What You Need to Know about Birth Control and STI Prevention

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Birth control and sexually transmitted infection (STI) prevention are topics that every sexually active person needs to understand. While you may think you “know it all” about avoiding pregnancy and staying safe, information is always changing.

Don’t wait. Get the facts on all the methods currently available, and find out how to protect yourself and your partner. Remember, about 50% of pregnancies are unplanned, and about 1 in 4 people has an STD. Talk about the subject openly and regularly. Birth control and STI prevention are everyone’s responsibility.

Methods: The Facts

The Male Condom

Summary: The male condom is a sheath that is placed over a man’s erect penis before sex (vaginal, oral, or anal) occurs. It prevents sperm from entering and STIs from being transmitted. Advantages of condoms are that they are simple, cheap, easy to get (anyone can buy them), protect against STIs, and have no side effects, unless someone is allergic to latex (or spermicide, if using spermicidal condoms).  Disadvantages are that they can be hard to use or annoying to use correctly every time, and they reduce sensation.

Efficacy: Male condoms are fairly effective at preventing pregnancy—about 82% with typical use.

STI Protection: Condoms are typically the method of choice to protect against STIs when used during penis-vagina sex, anal sex, or oral sex on men. Be aware that lambskin condoms do not offer STI protection.

How do you get it? Men and women can buy condoms over the counter at many kinds of stores and online. They may also be available free at clinics, community centers, colleges and universities, and even nightclubs.

Cost: About $1 each, though free sources exist.

The Female Condom

The female condom is somewhat similar to the male condom, but instead of being a sheath that goes over the penis, it is a pouch that goes inside the vagina. It serves as a barrier so sperm cannot enter the uterus, and also protects against STIs. Advantages of the female condom are that it is a simple and inexpensive method that protects against STIs and has no side effects, and that it can be used if the man doesn’t want to wear a condom or cannot keep an erection with one on.  Disadvantages are that it can be awkward to use, and is not that effective at preventing pregnancy, due to user error being common.

Efficacy: The female condom is somewhat effective at preventing pregnancy —about 80% with typical use.

STI Protection: Like the male condom, female condoms are an excellent choice for protecting against STIs.

How do you get it? Female condoms are not as easy to find as male condoms. You may be able to find them at family planning clinics and doctor’s offices, or you can actually get a prescription for them that should be covered by insurance at your local pharmacy. If uninsured, you can buy them directly online at FC2.

Cost: Most health insurance plans and government programs will fully cover the cost of the female condom if you have them prescribed. (This could change if health insurance coverage rules for birth control change.) Or, you can buy them online with no prescription for about $2 each.

The Dental Dam

The dental dam, or sex dam, is NOT a birth control method, but it is an STI prevention method. Dental dams are small, thin pieces of latex placed over the genitals during oral sex or analingus. While most people don’t know much about them, they are an effective tool for preventing transmission of certain STDs, such as herpes and genital warts. These STIs should be taken seriously, as they can cause long-term health issues.

Efficacy: N/a against pregnancy

STI Protection: Dental dams are a good choice for preventing STI transmission during oral-genital and oral-anal sex.

How do you get it? Dental dams can be bought in stores and online. They can also be DIY-ed from a condom or a latex glove; info is available online. They may also be available free through some sources.

Cost: About .50-$1 each.

The Pill

The birth control pill is a pill a woman takes every day to prevent pregnancy. The pills contain hormones that prevent ovulation and fertilization of eggs. Advantages of the pill are that it is easy to use, does not interrupt the moment, and is effective. It can also regulate women’s cycles and protect against some annoyances, such as menstrual cramps and acne, as well as some more serious health problems. Disadvantages are that the woman must remember to take it every day, and that it can have side effects, such as mood changes, loss of sex drive, irregular menstrual bleeding, headaches, sore breasts, or nausea. Many pills are also not right for women with some health issues because they contain estrogen. The pill may not be right for women who are nursing.

Efficacy: The pill is very effective at preventing pregnancy—about 91% with typical use.

