If a couple decides to have sexual intercourse, but doesn't want to start a pregnancy, then they can use birth control or contraception. What is best for one couple may not be suitable for another. There is no contraception that is 100% effective. However, some methods can be very effective if they are used properly.
Making mistakes or "taking chances" by not following instructions carefully makes any method risky.
Pregnancy can start almost any time. A woman can get pregnant,
-the first time she has sex
-in any position
-uring her menstrual period
- even if she doesn't have sex very often
- even if she doesn't have an orgasm
- even if her partner pulls his penis out of her vagina before he ejaculates or "comes"
- even if she doesn't have vaginal intercourse, if her partner ejaculates near the outside of her vagina.

These are some of the reasons why 85 to 90 of every 100 women who don't use birth control when they have intercourse get pregnant within one year. That's up to 90%! So, the question is, "Which method would we use carefully, every time?"

There are many types of birth control. Some can be bought at the drug store without a prescription, for instance condoms and foam or the sponge. For others, such as the diaphragm, birth control pill, IUD, cervical cap, Depo-Provera or Norplant, you must see a doctor or health care worker. Natural Family Planning requires cooperation and training for both partners. This is not the same as the old rhythm method, counting days on a calendar. Many people, after they are sure they don't want children in the future, consider permanent sterilization.

Another method of preventing pregnancy is not including sexual intercourse in your lovemaking. Many couples find that creative sexual stimulation is as exciting and satisfying as intercourse.

You may have heard of other methods of birth control. Withdrawing the penis just before ejaculation has a high failure rate. Breast feeding cannot be counted on to prevent pregnancy. Douching can actually speed the sperm on their way.
So, if you don't want to start a pregnancy, you need to choose an effective birth control method that suits you and your partner. Think about the following questions:
? What would you do about a pregnancy?
? How would your partner feel about it?
? How does your partner feel about birth control?
? Can you talk about it together?
? Could you cooperate to use a method of birth control?
? What will it cost? Will you and your partner share the cost?
? Are you protecting yourself and your partner against sexually transmitted diseases at the same time?
The type of birth control you choose now may not be the right method for you in a year, or even next month. As you and your lifestyle change, your birth control needs may change too. Some women have side effects with some types of birth control, and have to change methods. The best method is the one you will use correctly and safely.
If you want to talk with someone about birth control, you can call a local Planned Parenthood organization or Public Health Unit .

Using Condoms

A latex condom is one method of birth control and one of the best ways to protect yourself from sexually transmitted diseases. They can be bought at a drug store or clinic without a prescription or a doctor's examination.

Condoms, also called "rubbers" or "safes", are thin coverings usually made of latex, which fit over a man's erect, hard penis. They may be smooth or textured, lubricated, coloured or even flavoured. Latex condoms prevent pregnancy by keeping semen from getting into the woman's vagina. They also help prevent sexually transmitted diseases during both vaginal and anal intercourse.

Some people think that condoms interfere with sexual pleasure. However, latex ones are very thin so they do transmit body heat. Even if they do interfere, they provide great protection for both yourself and your partner -- a small price to pay to prevent unplanned pregnancy and sexually transmitted disease.

To be most effective, condoms should be used with "contraceptive" or "spermicidal" foam, jelly or cream, and another "barrier method" such as the cap,diaphragm or sponge, every time you have vaginal intercourse. Contraceptive foam, jelly and cream contain Nonoxynol-9 which kills sperm and some of the germs that cause sexually transmitted diseases. Note that the contraceptive foam is different from "feminine hygiene" products like douches and sprays. These other products are useless for birth control or preventing sexually transmitted diseases.

When people use a new condom with contraceptive foam correctly every time and the condom does not break or slip off less than one out of every 100 women will get pregnant.

Condoms are wrapped in individual packages. The condom must be removed and unrolled over the penis as soon as the man has an erection, before there is any contact between the penis and the vagina, anus or mouth. Early semen or fluid contains sperm, and can start a pregnancy even without ejaculation.
It is important to leave a space at the end of the condom with no air in it so that the semen or "come" can collect there. To do this, pinch the tip of the condom and hold it as the condom is rolled down the penis. A condom that is pulled too tightly over the head of the penis is more likely to break.

