Your body
The reproductive organs of women are well hidden, so how it all works can be confusing. A look at anatomy from the outside to the inside reveals the following parts:

The vagina

is a passageway from the outside of the body that ends several inches up at the cervix. The vagina is a "potential space" (like a balloon), and it expands to accommodate things like a penis or a baby passing through. You can not lose anything in the vagina because it is like a pouch.

The cervix

is at the top of the vagina. It looks like a small doughnut and the hole in the center is only large enough for blood to get out and sperm to get in. The cervix is actually the lower part of the uterus and can be felt by inserting the finger deep into the vagina.

The uterus

is the size and shape of a pear.

The fallopian tubes

connect the uterus and ovaries.

The ovaries

are two walnut-size structures located on either side of the uterus. They make the hormones and eggs needed for pregnancy.

The menstrual cycle
The purpose of the menstrual cycle is to prepare the ovaries for ovulation (making an egg) and to prepare the uterus for the fertilized egg to implant and grow. If an egg is produced but not fertilized, the lining of the uterus is shed two weeks later and menstruation occurs. Many women cycle every 28 days; however, it is normal for women to cycle every 21 to 35 days or more. A cycle is counted from the first day of one period to the first day of the next period. It is wise for a woman to keep a menstrual calendar, because a change from one's usual pattern may indicate a health concern.

When in your cycle are you most fertile?
In general, the time when you are most fertile occurs 14 days before your next period. When you ovulate (make an egg), the egg lives only 24 hours. If the egg is not fertilized, two weeks later you will shed the lining of the uterus and have a period. Please note that although the egg lives only 24 hours, sperm can live three to five days inside the body waiting for the egg to mature. Therefore, it is possible to become pregnant during five to six days of each menstrual cycle. In women who cycle every 28 days, this fertility occurs mid-cycle. Fertility cannot be predicted with absolute certainty, because no two women are exactly alike and even an individual woman's cycles may vary from month to month or be affected by stress.

Consider the "big picture"
Being sexually active places you at risk for many other concerns besides pregnancy. Sexually transmitted diseases (STDs) such as herpes, chlamydia and genital warts are common on college campuses and in the general population. Once you have intercourse you are at greater risk for cervical cancer and need to be getting Pap smears annually. HIV is a major factor to be considered. Your emotional and psychological health and your readiness for physical intimacy are other parts of the big picture. Only you can see your own "big picture."

Abstinence
This is the only method of birth control that is 100 percent effective.
Remember this when considering options.

Outercourse (lower risk intimate behaviors)
Sometimes we forget that not all intimate contact places us at risk for pregnancy or diseases. "Outercourse" (physical intimacy with clothes on) carries no risk for pregnancy. Mutual masturbation where "wet to wet" external genital contact is strictly avoided is also a way to avoid pregnancy and to decrease risk for diseases. It requires good self-control and commitment to the method.

Jump to The Pill |  IUDs | Diaphragm |  Depo Provera Injections | Condoms | Spermicides | Female Condoms | Natural Family Planning

Description:

These are synthetic hormone pills that contain both estrogen and progesterone. They are taken for 21 days and then sugar (placebo) pills are taken for seven days to allow for a menstrual period. Pills need to be taken daily at the same time each day. Bleeding on the pills is often much shorter and less painful than usual.

How it works:

Pills mimic the normal body hormones but control fluctuations so that an egg is not made. In addition to blocking ovulation, pills also make cervical mucous more likely to block sperm.

Advantages:

Very high effectiveness. Lighter periods with less cramping. Less blood loss means less risk for anemia. Reduces risk for ovarian and uterine cancer and decreases risk for pelvic inflammatory disease.

Disadvantages:

Associated with spotting between periods, missed periods, increase in blood pressure, and a variety of other side effects. Most side effects are uncommon and can be managed by changing pills. This method does not protect against STDs.

Description:

A small plastic device, containing copper or the hormone progesterone, is implanted by a health care professional inside the uterus. A short string hangs into the vagina where it cannot be seen but where a women can reach up and feel for its placement once a month after menses.

How it works:

The device is thought to prevent sperm from reaching or fertilizing the egg. Depending on the type of IUD, it may work for one to eight years. However, because a string hangs into the vagina, there is route of entry for STDs to get into the uterus and these infections may increase risk for infertility.

Advantages:

A single-decision method that is easily inserted and removed. No surgery required.

Disadvantages:

Women who are at high risk for STDs may develop infertility if infection occurs. Some devices may increase cramping and bleeding. This method is not recommended for women who have no children.

Description:

A dome-shaped, soft rubber or latex cup that is filled with two teaspoons of contraceptive jelly or cream and inserted into the vagina to cover the cervix before sex. The rim of the diaphragm is secured in place by the pubic bone and the rear wall of the vagina. A woman cannot feel it once it is in position.

How it works:

It provides a physical barrier to sperm and also holds contraceptive jelly against the cervix to kill sperm. The diaphragm is inserted before intercourse and should not be removed for up to six hours after sex. If intercourse occurs before the six-hour time limit, the diaphragm is not removed and an applicator is used to put extra spermicide into the vagina. Wearing it longer than 24 hours is not recommended. The diaphragm should be checked for holes or tears each time before use. Diaphragms are sturdy but should be replaced every two years.

