Raise your hand if most of your “professional” sex education has been fear based.
When I think back to sex ed in middle school and high school, I mostly remember the horrifying images of STDs run amok, and most significantly, the three days I had to spend senior year caring for an electronic baby that, rumor had it, our terrifying health teacher had set to be “extra fussy” in the middle of the night. Those three days of electronic baby hell nearly scared me into lifelong celibacy. In fact, it was almost a decade before I could even consider the possibility of motherhood. And while it may not have been the best road in getting there, it did convince me to use two methods of birth control for most of my adult life. Thankfully, I had not only comprehensive sex ed in school, but I also had parents who weren’t squeamish on the topic and a mom who made sure I had all the knowledge and resources I needed to make responsible decisions.
As women, even in this day and age, we still take a lot of guff about our sexuality. If we have too much sex, we’re sluts. If we have too little, we’re prudes. I still hear of far too many people telling women that if they don’t want to get pregnant, they shouldn’t have sex — without any mention of men doing the same. Because of these archaic attitudes, far too many women grow up without understanding the options available to them. Too many women are still in the dark about their own bodies. They’ve been given misleading or flat-out untrue information about birth control methods and access to healthcare. Without reproductive freedom, sex can be very scary and unappealing. That’s not a way any woman should have to live her life.
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Without birth control, I might not have the life I have today. I might not have graduated from college, or even high school, had I not been able to prevent an unwanted pregnancy. Because of it, I’ve been able to pursue my education, carve out my career path, and spend time working on myself. Birth control has afforded me time to mature and make decisions that are emotionally and financially responsible without having to compromise my sexuality. That’s pretty incredible.
I’ll say it without hesitation: Reproductive freedom should be a basic human right. Sex should be a positive, pleasurable experience — something to be enjoyed without fear, shame, or embarrassment. The first step is understanding your body. The next is knowing how to protect it — from disease and unwanted pregnancy. The power to have sex when you want, with whom you want, cannot be understated.
So, whether you need a refresher — or if saying the very word “vagina” turns you a crimson hue — the editors of Women’s Health and Sheila Curry Oakes bring you Vagina University, a comprehensive guide to everything from sex and periods to health and body image — and everything in between. If you’re ready to take control of your reproductive health and happiness, read on for their comprehensive guide to birth control options so that you can find the best method for you.
We’ve come a long way from inserting crocodile dung into the vagina like the ancient Egyptians used to do to prevent pregnancy. Currently, there is a huge range of birth control methods to suit every woman and lifestyle. Some birth control methods require a prescription; some are easily found in your local drugstore or pharmacy. Because of the variety of methods, it is worth having a conversation with your health-care provider or local clinic to assess which form of birth control is best for you and your lifestyle and so they can take into consideration any potential health issues or risks you may have. When you read the fine print on the packaging, you may see the range from perfect-use rate and the real-world rate. Because we don’t live in a perfect world, we are going to give you the effectiveness rate — that is, how the product works when used the way most people use that particular method. Not perfectly, but much, much better than not using anything at all.
Condom, rubber, French letter, raincoat, or johnny — no matter what you call it, it is the number one method for preventing pregnancy and preventing sexually transmitted diseases and infections. Okay, end of PSA.
Let’s get some condom-related myths out of the way. A primary excuse for not wearing condoms is that doing so diminishes pleasure because the sex is not skin-to-skin, and some say that sex simply feels better without one. Well, lube can help with any friction issues, and there is a huge range of condoms that are thinner, coated with lube, flavored, studded and/or ribbed and with various bells and whistles that enhance pleasure both for him and for her. Let’s just face it: You are going to be able to have a lot more sex if you get comfortable using condoms and your partners get comfortable as well — so bag it up!
Condoms are made of various materials: Latex, polyurethane, lambskin, and polyisoprene. Latex, polyurethane, and polyisoprene will all protect against sexually transmitted diseases or infections (STDs/STIs), whereas lambskin condoms (actually made from the intestinal membrane of a lamb) protect against pregnancy but are not effective against STDs and STIs. If you or your partner has a latex allergy, then you have choices that will not leave you with an allergic reaction in your genitals.
