Contraceptives or birth control methods can be categorized as barrier methods, hormonal or other. Next to each type of contraceptive is the effectiveness rate for prevention of pregnancy. For example the effectiveness rate of the male condom is 85-98%. The lower range of the effectiveness rate (85%) is for individuals who use the method either incorrectly or not every time they have sex. The higher range (98%) is for individuals who use the method correctly and every time they have sex.
Abstinence
Abstinence is the only method of birth control that is 100% effective against unwanted pregnancies, STIs and HIV. Abstinence means to not have sex. When talking about preventing pregnancy, abstinence is when couples choose not to put the man’s penis in or near the woman’s vagina or anus. When talking about preventing STDs, abstinence is when couples choose not to have sex of any kind. This includes vaginal, anal and oral sex.
Male Condom
Condoms have an effectiveness rate of 85 to 98%. They can be made out of latex, polyurethane, and polyisoprene. Never use two male condoms together because the friction can cause them to break. Only use water based lubricants with the male condom, because oil-based lubricant can break down the condom and cause tearing or breaking.
Female Condom
The female condom has an effectiveness rate of 79-95%. It is the same type of contraceptive device as the male condom, except that it fits inside of the vagina with an inner ring over the cervix and an outer ring over the vulva. This keeps the condom from being pushed up into the vagina, and puts a protective coveringover the outside of the vagina, preventing sperm from contacting the area. The female condom, which is also referred to as the “universal condom” can be used for anal sex only if the inner ring is removed before the condom is inserted into the rectum.
Diaphragm
The diaphragm is 84 to 94% effective at preventing pregnancy. It is a flexible, rubber barrier used with spermicidal cream or jelly. The barrier and spermicide block and kill sperm moving toward the uterus. The diaphragm is placed in the vagina to cover the cervix and is inserted before intercourse. Suction keeps the diaphragm in place so sperm cannot enter the uterus. A medical provider must fit the patient for the diaphragm and she will be prescribed one that is in her size.
Spermicides
Spermicides have an effectiveness rate of 75-85%. They are inserted into the vagina before intercourse (usually 15 minutes before) and act by blocking the cervix and killing the sperm. The various types of spermicides include foams, creams, jellies, suppositories and foaming tablets, all of which are available from a drugstore without a prescription. Foam is considered to be the most effective of these preparations. Spermicides must be inserted before each act of intercourse. For extra protection, they may be used in combination with a condom, a diaphragm or a cervical cap.
The Pill
Birth control pills, which have an effectiveness rate of 92-99%, contain estrogen and progestin in the first three weeks of pills, followed by one week of placebo pills. Estrogen prevents ovulation, while progestin thickens the cervical mucus. One pill is taken every day at the same time. It is important to note that birth control pills do not protect against HIV or STIs, as there is no physical barrier between the man and woman. There are pills available with no estrogen. Sometimes these are called the “mini pill”.
The Shot (Depo Provera)
Depo Provera has an effectiveness rate of 97-99%. This progesterone shot is given every three months at the beginning of your period. The dosage is like the combined birth control pill andit prevents ovulation, thickens cervical mucus, and prevents implantation of fertilized eggs if ovulation does occur. If used for more than 2 years, Depo Provera can cause bone density loss (osteoporosis).
The Implant (Implanon or Nexplanon)
The implant is 99.6% effective at preventing pregnancy. Implanon is a flexible, match-stick sized, plastic rod that continually releases hormones (progesting and etonogestrel). It must be surgically implanted under the skin in the inner part of the upper arm by a clinician. Implanon can be left in place for up to 3 years, but it can be taken out at any time if it is no longer wanted by the individual. Insertion of Implanon costs between $400-$800 and the removal cost ranges from $100-$300. The newest generation of implants will be called Nexplanon and are equally as effective.