STI Protection: The pill does not protect against STIs. You should use a condom or female condom to protect yourselves.

How do you get it? Women have to get the pill prescribed by a nurse or doctor. They can then fill the prescription at a pharmacy or online.

Cost: Currently, most health insurance plans and government programs will fully cover the cost of birth control pills. (This could change if health insurance coverage rules for birth control change.) Low-cost clinics can also help. But if you have to pay for it yourselves, it could cost up to as little as $10 a month to as much as $100+ per month, depending on the brand.

The IUD

The IUD is a small, T-shaped piece of plastic that is inserted into a woman’s uterus at a doctor’s office and remains there for 3-12 years, or until the woman has it removed. It prevents a man’s sperm from fertilizing a woman’s egg. Some IUDs contain hormones and some do not. Advantages of the IUD are that there is nothing to take or do, and it is highly effective with little chance for “mistakes.” Disadvantages are that insertion can be somewhat painful, that some women experience menstrual side effects, and that some partners report being able to feel the string of the IUD during sex. In rare cases, IUDs can fall out or infection can occur after insertion.

The copper IUD can also be inserted after unprotected sex as an emergency contraception method.

Efficacy: The IUD is very effective at preventing pregnancy with typical use—about 99%.

STI Protection: The IUD does not protect against STIs. You should use a condom or female condom to protect yourselves.

How do you get it? Women have to get an IUD inserted by a nurse or doctor.

Cost: Currently, most health insurance plans and government insurance programs will fully cover the cost of IUD insertion and removal. (This could change if health insurance coverage rules for birth control change.) Low-cost clinics can also help. But if you had to pay for it yourself, it could cost up to $800+ total. However, IUDs last 3-10 years.

The Implant

The birth control implant is a tiny, thin rod inserted into a woman’s upper arm by a doctor. It releases hormones that prevent pregnancy. Advantages of the implant are that it is very effective, lasts for a long time (up to 4 years), and that women don’t have to worry about it or do anything once it is inserted. Disadvantages are that some women experience side effects, such as irregular menstrual bleeding, headaches, nausea, and weight gain.

Efficacy: The implant is highly effective at preventing pregnancy with typical use—about 99%.

STI Protection: The implant does not protect against STIs. You should use a condom or female condom to protect yourselves.

How do you get it? Women have to get the implant inserted by and later removed by a nurse or doctor.

Cost: Currently, most health insurance plans and government programs will fully cover the cost of implant insertion and removal. (This could change if health insurance coverage rules for birth control change.) Low-cost clinics can also help. But if you had to pay for it yourselves, it could cost up to $1300 total. However, it can last 4 years.

The Birth Control Shot (“Depo”)

The birth control shot, sometimes called “Depo” because of its brand name, Depo-Provera, is a hormone shot women can get in their arm from a health care provider. Each shot prevents women from getting pregnant for 3 months at a time. Advantages of the shot are that women only have to “do something” once every 3 months and that it is highly effective. It also can be used by women who can’t use estrogen-based methods. Disadvantages are that some women experience side effects, such as irregular menstrual bleeding, headaches, nausea, and weight gain, and women must go see a doctor every 3 months. It also may take some time to be able to get pregnant again after discontinuing the shot, which some women find it to be a disadvantage. And some women dislike shots.

Efficacy: The shot is very effective at preventing pregnancy with typical use —about 94%.

STI Protection: The shot does not protect against STIs. You should use a condom or female condom to protect yourselves.

How do you get it? Women have to get the shot from a nurse or doctor.

Cost: Currently, most health insurance plans and government programs will fully cover the cost of the shot. (This could change if health insurance coverage rules for birth control change.) Low-cost clinics can also help. But if you had to pay for it yourselves, it may cost about $50-120 per 3-month shot.

The Birth Control Patch

The patch is a small beige “sticker” that a woman wears on her upper arm, stomach, butt, or back. It releases hormones that prevent pregnancy. The woman changes the patch every week for 3 weeks, then wears no patch for a week while she has her period. Advantages of the patch are that it may be easier for some people to only have to remember to change a patch weekly than to take a pill daily. It can also regulate menstrual cycles and protect against some health problems. Disadvantages are that some women experience side effects, including irregular menstrual bleeding, nausea, and breast tenderness. The patch is also not right for women with some health issues because it contains estrogen.

