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Contraception - what it is and why it matters

Everything you need to know about contraception

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Contraception is something that stops sexual intercourse between men and women resulting in pregnancy. Also referred to as birth control, it's an essential thing to consider for any adult or young person who is sexually active. 

What is contraception? 

Contraception is something that you use to prevent pregnancy from occurring. If you don't use contraception, you are at risk of getting pregnant every time you have sex. Even if it is your first time, you can still get pregnant. There are lots of different types of contraception; some of them are single-use, and you can use them as and when needed, and others are more long term. It can be confusing if you are not used to contraception, so it's important to take the time to consider which options are best for you, your situation and your sexual partners. 

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Pregnancy 

When a woman is of menstruating age, her body is prepared for pregnancy. Each month the ovaries release an egg into the womb, known as ovulation. The womb lining thickens, preparing for a fertilised egg. The egg is fertilised when a man ejaculates inside a woman's vagina; the sperm then swim into the womb to try and reach an egg. If this happens, the fertilised egg then implants itself into the wall of the womb, multiplying and growing into a foetus. 

Contraception works in numerous ways to prevent this. It can either create a barrier to stop sperm from getting through the vagina, stop ovulation or alter the womb and cervix lining so that sperm cannot enter or survive. 

Sexually transmitted infections 

Contraception is also used to stop the spread of sexually transmitted infections. Condoms are the only type of contraception which can do this. There are many different types of sexually transmitted infections (STIs), and many don't always have symptoms. This means you and any partner can have one without knowing. 

You should always protect yourself by using condoms with any new or multiple partners. Once you are certain of both yours and your partner's sexual health, you can then think about moving on to different types of contraception that don't interrupt sex. 

What types of contraception are there? 

The different methods of contraception available include barrier methods, hormonal methods, natural family planning and permanent changes to your body. 

Barrier methods include: 

  • Male condoms
  • Female condoms 
  • Diaphragm or cap
  • Contraceptive sponge 

Hormonal methods include: 

  • The combined pill 
  • The mini pill 
  • Contraceptive patch 
  • Vaginal ring 
  • Implant 
  • Injection 
  • IUS (hormonal coil) 

Non-hormonal long term methods include: 

  • IUD (copper coil) 
  • Natural family planning 

Permanent solutions include: 

  • Male vasectomy 
  • Female sterilisation 

Condoms 

Male condoms are also called rubbers. They are small, round devices made from latex which come in square, foil packets. After removing them from the package, it is placed over the surface of a man's penis, rolled down to cover the length of it. After ejaculation, sperm collects inside of the condom. Female condoms work similarly, except they are placed inside the vagina. 

Advantages: 

  • Easy to get a hold of and are free from sexual health clinics, GPs and college campuses 
  • Protect against STIs 
  • Produce no side effects 
  • Only use when needed 

Disadvantages: 

  • They interrupt sex 
  • They can tear or slip off 
  • They are only 97-98% reliable 

Are they suitable for me? 

It is advisable to use condoms if you are not using any other form of contraception, there is a risk of catching an STI, you have multiple partners, or you are a man having sex with men. They are a good option if you do not have a regular sexual partner. 

 

Diaphragm and cap

A diaphragm is a soft, round silicone device which is inserted into the vagina, in a similar manner to a tampon, and covers the cervix. The diaphragm and cap prevents sperm from getting into the womb. It is used alongside a type of contraceptive gel called spermicide which you apply to the diaphragm before insertion. You should leave a diaphragm in for 6 hours after sex before removing it. It can then be washed, dried and reused. A cap works in the same way, but it is smaller. 

Advantages: 

  • They don't require a doctor's appointment 
  • Produce no side effects 
  • Can be used as and when needed 

Disadvantages:

  • Less effective than other forms of contraception 
  • They take the spontaneity out of your sex life 
  • It can take a while to get the hang of it 

Is it suitable for me? 

A diaphragm is less effective than condoms and other long term methods. This may be more suitable for women in a long term relationship or marriage who wish to get pregnant or for older women who know how to track their cycle and wish to avoid sex while they are fertile.

