La version française sera ici bientôt Barrier and Chemical Contraception Condoms (male and female) Diaphragm Cervical Cap Spermicide Vaginal Contraceptive Film Contraceptive Sponge Dental Dam Hormonal Contraception Nuva-ring (contraceptive ring) Depo-Provera "The Pill" (oral contraceptives) "The Patch" Intrauterine Devices Non-homonal IUD (Nova T or Flexi T 300) Hormonal IUD (Mirena) Permanent Forms of Contraception Vasectomy Tubal ligation Essure Natural Methods Abstinence Lactational Amenorrhoeic Method (Breastfeeding) Basal Body Temperature Ovulation or Billings Method Symptothermal Method Calendar Method Coitus Interruptus (Withdrawl) Barrier Contraception Barrier contraceptives work to prevent pregnancy by preventing contact between sperm and egg. Some barrier contraceptives also help to prevent disease by covering the genitals of one partner, so that the skin between the sexually active persons does not come into contact. Condoms male – typical use: 85% perfect use: 98% female – typical use: 79% perfect use: 95% What is a condom? Condoms are the only form of protection which can both help to stop the transmission of sexually transmitted infections (STIs) such as HIV and prevent pregnancy. A condom is a sheath that covers the genitals and is usually made of latex or polyurethane. There are both male condoms, which cover the penis; and female condoms, which look like a larger version of the male condom and fits inside a woman’s vagina. In Canada, male latex condoms are the most popular barrier type of contraception. How do you use the male condom? 1. Check the expiration date on the outside of the condom wrapper. A condom that is expired is not guaranteed to be effective. 2. Carefully tear open the wrapper. Be careful not to tear the condom if you have sharp nails or use your teeth. 3. If you are using lubricant, place a drop or two inside the condom. 4. If you or your partner has not been circumcised, then pull back the foreskin. 5. Most condoms have a tip of latex at the end of the condom that is used to catch the semen. If your condom does not have a tip, leave a 2 cm space at the top of it. Pinch the tip of the condom and begin to roll it on to the penis. The roll should lie on the outside of the condom. 6. Unroll the condom all the way to the base of the penis. 7. Make sure there are no air bubbles or tears. Air bubbles can cause the condom to break during sex. 8. If you like, put some more lubricant onto the outside of the condom once your partner has it on. 9. When taking off the male condom, first hold it onto the base of the penis and pull out slowly before the penis becomes soft. Then, away from your partner, pull the penis out of the condom and throw out the condom. Wash your hands immediately afterwards to avoid ejaculate transfer. Warning! When using lubrication, be sure to use a water-based lube. Oil based products can cause latex condoms to break and can irritate the skin. Also, it is important that you store your condoms in a cool, dry place. Keeping a condom in your back pocket or wallet is not advised as the latex can deteriorate or the condom may tear. What are the benefits of the male condom? • It does not require a prescription. • Condoms are the only contraceptive (protects against pregnancy) that also helps prevent the spread of sexually transmitted infections (STIs). • Condoms are one of the most reliable methods of birth control when used properly and consistently. • Condoms have none of the medical side-effects of some other birth control methods. • Condoms are available in various shapes, colours, flavours, textures and sizes - to increase the fun of making love with condoms! • Condoms make sex less messy. • Condoms are user friendly. With a little practice, they can also add confidence to the enjoyment of sex. • Condoms are only needed when you are having sex, unlike some other contraceptives that require you to take or have them all of the time. What are the disadvantages of the male condom? • Possible allergic reaction to latex. • Can “interrupt the mood” (Prevent this by making condom use part of your foreplay!). • Must be readily available at the time of sex. • May break or leak. How does the female condom work? The female condom is a polyurethane sheath or pouch. It is usually about 17 cm (6.5 inches) in length. It entirely lines the vagina and it helps to prevent pregnancy and sexually transmitted infections (STIs). At each end of the condom there is a flexible ring. At the closed end of the sheath, the flexible ring is inserted into the vagina to hold the female condom in place. At the other open end of the sheath, the ring stays outside the vulva at the entrance to the vagina. This ring acts as a guide during penetration and it also stops the sheath from bunching up inside the vagina. How do you use the female condom? 1. Open the package carefully and choose a position that is comfortable for insertion. Many women find inserting the female condom to be most comfortable in the same position that they would insert a tampon. 2. Make sure the inner ring of the condom is at the bottom, closed end of the sheath. Hold the sheath with the open end hanging down. 3. Squeeze the inner ring with thumb and middle finger (so it becomes long and narrow), and then insert the inner ring and sheath into the vaginal opening. Gently, place the index finger inside of the condom and push the inner ring up as far as it will go. Make sure the condom is inserted straight, and is not twisted inside the vagina. The outer ring should remain on the outside of the vagina. 4. The penis should be guided into the condom in order to ensure that the penis does not slip into the vagina outside of the condom. 5. To remove the condom, twist the outer ring gently and slowly pull the condom out of the vagina while keeping the sperm inside. It is generally recommended that the female condom not be reused. Only “generally” because in some countries that have limited supplies and money, condoms often have to be reused rather than go without any protection at all. What are the benefits of the female condom? • It does not require a prescription. • Opportunity for women to share the responsibility for the condoms with their partners. • A woman can use the female condom if her partner refuses to use the male condom. • The polyurethane, the material the female condom is made of, is less likely to cause an allergic reaction than a male latex condom. • The female condom will protect against most STIs and pregnancy if used correctly. • It can be inserted up to 8 hours before intercourse so it does not “interfere with the moment”. • The polyurethane is thin and conducts heat well so sensation is preserved. • The female condom can be used with oil-based lubricants. • No special storage requirements are needed because, unlike latex, polyurethane is not affected by changes in temperature and dampness. The expiry date for female condoms is generally 5 years from the date of manufacture. What are the disadvantages? • The outer ring is visible outside the vagina, which can make some women feel self-conscious. • The female condom can make noises (sound of a wet