A Quickie Roundup of Birth Control Options

by Marjorie Ingall

Safer sex and birth control are totally separate issues. Condoms are the only form of birth control that protects you from sexually transmitted diseases and HIV. Other birth control methods are worth checking into if you and your partner are in a monogamous relationship and have been tested for the aforementioned diseases and virues within the last 6 months.

However, some men just refuse to wear a condom, flat out. If you're a woman and that's your man's deal, you need birth control you can use without his cooperation; some protection (from pregnancy, if not from STDs and HIV) is better than none at all. But in such a case, perhaps you ought to re-evaluate the relationship. There are definitely men out there who care about their health and yours. (If you're in an abusive relationship and the guy refuses to use condoms, you may need help extricating yourself. Call a local crisis center, or the National Domestic Violence Hotline at 1-800-333- SAFE.)

What Doesn't Work:

Pulling out.
A man may say he won't cum inside you, and he may even mean it. But in the heat of the moment many men are unable to pull out before they shoot their load. And even if they do manage to abort takeoff before firing the rocket, you can still get pregnant. If any cum or pre-cum gets on your vaginal lips, the determined little sperm contained therein can swim all the way to the fallopian tubes.

Pre-cum is the tiny drop of fluid that often escapes the penis before the guy actually cums. Sperm (and possibly the HIV virus) may be in that little droplet.

The rhythm method.
To be fair, the rhythm method can work if you have a very regular cycle and practice it perfectly. Unfortunately, many teenagers don't have a regular cycle. And this is a birth control method that requires constant vigilance and the cooperation of your partner, because you can't have sex at certain times.

Douching with carbonated beverages (or any other substance), jumping up and down, hot baths, etc.
The folkloric methods people have to prevent pregnancy can range from useless to dangerous. DON'T.

A little history of birth control

Almost 3,500 years ago, men in Egypt wore condom-like sheaths as attractive and fabulous penis covers. By the 18th century, condoms were being made from sheep intestines. In Victorian England, sexual stimulation was believed to shorten one's life (and oral sex was thought to cause cancer of the mouth), so sex once a month (in the missionary position, please) was considered more than enough. In the ancient Middle East, Arabs placed pebbles in the uteruses of female camels when they set off on long journeys. For some reason, a foreign object in the uterus prevents pregnancy. Today, the IUD is based on the same theory. According to The New Our Bodies, Ourselves(a book we highly recommend for anyone interested in birth control or women's health issues in general), women in ancient Sumatra used to mold opium into cuplike shapes and use them to block the cervix.

What Does Work:

The Male Condom.
There's a whole section on condoms elsewhere in on the Safer Sex Page, so we'll keep this short. Condoms are not only your best friend in the fight against AIDS and STDs; they're a supercheap birth control method. Always choose latex (not animal skin), and use a water-based lube (not oil-based). Read the ingredients--Probe, Astroglide, KY Jelly are all water- based. Some condoms are pre-treated with Nonoxynol 9, which may prevent the transmission of HIV. And it lubricates too! However, it does make some people (usually guys) itch or get a rash. If so, buy pristine unlubricated latex condoms and use a side of lube (Probe, Astroglide, KY Jelly). As mentioned elsewhere, spread the lube on the outside of the condom after you put it on, and put one friction-increasing droplet on the inside before you put it on, if you so desire. (Not too much, or the condom could slip off.) Yum. When used right, condoms have a failure rate of about 2%, but more typically they fail about 12% of the time. If you follow the explicit how-to-use-a-condom directions elsewhere on this page, and combine a condom with spermicide, you'll achieve the joy that is nearly 100% protection from pregnancy.

By the way, the U.S. government, as represented by the Centers for Disease Control and Prevention, says that all condoms made in the U.S. have to pass stringent tests by the manufacturer. In addition, both imported and domestic condoms are randomly tested by the government to be sure they meet quality requirements. Therefore, says the CDC, there's no need to worry that you're buying an inferior brand of condom. But just so you know, a certain consumer publication tested a bunch of condoms in, admittedly, a way that doesn't mimic real-life conditions: they inflated condoms with air and observed when they popped. The publication found that the seven top performers were Excita Extra Ultra-Ribbed with spermicide, Ramses Extra Ribbed with spermicide, Sheik Elite 1, LifeStyles Vibra-ribbed, Ramses Extra with spermicide, Ramses Sensitol and Sheik Elite, Ribbed with spermicide. The seven least reliable performers were LifeStyles UltraSensitive, Trojan Extra Strength, Trojan Mentor, Trojan Plus, Trojan Very Thin, Trojan-Enz, Trojans Nonlubricated.

The Polyurethane Condom.
There exists a male condom made from polyurethane instead of latex. In the U.S., it's sold under the name Avanti. It's promoted as being twice as thin as latex condoms and impervious to oil-based lubricants, but some studies have indicated that it breaks far more easily than its latex counterpart. Good Vibrations, a longtime purveyor of sex tools and toys for women, decided to stop selling them because of customer complaints. Still, for people who are sensitive to latex, it's an option.

The Female Condom.
Sold in the United States under the name Reality. It's a polyurethane tube that looks a bit like a big ol' mutant male condom. One end goes inside the vagina, covering the cervix, and the other rests outside, creating a little plastic tunnel. It costs more than the male condom (about $2.50 apiece) and some people find it visually creepy. But it's a good alternative for women whose lovers refuse to wear a condom or have trouble sustaining an erection when they use condoms (hey, it happens). It's also good for folks who are sensitive to latex. And it's the only birth control method besides the male condom that offers near-total STD and HIV protection. The government says it's got a failure rate of 26%, but in reality (pun!) it's more reliable, IF you use it consistently and correctly. READ THE INSTRUCTIONS.