Use a fresh condom every time you have intercourse. Every package should have a date stamped on it; don't use the condom if that date has already passed. Don't leave them in a wallet, car glove compartment or other place that gets hot; heat damages the latex. Condoms that are old or damaged should be thrown away. But don't inflate the condom first to check it, as this can damage the latex also.

After the man ejaculates or "comes" he should withdraw his penis before he loses his erection. Hold onto the condom at the base to keep it from slipping or spilling.

For further information, you can call a local Planned Parenthood organization or Public Health Unit .

The Birth Control Pill

Birth control pills usually contain 2 female hormones called estrogen and progesterone which stop the ovaries from releasing an egg, or ovum. They also cause other changes in a woman's body which make pregnancy very unlikely. Used correctly, it can be more than 99% effective. "The Pill" does not protect against sexually transmitted diseases.
If a woman wants to go on The Pill, she has to get a prescription. The doctor will first ask questions about her health, her family's health and whether she smokes. If she starts, she will need to know exactly how to take it. She will not be protected from pregnancy for the first month, and should use a back-up method of birth control such as latex condoms with foam.
She needs to know which day to start taking the pills, and when to start the next pack. She will always start a new pack on the same day of the week. If she takes the first pill on a Sunday, she will always take the first pill of every pack on a Sunday.A woman who takes the Pill according to the instructions is protected from pregnancy every day.It is normal for menstrual periods to become lighter, or even for a woman to skip a period while on the Pill.

The Pill is most effective if it is taken properly. Here are some guidelines to follow:
1. Take the Pill at the same time every day. This keeps a steady supply of hormones in the body.

2. Pick a time of the day when you will remember to take the Pill, and when the pills will be handy, then stick to it. It is helpful to connect pill-taking with another activity, such as brushing your teeth or eating lunch.

3. If you are late taking a pill or forget to take a pill by four hours or more, take the pill as soon as you remember, but use a back-up method of birth control such as condoms and spermicide for the rest of the month. If you and your partner don't, you could get pregnant.

4. Other types of medicine such as antibiotics or antacids can stop birth control pills from working. If you are taking antibiotics or any other kind of medicine, even one that you got without a prescription, check with a doctor or pharmacist to see if it will affect the Pill. If it will, you and your partner will need to use a back-up method such as condom and spermicide while you are taking the other medicine. Also, if you are vomiting or have diarrhea you may not be protected from pregnancy. So you and your partner should use an additional method of birth control such as condom and spermicide for the rest of the month.
Many women notice some changes in their bodies when they go on the Pill. Tell your doctor or go to a clinic if any of the following changes are upsetting or a problem: nausea, headaches, breast tenderness, weight gain, spotting or bleeding during your cycle, irritability, depression or other mood changes. Some of these changes are no problem, and most of them go away in 2 or 3 months when the body gets used to the Pill. But some women may need to switch to a different type of pill, or use another method of birth control.
The Pill can cause very serious problems for some women, especially women who smoke. There is a slight risk of high blood pressure, blood clots, heart attack and stroke. Some women who have high blood pressure or diabetes may not be able to take the Pill.
The warning signs of serious problems when a woman is taking the Pill are severe abdominal pain or cramps; chest or stomach pain; shortness of breath; coughing up blood; severe headaches; pain, tingling, swelling or numbness in the leg; and blurred or temporary loss of vision. If you notice any of these signs, get to a doctor or clinic right away.
There is no evidence that the Pill causes cervical, uterine or breast cancer. Research on a connection between the Pill and breast cancer has not reached any conclusion yet. There is no evidence that taking the Pill will make it harder for a woman to get pregnant in the future.
Beneficial side effects of the Pill include having clearer skin, having shorter, lighter periods and less menstrual cramping, and a reduced chance of ovarian and endometrial cancers. Many women who get Pre-Menstrual Syndrome find the Pill helpful. There is some protection against breast and ovarian cysts. For many women, not having to worry about pregnancy makes sexual intercourse more enjoyable.
The Pill is a good method of birth control for many women. Remember, it will not protect against sexually transmitted diseases. If you start, be sure to remember to take it at the same time every day, and watch for the warning signs for serious problems! For more information, you can call a local Planned Parenthood organization or Public Health Unit .

