Protecting Against Unintended Pregnancy: Choosing a Contraceptive

by Food and Drug Administration (FDA)

I am 20 and have never gone to see a doctor about birth control. My boyfriend and I have been going together for a couple of years and have been using condoms. So far, everything is fine. Are condoms alone safe enough, or is something else safe besides the Pill?

— Letter to the Kinsey Institute for Research in Sex, Gender, and Reproduction

This young woman is not alone in her uncertainty about contraceptive options. A 1995 report by the National Academy of Sciences' Institute of Medicine, The Best Intentions: Unintended Pregnancy and the Well-being of Children and Families, attributed the high rate of unintended pregnancies in the United States, in part, to Americans' lack of knowledge about contraception. About six of every 10 pregnancies in the United States are unplanned, according to the report.

Being informed about the pros and cons of various contraceptives is important not only for preventing unintended pregnancies but also for reducing the risk of illness or death from sexually transmitted diseases (STDs), including AIDS.

The Food and Drug Administration has approved a number of birth control methods, ranging from over-the-counter male and female condoms and vaginal spermicides to doctor-prescribed birth control pills, diaphragms, intrauterine devices (IUDs), injectable hormones, and hormonal implants. Other contraceptive options include fertility awareness and voluntary surgical sterilization.

"On the whole, the contraceptive choices that Americans have are very safe and effective," says Dennis Barbour, former president of the Association of Reproductive Health Professionals, "but a method that is very good for one woman may be lousy for another."

The choice of birth control depends on factors such as a person's health, frequency of sexual activity, number of partners, and desire to have children in the future. Effectiveness rates, based on statistical estimates, are another key consideration. (See "Birth Control Guide.") FDA has developed a consumer-friendly table of pregnancy rates, which the agency encourages all contraceptives marketers to add to their products' labeling. Single copies of the table may be ordered from FDA, HFZ-210, 1350 Piccard Drive, Rockville, MD 20850.

Barrier Methods

Male Condom.

The male condom is a sheath placed over the erect penis before penetration, preventing pregnancy by blocking the passage of sperm.

A condom can be used only once. Some have a chemical added to kill sperm The addition of this spermicide, usually nonoxynol-9 in the United States, has not been scientifically shown to provide additional contraceptive protection over the condom alone. Because it acts as a mechanical barrier, a condom prevents direct contact with semen, infectious genital secretions, and genital lesions and discharges.

Most condoms are made from latex rubber, while a small percentage are made from lamb intestines (sometimes called "lambskin" condoms). Condoms made from a type of plastic called polyurethane have been marketed in the United States since 1994.

Except for abstinence, latex condoms are the most effective method for reducing the risk of infection from the viruses that cause AIDS, other HIV-related illnesses, and other STDs. For people who are sensitive to latex, polyurethane condoms are a good alternative.

Some condoms are prelubricated. These lubricants do not increase birth control or STD protection. Non-oil-based lubricants, such as water or K-Y jelly, can be used with latex or lambskin condoms, but oil-based lubricants, such as petroleum jelly (Vaseline), lotions, or massage or baby oil, should not be used because they can weaken the condom and cause it to break.

Female condom.

The Reality Female Condom, approved by FDA in April 1993, consists of a lubricated polyurethane sheath shaped similarly to the male condom. The closed end, which has a flexible ring, is inserted into the vagina, while the open end remains outside, partially covering the labia.

The female condom, like the male condom, is available without a prescription and is intended for one-time use. It should not be used together with a male condom because they may slip out of place.

Diaphragm.

Available by prescription only and sized by a health professional to achieve a proper fit, the diaphragm is a dome-shaped rubber disk with a flexible rim that works in two ways to prevent pregnancy. It covers the cervix so sperm can't reach the uterus, while a spermicide cream or jelly applied to the diaphragm before insertion kills sperm.

The diaphragm protects for six hours after it is inserted. For intercourse after the six-hour period, or for repeated intercourse within this period, fresh spermicide should be placed in the vagina with the diaphragm still in place. The diaphragm should be left in place for at least six hours after the last intercourse but not for longer than a total of 24 hours because of the risk of toxic shock syndrome (TSS), a rare but potentially fatal infection. Signs and symptoms of TSS include sudden fever, stomach upset, sunburn-like rash, and a drop in blood pressure.

Cervical cap.

The cervical cap is a soft rubber cup with a round rim, sized by a health professional to fit snugly around the cervix. It is available by prescription only and, like the diaphragm, is used with spermicide cream or jelly.

It protects for 48 hours and for multiple acts of intercourse within this time. Wearing it for more than 48 hours is not recommended because of the risk, though low, of TSS. Also, with prolonged use of two or more days, the cap may cause an unpleasant vaginal odor or discharge in some women.

Sponge.

The sponge, a disk-shaped polyurethane device containing the spermicide nonoxynol-9, is not currently marketed but may be sold again in the future. Inserted into the vagina to cover the cervix, the sponge is attached to a woven polyester loop for easier removal.

The sponge protects for up to 24 hours and for multiple acts of intercourse within this time. It should be left in place for at least six hours after intercourse but should be removed no more than 30 hours after insertion because of the risk, though low, of TSS.

Vaginal Spermicides Alone

Vaginal spermicides are available in foam, cream, jelly, film, suppository, or tablet forms. All types contain a sperm-killing chemical.

Studies have not produced definitive data on how well spermicides alone prevent pregnancy, but according to the authors of Contraceptive Technology, a leading resource for contraceptive information, the failure rate for typical users may be 26 percent per year.

Package instructions must be carefully followed because some spermicide products require the couple to wait 10 minutes or more after inserting the spermicide before having sex. One dose of spermicide is usually effective for one hour. For repeated intercourse, additional spermicide must be applied. And after intercourse, the spermicide has to remain in place for at least six to eight hours to ensure that all sperm are killed. The woman should not douche or rinse the vagina during this time.

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.