Contraception || A way of having sex without fear of unwanted pregnancy

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condoms

diaphragm

female condom

female pill

intra-uterine device (IUD)

Contraception is a way of having sex without the fear or hassle of an unwanted pregnancy. Some popular contraceptive methods are described here. The best contraceptive methods are the ones that can prevent both pregnancy and diseases like HIV at the same time. It makes sense to kill two birds with one stone.

Informed Choice: This is the most important issue in choosing your lifestyle, your contraceptive, and even your partner. This means that you know everything - disadvantages and advantages, side effects and fall-outs - about a contraceptive method or sex or your partner before you decide what is relevant and safe for you.

Do not adopt a method because it is the only one you have come across; its not a choice if you have been given only one option.
You need to take the spread of HIV, the risk of pregnancy, the possibility of contracting STD, and a host of other complications seriously before you decide what the right safe sex method is for you.
Do not allow someone else to make the decisions for you. Make sure you are informed - the safety of your body and mind is only in your hands!!
Always talk to your partner about the kind of contraceptive you are both comfortable with. Talking about it and sharing the responsibility for contraception belongs to both partners.

When choosing a contraceptive here are some things to keep in mind while making your decision.

Frequency of sexual relations: Do you want to be on the daily contraceptive pill if you have sex only twice a year?
Number of partners: If you're having sex with many different people, then not only are you at risk for pregnancy, but also more importantly HIV and sexually transmitted diseases. So the pill is not an effective contraceptive while the condom is.
Communication with partner: remember that any contraceptive you adopt should be discussed with your partner. If you are uncomfortable doing this or feel that the partner will not approve then there may be a problem in your relationship. Many women cannot ask their male partners to use a condom (because men say it’s like eating a banana with the skin on), and may expose themselves to considerable risk especially if the male has different sexual partners. Whether you doubt your partner’s sexual fidelity or not, insist on a condom. If you do not have a choice in the matter of contraception because your partner is not concerned about the risk you are exposed to, you need to ask yourself what is more important - your partner or your life-span???
Availability of contraceptive options: Some advanced contraceptives are available only in major cities and for a steep price.
Overall health and family history: Women should inform a gynaecologist about family medical history because there are contra-indications with some types of contraceptives, which could be detrimental to your health. A family history of breast or other cancers, smoking, diabetes, strokes etc. can be aggravated by contraceptives like the oral pill or injectibles.

Condoms		Diaphragms
Female Condoms		Female Pills
Sterilisation		Natural Methods
Implant		Intrauterine Device (IUD)
Spermicides		Emergency Contraception

A condom is a barrier method of contraception to stop sperm meeting the egg. The male condom fits over a man's erect penis and is made of very thin rubber or polyurethane plastic. Condoms can help to prevent sexually transmitted diseases (see Sexual Health and Safety) like gonorrhoea, HIV, syphilis, and chlamydia and to protect against cervical cancer and, pregnancy.

Latex condoms offer good protection against - Vaginosis / Pelvic inflammatory disease (PID) / Gonorrhoea / Chlamydia / Syphilis / Chancroid / Human Immunodeficiency Virus / Human Papilloma Virus (HPV) that can cause genital warts / Herpes Simplex Virus (HSV) that can cause genital herpes / Hepatitis-B virus.

Condom-Care
Putting on a Condom
If a Condom Breaks...

Don't Let Embarrassment Become a Health Risk

Nearly as many women as men buy and carry condoms. And many people use them - every time they have sexual intercourse. If you are embarrassed to talk with your partner about using condoms, practice before you are in a sexual situation. Then, choose the right time to talk - don't wait until the heat of passion takes over. It may overwhelm your good intentions.

Don't be shy - be direct. Be honest about your feelings and needs. Talking with your partner about using condoms makes it easier for you both. It can help create a relaxed mood to make sex more enjoyable.

It may be difficult to talk about using condoms. It will be easier if you are in a loving relationship that makes you feel happy and good about yourself and your partner. In any case, don't let embarrassment become a health risk.

If your partner absolutely refuses to wear a latex condom, you can use a female condom. Some men have said that the sensation is not so reduced with a female condom.