The Patch (Ortho Evra)
The patch is 99% effective at preventing pregnancy. The birth control patch is a thin, plastic patch that is worn directly on the skin. The hormones are inside the patch, and are released into the body through the skin. A patch is put on the body at the beginning of the week for three weeks, and at the beginning of the fourth week, no patch is applied and the female has her period. After seven days, a new patch is applied and so on. The patch can be applied to any part of the body, and it will not fall off while in the shower. This method of birth control costs about $15-$70 for a one month pack.
The Ring (Nuva Ring)
The ring is 92 to 99.7% effective at preventing pregnancy. It is a flexible plastic ring that contains both estrogen and progesterone. The hormones will slowly release through the ring into the vaginal walls. It must be worn in the vagina for 21 days and then taken out for menstruation. On the 28th day, a new ring is inserted into the vagina. The woman inserts and removes the ring by herself. It can be left in the vagina during sexual activity.
Intrauterine Device (IUD)
There are two types of IUDs: Paragard which is copper wrapped (non-hormonal) and Mirena which has progesterone in it that is slowly released.
Paragard is 99.2 to 99.4% effective at preventing pregnancy. There are no hormones in the this IUD. Very thin copper wire is wrapped around the IUD and it is inserted into the uterus by a medical provider. A woman can leave the copper IUD in her uterus for up to 12 years. A medical provider must remove it as well. This can be removed at any time.
Mirena is nearly 100% effective at preventing pregnancy. This IUD contains progesterone and must be inserted and removed by a medical provider. The hormones slowly release into the uterine walls. Mirena can be left in the uterus for up to 5 years, but can be removed whenever the woman chooses.
Tubal Ligation for Women
Tubal ligation is a surgical procedure conducted by a medical provider that is 99.5% effective at pregnancy. This is a non-reversible procedure; thus a woman must choose that she no longer wishes to become pregnant at any point in her lifetime.
Vasectomy for Men
Vasectomy is a surgical procedure conducted by a medical provider that is nearly 100% effective at preventing pregnancy. This procedure is not considered reversible and should be considered permanent. The male will no longer be able to impregnate a woman several months after the procedure.
Chlamydia
In the United States, chlamydia is the most reported STI. Chlamydia trachomatis is the bacterium that causes chlamydia and is transmitted during sexual intercourse (anal, vaginal, and / or oral). Each year, it is estimated that 2.8 million people are infected with chlamydia. Approximately 75% of infected women and 50% of infected men have no symptoms. Therefore, it is recommended that sexually active individuals have an annual test to detect this infection (CDC, 2006a). When symptoms are present, they occur between 1 to 3 weeks after exposure. When detected early, antibiotics can treat and cure a chlamydia infection.
Signs and Symptoms in Women:
Signs and Symptoms in Men:
Complications:
Chlamydia infection can cause pelvic inflammatory disease (PID) and occurs in 40% of untreated women. PID occurs in the pelvic area and results in permanent damage to reproductive organs (uterus, fallopian tubes, and surrounding tissues). "The damage can lead to chronic pelvic pain, infertility, and potentially fatal ectopic pregnancy (pregnancy outside the uterus). Women infected with chlamydia are up to five times more likely to become infected with HIV, if exposed" (CDC, 2006a). If pregnant, the infection can cause premature delivery. Also, an infected mother can pass the infection to her child during vaginal delivery. In the newborn, pink eye and pnuemonia can develop (CDC, 2004b).
It is rare for complications to occur in men, but the infection can spread to the "epididymis (a tube that carries sperm to the testis)." As a result, the infection can cause "pain, fever, and rarely, sterility" (CDC, 2006a).
Reducing Your Risk of Transmission:
To prevent complications of untreated Chlamydia infections, sexually active women and men at risk for Chlamydia should have a routine test every year. All women who are pregnant should be screened for Chlamydia.
Genital Warts
Genital warts are mucousal warts caused by the genital human papillomavirus (genital HPV) and is a very common sexually transmitted infection. "At least 50 percent of sexually active men and women acquire genital HPV infection at some point in their lives" (CDC, 2004a). There are over 100 different types of HPV and about 30 of these are sexually transmitted. There are about 10 genital HPV that can lead to cervical cancer. Most people who are infected do not show any signs or symptoms. Therefore, they do not know they are transmitting genital HPV through genital contact. At this time, there is no cure for HPV.