Diaphragm And Jelly

The diaphragm is a soft rubber cup. It is worn inside a woman's vagina during intercourse. It must be filled with special jelly or cream which kills sperm. Then it is inserted at the back of the vagina, to cover the cervix -- the opening to the uterus or womb. It blocks sperm from getting into the uterus. If any sperm get around the diaphragm, they are killed by the jelly or cream.
Diaphragms come in different sizes. Each woman is fitted by a doctor or health worker to get the right size. Make sure you learn how to put it in correctly, know if it is in place and remove it. When it is in place, the woman and her partner usually can't feel it. If it is uncomfortable, then it may be the wrong size or inserted incorrectly.

For more information about the diaphragm, you can call a doctor or family planning clinic. Or, call a local Planned Parenthood organization or Public Health Unit -- see References/Resources.

The IUD

The IUD, or intrauterine device, is a small piece of plastic or copper, shaped like a T, which is placed inside a woman's uterus or womb by a doctor. The IUD causes a fertilized egg to leave the uterus during menstruation. It is very reliable: about 99% effective in preventing pregnancy. Once it's in, the IUD is good for 1 to 5 years, depending on the type.

An IUD may not be the best kind of birth control for everyone. Some women with IUDs notice changes in their bodies. These changes can include longer or heavier periods, more cramps, spotting between periods or heavier discharge from their vaginas. These often settle down after their bodies get used to the IUD, but some women decide to have the IUD removed.

For a few women, the IUD can cause serious problems. It is rare, but the IUD can push through the wall of the uterus. Also, if pregnancy occurs with an IUD in place, there is a higher chance of having a tubal pregnancy. But the most serious problem is pelvic infection.

The IUD has a thread on it which hangs down through the cervix. This lets a woman check that the IUD is in place, and makes it easy for a doctor to remove it. The woman should check with her finger every week during the first month after the IUD is inserted, and monthly after that. The IUD doesn't interrupt love-making, isn't messy and doesn't have to be remembered at the same time every day.

The IUD will not prevent sexually transmitted diseases. Sometimes bacteria, such as those causing gonorrhea or chlamydia, will travel up the thread into the uterus. So there is a greater risk of getting a sexually transmitted disease while an IUD is in place. The bacteria can cause a pelvic infection which can leave a woman infertile, that is, unable to get pregnant. However, this happens very rarely if a woman has only one sexual partner or practices safer sex. There is a greater chance of getting a pelvic infection if you have had a pelvic infection or a tubal pregnancy. Some doctors will not insert an IUD in a woman who plans to have children in the future.
A person you might feel abdominal pain and cramps at first. The IUD danger signs include unusual heavy abdominal pain or cramps, heavy bleeding, fever or chills, or unusual vaginal discharge. In case of any of these danger signs, or if you just want more information about the IUD, you can call a local Planned Parenthood organization or a Public Health Unit .

Natural Family Planning: Is There A Safe Time Of The Month?

