious liver disease or
have had liver cancer • have very bad diabetes or have had diabetes for longer than 20
years • have uncontrolled high blood pressure • smoke and are 35 or older • smoke and
have high blood pressure • have had complications after organ transplant • need to stay in
bed for a long time
23. Birth Control Pill
What Are the Benefits of Birth Control Pills?
Taking the pill is simple, safe, and convenient. It does not interfere with having sex. Many women say it
improves their sex lives because it helps them feel more spontaneous.
Women who do not need birth control often choose to take the pill for the other benefits it offers. Combination
and progestin-only pills
reduce menstrual cramps
make periods lighter
offer some protection against pelvic inflammatory disease, which often leads to infertility when left untreated
The combination pill offers many other benefits, including some protection against
Acne
bone thinning
breast growths that are not cancer
ectopic pregnancy
endometrial and ovarian cancers
serious infection in the ovaries, tubes, and uterus
iron deficiency anemia
cysts in the breasts and ovaries
premenstrual symptoms, including headaches and depression
bad cramps
heavy and/or irregular periods
Combination pills can be used to control when and how often you have your period. Some pills are
specially packaged for women to have only a few periods a year. Other pills can also be used
continuously to prevent having periods. With these pills, women take an active pill every day to keep from
getting their periods. It is normal for them to have spotting or bleeding the first 6 months. It may get less
over time. Some stop having any bleeding at all. This is normal and will not harm your body. But it’s a
good idea to get tested if you think you might be pregnant.
24. Birth Control Pills
What Are the Disadvantages of Birth Control Pills?
Some women may have undesirable side effects while taking birth control pills. But
many women adjust to the pill with few or no problems.
Some of the most common side effects usually clear up after two or three months.
They include
bleeding between periods (most often with progestin-only pills)
breast tenderness
nausea and vomiting
Nausea and vomiting may be helped by taking the pill in the evening or at bedtime. But
do not stop taking the pill because you feel sick to your stomach — you will be at risk of
pregnancy if you do. The hormones in the pill may change a woman’s sexual desire.
It’s important that you find a method that won’t make you feel sick or uncomfortable. If
you continue to experience side effects after taking the pill for three months, talk with
your health care provider about changing your prescription. After stopping the pill, it
usually takes one or two months for a woman’s periods to return to the cycle she had
before taking the pill. Once in a while, a woman may have irregular periods or no periods
at all. This may go on for as long as six months after stopping. This is more likely if her
periods were irregular before starting the pill.
25. Birth Control Pill
Serious problems usually have warning signs.
Report any of these signs to your health care provider
as soon as possible:
a new lump in your breast
a sudden very bad headache
achy soreness in the leg
aura — seeing bright, flashing zigzag lines, usually
before a very bad headache
bad pain in your abdomen or chest
headaches that are different, worse, or happen more
often than usual
no period after having a period every month
trouble breathing
yellowing of the skin or eyes
27. Condoms
What Are Condoms? Condoms are worn on the penis during
intercourse. They are made of thin latex or plastic that has been
molded into the shape of a penis. Sometimes they are called
rubbers, safes, or jimmies. They prevent pregnancy and reduce
the risk of sexually transmitted diseases. Condoms are
available in different styles and colors, and are available dry,
lubricated, and with spermicide.
How Do Condoms Work? Condoms prevent pregnancy by
collecting pre-cum and semen when a man ejaculates. This
keeps sperm from entering the vagina. Pregnancy cannot
happen if sperm cannot join with an egg. By covering the penis
and keeping semen out of the vagina, anus, or mouth, condoms
also reduce the risk of sexually transmitted infections.
28. Condoms
How Effective Are Condoms?
Effectiveness is an important and common concern when choosing a birth control method.
Like all birth control methods, condoms are more effective when you use them correctly.
Each year, 2 out of 100 women whose partners use condoms will become pregnant if they always use
condoms correctly.
Each year, 18 out of 100 women whose partners use condoms will become pregnant if they don't
always use condoms correctly.
You can make condoms more effective if you
use spermicide with them
pull out before ejaculation.
Effectiveness is also a concern when it comes to safer sex. Condoms also protect both you and
your partner from sexually transmitted infections. Condoms that are made of latex offer very good
protection against HIV. Latex condoms also reduce the risk of other sexually transmitted infections,
including
Chlamydia
Chancroid
Gonorrhea
Hepatitis
Herpes
HPV
pelvic inflammatory disease (PID)
Syphilis
trichomoniasis
Condoms can also prevent urinary tract infections in men who wear them.
29. Condoms
How Safe Are Condoms? Almost everyone can use a condom safely.
Some people are allergic to latex. If you are allergic to latex, you can try
using a condom that is made from plastic.
What Are the Benefits of Condoms? Using condoms is safe, simple, and
convenient. Women and men like condoms because they
let men help prevent pregnancy and sexually transmitted infections
are inexpensive and easy to get
are lightweight and disposable
do not require a prescription
can help relieve premature ejaculation
may help a man stay erect longer
can be put on as part of sex play
can be used with all other birth control methods except the female condom to
provide very effective pregnancy prevention and to reduce risk of sexually
transmitted diseases
Many women and men say they have better sex when they use condoms. They are
able to focus on their sexual pleasure without worrying about unintended
pregnancy and sexually transmitted infection. Some couples put the condom on as
part of their foreplay.
30. Condoms
What Are the Disadvantages of Condoms?
Most women and men can use condoms with no problem.
Condoms have no side effects except for people who are allergic
to latex. Up to 6 out of 100 people have such allergies. If you are
allergic to latex, you can use condoms or female condoms made
of plastic instead.
Some men and women feel that the condom dulls sensation.
Others become frustrated and lose some of their sexual
excitement when they stop to put on a condom. Some men are
self-conscious about using condoms. Others feel pressured to
ejaculate. And some men feel pressured about having to maintain
an erection to keep the condom on. (If this is a concern,
maintaining an erection is not necessary when using the female
condom.)
Many men overcome these pressures and learn to enjoy using
condoms by using them during sex play before intercourse. It may
also help to try different styles and sizes to find the condom that is
most comfortable for you and your partner.
31. Condoms
Putting on a Condom
Each package of condoms includes detailed instructions. Be sure to read and
understand the instructions and check the expiration date before you use a
condom.
Put the condom on before the penis touches the vulva. Men leak fluids from their
penises before and after ejaculation. This fluid can carry enough germs to pass
sexually transmitted infections and possibly cause pregnancy.
Use a condom only once. Use a fresh one for each erection ("hard-on"). Have a
good supply on hand.
Condoms usually come rolled into a ring shape. They are individually sealed in
aluminum foil or plastic. Be careful — don't tear the condom while unwrapping it. If
it is torn, brittle, stiff, or sticky, throw it away and use another.
Put a drop or two of lubricant inside the condom.
Pull back the foreskin, unless circumcised, before rolling on the condom.
Place the rolled condom over the tip of the hard penis.
Leave a half-inch space at the tip to collect semen.
Pinch the air out of the tip with one hand while placing it on the penis.
Unroll the condom over the penis with the other hand.
Roll it all the way down to the base of the penis.
Smooth out any air bubbles. (Friction against air bubbles can cause condom
breaks.)
Lubricate the outside of the condom
32. Condoms
How Do I Take Care of Condoms?
It is important to handle and store condoms properly. Long
exposure to air, heat, and light makes them more likely to break.
Store them in a cool, dry place.
Don’t store them in a back pocket, wallet, or glove compartment
for long periods of time.
Keep them in their individual foil or plastic pouch.