Advantages:

Birth control is completely in the hands of the woman. The diaphragm also may provide a barrier to STDs. If used with a condom, the effectiveness rate is almost 100 percent.

Disadvantages:

Increased risk for bladder infections especially in women who already have that tendency. (Urinating after sex may help flush out bacteria that can cause bladder infections.) Occasionally minor vaginal irritation may occur. It cannot be used during menses. If a woman gains or loses 10 pounds or more, her diaphragm must be refitted.

Description:

This is an injection or shot of synthetic progesterone that is given once every three months. It has been used safely in Europe for more than 15 years.

How it works:

Depo Provera virtually eliminates any chance of ovulation for at least 12 weeks (or three months). Because you do not ovulate, you also no longer have menstrual cycles. Women using this method experience irregular spotting. However, after one year of use half of women no longer have any menstrual blood at all.

Advantages:

Simplicity! You only have to do something once in 12 weeks to prevent pregnancy. (You still need to consider STD prevention.) Many women also consider the loss of menses to be an advantage.

Disadvantages:

Inability to predict when you will bleed. If planning a pregnancy in the next two years, note that infertility may continue for six to 18 months after last injection. Weight gain may be noted over time. Other side effects, such as depression, are less common but can occur.

Description:

A thin sheath worn on the erect penis during sexual intercourse. Condoms may be non-lubricated, coated with water-soluble jelly, or lubricated with nonoxynol-9. They can be made of latex or natural lambskin. Natural lambskin does not block the passage of small viral particles such as HIV and herpes; therefore, only latex condoms are recommended.

How it works:

The condom is a mechanical barrier that blocks the passage of sperm. To be effective, a condom needs to be placed on the penis before there is any genital contact. About 1/2 inch of space needs to be left at the tip for the ejaculate, but make sure not to allow any air trapping in the condom. The man needs to hold onto the base of the condom and withdrawal immediately after ejaculation. Only water soluble lubricants should be used.

Advantages:

Protection against HIV and other STDs! Almost 100 percent effectiveness rate if used with another barrier method such as the sponge, diaphragm or spermicide.

Disadvantages:

User technique is important, so practice and understanding the basics of use are important

Description:

A wide variety of spermicidal products are available over the counter. Some types have reusable applicators that need to be washed. Some types come with prefilled disposable applicators. Some are suppositories.

How it works:

Most use nonoxynol-9 or octoxynol, which kill sperm and help inactivate viruses and bacteria. Specific directions in the packages tell you how to insert the method and what time recommendations and repeat applications are necessary.

Advantages:

Economical. If used with a condom, they provide an immediate backup contraception should the condom break and effectiveness approaches 100 percent.

Disadvantages:

Can be messy. May cause vaginal irritation and burning.

Description:

A soft, loose-fitting plastic pouch that lines the vagina. It has a soft ring at each end. The ring at the closed end is used to put the device inside the vagina and holds it in place. The other ring stays outside the vagina and partly covers the lip area. Extra lubricant is provided in the kit.

How it works:

Can be used up to eight hours before sex and should be removed after sex and before you stand up. Prior to sex the inner ring is inserted deep into the vagina. About 1 inch of the open end of the condom will stay outside the body. Make sure the penis goes into the pouch and that the pouch is not twisted. Add extra lubricant if the pouch feels like it is slipping. After intercourse, squeeze the outside ring and twist to keep the sperm inside the pouch, gently pull it out. A new female condom must be used for each act of intercourse.

Advantages:

Warms up as soon as inserted. Many couples say it enhances sensation or at least does not decrease sensation.

Disadvantages:

Cannot be used with a male condom, and it is not as effective as the male condom. About one in four women who use the female condom may become pregnant during a year. Occasionally the outer ring may get pushed inside the vagina. Other problems include minor irritation, discomfort or breakage, but these risks are decreased by using enough lubrication. Costs more than male condoms.

This method is recommended only for women who have very regular, predictable cycles and who have no reason to be concerned about STDs. Natural family planning requires a high level of education about the method and daily persistence in noting body changes as well as abstaining during fertile times. If you are interested in this method, please ask for more information from the clinic staff.

Withdrawal: Common wisdom is that it is better than nothing, but it puts the woman at risk for both pregnancy and disease, and it puts all of the power and method effectiveness on the man. No matter how good his control is, pre-ejaculate may leak, carrying disease or sperm.

Will your method of birth control work?

Keep in mind that failure rates in studies apply to groups, not to individuals. Even the best method in the world won't protect you if you don't use it or if you use it incorrectly. If you are careful about using your method correctly, your failure rate may be much lower than others in the group.

Using two methods at once dramatically lowers the risk of accidental pregnancy. For example, using a condom with any of the barrier methods (spermicide, diaphragm, cap, etc.) lowers the failure rate to the same as the Pill -- 0.1 percent.

Revised 6/03