Birth control

Birth control, also known as contraception and fertility control, is a method or device used to
prevent pregnancy.[1] Planning, making available, and use of birth control is called family planning.[2][3] Birth control
methods have been used since ancient times, but effective and safe methods only became available in the 20th
century.[4] Some cultures limit or discourage access to birth control because they consider it to be morally,
religiously, or politically undesirable.[4]
The most effective methods of birth control are sterilization by means of vasectomy in males and tubal ligation in
females,intrauterine devices (IUDs), and implantable birth control. This is followed by a number of hormone
based methods including oral pills, patches, vaginal rings, and injections. Less effective methods
include physical barriers such as condoms, diaphragms andbirth control sponges and fertility awareness
methods. The least effective methods are spermicides and withdrawal by the male before ejaculation.
Sterilization, while highly effective, is not usually reversible; all other methods are reversible, most immediately
upon stopping them.[5] Safe sex practices, such as with the use of male or female condoms, can also help
prevent sexually transmitted infections.[6] Other methods of birth control do not protect against sexually
transmitted diseases.[7] Emergency birth control can prevent pregnancy if taken within the 72 to 120 hours after
unprotected sex.[8][9] Some argue not having sex as a form of birth control, but abstinence-only sex education may
increase teenage pregnancies if offered without birth control education, due to non-compliance. [10][11]
In teenagers, pregnancies are at greater risk of poor outcomes. Comprehensive sex education and access to
birth control decreases the rate of unwanted pregnancies in this age group. [12][13] While all forms of birth control
can generally be used by young people,[14] long-acting reversible birth control such as implants, IUDs, or vaginal
rings are more successful in reducing rates of teenage pregnancy.[13] After the delivery of a child, a woman who is
not exclusively breastfeeding may become pregnant again after as few as four to six weeks. Some methods of
birth control can be started immediately following the birth, while others require a delay of up to six months. In
women who are breastfeeding,progestin-only methods are preferred over combined oral birth control pills. In
women who have reached menopause, it is recommended that birth control be continued for one year after the
last period.[14]
About 222 million women who want to avoid pregnancy in developing countries are not using a modern birth
control method.[15][16] Birth control use in developing countries has decreased the number of deaths during or
around the time of pregnancy by 40% (about 270,000 deaths prevented in 2008) and could prevent 70% if the
full demand for birth control were met.[17][18] By lengthening the time between pregnancies, birth control can
improve adult women's delivery outcomes and the survival of their children. [17] In the developing world women's
earnings, assets, weight, and their children's schooling and health all improve with greater access to birth
control.[19] Birth control increases economic growth because of fewer dependent children, more women
participating in the workforce, and less use of scarce resources.[19][20]

Methods[edit]
Chance of pregnancy during first year of use[21][22]

Method

Typical use

Perfect use

No birth control

85%

85%

Combination pill

9%

0.3%

Progestin-only pill

13%

1.1%

Sterilization (female)

0.5%

0.5%

Sterilization (male)

0.15%

0.1%

Chance of pregnancy during first year of use[21][22]

Method

Typical use

Perfect use

Condom (female)

21%

5%

Condom (male)

18%

2%

Copper IUD

0.8%

0.6%

Hormonal IUD

0.2%

0.2%

Patch

9%

0.3%

Vaginal ring

9%

0.3%

Depo-Provera

6%

0.2%

Implant

0.05%

0.05%

Diaphragm and spermicide

12%

6%

Fertility awareness

24%

0.45%

Withdrawal

22%

4%

Lactational amenorrhea method

(6 months failure rate)

0-7.5%[23]

<2%[24]

