Health Library ~ Family Medicine in Mullica Hill, NJ

All Material copyright Craig M. Wax, DO unless otherwise denoted.

Contraception:  Know your choices

Copyright American Osteopathic Association

Over the past several years, unwanted pregnancies in the United States have decreased, in part because of increased sexual education in schools and at home. This decrease also can be attributed to people's fear of untreatable sexually transmitted diseases (STDs) and a growing commitment to abstinence.

But sex continues and so too does the risk of pregnancy. For young women who choose to be sexually active, the good news is that the once guarded door of contraception has opened. As a result, a sometimes overwhelming array of choices stands before them. It is therefore vital to make an informed and educated choice when selecting the best form of contraception for yourself.

So Many Choices
Perhaps the first place to start when selecting a means of birth control is to look at your lifestyle. This includes your overall health, amount of sexual activity, number of partners, and desire to have children in the future. Another important element in selecting birth control is the statistical effectiveness of the contraceptive item. Your physician can be an invaluable resource for narrowing down your options.

"I listen to my patients when it comes to helping them select an appropriate form of birth control," says Margaret Nusbaum, D.O., an osteopathic family physician who practices in North Carolina. "I also take into account if they want to have children in the future, if they have ever been diagnosed with an STD, if their religion plays a role in their contraceptive options, and if they are certain they are in a monogamous relationship."

Barrier Methods
These types of contraceptives are designed to prevent pregnancy by blocking sperm. Some barrier methods also provide protection against STDs.

Male and Female Condoms
Today, there are two types of over-the-counter condoms available to consumers-male and female. The male condom is placed over the penis prior to penetration. The female condom, which is shaped much like the male condom, is inserted into the vagina, with an open ring remaining on the outside. Both condoms represent the only forms of birth control effective against STDs. Therefore, they are highly recommended by disease control advocates.

Condoms are recommend for individuals who have a variety of sexual partners, who have sexual intercourse infrequently, or who have STDs. For young women who are certain they are in monogamous, disease-free relationships, other barrier method contraceptive options are also available, as noted below.

Diaphragm, Cervical Cap
The diaphragm is available by prescription only and is sized by the health professional to get a perfect fit. The diaphragm, which is inserted into the vagina, is a dome-shaped rubber disk with a flexible rim. It is designed to block sperm from reaching the uterus. In addition, spermacide should be added to the diaphragm prior to insertion to provide additional protection against pregnancy.

The diaphragm should be left in place for at least 6 hours but no longer than 24 hours after intercourse. If multiple sessions of intercourse occur during this time period, fresh spermicide should be placed in the vagina while the diaphragm is still in place.

The cervical cap is another barrier method of contraception that is available by prescription only. The cap is a soft rubber cup with a round rim. Like the diaphragm, the cervical cap is sized by a health professional for the proper fit. It is inserted into the vagina and protects against pregnancy, including repeated intercourse, for up to 48 hours.

Hormonal Contraceptives
Hormonal methods are the most popular form of contraception among young women. This category includes oral contraceptives, minipills, and injectable progestins.
Birth Control Pills and Minipills

The most commonly chosen form of birth control in the U.S. is the birth control pill. While birth control pills do not protect against STDs, they are one of the most effective means for preventing pregnancy-aside from abstinence.

Known as the "pill," and available only by prescription, this form of birth control suppresses the monthly release of an egg from the ovaries by combining the actions of the hormones estrogen and progestin.

The pill is taken daily. In addition to providing birth control, the pill may help clear up acne, make a woman's menstrual cycle more regular, and help protect against pelvic inflammatory disease, ovarian cancer and endometrial cancers. Although it is a common choice for many women, the pill does have its side effects including weight gain, nausea, headache, breast tenderness, irregular bleeding, and depression.

Also, women who smoke and take the pill put themselves at increased risk for cardiovascular disease, high blood pressure, blood clots, and blockage of the arteries.
Minipills, available by prescription only, contain the hormone progestin but no estrogen. Minipills are not as effective as traditional oral contraceptives. But they are a popular choice for young women who cannot take estrogen because they are breast-feeding or because the hormone causes them to have severe headaches or high blood pressure. Women who use minipills may experience the same side effects as those who use oral contraceptives.

