Azrial's Guide to Birth Control

Most people, I believe, like sex. But sex has a side effect... Pregnancy, which can lead to children. But luckily a bunch of clever people through history have developed means of preventing pregnancy. The so called "contraceptives" or "birth control".

In the following, I will be giving you a list of some contraceptives, how they work, their safety value, and how to use them.

Azrial's Guide to Birth Control

(Picture from changeoflife.com)

A word of advice:

ALWAYS READ THE LEAFLET / INSTRUCTIONS THAT COME(S) WITH YOUR CONTRACEPTIVE

Sorry about the italic and all-caps writing, but the above is probably the most important message I can give you. What I write here may not match the data for your specific brand of contraceptive, and I can't go through every single side effect. So for side effects and warnings, read the leaflet and / or talk to your doctor.

An equally important message:

PULLING OUT IS NOT SAFE SEX

Pulling out is not at all safe. Studies have shown (I hate to tell you guys this) that it is safer than finishing inside. But men leak a little during sex, and there can be swimmers (sperm) in this so-called "pre-cum". Therefore: Never use pulling out as a contraceptive measure.

Abstinence

Not really a contraceptive, but not having sex is the only way to make 100 % certain you won't catch a sexually transmitted infection (STI) or get / make someone pregnant.

Condoms

The condom is a rubber tube that is closed in one end. It is the safest kind of contraceptive in both terms of STIs and pregnancy. The risk of pregnancy is below 1% if the condom is used correctly.

Because the condom is made of rubber, there are some things you should not do to it. Do not expose the condom to heat, don't put it somewhere it might get bent or ripped (e.g. a wallet), don't open the package with a scissor or your teeth (you could damage it). Never use a condom if it's past the expiration date or the package is damaged.

If you use lubricants with your condom, always use water-based lubricants. Oil-based lubricants can affect the latex and make the condom unsafe.

Some believe that condoms are only for vaginal intercourse. This is not true. STIs can be transmitted through oral and anal sex, too. Even if your partner is STI-free or non-contagious anal sex poses a risk of infection. This is because the anus is tighter than the vagina, and does not create lubrication (do add some lubricant when having anal sex). This increases the risk of tears and small injuries to the penis skin, thus increasing the risk of infections with bacteria from the intestines.

Condoms come in different sizes. Most men use the standard size, but if your condom fits too loose or too tight, go buy another size. I know we men hate to acknowledge if the penis is smaller than the standard size, but a loose fitting condom might slip off during the act and then you're not protected.

To use a condom, unpack it and grab the circumference (see picture above). Then give it a little shake to make it pop into the shape you see above. Press the sides of the central "bump" together to remove the air inside and place the condom on the tip of the penis with the "bump" pointing away from the body (the body of the owner of the penis). Keep the "bump" air-free until the condom has been partially rolled on. To roll the condom on, form a ring (or "OK" sign) with your thumb and index finger around the ERECT penis and pull from the tip to the root. Repeat until the condom is completely rolled out.

Once the man has climaxed, he should not stay inside or keep going. As soon as he climaxes, the penis will get flaccid (smaller and softer), and the condom will not fit tightly. This allows the condom to slip off.

Before pulling out, one should grab the condom and hold on to it. This way it won't come off as the man pulls out. Once it's out, pull off the condom and seal the end with a knot.

For both part of the intercourse, it should be noticed that touching the penis or the used condom can transfer sperm to the hands, and you should therefore wash your hands (or other things that may be sperm-contaminated) if you intent on putting them inside anybody.

Also, a condom is for single-use only. Do not reuse the condom or turn it inside out.

Dental Dam

The dental dam is made for cunnilingus (oral sex for women) and anilingus (oral stimulation of anus). It's a sheet of rubber that is placed between the mouth of the giving part and the vulva of the receiving part.