The female condom is another hormone-free way to prevent both pregnancy and STDs and STIs, and it is 79 percent effective in doing so. Because it can be inserted several hours prior to sex, you don’t have to have your passion interrupted while he wraps it up with a male condom or when you slip out of the sheets to put in a diaphragm or cervical cap.
The female condom is latex-free, made of nitrile (a flexible rubber), and does not contain any spermicides. It is essentially a long tube (about the same length as a condom but wider) that is closed at one end. There are flexible rings at each end; one at the closed end that anchors the female condom inside the vagina, and another at the other end that covers the opening to the vagina. It can take some getting used to, but it is another method of birth control that is effective, doesn’t have to squash spontaneity, allows you to choose a birth control method that can be used in the moment, and can give you peace of mind that you are protected.
Used during cunnilingus, when your partner is going down on your lady parts, or during analingus, when your partner is going down on your back door, a dental dam is a rectangle of latex that is placed over the vulva or the anus to prevent the spread of STDs/STIs.
When used correctly — meaning taken at the same time each and every day like clockwork — birth control pills boast a 95 percent effectiveness rate — but when the unpredictable realities of life are considered, they are 92 percent effective. The most commonly prescribed pills are the so-called combination pills that contain a blend of estrogen and progesterone. They typically come in packs of 21 or 28. The pills deliver the dosage of hormones that will prevent you from ovulating: No ovulation = no egg, and no egg = no pregnancy. They increase mucus production so sperm has a more difficult time getting to the uterus and also thin the lining of the uterus so it is not receptive to implanting an egg should it become fertilized. You get your period when you stop taking the pills that contain hormones. So in a 28-day pack, the 7 remaining inactive placebo or sugar pills are there largely as a reminder to maintain the habit of taking a pill every day. If you are using a 21-day pack, you will not take a pill for 7 days, then you start your next pack. Because the creators of the Pill believed women would feel more comfortable if they continued to bleed each month, the 28-day menstrual cycle that you have while on hormonal contraception is artificial because it is triggered by the hormones in the pills, not by ovulation.
The upsides of the Pill are that you will be protected from becoming pregnant (you don’t have to say “hold that thought” when you want to have sex and go insert a diaphragm or other birth control method or fumble in the bedside drawer for a condom), it can alleviate some of the more painful aspects of menstruating, and you will know exactly when to expect your period each month. It takes the guesswork out of planning for supplies or surprises. But — and this is a big but — the Pill will not protect you from sexually transmitted diseases or infections.
The “Mini” Pill
This version of the Pill only contains the hormone progestin. The “mini pill” is commonly prescribed if you are breastfeeding or cannot take estrogen. Mini pills are a lot trickier if you miss a pill, because their effectiveness relies on a strict schedule — they need to be taken at the same time every day. The mini pill is slightly less effective than the combination pill, but if you can’t deal with estrogen or are breastfeeding, it is the right way to go.
Extended-Cycle Birth Control Pills
This form of birth control pill limits the number of times per year that you will get your period. Extended-cycle birth control pills contain a combination of ethinyl estradiol and levonorgestrel so they prevent ovulation and make the cervical mucus a thicker barrier to sperm. While under this regimen, you will only get four periods a year. There is even an extended birth control method that you can take every day and you never get your period — until you stop taking the pills.
If taking a daily pill is too high maintenance for you, then the patch may be a better option. The patch — about 92 percent effective — can be obtained by prescription from your doctor. Named one of the Best Innovations of 2002 by Time magazine, the patch is like a square Band-Aid or sticker that adheres to your body and delivers hormones similar to those in the Pill into your system through your skin. There are three patches in a 28-day cycle, and it’s important to apply your new patch around the same time each week. The week you don’t use a patch will be when you get a period.
This form of prescription birth control brings a whole new meaning to the phrase “Put a ring on it!” Vaginal rings are about 2 inches in diameter, clear, and contain a combination of hormones much like the combination pill. The big difference is that the ring is inserted into the vagina like a tampon, and the hormones are slowly released to prevent ovulation, thicken cervical mucus, and potentially prevent a fertilized egg from implanting in your uterus. The ring is inserted once a month and left in for 3 weeks. At the end of week 3, you remove it, and then you get your period. Because it is a once-a-month birth control, you don’t have to deal with daily reminders, and a plus is that the ring can be worn during exercise or sex. It is also about 92 percent effective for most users.