When you are ready to use the condom, don’t use it if the pouch
is punctured or torn. Do not use your teeth or sharp objects, like
scissors, to open the pouch. Use only water-based lubricants,
such as K-Y jelly or Astroglide, with latex condoms. Oil-based
lubricants like petroleum jelly, cold cream, butter, or mineral and
vegetable oils damage latex.
34. Diaphragm
What Is the Diaphragm?
The diaphragm (DIE ah fram) is a shallow, dome-
shaped cup with a flexible rim. It is made of silicone.
You insert it into the vagina. When it is in place, it
covers the cervix.
How Does the Diaphragm Work?
Diaphragms prevent pregnancy by keeping sperm
from joining with an egg. In order to be as effective as
possible, the diaphragm must be used with spermicide
cream, gel, or jelly.
Diaphragms work in two ways:
The diaphragm blocks the opening to the uterus.
The spermicide stops sperm from moving.
35. Diaphragm
How Effective Is the Diaphragm?
Effectiveness is an important and common concern when choosing a
birth control method. Like all birth control methods, the diaphragm is
more effective when you use it correctly.
If women always use the diaphragm as directed, 6 out of 100 will
become pregnant each year.
If women don't always use the diaphragm as directed, 12 out of 100 will
become pregnant each year.
You can make the diaphragm more effective if you
Make sure it covers your cervix before each time you have intercourse.
Make sure spermicide is used as recommended.
Your partner can help you make the diaphragm more effective by using a
latex condom or pulling out before ejaculation.
Keep in mind that diaphragms do not protect you from sexually
transmitted infections. Use a latex condom to reduce the risk of infection.
36. Diaphragm
How Safe Is the Diaphragm?
Most women can use the diaphragm safely. But some conditions may make it
difficult or impossible for some women to use a diaphragm.
The diaphragm may not be right for you if you
are not comfortable touching your vagina and vulva
are sensitive to silicone or spermicide
gave birth in the last six weeks
have certain physical problems with your uterus or vagina
have difficulty inserting the diaphragm
have frequent urinary tract infections
have a history of toxic shock syndrome
have poor muscle tone in your vagina
recently had surgery on your cervix
recently had an abortion after the first trimester of pregnancy
Your health care provider can help you decide if the diaphragm is likely to be
safe for you.
Only for You
Your diaphragm should be used by you and only you. Do not share it with
friends. And don't ever use anyone else's diaphragm.
37. Diaphragm
What Are the Benefits of the Diaphragm? Using a diaphragm is
safe, simple, and convenient. Women like the diaphragm because
It can be carried in your pocket or purse.
It can be used during breastfeeding.
It generally cannot be felt by you or your partner.
It has no effect on a woman's natural hormones.
It is immediately effective and reversible.
There is no interruption of sex play — it can be inserted hours ahead
of time.
What Are the Disadvantages of the Diaphragm? The diaphragm
may be difficult for some women to insert
may be pushed out of place by some penis sizes, heavy thrusting, and
certain sexual positions
must be in place every time a woman has vaginal intercourse
may need to be refitted
38. Diaphragm
Side Effects
Most women can use the diaphragm with no problems. Serious problems are
very rare. But some women may experience some side effects.
Some women who use diaphragms may develop frequent urinary tract
infections. To avoid infection, you can urinate before inserting the diaphragm
and after intercourse. If you get frequent bladder infections, ask your health care
provider to check to see if your diaphragm fits correctly.
Some women who use diaphragms may develop vaginal irritation. This can be a
sign of a sensitivity to silicone or to spermicide. If you have a mild reaction, try
switching brands of spermicide to clear up the problem. If that doesn't work, stop
using the diaphragm until you speak with your health care provider.
Check with your health care provider if you
feel a burning sensation while urinating
are uncomfortable when the diaphragm is in place
have irregular spotting and bleeding
feel irritation or itching in the genital area
have redness or swelling of the vulva or vagina
have unusual discharge from the vagina
These symptoms may be a sign of infection or other condition. Most conditions
are easily treated.
39. Diaphragm
How Do I Take Care of My Diaphragm?
If you take good care of your diaphragm, it may last about two years. Taking
care of the diaphragm is simple.
After you remove the diaphragm, wash it with mild soap and warm water.
Allow it to air dry.
Do not use any powders on the diaphragm — they can cause infections.
Do not use oil-based lubricants — such as Vaseline or cold cream — with your
diaphragm. They can damage silicone.
Be sure to examine the diaphragm regularly. You can look for small holes or
weak spots by holding it up to the light. If there is a hole or weak spot, light will
shine through the diaphragm. You can also fill the cup of the diaphragm with
water and look for leaks.
Diaphragms can still be used if the silicone becomes discolored. But if
the silicone develops cracks or holes it has become too thin.
Stop using your diaphragm if you find that it has holes, weak spots, cracks, or
wrinkles. Talk to your health care provider about getting a replacement. In the
meanwhile, use another form of birth control, such as a condom, female
condom, or sponge.
41. Female Condom
What Are Female Condoms? The female condom is a plastic
pouch that is used during intercourse to prevent pregnancy and
reduce the risk of sexually transmitted diseases. It has flexible
rings at each end. Just before vaginal intercourse, it is inserted
deep into the vagina. The ring at the closed end holds the pouch in
the vagina. The ring at the open end stays outside the vaginal
opening during intercourse. And during anal intercourse, it is
inserted into the anus.
How Do Female Condoms Work? Female condoms work to
prevent pregnancy by covering the inside of the vagina. They
collect pre-cum and semen when a man ejaculates. This keeps
sperm from entering the vagina. Pregnancy cannot happen if
sperm cannot join with an egg. By covering the inside of the
vagina or anus and keeping semen and pre-cum out, condoms
reduce the risk of sexually transmitted infections.
42. Female Condom
How Effective Are Female Condoms?
Effectiveness is a common concern when choosing a birth
control method.
Like all birth control methods, the female condom is more
effective when you use it correctly.
If women always use the female condom correctly, 5 out of
100 will become pregnant each year.
If women don't always use the female condom correctly,
21 out of 100 will become pregnant each year.
You can make the female condom more effective if you
usespermicide or if your partner pulls out before ejaculation.
43. Female Condoms
How Safe Are Female Condoms? Almost everyone can use female
condoms safely. In fact, female condoms can be used by just about
any woman who can use a tampon. They are also safe to use during
anal sex.
What Are the Benefits of Female Condoms? Using a female
condom is safe, simple, and convenient. Women and men like female
condoms because female condoms
allow women to share responsibility for preventing infection
are easy to get — can be purchased in drugstores and some supermarkets
can be inserted by a partner as part of sex play
can be used by people who are allergic to latex
can be used with oil-based as well as water-based lubricants
do not have an effect on a woman's natural hormones
do not require a prescription
may enhance sex play — the external ring may stimulate the clitoris during
vaginal intercourse
stay in place whether or not a man maintains his erection
44. Female Condoms
What Are the Disadvantages of Female
Condoms?
Most people can use female condoms with no
problems for themselves or their partners.
Some women and men may not like the female
condom because it may
cause irritation of the vagina, vulva, penis, or anus
slip into the vagina during vaginal intercourse, or into
the anus during anal intercourse
reduce feeling during intercourse
be noisy — adding extra lubricant can help if the
female condom is noisy
45. Female Condom
How Do I Use Female Condoms?
With a little practice, female condoms are very easy to use.
To insert the female condom
Put spermicide or lubricant on the outside of the closed end.
Find a comfortable position. You can stand with one foot on a chair, sit on the
edge of a chair, lie down, or squat.
Squeeze together the sides of the inner ring at the closed end of the condom
and insert it into the vagina like a tampon.
Push the inner ring into the vagina as far as it can go — until it reaches the
cervix.
Pull out your finger and let the outer ring hang about an inch outside the
vagina.