Efficacy: The patch is very effective at preventing pregnancy with typical use —about 91%.

STI Protection: The patch does not protect against STIs. You should use a condom or female condom to protect yourselves.

How do you get it? Women have to get the patch prescribed by a nurse or doctor. They can then fill the prescription at a pharmacy.

Cost: Currently, most health insurance plans and government programs will fully cover the cost of the patch. (This could change if health insurance coverage rules for birth control change.) But if you have to pay yourselves, if may cost up to $80 per month.

The Vaginal Ring

The ring is a small bendable plastic ring that the woman inserts into her vagina and leaves there for 3 weeks at a time. After 3 weeks, she removes it for a week, during which time she will probably get her period. (Women can also wear the ring full-time, in which case they will skip their period, though they may spot. This is safe!) The ring works by releasing hormones that prevent pregnancy. Advantages of the ring are that it’s easy to use and doesn’t require “doing something” every day like the pill does. It can protect against some annoyances, such as menstrual cramps and acne, as well as some more serious health problems, and some women like being able to avoid periods. Disadvantages are that the woman must remember to take it out and insert a new one and that it can have side effects, such as loss of sex drive, irregular menstrual bleeding, headaches, sore breasts, or nausea.

Efficacy: The ring is very effective at preventing pregnancy with typical use—about 91%.

STI Protection: The ring does not protect against STIs. You should use a condom or female condom to protect yourselves.

How do you get it? Women have to get the ring prescribed by a nurse or doctor. They can then fill the prescription at a pharmacy.

Cost: Most health insurance plans and government programs will cover some to all of the cost of the ring. (This could change if health insurance coverage rules for birth control change.) But if you have to pay yourselves, it could cost up to $75 per month.

The Diaphragm

The diaphragm is a dome-shaped silicone cup that a woman inserts spermicide into and then inserts into her vagina to cover her cervix when she think she will have sex. It prevents sperm from reaching the egg. After sex, you remove the diaphragm. Advantages of the diaphragm are that it can be inserted up to 2 hours before sex (meaning there is no interruption of “the moment,”) that it is a nonhormonal method, and that it doesn’t create a lot of trash (unlike condoms). Disadvantages are that it is not as effective as some methods and causes irritation and UTIs for some women.

Efficacy: The diaphragm is fairly effective at preventing pregnancy with typical use—about 88%.

STI Protection: The diaphragm does not protect against STIs. You should use a condom or female condom to protect yourselves.

How do you get it? Women have to visit a doctor or nurse to get fitted for and get a prescription for a diaphragm. They can then fill the prescription at a pharmacy. Spermicide, which must be used with the diaphragm, can be bought at various drugstores and stores with no prescription.

Cost: Most health insurance plans and government health insurance programs will cover some to all of the cost of the diaphragm. (This could change if health insurance coverage rules for birth control change.) You will have to pay for spermicide. If you have to pay for the diaphragm yourselves, it could cost about $90 per year (replaced annually).

The Cervical Cap

The cervical cap is a small dome-shaped cap made of silicone that the woman inserts into her vagina up to 6 hours before sex, after applying spermicide to it. The cap blocks the cervix so sperm cannot reach the egg. Wait at least 6 hours after sex before removing it. Advantages of the cervical cap are that it is reusable, nonhormonal, can be put in long before sex, and is easier for some women to use than a diaphragm. Disadvantages are that it can be tricky to insert and is not very effective.

Efficacy: The cervical cap is fairly to somewhat effective at preventing pregnancy with typical use—about 71-86%.

STI Protection: The cervical cap does not protect against STIs. You should use a condom or female condom to protect yourselves.

How do you get it? Women have to visit a doctor or nurse to get fitted for and get a prescription for a cap. hey can then fill the prescription at a pharmacy. Spermicide, which must be used with the cervical cap, can be bought at various drugstores and stores with no prescription.