Injectable and Implantable Progestins

Injected in the arm or buttocks by a health professional once every three months, Depo-Provera is considered to be one of the most convenient forms of birth control available. In addition, it is extremely effective in preventing pregnancy. Depo-Provera works by inhibiting ovulation, by changing the cervical mucus to help prevent sperm from reaching the egg, and by changing the uterine lining to prevent the fertilized egg from implanting itself.

Norplant, which is an implantable progestin, is also considered to be highly effective for preventing pregnancy. This form of contraceptive consists of matchstick-sized rubber rods that are surgically implanted under the skin of the upper arm. From this location, the contraceptive steadily releases levonorgestrel. Norplant is available in two types.

The six-rod form can help prevent pregnancy for up to five years, while the two-rod form remains effective for up to three years.

As with oral hormonal contraceptives, the potential side effects of injectable and implantable progestins may include weight gain, breast tenderness, and irregular or missed periods.

Some Other Types of Contraception
Natural Family Planning and Withdrawal
Two other commonly practiced forms of birth control are periodic abstinence and the withdrawal method. Because these methods require both partners to be extremely motivated against pregnancy, they are not always reliable and are the least often suggested by physicians.

"Natural family planning and the withdrawal method both have a pretty high rate of failure," Dr. Nusbaum. notes "Both partners must be very strict and careful when they have intercourse. In addition, neither of these forms of birth control protects against STDs."

Periodic abstinence involves not having sexual intercourse on those days during a woman's menstrual cycle when she is most likely to become pregnant. Generally speaking, this period runs from seven days before ovulation to three days after.

Withdrawal is another highly unreliable from of birth control used by many people. The withdrawal method involves a male removing his penis from the vagina right before ejaculation.

"Women need to be aware that small amounts of semen are released before ejaculation," cautions Dr. Nusbaum. "It takes just one sperm, even if the male ejaculates outside of the vagina, to get you pregnant."

The Safest Means of Birth Control
Despite the statistics, the only 100 percent effective means of preventing pregnancy is abstinence.

Although the number of young women who are choosing to abstain from sexual intercourse is rising, many more are choosing to become sexually active.
Obtaining Contraceptives
Some contraceptives, such as condoms and spermacides, are available over-the-counter, at local health clinics, and in some school health offices. Prescription contraceptives can be obtained through a family physician or a health clinic.

"For the young woman who is concerned about seeing her family physician for birth control, Planned Parenthood is an excellent option," recommends Dr. Nusbaum. "Planned Parenthood offers young women birth control and gynecological exams at rates that are based upon income. In some cases, a young woman may not have to pay anything at all for contraceptives."

As physicians who emphasize prevention and wellness, D.O.s strongly support the U.S. Department of Health and Human Services Healthy People 2010 initiative in the quest to improve quality of life and increase the number of years of healthy life.
The American Osteopathic Association (AOA) reminds you that November 12-18 is National Osteopathic Medicine Week. This year's target group is young women from the ages of 12 to 24. During this time, osteopathic physicians (D.O.s) will work to raise awareness among young women regarding the many issues they face as they strive to maintain healthy lifestyles. In addition, D.O.s plan to educate them on how preventive care can help maintain good health throughout their lives. D.O.s are fully licensed physicians who have additional training that focuses on the body's structure and function as well as its ability to heal itself.

For more information on osteopathic medicine, or to locate a D.O. in your area, call the AOA at 1.800.621.1773, ext. 8252 or visit the AOA's Web site

Did You Know...?

* Abstinence is the only form of birth control that is 100 percent effective.

* Approximately six out of every 10 pregnancies in the U.S. are unplanned.

* Vaginal spermicides are known to have a 21 percent failure rate.

* A condom is the only contraceptive device that helps to prevent transmissions of STDs.

* Women who smoke are often warned against taking the pill.

Sources: National Campaign to Prevent Teen Pregnancy, Planned Parenthood Federation of America, Inc., Centers for Disease Control and Prevention, and the American Osteopathic Association.

You can contact these organizations for more information:

National Campaign to Prevent Teen Pregnancy
2100 M Street, N.W., Suite 300
Washington, D.C. 20037

Planned Parenthood Federation of America, Inc.
810 Seventh Ave.
New York, N.Y. 10019

Centers for Disease Control and Prevention
1600 Clifton Road, N.W.
Mail Stop EL7
Atlanta, GA 30333

Modified 04/13/02