Signs and Symptoms:
If signs or symptoms are present, they appear as genital or mucousal warts. They are usually small, soft, flesh-colored (pink or brown), cauliflower-like growths that may be found by themselves or in clusters. They are usually painless, but can be associated with itching and irritation.
Usually genital warts can be seen and felt in the outer genitalia, but can grow inside the anus, vagina, urethra, or cervix. They can also be spread to the throat, eyes, or under the nail from oral sex or manual stimulation.
Seek Treatment If:
Reducing Your Risk of Transmission
Gonorrhea
Gonorrhea is a common STI, which is caused by a bacterial infection called Neisseria gonorrhea. In the United States, it is estimated that 700,000 individuals become newly infected with Gonorrhea each year (CDC, 2006b). Gonorrhea grows and multiplies quickly in moist, warm areas of the body such as the cervix, urethra, mouth, or rectum. This bacteria can be passed from person to person during sexual activity (vaginal, oral, and anal intercourse) leading to infections of the cervix, vagina, urethra, anus, mouth, and eyes. In many men and women, gonorrhea produces no symptoms. If signs and symptoms occur, they usually appear two to five days after infection. Some symptoms may take up to 30 days to present itself. When detected early, Gonorrhea can be treated and cured with antibiotics.
Signs and Symptoms in Women:
Signs and Symptoms in Men:
Complications:
If the Gonorrhea infection is untreated, serious and permanent health problems could result in both women and men. The bacteria can spread to the bloodstream and infect the joints, heart valves, or the brain. "In addition, people with gonorrhea are more likely to contract HIV, the virus that causes AIDS. HIV-infected people with gonorrhea are more likely to transmit HIV to someone else" (CDC, 2006b).
In women, pelvic inflammatory disease (PID) is a common result of the gonorrhea infection. In the United States, it is estimated that about one million women develop PID each year. "PID can lead to internal abscesses (pus-filled 'pockets' that are hard to cure) and long-lasting, chronic pelvic pain. PID can damage fallopian tubes enough to cause infertility or increase the risk of ectopic pregnancy [pregnancy in the fallopian tube]" (CDC,2006b). This can be a life-threatening condition to the mother if not detected early. An infected woman who is pregnant may give the infection to her infant as the baby passes through the birth canal during delivery. Most states require that the eyes of newborns be treated with silver nitrate or other medication immediately after birth to prevent gonococcal infection of the eyes, which can lead to blindness. The baby can also develop a "joint infection or a life-threatening blood infection (CDC, 2006b). Due to the risk of gonococcal infection to both mother and child, doctors recommend that a pregnant woman have at least one test for gonorrhea during her pregnancy. Also, a baby can get the infection by an infected mother during vaginal delivery.
In men, the infection can spread causing prostatitis (prostate inflammation) and epididymo-orchitis (inflammation of the epididymis and testes).
Reducing Your Risk of Transmission
To prevent complications of untreated gonorrhea infections, sexually active women and men at risk for gonorrhea should have a routine test every year. All women who are pregnant should be screened for gonorrhea.
Hepatitis B
Hepatitis B (HBV) is a virus, which can lead to liver disease. In the United States, it is estimated that one out of 20 individuals will be infected with HBV at some point in their lives. "People of all ages get hepatitis B and about 5,000 die each year from sickness caused by HBV" (CDC, 2006c). HBV can be transmitted by direct exposure to contaminated blood/bodily fluids and by sexual contact. This includes the sharing of intravenous drugs and drug works. An infected mother can pass the infection to her baby during birth. HBV infection can result in acute hepatitis or chronic hepatitis. In acute HBV, an individual may develop flu-like symptoms or no signs/symptoms at all. In chronic HBV, an individual serves as a reservoir for the infection and may not develop any signs/symptoms. In the world, about 2 billion individuals become infected with HBV. Of those, "more than 350 million" develop chronic HBV infection (WHO, 2000).