Contraceptive sponge 

The sponge is made of soft squishy plastic and may be more comfortable than a diaphragm. It is used in a similar manner but does not need additional spermicide. It can be inserted up to 24 hours before sex. After removal, it should be discarded. 

Advantages:

  • They are comfortable to use 
  • You can have sex multiple times with one in 
  • You can insert them up to 24 hours before sex, so it doesn't need to interrupt the moment 

Disadvantages:

  • They are less effective than most forms of contraception 
  • They cannot be reused so you'd have to keep buying them 
  • It might take a while to get used to

Is it suitable for me? 

The sponge is the least effective method of contraception. It may be better suited to older women who know how to use natural family planning or for women who may want to have a baby.

The combined pill 

This is the most popular form of contraception used in the UK. It contains synthetic versions of the female hormones oestrogen and progestogen which stop ovulation and override your natural menstrual cycle. The pill needs to be prescribed by a doctor, and you take it every day for 21 days, then have a 7-day break where you have your period. 

Advantages:

  • The pill is very effective when used properly 
  • It doesn't interrupt sex 
  • It makes your period more regular, lighter and less painful 
  • It reduces your risk of certain cancers 

Disadvantages 

Is it suitable for me? 

The pill is a good option for young, healthy women with no underlying medical conditions. It can easily be used with condoms for women with multiple partners.

The mini pill 

The mini pill is another name for the progestogen-only pill. This is taken every day and releases a synthetic version of the progestogen hormone into the bloodstream to prevent pregnancy. It works in a similar way to the combined pill. 

Advantages:

  • It's very effective when used properly 
  • It can be used by women who cannot take estrogen 
  • There is no link to serious conditions like deep vein thrombosis 
  • It doesn't interrupt sex 

Disadvantages:

  • It must be taken on time for it to be effective 
  • It can cause unpleasant side effects 
  • Your periods might become irregular 

Is it suitable for me? 

The mini pill is a good option if you are unable to take the combined pill or have a sensitive reaction to oestrogen. You will need to take it at the same time every day, so if this is hard for you, it might not be the most effective method. 

Contraceptive patch 

The patch is a small, plaster-like patch which you apply to your skin and it releases hormones into your bloodstream. Each one lasts for 7 days and contains oestrogen and progestogen hormones, stopping ovulation from occurring. After 3 weeks, you'll have a 7-day break before applying a new patch. 

Advantages:

  • You don't need to remember to take it every day 
  • It's very effective 
  • It doesn't interrupt sex 
  • It regulates your period and reduces PMS and period pain 

Disadvantages:

  • It can produce unpleasant side effects 
  • It increases your risk of blood clots 
  • You must remember to change it on time 
  • It's not suitable for all women

Is it suitable for me? 

The patch might be preferable if you find it difficult to remember to take the pill every day, but you still want to have the same control over your period. It's not suitable for everyone though as it increases your risk of blood clots. 

Vaginal ring 

The vaginal ring works in the same way as the combined pill and patch except it is inserted into the vagina. It is a small plastic ring that you insert high up into the vagina which releases hormones directly into the womb. Each one lasts for 21 days. After this, remove it and wait for 7 days before putting a new one in. 

Advantages:

  • You don't have to think about it every day 
  • It doesn't interrupt sex 
  • It's very effective 
  • It's not affected by vomiting 

Disadvantages:

  • It can produce unpleasant side effects 
  • It increases your risk of blood clots 
  • It's not suitable for all women

Is it suitable for me? 

The ring works in the same way as the pill, but you only need to change it once a month. It might not be suitable if you are uncomfortable touching your vagina or have any risk factors for blood clots. 

Implant 

The contraceptive implant is a long term option. It is a small plastic rod which is inserted into your upper arm and releases a progestogen hormone over the course of three years. This involves a small procedure that needs to be carried out by a trained doctor under local anaesthetic. 

Advantages:

  • Once it's in, it lasts for three years 
  • You don't need to think about it 
  • It's one of the most reliable methods of contraception 
  • It can be used by women who cannot take the pill 

Disadvantages:

  • It involves an invasive procedure 
  • It can produce unpleasant side effects 
  • Your periods might become irregular 

Is it suitable for me? 