Don't be afraid of being rejected. Besides, the partner who doesn't care about protecting your health and well being is not worth your sexual involvement.

This is a BARRIER method of contraception used by the WOMAN. The diaphragm is a latex disc/dome that covers the cervix and is filled with a spermicide. The disc prevents the sperm from entering the cervix and uterus while the spermicide renders the sperm inactive. They are like circular domes made of thin soft rubber with a flexible rim. They stop sperm reaching an egg. There are 3 basic types - flat, coil or arcing spring and all come in different sizes It has a 80-98 % effectiveness. The diaphragm has to be fitted by a gynaecologist and is specially fitted for each woman. So if you lose or gain weight it will need to be refitted. The diaphragm is also not easily available in India. The diaphragm offers protection from STD and PID (pelvic inflammatory disease) and reduces the risk of cervical cancer. But it can be messy and difficult for a first time user. Some women also react to the latex/spermicide.

This is a new brand of barrier contraceptive that has recently been developed and is gaining popularity in the West. This is a polyurethane sheath with flexible rings at both ends. The interior ring is sealed off and functions much like the tip of the condom; the other end hangs outside the vagina. It’s a bit like a condom in reverse that fits inside the vagina. The inner end collects the ejaculated sperm. While no final figures are available for this new generation device, the expected effectiveness is comparable to the male condom. Of course comfort and convenience are a completely different issue!

There are two main types of Female Pill - the COMBINED Pill that contains oestrogen and progesterone AND the progesterone only Pill which DOES NOT contain oestrogen. Both oestrogen and progesterone are similar to the natural hormones women produce in their ovaries. The Pill works by stopping ovaries releasing an egg each month, makes it less easy for sperm to get through to fertilise an egg and also alters the lining of the womb so fertilisation is even less likely. Being on the pill does not stop a woman's menstruation. It eases harsh PMS symptoms and is often prescribed to women with irregular/very heavy periods. Always talk to a gynaecologist before going on the pill. Women who are over 35 years, who are smokers, or with a family history of strokes, heart attacks or cancer etc., should not go on the pill. Some users are hassled by having to remember to take the pill regularly and often forget the days when they are supposed to stop and re-start the dosage.

This is a permanent method for people who are absolutely sure they do NOT want any (more) children. Either a man or a woman can be sterilised; male sterilisation is called VASECTOMY. The man can still perform sexually, he still produces sperm, still gets an erection and is able of climax, it simply means that he cannot fertilise an egg inside the female womb after the operation. Sterilisation for a woman is IRREVERSIBLE, but a vasectomy can be reversed. Female sterilisation is called a TUBECTOMY where the fallopian tubes are cut and tied to prevent eggs from being released.

Sterilisation is a more complicated procedure for women than it is for men. A Tubectomy is much more traumatic for the woman's system than a Basectomy is for a man's.

This is based on predicting when the female will ovulate so that you can establish the `safe' time of day or of the month when you can have sex without any contraception but this requires careful planning by both partners and even with medical advice, can still be risky.

The rhythm method is based on knowing when the woman is least fertile (i.e. when there is the least chance of fertilisation) which is often just before and just after the menstrual period. But it is not possible to precisely predict when ovulation has occurred and what stage the ovum is at. This is therefore a very unsafe method to use.

The withdrawal method is when the man removes his erect penis from the vagina and ejaculates outside the woman. This is equally unsafe since the man cannot always know when he is going to 'come', unless he is experienced and knows his rhythm really well. Also, just before semen is ejaculated, a colourless fluid called precum is released from the penis and carries sperm as well, and since it is colourless and comes out in small droplets it is not easy to spot. Both the methods are extremely unsafe and inadvisable.

This contraceptive method for women consists of small soft hormone-filled tubes that are placed under the skin of the upper arm. They can provide contraception for up to 5 years. Going by the brand name 'Norplant', the implant releases synthetic hormones which prevent ovulation and alters the cervical mucus to block sperm. Once the hormones are used up the implant is removed. The implants are 99 % effective and are gaining popularity in the West since it involves no hassle, dates, times, creams etc. Most users report lighter periods and since the implants contain no estrogens there is a lower risk of clotting. It may also lead to cessation or irregularity of periods. The implants are linked to depression, headaches, nausea, and facial hair growth and body hair and breast tenderness. We have little information of the long-term effects of implants because they have not been in use long enough to test. Implants are difficult to access in India. It is always best to be wary of any contraceptive that alters the natural chemical balance of your body!!!