If you want to use the female condom for anal intercourse, follow above
instructions for inserting it into the anus.
During vaginal intercourse, it is normal for the female condom to move side to
side. Stop intercourse if the penis slips between the condom and the walls of
the vagina or if the outer ring is pushed into the vagina. As long as your
partner has not yet ejaculated, you can gently remove the condom from the
vagina, add extra spermicide or lubricant, and insert it once again.
46. Female Condom
To remove the female condom
Squeeze and twist the outer ring to keep semen inside
the pouch.
Gently pull it out of the vagina or anus.
Throw it away. Do not flush it down the toilet.
Do not reuse the female condom.
48. Fertility Awareness Based
Methods
What Are Fertility Awareness-Based Methods? Fertility
awareness-based methods (FAMs) are ways to track
ovulation — the release of an egg — in order to prevent
pregnancy. Some people call FAMs "natural family
planning."
How Do Fertility Awareness-Based Methods Work?
FAMs work by keeping sperm out of the vagina in the days
near ovulation, when a woman is most fertile — most likely to
become pregnant. To prevent pregnancy, women can
abstain from vaginal intercourse on their fertile days. Or they
can use withdrawal, a condom, a sponge, a diaphragm, or a
cap on those days. Or they may enjoy other kinds of sex play
instead of vaginal intercourse on their fertile days.
49. Fertility Awareness Based Methods
(FAMS)
UNDERSTANDING YOUR FERTILITY PATTERN
In order to know when you are most likely to get pregnant, you have to become familiar with
your menstrual cycle.
Before pregnancy can begin, a woman's egg must join with a man's sperm. This is called
fertilization. For a healthy woman, there are days when fertilization can happen. There are days
when it can't. And there are some days when it's unlikely — but still possible. To begin a
pregnancy, a woman can have vaginal intercourse — without protection — during the days when
it's possible for the egg and sperm to join. We call those days your fertile days.
A woman's fertile days depend on the life span of the egg and the sperm. Her egg lives for about
a day after ovulation. Sperm can live inside her body for about six days.
A woman has a chance of her egg joining a sperm about seven days of every menstrual cycle.
This includes the five days before ovulation.
It includes the day of ovulation.
It also includes the day or two after ovulation — even though it's less likely to happen then.
Knowing when your fertile days will happen can help you avoid a pregnancy. It can also help you
plan one. The key is to figure out when you will ovulate. This will let you figure out the other
fertile days that come before and after you ovulate. Then you can track your fertility pattern —
the days of the month when you are fertile and the days of the month when you are not. You
must do this carefully. Women don't all have the same fertility pattern. And some women have
different patterns from one month to the next.
50. Fertility Awareness Based
Methods (FAMS)
What Are the Different Fertility Awareness-Based Methods?
There are several methods you can use to predict when you will ovulate.
Temperature Method — You will take your temperature in the morning every
day before you get out of bed.
Cervical Mucus Method — You will check the changes in your cervical mucus
every day for the first part of your cycle until you are sure you have ovulated.
Calendar Method — You will chart your cycles on a calendar.
It is most effective to combine all three of these methods. Together, they are
called the symptothermal method.
Standard Days Method — You will track your cycle for several months to be
sure that your cycle is always between 26 and 32 days long. Never longer or
shorter. Then, you will not have unprotected vaginal intercourse on days 8–
19.
51. Fertility Awareness Based
Methods (FAMS)
What is the Calendar Method?
To prevent pregnancy, women can keep track of their menstrual cycles
and abstain from unprotected vaginal intercourse when they are most
likely to become pregnant. The methods you can use to do this are called
fertility awareness-based methods (FAMs).
One way that women track their fertility patterns is called the calendar
method.
The Calendar Method
With the calendar method, you need to keep a record of the length of
each menstrual cycle in order to determine when you are fertile. You can
use an ordinary calendar. Circle day one of each cycle, which is the first
day of your period. Count the total number of days in each cycle. Include
the first day when you count. Do this for at least eight cycles (12 is
better).
52. Fertility Awareness Based
Methods (FAMS)
Cycle Record
First Day of Period Number of Days in Cycle
Jan. 20 29
Feb. 18 29
Mar. 18 28
Apr. 16 29
May 12 26
June 9 28
July 9 30
Aug. 5 27
Don't use the calendar method if all your cycles are shorter
than 27 days.
53. Fertility Awareness Based Methods
(FAMS)
Chart Your Calendar Pattern
To predict the first fertile day in your current cycle
Find the shortest cycle in your record.
Subtract 18 from the total number of days.
Count that number of days from day one of your current cycle, and mark
that day with an X. Include day one when you count.
The day marked X is your first fertile day.
To predict the last fertile day in your current cycle
Find the longest cycle in your record.
Subtract 11 days from the total number of days.
Count that number of days from day one of your current cycle, and mark
that day with an X. Include day one when you count.
The day marked X is the last fertile day.
54. Fertility Awareness Based
Methods (FAMS)
Here is an example:
Predicting your first fertile day. If your shortest cycle is 26
days long, subtract 18 from 26. That leaves 8. If day one
was the fourth day of the month, the day you will mark X will
be the 11th. That's the first day you're likely to be fertile. So
on that day, you should start abstaining from sex or start
using a cervical cap, condom, diaphragm, or female
condom.
Predicting your last fertile day. If your longest cycle is 30
days, subtract 11 from 30. That leaves 19. If day one was
the fourth day of the month, the day you will mark X will be
the 22nd. That's the last day you're likely to be fertile during
your current cycle. So you may start to have unprotected
vaginal intercourse after that day.
In this example, the 11th through the 22nd are unsafe days.
All the others are safe days.
55. Fertility Awareness Based
Methods (FAMS)
The Role of the Calendar Method
The calendar method can only predict what
are most likely to be safe days. It is
especially risky if your cycles are not always
the same length. That's why it should always
be used with other methods. Do not have
unprotected intercourse on any day that the
calendar method says is unsafe
56. Fertility Awareness Based Methods
(FAMS)
How Effective Are Fertility Awareness-Based Methods?
Effectiveness is an important and common concern when choosing a birth
control method. Like all birth control methods, fertility awareness-based
methods are more effective when you use them correctly.
Twenty-four out of every 100 couples who use fertility awareness-based
methods each year will have a pregnancy if they don't always use the
method correctly or consistently. Always practicing these methods correctly
will make them more effective.
How well fertility awareness-based methods work depends on both partners.
That's why it is important for both to learn about the methods and support
each other in their use.
These methods can work best for you if you
have received careful instruction
have only one sex partner and he is as committed to fertility awareness-
based methods as you are
have the discipline you need to check and chart your fertility signs
don't mind abstaining or using withdrawal, a cervical cap or diaphragm, a
sponge, spermicide, or latex or female condoms on your unsafe days
57. Fertility Awareness Based
Methods (FAMS)
How Safe Are Fertility Awareness-Based Methods? Fertility
awareness-based methods are very safe — there are no side
effects.
What Are the Benefits of Fertility Awareness-Based
Methods?
they cost very little.
They are safe.
They can be stopped easily to plan a pregnancy.
Calendars, thermometers, and charts are easy to get.
Medication is not needed.
58. Fertility Awareness Based Methods
(FAMS)
What Are the Disadvantages of Fertility Awareness-Based Methods?
Fertility awareness-based methods may not work for you if you
have more than one sex partner
have a sex partner who isn't as committed to fertility awareness-based methods as you are
don't want to keep close track of your safe days
are not able to abstain or use another method for at least 10 unsafe days during each cycle
take medicine that may affect reading the signs of these methods
Do not depend on tracking your fertility if you
have irregular periods
have a partner who is not cooperative
have a sexually transmitted infection or frequent abnormal vaginal discharges
cannot keep careful records
It may be more difficult to track your fertility if you are breastfeeding, are a teenager, or are getting
close to menopause. The hormone shifts may make the signs unpredictable.