The implant is a good option for many women as you don't need to think about it once it's in and it's safe for most people, including those who can't take the pill. It's useful for women in long term relationships who have a regular sex life. 

Injection 

The contraceptive injection is administered every 12 weeks and contains a dose of the progestogen hormone. You'll need to have an appointment every 3 months to renew your injection. 

Advantages:

  • It lasts for 12 weeks 
  • it doesn't interrupt sex 
  • It's not affected by any medications 
  • It can make your periods lighter 

Disadvantages:

  • You'll need to have an appointment every 8-13 weeks 
  • Your fertility can take up to a year to return 
  • You might experience side effects 
  • Your periods can become irregular 

Is it suitable for me? 

The injection is a good option for sexually active women who are not looking to get pregnant in the near future. If having regular appointments is convenient and you can't use oestrogen, then this can be a good option. 

Hormonal IUS

Also known as the hormonal coil, or Mirena, this is a small plastic T-shaped device which is inserted into the womb by a trained doctor or nurse. It steadily releases hormones over 3-5 years to prevent pregnancy. 

Advantages:

  • It lasts for 3-5 years, so you don't need to think about it once it's in
  • It's one of the most effective forms of contraception 
  • It doesn't interrupt sex
  • Your periods may become lighter and less painful 

Disadvantages: 

  • You may experience side effects
  • It involves an uncomfortable procedure to have it inserted 
  • Your periods might be irregular 

Is it suitable for me? 

The IUS is safe for most women and is useful for those in long term relationships as you won't have to think about it once it's in. If you've never used hormonal contraception, then you might want to try something short term like the pill first.

Copper IUD

Similar to the IUS, the IUD is also a small T-shaped device, but it is made of copper instead of containing hormones. The copper is released into the womb to kill off any sperm that enter and lasts for 10 years. 

Advantages:

  • It's highly effective 
  • It lasts for 10 years 
  • It doesn't produce side effects 
  • It's safe for most women 

Disadvantages:

  • Insertion can be uncomfortable 
  • It can cause painful cramps in the first couple of weeks or months 
  • Your periods might be heavier and more painful 

Is it suitable for me? 

The copper coil is a good option for sexually active women who want to avoid using hormones and don't plan on starting a family any time soon. If you've only just started to become sexually active, you might want to try a few options first before thinking about something long term. 

Natural family planning 

This type of contraception involves tracking your menstrual cycle to find out when you are fertile and planning your sex life around that. There are apps which can help with this, but this method should only be used after attending classes at a family planning clinic as it can take several months to get the hang of it. Most women opt to use condoms or a diaphragm on the days that they are fertile. 

Advantages:

  • You can avoid artificial hormones 
  • There is nothing interrupting sex 
  • It allows you to get to know your body better 
  • This makes it easy if you are planning to get pregnant 

Disadvantages: 

  • It can take a long time to get this technique right 
  • You'll need to measure your temperature daily 
  • If it fails, you might get pregnant 

Is it suitable for me? 

Only use natural family planning if you've correctly learned the technique and are confident that you can monitor your menstrual cycle to know when you are fertile. This is not recommended for women with multiple partners or if your periods are irregular. 

Male vasectomy 

This is a permanent solution which involves having surgery. The tubes which carry sperm are cut so that semen will no longer carry sperm, lacking the ability to fertilise an egg. 

Advantages:

  • You do not have to worry about getting your partner pregnant 
  • Your partner will not need to use contraception 
  • In some cases, it can be reversed

Disadvantages:

  • You will need to have surgery 
  • If you change your mind later in life and want to have children, you may not be able to

Is it suitable for me? 

This is a big decision to make as it involves making a permanent change to your body. You must be absolutely sure that you don't wish to father a child, and the option is unlikely to be available to younger men. 

Female sterilisation 

This is also a permanent solution where the fallopian tubes are blocked off, stopping eggs from being able to reach the womb to be fertilised. 

Advantages:

  • You will never need to worry about contraception again (apart from protecting yourself from STIs) 
  • There is no need to use artificial hormones or suffer from side effects 

Disadvantages:

  • If you change your mind and want to have children in the future, you won't be able to
  • Most doctors will not refer you for this if you are under a certain age 
  • It involves surgery 

Is it suitable for me? 

