Infant, Maternal & Reproductive Health Unit

What's Right For Me?

• Abstinence
• Natural Family Planning
• Calendar/Rhythm
• Withdrawal
• Male Condom
• Female Condom
• Vaginal Spermicides
• Diaphragm with Spermicide
• Cervical Cap
• Combined Oral Contraceptive Pills
• The Patch
• Vaginal Ring
• The Minipill
• Depo-Provera
• IUD
• Female Sterilization
• Male Sterilization




ABSTINENCE
How Does it Work?	How Well Does it Work?
Egg and sperm do not meet Fertilization does not occur	100% effective as long as sex does not occur
Does it Reduce Risk for HIV/AIDS and STDs?
100% reduced risk for sexual transmission of HIV/AIDS and STDs if abstaining from all forms of sex (vaginal, oral, and anal) Does not reduce risk for HIV/AIDS and STDs if only abstaining from vaginal sex or if engaging in other risky behavior
What are its Main Advantages?	What are some Possible Problems?
Eliminates the risk for sexually transmitting or contracting HIV/AIDS or STDs No health risks or side effects Can be used at any time, regardless of prior sexual experience May be a strong value for some individuals, families, and religious groups Allows users to focus on non-sexual aspects of relationship	May be hard to stick with Requires learning and using decision-making, negotiation, and planning skills

Back to Top

NATURAL FAMILY PLANNING (Periodic Abstinence, Sympto-Thermal, Billings/Ovulation Method, Basal Body Temperature)
How Does it Work?	How Well Does it Work?
Users abstain from sex on fertile days to prevent egg and sperm from meeting Fertilization does not occur	Typical use: 81% Perfect use: 91-99%
Does it Reduce Risk for HIV/AIDS and STDs?
Does not reduce risk for HIV/AIDS or STDs Using a male, latex condom reduces the risk
What are its Main Advantages?	What are some Possible Problems?
No health risks or side effects caused by method Accepted by most religions Can be used to determine fertile days when pregnancy is desired Responsibility can be shared by couple	Have to abstain from intercourse on fertile days (back-up method can be used on fertile days, if couple chooses not to abstain) Temptation to take risks may occur Care is needed to keep records and observe signs Fertility signs and symptoms may be difficult for some women to identify

Back to Top

CALENDAR/RHYTHM
How Does it Work?	How Well Does it Work?
Users abstain from sex on fertile days to prevent egg and sperm from meeting Fertilization does not occur	Typical use: 75% Perfect use: 91%
Does it Reduce Risk for HIV/AIDS and STDs?
Does not reduce risk for HIV/AIDS or STDs Using a male, latex condom reduces the risk
What are its Main Advantages?	What are some Possible Problems?
No health risks or side effects caused by method Accepted by most religions Can be used to determine fertile days when pregnancy is desired Responsibility can be shared by couple	Menstrual cycle can change due to stress, illness, or other factors making it difficult to predict ovulation and fertile days based on past cycles Have to abstain from intercourse on fertile days (back-up method can be used on fertile days, if couple chooses not to abstain) Temptation to take risks may occur Care is needed to keep records and observe signs

Back to Top

WITHDRAWAL
How Does it Work?	How Well Does it Work?
Egg and sperm do not meet Fertilization does not occur	Typical use: 81% Perfect use: May be as high as 96% Effectiveness varies according to the skill and control of the male Failure rate increases with repeated sex or inability to control ejaculation
Does it Reduce Risk for HIV/AIDS and STDs?
Does not reduce risk for HIV/AIDS or STDs Pre-ejaculate ("pre-come") may contain HIV and STDs Using a male, latex condom reduces the risk
What are its Main Advantages?	What are some Possible Problems?
No health risks or side effects caused by method Reversible No cost Always available	Requires good self-control for the male May decrease pleasure and satisfaction Some mates may be unable to predict ejaculation and withdraw in time

Back to Top

MALE CONDOM ("rubber")
How Does it Work?	How Well Does it Work?
Creates a barrier between the penis and the vagina Collects and holds the semen Egg and sperm do not meet Fertilization does not occur	Typical use: (condom alone) 84% Perfect use: (condom alone) 97% Using a condom with spermicide increases the effectiveness up to 99%
Does it Reduce Risk for HIV/AIDS and STDs?
Male, latex condoms reduce risk for HIV/AIDS and most STDs Animal "skin" condoms do not provide HIV/AIDS and STD protection
What are its Main Advantages?	What are some Possible Problems?
Latex condoms reduce the risk for transmitting and contracting HIV/AIDS and STDs No prescription needed; can be purchased at most drug stores No health risks or side effects caused by method (except for those allergic to latex) Delays premature ejaculation	Condoms may slip off, or break Proper use may interfere with spontaneity May affect sexual sensations May cause irritation or discomfort If allergic to latex, can have a severe reaction; plastic condoms may be used Latex condoms should not be used with oil-based lubricants

