As some of you may know, human beings have a penchant for getting naked with one another. And not always in the context of a Church-and-State-sanctified, intending-to-promulgate-the-species marriage bed (sorry, Nana!).  And that’s great!  But there can be downsides to engaging in the Waltz of the Bumped Uglies, such as sexually transmitted infections (that’s right, Olds; they’re not STDs anymore, they’re STIs) and, horror of horrors, children.  As a public service to all you nasties out there, here’s a survey of your options if you want to avoid either or both of the above.

Abstinence

  • Pros:
    • 100% effective at preventing both pregnancy and STIs (well, 99.9999999999999%, if you count Jesus, I guess?)
    • Does not conflict with religious mandates concerning birth control
  • Cons:
    • No sex.

Pretty straightforward; if you don’t have sex, it’s pretty hard NOT to avoid pregnancy and STIs.

Timing and Methods of Intercourse

  • Pros:
    • No pills, barriers, objects
    • Does not generally conflict with religious mandates concerning birth control
  • Cons:
    • Not as effective at preventing pregnancy (about 76-88% effective)
    • Does not prevent STIs
    • Can be very complicated
    • Can be frustrating to both partners

These are the methods that involve nothing but the people who want to have some quality time together.  Usually used in longer term relationships rather than one-off encounters, these methods require both parties to have the same objectives and priorities to work to the fullest extent.

Fertility Awareness Methods (Rhythm Method):

These methods generally involve using the female body’s natural fertility cycle to only engage in intercourse when the woman is least likely to get pregnant.  There are a few ways of tracking this, and this method is most effective when the different ways are used together to determine “safe” days.  The three indications of female fertility include checking her temperature first thing in the morning before getting out of bed; checking the consistency of vaginal discharge every day; and tracking a woman’s ovulation on a calendar.  This means that on some days a woman simply won’t be able to safely have sex, and she may or may not want to do so on the days that are “safe.”  STIs can also still be spread when intercourse does occur.

Withdrawal (Pull-Out):

The withdrawal or pull-out method refers to removing the penis from the vagina prior to ejaculation.  Efficacy of this method varies; if all ejaculate is kept away from the vagina and vulva, the method is about 96% effective, but this is difficult to do in practice; in reality, it is generally about 78% effective.  It also doesn’t prevent STIs.

Outercourse:

“Outercourse” (as opposed to “intercourse”) generally refers to sexual activity without penetration. As long as no semen enters (or gets very, very close to) a vagina, the effectiveness at preventing pregnancy is 100%.  However, STIs can still be spread via oral and anal sex, which some couples include in the definition of outercourse.

Barrier Methods

  • Pros:
    • Reduce the chance of pregnancy
    • Some prevent most STIs; see below for details
  • Cons:
    • Some may involve decreased sensation
    • Breaking the flow to pull out a hunk of latex or whatever is a mood killer
    • Higher failure rate than hormonal methods of birth control
    • Some people are allergic to latex or the spermicides that make some barrier methods effective
    • Some religions deem barrier birth control unacceptable
    • Wayward spermicide (i.e. in the urethra) burns like hellfire

Barrier methods are physical items used to block bodily fluids from passing from one person to another.  You’ve actually got more options here than you might think, other than Ye Olde Condomme:

Condoms (Male):

These are the familiar sheaths that cover the penis and keep semen from just going everywhere (God, seriously, everywhere).  You can buy them almost anywhere, just about everyone knows how they work and how to use them, and they take approximately 15 seconds from opening the wrapper to resuming the task at hand.  They’re also the most effective way of avoiding STIs, after abstinence, since they act as a physical barrier.  The exception here, unfortunately, is herpes.  Since the herpes virus often takes up residence in the broader pelvic area, and a condom only covers the penis itself, using one only reduces your risk of spreading the Gift that Keeps on Giving.  If it makes you feel better (or probably worse) somewhere between 10 and 25% of American adults have the herpes virus, and most never know they have it because it doesn’t always show symptoms.  Hooray?