To use the dental dam, open the package and unfold the rubber sheet. Add a bit of lubricant (water-based) to the vulva / anus and place the dental dam so that it covers the area, you wish to stimulate. Once placed, use your hands (or ask your partner) to hold it still. Now you can give oral stimulation.

Once you're done, throw the dental dam away. Do not reuse or flip it.

Pessary

This is the female equivalent of the condom. It's a curved piece of rubber that is placed inside the vagina.

To use it, unpack it and put it inside the vagina so that once it is inside, the convex side is facing the entrance of the vagina. The pessary must be placed all the way in, so it seals off the cervix (the entrance to the womb).

From what I've been told, the pessary is not as good as the condom or pills, which is why it's a good idea to combined it with a spermicidal crème (see later). The pessary does not protect against infections.

Azrial's Guide to Birth Control

Oral Contraceptives (Pills)

Oral contraceptives come in different types. There are combination drugs and mini-pills. I will explain how the two types work below. Here I will explain how to use them.

As always: Read the leaflet before using the pills and see a doctor. There are certain conditions that should not be combined with the use of oral contraceptives (e.g. increased risk of thrombosis (occlusion of blood vessels).

Also, the pills are for women! Rumour has it that a male oral contraceptive may come soon, but currently they are only for women.

Oral contraceptives are approximately as safe as condoms in term of pregnancy-prevention (vomiting / diarrhoea, missing pills, and other factors do reduce the effect of the pills). Pills do, however, not protect against diseases!

Combination Drugs

Usually, these pills should be taken on the first bleeding day of the menstruation. The pills must be taken once a day at approximately the same time. If you start on the first bleeding day, you should be fully protected from day one. You take 21 pills (three weeks) and pause for one week. In this week you'll have a menstruation-like bleeding. After one week, start taking the pills again (protected from day one; you are safe during the bleeding period, too).

If you start at another time in your cycle, you may not be fully protected for the first seven days of taking the pills and you should use other means of contraception (preferably a condom).

Should you forget a pill, you can usually take the missed pill up to 24 hours (some pills only 12 hours) after it should have been taken and still be fully protected. If you miss more than one pill, you should use a condom for the next days (the number of day may vary, check leaflet).

Mini-pills

These pills are taken once a day, too. The span in which you can take the pill is, however, much narrower than with the combination pills (I believer it's 3-6 hours depending on the pill). Mini-pills are taken every day with no break.

A side effect that many women enjoy is that mini-pills can reduce the bleeding during menstruation.

Pills (Mechanism)

Combination Drugs

These contain both an oestrogen (female sex hormone) and a gestagen (hormone related to pregnancy). When not taking the pills, a woman's ovulation (release of an egg cell from the ovaries) is triggered by a rapid increase (peak) in the amount of oestrogen in the body. By adding artificial oestrogen to the body, the concentration of oestrogen in the body will become more permanent and the peak does not occur. Therefore no egg cell is released. Gestagens make the mucus in the cervix thicker, preventing sperm cells from entering the uterus.

Mini-pills

These contain only gestagens. They work by making the mucus in the cervix more viscous and by thinning the inside lining (endometrium) of uterus thinner. So sperm cells can't enter and egg cells can't stick to the uterus.

Intrauterine Devices

These are the copper and the hormone spiral. The copper spiral is a wee bit less safe than the condom, and the hormone spiral equals mini-pills.

They are both T-shaped devices that are placed inside the uterus. The copper spiral releases small amounts of copper and causes a slight inflammation in the uterus wall. This prevents the egg-cells from attaching to the uterus, and should they attach, the body's immune system will remove it. The released copper also kills the sperm cells.

The copper spiral can cause increased bleeding and worsen the cramps during menstruation.

The hormone spiral releases gestagens like the mini-pills and work in the same way.

Some women have such great effect of the hormone spiral that they stop having menstruation bleeding. The bleeding will return when you stop using the spiral.

The spirals are put in place by a doctor and must be replaced every 3-5 years (hormone releasing spiral) and ~10 years (copper releasing spiral).