Signs and Symptoms
Complications:
Chronic HBV infection develops in 90% of infants who are infected with HBV at birth, 30% of children who are infected with HBV between the ages of 1 and 5, and 6% of individuals who are infected with HBV older than 5 (CDC, 2006d). An individual who has chronic HBV infection is at an increased risk for developing cirrhosis (scarring of the liver), liver cancer, and liver failure. As a result, 15 - 25% of these individuals may die at a younger age due to liver cirrhosis or liver cancer (CDC, 2006c).
Reducing Your Risk of Transmission:
Syphilis
In the United States, there were 32,000 cases of syphilis reported in 2002, which included 6,862 cases of primary and secondary (P&S) syphilis (CDC, 2004c). Syphilis is a bacterial infection caused by Treponema pallidum, which can be transmitted sexually or congenitally (pregnant mother to baby). Syphilis is transmitted by exposure to a syphilis sore through anal, vaginal or oral sex. Sores usually appear on the external genitals, vagina, anus, or in the rectum. Sores can also appear in the mouth and on the lips. Unfortunately, many people are unable to recognize the sores and transmit the infection unknowingly. Many people who are infected with syphilis do not have any signs or symptoms for years, but are at risk for complications if not treated. When detected early, syphilis can be cured and treated with antibiotics.
Syphilis occurs in three stages:
Primary stage: This stage begins with an appearance of a chancre sore (firm, round, small, and painless) that occurs between 10 and 90 days from infection. The sore usually appears at the infection site. The chancre sore will remain 3 to 6 weeks from onset and disappear without treatment. If treatment is not obtained, syphilis will progress to the secondary stage.
Secondary stage: This stage begins with the appearance of a skin rash and mucous membrane lesions, which occur as the chancre is healing or has healed. A skin rash is the hallmark of this stage and lesions may appear again. The lesions are very infectious in this stage. The appearance of the rash may include: rough, red, reddish brown spots on the palms of the hands and the bottoms of the feet. Some rashes can appear faint and unnoticeable. Without treatment, these symptoms will disappear and syphilis will progress to late stage.
Latent stage/Late stage (Tertiary): In latent stage, there are no signs or symptoms in this stage and the individual is still infected, which begins when the symptoms of secondary stage disappear. In the late stage, irreversible damage occurs to internal organs and do not show up until many years later. The internal organs that can be damaged include: the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. As a result, the signs and symptoms may include: difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, dementia, and death (CDC, 2004c).
Complications:
A pregnant woman has a higher risk of giving birth to a baby who has already died or dies shortly after birth. A baby infected with syphilis may have no signs or symptoms. If treatment is not rendered, the baby can become developmentally delayed, have seizures, or die (CDC, 2004c).
Signs and Symptoms (of untreated syphilis):
Primary symptoms: (Gandhi, 2006)
Secondary symptoms: (Gandhi, 2005)
Late symptoms (tertiary stage): (Smith, 2006)
STI Facts
STI Prevention
Staying Healthy
Practice "Outercourse"
The only sure way to prevent STIs is to avoid contact between the penis, vagina, mouth and anus. You can touch, cuddle, massage, or tell each other your fantasies. In general, using your hands to give pleasure is safe.
Use a condom
Use a condom from start to finish every time you have sex. Female condoms and male condoms are now available. For extra protection, use a spermicidal jelly or foam during vaginal sex. Use it with condoms, not in place of them.
Be Prepared
Have condoms on hand and be ready to use them. Be aware that people often don't make good decisions in the heat of the moment, especially if they are under the influence of alcohol or drugs.
Limit the Number of Partners
The more people you have sex with, the greater your risk of getting an STI. If your partner has sex with others, you are also at risk.
Get Tested
If you think you have an STI, go to your health care provider or clinic right away. Ask your partner to get tested too, so you won't pass a disease back and forth. If you have sex, get a check up at least once a year.