Many people wonder if there's a safe time of the month when a woman can have intercourse without getting pregnant. There may be, but you can't know when just by guessing or counting days on a calendar. Pregnancy is possible the very first time a woman has intercourse and at any time during a woman's menstrual cycle, even during her period. Sperm can live inside a woman's body for several days.
Natural Family Planning or Fertility Awareness is not the old "Rhythm Method". It can be used to prevent pregnancy, and combined with other birth control methods for greater effectiveness.
Every month, a woman's body gets ready for pregnancy. An ovum or egg leaves one of her ovaries and travels down her tubes. If the egg meets a sperm, it is fertilized and a pregnancy starts. The egg leaves the ovary about 2 weeks before her period starts; however, this time can depend on things like illness, stress, travel or changes in diet. This means that the egg could leave an ovary a few days earlier or a few days later than usual. For some women this could happen during their period. Once the egg leaves the ovary, it can take a day to travel down the tubes. If it meets a sperm at any time, the woman can get pregnant.
You can see why just guessing or counting days on a calendar can't tell you when the chance of pregnancy is small. The method called Natural Family Planning teaches couples how to tell what days of the month are safest. They learn how a woman's temperature changes during her monthly cycle, how to take it and record it on a graph. They also learn how her vaginal mucus changes during her cycle. People need patience, cooperation and special training to use this method properly. There are courses in some communities for couples to take. You can also get books and pamphlets in libraries and Public Health Units.
If you are interested in learning more about natural family planning or birth control, you can call a local Planned Parenthood organization or Public Health Unit .

Sterilization For Men: Vasectomy

Vasectomy is a permanent method of birth control for men. It is a simple 15-30 minute operation which prevents the man's sperm from being released during sexual intercourse.
During a vasectomy, the vas deferens or tubes which carry the sperm are cut and tied. This prevents sperm from getting into semen. When a man has sex, he still releases semen, but the semen doesn't contain sperm. Therefore he can't start a pregnancy.
The operation is done in a doctor's office or the outpatient department of a hospital. A local anesthetic is used, numbing or freezing the genital area.
After giving the man an anesthetic, the doctor makes a small cut on each side of the scrotum, the sac which holds the testicles. The tubes which carry sperm are cut and tied, and small cut is sewn up.
Most men recover from a vasectomy in a day or two. There is pain and bruising, and he will need to take it easy at first. Ordinary pain killers are often helpful.
A vasectomy is not effective right away. There are still sperm in the tubes above the place where they are tied off. After about 6 weeks, the man needs to go back to his doctor to make sure that no sperm are getting into his semen. Until the doctor is sure this isn't happening, the couple should use another kind of birth control, like condom and foam, to prevent pregnancy.
A man's sex drive is affected by a hormone called testosterone which is produced in the testicles. This doesn't change because of a vasectomy. The penis and testicles are not affected. Only two tiny pieces of tubes are removed. Vasectomy is one of the most effective methods of birth control: over 99.9% effective.
You should not have a vasectomy unless you are sure that you will not want children in the future. There is no guarantee that a vasectomy can be reversed, although some men have had this done. The reversal operation is long and difficult and not always successful. Be sure before you decide to have a vasectomy.
For more information about vasectomy, you can call a local Planned Parenthood organization or Public Health Unit.

Sterilization For Women: Tubal Ligation

Sterilization for women, or tubal ligation, is a permanent method of birth control. The fallopian tubes which carry eggs from the ovaries to the uterus are closed off. This operation is often called "having your tubes tied". Some women stay overnight in hospital, while others have the operation done in the hospital's outpatient department.
Tubal ligation is nearly always successful, and very few tubes ever grow back together again. This makes it the most effective method of birth control: over 99.9%. After one menstrual period following the operation, a women can have intercourse without risk of pregnancy.
It "usually" does not affect her menstrual periods, or her sex drive. The uterus or womb is not removed; however, sperm can no longer reach the egg. Some women enjoy sex more when they do not have to worry about pregnancy.
A woman needs a general anaesthetic for this operation and time to recover after she wakes up. Therefore, there is a slightly greater risk with tubal ligation than there is with vasectomy for men. Vasectomies are done under local anesthetic, freezing the genital area, and do not require cutting into the abdomen.
Some women who have had a tubal ligation try later on to have their tubes reconnected, but it is a long and difficult operation and hardly ever successful. A woman should not have a tubal ligation unless she is sure that she will not want children in the future.
For more information, you can call a local Planned Parenthood organization or Public Health Unit -- see References/Resources.

