Treatments
Barrier methods prevent the man's sperm from reaching the woman's egg. Types of barrier methods include condoms (male and female), spermicides, the sponge, the diaphragm, and, although less commonly used, the cervical cap and Lea's Shield. Using a spermicide with a barrier method can help reduce the risk of pregnancy even more.
Condoms
Condoms come in male and female versions. The male condom is a thin sheath made of latex (rubber), polyurethane (plastic), or animal membrane that is worn by the man over his erect penis. Latex condoms also protect against STDs, including HIV.
The female condom is a thin plastic pouch that lines the vagina. It is held in place by a closed inner ring at the cervix and an outer ring at the opening of the vagina. The female condom can be difficult to insert, so it is best suited for women who cannot be sure their partner will use a male condom every time they have sex. The female condom can be inserted up to 8 hours before sex and reduces the risk of STDs.
When sperm is released, it stays inside the condom and does not pass into the woman's vagina. Both types of condoms are more effective when used with a spermicide.
To be effective, condoms must be used every time you have sex and must be put on correctly (see box). A condom should be used only once and only one should be used at a time. A female condom should not be used with a male condom because both are more likely to break.
Spermicides
Spermicides often are used in suppositories, foam, cream, jelly, and film (thin sheets that contain spermicide) to kill sperm or make them inactive. Before each act of sex, spermicide is placed in the vagina close to the cervix. Some types of spermicide need to be placed in the vagina before sex so they have time to melt and become active. Be sure to follow the instructions supplied with the product. Frequent use of some spermicides may irritate vaginal tissue and increase the risk of STDs.
Spermicide can be used with all barrier methods except the sponge, which already contains a spermicide.
Sponge
The sponge is a doughnut-shaped device made of soft foam coated with spermicide. To use the sponge, it must be moistened with water. Once inserted in the vagina, it covers the cervix and blocks sperm from entering the uterus.
The sponge may be put in up to 24 hours before sex and should be left in place for at least 6 hours, but not more than 24 hours, after sex. During this time, it is good for more than one act of sex. The sponge should not be used during menstruation.
Diaphragm
The diaphragm is a small, latex, dome-shaped device that fits inside the vagina and covers the cervix. It is used with spermicide. A diaphragm requires a prescription and needs to be fitted by a doctor.
The diaphragm can be inserted up to 6 hours before sex. After sex, the diaphragm must be left in place for about 6 hours, but not more than 24 hours. Once inserted, the diaphragm stays in place and, if it is properly placed, cannot be felt.
A diaphragm is not reliable without spermicide. More spermicide should be used before each act of sex, no matter how closely timed they are. This can be inserted while the diaphragm is still in place.
Women using a diaphragm should practice how to insert and remove it. Before the diaphragm is inserted, spermicidal cream or jelly should be applied around the rim and inside the dome of the diaphragm. It is then folded and inserted into the vagina. When the diaphragm is pushed up as far as it will go, the front part of the rim should be up behind the pubic bone. After the diaphragm is in place, the cervix should be completely covered by the rubber dome. You can feel to check if it is placed correctly. To remove the diaphragm, pull gently on the front rim.
Women using a diaphragm also should learn how to care for it. To wash the diaphragm, use mild soap and water. Rinse the soap off well (it can damage the rubber), dry it, and put it back in its case. It should be checked monthly for holes. A diaphragm should be replaced about every 2 years.
Using the diaphragm may reduce the risk of some STDs. When the diaphragm is used with the male condom, it provides added protection from pregnancy and STDs. The diaphragm should not be used during menstruation.
Cervical Cap
The cervical cap is a small, thin, dome-shaped device made of latex or plastic. It fits tightly over the cervix and stays in place by suction. A cervical cap must be fitted and prescribed by a doctor.
Like the diaphragm, the cap works better with a spermicide. Inserting a cervical cap is like inserting a diaphragm. Spermicide is placed inside the cap, which then is squeezed and inserted into the vagina. The cap is then pressed onto the cervix until the cervix is completely covered. Before each act of sex, the cervix should be checked to make sure it is covered. This is done by pressing on the dome of the cap. Spermicide does not need to be reapplied before each act of sex. After sex, the cap should be left in place for 6 hours but not longer than 48 hours.
Care for the cervical cap also is similar to that of the diaphragm. It must be checked regularly for wear or holes and needs to be replaced yearly. Refitting may be needed after having a baby or after weight gain or loss. A cervical cap may reduce the risk of some STDs, particularly if it is used with a spermicide. The cervical cap should not be used during menstruation.
Lea's Shield
The Lea's Shield is a dome-shaped silicone device with a loop for removal that fits inside the woman's vagina and covers her cervix. It is used with spermicide.
The Lea's Shield comes in only one size and requires a prescription. It has a one-way valve that creates suction that helps it fit against the cervix. The valve lets secretions flow out without letting sperm in.
The Lea's Shield can be inserted anytime before sex. It must be left in place for at least 8 hours after sex, but should not be in place for more than 48 hours total. It can be reused and should be washed with soap and water between uses and be replaced as soon as it shows any signs of wear or weakness. The Lea's Shield does not protect against STDs.