Birth control methods include barrier methods, hormonal birth control, intrauterine devices (IUDs),sterilization,
and behavioral methods. They are used before or during sex while emergency contraceptivesare effective for up
to a few days after sex. Effectiveness is generally expressed as the percentage of women who become pregnant
using a given method during the first year,[25] and sometimes as a lifetime failure rate among methods with high
effectiveness, such as tubal ligation.[26]
The most effective methods are those that are long acting and do not require ongoing health care visits.
[27]
Surgical sterilization, implantable hormones, and intrauterine devices all have first-year failure rates of less
than 1%.[21] Hormonal contraceptive pills, patches or vaginal rings, and the lactational amenorrhea method(LAM),
if used strictly, can also have first-year (or for LAM, first-6-month) failure rates of less than 1%. [27]With typical use
first-year failure rates are considerably high, at 9%, due to incorrect usage. [21] Other methods such as condoms,
diaphragms, and spermicides have higher first-year failure rates even with perfect usage. [27] The American
Academy of Pediatrics recommends long acting reversible birth control as first line for young people.[28]

While all methods of birth control have some potential adverse effects, the risk is less than that ofpregnancy.
[27]
After stopping or removing many methods of birth control, including oral contraceptives, IUDs, implants and
injections, the rate of pregnancy during the subsequent year is the same as for those who used no birth control.
[29]

In those with specific health problems, certain forms of birth control may require further investigations. [30]For
women who are otherwise healthy, many methods of birth control should not require a medical examincluding
birth control pills, injectable or implantable birth control, and condoms. [31] Specifically, a pelvic exam, breast exam,
or blood test before starting birth control pills do not appear to affect outcomes and, therefore, are not required. [32]
[33]
In 2009, the World Health Organization (WHO) published a detailed list of medical eligibility criteria for each
type of birth control.[30]

Hormonal[edit]
Hormonal contraception is available in a number of different forms, including oral pills, implants under the
skin, injections, patches, IUDsand a vaginal ring. They are currently available only for women, although
hormonal contraceptives for men have and are being clinically tested. [34] There are two types of oral birth control
pills, the combined oral contraceptive pills (which contain both estrogen and progesterone) and the progestogenonly pills (sometimes called minipills).[35] If either is taken during pregnancy, they do not increase the risk
of miscarriage nor cause birth defects.[33] Both types of birth control pills prevent fertilization mainly by
inhibiting ovulation and thickening cervical mucous.[36][37] Their effectiveness depends on the user remembering to
take the pills.[33] They may also change the lining of the uterus and thus decrease implantation. [37]
Combined hormonal contraceptives are associated with a slightly increased risk of venous and arterial blood
clots.[38] Venous clots, on average, increase from 2.8 to 9.8 per 10,000 women years [39] which is still less than that
associated with pregnancy.[38] Due to this risk, they are not recommended in women over 35 years of age who
continue to smoke.[40] The effect on sexual desire is varied, with increase or decrease in some but with no effect
in most.[41] Combined oral contraceptives reduce the risk of ovarian cancer and endometrial cancer and do not
change the risk of breast cancer.[42][43] They often reduce menstrual bleeding and painful menstruation cramps.
[33]
The lower doses of estrogen released from the vaginal ring may reduce the risk of breast tenderness, nausea,
and headache associated with higher dose estrogen products.[42]
Progestin-only pills, injections and intrauterine devices are not associated with an increased risk of blood clots
and may be used by women with previous blood clots in their veins. [38][44] In those with a history of arterial blood
clots, non-hormonal birth control or a progestin-only method other than the injectable version should be used.
[38]
Progestin-only pills may improve menstrual symptoms and can be used by breastfeeding women as they do
not affect milk production. Irregular bleeding may occur with progestin-only methods, with some users
reporting no periods.[45] The progestins drospirenone and desogestrel minimize the androgenic side effects but
increase the risks of blood clots and are thus not first line. [46] The perfect use first-year failure rate of the injectable
progestin, Depo-Provera, is 0.2%; the typical use first failure rate is 6%.[21]

Barrier[edit]
Barrier contraceptives are devices that attempt to prevent pregnancy by physically preventing sperm from
entering the uterus.[47] They include male condoms, female condoms,cervical caps, diaphragms,
and contraceptive sponges with spermicide.[47]

