Contraception - Preserving the romance…

If you don’t wish to conceive a child in the near future and would like to have only the fondest memories of your romantic evenings, it is important to plan for an effective method of contraception with your partner. Don’t forget that all it takes is a single lapse for a pregnancy to come disrupt your medium-term projects… not to mention the risk of contracting a sexually transmitted infection (STI)!

When it comes to methods of contraception, there is plenty of choice. It’s important to get well informed in order to make the right decision.

1. Physical methods of contraception

Physical methods of contraception are also called barrier methods, because they prevent the sperm from reaching an ovum, thereby preventing pregnancy. The various products available include condoms for men and women, contraceptive sponges, cervical caps, diaphragms and Lea’s Shield.

The male condom is probably the best-known contraceptive: it is a latex or polyurethane sheath that is rolled onto an erect penis. Its purpose is to prevent any penile secretions from coming into contact with the vagina. Condoms are affordable (about $0.50 per condom), easy to use and effective (up to 97 percent effective when used perfectly). When used as recommended, they provide better protection against AIDS and other STIs than any other method of contraception. They do have their limitations, as they only protect the areas of the skin that they cover. This means that a herpes lesion or genital warts located somewhere other than the penis or inside the vagina could lead to a partner getting infected, for example. It is no longer recommended to use a spermicide along with a condom, as the practice offers no additional protection.

The female condom is a polyurethane sheath that is inserted into the vagina before sexual intercourse. It plays basically the same role as the male condom, but it is more expensive (about $3 per condom) and slightly less effective (failure rate of about 5 percent).

The disposable contraceptive sponge combines a barrier method with a chemical, as it covers the cervix while also containing a spermicide. It can be inserted into the vagina up to six hours before intercourse and should be left in place at least six hours after sex. It should be used together with a condom in order to prevent the transmission of STIs.

The cervical cap, diaphragm and Lea’s Shield are three similar contraceptive methods: they are all latex or silicone caps that are inserted into the vagina in such a way as to cover the cervix, which prevents sperm from entering the uterine cavity. The advantage they offer is that they can be inserted a few hours before intercourse. However, they must always be used with a spermicide, because they are not that effective when used alone. With the cervical cap and Lea’s Shield, the failure rate (i.e. the pregnancy rate) is about 10 and 13 percent, while with the diaphragm it is between 4 and 8 percent. These methods do not protect against STIs, so they should be used with a condom. They cost approximately $40 to $50, but they are reusable.

2. Chemical methods of contraception

The most common chemical methods of contraception include spermicides, oral contraceptives, the vaginal ring, the contraceptive patch, intra-uterine devices and progestin injections. None of these methods protect against STIs, so it is advisable to use them together with a condom.

Nonoxynol-9 is a spermicide that destroys sperm on contact. It comes in many forms: cream, gel, foam, film and vaginal suppository. It is used with the cervical cap, diaphragm and Lea’s Shield.

Oral contraceptives, commonly called “the pill,” are among the most-prescribed types of medication. Oral contraceptives offer many advantages: along with preventing ovulation (and therefore unwanted pregnancies), they can also regulate the menstrual cycle, reduce menstrual flow and reduce acne. When used perfectly, the pill is almost 100 percent effective, making it one of the most reliable methods of contraception.

The vaginal ring works like the pill, but comes in a different format. It is inserted into the vagina and is left there for three consecutive weeks. Over those three weeks, the ring releases two female hormones (estrogen and a progestin). It therefore has the same action and effectiveness as the pill, and it rarely causes adverse effects.

The contraceptive patch also works like oral contraceptives, except that it releases the hormones through the skin. It is worn for seven days and must always be replaced on the same day of the week for three consecutive weeks. It is about as effective as the pill.

Intra-uterine devices (IUDs), for their part, are T-shaped devices inserted into the uterine cavity. IUDs have changed quite a bit over the past few decades. One of their main advantages is that once they are inserted, the woman does not have to think about contraception… for several years! Some IUDs are wrapped in a copper coil that triggers chemical changes that destroy sperm, while others gradually release a hormone that makes the lining of the uterus become thinner and makes the cervical mucus become thicker. While an IUD is a significant expense initially, it offers protection that can last a couple of years depending on which IUD is used. With a copper IUD, menstruation is often more painful, whereas with a hormone-releasing IUD, menstruation slows and sometimes even stops. This is a very effective method for preventing pregnancy and it is reversible upon removing the device.

Injecting a progestin every 12 to 13 weeks (i.e. four times a year) is another chemical method for preventing ovulation. It can be an interesting option for women who have trouble taking oral contraceptives regularly. It is close to 100 percent effective. However, it can cause a decrease in bone density in its users, which explains its limited use.

3. Contraception for good

If you want to permanently stop conceiving and would like to stop using the above methods, you can then consider a surgical approach. Tubal ligation can be an option for women, while men can opt for a vasectomy. Bear in mind, however, that reversing these methods can be very difficult.

Choose the method that suits YOU

Faced with such a selection of contraception, it is important to choose the method that best suits your needs and those of your partner. In addition to the need for contraception, consider the risk of contracting a STI.

To find out more, the website put together by the Society of Obstetricians and Gynaecologists of Canada provides a lot of additional information on the methods of contraception available in Canada (www.sexualityandu.ca). Your doctor and pharmacist can also help you choose the best option for your needs. Don’t hesitate to consult them.