Cost: Most health insurance plans and government programs will cover some to all of the cost of the cap. (This could change if health insurance coverage rules for birth control change.) You will have to continue to buy spermicide. If you have to pay yourself, it could cost about $90 (replaced annually).

Spermicide

Spermicide can be a gel, film, foam, or cream. The woman puts it inside her vagina before sex and the chemicals contained in it kill sperm. It also helps create a barrier between sperm and the egg. The advantages of spermicide are that it is easy to buy at the store, relatively inexpensive, and easy to use.  The disadvantages are that it can be messy and is not very effective on its own.

Efficacy: By itself, spermicide is only somewhat effective at preventing pregnancy with typical use—about 72%. Those aren’t very good odds, so it’s not a good method to use solo. But spermicide is very useful when combined with other methods, like the diaphragm or the cervical cap.

STI Protection: Spermicide does not protect against STIs. You should use a condom or female condom to protect yourselves.

How do you get it? Spermicide is available at drugstores and other stores without a prescription.

Cost: Spermicide is bought over the counter. It’s fairly inexpensive—about $8-15 per package. However, this works out to about .50-$1.50 per sexual encounter., which can add up.

The Sponge

The sponge looks like a small, soft piece of foam with a dimple in the middle and a loop. The woman inserts it into her vagina before having sex, and it blocks sperm from getting into the uterus and also releases spermicide. You can put the sponge in up to 24 hours before sex and have sex as many times as you want within that 24 hours. It should be left in for at least 6 hours after sex, then removed.

Advantages of the sponge are that it is easy to use, nonhormonal, can be inserted ahead of time, and is available over the counter. Disadvantages are that it may cause irritation, has a fairly high failure rate and is somewhat expensive.

Efficacy: The sponge is somewhat to fairly effective against pregnancy with typical use—about 75-85%.

STI Protection: The sponge does not protect against STIs. You should use a condom or female condom to protect yourselves.

How do you get it? The sponge can be purchased over the counter at drugstores and other stores, as well as online.

Cost: The sponge is somewhat more expensive than other over-the-counter methods. You will probably pay about $12-15 for 3.

Sterilization

If you are certain that you are not interested in having children or that you are finished with having children, one option is permanent sterilization through a vasectomy or tubal ligation.  These are minor surgical procedures that make it impossible for a man to impregnate a woman (vasectomy) or a woman to become pregnant (tubal ligation/Essure).

Advantages are that once the procedure is complete, you never have to worry about birth control and its costs and side effects again. Disadvantages are that you need to be ready for a permanent decision, any surgery has risks, and there is a waiting period before the procedure is fully effective; sometimes there are minor side effects after the procedures.

Efficacy: Sterilization is very effective at preventing pregnancy with typical use--99%.

STI Protection: Sterilization does not protect against STIs. You should use a condom or female condom to protect yourselves.

How do you get it? Sterilization must be performed by a doctor.

Cost: Most health insurance plans and government programs will cover some to all of the cost of sterilization. (This could change if health insurance coverage rules for birth control change.) However, if you had to pay for it yourself, it could cost $2000 or more.

The Withdrawal Method

The withdrawal method consists of the man “pulling out” before orgasm is achieved, while ensuring that no sperm enters the woman’s vagina. While you may think of it as a non-method, it may work for some people if there is a lot of trust between partners and the man has strong self-control. It can function better when combined with fertility awareness and an alternate method on fertile days.

Advantages of the withdrawal method are that it is nonhormonal, free, and always available. Disadvantages are that it has a fairly high failure rate, may be less satisfying for both partners, can create stress during and around sex, is hard to do right every time, and requires maturity and control.

Efficacy: The withdrawal method is somewhat effective at preventing pregnancy with typical use—about 78%.

STI Protection: The withdrawal method might seem like it could protect against STIs; however, some STIs, such as chlamydia, syphilis, or gonorrhea, can be carried in pre-ejaculatory fluid. You should use a condom or female condom to protect yourselves.

