Different Types Of Contraception

If you and your partner are planning to have sex, you must think about contraception. Even if you are having sex for the first time it is possible for a woman to become pregnant. Condoms, as well as being an effective form of contraception if they are used properly, are also effective in preventing infection, including HIV infection. Use a condom even if you are using other forms of contraception - this will help to prevent infection.

Contraception is not the woman's responsibility or the man's, but the responsibility of both. It is best if you and your partner can discuss contraception together and decide on the best method to use. There are a number of different methods and they are described in the sections which follow.

If you are over 16 your GP can give you advice and prescribe contraceptives. It is up to you whether or not you tell your parents that you are using contraceptives. If you are under 16 your GP can also provide you confidential advice and prescribe contraceptives. See below for more details.

If you are under 16:

According to the Department of Health if you are under 16, the doctor must satisfy him/herself on a number of counts before prescribing contraceptives. These will include the maturity and understanding of the young person, the likelihood of them having unprotected sexual intercourse, the likelihood of them suffering physical or mental harm if contraceptives are not prescribed, and the young person's best interests. The doctor must also encourage young people to talk to their parents and explore the reasons if they are not prepared to do so.

Advice on contraception is also available in family planning clinics, Brook Advisory Centres and in some advice and information centres.

One of the most important messages about contraception is that it is only as reliable as the user! For example the pill can be very effective if the instructions are followed carefully. But if you forget to take the pill it ceases to be effective. Forgetfulness is something the user also has to be responsible for!

The "pill"

- is a contraceptive containing drugs which alter the chemical make-up of a woman's body. Because of this it is only available on prescription from the doctor.

There are two basic types of pill: the combined pill which contains small amounts of the hormones oestrogen and progestogen, and the progestogen-only pill. Although both types are reliable, neither helps in preventing sexually transmitted diseases or AIDS.

The combined pill - is taken for 21 days followed by a seven day break before starting the next pack. During the break some bleeding occurs. A version of this pill is available containing 28 pills, the last seven of which are inactive. This helps women who like the routine of taking the pill. Bleeding occurs when the inactive pills are being taken.

The combined pill has the advantage of reliability - there is almost no possibility of becoming pregnant as long as the pill is taken exactly according to the instructions. It can make periods lighter and less painful. However some women suffer side-effects from the pill and it is therefore not prescribed for women with certain health problems.

Progestogen-only pill - must be taken at the same time every day without a break between packs. It is not suitable for people who may be forgetful or unable to take the pill punctually (if it is taken more than three hours late it can lose its effectiveness). It can be useful for women who cannot take oestrogen (found in the combined pill).

Injectable contraceptives

There are two types: Depo-Provera which lasts for up to 12 weeks and Noristerat which lasts for 8 weeks. The contraceptive progestogen is injected into your buttock. This is released slowly over a period of two to three months.

Injectable contraception is extremely convenient as you are protected as soon as you have the injection. They work by releasing a hormone into your body which prevents pregnancy by stopping the ovulation process. The injections are greater than 99% effective.

However, if you are planning to become pregnant in the coming year or two, these contraceptives are not recommended. It can take up to two years for the body to readjust and get back to a normal reproductive pattern.

Injectable contraceptives can have side effects such as irregular bleeding (your periods may stop altogether), weight gain or headaches. If you experience any of these symptoms, consult with your doctor.

Injectable contraceptives offer no protection against sexually transmitted infections.

Condoms (male and female)

There are both male and female condoms. They are easy to obtain (from shops, supermarkets, pharmacies and family planning clinics) and if used properly, are reliable. One advantage of using condoms is that they can help prevent sexually transmitted infections, including HIV.

The male condom is rolled over the penis when erect. After ejaculation the semen stays inside the condom. It is important to hold the condom on until he has withdrawn from the vagina. This avoids spillages. After withdrawal the condom can be carefully removed and thrown away. Don't try to flush them down the toilet as they float!