Globally, condoms are the most common method of birth control.[48] Male condoms are put on a man's
erect penis and physically block ejaculated sperm from entering the body of a sexual partner.[49] Modern condoms
are most often made from latex, but some are made from other materials such as polyurethane, or lamb's
intestine.[49] Female condomsare also available, most often made of nitrile, latex or polyurethane.[50] Male
condoms have the advantage of being inexpensive, easy to use, and have few adverse effects. [51]Making
condoms available to teenagers does not appear to affect the age of onset of sexual activity or its frequency.[52] In
Japan about 80% of couples who are using birth control use condoms, while in Germany this number is about
25%,[53] and in the United States it is 18%.[54]
Male condoms and the diaphragm with spermicide have typical use first-year failure rates of 18% and 12%,
respectively.[21] With perfect use condoms are more effective with a 2% first-year failure rate versus a 6% firstyear rate with the diaphragm.[21] Condoms have the additional benefit of helping to prevent the spread of some
sexually transmitted infections such as HIV/AIDS.[5]
Contraceptive sponges combine a barrier with a spermicide. [27] Like diaphragms, they are inserted vaginally
before intercourse and must be placed over the cervix to be effective.[27] Typical failure rates during the first year
depend on whether or not a woman has previously given birth, being 24% in those who have and 12% in those
who have not.[21] The sponge can be inserted up to 24 hours before intercourse and must be left in place for at
least six hours afterward.[27] Allergic reactions[55] and more severe adverse effects such as toxic shock
syndrome have been reported.[56]

A contraceptive spongeset inside its open package.

Intrauterine devices[edit]
Copper T shaped IUD with removal strings

The current intrauterine devices (IUD) are small devices, often 'T'-shaped, often containing either copper or
levonorgestrel, which are inserted into the uterus. They are one form of long-acting reversible
contraception which are the most effective types of reversible birth control.[57] Failure rates with the copper IUD is
about 0.8% while the levonorgestrel IUD has a failure rates of 0.2% in the first year of use. [58] Among types of
birth control, they along with birth control implants result in the greatest satisfaction among users. [59] As of 2007,
IUDs are the most widely used form of reversible contraception, with more than 180 million users worldwide.[60]

Evidence supports effectiveness and safety in adolescents [59] and those who have and have not previously had
children.[61] IUDs do not affect breastfeeding and can be inserted immediately after delivery.[62] They may also be
used immediately after an abortion.[63] Once removed, even after long term use, fertility returns to normal
immediately.[64]
While copper IUDs may increase menstrual bleeding and result in more painful cramps [65] hormonal IUDs may
reduce menstrual bleeding or stop menstruation altogether.[62]Cramping can be treated with NSAIDs.[66] Other
potential complications include expulsion (25%) and rarely perforation of the uterus (less than 0.7%). [62][66] A
previous model of the intrauterine device (the Dalkon shield) was associated with an increased risk of pelvic
inflammatory disease, however the risk is not affected with current models in those without sexually transmitted
infections around the time of insertion.[67]

Sterilization[edit]
Surgical sterilization is available in the form of tubal ligation for women and vasectomy for men.[4] There are no
significant long-term side effects, and tubal ligation decreases the risk of ovarian cancer.[4] Short term
complications are twenty times less likely from a vasectomy than a tubal ligation. [4][68] After a vasectomy, there
may be swelling and pain of the scrotum which usually resolves in a week or two. [69] With tubal ligation,
complications occur in 1 to 2 percent of procedures with serious complications usually due to theanesthesia.
[70]
Neither method offers protection from sexually transmitted infections.[4]
This decision may cause regret in some men and women. Of women aged over 30 who have undergone tubal
ligation, about 5% regret their decision, as compared with 20% of women aged under 30. [4] By contrast, less than
5% of men are likely to regret sterilization. Men more likely to regret sterilization are younger, have young or no
children, or have an unstable marriage.[71] In a survey of biological parents, 9% stated they would not have had
children if they were able to do it over again.[72]
Although sterilization is considered a permanent procedure, [73] it is possible to attempt a tubal reversal to
reconnect the fallopian tubes or a vasectomy reversal to reconnect thevasa deferentia. In women the desire for a
reversal is often associated with a change in spouse.[73] Pregnancy success rates after tubal reversal are
between 31 and 88 percent, with complications including an increased risk of ectopic pregnancy.[73] The number
of males who request reversal is between 2 and 6 percent. [74] Rates of success in fathering another child after
reversal are between 38 and 84 percent; with success being lower the longer the time period between the
original procedure and the reversal.[74] Sperm extraction followed by in vitro fertilization may also be an option in
men.[75]