bag rustling) during intercourse. Adding more lubricant and playing some background music can help solve this problem. • Some women find the female condom hard to insert and to remove. • It has a higher failure rate in preventing pregnancy than non-barrier methods such as the pill. • It is more expensive than male condoms and can be limited in availability in some parts of the country. • It is recommended that the female condom is only used once. Diaphragm typical use: 84% perfect use: 91% What is a diaphragm? A diaphragm is a soft, thin, dome-shaped rubber cup with a flexible rim that is made to fit over a woman’s cervix. Since each woman’s body is different, a doctor must fit each woman individually for her diaphragm in order for it to be effective. The diaphragm is used to prevent pregnancy, but does not protect against sexually transmitted infections (STIs). How does it work? The diaphragm acts as a barrier between the penis and the cervix. Its goal is to prevent the sperm from getting inside of the uterus. However, because the diaphragm is not a perfect seal, a spermicide is also used to immobilize the sperm. The diaphragm and spermicide combination is far more effective than just the diaphragm or spermicide alone. How do you use a diaphragm? 1. Make an appointment with your doctor or with a gynaecologist to be fitted for a diaphragm. 2. Buy contraceptive/spermicidal cream, foam or jelly. 3. Wash your hands. 4. Dab the spermicide in the cup and around the rim of the diaphragm. 5. Find a comfortable position, similar to the position you would use to insert a tampon, and pinch the rim of the diaphragm with one hand, folding it in half with the spermicide on the inside of the fold. 6. Gently push the diaphragm as far up and as far back into the vagina as possible, making sure the cervix is covered. 7. Wash your hands again. 8. After intercourse, leave the diaphragm in for another 6-8 hours to guarantee efficacy. What are the benefits of the diaphragm? • It can be inserted up to two hours before intercourse. (If you have inserted it more than two hours before intercourse, make sure to put additional spermicide into the vagina before having sex. Spermicide begins to lose its efficacy after two hours. Also, add spermicide before each additional time of having intercourse.) • Can be left in for up to 24 hours. • Reusable and easy to carry around. • Diaphragms are only needed when you are having sex. (Unlike some other contraceptives which require you to take or have them all of the time.) • Diaphragms can be inserted and used in privacy; your partner cannot tell if you are using one. • May help you to become more in tune with your body. What are the disadvantages of using a diaphragm? • Does not protect against sexually transmitted infections (STIs). • Requires a fitting in a clinic (and may need occasional refitting). • A diaphragm that is the wrong size can cause cramping, pelvic pain or pregnancy. • Possible allergic reaction (for you or your partner). • Can be messy. • Cannot be used during menstruation (can cause Toxic Shock Syndrome). Cervical Cap Nulliparous Women - typical use: 84% perfect use: 91% Parous Women - typical use: 68% perfect use: 74% What is a cervical cap? The cervical cap is a thimble sized, latex device that in inserted into the vagina and fits snugly over the cervical opening. Suction keeps the cap in place. The cervical cap provides a barrier to block sperm from entering the uterus, thus preventing fertilization. Cervical caps are to be used with spermicidal cream, foam or jelly. How do you use a cervical cap? 1. The effectiveness of cervical caps comes from its fit. Therefore, it is important that a doctor fit a woman for a cervical cap. 2. Once you have a properly fitting cervical cap, buy some spermicidal cream, foam or jelly. 3. Up to two hours before intercourse, fill the cap 1/3 full with spermicide. Be careful not to spread the cream, foam or jelly on the rim, this may affect the suction of the cap and cause the cap to slip off your cervix. 4. Find a comfortable position to insert the cap. (Some women find it most comfortable to use the same position that they would insert a tampon in.) 5. Squeeze the rim of the cap and insert it as far as you can into your vagina. Use a finger to push in into place, covering the cervical opening. 6. Check to make sure that it is firmly in place by running your finger over the rim to make sure the cervix is covered and by gently pulling or pinching it. You should feel some resistance. 7. After intercourse, wait 8 hours before removing the cervical cap. Try using one finger to release the suction of the rim, and then remove the cap from your vagina. If you are having difficulty stopping the suction of the rim, try squatting and pushing with your pelvic muscles. What are the benefits of the cervical cap? • Privacy and control since a woman can discretely insert it up to two hours prior to sex. • Reusable and easy to carry around. • Does not affect menstrual cycle. • Cervical caps are only needed when you are having sex, unlike some other contraceptives which require you to take or have them all of the time. • May help you become more in tune with your body. What are the disadvantages of the cervical cap? • Does not protect against sexually transmitted infections (STIs). • Requires a fitting at a clinic or doctor’s office. • Some women cannot be fitted. • Can be difficult to insert or remove. • Can be dislodged during intercourse. • Possible allergic reactions. Spermicide typical use: 71% perfect use: 82% Can be in cream, foam, jelly, film (with manual insertion) and tablet suppository form. Spermicides are available at drugstores without a prescription. Read individual instructions before use. When used in combination with another barrier contraception method the effectiveness in preventing pregnancy increases. Vaginal Contraceptive Film What is vaginal contraceptive film? VCF is a 5x5 centimetre paper-thin sheet that resembles a Listerine Pocketpacks breath strip. It is a dissolvable film laced with Nonoxnol-9 (a spermicide). How do you use vaginal contraceptive film? 1. Wash your hands and dry them well. Your hands must be completely dry or the film will stick to your fingers and lose some of its efficacy. 2. Remove one film from the package with dry fingers. Fold it in half and place over fingertip. Slide your finger, covered with the VCF film, into the vagina as far as you can go so the film rests on or near the cervix. 3. Insert VCF not less than 15 minutes and not more than 1 hour before intercourse. If more than one hour passes since the VCF was inserted, insert another film. 4. Use one VCF for each act of intercourse. 