Condoms also work very well at preventing pregnancy, when used properly (i.e., pinch the tip before you put it on (you should NOT leave an air bubble), wear the right size (condoms are really stretchy, I promise you almost certainly don’t need to be wearing Super Magnum XXXXXL), never EVER double-bag, etc.), but they’re not perfect.  They can tear or fall off, and if that happens, both the STI and pregnancy prevention aspects fall to pretty much nil.  Some people also complain about decreased sensation, but honestly, if you’re interested in keeping things going longer than a couple of minutes, that’s not really a bad thing.

Condoms can also be used for fellatio (oral sex on a man).  If you’re laughing, all I’ll say is that most of the infections that can take up residence in your genitals are perfectly happy to do the same in your mouth.  Do you want mouth-gonorrhea?  Because that’s a thing, and you can get it.  If using for oral sex, use either an unlubricated condom or one made specifically for oral sex (you can tell because they’re often flavored, I guess if you want your man’s stuff to taste like banana?).  The lubricant used on regular lubricated condoms isn’t made for consumption, and also just wouldn’t taste very good.

Condoms (Female):

This is basically the same thing as the male condom, but instead of covering the penis, it is inserted into the vagina.  Forgive the comparison, but it’s kind of like a trash can liner.  It’s a bit less effective than the male condom at preventing STIs, it has a slightly higher failure rate, and because it’s less common, it might take some mid-coitus explaining, which is not exactly the Road to Sexytown. You also can’t use a male and female condom simultaneously, because one or both of the condoms is very likely to tear.

Diaphragm and Cervical Cap:

A diaphragm is basically a cup that is inserted into the vagina and sits at the cervix, blocking sperm from passing from the vagina into the uterus.  (The cervical cap is the same, only smaller and shaped a little differently.) They’re only really effective if used with a spermicide (a chemical that kills most but not all of the swimmers), and even then, they’re less effective than condoms.  They also don’t prevent STIs pretty much at all.  On the plus side, intercourse with a diaphragm feels like intercourse with no barrier, so it’s a personal choice of whether that’s worth the decreased effectiveness, and you can insert them prior to the actual moment of intercourse.  The diaphragm and cervical cap can be used with a condom simultaneously to up your protection, though, if you really do not want a baby, thankyouverymuch, and would like to avoid STIs at the same time.

Sponge:

This is basically the same thing as a diaphragm, but it’s squishy and absorbent, plus it comes pre-loaded with spermicide.  They’re as effective as the diaphragm for women who have never given vaginal birth, but half as effective for women who have.

Dental Dam:

This is used for female oral sex or anal oral sex. They’re basically a small, flat sheet of latex that covers the vagina or anus, so the mouth doesn’t come into direct contact.  They’re available for sale, but you can also make one yourself by cutting down the length of a male condom, turning it from a tube into a flat sheet.  As when used for male oral sex, make sure you use a condom that is either unlubricated or specifically for oral sex if you’re making your own dental dam.

Hormonal Methods

  • Pros:
    • Greatly reduce the chance of pregnancy when used as directed
    • Don’t interrupt coitus
    • Can result in no or lighter periods
    • Reduced cramping during menstruation
    • Reduced risk of ovarian cancer
  • Cons:
    • Do not prevent STIs
    • Effectiveness can be affected by certain medications
    • Some must be taken consistently on a daily basis
    • Can cause irregular bleeding
    • Can cause decreased libido
    • Can cause some weight gain
    • Some evidence of slightly elevated risk of breast cancer
    • Some religions deem hormonal birth control unacceptable

At present, all hormonal methods of birth control are for women. We got pretty far with one for men fairly recently, but the side effects were so devastating that the study was discontinued. While hormonal birth control prevents pregnancy, none of these methods protect against STIs, but they can also be used in conjunction with barrier methods like condoms and diaphragms for added protection.  Like with barrier methods, there are far more options available than the most common version:

The Pill

The pill is, as may be evident, a pill that a woman takes daily to avoid pregnancy.  It works by both preventing ovulation, which means there’s no egg to be fertilized during sex, and by thickening cervical mucus, which makes it harder for sperm to travel into the uterus to fertilize any egg that does decide to stop by.  It comes in two major forms: (1) a triphasic pill, which most closely mirrors the body’s natural hormone cycle and delivers three different levels of hormone throughout the month (plus a week of no hormones at all during which the woman generally menstruates, and (2) a monophasic pill, which contains the same amount of hormone all month long, with the exception of the week of menstruation.  Some pills are also designed to be taken continuously, and usually stop menstruation entirely.  The pill’s pregnancy prevention kicks in about a week after first use.

