Issue 12  •  Spring 2013

Doing it Naturally

Written by Jessica Kramer
      Sample Image                                  Many of us are not fully aware, or informed about, our birth control options. So here is a brief list of many of the forms out there, their effectiveness, and the pros and cons of each approach. Unfortunately, I would probably need to write an entire book, maybe even a few volumes, to discuss every option, so I will just touch on a few of the most popular. If any sound particularly appealing, I encourage you to further research them. So, here’s to lots of great sex with excellent birth control options!

Photo by Ellie Chavez
Many of us are not fully aware, or informed about, our birth control options. So here is a brief list of many of the forms out there, their effectiveness, and the pros and cons of each approach. Unfortunately, I would probably need to write an entire book, maybe even a few volumes, to discuss every option, so I will just touch on a few of the most popular. If any sound particularly appealing, I encourage you to further research them. So, here’s to lots of great sex with excellent birth control options!

Before choosing a form of birth control, you should probably ask yourself the following questions:

Do I need protection from both STDs and pregnancy or just pregnancy?
If you are not protecting yourself from STDs, you want to be as sure as possible that you are in a monogamous relationship in which both you and your partner have been tested for STDs.

• What might happen if I become pregnant?
Not a single form of birth control is 100 percent effective. Rather than pretending that you won’t be the one who gets pregnant while using a dependable (or not so dependable) form of birth control, it’s a good idea to talk to your partner about the what-if. What if I do become pregnant? Would I want to keep the baby? Have an abortion? Give the baby up for adoption? These are some pretty major decisions, and they may seem absurd to talk about but having thought about and discussed them with your partner can ensure that the two of you are on the same page. In the long run, this can alleviate stress and improve your sex life.

• How do I feel about pharmaceutical hormones? Am I fully informed about how the hormones work in my body?
People have, for many years, been overly casual about the use of birth control pills, particularly in terms of the impact they can have on the body. Many women don’t realize that the pill tricks their bodies into thinking that they’re pregnant all month long, except for those few days when they are off it. This means that a pill-user is not ovulating and therefore not having the hormonal cycles her body was built to have. I am not implying that birth control pills should never be used, but rather, that a person should be fully informed when deciding whether or not to use them.

• What is my lifestyle, what are my daily routines, and what is my sex lifestyle?
Sex is not something that fits into everyone’s lives in the same way, nor does it fit into our own lives in the same way at all times and with all partners. When considering birth control options, we need to be extremely honest with ourselves, and our partners, about what we will and will not do.

Before I get into the details of different birth control options, I want to address two cultural pitfalls that many of us fall into:

1. The idea that birth control is the woman’s responsibility, and it’s not sexy to talk about it with our partners. This is a sad and extremely untrue belief. Birth control is an extremely important responsibility that should be equally shared between both partners.

2. The extremely unfortunate idea that the sex is too hot to interrupt with a contraceptive device before intercourse. While many of us like to act like innocent victims to the passions of sex, the falseness of this hits hard when people find out they are pregnant and need to make serious decisions rather quickly and potentially find the money for an abortion, etc. Remember that it’s hot to be a mature adult who takes responsibility for her health and decisions.

Before introducing the various types of birth control, I would like to note that the effectiveness for each form of birth control is a bit tricky. There are the statistics for perfect use, but many people make mistakes in use. Thus, the statistic you should have in mind is the one that goes with typical user effectiveness. For example, many people put a condom on, or remove it, incorrectly, which significantly reduces its effectiveness. Whatever method(s) you choose to use, go online, to Planned Parenthood, to your midwife, doctor or nurse-practitioner, or to a local sex educator to find out how to use it correctly.

A male condom is a thin barrier that is placed onto the erect penis before intercourse. The condom has a reservoir at the tip where the semen accumulates after ejaculation. Male condoms come in several varieties including latex, lambskin, polyisoprene for those with latex allergies, as well as various sizes, with or without spermicide, with textures, and much more.