5. You do not need to remove the VCF. It will naturally dissolve. What are the benefits of vaginal contraceptive film? • It does not require a prescription. • It is easy to use and is not messy. • It is discreet since it can be inserted up to one hour before intercourse (at least 15 minutes). • Neither partner can feel it or detect it while having intercourse. • VCF is only needed when you are having sex, unlike some other contraceptives which require you to take or have them all of the time. • Does not affect menstrual cycle. • It can be used during breastfeeding. • May help you become more in tune with your body. What are the disadvantages of vaginal contraceptive film? • Does not protect against sexually transmitted infections (STIs). • Insertion may interrupt sex. You need to use another one each time you have sex. • May be irritating for people with a sensitive vaginal lining. • VCF is not as effective as other contraceptives. Contraceptive Sponge Nulliparous Women - typical use: 84% - perfect use: 91% Parous Women - typical use: 68% - perfect use: 80% What is a contraceptive sponge? A contraceptive sponge is a soft, round piece of foam with a handle on it so that you can easily remove it. The sponge works in three ways to protect you against pregnancy. It acts as a barrier between the sperm and the egg by covering the cervix, it absorbs the sperm, and it contains spermicide, which kills sperm. The Today Sponge has recently been introduced into Canada. Unlike other sponges that often require more spermicide to be added, or that need to be removed after 12 hours, The Today Sponge protects from pregnancies for up to 24 hours, regardless of how many times the woman has sex, without the need of more spermicide. It must be left in at least 6 hours after the last act of intercourse, and no more than a total of 30 hours. How do you use a contraceptive sponge? 1. At least 15 minute prior to intercourse, remove the sponge from is packaging. 2. Carefully read the directions, as some sponges will require you to make them sudsy before insertion, while others you just insert as they are. 3. Fold the sponge in half, with the removal handle on the outside. 4. Insert the sponge into the vagina, placing it as far as it will go so that it covers the cervix. 5. Leave the sponge in if you have sex more than once within the same 24 hours of insertion. 6. After you have finished having sex, leave the sponge in for 6-8 hours. 7. Remove the sponge by firmly pulling on the handle. If you are having trouble releasing it, wait a few minutes, then push your pelvic muscles as you try to pull it out. 8. Dispose of the sponge. What are the advantages of the sponge? • The sponge is available without a prescription. • The sponge is only needed when you are having sex, unlike some other contraceptives which require you to take or have them all of the time. • The sponge is fairly discreet (you can insert it in advance, neither partner can feel it etc.). • It does not cause any changes to your hormonal levels or menstrual cycle. • You may become more in tune with your body. What are the disadvantages of the sponge? • The sponge does not protect you from sexually transmitted infections (STIs). • It can be expensive if you use it a lot. • Some women find it difficult to insert and/or remove. • You cannot use it if you or your partner is allergic to spermicides. • You cannot use it during your menstrual period. • You may be at risk of getting Toxic Shock Syndrome. Dental Dam (Dental Dams are NOT contraception devices) What is a Dental Dam? Dental Dams are square pieces of latex that act as a barrier to protect against the spread of HIV, STIs, bacteria, and parasites during oral sex. How do you use a Dental Dam? The dental dam is placed over your partner’s vulva or anus and must be held in place with your hands or your partner’s hands. For heightened sensation, place a drop or two of water-based lubricant between the vulva/anus and the dental dam. Dental Dams should only be used once and then thrown away. If necessary and only if necessary, Dental Dams can be reused if washed carefully with a mild soap and only used with one partner (its better to reuse than not use one at all!). How can you make a Dental Dam? 1. Unroll an unlubricated, spermicide-free condom. 2. Cut off the tip of the condom. 3. Cut down the length of the condom and spread the condom out to form a square. or Dental Dams can also be made out of surgical gloves. Simply, cut off the fingers of the glove and then cut along the length of the side of the glove. This forms a square of latex to be used as a Dental Dam. The thumb of the glove can be left on to stimulate your partner’s anus. What are the benefits? • Protects against the spread of HIV, STIs, bacteria, and parasites. • Can be made out of condoms, surgical gloves or plastic wrap. • Available in different colours and flavours so experiment and enjoy! What are the disadvantages? • Must be readily available at time of sex. • May break. • May be difficult to hold it in place. Hormonal Contraception Nuva-ring (Contraceptive ring) typical use: 92% perfect use: 99.7% What is the contraceptive ring? The contraceptive ring, commonly called the “Nuva-ring”, is one of the newest contraceptive methods on the Canadian market. It is a flexible contraceptive ring that is about 5 centimetres in diameter. Once a month, you insert it into your vagina, where it slowly releases a combination of the hormones, progestin and estrogen. The contraceptive ring is not a barrier contraceptive, like a diaphragm, so it does not need to be “fitted” or “sized”. It acts like the birth control pill, releasing hormones that prevent your ovaries from producing mature eggs. How does it work? Like the combination pill, the contraceptive ring works by: • inhibiting the monthly release of an egg by the ovaries • changing the mucus produced by the cervix to prevent the sperm from reaching the egg • causing changes to the lining of the uterus to further prevent pregnancy. The contraceptive ring delivers a low, steady dose of hormones over the 21-day treatment period. The hormones are activated by contact with the vagina – anywhere in the vagina that is comfortable for you. The walls of your vagina absorb the hormones and distribute them into your bloodstream. How do you use a Nuva-ring? You insert the Nuva-ring into your vagina for a period of 21 days and then remove it for a seven-day break, during which you will get your period. After the seven-day break, you insert a new contraceptive ring. What are the benefits? • Only have to remember to insert it once a month (as opposed to daily or weekly hormonal contraceptive options). • Contraceptive-rings have the same non-contraceptive benefits as the combination pill (ex. Dermatological advantages). • The contraceptive ring provides steady, consistent hormone release over an entire month. • Can make your periods lighter, shorter, more regular and less painful. • Is easily reversible when you wish to become pregnant. • It tends to have milder side effects than combined Oral Contraceptives because it works with a low dose of hormones. • Is easily inserted and removed by the woman What are the disadvantages? • The contraceptive ring does not protect against sexually transmitted infections (STIs). • May result in a slight increase in vaginal secretion. • If the contraceptive ring is removed and is out for more than three hours, you will need to use a backup method of birth control, such as condoms and/or spermicide, until the Ring has been used continuously for seven days. Depo-Provera typical use: 97% perfect