Back to Top

FEMALE CONDOM (vaginal pouch, Reality Female Condom®)
How Does it Work?	How Well Does it Work?
Creates a barrier between the penis and the vagina Collects and holds the semen Egg and sperm do not meet Fertilization does not occur	Typical use: 79% Perfect use: 95%
Does it Reduce Risk for HIV/AIDS and STDs?
The female condom has not been well tested for HIV/AIDS and STD prevention In theory, all barrier methods provide some protection against HIV/AIDS and STDs Female condoms should not be used with a male latex condom If female is at high risk for HIV/AIDS or other STDs, using a male, latex condom instead reduces the risk
What are its Main Advantages?	What are some Possible Problems?
Reversible Can be bought at many drug stores Can be placed in vagina up to 8 hours before use May not tear as easily as male condoms; polyurethane is stronger than latex	May slip out of place during sex May be difficult for some women to insert May affect sexual sensations May cause irritation or discomfort Increased risk for toxic shock syndrome

Back to Top

VAGINAL SPERMICIDES
How Does it Work?	How Well Does it Work?
Kills sperm Some forms block sperm from entering the cervix Fertilization does not occur	Typical use: (spermicide only) 71% Perfect use: (spermicide only) 85% Using a condom with spermicide increases effectiveness to 99.9% Some types are not effective until 10-15 minutes after placing in vagina; follow instructions Only effective for about one hour when used alone Additional application is needed for each act of intercourse
Does it Reduce Risk for HIV/AIDS and STDs?
Somewhat reduced risk for some STDs Uncertain action against HIV/AIDS Using a male, latex condom reduces the risk
What are its Main Advantages?	What are some Possible Problems?
Reversible No prescription needed Available at most drug stores	May cause irritation or discomfort Increased risk of vaginal and urinary tract infections Some individuals are allergic to spermicides Proper use may interrupt "sexual mood" May leak and feel messy

Back to Top

DIAPHRAGM WITH SPERMICIDE
How Does it Work?	How Well Does it Work?
Cup acts as barrier to semen contact with the cervix Spermicide kills sperm Fertilization does not occur	Typical use: 80% Perfect use: 94% Failure rate increases with increased sexual activity (more than 3 times a week)
Does it Reduce Risk for HIV/AIDS and STDs?
Somewhat reduced risk for some STDs and PID Uncertain protection against HIV/AIDS Lowers risk for cancer of the cervix Using a male, latex condom reduces the risk for HIV/AIDS and STDs
What are its Main Advantages?	What are some Possible Problems?
Reversible Can be used with or without partner cooperation Can be placed in vagina up to 6 hours before sex	Requires a prescription and clinic visit May be difficult for some women to insert Some individuals are allergic to the rubber or the spermicide Pelvic pressure, vaginal discharge, or vaginal irritation if left in too long Increased risk for vaginal and urinary tract infections Increased risk for toxic shock syndrome; must be removed within 24 hours Cannot be used with oil-based lubricants or vaginal medications

Back to Top

CERVICAL CAP
How Does it Work?	How Well Does it Work?
Covers and fits snugly around the cervix Cup holds spermicide in contact with the cervix Cup acts as barrier to semen contact with the cervix Spermicide kills sperm Fertilization does not occur	Typical use in woman who has never had a baby: 80% Perfect use in woman who has never had a baby: 91% Typical use in woman who has already had a baby: 60% Perfect use in woman who has already had a baby: 74%
Does it Reduce Risk for HIV/AIDS and STDs?
HIV/AIDS and STD protection has not been studied in the cap In theory, barrier methods provide some protection against HIV/AIDS and STDs Using a male, latex condom reduces the risk
What are its Main Advantages?	What are some Possible Problems?
Reversible Can be used with or without partner cooperation Can be used for repeated sex for up to 48 hours	Few clinicians are trained to fit the cap Some women have difficulty inserting and removing the cap Should not be used during the menstrual period Possible allergy to rubber or spermicide Pelvic pressure, vaginal discharge, or vaginal irritation if left in too long Increased risk for vaginal and urinary tract infections Increased risk for toxic shock syndrome; must remove within 48 hours Cannot be used with oil-based lubricants or vaginal medications