Don't switch to a fertility awareness-based method after using a hormonal one, such as the pill. The
hormones will affect your cycle. Use a method without hormones while you're learning to track your
fertility.
59. IUD
What Is an IUD?
The letters IUD stand for "intrauterine device." IUDs are
small, "T-shaped" devices made of flexible plastic. A health
care provider inserts an IUD into a woman's uterus to
prevent pregnancy.
There are two brands of IUD available in the United States
— ParaGard and Mirena.
The ParaGard IUD contains copper. It is effective for 12 years.
The Mirena IUD releases a small amount of progestin, a
hormone. It is effective for five years.
60. IUD
How Does an IUD Work?
Both the ParaGard and the Mirena IUDs affect the way
sperm move, preventing them from joining with an egg. If
sperm cannot join with an egg, pregnancy cannot happen.
Both types also alter the lining of the uterus. Some people
say that this keeps a fertilized egg from attaching to the
lining of the uterus. But there is no proof that this actually
happens.
The progestin in the Mirena IUD helps prevent pregnancy.
Progestin works by keeping a woman's ovaries from
releasing eggs — ovulation. Pregnancy cannot happen if
there is no egg to join with sperm. Progestin also prevents
pregnancy by thickening a woman's cervical mucus. The
mucus blocks sperm and keeps it from joining with an egg.
61. IUD
How Effective Is the IUD?
Effectiveness is an important and common concern
when choosing a birth control method. IUDs are one of
the most effective forms of birth control available. Less
than 1 out of 100 women will get pregnant each year if
they use the ParaGard or the Mirena IUD.
Keep in mind that the IUD doesn't protect against
sexually transmitted infections. Use a latex or female
condom along with the IUD to reduce the risk of
infection.
62. IUD
How Safe Is the IUD?
Most women can use either the ParaGard or the Mirena IUD safely. But all medications have some risks, so
safety is a common concern when choosing a birth control method. Certain conditions increase the risk of
side effects. Talk with your health care provider about your health and whether an IUD is likely to be safe for
you. There are many other methods of birth control that may be safe for you if you cannot use an IUD.
You should not use an IUD if you
have had a pelvic infection following either childbirth or an abortion in the past three months
have or may have a sexually transmitted infection or other pelvic infection
think you might be pregnant
have cervical cancer that hasn't been treated
have cancer of the uterus
have unexplained bleeding in your vagina
have pelvic tuberculosis
have a uterine perforation during IUD insertion
A health care provider may find that the unique size, shape, or condition of a woman’s uterus does not allow
correct placement of an IUD. This is not common.
You should not use the ParaGard IUD if you
have, or may have, an allergy to copper or have Wilson's Disease — an inherited disease that blocks the body’s
ability to get rid of copper
You should not use the Mirena IUD if you
have severe liver disease
have, or may have, breast cancer
63. IUD
What Are the Benefits of an IUD?
The ParaGard and the Mirena IUDs are two of the least expensive, longest lasting forms of
birth control available to women today. There are many other benefits.
IUDs may improve your sex life. There is nothing to put in place before intercourse to
prevent pregnancy. Some women say that they feel free to be more spontaneous because
they do not have to worry about becoming pregnant.
The ParaGard IUD does not change a woman's hormone levels.
The Mirena IUD may reduce period cramps and make your period lighter. On average,
menstrual flow is reduced by 90 percent. For some women, periods stop altogether.
IUDs can be used during breastfeeding.
The ability to become pregnant returns quickly once the IUD is removed.
Some women may worry that they are pregnant if they do not have a regular period. But
the IUD is very effective. If you are concerned about a possible pregnancy, you can always
take a pregnancy test.
Overall, most women who get an IUD are satisfied with their choice. Ninety-nine percent of
IUD users are pleased with them.
64. IUD
What Are the Disadvantages of an IUD?
It's important to think about the possible side effects of using
an IUD.
You may have
mild to moderate pain when the IUD is put in
cramping or backache for a few days
spotting between periods in the first 3–6 months
irregular periods in the first 3–6 months — with Mirena
heavier periods and worse menstrual cramps — with
ParaGard
Pain relievers can usually reduce bleeding, cramping, and
other discomforts. If they are severe and do not seem to
lessen, tell your health care provider.
65. IUD
Serious problems with the IUD are rare. There are three main things to
watch out for when using an IUD:
The IUD can sometimes slip out of the uterus. Sometimes it comes all the way
out. Sometimes it only comes out a little. This is more likely to happen to
women who are younger and who have never had a baby. If the IUD slips out
of place, pregnancy can happen. If it comes out only part of the way, it has to
be removed.
In rare situations, a woman could develop an infection when using the IUD.
This happens if bacteria get into the uterus when the IUD is inserted. Most
infections develop within three weeks of having the IUD inserted. If the
infection is not treated, it can affect a woman's ability to become pregnant in
the future.
In very rare situations, when the IUD is inserted, it can push through the wall
of the uterus. This might sound painful, but it usually isn't. Usually, when this
happens, the health care provider will notice it and it can be fixed right away.
But if not, the IUD can move around and harm other parts of the body. When
this happens, surgery may be needed to remove the IUD.
Most often, if complications happen, they are easy to treat with medicine or
other treatments.
66. IUD
It's important to pay attention to any symptoms you might have after starting
the IUD. Tell your health care provider immediately if you
find the length of the string ends to be shorter or longer than they were at
first, when you feel for them with your fingers
are not able to feel the string ends when you check
feel the hard plastic bottom of the "T" part of the IUD against the cervix,
when you check
think you might be pregnant
have periods that are much heavier than normal or last much longer than
normal
have severe abdominal cramping, pain, or tenderness in the abdomen
have pain or bleeding during sex
have unexplained fever and/or chills
have flu-like symptoms, such as muscle aches or tiredness
have unusual vaginal discharge
have a missed, late, or unusually light period
have unexplained vaginal bleeding
67. IUD
How Soon After Getting an IUD Can I Have Sex?
You can have sex as soon as you like after the IUD is
inserted.
The ParaGard IUD is effective immediately.
The Mirena IUD is effective immediately if inserted within
seven days after the start of your period. If you have
Mirena inserted at any other time during your menstrual
cycle, use another method of birth control like a condom,
female condom, or spermicide if you have vaginal
intercourse during the first week after insertion.
Protection will begin after seven days.
68. IUD
What Happens When I Have an IUD Inserted?
To get an IUD, you need to visit a health care provider. Your health
care provider will ask you some questions about your medical
history and the way you live your life. It is important to be open
about your sex life because the IUD may not be right for you. But
don’t worry. There are many other birth control methods to choose
from if you cannot use the IUD.
If an IUD seems to be a good choice for you, your health care
provider will check your vagina and internal organs. You may be
tested for sexually transmitted infections or for other infections to
make sure it’s safe for you to get an IUD. If you have any kind of
pelvic infection, you may need treatment before getting an IUD.
An IUD can be inserted at any time of the month. But it is usually
more comfortable if you have it inserted in the middle of your
menstrual cycle. That is when the cervix — the opening to the
uterus — is the most open.
69. IUD
What Should I Do After Getting an IUD?
You should have a checkup after your first period. Don't
wait longer than three months after you get your IUD to
make sure it is still in place. Women using an IUD
should have regular checkups to make sure everything
is all right. This can be done at the same time as your
periodic GYN exam. Remember when you have your
IUD inserted. That way, if you see other health care
providers, you can tell them when it needs to be
replaced. The ParaGard IUD should be replaced after
12 years. The Mirena IUD should be replaced after five
years.