Behavioral[edit]
Behavioral methods involve regulating the timing or method of intercourse to prevent introduction of sperm into
the female reproductive tract, either altogether or when an egg may be present. [76] If used perfectly the first-year
failure rate may be around 3.4%, however if used poorly first-year failure rates may approach 85%. [77]
Fertility awareness[edit]
A CycleBeads, used for estimating fertility based on days since last menstruation

Fertility awareness methods involve determining the most fertile days of the menstrual cycle and avoiding
unprotected intercourse.[76]Techniques for determining fertility include monitoring basal body temperature, cervical
secretions, or the day of the cycle.[76] They have typical first-year failure rates of 24%; perfect use first-year failure
rates depend on which method is used and range from 0.4% to 5%. [21]The evidence on which these estimates are
based, however, is poor as the majority of people in trials stop their use early.[76] Globally, they are used by about
3.6% of couples.[78] If based on both basal body temperature and another primary sign, the method is referred to
as symptothermal. Overall first-year failure rates of <2% to 20% have been reported in clinical studies of the
symptothermal method.[79][80]
Withdrawal[edit]

The withdrawal method (also known as coitus interruptus) is the practice of ending intercourse ("pulling out")
before ejaculation.[81] The main risk of the withdrawal method is that the man may not perform the maneuver
correctly or in a timely manner.[81] First-year failure rates vary from 4% with perfect usage to 22% with typical
usage.[21] It is not considered birth control by some medical professionals.[27]
There is little data regarding the sperm content of pre-ejaculatory fluid.[82] While some tentative research did not
find sperm,[82] one trial found sperm present in 10 out of 27 volunteers.[83] The withdrawal method is used as birth
control by about 3% of couples.[78]
Abstinence[edit]

Though some groups advocate total sexual abstinence, by which they mean the avoidance of all sexual activity,
in the context of birth control the term usually means abstinence from vaginal intercourse. [84][85] Abstinence is
100% effective in preventing pregnancy; however, not everyone who intends to be abstinent refrains from all
sexual activity, and in many populations there is a significant risk of pregnancy from nonconsensual sex.[86][87]
Abstinence-only sex education does not reduce teenage pregnancy.[7][88] Teen pregnancy rates are higher in
students given abstinence-only education, as compared with comprehensive sex education. [88][89] Some authorities
recommend that those using abstinence as a primary method have backup method(s) available (such as
condoms or emergency contraceptive pills).[90] Deliberate non-penetrative sex without vaginal sex or
deliberate oral sex without vaginal sex are also sometimes considered birth control. [91]While this generally avoids
pregnancy, pregnancy can still occur with intercrural sex and other forms of penis-near-vagina sex (genital
rubbing, and the penis exiting from anal intercourse) where sperm can be deposited near the entrance to the
vagina and can travel along the vagina's lubricating fluids.[92][93]
Lactation[edit]

The lactational amenorrhea method involves the use of a woman's natural postpartum infertility which occurs
after delivery and may be extended by breastfeeding.[94] This usually requires the presence of no periods,
exclusively breastfeeding the infant, and a child younger than six months. [24] The World Health
Organization states that if breastfeeding is the infant's only source of nutrition, the failure rate is 2% in the six
months following delivery.[95] Six uncontrolled studies of lactational amenorrhea method users found failure rates
at 6 months postpartum between 0% and 7.5%.[96] Failure rates increase to 47% at one year and 13% at two
years.[97] Feeding formula, pumping instead of nursing, the use of a pacifier, and feeding solids all increase its
failure rate.[98] In those who are exclusively breastfeeding, about 10% begin having periods before three months
and 20% before six months.[97] In those who are not breastfeeding, fertility may return four weeks after delivery.[97]

Emergency[edit]
A single-dose emergency contraceptive pill.