How do you get it? You don’t have to “get” this one anywhere, except from your own self-control.

Cost: Free

Fertility Awareness

Fertility awareness involves monitoring the woman’s menstrual cycle, cervical mucus, and/or basal body temperature to understand when she is and is not fertile. On fertile days, the couple avoids sex or uses another birth control method, such as condoms, the diaphragm, etc.  Advantages of FA are that it is inexpensive, increases body awareness, and involves no hormones, no products, and nothing that gets in the way of sex—except during fertile times. Disadvantages are that it can be hard to do correctly, it requires self-discipline, organization, and maturity, it doesn’t work well for women with irregular cycles, and it has a fairly high failure rate.

Efficacy: Fertility awareness is somewhat to fairly effective at preventing pregnancy with typical use—about 75-85%.

STI Protection: Fertility awareness does not protect against STIs. You should use a condom or female condom to protect yourselves.

How do you get it? Typically, people learn to do fertility awareness on their own, using books and websites. Some couples take classes.

Cost: Fertility awareness can be 100% free, or you can use tools such as books, cycle monitoring beads, basal body thermometers, or inexpensive apps to assist you. In any case, it’s still likely to be very cheap if there is a cost.

The Morning-After Pill

The morning-after pill, also often called Plan B, is different from the other options on this list because it is used AFTER sex has taken place. It is important to distinguish between the morning-after pill (also often called Plan B) and the “abortion” pill (also called RU-486). The morning-after pill contains hormones that reduce the chances of pregnancy by preventing ovulation and fertilization, if taken within 5 days of unprotected sex. Scientists believe that the pill cannot prevent implantation if an egg has already been fertilized. (The abortion pill, on the other hand, can be taken up to 70 days after the day of the last menstrual period and causes the woman’s uterus to contract and empty.)

Many morning-after pills are available over the counter without age restrictions, while one type is available by prescription. To use the morning-after pill, the woman takes the pills as described on the packaging as soon as possible after unprotected sex (it can be as late as 4 days later). Typically, there will be two doses.

Advantages of the morning-after pill are that it is available to anyone and a fairly effective method for preventing pregnancy in cases where your regular contraception method fails, isn’t used, or is unavailable (for example, if you were drunk or impaired and forgot birth control, if a mistake occurred with another method and you need back-up, or if a woman is sexually assaulted). Disadvantages are that it may cause side effects, such as nausea, dizziness, cramps, and irregular bleeding. It is not to be used as a regular method of contraception.

Efficacy: The morning after-pill is somewhat to fairly effective at preventing pregnancy with typical use—about 70-90%. The morning-after pill may not as work as well for obese women.

STI Protection: There is no STI protection from the morning-after pill.

How do you get it? Many types are available over the counter in pharmacies with no prescription (though they may be stored behind the counter, meaning you have to ask), or can be bought online. One kind, Ella, needs a prescription.

Cost: About $25-50 for one dose over the counter.

More Info

This article is a good place to start, but there’s lots more to know about methods of birth control. Try these resources to find out more.

Bedsider: Comprehensive info provided by the federal government

Birthcontrol.com: Another comprehensive site

Birth Control Methods: From Womenshealth.gov

Birth Control Methods: From Stay Teen

Birth Control Locator: Find a clinic or learn how to order online

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References:

Bedsider.com (n.d.) Retrieved from https://www.bedsider.org/

Birthcontrol.com. (n.d.)  Retrieved from https://www.birthcontrol.com/

Center for Young Women’s Health. (2017). Dental dams. Retrieved from https://youngwomenshealth.org/2017/08/07/dental-dams/

Planned Parenthood. (n.d.) All about birth control methods. Retrieved from https://www.plannedparenthood.org/learn/birth-control

Planned Parenthood. (2016). The difference between the morning-after pill and the abortion pill. Retrieved from https://www.plannedparenthood.org/files/3914/6012/8466/Difference_Between_the_Morning-After_Pill_and_the_Abortion_Pill.pdf