70. IUD
How Do I Check My IUD?
If an IUD is going to slip out of place, it will most likely happen in the first few months of
use. But it may occur later. The IUD is most likely to slip out of place during your period.
Check your pads, tampons, or cups to see if the IUD has fallen out. If it has, you must
check with your health care provider. Until then, use another form of birth control such as
latex or female condoms.
Between your periods, you can check for the string ends. It is especially important to
check every few days for the first few months.
To check for the string ends ...
Wash your hands. Then either sit or squat down.
Put your index or middle finger up into your vagina until you touch the cervix. Your cervix
will feel firm and somewhat rubbery, much like the tip of your nose.
Feel for the string ends that should be coming through. If you find them, it means that
the IUD is in place and working. However, if the string ends feel longer or shorter than
before, or if you feel the hard part of the IUD against your cervix, it may be that the IUD
has moved and needs to be put back in place by your health care provider. You should
not attempt to put the IUD back in place yourself. Be sure to use another form of birth
control until it is put back in place.
Do not pull on the string ends. Pulling might make the IUD move out of place or even
come out.
71. IUD
How Is an IUD Removed?
Having an IUD removed or replaced is usually simple.
Your health care provider will do it for you. Women
should never try to remove IUDs themselves or ask
nonprofessionals to do it for them. Serious damage
could result.
In rare cases, IUDs cannot be easily pulled free. In
these cases, the cervix may have to be dilated and a
surgical tool may be used to free the IUD. In very rare
cases, surgery becomes necessary
73. Emergency Contraception
What Is the Morning-After Pill (Emergency Contraception)?
Emergency contraception is a safe and effective way to prevent pregnancy after
unprotected intercourse.
There are two kinds of emergency contraception:
a pill, commonly called the morning-after pill. The brand names of the morning-after
pill are ella, Next Choice, and Plan B One-Step.
ParaGard IUD insertion
Both kinds of emergency contraception can be used up to five days (120 hours) after
unprotected intercourse.
You may want to use it if
The condom broke or slipped off, and he ejaculated in your vagina.
You forgot to take your birth control pills, insert your ring, or apply your patch.
Your diaphragm or cap slipped out of place, and he ejaculated inside your vagina.
you miscalculated your "safe" days.
He didn't pull out in time.
You weren't using any birth control.
You were forced to have unprotected vaginal sex.
74. Emergency Contraception
How Does the Morning-After Pill (Emergency Contraception) Work?
Two brands of the morning-after pill — Plan B One-Step and Next Choice —
are made of one of the hormones found in birth control pills called progestin.
Hormones are chemicals made in our bodies. They control how different parts
of the body work.
The other brand of the morning-after pill — ella — is made of a medication
called ulipristal acetate.
All brands of the morning-after pill work by keeping a woman's ovaries from
releasing eggs — ovulation. Pregnancy cannot happen if there is no egg to join
with sperm. The hormone in the morning-after pill also prevents pregnancy by
thickening a woman's cervical mucus. The mucus blocks sperm and keeps it
from joining with an egg.
The morning-after pill can also thin the lining of the uterus. In theory, this could
prevent pregnancy by keeping a fertilized egg from attaching to the uterus.
You might have also heard that the morning-after pill causes an abortion. But
that's not true. The morning-after pill is not the abortion pill. Emergency
contraception is birth control, not abortion.
75. Emergency Contraception
How Effective Is the Morning-After Pill (Emergency Contraception)?
Emergency contraception can be started up to 120 hours — five days —
after unprotected intercourse. The sooner it is started, the better it works.
Emergency contraception is also known as the morning-after pill, emergency
birth control, backup birth control, and by the brand names Plan B One-Step,
ella, and Next Choice. Plan B One-Step and Next Choice reduce the risk of
pregnancy by 89 percent when started within 72 hours after unprotected
intercourse. They continue to reduce the risk of pregnancy up to 120 hours
after unprotected intercourse, but they are less effective as time passes.
You need to use the morning-after pill to prevent pregnancy after each time
you have unprotected intercourse. The morning-after pill will not prevent
pregnancy for any unprotected intercourse you may have after taking the
pills. If you do not have your period within three weeks after taking
emergency contraception, you may want to consider taking a pregnancy
test.
The morning-after pill offers no protection against sexually transmitted
diseases or infections. You may want to consider STD testing if there is a
possibility that unprotected sex put you at risk.
76. Emergency Contraception
How Safe Is the Morning-After Pill (Emergency
Contraception)?
Emergency contraception is safe, and millions of women
have used it. Various forms of emergency contraception
have been used for more than 30 years. There have been
no reports of serious complications.
Even though Plan B One-Step and Next Choice are made of
one of the same hormones used in the birth control pill, the
morning-after pill does not have the same risks as taking the
pill or other hormonal birth control methods continuously.
That's because the hormone in the morning-after pill is not in
your body as long as it is with ongoing birth control.
77. Emergency Contraception
What Are the Disadvantages of the Morning-After Pill (Emergency
Contraception)?
You may have some undesirable side effects while using the morning-after
pill. But many women use Plan B One-Step, ella, and Next Choice with few
or no problems.
Nausea and throwing up are the most common side effects. Less than 1 out
of 4 women feel sick when they take them. You can use anti-nausea
medicine one hour before taking emergency contraception if you are
concerned about being nauseous. Many women also find it helpful to take
the emergency contraception pills with a full stomach.
Other side effects of the morning-after pill may include
breast tenderness
irregular bleeding
Dizziness
headaches
If you use the morning-after pill frequently, it may cause your period to be
irregular. Emergency contraception should not be used as a form of
ongoing birth control because there are other forms of birth control that are
a lot more effective.
78. Emergency Contraception
How Do I Use the Morning-After Pill (Emergency Contraception)?
Take emergency contraception as soon as possible after unprotected intercourse. The
sooner you start it, the better it will work. But it will reduce your risk of pregnancy if you
start it up to 120 hours — five days — after unprotected intercourse.
Next Choice can be taken in one dose or two doses. If you take it in two doses, take the
second pill 12 hours after the first pill. Or simply take them both at the same time. It's
your choice.
You can use anti-nausea medicine one hour before taking emergency contraception if
you are concerned about getting nauseated. Many women also find it helpful to take the
emergency contraception pills with a full stomach.
After you take emergency contraception, it's normal for your next period to be different
from usual.
It may be earlier or later than usual.
It may be heavier, lighter, more spotty, or the same as usual.
Be sure to tell any health care provider that you may see before your next period that you
have taken the morning-after pill. If you do not have your period within three weeks after
taking emergency contraception, or if you have any symptoms of pregnancy, take a
pregnancy test or schedule an appointment with your health care provider.
79. Female Sterilization
What Is Sterilization?
Sterilization is a form of birth control. All sterilization
procedures are meant to be permanent.
During a sterilization procedure, a health care provider
closes or blocks a woman's fallopian tubes. Closing the
tubes can be done in several ways.
One way is by tying and cutting the tubes — this is called
tubal ligation. The fallopian tubes also can be sealed using
an instrument with an electrical current. They also can be
closed with clips, clamps, or rings. Sometimes, a small
piece of the tube is removed.
Sometimes, tiny inserts are put in the tubes. Tissue grows
around them and blocks the tubes. The brand names for
these types of sterilization are Adiana and Essure.
80. Female Sterilization
How Does Sterilization Work? Eggs are made in a
woman's ovaries. One egg is released each month. It
passes through one of the fallopian tubes toward the uterus.
Sterilization blocks each tube. Pregnancy cannot happen if
sperm cannot reach the egg.
