Contraception

Contraceptive means are the various ways of controlling pregnancy by preventing the fertilization of the ovum by sperm cells. There are multiple different means of contraception available, which are described below.

The condom and femidom are the only means of contraception that can protect you from getting STIs or from passing them on. Withdrawal (in both homosexual and heterosexual sex) is not an efficient way of protecting yourself and your partner.

The coil, inter–uterine device (or IUD)

What it is? A small plastic and copper device fitted in the womb that stops sperm meeting an egg, and stops an egg from settling in the womb.

Advantages:
  • Does not interfere with sex,
  • Can be left in for at least five years,
  • Works as soon as it is fitted.
Disadvantages:
  • No protection against STIs,
  • Periods may be heavier or longer and more painful,
  • Not suitable for women who have especially heavy periods.
Notes:
  • Usually changed every five years,
  • Women are taught how to check their IUD by feeling the threads, high up in the vagina,
  • Not a first choice contraceptive for young women who have not had children.

Condom

What is it? A very thin rubber sheath that is rolled over the erect penis, acting as a physical barrier. A teat at the end traps all the sperm.

Advantages:
  • Protects from HIV and other STIs,
  • Free from Family Planning Clinics, DHIVERSE and some GPs, and sold widely (including from the JCR Welfare Officers),
  • Useful where intercourse takes place infrequently or unpredictably,
  • May help protect against cervical cancer,
  • Either partner can take responsibility for contraception.
Disadvantages:
  • Putting it on can interrupt sex,
  • Could slip off or split if not used properly (to avoid this, remember to hold the tip whilst you put it on and the man should withdraw as soon as he has ejaculated and be sure he doesn’t spill any semen).
Notes:
  • Only water based lubricants may be used, as oil based lubricants will degrade the condom and cause it to split,
  • Only one condom should ever be worn at a time. Wearing more than one may result in the condom splitting during the intercourse,
  • Only condoms with the CE logo or “kite mark” provide real protection.
If the condom breaks:
  1. Take the emergency pill the day after if you do not want to get pregnant,
  2. Call the NHS immediately to get information about anti–HIV antibiotics. These must be taken within 24 hours to be effective. NHS Direct is a 24–hour nurse–led helpline providing confidential healthcare advice and information. Telephone: 0845 4647.

Depo–provera

What it is? An injection that releases the hormone progesterone into the body, stopping ovulation.

Advantages:
  • Does not interfere with sex,
  • One injection lasts for up to 12 weeks,
  • May provide protection against cancer of the womb.
Disadvantages:
  • No protection against STIs,
  • Periods often become irregular or stop,
  • Fertility may take a year or more to return after injections stop.
Notes:
  • The Depo–provera injection works for 12 weeks–it cannot be removed from the body, so any unwanted effects will continue during this time,
  • Not recommended as a first choice contraception, but may be suitable for those for whom other methods cannot be used, or have proven unsatisfactory.

Diaphragm

Also called: Cap and Dutch cap

What it is? A flexible rubber bowl used with spermicide which is specially fitted to cover the cervix.

How does it work? The cap works by:
  1. Carrying spermicide to the cervix,
  2. Holding sperm in the acidic environment of the vagina,
  3. Peventing cervical mucus from entering the vagina.
Advantages:
  • Protects against pelvic inflammatory disease,
  • Can be put in before sex, and need only be used when required,
  • May protect against cancer of the cervix,
  • A variety of types to choose from.
Disadvantages:
  • Mnimal protection from STIs only,
  • Initial fitting requires a doctor or nurse,
  • Putting it in could interrupt sex,
  • Extra spermicide needed to have sex again,
  • Cystitis can be a problem for some diaphragm users,
  • In practise less effective than hormonal contraceptives.
Notes:
  • Some people can have sensitive reactions to spermicide,
  • Fitting should be checked every 12 months or if you gain/lose more than 3kg,
  • Not to be left in for more than 30 hours,
  • Must be left in for six hours after sex,
  • Extra spermicide must be added if having sex again.

Femidom

What it is? A soft polyurethane sheath that lines the vagina, and the area just outside.

Advantages:
  • Protects from HIV and other STIs,
  • Can be put in before sex,
  • May help protect against cancer of the cervix,
  • Oil based products are ok to use with femidoms.
Disadvantages:
  • Need to ensure the penis enters the femidom, and doesn’t slip between the femidom and the vagina/anal passage,
  • May slip or cause lack of sensitivity,
  • Expensive to buy.
Notes:
  • Not yet subject to BSI Kitemark,
  • Femidoms can also be used as protection for anal sex,
  • 95% effective if used according to instructions, otherwise less effective.

Implant

What it is? A small (40mm), flexible tube containing progesterone inserted under the skin of your upper arm by a trained professional.

Advantages:
  • Lasts for up to 3 years,
  • You don’t have to remember to take a pill everyday,
  • Suitable for those who cannot take pills with oestrogen in.
Disadvantages:
  • For the first few days after the implant is put in you may experience some bruising, tenderness and swelling,
  • The first year after the implant your periods may become irregular, lighter, heavier or longer. This usually settles down after the first year,
  • Your periods may stop all together (this is not harmful),
  • Implant has to be put in and taken out by a trained professional.
Notes:
  • If implanted correctly, it is more than 99.9% effective,
  • Offers no protection against STIs,
  • If side effects do occur, it can be taken out at anytime.

The pill

What it is? There are two kinds of pill (the combined pill, and the progesterone only pill), but the gist is the same. They are both taken orally at the same time each day. The hormones it contains prevent pregnancy.

Advantages:
  • Does not interfere with sex,
  • Often reduces bleeding, period pain and premenstrual tension,
  • May protect against cancer of the ovary and womb, and against some pelvic infections,
  • Can reduce acne and unwanted hair.
Disadvantages:
  • No protection against STIs,
  • May not suit all women (a full medical history should be taken by a doctor),
  • Possible sid–effects, which may include: mood swings, dry skin, dry and irritated eyes (horrible if you wear hard contact lenses), swollen or painful breasts, and weight gain. Though most of these side effects will only affect certain women on certain pills, so don’t panic! It is best to discuss the possible side–effects with a doctor, and if a trial time presents problems, go back to the doctor and try a different one. Most women find a pill they are more than happy with.
Notes:
  • Not reliable if taken over 12 hours late or after vomiting or severe diarrhoea,
  • Pill users should try not to smoke.

Emergency contraception

Also called: The morning after pill

How does it work? Despite being known as “the morning after pill”, current guidelines from the FPA (Family Planning Association) state that the pill can be taken within 72 hours of intercourse. It is, however, significantly more effective if taken within the first 24 hours. It is therefore important that you act quickly.

Where can I get it? If you need post–coital contraception, seek help immediately by phoning your GP or the Family Planning Clinic, who will be able to prescribe you with the morning after pill for free. Alternatively, you can buy it over the counter from a licensed pharmacist (such as Boots or Superdrug) for around £25, or it is available out of hours from Addenbrooke’s A+E department.

Notes:
  • The morning after pill can be pretty hard on your system, and may induce nausea. However, as long as you do not use it regularly the threat to your health is very small.
  • The emergency contraception does not provoke an abortion. It prevents any fertilised ovum from implanting itself in the uterus.
  • Remember that emergency contraception offers no protection from Sexually Transmitted Infections, so if you have had unprotected sex or if you have used a condom which broke during the intercourse, you may wish to consider having a sexual health check–up.