Back to Top

COMBINED ORAL CONTRACEPTIVE PILLS (estrogen/progestin pill)
How Does it Work?	How Well Does it Work?
Thickens cervical mucus, blocking sperm Prevents ovulation Prevents implantation of fertilized egg	Typical use: 95% Perfect use: 99.9% Failure rate increased with: some medications, missed pills, taking pills late Use backup method for: first cycle, any missed pills, discontinuing pill, or if taking some medications
Does it Reduce Risk for HIV/AIDS and STDs?
Does not reduce risk for HIV/AIDS or STDs May increase risk for chlamydia and cervicitis Using a male, latex condom reduces the risk
What are its Main Advantages?	What are some Possible Problems?
Reversible Does not interfere with sex Medically safe for most women Regulates periods, lighter periods Decreases menstrual pain and PMS May improve acne Decreases risk for ovarian and endometrial cancers	Side effects: nausea, weight gain, headaches, dizziness, breast tenderness, break-through bleeding (spotting between periods) More serious complications include depression, liver tumors May increase risk of stroke, heart attack, blood clots, and high blood pressure for some women (especially women over 35 who smoke) Possible increased risk for breast cancer and cervical cancer

Back to Top

THE PATCH (OrthoEvra®)
How Does it Work?	How Well Does it Work?
Thickens cervical mucus, blocking sperm Prevents ovulation Prevents implantation of fertilized egg	Typical use: unknown Perfect use: 99.7% Appears to be less effective in women weighing more than 198 pounds
Does it Reduce Risk for HIV/AIDS and STDs?
Does not reduce risk for HIV/AIDS or STDS May increase risk for chlamydia and cervicitis Using a male, latex condom reduces the risk
What are its Main Advantages?	What are some Possible Problems?
Simple and easy to use; place a new patch weekly for three weeks Reversible Does not interfere with sex Medically safe for most women Regulates periods, lighter periods Decreases menstrual pain and PMS May improve acne	Side effects: nausea, weight gain, headaches, dizziness, breast tenderness, break-through bleeding (spotting between periods) More serious complications include depression, liver tumors May increase risk of stroke, heart attack, blood clots, and high blood pressure for some women (especially women over 35 who smoke) Application site problems include partial detachment or complete detachment and skin irritation

Back to Top

VAGINAL RING (NuvaRing)®
How Does it Work?	How Well Does it Work?
Thickens cervical mucus, blocking sperm Prevents ovulation Prevents implantation of fertilized	Typical use: unknown Perfect use: 99.7%
Does it Reduce Risk for HIV/AIDS and STDs?
Does not reduce risk for HIV/AIDS or STDS May increase risk for chlamydia and cervicitis Using a male, latex condom reduces the risk
What are its Main Advantages?	What are some Possible Problems?
Simple and easy to use; remains in vagina for 3 weeks, then removed for 4th week Reversible Does not interfere with sex Lowest dose combined estrogen and progestin method making it medically safe for most women Regulates periods, lighter periods Decreases menstrual pain and PMS May improve acne Decreases risk for ovarian and endometrial cancer	May be difficult for some women to insert and remove Side effects: nausea, weight gain, headaches, dizziness, breast tenderness, break-through bleeding (spotting between periods) More serious complications include depression, liver tumors May increase risk of stroke, heart attack, blood clots, and high blood pressure for some women (especially women over 35 who smoke) Possible increased risk for breast cancer and cervical cancer Vaginal discharge, vaginitis or irritation If ring is expelled and remains out for more than 3 hours, another birth control method must be used until ring has been used continuously for 7 days

Back to Top

THE MINIPILL (progestin-only pill)
How Does it Work?	How Well Does it Work?
Thickens cervical mucus, blocking sperm May or may not prevent ovulation Prevents implantation of fertilized egg	Typical use: 95% Perfect use: 99.5% Failure rate increased for women who take seizure medications Use backup method: every time a pill is missed or taken late (even 3 hours late!)
Does it Reduce Risk for HIV/AIDS and STDs?
Does not reduce risk for HIV/AIDS or STDs Using a male, latex condom reduces the risk
What are its Main Advantages?	What are some Possible Problems?
Reversible Does not interfere with sex Can be used by some women who cannot take regular birth control pills Can be used while breastfeeding	Progestin-only methods often cause changes in menstruation including: spotting, missed periods, irregular bleeding, heavy flow Side effects: weight gain, headaches, breast tenderness, ovarian cysts