Emergency contraceptive methods are medications (sometimes misleadingly referred to as "morning-after pills")
[99]
or devices used after unprotected sexual intercourse with the hope of preventing pregnancy.[8] They work
primarily by preventing ovulation or fertilization. [4][100]They are unlikely to affect implantation, but this has not been
completely exclude.[100] A number of options exist, including high dose birth control
pills, levonorgestrel, mifepristone, ulipristal and IUDs.[101] Levonorgestrel pills, when used within 3 days, decrease
the chance of pregnancy after a single episode of unprotected sex or condom failure by 70% (resulting in a
pregnancy rate of 2.2%).[8] Ulipristal, when used within 5 days, decreases the chance of pregnancy by about 85%
(pregnancy rate 1.4%) and might be a little more effective than levonorgestrel. [8][101][102] Mifepristone is also more
effective than levonorgestrel while copper IUDs are the most effective method. [101]IUDs can be inserted up to
five days after intercourse and prevent about 99% of pregnancies after an episode of unprotected sex
(pregnancy rate of 0.1 to 0.2%).[4][103] This makes them the most effective form of emergency contraceptive.[104] In
those who areoverweight or obese levonorgestrel is less effective and an IUD or ulipristal is recommended.[105]
Providing emergency contraceptive pills to women in advance does not affect rates of sexually transmitted
infections, condom use, pregnancy rates, or sexual risk-taking behavior.[106][107] All methods have minimal side
effects.[101]

Dual protection[edit]
Dual protection is the use of methods that prevent both sexually transmitted infections and pregnancy.[108] This
can be with condoms either alone or along with another birth control method or by the avoidance of penetrative
sex.[109][110] If pregnancy is a high concern using two methods at the same time is reasonable, [109] and two forms of
birth control is recommended in those taking the anti-acne drug isotretinoin, due to the high risk of birth defects if
taken during pregnancy.[111]

Types of Contraceptives
Hormonal and Barrier Contraception

There are about 15 different types of contraceptives which allow you to enjoy sex without the risk of getting pregnant.
These birth control methods include: condoms, the diaphragm, birth control pills, implants, IUDs (intrauterine devices),
sterilization and the emergency contraceptive pill.
Many of these methods of contraception also lower your chance of getting an STI.
Condoms, spermicides and sponges aside, most types of contraception can only be obtained with the help of a doctor.

GMC registered doctors

Free Delivery

Which methods of contraception are there?

In the last 50 years, the number of contraception methods has dramatically increased. You can differentiate between
different types of contraception based on how they work: there are barrier methods (e.g. condoms or a cervical cap),
hormonal methods (e.g the pill), intrauterine devices (IUD) and sterilization.
Emergency contraception (morning after pill) is another method, but we will only review "planned contraception" here.
Most types of contraceptives work by:
a) preventing an egg from being released every month (hormones)
b) preventing sperms from reaching the egg (barrier and some IUD methods)
c) blocking the reproductive function in men or women (sterilization)
d) preventing a fertilized egg from implanting in the uterus (hormones)

The Pill
The condom and the pill consistently rank at the top as the most commonly used types of contraception.
The contraceptive pill was invented in 1960. Fifty years on, many new inventions have been added to the list of available
contraception methods, but the pill remains the most popular form of female contraception.
The contraceptive pill will prevent you from getting pregnant in 95% of cases and it comes close to providing 99% protection
if you take one pill every day as prescribed.
The pill can come in two forms: the combined contraceptive pill (containing the hormones estrogen and progestin) or the
mini-pill (only progestin). In the case of the mini-pill, it's important that you take your pill every day at the same time (you
should not be late by more than three hours).
Keep in mind that the pill does not provide any protection against STIs and that a doctor's prescription is required to buy it.

The Male Condom

Among the different types of contraceptives, the male condom is a strong contender to the title of most common
contraception method. It is easy to use, affordable and offers the best protection against STIs (e.g. gonorrhoea, chlamydia,
HIV).

Condoms are usually made of latex, but if you are allergic to latex, some brands also specialize in condoms made of
polyurethane or lambskin. These two are also compatible with lube (latex condoms are not, unless with water-based
lubricant); however lambskin condoms do not provide protection against STIs.
For safety reasons, make sure you use a new condom each time you have sex.