A condom should never be re-used. A condom can slip off the penis or split during sex if it is not used properly. If this happens get advice immediately from your GP or family planning clinic about emergency contraception.

Don't use a condom with some body lotions or creams as they contain a corrosive chemical that will dissolve rubber making your condom ineffective.

A common myth about condoms is that they spoil sex for a man by reducing their sensitivity. This is not true. Condoms are much better than they used to be and if anything they can improve sex by making it last longer.

The female condom is a new kind of condom which fits inside the vagina, protecting the woman and allowing her to have more responsibility for safer sex. The condom has a ring at the closed end which helps it to stay in place. During intercourse the sperm is held inside the condom, preventing sperm from entering the uterus.

Contraceptive implants

A contraceptive implant is a small flexible capsule that is placed under the skin in the upper arm. Like contraceptive injections they release a hormone into your body which prevents pregnancy by stopping the ovulation process.

The implant is inserted by injecting the capsule into your upper arm. This is done by your GP. You will be given a local anaesthetic. The procedure is quick and not painful but you may have a slight bruise from the injection. The implant is not noticeable. You can expect your implant to last for up to 3 years but they can be removed sooner. They are over 99% effective.

The implants are convenient and unlike contraceptive injections, your normal level of fertility will return as soon as they are removed. You can breastfeed while using implants. However, they will not protect you from sexually transmitted infections.

There are some side effects and the implants may not suit everyone. You may experience headaches, acne and some weight gain. Your periods will change. If you experience any of these symptoms consult with your doctor.

Contraceptive patches

The contraceptive patch also called Evra, is like a sticking plaster that releases two hormones through the skin to prevent pregnancy. The patch releases oestrogen and progestogen into the bloodstream. Like the combined pill it stops the monthly ovulation process.

The patch can be worn discreetly and provides protection against pregnancy immediately if applied on the first day of your period. It does not however, offer protection against sexually transmitted infections.

Other forms of contraception include:

• Barrier methods: A diaphragm or cervical cap is used with a permicide and fits inside the vagina covering the cervix. They work by preventing sperm from entering the uterus.

• Spermicides usually contain a chemical known as nonoxynol which kills sperm and other organisms which cause infections. Spermicides should be used with another type of contraceptive because on their own they are not reliable. Spermicides are available as pessaries (soft tablets inserted into the vagina), gels or creams, foam (which is squirted into the vagina from an aerosol) and film (which dissolves).
• The intrauterine device (IUD) or coil is a small piece of plastic wound with copper wire. The IUD makes it difficult for a fertilised egg to settle in the uterus. It must be fitted by a doctor and can last for up to five years. The IUD has cotton threads which hang down so you can check that it is still in place. Although the IUD is very effective it can lead to heavy and painful periods and can cause infection of the uterus and fallopian tubes. This, in turn could lead to infertility. The IUD is not often recommended for young women unless they are in a very stable relationship.
• Sterilisation is rarely used for young people. Male sterilisation (vasectomy) involves cutting the sperm duct and female sterilisation is done by cutting or blocking the fallopian tubes. Both types of sterilisation are effectively irreversible. Neither has an effect on a man or woman's ability to have or enjoy sex.
• The rhythm method involves working out whether or not a woman is fertile, according to her menstrual cycle. If you want to use the rhythm method you should get expert advice. It is not something you should try otherwise. The rhythm method is the only form of contraception officially approved by the Roman Catholic Church (although some Catholics do use other types of contraception).
• A new device has been developed which if used as part of the rhythm method makes it more reliable and scientific. The device is called Persona and is available in Boots chemists. The device works by monitoring when a woman is fertile and when she is not. Because of this you can also use the device to help you become pregnant if you decide this is what you want.

• Withdrawal is when the man withdraws his penis from the woman's vagina before ejaculation. Withdrawal is not a form of contraception and is very unreliable because sperm can come out of the penis before ejaculation.

NYA would like to thank Brook Advisory Centres for their assistance in compiling this information.

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