At its peak the pill is very effective at preventing pregnancy, but it must be taken not just daily, but at the same time every day.  If a woman takes her pill first thing in the morning, but sleeps in on weekends, the efficacy of the pill will be slightly reduced due to the inconsistency in her schedule.  Skipping a pill entirely decreases the pill’s efficacy dramatically.

The pill is also the method of hormonal birth control with the highest dose of hormones, and is associated with a number of side effects, such as changes (particularly decreases) in libido, mood swings, irregular bleeding, nausea and headaches, and tender breasts.  Like with any medication, the exact prescription that will fit a woman best varies by the person, so a doctor may suggest changing types of pill if side effects are serious.

If a woman changes her mind and wants to conceive, the pill can work its way out of her system fairly quickly, in as little as two weeks.  It takes longer for some women, but generally, full fertility returns within a few months.

The Patch

The patch is a lot like a nicotine patch, except that instead of that sweet, sweet tobacky replacement, it delivers hormones like those in the pill.  It works in the same fashion as the pill does, but through a transdermal patch that a woman wears for a week at a time for three weeks before taking a week off, during which she gets her period.  It can be worn anywhere on the body with enough smooth, exposed skin to apply it, and there’s nothing that has to be done other than removing old patches and applying new ones on schedule.  It kicks in after about a week and then works continuously so long as it is used as directed.

Like the pill, when used perfectly, the patch is about 99% effective, but real-life, imperfect use brings that rate closer to 91%.  The patch can also, rarely, fall off, which obviously makes it even less effective.  It also has the same side effects as the pill, though these may be less because the hormone dosage is lower.

Like the pill, the patch’s anti-fertility effects wear off quickly, and a woman can usually conceive normally within two months of the time they stop using the patch.

The Shot

The shot is an injection given once every three months which functions in the same way as the pill and the patch.  It’s as effective as both the pill and the patch.  It works immediately if you receive the shot within 7 days after starting your period, but takes a week to kick in if you get it later.  The side effects are similar to those experienced on the pill or the patch.

About half of women who get the shot stop getting their periods entirely, which is pretty great.  However, if you decide you do want to get pregnant, it can take 9-10 months before full fertility is restored, so it’s not like flicking a light switch.

Vaginal Ring

The vaginal ring (often called NuvaRing, its brand name in the U.S.), is a soft, flexible ring that is inserted by the woman into the vagina and remains there for three weeks.  The woman takes it out after three weeks, takes a week off (during which she gets her period), then puts a new ring in.  A woman can also skip her period entirely if she leaves the ring in for four weeks and immediately replaces it with a new ring. It works in the same way as the pill, the patch, and the shot.

The ring is meant to be worn all the time, including during sex, and most users (and their partners) say they can’t feel it at all.  The side effects are similar to those experienced on the pill, the patch and the shot.

The ring stops working as soon as you remove it, though it may take 1-2 months for normal menstruation to resume.

Implant

This is the most effective form of birth control outside of abstinence.  It is a small, flexible rod about the side of a matchstick that is inserted into a woman’s upper arm by her doctor via a small incision. The insertion takes less than a minute, and is done after your doctor numbs your arm with a shot.  You can feel the implant in your arm if you feel for it with your fingers, but it is painless after insertion and works continuously.

The implant works for up to four years at a time, though it’s recommended to have it removed and replaced after three years.  It’s 99.9% effective at preventing pregnancy, and functions the same was as the other hormonal methods listed above.  About a third of women stop getting their periods entirely with the implant, and many that don’t experience lighter periods.