use: 99.7% What is Depo-Provera? Depo-Provera is a hormonal injection of Progestin only (no estrogen) that lasts for three months and is taken to prevent pregnancy. It is usually given in the arm or rear, delivering a high level of progesterone into the body. Depo-Provera stops the ovaries from releasing eggs, causes the cervical mucus to thicken and changes the uterine lining, making it harder for sperm to enter or survive in the uterus. How do you get Depo-Provera? You can access Depo-Provera through a doctor or clinic. A doctor must inject the Depo-Provera into you. The first shot of Depo-Provera is usually given during or a few days after the start of a menstrual period. After 24 hours, the shot is effective birth control for the next 13 weeks. Many women find it useful to schedule their next shot slightly earlier than necessary; if something prevents them from making their appointment, there will be a window of opportunity to receive their next shot. What are the benefits of Depo-Provera? • Depo-Provera is a very private form of birth control because it cannot be seen on the body and requires no home supplies. • May decrease the risk of endometrial cancer, ovarian cancer, and pelvic inflammatory disease. You may have less menstrual cramping and pain, fewer periods, and less chance of anemia. • You only have to take Depo-Provera every three months. It is useful for women who have difficulty remembering to take the pill or who cannot rely on barrier contraceptives. • Effective within 24 hours. • No menstruation (after about 1-2 months). • Can take it if you are breastfeeding. What are the disadvantages of Depo-Provera? • Requires a clinic appointment every 3 months. • It does not protect against sexually transmitted infections (STIs). • If your body reacts harshly to the shot, it will still be in your system for three months. • Depo-Provera can cause a loss of bone density and can lead to osteoporosis. It is crucial to take calcium supplements the entire time you are on the shot. • Possible weight gain. Norplant Norplant was discontinued in the fall of 2002 because there was a possibility of serious side effects in women. Some side effects include ovarian cysts, acne or skin rash, enlargement of ovaries, higher risk of ectopic pregnancy (pregnancies outside of the uterus, ex. in fallopian tubes), blindness and depression. Currently, no similar product is available in Canada. The Norplant system consists of six silicon rods containing levonorgestrel, which is effective against pregnancy for five years. Though the product was discontinued, some people may still be using the product until 2007 (they were implanted just before it was discontinued). Oral Contraceptives “The Pill” typical use: 92% perfect use: 99.7% What is The Pill? The Pill is the most popular type of birth control in Canada. The Pill stops ovulation by preventing the ovaries from releasing an egg, and thickens the cervical mucus, making it harder for the sperm to enter the uterus. How do you use the Pill? There are many different brands of The Pill, and they come in 21 or 28 day packages. In a 21-day package, all of the pills are hormonal. After taking the pills for 21 days, a woman does not take any pills for 7 days. This is when she has her period. In a 28-day package, a woman takes one pill every day. The last seven pills are non-hormonal “sugar pills”. It is during the last 7 pills that a woman has her period. In Canada, The Pill is a drug that must be prescribed to you by a doctor. This is because there are many different types of pills and your doctor will help find one that is right for you. 1. Make an appointment with your doctor and get a prescription. Some sexual health clinics also provide The Pill. 2. The Pill is most effective when the first time that it is taken is 6 days after the start of your period, or 6 days after an abortion. 3. One pill is then taken every day until the package is finished. 4. If you have a 28-day pack, start a new pack immediately after you finish the old one. If you have a 21-day pack, take one pill every day for 21 days, no pills for 7 days and then start the new pack immediately. Start a new pack even if you are still bleeding. 5. For best efficacy, take your pill around the same time every day. You can remember to take it at the same time by associating taking the pill with another daily routine, such as brushing your teeth in the morning. As long as you take The Pill at the same time each day, it does not matter whether you take it in the morning, noon, or night. What are the benefits of The Pill? • When used properly, The Pill is highly effective in preventing pregnancy. • It is discreet. • Periods may be lighter or more regular. • Does not interrupt sex play (allows for spontaneous sex). • May protect against uterine and ovarian cancers. • May reduce acne. What are the disadvantages of The Pill? • The Pill does not protect against sexually transmitted infections (STIs). • User must remember to take it every day. • It is less effective when taken with some drugs. • Can cause blood clots (especially in women over 35 and smokers). • Requires a prescription. • Possible side-effects (ex. Weight gain of about 2-4 pounds, mood swings, nausea etc.). The Patch typical use: 92% perfect use: 99.7% What is the Patch? The Patch looks like a Band-Aid and is about 2.5 cm squared. It is very thin and has one sticky side. It works by releasing estrogen and progesterone hormones into the body through contact with the skin, thus preventing ovulation and pregnancy. The Patch has lower doses of hormones than the Pill, but is equally effective. How do you use the Patch? 1. Obtain a prescription for the Patch from a doctor or clinic. 2. Stick the Patch onto your buttocks, abdomen, upper torso (except breasts) or upper outer arm. 3. Wear the Patch for one week, then remove it and put on another Patch. The Patch should be placed in a slightly different spot each week. 4. After you have used the Patch for three consecutive weeks (3 Patches changed once a week), remove the Patch and do not wear a new one for the fourth week. This is when you have your period. A woman can wear the Patch during all of her regular activities. It should not come off during bathing, swimming or in hot, cold, humid conditions. If it does come off, you can reapply the same patch immediately. If the Patch falls off for more than one day, start a new four-week cycle of patches and use a backup method of contraception for the first week. What are the benefits of the Patch? • When used properly, the Patch is highly effective in preventing pregnancy. • Only have to remember to change it once a week. • Fairly discreet. • Periods may be lighter or more regular. • Does not interrupt sex play (allows for spontaneous sex). • May protect against uterine and ovarian cancers. • May reduce acne. What are the disadvantages of the Patch? • The Patch does not protect against sexually transmitted infections (STIs). • May have some side effects for some women (ex. Nausea, breast tenderness, blood clots - especially for women over 35 or those who smoke). • Requires a prescription. Intrauterine Devices What is an intrauterine device? There are two kinds of intrauterine devices, hormonal and non-hormonal. Commonly called an IUD, an intrauterine device is a small device that is usually shaped like a T, is made of copper or plastic, and fits inside of the uterus to prevent pregnancy. An IUD prevents pregnancy both by stopping the sperm from reaching the egg, and by changing the lining of the uterus to make it hard for a fertilized egg to attach itself to the wall of the uterus. How do you use an IUD? Women who have had at least one child are good candidates for an IUD (women who have never had a child may find that their uterus rejects the foreign object). It is not recommended that teenagers, women with a poor immune system, or women who have more than one sexual partner use an IUD. An IUD must be inserted by a doctor. 