How Safe Is Sterilization? Most women can be sterilized
safely. But like any medical procedure, there are risks. One
possible risk is that the tubes may reconnect by themselves
— but this is rare. When women get pregnant after being
sterilized, about 1 out of 3 has a pregnancy that develops in
a fallopian tube. This is called ectopic pregnancy. Ectopic
pregnancy is serious and may be life threatening.
81. Female Sterilization
What Are the Benefits of Sterilization?
Sterilization is safe and, because it lasts for life, it is simple and convenient. It
allows a woman to enjoy sex without worrying about pregnancy. Many women
and men report that they have more sexual pleasure because they don't have
to think about unwanted pregnancy anymore.
Sterilization does not change your hormones. The hormones that affect hair,
voice, sex drive, muscle tone, and breast size, are still made in the ovaries.
Those hormones still flow through the body after sterilization. It will not cause
symptoms of menopause or make menopause happen earlier. And most
women who have been sterilized will still have normal periods.
Sterilization may be right for you if
You don't want to have a child biologically in the future.
You have concerns about the side effects of other methods.
Other methods are unacceptable.
Your health would be threatened by a future pregnancy.
You don't want to pass on a hereditary illness or disability.
You and your partner agree that your family is complete, and no more children are
wanted.
You and your partner have decided that sterilization is better for you than vasectomy
is for him.
82. Female Sterilization
What Are the Disadvantages of Sterilization?
There are several possible disadvantages of sterilization.
Sterilization may not be a good choice for you if you
may want to have a child biologically in the future
are being pressured by a partner, friends, or family
are using it to solve problems that may be temporary — such as
marriage or sexual problems, short-term mental or physical
illnesses, financial worries, or being out of work
You should consider any possible life changes, such as divorce,
remarriage, or death of children. You don't need your partner's
permission to be sterilized, but it may be helpful to discuss it with
your partner or anyone else who could be part of the decision-
making process.
There are risks with any medical procedure, including
sterilization. It's important to understand the risks before being
sterilized. Read below about the risks of each type of sterilization.
83. Female Sterilzation
What Are the Types of Sterilization?
There are a few different types of sterilization. One type
does not require an incision — a cut. It is called
hysteroscopic sterilization. All the other methods require an
incision.
NO-INCISION (HYSTEROSCOPIC) METHODS — ADIANA,
ESSURE
INCISION METHODS — LAPAROSCOPY, MINI-
LAPAROTOMY, LAPAROTOMY
HIGH-RISK METHOD — HYSTERECTOMY
Your health care provider will help you decide which kind of
sterilization might be right for you. Your medical history,
including your weight and previous surgeries, may influence
which kind will be best and safest for you.
84. Female Sterilization
How Effective Is Sterilization?
Effectiveness is an important and common concern when
choosing a birth control method. Sterilization is nearly 100
percent effective.
For every 1,000 women who have Essure, fewer than 3 will
become pregnant.
For every 1,000 women who have traditional incision methods,
about 5 will become pregnant.
For every 1,000 women who have Adiana, fewer than 20 will
become pregnant.
Most kinds of sterilization for women are effective right away.
But it takes about three months before Adiana and Essure
are effective.
Keep in mind that sterilization provides no protection against
sexually transmitted diseases. Latex or female condoms can
reduce your risk of STDs.
85. Female Sterilization
What Happens During Sterilization with Adiana?
To use Adiana, a health care provider puts a tiny insert into each of the fallopian
tubes. Natural tissue grows around the inserts, blocking the tubes.
During the procedure, the health care provider uses local anesthesia to numb the cervix.
You may be offered other medication to help you relax and reduce your discomfort. A
small, rigid, tube-like instrument called a hysteroscope is inserted into the vagina and
through the cervix. A small amount of heat is applied to each fallopian tube. Two inserts
— the size of a grain of rice — are placed in the spots where the heat was applied.
While Adiana is being inserted — and for a short time after — you may have
pain or cramping, like strong menstrual cramps
mild nausea or vomiting (“sick to your stomach”)
You may have a vaginal discharge, like a light menstrual period, for a few days.
Like Essure and vasectomy, Adiana is not effective right away. Three months after
insertion, a special x-ray is performed to make sure the tubes are fully blocked. You
must use another form of birth control until then, or you may get pregnant.
Adiana offers some advantages over other methods of sterilization:
The procedure is safer than methods that require an incision.
General anesthesia is not needed.
A surgical setting is not needed.
Recovery is faster — some women return to normal activities the same day.
With Adiana, no incisions are necessary. So you won't have any visible scars.
86. Female Sterilization
What Are the Risks with Adiana?
Studies have shown that Adiana is safe, but there are still some
possible risks:
One or both of the inserts may not be put in place correctly the first
time. A second procedure may be needed.
The uterus may be injured during the insertion. This rare
complication may require surgery.
The tubes may not be completely blocked after three months. It may
be necessary to wait three more months to see if they become
blocked. If they don’t, a second procedure may be needed.
Other rare complications include too much fluid build up in your
bloodstream, changes in the menstrual cycle, infection, and pelvic
or back pain.
Talk with your health care provider about the benefits and risks of
Adiana to help you decide if it may be right for you.
87. Female Sterilization
What Happens During Sterilization with Essure?
To use Essure, a health care provider puts a tiny insert called a microinsert into
each of the fallopian tubes. Once in place, the inserts cause natural tissue to
grow, blocking the tubes.
During the procedure, the health care provider uses local anesthesia to numb
the cervix. You may be offered other medication to help you relax and reduce
your discomfort. Some women report mild to moderate pain while the inserts
are being placed. A small, rigid, tube-like instrument called a hysteroscope is
inserted into the vagina and through the cervix. The inserts are placed in the
opening of the tubes.
Like Adiana and vasectomy, Essure is not effective right away. Three months
after insertion, a special x-ray is performed to make sure the tubes are fully
blocked. You must use another form of birth control until then, or you may get
pregnant. Essure offers some advantages over other methods of
sterilization:
The procedure is safer than methods that require an incision.
General anesthesia is not needed.
A surgical setting is not needed.
Recovery is faster — some women return to normal activities the same day.
With Essure, no incisions are necessary. So you won't have any visible scars.
88. Female Sterilization
What Are the Risks with Essure?
Studies have shown that Essure is safe, but there are still some
possible risks:
One or both of the inserts may not be put in place correctly the first time. A
second procedure may be needed.
The inserts may move out of place.
The tubes may not be completely blocked after three months. It may be
necessary to wait three more months to see if they become blocked. If they
don't, a second procedure may be needed.
The uterus may be injured during the insertion. This rare complication may
require surgery.
The inserts may be damaged during other medical procedures.
Other rare complications include too much fluid build up in your
bloodstream, changes in the menstrual cycle, infection, and pelvic
or back pain. Talk with your health care provider about the benefits
and risks of Essure to help you decide if it may be right for you.
89. Female Sterilization
What Happens During Sterilizations that Require an Incision?
Laparoscopy
Laparoscopy is one of the two most common types of sterilization.
First you will get either general, regional, or local anesthesia. Then, your abdomen is inflated with an
injection of harmless gas (carbon dioxide). This allows your health care provider to see your organs
clearly. Then the provider makes a small cut near your navel and inserts a laparoscope (a rod-like
instrument with a light and a viewing lens) to locate the fallopian tubes. The health care provider also
may insert an instrument for closing the tubes, usually through a second small opening. Sometimes only
one incision and one instrument are used.
The procedure can be performed in outpatient surgical clinics. It usually takes 20–30 minutes. Very little
scarring occurs. Women often go home the same day.
Mini-Laparotomy
Mini-laparotomy is another common type of sterilization. It is often performed after childbirth. No gas or
laparoscope is used. Usually, local anesthesia is used. A small cut is made in the lower abdomen, just
above the pubic hair or just below the navel. The health care provider locates the tubes, then ties, clips,
or uses a probe with an electrical current to block them off. Women usually recover in a few days.