Hormonal Methods
With hormonal birth control, a woman takes hormones similar to those her body makes naturally. In most cases, these hormones prevent ovulation and change the lining of the uterus. The hormones also cause the cervical mucus to thicken, which makes it hard for the sperm to get through the cervix to the uterus. Hormonal birth control comes in several forms:
Birth control pills
Skin patch
Vaginal ring
Injections
Implant
Hormonal methods of birth control do not protect against STDs.
For most women, the risk of serious complications is small. However, women with certain medical conditions should discuss them carefully with their doctors. Methods that contain both estrogen and progesterone are not recommended for women older than 35 years who smoke cigarettes. A prescription is required for this type of birth control.
Birth Control Pills
Continuous-Dosing Pills
Continuous dosing (also called extended use) is a new option available in combination pills. With this method, instead of taking hormones for 21 days with 7 days off, you take hormones for 84 days with 7 days off. This means that you will have only four periods of bleeding in a year. There are also pills that come in packs of 28, in which all the pills are active. This means that you will not have any bleeding.
Some women decide to take this type of pill simply because they want to have fewer or no periods. For others, this method can help with health problems that are affected by having periods, such as dysmenorrhea (painful periods), endometriosis or fibroids. If you have fewer periods, you have fewer symptoms. Eventually most women who take these types of pills will not get periods.
It may take some time for your body to adjust to the constant levels of hormones. A common side effect, breakthrough bleeding (bleeding at a time other than your period), can happen on and off when you first start taking these pills. Over time, the number of these days often decreases.
If You Miss a Pill
You may forget to take a pill once in a while. To find out what to do, read the information that came with your pill pack or call your doctor or nurse. You may need to use a backup method of birth control (such as condoms) or emergency contraception.
If you miss some pills, you may have some spotting or light bleeding even if you make up the missed pills. These side effects are not harmful.
There are many different brands of pills that use certain hormones or a combination of hormones. This variety allows a woman to find a pill that is right for her.
Combination pills contain the hormones estrogen and progestin. Combination birth control pills offer health benefits to some women. They help protect against ovarian and endometrial cancer. Women who take birth control pills have shorter, lighter periods of bleeding (similar to that of a menstrual period).
Most pills come in packs of 28 pills. With this type of pill, one pill is taken at the same time each day for 28 days. When all the pills in the pack are finished, a new pack is started the next day. Bleeding occurs during the week when the last 4 or 7 pills are taken, depending on the type of pill.
Missing a period is common. If this occurs, the pills should be continued. Using birth control pills during pregnancy does not increase the risk of birth defects.
Side effects of the pill include nausea, breast tenderness, and headaches. They often go away after a few months of use. There will likely be fewer side effects if the pill is taken at the same time every day.
Progestin-only pills, sometimes called minipills, do not contain estrogen. This type of pill is a better choice for women who have certain health problems and cannot take pills with estrogen. It often is recommended for women who are breastfeeding. The progestin-only pill comes in packs of 28 pills. All the pills in the pack contain hormones. It is important not to miss a pill and to take it at the same time each day.
Skin Patch
The contraceptive skin patch is a small (1.75 inch) adhesive patch that is worn on the skin to prevent pregnancy. With the patch, estrogen and progestin are absorbed through the skin into the bloodstream. The patch may offer many of the same benefits and risks as the combination birth control pill. Once a woman obtains a prescription for the patch, she does not need to visit her doctor to apply or remove it.
The patch can be worn on the buttocks, chest (excluding the breasts), upper back or arm, or abdomen. It should be applied to a new place each week to avoid irritation.
A patch is worn for a week at a time for a total of 3 weeks in a row. During the fourth week, a patch is not worn, and bleeding occurs. After week 4, a new patch is applied and the cycle is repeated. Although the patch starts working right away, a backup method of birth control, such as a condom, should be used for the first week of the first cycle. The patch may be less effective in women who weigh more than 198 pounds.
Vaginal Ring
The vaginal ring is a flexible, plastic ring that is placed in the upper vagina. It releases both estrogen and progestin. The ring may have the same benefits and risks as those of the combination birth control pill.
The ring is worn for 21 days, removed for 7 days, and then a new ring is inserted. During the week it is out, bleeding similar to that of a menstrual period occurs. A woman does not need to visit her doctor for insertion or removal of the ring, although a doctor must prescribe it.
To use the ring, it is folded and inserted into the vagina. This is all that needs to be done to place the ring in the correct position. After 3 weeks, the ring is removed on the same day of the week and around the same time that it was inserted.
Bleeding usually will start 2–3 days after the ring is removed. A new ring is inserted 1 week after the last one was removed.
Although this rarely happens, the vaginal ring can slip out of the vagina. If it has been out for more than 3 hours, a backup method of birth control should be used for 7 days. If the vaginal ring slips out often, a different method of birth control may be needed.
Pregnancy is prevented as it is with other hormonal methods. When a woman begins using the vaginal ring, she should use a backup method of birth control, such as condoms or spermicide, for the first 7 days of use.
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