Assess STI Risk
It is important to know your risk and see your healthcare provider for possible treatment options based on level of risk. The STD Wizard is a website to assess your personal risk of attaining an STI (also known as STD or sexually transmitted disease). It is completely anonymous and does not require the input of any identifiable information. In order to ensure confidentiality the Privacy Policy should be read and guidelines should be followed. The Wizard will ask a series of questions about personal information, such as: age, gender, ethnicity, and sexual practices. The questions should be answered as truthfully as possible. Your answers will be assessed and recommendations based on your responses will be given. A copy of the questions and your responses with the recommendations can be printed for personal information or for your healthcare provider.
The Gynecological Examination ("The Pap")
What is a gynecological examination?
A gynecological examination includes a Pap test (a cervical cancer screening test), pelvic examination, clinical breast examination, and sometimes sexually transmitted infection testing. When you have a gynecological examination at the Student Health Services (SHS), you will be tested for gonorrhea and chlamydia. If you have any questions regarding which STI test was administered, ask your clinician.
How to Prepare for a Gynecological Examination?
For at least 48 hours prior to the appointment, it is recommended that you refrain from vaginal sexual intercourse and avoid inserting anything into your vagina (vaginal creams, douches or other preparations).
References:
Center for Disease Control and Prevention (CDC). (2006a). Chlamydia Fact Sheet. Retrieved on April 20, 2007, from http://www.cdc.gov/std/chlamydia/STDFact-Chlamydia.htm#symptoms.
Center for Disease Control and Prevention (CDC). (2006b). Gonorrhea Fact Sheet. Retrieved on May 3, 2007, from http://www.cdc.gov/std/Gonorrhea/STDFact-gonorrhea.htm
Center for Disease Control and Prevention (CDC). (2006c). Hepatitis Fact Sheet. Retrieved on May 3, 2007, from http://www.cdc.gov/std/hepatitis/STDFact-Hepatitis-B.htm
Center for Disease Control and Prevention (CDC). (2006d). Viral Hepatitis B Fact Sheet. Retrieved on May 10, 2007, from http://www.cdc.gov/Ncidod/diseases/hepatitis/b/fact.htm
Center for Disease Control and Prevention (CDC). (2004a). Genital HPV Infection Fact Sheet. Retrieved on April 26, 2007, from http://www.cdc.gov/std/HPV/STDFact-HPV.htm
Center for Disease Control and Prevention (CDC). (2004b). STDs and Pregnancy. Retrieved on April 20, 2007, from http://www.cdc.gov/std/STDFact-STDs&Pregnancy.htm
Center for Disease Control and Prevention (CDC). (2004c). Syphilis Fact Sheet. Retrieved on May 10, 2007, from http://www.cdc.gov/std/Syphilis/STDFact-Syphilis.htm
Gandhi, M. (2006). Syphilis - Primary. Medical Encyclopedia MedlinePlus. Retrieved on May 10, 2007, from http://www.nlm.nih.gov/medlineplus/ency/article/000861.htm
Gandhi, M. (2005). Syphilis - Secondary. Medical Encyclopedia MedlinePlus. Retrieved on May 10, 2007, from http://www.nlm.nih.gov/medlineplus/ency/article/000854.htm
Mast, E.E., Margolis, H.S., Fiore, A.E., Brink, E.W., Goldstein, S.T., Wang, S.A., Moyer, L.A., Bell, B.P., and Alter, M.J. (2005). A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States. Morbidity and Mortality Weekly Report (MMWR). 54(RR16); 1-23. Retrieved on May 4, 2007, from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5416a1.htm
Smith, D.S. (2006). Syphilis - Tertiary. Medical Encyclopedia MedlinePlus. Retrieved on May 10, 2007, from http://www.nlm.nih.gov/medlineplus/ency/article/000662.htm
World Health Organization (WHO). (2000). Hepatitis B Fact Sheet. Retrieved on May 4, 2007, from http://www.who.int/mediacentre/factsheets/fs204/en/
Web Resources
American Social Health Association Centers for Disease Control & Prevention Choosing a Contraceptive Intellihealth Mayo Clinic Planned Parenthood Federation of America Sex Talk. org