The Morning After Pill and Post-Coital IUD

What can you do if the condom breaks? What can you do if you had unprotected sexual intercourse, and don't want to become pregnant? What can you do if you have been sexually assaulted? There is something to do if you act quickly.
The Morning After Pill is really four hormone pills. A doctor can prescribe them to a woman who has had intercourse once within the past 72 hours, or 3 days. It will not interrupt a pregnancy from a previous act of intercourse. And it does not protect you from pregnancy for the rest of your cycle. It affects the lining of your uterus or womb so that a fertilized egg can't implant.

The possible side effects can be spotting or bleeding from the vagina, cramps and diarrhea. These are temporary but may last several days. The bleeding is not a menstrual period. The period will probably come when it is due. If it does not, then the woman should have a pregnancy test. The Morning After Pill will not protect you from pregnancy for the rest of your cycle.
The effectiveness rate for the Morning After Pill is very high -- about 98%, especially if taken early; however, a woman should consider what she would do if it doesn't work. Then she may choose to have an abortion or continue the pregnancy.
Many doctors and clinics prescribe the Morning After Pill. You can often get it at the Emergency Ward of a hospital, which is open 24 hours a day. But call before you go to make sure.
The Morning After Pill is simpler than the second option in this situation: a post- coital IUD. Some doctors will insert an IUD in a woman after intercourse to prevent pregnancy. This can be done up to 7 days after unprotected intercourse.
For more information, you can call a local Planned Parenthood organization or Public Health Unit.

Norplant

Norplant is available in many countries around the world. Women who want a long-term method of birth control but may want to have children in the future might consider Norplant. If you chose Norplant, you would not have to remember to take the Pill every day, or to use contraceptive jelly or foam every time you had intercourse.
Norplant is a set of six small capsules or rods, about the size of matchsticks. A specially trained doctor makes a small cut in a woman's upper arm and inserts the rods just under the skin, in a fan shape. This takes 10 to 15 minutes. No stitches are needed, but a bandage will cover the area for a few days.
Once inserted, the capsules become effective within 24 hours, and prevent pregnancy for up to five years. They do not prevent sexually transmitted diseases.
The Norplant capsules release the hormone progestin, also present in many birth control pills. It stops pregnancy in three ways.
First, it helps prevent ovulation, or release of an egg each month. Second, it increases the thickness of the woman's cervical mucus. This makes it harder for sperm to enter the uterus or womb. It also decreases the thickness of the lining of the uterus, also called the endometrium. A fertilized egg needs to attach itself to a thicker lining.
Norplant contains no estrogen. It is therefore an option for women who cannot take birth control pills which have estrogen.
Even though they will work for five years, the capsules can be removed from a woman's arm at any time, for any reason. Removal is also done by a trained doctor. A woman can become pregnant shortly after the capusles are removed.

In the rare instance when a woman using Norplant does become pregnant, there is a slightly higher risk of ectopic or tubal pregnancy. There is no evidence that Norplant causes birth defects.
Many women who use Norplant experience side effects, especially during the first year. The most common side effect is irregular menstrual bleeding. Usually this means longer but often lighter periods, or bleeding between periods. Other side effects can include weight gain, acne, depression, headaches, hair growth and itching around the capsules. Very rarely, there is numbness in the arm around the capsules.
It is very important for a woman considering Norplant to talk to a counsellor. Counsellors can describe Norplant's advantages and disadvantages, possible side effects and suggestions for dealing with them.
Norplant is not a good choice for some women, including women who have liver disease, breast cancer or a history of blood clots. Women who are pregnant or think they might be pregnant should also not use Norplant.
For a woman who is well informed and who protects herself and her partner against sexually transmitted diseases, Norplant may be a good birth control method. For more information, you can call a local Planned Parenthood organization or Public Health Unit.

There is a female condom available in some countries. This gives the woman more control over her own protection. It is a pre-lubricated sheath of latex similar to the condom for men, but has a ring at the bottom end. The top end is closed, and fits over the woman's cervix like a diaphragm. The bottom end is open. It covers the labia, or lips of the pubic area. Like the condom, it is disposable.