A female condom is also a barrier, but rather than placing it onto the penis it is placed into the vagina and then acts as a reservoir for the penis.
Male Latex Condom without Spermicide
Typical User Effectiveness = 86% Perfect User = 97%
• Protects against both STDs and pregnancy
• No hormones or chemicals
• Does not require planning ahead (other than having condoms on hand)
• Some experience diminished sensation or do not like the feeling
• Can cause an allergic reaction to those with latex allergies
• Man must pull penis out of vagina before penis becomes soft

Female Latex Condom
Typical User Effectiveness = 79% Perfect User = 95%
• Woman feels like she can take the lead on protection
• Protects against both STDs and pregnancy
• No hormones or chemicals
• Does not require planning ahead
• Diminished sensation
• Bulkier than male condom
• Many people are unfamiliar with how to use them
• More expensive than male condoms

Lambskin Condom
Unable to find data on effectiveness
• Most users experience a greater sensation than they do with latex condoms
• Usable by those with latex allergies
• Does not protect against STDs
• More expensive than latex condoms

Birth Control Pills
Birth control pills come in many different forms.  Some of them are on three-month cycles; others are on one-month cycles. Each pill contains a different cocktail of hormones, but they all work on the same principle of shifting the body's hormones in a way that convinces the body that it is pregnant and therefore does not need to ovulate or build up much of an endometrial lining (the lining that the uterus creates each month, which acts as a home and food for a newly fertilized egg and is released each month when you menstruate).  Because it is too stressful on the body to be in a continual hormonal state of pregnancy, you must take a few days occasionally for your body to not receive any synthetic hormone and release any endometrial lining that may have been built.
Typical User Effectiveness = 95% Perfect User = 99.5%
• Allows spontaneity
• Does not require both partners to participate in birth control
• No barrier method required
• Does not protect against STDs
• Does not require both partners to participate in birth control
• Alters the body’s hormone levels, stops ovulation, and tricks the body into thinking it is pregnant all the time
• Must know what medications will interfere with effectiveness
• Smoking cigarettes while on the pill is extremely stressful on the heart and has been linked to early heart attacks.

Diaphragm (with Jelly)
A diaphragm is a silicone or latex cup that is filled with spermicide and placed inside the vagina prior to having sex.  The diaphragm is a barrier to the cervix (the entryway to the uterus) so that it becomes difficult for sperm to access the cervix. If the sperm are able to get past the barrier of the diaphragm, the spermicide is meant to kill them.
Typical User Effectiveness = 80% Perfect User = 94%
• Usually has no side effects
• Minimal hormones/chemicals
• Allows full sensation and comfort during sex
• Requires planning ahead
• Some feel awkward about inserting it

IUD (Intra-Uterine Device)
An IUD is a small T-shaped object inserted through the cervix into the uterus with a small string that hangs through the cervix into the top of the vagina. The string is not felt during intercourse. The IUD alters the lining of the uterus, making it inhospitable to fertilization.There are different kinds of IUDs, some with hormones, some without. You should speak to your care provider about which one would be more appropriate for you. The user effectiveness rate and perfect use rate will vary some with the type of IUD you get.
Typical User Effectiveness = 98% Perfect User = 98.5%
• Allows total spontaneity
• Allows full sensation
• If using the IUD without hormones, your body simply has a physical object that interferes with implantation.
• Does not require your partner to participate in birth control
• Once inserted, it can be left in for several (up to twelve) years 
• One of the most effective kinds of birth control with very little user failure
• Very little room for misuse
• Can be removed at any time with no recovery period
• Does not protect against STDs
• In some users it causes heavy bleeding and cramping during menstruation.
• Can be somewhat pricey (somewhere around $500) and many health insurance companies will not cover it (though you can get it at Planned Parenthood for a price that corresponds to your income)
• Does not require both partners to participate in birth control
Fertility Awareness Method (FAM)
Many people think that the Fertility Awareness Method (sometimes called “charting your cycle”) is the same as the rhythm method. BUT, let me be very clear here: FERTILITY AWARENESS IS NOT THE SAME AS THE RHYTHM METHOD. FAM is an extremely refined and highly effective use of birth control for those whose lifestyle, sex style, and relationship style it fits. FAM requires you to keep track of a few different things in your body and life:

• Your basal body temperature (your body temperature upon first waking before you get out of bed)
• Your cervical fluid (for example, you check on and write down whether the fluid in your vagina feels dry, creamy, or super wet and slippery)
• The position of your cervix
• The day of your cycle you are on
• Previous cycles
• When you have sex

It seems like a lot of things to keep track of but when you are in the flow of it, it’s actually quite natural. You check your cervical fluid each time you pee, you pop a thermometer in your mouth when you wake, and you note these things on a piece of paper—that’s basically what it ends up feeling like.