1. Make an appointment with your doctor or with a doctor at a sexual health clinic. 2. Your primary appointment will usually consist of a pelvic examination and health check to make sure that an IUD is a good contraceptive choice for you. 3. An IUD is usually inserted when a woman has her period, after an abortion or following childbirth. In each of these cases, the uterus is more likely to accept the IUD and not reject it. 4. The doctor will insert the IUD into your uterus, leaving two strings hanging out through your cervical opening. The strings will be cut so that they are just long enough to feel with your fingers so that you can make sure that your IUD is still in place. 5. Before having intercourse and after each menstrual period, check to make sure that the strings are still in place. If you feel the plastic part of the IUD or if you cannot feel the strings, use another form of birth control and contact your doctor. 6. Have a check-up three months after the initial insertion of the IUD to make sure that your body has accepted it. Have a check up sooner if you experience a late period, have no period, have abdominal pain, have unusual discharge or have an abnormal period. 7. An IUD is effective for up to 5 years depending on what type you use. Never try to remove an IUD yourself. This could cause internal damage. 8. An IUD can be replaced or removed at any time, either to renew its effectiveness or to allow for pregnancy. After an IUD is removed, you may become pregnant right away. Non-hormonal IUD (Nova T and Flexi T 300) typical use: 99.2% perfect use: 99.4% What is a non-hormonal IUD? It is a T shaped IUD that has copper on the arms of the T-shaped device. The copper reduces the ability of the sperm to reach the egg and prevents a fertilized egg from successfully implanting itself on the uterine wall. A non-hormonal IUD is effective for up to 5 years. What are the benefits of the non-hormonal IUD? • An IUD is the most effective form of birth control in Canada that is reversible. • Effective up to 5 years. • Can be used by women who cannot/ do not want to use hormonal contraception. • It is a very private form of birth control because it cannot be seen on the body and requires no home supplies. • Although you should check for the strings of your IUD every month, you only have to have it replaced every 5 years. It is useful for women who have difficulty remembering to take the pill or who cannot rely on barrier contraceptives. • Can use an IUD if breastfeeding. • Prevents ectopic pregnancies (pregnancies outside of the uterus ex. In fallopian tubes). • Very low cost over time. • Effective as soon as inserted and remains effective throughout use. What are the disadvantages of the non-hormonal IUD? • Does not protect against sexually transmitted infections (STIs). • May have increased menstrual bleeding and cramping. • Initial high-cost of insertion (but balanced out over usage time it is cheap). • Must be inserted at a doctor’s office or clinic. • Some women are allergic to copper. Hormonal IUD (Mirena) typical use: 99.9% perfect use: 99.9% What is the Mirena IUD? (hormonal) The Mirena IUD is a flexible plastic IUD that is T shaped and is about the size of a quarter. Once in place, it releases a small amount of the hormone levonorgestrel into the lining of the uterus. The combination of the placement of the IUD and the hormones causes the lining of the uterine wall to thin, the thickening of cervical mucus, and the inhibition of sperm movement, which work together to prevent the sperm from travelling towards the egg. The hormonal addition of the Mirena IUD makes it even more effective than the non-hormonal IUD. It is effective for up to 5 years. What are the benefits of Mirena? • An IUD is the most effective form of birth control in Canada that is reversible. • Mirena has very low doses of hormones are needed since they are absorbed directly by the uterus wall. • Many women experience either decreased bleeding or no menstrual period at all after a few months on Mirena. • Effective for at least five years (less in women who are overweight). • It is a very private form of birth control because it cannot be seen on the body and requires no home supplies. • Although you should check for the strings of your IUD every month, you only have to have it replaced every 5 years. It is useful for women who have difficulty remembering to take the pill or who cannot rely on barrier contraceptives. • Very low cost over time. • Effective as soon as inserted and remains effective throughout use. What are the disadvantages of Mirena? • Does not protect against sexually transmitted infections (STIs). • May have irregular bleeding for the first few months. • Initial high-cost of insertion (but balanced out over usage time it is cheap). • Must be inserted at a doctor’s office or clinic. • Some women may not want to use hormones. Permanent Forms of Contraception Sterilization Sterilization is a permanent form of contraception that is only to be used when it is certain that no future children are wanted. Women and men who wish to be sterilized must be certain that they do not want to ever have another child and be sure that they will not change their mind. There are two kinds of sterilization. Both types of sterilization are surgical and are very difficult to reverse. Men wishing to be sterile have a vasectomy, and women have a tubal ligation. Vasectomy (men) typical use: 99.85 perfect use: 99.9% A vasectomy blocks the vas deferens (tubes that carry a man’s sperm) and therefore prevents the sperm from being able to exit the male body through the urethra and impregnate an egg. A man who has had a vasectomy will still ejaculate, but his semen will not contain any sperm. The testicles continue to produce sperm, but the sperm are reabsorbed by the body. The reabsorption of sperm that has not been ejaculated is a natural process that occurs regardless of whether you have had a vasectomy or not. A vasectomy is done surgically in an office or clinic, and involves a small incision in the scrotum after which the vas deferens are cut and tied off or cauterized. The entire procedure takes between 15 and 20 minutes. After the vasectomy, a man should still use another form of birth control for the next 15-20 ejaculations while the remaining accessible