Part IV: Learn the Proper Precautions

This is Part IV of a larger resource, The Authoritative Guide to Safer Sex.  

When you and a partner agree to have safer sex and have undergone pre-screening for STIs (see Part V: Understand the Realities of STIs), the next step is to choose the protection method that works for you both. Different forms of contraception and STI prevention are available for men and women; and there are numerous options that you can experiment with until you find what is most comfortable.

Hormonal Birth Control

Hormonal contraceptives have been on the market for decades. Throughout the years they have been refined and improved. It is important to note that while hormonal contraceptives prevent pregnancy, they do not prevent STIs. An additional method of protection from disease is necessary.

    • The Pill is a prescribed oral contraceptive that, when used properly, is 97% to 99% effective in preventing pregnancy. This contraceptive contains estrogen and progestin, which prevent eggs from maturing within the ovaries, thereby halting ovulation. The Pill must be taken consistently; missed or forgotten pills often result in surprise pregnancies.

Some women are not good candidates for the Pill. The hormonal combination is known to cause increased risk of blood clots, cancer, and strokes. Women with a familial history of breast or ovarian cancer and women with diagnosed cardiac or clotting problems should not take the Pill. There is proven correlation between smokers who take the Pill and heart disease or stroke. Antibiotics may also reduce the efficacy of the Pill.

    • Injectable hormonal contraceptives are spaced 12 weeks apart. A synthetic hormone called depot medroxyprogesterone acetate (DMPA) is administered intramuscularly. DMPA is composed of a progesterone-only component that prevents ovulation and creates a uterine environment that hampers the travel of sperm. DMPA use is almost 100% effective in delaying pregnancy and carries few health risks.
    • Insertion devices also provide effective birth control in the form of a ring-shaped device placed in the vagina. This ring slowly emits low dosages of synthetic hormones over a period of 3 weeks, after which it is removed for a week to allow for a period. Another option is a rod-shaped implant placed in the upper arm that slowly releases etonogestrel for up to 3 years. The effectiveness of contraceptive implants is similar to that of tubal ligations.
    • Birth control patches contain estrogen and progesterone and must be changed weekly. This patch can be placed anywhere it will not be disturbed during a week’s activities, such as the upper arm. These hormones work by suppressing ovulation. This method carries the same success rate as the Pill.

Condoms

Condoms are arguably the most common form of protection from pregnancy and STIs. Condoms are a proven barrier method between the mouth, vagina, anus or penis; this barrier stops the flow of bodily fluids and reduces skin-to-skin contact that can cause STIs to spread. When used consistently and correctly, condom users can expect a 97% success rate.

Condoms are tested for strength and durability; Consumer Reports states that of 20 top condom brands reviewed, all 20 met safety and protection standards. Latex condoms are recommended, but consumers with allergies may purchase polyurethane or polyisoprene condoms for a slightly higher price. Lambskin condoms, once the only kind available, are not recommended because they do not protect against STIs.

Tips for proper use of condoms:

    • Throw away expired condoms. If you aren’t sure, err on the side of caution and get new ones.
    • Heat is damaging to latex and may break down its barrier, so carrying condoms in a wallet or accidently putting them in the laundry are not good ideas. Condoms should be stored in a cool, dark place.
    • Be sure to examine unopened condoms. A condom is properly sealed in its packaging when there is a visible air bubble. Condom packaging that has lost its “bubble” should be considered unusable. This often occurs due to a tiny puncture. Condoms with flat, dried out or cracked packaging should also be discarded.
    • Only use water-based lubricants with your latex condoms. Lubes or products containing oils can break down latex and cause condoms to rip or tear during use.
    • Only use a condom once and then immediately discard it.

Dental Dams

A dental dam is a rectangular piece of thin, stretchable rubber that is used to cover genital areas during oral sex. Effective barrier methods for bodily fluids, dental dams are made of latex or silicone. In a pinch, non-microwaveable plastic wrap or a condom that is cut open lengthwise can also serve as a dental dam. When used correctly and consistently they serve as effective prevention against herpes, genital warts, and HIV.

The Morning-After Pill

While it should never be used as a regular means of birth control, the morning-after pill may be useful if:

    • A condom broke or slipped off during intercourse
    • You forgot to use hormonal birth control options correctly
    • You miscalculated the fertile days of your cycle
    • You had unprotected intercourse
    • Your partner didn’t pull out in time

It is worth reiterating that the morning-after pill should never require a prescription. The pill itself contains high dosages of the same hormones found in birth control pills and operates in much the same way, by using synthetic progestin to create a hostile environment in the uterus. It may be taken up to 120 hours after intercourse but is most effective during the first 72 hours. Many women experience mild nausea and a disrupted menstrual cycle after taking this medication.

Users within the first 72 hours can expect an 89% success rate, while users in the 72 to 120-hour window can expect 75% efficacy. Morning-after pills are dangerous to developing fetuses; if it is at all possible that you are already pregnant from recent sex, take a pregnancy test before using the morning-after pill.

Coitus Interruptus

Popularly called “pulling out,” this form of birth control requires the male to ejaculate outside of a woman’s vagina during unprotected intercourse. This contraceptive method has the highest failure rate of all and is not recommended. Even if a male has the requisite self-control, the risk of pregnancy from pre-ejaculate still exists. Additionally, most of the microorganisms in sexually transmitted diseases do not need the act of orgasm to pass from host to host.

Abortion

Abortion is legal in all states. Age requirements vary, but anyone over 18 can obtain an abortion without parental consent. The emotional and physical ramifications from abortion must be considered, as many women have conflicted emotions following this procedure. Costs range from $300 to $1000, depending on the type of abortion and the extra medical treatment that may be needed.

A medically-induced abortion can be obtained up to 9 weeks after your last period. You will likely be given two medications in succession. The first pill blocks the body’s natural production of progesterone, causing the uterine lining to break down. Within three days you will be given misoprostol, once known as RU-486. This drug causes the uterus to empty its contents, resulting in cramping and heavy bleeding. Most women abort within hours of taking misoprostol and complete the process within a few days.

Pregnancies from 9 to 16 weeks’ duration require an aspiration abortion. Usually under mild sedation, the cervix is dilated first. Once the cervix is open, a physician uses a technique called vacuum extraction to gently clear the uterus of its contents. Aspiration takes 5 to 10 minutes, but more time will be required to dilate your cervix.

Continue to Part V: Understand the Realities of STIs.
Return to The Authoritative Guide to Safer Sex: Table of Contents.