It's unlikely that you will be able to have sterilisation if you are under the age of 30 and have never had children. This is because you might change your mind and wish to have children in the future. If you have had children and do not want any more, then this option might be suitable for you.

How effective is contraception? 

Not all contraceptive methods are equally reliable at preventing pregnancy. This is another factor you should take into account when choosing your birth control.

  • Male condoms: 99%
  • Female condoms: 95%
  • Diaphragm or cap: 91-96%
  • Sponge: 88%
  • The combined pill: 99%
  • The mini pill: 99% 
  • Implant: 99%
  • Injection: 99%
  • IUS: 99%
  • IUD: 99%
  • Natural family planning: 99%
  • Sterilisation: 100% 

Whichever method you choose, the effectiveness relies upon you using it correctly. For example, the diaphragm is 96% effective with perfect use but less effective if it is not inserted correctly or removed too soon. 

Q&A 

I'm in a same-sex relationship. Do I need to think about contraception? 

While you don't need to worry about birth control in a same-sex relationship, you still need to use contraception to avoid the spread of sexually transmitted infections. For men, you can wear condoms during oral and anal sex. Dental dams are available for women and are used as a barrier during oral sex. 

It's my first time having sex, can I get pregnant? 

Yes, it only takes one time to get pregnant. If you are ready to have sex, then make sure you have condoms available and that you know how to use them. Your sexual partner should respect this, so make it clear that you are not using anything like the pill. You can also catch an STI during your first time. 

Will pulling out work as birth control? 

No, pulling out before ejaculation should not be used in place of contraception. Sperm can easily be released during pre-ejaculation, and this can happen at any time during sex. 

What should I do if the condom splits? 

Occasionally, condoms can break or puncture during sex. If this happens, you are at risk of pregnancy and should seek emergency contraception, also known as the morning-after pill. See your GP or a pharmacist as soon as possible as you'll need to take it within 72-120 hours. 

What causes the pill to be less effective? 

If you miss pills, vomit after taking it or take certain medications, this can make it ineffective. The mini-pill needs to be taken within either 3 to 12 hours or it won't be effective. You should read the information leaflet carefully before starting so that you know what to do if you get sick or miss a pill. 

Will the contraceptive patch fall off? 

It's rare for the patch to come off as it is very sticky. You should apply it to an area of skin which is dry, hair-free and will not rub up against clothing or waistbands. 

What is spermicide? 

Spermicide is a contraceptive gel which is applied to a diaphragm to increase its effectiveness. It works by killing off sperm inside the vagina. It can be used on its own, but this will only be 70% effective. 

Does the pill protect against STIs?

No, taking the pill will not protect you against STIs; only condoms can do this. It would be best if you used condoms until you are sure your partner is free from STIs. 

Do I need to have given birth to use an IUD? 

No, the IUD can be used by all women, whether or not you have had a baby. The device is tiny and is easily inserted into the womb by a health professional. 

How do I know if I'm pregnant? 

Missing your period is the most obvious early indication of pregnancy. If you've missed a pill, or a condom has split, and you don't get your period, you should take a pregnancy test. Other early symptoms include nausea, breast tenderness, increased sense of smell and unusual cravings. 

How do I know if I have an STI? 

Not all STIs always produce symptoms, so the only way to know for sure is to get tested. You can do this at your local sexual health clinic. Some common symptoms include unusual discharge, burning or pain during urination, pain during or after sex, a smelly discharge, red blister-like spots and small warts around the genitals. 

Where can I get contraception? 

You can get free access to contraception from your GP, sexual health clinic or family planning clinic. You can get a C card to get free access to condoms from pharmacies, clinics and college campuses and they are also available to buy from shops. You can visit your GP for a prescription for the pill if you have never taken it before as you'll need to have your blood pressure measured. You'll also need an appointment with a doctor to have an implant, IUD or IUS fitted or to have the injection. 

Sources

NHS > Your Contraception Guide
NHS > Getting Contraception
Sexwise > Which Method of Contraception is Right for Me?
SH:24 > Contraception

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