Back to Top

DEPO-PROVERA ("the shot")
How Does it Work?	How Well Does it Work?
Thickens cervical mucus, blocking sperm Prevents ovulation Prevents implantation of fertilized egg	Typical use: 100% Perfect use: 100% Works for 12 weeks Failure rate increase if shot is not repeated every 12 weeks
Does it Reduce Risk for HIV/AIDS and STDs?
Does not reduce risk for HIV/AIDS or STDs Using a male, latex condom reduces the risk
What are its Main Advantages?	What are some Possible Problems?
Lasts for 3 months Does not interfere with sex Can be used by women with a history of seizures (reduces seizures) or sickle cell anemia Can be used while breastfeeding Menstrual changes are common including a light period or no period Less cramping during period	Need to return for shot every 3 months. Menstrual changes may include: irregular bleeding or spotting Side effects: weight gain, depression, breast tenderness, headaches, allergic reaction Side effects may last for up to 6 months after the last injection May cause delay in ability to get pregnant after discontinuation May cause bone density changes or bone loss; adverse effects on lipids

Back to Top

IUD (intrauterine device)
How Does it Work?	How Well Does it Work?
May inactivate sperm and/or egg, preventing fertilization Creates an inflammatory condition in the uterus, preventing implantation of fertilized egg	The Paragard® (CuT 380A) is effective for up to 10 years Typical use: 99.2% Perfect use: 99.4% The Mirena® is effective for 5 years Typical use: 99.9% perfect use: 99.9% The Progestasert® is effective for 1 year Typical use: 98% Perfect use: 98.5%
Does it Reduce Risk for HIV/AIDS and STDs?
Does not reduce risk for HIV/AIDS or STDs May increase risk of HIV/STD transmission May increase risk of pelvic inflammatory disease (PID) soon after insertion Using a male, latex condom reduces the risk Should only be used by women at low risk for HIV/AIDS and STDs (only have sex with one uninfected partner)
What are its Main Advantages?	What are some Possible Problems?
Reversible method Does not interfere with sex Nothing to remember (except checking the string) Menstrual changes are common including light period or no period Less cramping during period Long-acting (up to 10 years with the CuT 380A)	Up to 10% of women expel IUD during first year of use Insertion requires a minor medical procedure which may be somewhat uncomfortable Must be removed by a clinician Possible uterine perforation at time of insertion May cause menstrual problems, including heavy bleeding and cramps Increased risk for PID which may lead to infertility; may not be a good choice for women who have not had children Should not be used by women who are at high risk for HIV/ AIDS/STDs Should not be used by women with diabetes, HIV infection, other impaired immune conditions, or anemia IUD may not stay in place (may fall out, move out of reach or become imbedded) Partner may feel the string during sex

Back to Top

FEMALE STERILIZATION (tubal ligation)
How Does it Work?	How Well Does it Work?
Egg and sperm cannot meet Fertilization does not occur	Typical use: almost 99.5% Perfect use: almost 99.5% Failure rate may be increased with some methods of tubal ligation
Does it Reduce Risk for HIV/AIDS and STDs?
Does not reduce risk for HIV/AIDS or STDs Using a male, latex condom reduces the risk Reduces risk of ovarian cancer
What are its Main Advantages?	What are some Possible Problems?
Permanent Safe medical procedure (although male sterilization is easier and safer) Does not interfere with sex Nothing to remember	May require a 30 day waiting period; may have minimum age requirement Risks of surgery, including: reaction to anesthetic, infection and bleeding Temporary pain at surgical site Some individuals later regret decision If pregnancy occurs, risk of ectopic (tubal pregnancy) is high; any symptoms of pregnancy should be reported to health care provider immediately and evaluated Reversal requires surgery, is very expensive and may not be successful

Back to Top

MALE STERILIZATION (vasectomy)
How Does it Work?	How Well Does it Work?
Egg and sperm cannot meet Fertilization does not occur	Typical use: almost 99.8% Perfect use: almost 99.9% Vasectomy is not effective until sperm is cleared from the male system (takes about 15 ejaculations or 6 weeks)
Does it Reduce Risk for HIV/AIDS and STDs?
Does not reduce risk for HIV/AIDS or STDs Using a male, latex condom reduces the risk
What are its Main Advantages?	What are some Possible Problems?
Permanent Safe medical procedure Easier and safer than female sterilization Does not interfere with sex Nothing to remember	Risks of surgery, including: reaction to anesthetic, bleeding and infection Temporary bruising, swelling, tenderness of the scrotum Some individuals later regret decision Reversal requires surgery, is very expensive and may not be successful