This is a copper COIL fitted to the woman’s womb within 5 days of having unprotected sex or within 5 days of the earliest time you could have released an egg. It is an effective method of stopping an egg being fertilised or implanting in the womb. It offers a very good alternative to those who do not like or cannot take hormones. The device contains chemicals that change the uterine lining to prevent implantation of the egg in it. Some of them are made of copper, hence the well-known name that we know - Copper T (because its shaped like a T) Depending on the kind of device used it can be effective for 5-10- years. Because it is 97 % effective with no mess or effort once it is in place, the IUD is a popular contraceptive. Risks could surface in the absence of proper medical care. A wrongly inserted Copper T could cause pelvic inflammation and even puncture the uterus. Most physicians advise against IUD usage in women with no children, with multiple partners, or with heavy menstrual bleeding. The device is also linked to a higher risk of contracting STDs. The cost of the device (including tests, insertion, and cost of the IUD) at a doctor's clinic can be as little as Rs. 400.

These are available as foams, creams, gels or suppositories (to be inserted into the vagina before sex) and as the name suggests they destroy the sperm entering the vagina. They contain a chemical agent called Nonoynol-9 or Octoxynol. Spermicides have 70-90 % effectiveness because there is a chance of misuse and spermicides do not provide adequate protection unless used with another barrier method like a diaphragm or condom. The process of using a spermicide can be quite messy; it has to be applied or inserted 30-45 minutes before intercourse and might need to be reapplied since the effectiveness wears off with time. In addition, some women might be sensitive and allergic to some chemical compositions of the spermicides. The most common spermicide in India, a suppository called Today, has reported very high failure rates.

This is a scary situation to be in and you should know about Emergency Contraceptive Methods (ECM) to make sure that you are protected against unwanted pregnancies. Note that this is to be used only in emergencies as the name implies and not as a regular contraceptive / abortive measure. You must always take the right precautions and not rely on ECM to bail you out. Two methods of ECM are available, the combined Morning After Pill (like RU 486) and the IUD.

Pregnancy is defined as the implantation of the fertilised egg in the uterine lining. ECM comes into effect before implantation and morning-after pills are used as an early abortion method after implantation has occurred.

In India, ECM is used under medical supervision for up to 5 days after unprotected sex, though ideally it should be just within 72 hours. The IUD insertion prevents fertilisation and prevents implantation of the fertilised egg. The newer varieties of IUD are made with plastic rather than copper and are more suitable for women with an allergy or sensitivity to copper. However, the success rate of the plastic IUD is less than the copper one.

The more popular ECM is actually a powerful contraceptive pill. Depending on the time of the menstrual cycle you are at, the emergency contraceptive pill may inhibit or delay ovulation, restrict movement of the egg or sperm, and alter the uterine lining to prevent implantation (like inducing menstruation). Generally the pill is administered in two doses with a gap of 12 hours. A woman has 30 % chance of conceiving if she has unprotected sex mid-cycle and if taken within 72 hours of this, the contraceptive pill can reduce that chance by 75 %.

The ECM is really a high dosage of contraceptive pills (female pill) with the right combination of the two female hormones. There is no additional risk for women who are already using the birth control pill because the ECM delivers no more than 4 doses of the combined estrogens-progesterone pill (most commonly used in India) as a "single-burst" of high dosage.

ECM in India goes by names like Duoluton, Ovral and Mala D, which are regular oral pills."

Side Effects: Most women report short-term side effects of the emergency contraceptive pill. Studies in the US show that 50 % of users feel nauseous while 20 % actually throw up. If you vomit after taking the pill you might have to repeat the dosage. Some women also report headaches, fluid retention and breast tenderness. You need to take the ECM under the supervision of a physician to prevent and foresee any complications.

Source: www.plannedparenthood.org
Single in the City ' The Independent Womans Handbook' by Sunny Singh, Penguin, 2000.