What if we told you there was a birth control method that would last for years, where nothing has to be placed in your lady parts and you didn’t have to worry about getting pregnant? No, we’re not talking about abstinence or taking a vow of chastity or secluding yourself in a cave — there is another way! The implant is a form of birth control that is totally hands-off because it is inserted under the skin in your arm. Sounds like it’s right out of the plot for a science fiction film, doesn’t it? No worries, it’s a common form of birth control that is 99 percent effective and unobtrusive. Only you and your doctor need to know that the implant is there. It just takes a couple of minutes for your doctor to insert the small plastic rod, about the size of a toothpick, into the inside of your upper arm. The rod contains a hormone called etonogestrel, and it’s a form of progestin. If that name sounds familiar, know that the cast of hormone characters called on to prevent pregnancy is not large. You will remember that progestin is in the mini pill as well as in the patch.
IUD — Intrauterine Device
An intrauterine device — or IUD — is a long-term form of birth control that is inserted directly into your uterus by your doctor. It is the ultimate in “out of sight, out of mind” birth control. Based on typical use, IUDs are 45 times more effective than the Pill and 90 times more effective than male condoms.
Diaphragm and Cervical Cap
While less common in recent years, these reusable, sperm-blocking methods of birth control that you insert yourself are available for prescription from your doctor. They come in different sizes; your ob-gyn will measure and prescribe the correct size for you. They work by covering the entrance to your cervix so sperm cannot move from your vagina to the uterus and fertilize an egg. The primary difference between the diaphragm and the cap is size: The diaphragm is larger, and the cap, which is smaller, fits snugly over the cervix. The diaphragm is a silicone dome with a flexible base that you insert into your vagina, and it blocks the entrance to the cervix. The cervical cap is shaped like a thimble and a bit more precisely placed on the surface of the cervix.
To doubly ensure that no sperm survives its time in the vagina and goes where it shouldn’t, these pregnancy preventers must be used with a spermicide (nonhormonal foams, creams, gels — your choice).
A diaphragm has a slightly higher effectiveness rate than the cervical cap, and the cap may be better for use by women who have not yet had children. They are effective around 84 percent of the time. The exception is if you are a woman who has had children and who uses the cervical cap — the effectiveness rate is about 68 percent in that case.
Over the counter and available without a prescription, another form of sperm-blocking birth control that you can insert before having intercourse is the sponge. This is a round, spermicide-filled foam device with a retrieval loop that is, well, spongy. You insert it in your vagina up to 24 hours before having sex. Like the diaphragm or cervical cap, because it is placed deep in your vagina, neither you nor your partner should be able to feel it during intercourse. You need to leave it in for at least 6 hours after the last time you have sex. You don’t take it out and reinsert it, because it is one-time use only — although in the plus column, you can use it multiple times during one sex session, and you toss it in the trash when done.
You don’t need a prescription, it’s portable, and it doesn’t do anything to your cycle or influence hormones, which is a major reason why some women use it. The effectiveness rate varies with usage, 68 to 84 percent, and it is more effective for women who have not given birth.
If you have had unprotected sex or had what is commonly referred to as a “birth control failure” (the condom broke, or you realized you haven’t taken your birth control pills for a couple of days), then you may need to seek a form of emergency contraception. Emergency contraception stops a pregnancy before it can start, and although it’s not ideal, it’s essential if you do not want to become pregnant.
Over-the-counter emergency contraception contains the hormone levonorgestrel (a progestin) and comes in one-pill or two-pill dosages depending on the brand. It is effective when taken within 3 days or 72 hours of your bedroom slip up. Another type that you can take up to 5 days from having unprotected sex contains ulipristal acetate and is available by prescription only, but the pills work to delay or inhibit ovulation, which is why they are time sensitive. If you are already pregnant, they will not work.
The Man’s Turn
Although studies are in their early stages and researchers are working to perfect the hormone formula, women around the world are cautiously celebrating the soon-to-be-introduced birth control shot for men. After centuries of bearing the responsibility of not getting pregnant, it could be time for men to take a turn. And it doesn’t seem like many women will feel too badly about the potential side effects men could experience: mood disorders, increased libido, acne, and muscle pain. Sound familiar? Despite those side effects, though, 75 percent of the clinical trial participants said that they would be willing to use this method.
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