The physiology behind it is that there are, in actuality, very few days of the month when you can get pregnant. As long as you don’t have unprotected intercourse on those days, you should be fine. It just comes down to knowing when you are and when you are not fertile. There will be days when you are 100 percent sure you are fertile, days when you are 100 percent sure you are not fertile, and then there are some in-between days. If you keep track of all these things it becomes quite natural.

Typical User Effectiveness = Unable to determine based on such variety
Perfect User = 98% (Perfect use includes no intercourse during fertile phase)
• You can have unprotected intercourse to your heart’s content when you are not fertile
• You get to know your body much better than you ever have before
• You are not throwing caution to the wind or hoping your medication or barrier is working for you; you actually know when you cannot get pregnant
• Requires both partners to participate in birth control
• Encourages sexual creativity. When there are a few days a month during which you are not having intercourse you tend to get pretty creative and discover all kinds of fun things to do for sexual pleasure!
• If you add FAM to another form of non-hormonal birth control, the effectiveness of the other birth control may increase. Plus, if something should go wrong with another form of birth control—if, for example, you have a condom break—you will know whether or not to worry about potential pregnancy.
• Does not protect against STDs
• Requires some consistency in your schedule. FAM is heavily dependent on tracking your basal body temperature (meaning temperature upon first waking) and to do this accurately there needs to be some consistency in what time you wake up and take your temperature. It doesn't have to be exact, but waking up at 6:00 a.m. some days and 11:00 a.m. on other days is too wide a range, and while it is okay to miss a day here and there, if your schedule is all over the place all the time, it won't work.  It also requires you to have slept a certain number of hours for your body temperature to have settled in to an accurate reading. When you are fertile you must either abstain from intercourse or find a reliable form of birth control such as condoms. However, take note that the effectiveness of condoms is greatly diminished when used during your fertile time because effectiveness data on condoms is based on average use, which includes when a woman cannot become pregnant regardless of protection.
• Requires both partners to participate in birth control
• Does not allow unprotected sex at all times of day (first thing in the morning, it is difficult to tell if fertile cervical fluid has begun because it may still be high inside and not yet made its way to your labia)
• Most women are most interested in sex when they are fertile—and most men respond to a woman’s fertility and are also more interested in sex when she is fertile.

I very strongly encourage all women to learn about FAM even if they do not use it as their primary form of birth control. It is so valuable, fascinating, and empowering to learn about your body, your cycles, and your fertility, and this knowledge can become a helpful tool in self-care and knowledge about the health of your body. Men even become interested in learning about it with you.

The best resource for learning about this and using it is Taking Charge of Your Fertility by Toni Weschler.

I hesitate to even include this as a method of birth control. Far too many women can tell you just how ineffective this is as birth control (I could give a very long list of friends I know and people I’ve met through work who got pregnant this way). However, I know many women who use this thinking it’s reliable and don’t realize just how much they are playing with fire. While I want to be sure to include all available data, I’d encourage you to not even consider “perfect use.” The number of stories I’ve heard of men forgetting to pull out, pulling out just a little too late or waiting for full ejaculation to pull out but disregarding the moments of pre-ejaculate are much too high. If you are going to use this, I will emphasize what I said at the beginning; discuss with your partner what you will do should you become pregnant.
Typical User Effectiveness = 81% Perfect User = 96%
• Can enjoy unprotected sex anytime
• Does not protect from STDs
• Must rely on your partner to identify that he is about to ejaculate, and he must withdraw before that happens
• Disregards the fact that pre-ejaculate is all that is needed to cause pregnancy
By this I mean having unprotected intercourse whenever you want without any form of birth control. I include this because I believe it is valuable information when learning about the different options and the data associated with them.
Effectiveness = 15%
• Can enjoy unprotected sex anytime
• You have an 85% chance of becoming pregnant, which means you should basically consider yourself open to becoming pregnant.
• Does not protect against STDs

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