The Pill.
Wee hormone pills you take at the same time every day. Used right, they're almost 100% effective in preventing pregnancy. (Remember, they offer no protection against STDs or HIV.) If you sometimes forget to take them, take them at varying times of day or use antibiotics while you're on them, they're about 97% effective. Some women experience side effects--painful breasts, weight gain, nausea, headaches, depression--while others have none. There are different varieties of Pill, so you can switch kinds if you're having trouble. One plus for women with painful periods is that the Pill often makes this special time almost cramp-free, as well as shorter and less gushing. The Pill also may protect you against ovarian cancer. However, one big caveat is that no one really knows the effects of using daily hormones for a long time. And the Pill has been linked to heart attacks and strokes, which means you definitely shouldn't use it if you smoke. It's also been linked to breast and cervical cancers. (In the past, the doses of estrogen in the Pill were much larger; this may have been a source of many of these problems.) In short, there are big advantages and disadvantages to this method. It may be right for you; it may not be. Discuss it with your health care practitioner. The Pill costs about $200 a year, plus the cost of a clinic visit, but it may be covered by insurance or Medicaid. Ask.

Norplant consists of six match-size capsules implanted in your arm. Over five years, they slowly release synthetic progestin. Only about 4% of the women who use Norplant for the full five years get pregnant. Studies have shown that teenagers who use Norplant are much less likely to get pregnant than teenagers who use The Pill. (Probably because you can forget to take the Pill; you can't forget to take Norplant when you're carrying around INSIDE YOUR ARM!) And Norplant had no impact on whether or not the teenagers used condoms. However, smokers should avoid this method, because Norplant increases the risk of cardiovascular problems. Like the Pill, it's also been linked to breast cancer. In addition, about 75% of women using Norplant have irregular menstruation the first year, and some have serious spotting between periods. It doesn't offer std or HIV protection, and it may be less effective for women who weigh more than 154 pounds, Some folks are concerned about women getting inappropriately coerced into using Norplant, especially teenagers and poor women (there's legislation pending in several states that would try to noodge moms on public assistance into getting it). Norplant costs about $365 for five years, which works out to be cheaper than birth control pills over the same time period. A warning: Medicaid will sometimes pay to put it in, but not take it out before five years are up.

An injection of synthetic progestin, which seeps into your bloodstream gradually over the next three months. Around 9 million women in over 90 countries have used this method, which was developed in the '60s but not approved by the FDA until 1992. It's 99 percent effective. Most evidence says that Depo causes fewer health problems than the Pill, and most women who use it are happy with it. However, some women have menstrual irregularities and weight gain, and it may also increase the risk of breast cancer in young women. (Since African-American women are more likely to develop breast cancer at younger ages, Depo may be particularly ill-suited for them.) And as with Norplant, Depo may sometimes be pushed too hard on teenagers, low-income women and women of color. And again, it offers no protection from STDs or HIV. On the other hand, health care providers say that battered women often request this method, because their partner doesn't have to know they're using it. And at about $120 a year, it's comparatively cheap.

The Diaphragm.
The diaphragm is a Frisbee-like shallow cup you fill with spermicidal cream or jelly and insert before having sex. You have to be fitted for the right size (like shoes!). It's 94% effective if used consistently and correctly. There are almost no side effects or dangers, it offers some protection against the gonorrhea and trichomoniasis, and it's affordable: About $20 plus the cost of a clinic visit and spermicide (about $8 a tube). Many women like it because unlike the Pill, Depo or Norplant, you're not introducing outside hormones into your body. However, it takes practice to put a diaphragm in, and it can also put a damper on spontaneity (you have to insert it within six hours of having sex, and it's thought that the closer to intercourse you put it in the better). Plus you must add more spermicide if you do the wild thing twice in one night. You also may ooze warm, goopy spermicide over the course of the next day, which annoys some women. The cervical cap is similar to the diaphragm in many ways, but it's much smaller (it fits over just the tip of your cervix). It's not available everywhere in the U.S., but if your doctor or clinic is familiar with it, do check it out. Its small size means fewer problems with dripping problems.

These are great insurance when used with a condom, much less so when used alone. They increase your protection against gonorrhea and chlamydia, but not all STDs and not necessarily HIV (the jury is still out on Nonoxynol-9, one particular spermicide). For some reason, spermicidal foams and suppositories seem to work better than creams or jellies, which are usually designed to be used with a diaphragm. Their effectiveness when used alone ranges from 3 to 21 pregnancies per 100 users--this is not too inspiring. You have to insert them immediately prior to sex--if you put them in too early, they won't work. And here's a helpful hint: They usually taste disgusting, so have oral sex before you put 'em in. Also, a few people are sensitive to the chemicals in spermicides, finding 'em itchy and unpleasant.

Other methods
The IUD (intrauterine device) and sterilization probably aren't appropriate for women who think they might like to have children one day. Neither one offers protection from STDs or HIV, and the IUD carries a risk of long-term infertility if you get an STD or pelvic inflammatory disease. Incidentally, the IUD is more effective for women over 30. As for sterilization...well, duh, if you change your mind and decide you want kids, you are in for a costly and possibly futile reversal process. Again, though, it's your choice. Ask your doctor for more data.

[email protected] (Fri Feb 2 02:42:37 1996)