Laparotomy
Laparotomy is major surgery. It is less commonly used than the other incision methods.
The health care provider makes a two-to-five-inch cut in the abdomen. The provider locates and closes
off the tubes. The operation requires general or regional anesthesia. You may need to be hospitalized
for 2–4 days. It may take several weeks at home to completely recover. If the procedure is done after
delivery, your hospital stay may be extended by 1–2 days.
90. Female Sterilization
What Are the Risks of Sterilizations that Require an
Incision?
Complications can occur with any kind of surgery. These
incision methods are considered low-risk surgeries. The
complications that can occur during or after these them
include
Bleeding
Infection
reaction to the anesthetic
Infection is rare. It is treated with antibiotics. Very rarely, the
bowel, bladder, uterus, or blood vessels are injured. You
may need additional surgery to repair this.
Complications may develop in 1–4 out of every 100
sterilizations that are performed through the abdomen.
Death resulting from sterilization is extremely rare and is
usually caused by a reaction to general anesthesia.
91. Female Sterilization
What Happens During Hysterectomy? Hysterectomy is the
removal of the uterus. It is major surgery and is not usually used for
sterilization. It is used to correct serious medical conditions. If you
have a hysterectomy, you will no longer have your period. Usually, it
will not affect your fallopian tubes. However, some medical conditions
also call for the removal of a tube and/or ovary, on one side or
both. Hysterectomy is performed through the abdomen and/or
vagina. Women need to spend several days in the hospital. They
usually spend several weeks at home recovering. They should
abstain from sexual intercourse for 4–6 weeks, until the health care
provider says it is safe to have sex.
What Are the Risks with Hysterectomy? Complications after
hysterectomy, such as infection or blood loss, occur in 10–20 out of
every 100 cases. Because hysterectomy is usually performed as a
result of a serious medical problem, the risk of death is much greater
than it is for more common sterilization methods.
92. Female Sterilization
Does Sterilization Hurt? Your health care provider will give you medicine to make sterilization as
comfortable as possible. Numbing medication and/or sedatives will be used. The choice depends on
your health and the method of sterilization being used. Conscious sedation allows you to be awake but
deeply relaxed. Local and regional anesthesia block the feeling of pain in certain areas of your body.
These are much safer than general anesthesia. General anesthesia is entirely painless. It allows you
to sleep through the procedure. When you get local or regional anesthesia, you may feel brief
discomfort. The pain is relieved with medications and, sometimes, sedatives. Most likely, you will feel
little or no discomfort during the procedure.
How Will I Feel After Sterilization? The discomfort you feel after the procedure depends on your
general health, the type of procedure, and how well you deal with pain. You may feel tired and have
slight pain in your abdomen. You may occasionally feel dizzy, nauseous, bloated, or gassy, or have
shoulder pain or abdominal cramping. Women who use Adiana or Essure may have vaginal discharge,
like a light menstrual period. Most symptoms will last 1–3 days. Contact your health care provider
immediately if you
bleed from an incision
develop a rash or fever
have difficulty breathing
have fainting spells
have severe, continuous abdominal pain
have unusual discharge or odor from your vagina
93. Female Sterilization
How Long Does It Take to Recover from Sterilization?
It depends on your general health, lifestyle, and the method
of sterilization that you use. With mini-laparotomy and
laparoscopy, recovery is usually complete in a day or two.
You may want to take it easy for the next week or so. In any
case, you should avoid heavy lifting for about one week.
Recovery from sterilization with Adiana or Essure is faster —
some women return to normal activities the same day as the
procedure. Others take a day or two.
Talk with your health care provider about when it's safe to
start having sex again. Remember, if you've had Adiana or
Essure, you need to use another birth control method until
your health care provider confirms that your tubes are
blocked.
94. Vasectomy
What Is Vasectomy? Vasectomy is a form of birth control
for men that is meant to be permanent. During vasectomy,
a health care provider closes or blocks the tubes that carry
sperm. When the tubes are closed, sperm cannot leave a
man's body and cause pregnancy.
How Does Vasectomy Work? Sperm are made in the
testicles. They pass through two tubes called the vasa
deferentia to other glands and mix with seminal fluids to
form semen. Vasectomy blocks each vas deferens and
keeps sperm out of the seminal fluid. The sperm are
absorbed by the body instead of being ejaculated. Without
sperm, your "cum" (ejaculate) cannot cause pregnancy.
95. Vasectomy
How Effective Is Vasectomy?
Effectiveness is an important and common concern
when choosing a birth control method. Vasectomy is the
most effective birth control for men. It is nearly 100
percent effective.
However, vasectomy is not immediately effective. Sperm
remains beyond the blocked tubes. You must use other
birth control until the sperm are used up. It usually takes
about three months. A simple test — semen analysis —
shows when there are no more sperm in your ejaculate.
96. Vasectomy
What Are the Types of Vasectomy?
There are different ways for men to be sterilized. One type does not require an
incision — a cut. The other types of vasectomy require an incision. Incision
methods take about 20 minutes. The no-incision method takes less time.
INCISION METHODS
Usually, a local anesthetic is injected into the pelvic area. Then, the doctor
makes an incision on each side of the scrotum to reach each vas deferens —
the tubes that carry sperm. Sometimes a single incision is made in the center.
Each tube is blocked. In most procedures, a small section of each tube is
removed. Tubes may be tied off or blocked with surgical clips. Or, they may be
closed using an instrument with an electrical current.
NO-INCISION METHOD
With the no-incision ("no-scalpel") method, the skin of the scrotum is not cut.
One tiny puncture is made to reach both tubes. The tubes are then tied off,
cauterized, or blocked. The tiny puncture heals quickly. No stitches are needed,
and no scarring takes place.
The no-scalpel method reduces bleeding and decreases the possibility of
infection, bruising, and other complications.
97. Vasectomy
How Safe Is Vasectomy? Most men can have a vasectomy safely. But like any medical
procedure, there are risks. Talk with your health care provider about whether vasectomy
is likely to be safe for you.
What Are the Benefits of Vasectomy? Vasectomy is safe and, because it lasts for life,
it is simple and convenient. It allows women and men to enjoy sex without worrying about
pregnancy. Vasectomy does not change your hormones or masculinity. And it will not
affect your ability to get and stay erect. It also will not affect your sex organs, sexuality,
and sexual pleasure. No glands or organs are removed or altered. Your hormones and
sperm continue being produced. Your ejaculate will look just like it always did. And there
will be about the same amount as before. Vasectomy may be right for you if
You want to enjoy having sex without causing pregnancy.
You don't want to have a child biologically in the future.
Other methods are unacceptable.
You don't want to pass on a hereditary illness or disability.
Your partner's health would be threatened by a future pregnancy.
You and your partner have concerns about the side effects of other methods.
You and your partner agree that your family is complete, and no more children are wanted.
You want to spare your partner the surgery and expense of tubal sterilization — sterilization
for women is more complicated and costly.
98. Vasectomy
What Are the Disadvantages of Vasectomy?
Vasectomy may not be a good choice for you if you
may want to have a child biologically in the future
are being pressured by a partner, friends, or family
want to use it to solve problems that may be temporary
— such as marriage or sexual problems, short-term
mental or physical illnesses, financial worries, or being
out of work
99. Vasectomy
Possible Risks of Vasectomy
There are risks with any medical procedure, including vasectomy. Major complications with
vasectomy are rare and are usually caused by infection.
Complication rates for vasectomy are generally lower for the no-incision method than for methods
that include cutting the skin.