The Female Condom

Just like the male condom, the female condom is one of the few types of contraception that you can buy over-the-counter at
pharmacies and grocery stores without a prescription.
It was first introduced twenty years ago and offers 95% effective protection for pregnancy, as well as some protection against
STIs. Female condoms are generally more expensive than the male ones but they are less likely to burst. They can be
inserted up to eight hours before sex.

The Diaphragm
Continuing with the list of barrier contraception methods, there is the diaphragm which is placed inside the vagina so that it
prevents the sperm from getting into the uterus. Despite being a barrier method, it doesn't protect against STIs.
The diaphragm must be coated with spermicide each time before sex and a doctor needs to show you how to use it (you
need a prescription to get one). It is inserted at least six hours before sex and it needs to be removed after 24 hours for
cleaning. Depending on the material and type of the diaphragm, it can be reused many times.

The Cervical Cap - Femcap

The cervical cap (sold as Femcap) is a thimble-shaped latex cup, basically like a diaphragm but smaller. It also needs to be
used with a spermicide. The cervical cap must remain in the vagina at least 6 hours after sex, but it also has to be taken out
within 48 hours after sex.
Because some women get cystitis (bladder infection) from using a diaphragm, the cervical cap is a useful replacement
because it has less contact with the vagina (it only covers the cervix).
The problem with types of contraceptives such as the Femcap or the diaphragm is that their effectiveness - 92 to 95%
protection in ideal use - is lower than other types (98-99%) and that they offer only partial protection against STIs (e.g. no
HIV protection).

The Intrauterine Device (IUD)

You have the choice between two types of IUDs: hormonal or copper-based devices. Hormonal and copper IUDs are part of
the few long-term solutions, meaning that you can keep them inside the vagina for up to five or ten years respectively.
The effectiveness rate for IUDs is above 99%, however they provide no protection against STIs. Note that IUDs can be a
form of emergency contraception if the device is inserted within 5 days after unprotected sex. You will nonetheless need to
visit a doctor to have it properly inserted and follow the prescription (e.g. a few follow-ups and check-ups for possible
infection in the first weeks).

The Contraceptive Implant

The implant is another option among the types of contraceptives that offer long term protection. It lasts for about three years
on average. Just like IUDs, the implant does not protect against STIs.

The contraceptive implant contains progestin (progesterone), the same hormone as the contraceptive pill. The hormone is
released into your body at a steady, slow pace for three years, producing the same effects as the pill.
The implant is inserted in the arm by a healthcare specialist and must be removed after three years. Since the risk of human
mistake is ruled out, the implant has a much higher effectiveness rate than the pill around 99.99%.

The Contraceptive Sponge

The sponge is a small, round-shaped foam (polyurethane) placed deep inside the vagina. It contains spermicide so that
sperm does not get past the foam. You should leave the sponge inside the vagina for at least six hours after sex, but remove
it within 24 hours following sexual intercourse (to lessen the risk of toxic shock).
The sponge does not protect past those 24 hours and does not provide any STI protection. It is sometimes used as a backup
for other contraception methods (e.g. when you forgot to take the pill) and you can buy it without a prescription from the
pharmacy.

Spermicide
Spermicide is a recurrent "ingredient" in contraception because it proves very effective when used in combination with other
methods (e.g. diaphragm, sponge). In itself spermicide doesn't always offer the best protection against pregnancy, although
this is also due to inconsistent use of the product.
You don't need a prescription to buy spermicide and it has very few associated side-effects, but keep in mind that it does not
protect against STIs.

Contraceptive Injections
This method dates back to the 60s with the invention of artificial progesterone (progestin). One shot of hormones lasts in the
body for 8 to 12 weeks (3 months) and has the same effect as the pill.
Injections are about 99% effective, with pregnancy occurring mostly with women who forgot to renew their contraceptive shot
in time (i.e. past weeks 11 to 12). Obviously, once the shot is given it cannot be reversed, so you are effectively infertile for
the next three months.
Just like the pill, contraceptive injections do not protect from STIs.