The implant kicks immediately if you receive it within 5 days of starting your period, and after a week otherwise.  If you get it removed, you can get pregnant right away.

Intra-Uterine Device (“IUD”)

IUDs are almost as effective as the implant.  An IUD is a small, t-shaped device about an inch or two long that is inserted by a doctor into a woman’s uterus, where it sits just above the cervix.  Though I’ve included it under hormonal methods, there are actually two types: IUDs that release hormones, and the copper IUD.  The hormonal IUD works like the other methods already described, but the copper IUD is different: copper is a natural spermicide, which affects sperm’s ability to “swim” and damages them, making them less able to fertilize an egg.

Though hormonal IUDs release a very low dose of hormones, getting either IUD inserted is the most intensive process of those described above.  Many women say that the insertion is very painful, though others report only discomfort.  Pain and cramping can continue for some time after the insertion, and many women report particularly uncomfortable periods for up to six months.  There are few other side effects, and these generally pass after the initial adjustment period. Very rarely, IUDs can be associated with spreading pelvic infections into the uterus, if a woman is already infected when she has the IUD inserted.  Additionally, and even more rarely, an IUD can perforate the uterine wall, which is a condition that requires urgent medical treatment.

IUDs last for a long time.  The hormonal versions can last from 3-6 years, depending on the brand, and the copper IUD lasts up to 12 years.  Neither the woman nor her partner can feel the IUD; if either can, this often means that the IUD has “fallen out” and needs to be reinserted, which is rare but does happen.

While a woman can remove an IUD on her own by pulling on two plastic strings attached to the device, this is not recommended, and a doctor generally removes the IUD.  A woman can get pregnant almost immediately after the IUD is removed.

Sterilization

  • Pros:
    • One and done — when performed correctly, a sterilization is performed once and pregnancy can no longer occur
    • Doesn’t affect hormone levels in the body
  • Cons:
    • Do not prevent STIs
    • Generally irreversible; if you change your mind, it is very difficult or impossible to reverse a sterilization

For them as know they don’t want no dang babbies, or that they have produced sufficient babbies for their needs, there is sterilization, which alters the reproductive organs to make them incapable of doing their jobs.

Vasectomy

A vasectomy is the male sterilization procedure, which blocks the vas deferens in the scrotum and keeps them from carrying sperm from the testicles to the penis.  This can be done in two ways; via a small incision, or via a tiny puncture in the scrotum, through which the procedure is performed. It is a very quick procedure, and the man can go home the same day.  Most men feel healed enough to resume sex within a few days.

It takes some time before the vasectomy is fully effective: about three months.  After that point, however, the man will be “shooting blanks,” i.e., ejaculating without sperm, and the procedure is nearly 100% effective.  Sex is not affected by the procedure in any way, and the man will not be able to tell the difference following healing.  Even the consistency, appearance, taste and volume of ejaculate remains the same following a vasectomy.

Tubal Ligation

Also known as “getting your tubes tied,” tubal ligation is the female sterilization procedure.  The procedure blocks the fallopian tubes, which are how the egg gets from the ovaries to the uterus.  The procedure can be done either (1) through an incision in the abdomen, through which the fallopian tubes are closed off with clips or a small portion removed, or (2) through the vagina, through which tiny coils are inserted in the fallopian tubes around which the body builds scar issue, sealing the tubes on its own.  Once complete, the procedure is nearly as effective as a vasectomy.

Tubal ligation is a more intensive procedure than a vasectomy, and it takes a little longer to heal.  Women should feel comfortable resuming sex within two weeks, but some report pain during intercourse for up to a year after receiving the second type of tubal ligation.  Additionally, while the first type of tubal ligation prevents pregnancy immediately, the second can take a few months or more to be effective, and a doctor should confirm that a woman can no longer get pregnant before she refrains from using other methods of contraception.

* * *

So that’s that!  Contraception and STI prevention is a personal choice, and your life, body, and sexual identity will affect which method is best for you.  Whatever you do, stay safe, and if you’re ever in a situation where a partner is threatening you or messing with your reproductive autonomy, help is out there.