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
WhatAre 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.