The Vaginal Ring

The vaginal contraceptive ring is a small, transparent plastic ring that is inserted in the vagina and kept for three weeks. You
should then remove it during your periods and replace it with a new one after that.
The ring contains the same hormones as the contraceptive pill (progesterone and estrogen), therefore providing the same
kind of effective protection and side effects. You will need your doctor's prescription to buy the ring.
Just like other hormonal contraception, the vaginal ring does not protect from STIs.

The Contraceptive Patch

The contraceptive patch is exactly the same thing as the contraceptive pill but in the form of a patch. It provides the same
effective protection against pregnancy and has the side effects (positive and negative). It does not protect from STIs.
You wear the patch for three weeks, take it off for one week - allowing your menstrual cycle then you start with a new
patch. The patch is an interesting option in as much as you don't need to think about taking the pill every day.

There is however a risk of skin irritation, and a (rare) chance that the patch accidentally comes off.

Emergency Contraception
Emergency contraception exists to stop you getting pregnant if you have had unprotected sex.
This method is for one-off occasions and is not recommended for daily use. It is particularly useful if a condom broke or if
you missed one of your contraceptive pills.
The most common brand of emergency contraceptive pill is Levonelle. You should take it ideally within 24 hours after
unprotected sex (this offers over 95% protection). The longer you wait, the less effective it will be. After 72 hours (3 days) the
effectiveness drops to below 50%.
If you vomit within three hours after taking the pill, you must take another one.

Sterilization
A sterilization is an option available to both men and women.
As far as male contraception is concerned, the technique is called vasectomy and consists in tying off and cutting the tubes
that carry sperm without the need for a scalpel intervention or stitches. The man can then go home in the same day.
This provides no protection against STIs and the effects are for life. In very rare cases (less than 1%), the tubes can grow
back, making pregnancy a risk.
As for female sterilization, this is also a very simple operation after which you can go back home the very same day. You
have the choice between surgical and non-surgical types of sterilization.
Surgical sterilisation (known as tubal litigation) requires very small cuts in the belly to access the Fallopian tubes, cut them
and tie them so that they cannot link the ovaries with the uterus any more. The effects are permanent so you must be sure of
your choice concerning sterilization.
Non-surgical sterilisation consists of placing a coil in each Fallopian tube through the vagina and uterus so that scars
appear and eventually block each tube completely. The scars may take up to 3 months to completely block the tubes, so you
need to use another method of contraception in the meantime.
Both options also offer more than 99% of protection against pregnancy (and none against STIs) because of rare cases
where blocked tubes happen to grow back and reconnect (1 in 200 women).

Natural Family Planning

Although not a device or a pill, this is still a method of contraception. Natural family planning relies on knowing the menstrual
cycle (periods) so that couples avoid having sex when the woman is fertile.
Three techniques (basal body temperature, cervical mucus and rhythm/calendar method) can be used for this, with higher
protection rates when all three methods are used in combination. The effectiveness of this type of contraception varies
between 75% to 99% (but 85% on average) with the higher uncertainty due to the fact that most women do not have a
perfectly regular menstrual cycle.

What If I Use No Contraception?

In the absence of contraception, over 80% of women will fall pregnant within one year.
Needless to say, abstinence remains the only way to enjoy 100% protection from both pregnancy and STIs.

The use of contraception is widespread. It is used by anyone who wants to have sex, but avoid getting pregnant or
contracting a sexually transmitted infection.

Contraception effectiveness
There is no such thing as a contraception method that offers 100% protection against pregnancy or STIs, because there is
always a risk (even one in a thousand) that an accident could happen, be it rupture of a condom or human error (e.g.
forgetting to take the pill).
This makes it all the more important to look at effectiveness rates for different methods. Overall it's important to take into
account that human errors can happen (e.g. more with the pill than with injections), how easy it is to use (e.g. condoms vs.
diaphragm), and how good the effectiveness is for every method, in ideal use.
On average, hormonal contraception methods (e.g. the pill) are over 95% effective or more, and the condom is about 99%
effective, although other barrier methods such as the diaphragm offer a protection rate between 80% to 95%.
The more careful and consistent you are, the higher is the contraceptive effectiveness for each method. For example, a
careless use of condoms can make the effectiveness rate drop to nearly 85%.