sperm clears out of his system. To find out if you are sterile, have your semen examined under a microscope after about 15 ejaculations. How do you get a vasectomy? A vasectomy is a minor surgery and must be performed by a doctor. Speak with your urologist, family physician or clinician about having the surgery. Many public health units, sexual health clinics and hospitals will refer you for a vasectomy. What are the benefits of a vasectomy? • The cost of a vasectomy is covered by all provincial health plans in Canada. • It is only a minor surgery that is safe, extremely effective and permanent. • It is a very private form of birth control because it cannot be seen on the body and requires no home supplies. • Requires no daily attention and does not interrupt sex play. • Does not affect pleasure. • Less complicated than female sterilization. • Able to do check-ups to ensure that your operation is still working. • An opportunity for the male partner to play a responsible role in contraception. What are the disadvantages of a vasectomy? • Does not protect against sexually transmitted infections (STIs). • Some men change their mind about wanting to have children. If this is the case, the permanency of a vasectomy may be negative. While the operation may be reversible, it is difficult to reverse and may not be effective. Men should be certain that they do not want future children no matter what the circumstances (ex. death of child or partner) before they have a vasectomy. • Surgery is required and some men may be afraid of an operation on their testicles. • Not effective immediately, must wait approximately 15-20 ejaculations and have semen examined before knowing of effectiveness. • Slight possibility that the vas deferens may rejoin. Tubal ligation (women) typical use: 99.5% perfect use: 99.5% Tubal ligation is a permanent operation that blocks a woman’s fallopian tubes, thus preventing them from being able to carry an egg to her uterus. When performed correctly, the egg and sperm have no way of coming into contact with each other and a woman cannot become pregnant. One of the most common forms of tubal ligation is done by laparoscopy and is done under local or general anesthetic. In the laparoscopy procedure, the abdomen is filled with carbon dioxide gas so that the abdominal wall balloons away from the uterus and tubes. The surgeon makes a small cut just below the navel and inserts a laparoscope, a small telescope-like instrument. A second incision is made just above the pubic hairline to allow the entrance of the instrument that will cut, sew or burn the tubes. The surgery takes about half an hour and although it is fairly straightforward, it is associated with more risks than the male sterilization procedure of vasectomy. A tubal ligation is effective immediately. How do you get a tubal ligation? A tubal ligation is an operation and must be performed by a doctor. Speak with your obstetrician or gynaecologist, family physician or clinician about having the surgery. Many public health units, sexual health clinics and hospitals will refer you to a doctor who performs tubal ligations. What are the benefits of tubal ligation? • The cost of tubal ligation is covered by all provincial health plans in Canada. • It is a permanent form of birth control. • It is effective immediately. • It is a very private form of birth control because it cannot be seen on the body and requires no home supplies. • Requires no daily attention and does not interrupt sex play. • Does not affect pleasure. What are the disadvantages of tubal ligation? • Does not protect against sexually transmitted infections (STIs). • Some women change their mind about wanting to have children. If this is the case, the permanency of a tubal ligation may be negative. While the operation may be reversible, it is difficult to reverse and may not be effective. Women should be certain that they do not want future children no matter what the circumstances (ex. death of child or partner) before they have a tubal ligation. • Surgery is required and some women may be afraid of an operation. • In the possibility that a pregnancy does occur, an ectopic pregnancy (located outside of the uterus) is more likely. • More complicated than male sterilization. • Not able to do a check-up to ensure that the operation is still working. Permanent Non-Sterilization Essure 99.8% Essure is a fairly new (approved in Canada in 2001) and permanent form of birth control that does not require surgery. Essure works by having two tiny wires, surrounded by a large coil, inserted into each fallopian tube. Essure is inserted into the tubes by a doctor, with the help of a hysterscope (a small camera) and is inserted through the vaginal opening, rather than through an incision in the abdomen. The entire procedure takes about 45 minutes, of which, only about 13 minutes are spent inserting the wire. Essure works by causing the fallopian tubes to form scar tissue over the implant. The scar tissue blocks the tubes and prevents fertilization. While the scar tissue is forming, another form of birth control must be used. Scar tissue usually forms after about three months. A doctor will perform an x-ray on your pelvis after three months to tell you whether or not Essure is working. How do you get Essure implants? Essure insertion must be performed by a doctor. Speak with your obstetrician or gynaecologist, family physician or clinician about getting Essure. Many public health units, sexual health clinics and hospitals will refer you to a doctor who inserts Essure. What are the benefits of Essure? • It does not require a general anesthetic, recovery is quick and there is no scarring. • Unlike other permanent contraceptive methods, Essure does not require surgery. • It is a permanent form of birth control. • It is a very private form of birth control because it cannot be seen on the body and requires no home supplies. • Requires no daily attention and does not interrupt sex play. • Does not affect pleasure. What are the disadvantages of Essure? • Does not protect against sexually transmitted infections (STIs). • Some women change their mind about wanting to have children. If this is the case, the permanency of Essure may be negative. Women should be certain that they do not want future children no matter what the circumstances (ex. death of child or partner) before they have Essure inserted (since it is fairly new, there is no data on the reversibility of Essure). • Essure is not effective immediately. Women must use another form of birth control for at least three months while scar tissue grows over the implant. After three months, a hysterosalpinogram (a special x-ray) is performed to ensure the fallopian tubes are blocked. Natural Methods Natural methods of contraception do not require the use of external hormones or of external objects (IUDs, condoms etc.). A significant knowledge of one’s own body and lifestyle, as well as dedication and consistency is required for natural methods to be effective. Natural methods are generally not recommended for people whose cycles are not regular, whose sexual lifestyle is spontaneous or for