After you've had a vasectomy, look for signs of infection:
a fever over 100° F
blood or pus oozing from the site of the incision
excessive pain or swelling
See a health care provider if you have signs of infection. You may need an antibiotic.
Other potential problems include
bruising, which usually clears up on its own
hematomas — swellings that contain blood. They usually clear up by themselves, or with bed rest or ice
packs. In rare cases, they need to be drained by a health care provider.
hydroceles — swellings that contain fluid and tenderness near the testicles. They usually clear up in
about a week. Applying heat and wearing an athletic supporter can help. In rare cases, they need to be
drained with by a health care provider.
granuloma — sperm that leaks from the tubes and causes a small lump under the skin near the site of
the surgery. This usually clears up by itself. Surgical treatment is sometimes required.
pain or discomfort in the testicles. This is usually temporary, but in about 2 out of 100 cases the pain may
be chronic and severe. Most of the time, pain is relieved by taking anti-inflammatory drugs or other
medications. Very rarely, an injection called a spermatic cord block can be used to deaden the pain
temporarily. Vasectomy reversal is very rarely needed to relieve pain permanently.
Very rarely, the cut ends of a tube grow back together. This most often happens within four months of the
operation and may allow pregnancy to happen.
Decreased sexual desire or an inability to have an erection occurs in 4 out of 1,000 cases. The most
likely cause is emotional — there is no physical cause for sexual dysfunction associated with vasectomy.
100. Vasectomy
What Are the Risks of Vasectomy?
Major complications with vasectomy are rare and are usually caused by infection.
Complication rates for vasectomy are generally lower for the no-incision method than for methods
that include cutting the skin.
After you've had a vasectomy, look for signs of infection:
a fever over 100° F
blood or pus oozing from the site of the incision
excessive pain or swelling
See a health care provider if you have signs of infection. You may need an antibiotic.
Other potential problems include
bruising, which usually clears up on its own
hematomas — swellings that contain blood. They usually clear up by themselves, or with bed rest or ice
packs. In rare cases, they need to be drained by a health care provider.
hydroceles — swellings that contain fluid and tenderness near the testicles. They usually clear up in about
a week. Applying heat and wearing an athletic supporter can help. In rare cases, they need to be drained
with by a health care provider.
granuloma — sperm that leaks from the tubes and causes a small lump under the skin near the site of the
surgery. This usually clears up by itself. Surgical treatment is sometimes required.
pain or discomfort in the testicles. This is usually temporary, but in about 2 out of 100 cases the pain may
be chronic and severe. Most of the time, pain is relieved by taking anti-inflammatory drugs or other
medications. Very rarely, an injection called a spermatic cord block can be used to deaden the pain
temporarily. Vasectomy reversal is very rarely needed to relieve pain permanently.
Very rarely, the cut ends of a tube grow back together. This most often happens within four months of the
operation and may allow pregnancy to happen.
Decreased sexual desire or an inability to have an erection occurs in 4 out of 1,000 cases. The most likely
cause is emotional — there is no physical cause for sexual dysfunction associated with vasectomy.
101. Vasectomy
Does Vasectomy Hurt? Your health care provider will give you medicine to
make it as comfortable as possible. Numbing medication and/or sedatives will
be used. The choice depends on your health and the method of sterilization
being used. Conscious sedation allows you to be awake but deeply relaxed.
Local anesthesia blocks the feeling of pain in a certain area of your body. It is
much safer than general anesthesia. General anesthesia is entirely painless.
It allows you to sleep through the procedure. When you get local anesthesia,
you may feel brief discomfort. You may also feel some pain when the tubes
are brought out through the incision.
How Will I Feel After Vasectomy? As with any surgery, there's some
discomfort after the operation. It will be different for each man. However, most
men say the pain is "slight" or "moderate" and not "excessive." An athletic
supporter, ice bag, and non-aspirin pain reliever may help ease the pain.
Avoid strenuous physical work or exercise for about a week. There seems to
be less pain associated with no-incision procedures.
102. Vasectomy
How Long Does Recovery Take After Vasectomy?
That depends on your general health and lifestyle. Most
men lose little or no time from work. A few need a day or
two to rest. You will have to avoid strenuous work or
exercise for about a week.
Rare complications may require more days at home.
However, prompt medical attention usually clears up any
problems.
For most men, sexual activity can begin again within a
week. Others have sex sooner. Some wait longer. But
remember, after the procedure, it takes about three
months to clear sperm out of your system. Use another
form of birth control for vaginal intercourse until a semen
analysis shows there are no longer any sperm in your
seminal fluid.
103. Withdrawal
What Is Withdrawal? A man who uses withdrawal will pull
his penis out of the vagina before ejaculation — the moment
when semen spurts out of his penis. Withdrawal is also
known as coitus interruptus and the pull out
method. Withdrawal may be the world's oldest way to
practice birth control. About 35 million couples worldwide
rely on withdrawal.
How Does Withdrawal Work? Withdrawal prevents
pregnancy by keeping sperm out of the vagina. Pregnancy
cannot happen if there is no sperm present.
104. Withdrawal
How Effective Is Withdrawal?
Effectiveness is an important and common concern when choosing a birth control
method. Like all birth control methods, the pull out method is much more effective when
you do it correctly.
Of every 100 women whose partners use withdrawal, 4 will become pregnant each year if
they always do it correctly.
Of every 100 women whose partners use withdrawal, 27 will become pregnant each year if
they don't always do it correctly.
Couples who have great self-control, experience, and trust may use the pull out method
more effectively. Men who use the pull out method must be able to know when they are
reaching the point in sexual excitement when ejaculation can no longer be stopped or
postponed. If you cannot predict this moment accurately, withdrawal will not be as
effective.
Even if a man pulls out in time, pregnancy can still happen. Some experts believe that
pre-ejaculate, or pre-cum, can pick up enough sperm left in the urethra from a previous
ejaculation to cause pregnancy. If a man urinates between ejaculations before having
sex again, it will help clear the urethra of sperm and may increase the effectiveness of
withdrawal.
Pregnancy is also possible if semen or pre-ejaculate is spilled on the vulva.
Keep in mind that the withdrawal method does not protect you from sexually transmitted
diseases. Use a latex condom or female condom to reduce the risk of infection.
105. Withdrawal
How Safe Is Withdrawal? Anyone can use withdrawal
safely — there are no side effects.
What Are the Benefits of Withdrawal? The pull out
method is safe, simple, and convenient. Women and men
like it because
It can be used to prevent pregnancy when no other method is
available.
There are no medical or hormonal side effects.
No prescription is necessary.
It is free.
The pull out method can also make other forms of birth control,
such as the cap, condom, diaphragm, or female condom, more
effective.
106. Withdrawal
What Are the Disadvantages of Withdrawal?
There are a few risks to using withdrawal as your only
form of birth control. The biggest disadvantage is the
risk of using withdrawal incorrectly.
Withdrawal
requires great self-control, experience, and trust
is not for men who ejaculate prematurely
is not for men who don't know when to pull out
is not recommended for teens and sexually
inexperienced men because it takes lots of experience
before a man can be sure to know when he's going to
ejaculate
107. Withdrawal
How Do I Practice Withdrawal?
During sex, the man withdraws his penis from the vagina
when he feels he is about to ejaculate, or before he
reaches that point. He ejaculates, or comes, outside the
vagina, being careful that semen does not spill onto his
partner's vulva.
Men who want to use the pull out method need to
understand their own sexual response. They need to know
when they reach the point in sexual excitement when
ejaculation can no longer be stopped or postponed.
There are many other methods available if withdrawal is not
right for you. If you need help choosing a method, we're
here to help. The staff at your local Planned Parenthood
health center can talk with you and help you get the birth
control method that's best for you.