Azrial's Guide to Birth Control
(Copper releasing spiral; picture from medicalnewstoday.com)

Spermicide

Not the safest choice, but good in combination with other contraceptives. Spermicide comes in different types (e.g. foam or gel) and is inserted into the vagina before intercourse. The spermicide contains ingredients that kill sperm cells.

The spermicides I have seen come with a syringe (not with a needle) which you fill with the gel/foam. Then you put the syringe as far as you can get it inside the vagina (while still holding on to it) and empty the gel / foam into the vagina.

In Case of Emergency

Should you get pregnant (or fear that you might be), there are ways to end the pregnancy. These include medical or clinical treatment. As with all medical interventions, there are risks. Talk to your doctor and read the instructions you get before doing anything.

Morning-After Pills

If you had sex within the last 3-5 days (depending on the brand of the pill) and things did not go as planned (e.g. broken condom), there are pills (morning-after pills) that may help you. These pills delay your ovulation so that there won't be an egg cell for the sperm to fertilise.

This method of birth control will not guarantee that you prevent a pregnancy, so do keep an eye out for signs of pregnancy (such as a missing menstruation). Also, being overweight / obese can decrease the success rate of the pills.

In term of side effects, these pills are relatively safe, but I would recommend saving this option for when things go wrong, as repeated use might be harmful to the body. I wouldn't use this as the only contraceptive mean.

Abortion Pills

Should you get pregnant and regret it, and has it been less than 70 days (10 weeks) since the first day of your last menstruation, you can take an "abortion pill". It is actually two pills; one that makes your uterus unable to keep hold of the foetus, and one that makes the uterus contract resulting in an abortion. You get these pills after talking to a doctor, and (s)he should provide you with information and instructions about using the pills.

The drugs will cause you to bleed and you will probably feel cramps, too. What happens is actually a medically provoked, early miscarriage. So bleeding and cramps (along with other symptoms) is perfectly normal.

It is rather unlikely that you will remain pregnant after taking the pill, but you should get a check-up at your doctor to make absolutely sure. Should the pill fail, you may need to take another one or have the foetus remove at a clinic / hospital.

Clinical Abortion

If you regret your pregnancy after 10 weeks (since first day of last menstruation), you can have the foetus / child removed at clinic. There are different techniques and different "dead-lines" for them.

In general the doctors will widen your cervix and remove the child from your womb.

Sterilisation

If you don't want any more children, you can consider sterilisation. Male sterilisation is safer than female sterilisation, and female sterilisation equals condoms / pills.

Both interventions are done through surgery.

Male sterilisation / vasectomy is done by cutting the connection between the testicles (sperm cell factory) and the urethra (where sperm exits the body). The connection is called ductus deferens. Very few men (much less than 1 %) experience that the two ends grow back together, making them fertile again.

Once a man has been sterilised, he can have the ductus deferens sown back together, but is is far from guaranteed that he will regain his fertility. An uncomplicated vasectomy will not cause impotence. The procedure that causes impotence is castration.

Female sterilisation / tubal ligation is done by tying a band around the connection between the ovaries (egg cell storage) and the uterus. The connection is called salpinx or tuba uterina.

The reason why male sterilisation is safer than female sterilisation is that the tuba uterina may "re-canalise", which means that the body creates a new whole where the band is located. This will reopen the path from ovary to uterus.

On the other hand, women have a much better chance of regaining fertility, should they regret having been sterilised. The doctor simply have to remove the band.

Final Words

These are not all the contraceptives out there, but I think I have covered a broad range of choices.

I will not tell you what to use; that should be up to you. But only condoms and dental dams protect agains STIs.

Finally, do remember, than you can talk to doctors about anything. They are not embarrassed or disgusted by you. Doctors are here to help and provide guidance / information. Therefore, do not be afraid of talking to your doctor about this (and other) health subjects.

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