those who are not intimately familiar with their body and its functions. With typical use, natural methods of contraception are not as reliable as other contraceptives and do not protect against sexually transmitted infections. Many natural family planning methods of contraception rely on intimately knowing and understanding a woman’s menstrual cycle. Natural contraceptive methods of this kind usually rely on recognizing when a woman is most likely to be fertile, and abstaining from sexual intercourse, or using another form of contraception during that time. The main fertility indicators that are monitored on a daily basis to know when a woman is most likely to get pregnant are recording your body temperature, monitoring cervical secretions (vaginal discharge/mucus), and calculating how long your menstrual cycle lasts. It is very hard to calculate the effectiveness of Natural Family Planning methods. Therefore, we have not included a percentage of effectiveness in the following sections. Even when these methods are used properly, they can be significantly less effective than barrier, hormonal or permanent methods. While there are many reasons why a person may choose a natural method of contraception over other methods, they are not always effective. Abstinence What is abstinence? People have different definitions of what abstinence is. Generally, abstinence is voluntarily refraining from participating in some or all forms of sexual activity. Due to the varying definitions of abstinence an effectiveness rating cannot be calculated. If you refrain from participating in all forms of sexual activity, abstinence is the most effective method of birth control. How do you practice abstinence? Abstinence can be practiced in many different ways. Some people may refrain from sexual activity altogether, while others may use “outercourse” as their choice of abstinence. Outercourse, as opposed to intercourse, is sex play without penetration of the penis into the vagina or anus. Outercourse can include: hugs, kisses, petting, oral-genital stimulation, mutual masturbation, touching, massaging and frottage (aka. “dry humping”). You should decide ahead of time, what you definition of abstinence is, and think about how you will maintain abstinence in high-pressure situations. If you have a partner, you and your partner should both discuss what abstinence means to each of you, and how you will practice abstinence. Talking about abstinence ahead of time can help to avoid confusion, misunderstanding, and pressure in the heat of the moment. What are the benefits of abstinence? • Abstinence is free, and can be used by anyone. • Since no fluid is being deposited in the vagina, pregnancy can be prevented. • There are no hormonal changes, medical risks or complications associated with it. • It may be a more acceptable practice than other forms of contraception for individuals who live with certain cultural or religious expectations. • Can increase emotional closeness between individuals. What are the disadvantages of abstinence? • Outercourse does not protect you from sexually transmitted infections (STIs). If you practice outercourse, use a dental dam or a condom when performing and receiving oral sex. • If semen spills on or near the vagina, pregnancy may still be possible, even without penetration. • If one partner really wants intercourse, stress and emotional upset may result. • The concern that “things might get out of control in the heat of the moment” might decrease a partner’s enjoyment. • A couple may not be prepared to protect themselves from pregnancy or sexually transmitted infections if they decide to switch to intercourse. • Some people who practice abstinence may feel insecure that they are the only people not having sex (although this is far from the truth). Lactational Amenorrhoeic Method (Breastfeeding) What is the Lactational Amenorrhoeic Method? For a period of up to six months after giving birth, ovulation is suppressed in women who breastfeed. This is not a very reliable form of contraception. How do you practice the Lactational Amenorrhoeic Method (LAM)? LAM is only effective if you have not resumed menstruating and are intensively breastfeeding (no longer than four hours between breastfeeding or pumping). What are the benefits of LAM? • LAM is free and has no side effects. • Mothers who chose to breastfeed receive an added bonus of contraception. What are the disadvantages of LAM? • It is not as reliable as other barrier or hormonal methods of contraception. • LAM does not protect you from sexually transmitted infections (STIs). • If you begin to breastfeed less you should use a back up method of contraception. • LAM does not always work and you cannot be sure exactly when it will stop being effective. Basal Body Temperature What is Basal Body Temperature (BBT)? BBT is one method of monitoring physical changes in a woman’s body to determine periods when she is likely or unlikely to become pregnant. BBT requires women to keep track of their body temperature to determine when ovulation will occur. A woman’s body temperature will increase on the day of ovulation and remain elevated approximately 2 days after ovulation. How do you practice BBT? Every morning measure your temperature and record it on a calendar. You will eventually discover a pattern and be able to pinpoint when ovulation occurs. On the day ovulation occurs, your body temperature increases and will remain 0.5 degrees higher for two days after ovulation. After ovulation, you may engage in intercourse with a decreased likelihood of becoming pregnant. This is not a very reliable form of contraception. What are the benefits of BBT? • After initial cost of a thermometer, the Basal Body Temperature Method is essentially free. • It may be a more acceptable practice than other forms of contraception for individuals who live with certain cultural or religious expectations. • The Basal Body Temperature Method has no physical side effects. • Can increase emotional closeness between individuals because it requires cooperation and communication. • You become more in tune with your body and your menstrual cycle. Knowing when you are the most fertile is helpful if you decide to become pregnant. What are the disadvantages of BBT? • It is not as reliable as other barrier or hormonal methods of contraception. • Takes time to learn your body and properly track your cycle. • Illness, medications, stress, peri-menopause and adolescence may disturb your cycle. • Does not protect you from sexually transmitted infections (STIs). • Sexual intercourse must be limited within specific times resulting in the loss of spontaneity. Ovulation or Billings Method What is the Ovulation or Billings Method? The Ovulation or Billings Method is a second method of monitoring physical changes in a woman’s body to determine periods when she is likely or unlikely to become pregnant. The Billings Method requires women to keep track of changes in cervical mucus to determine when ovulation will occur. One day before, during and one day after ovulation the cervical mucus becomes slippery and transparent. After ovulation, mucus will disappear from the vulva. This is not a very reliable form of contraception. How do you practice the Ovulation or Billings Method? Observe cervical mucus at the vulva by visually inspecting its colour and feeling the consistency. One day before, during and one day after ovulation the cervical mucus becomes slippery and transparent. Then the cervical mucus will disappear from the vulva for the rest of the cycle. After ovulation, you may engage in intercourse with a decreased likelihood of becoming pregnant. What are the benefits of the Ovulation or Billings Method? • The Ovulation or Billings Method is free and has no side effects. • It may be a more acceptable practice than other forms of contraception for individuals who live with certain cultural or religious expectations. • Can increase emotional closeness between individuals because it requires cooperation and communication. • You become more in tune with your body and your menstrual cycle. Knowing when you are the most fertile is helpful if you decide to become pregnant. What are the disadvantages of the Ovulation or Billings Method? • It is not as reliable as other barrier or hormonal methods of contraception. • Takes time to learn your body and properly track your cycle. • Illness, medications, stress, peri-menopause and adolescence may disturb your cycle. • Does not protect you from sexually transmitted infections (STIs). • Sexual intercourse must be limited within specific times resulting in the loss of spontaneity. Symptothermal Method What is the Symptothermal Method? The Symptothermal Method is a third method of monitoring physical changes in a woman’s body to determine periods when she is likely or unlikely to become pregnant. This method combines the tracking of a woman’s body temperature and the changes to the cervical mucus to determine when ovulation will occur. This is not a very reliable form of contraception. How do you practice the Symptothermal Method? Every morning measure your temperature and observe any changes to cervical mucus and record it on a calendar. Cervical mucus becomes slippery and transparent on the day before, during, and the day after ovulation. On the day ovulation occurs, your body temperature increases and will remain 0.5 degrees higher for two days after ovulation. After ovulation, the cervical mucus at the vulva will disappear. You will eventually discover a pattern and be able to pinpoint when ovulation occurs. After ovulation, you may engage in intercourse with a decreased likelihood of becoming pregnant. What are the benefits of the Symptothermal Method? • It may be a more acceptable practice than other forms of contraception for individuals who live with certain cultural or religious expectations. • Can increase emotional closeness between individuals because it requires cooperation and communication. • You become more in tune with your body and your menstrual cycle. Knowing when you are the most fertile is helpful if you decide to become pregnant. • After initial cost of a thermometer and charts, the Basal Body Temperature method is essentially free. What are the disadvantages of the Symptothermal Method? • It is not as reliable as other barrier or hormonal methods of contraception. • Takes time to learn your body and properly track your cycle. • Illness, medications, stress, peri-menopause and adolescence may disturb your cycle. • Does not protect you from sexually transmitted infections (STIs). • Sexual intercourse must be limited within specific times resulting in the loss of spontaneity. Calendar Method What is the Calendar Method? The Calendar Method uses a calendar to keep track of a woman’s cycle. After 12 menstrual cycles, it is possible to calculate a time frame when ovulation is most likely to occur. The calculation is based on ovulation (release of an egg from an ovary) occurring 12 to 16 days before menstruation. This is not a very reliable form of contraception. How do you practice the Calendar Method? This method requires a woman to record her menstrual cycle on a calendar. The first day of the cycle is the first day of menstruation and the last day of the cycle is the day before the next menstruation. The average cycle is 28 days, but every woman’s body is different therefore the cycle length will vary. After recording 12 cycles, take the shortest cycle and subtract 19 days (ie. 26 – 19 = 7) and the longest cycle and subtract 10 days (ie. 32 – 10 = 22). This calculation provides an 8 to 10 day fertile period when the woman will most likely be ovulating. During the calculated fertile period sexual intercourse must be avoided. What are the benefits of the Calendar Method? • The Calendar Method is free and has no side effects. • It may be a more acceptable practice than other forms of contraception for individuals who live with certain cultural or religious expectations. • Can increase emotional closeness between individuals because it requires cooperation and communication. • You become more in tune with your body and your menstrual cycle. Knowing when you are the most fertile is helpful if you decide to become pregnant. What are the disadvantages of the Calendar Method? • It is not as reliable as other barrier or hormonal methods of contraception. • Takes time to learn your body and properly track your cycle. • Illness, medications, stress, peri-menopause and adolescence may disturb your cycle. • Sexual intercourse must be limited within specific times resulting in the loss of spontaneity. • The Calendar Method requires a longer period of abstinence than the other natural contraception methods because it does not track physical changes. Coitus Interruptus What is Coitus Interruptus? Coitus Interruptus (“interrupted intercourse”) occurs when the man withdraws his penis from a woman’s vagina before ejaculation. You and your partner must agree on this method before attempting Coitus Interruptus, as it requires a large degree of self-control and practice and is not a reliable form of contraception. How do you practice Coitus Interruptus? The man removes his penis from the woman’s vagina and away from the vaginal opening before ejaculation occurs. This ideally prevents sperm from entering the vagina and consequently from fertilizing an egg. What are the benefits of Coitus Interruptus? • Coitus Interruptus is better than using no method of contraception at all. However, since there is the chance of sperm getting into the vagina before ejaculation, this method is not reliable. What are the disadvantages of Coitus Interruptus? • It is a form of contraception that has one of the highest failure rates. • Does not protect you from sexually transmitted infections (STIs). • Pre-ejaculate may contain sperm. The sperm from the pre-ejaculate enters the vagina and can result in a pregnancy. • If male partner gets carried away during sexual intercourse or cannot anticipate orgasm and ejaculation, he may pull out too late resulting in a possible pregnancy. Especially in younger men, men who do not know their bodies well and men who have just started engaging in sexual activity, it can be very difficult to know when ejaculation is about to occur.