Contraceptive Methods: Different Types and How They Work

Now that everybody is talking about the men’s pill (about time!), we realise that the options regarding birth control are starting to be quite numerous and different from each other. This is great, the more possibilities the better. But without counting on all the information possible about the subject, choosing your preferred method can prove a complicated task.

We sure don’t want the world of contraceptives to become a confusing and overwhelming environment: we will also dominate this one. We have decided to make a quick stop along the way and go back to reviewing with you what methods are there in the market and how each one works:

Barrier contraceptive methods

  • Male condom: also known as prophylactic, it does not present any type of contraindication. It is still the most used method of birth control and it is the best one to prevent sexual diseases. It is usually made with latex or polyurethane and it is placed on the penis covering it. There is a natural alternative, lamb skin condoms (made with lamb’s intestinal membrane), but these do not prevent STDs.

These are a single-use method and their effectiveness is between 85 and 97%, but it is important to emphasise that this is so when they are used optimally (avoiding breakage, leakage, etc). Likewise, when it has been 5 years since it came out of the factory, latex loses flexibility and there is a risk of it tearing.

  • Spermicide: it is one of those less-effective methods and it is advisable to use it along with another one, such as a diaphragm or a cervical cap. These are vaginal creams or ovules with chemical substances that act as a chemical barrier, destroying the sperm. They should be inserted in the vagina, near the uterus, maximum half an hour before sexual intercourse and should remain there for 6-8 hours after the same. It is important to note that they do not prevent the transmission of sexual diseases and can cause allergic reactions.
  • Female condom: Its effectiveness rate is lower than in its male version, but it also very effectively protects from sexually transmitted diseases. It is somewhat more uncomfortable, being a lubricated sheath that covers the walls of the vagina and vulva. One part of the condom is inserted into the vagina before having sex, similar to the way in which a tampon is inserted.
  • Diaphragm: it is less advisable for avoiding STDs since it does not cover the vaginal mucosa. It consists of a flexible silicone or latex cup that is inserted into the vagina before having sex. It is recommended to use spermicidal gel along with it. It must remain inside the body for 6-8 hours after sex, but it is important to remove it within 24 hours. A health professional will recommend the ideal size of it for each woman, so you must visit the gynaecologist before you start using it. Ensuring a good use and cleaning of this one, it can be used several times.
  • Vaginal sponge: small, round-shaped, soft foam sponge. It has to be impregnated with spermicide and introduced into the vagina before sexual intercourse. The sponge prevents the sperm from entering the uterus, and the spermicide destroys it. It must be taken into account that it does not protect against STDs and that it is more effective in women who have not been mothers, since their vaginal canal has not dilated. Like tampons, it has a strip to be able to pull and remove it, and then discard it.
  • Copper Intrauterine Device (IUD): is it a small T-shaped device that, when placed inside the uterus, releases a certain amount of copper. This generates an inflammatory reaction that prevents sperm from reaching the egg. In addition, if this one is fertilised, the presence of the device prevents it from implanting in the lining of the uterus. This device requires an intervention by a gynaecologist and can remain in the body for up to 12 years. It is reliable in more than 99% of cases.

Hormonal contraceptive methods

  • The female pill: it is important to remember that these method should only be used with a prescription, the gynaecologist will help you choose the most appropriate for you. They contain different combinations of oestrogen and synthetic progestins that are administered to interfere with ovulation. It requires discipline in its use, since the woman must take one each day, preferably always at the same time, but when used correctly it works 99.7% of the times. This is possibly what makes it one of the preferred methods.

Like any hormonal treatment, its side effects can be positive or negative (or even non-existent), this is why it is so important to consult with a gynaecologist. There are types of pills that are taken for 21 days and others that are taken for 28 days, depending on certain factors such as whether they have placebo pills or not. On exceptional occasions they can be used to modify the menstrual cycle.

  • The male pill: the star of the week for being the most recent method, although there is going to be quite the wait to see it available in pharmacies. It is the same method as the female pill, but meant for men. When they do reach the market, these will be a pill that combines two hormonal activities in one: it produces a decrease in the sperm while preserving the libido.
  • The mini-pill (progestogen pill): it emerged as an alternative to the aforementioned pill to avoid the side effects caused by it. These pills thicken the cervical mucus, altering the normal cyclic changes in the uterine lining. In the same way, the woman should also take one per day preferably at the same time.
  • The morning-after pill: This is considered an emergency method. It should only be administered in very specific cases, given the high dose of hormones it contains, and within the next 72 hours after sexual intercourse. They are normally taken as a single dose or in two doses, allowing 12 hours between them. These pills can act by delaying or inhibiting ovulation for at least five days to allow the sperm to become inactive.
  • The contraceptive adhesive (or patch): it is one of the simplest methods to use and it is a square adhesive of fine plastic that adheres to the skin and releases hormones, it has a duration of seven days. Its effectiveness is very high, but you have to remember that it should always be applied on clean skin without creams to prevent it from slipping. Unlike the pill, this method does not run the risk of expelling hormones through vomiting or diarrhea since they are not ingested.
  • The vaginal ring: it is a thin, flexible plastic ring that administers a combination of synthetic estrogen and progestin when it is introduced into the vagina. It releases these hormones for three weeks, after which it must be extracted and discarded. The effectiveness is the same as that of the conventional pill and you can insert it easily.
  • The injectable contraceptive: this method is done by injecting, in a gynaecological consultation, a progestin. It is usually done on the arm or buttock and lasts up to three months (there is also a monthly option). It is important to mention that the majority of women who opt for this method should make sure to maintain a diet rich in calcium and vitamin D, or to take vitamin supplements, as this option can cause a temporary loss of bone density.
  • The contraceptive implant (implantable rods): it is a highly effective method that lasts up to five years. It consists of the insertion under the skin, done of course by a doctor, of a flexible plastic rod that has the size of a match. This one releases progestin slowly. It is considered one of the simplest methods because once implanted the woman doesn’t have to do anything else.
  • Hormonal Intrauterine Device (IUD): Like the copper IUD, it is a small device that must be placed by the gynaecologist. It is made of plastic and it’s introduced into the uterus, where it releases a progestin hormone that inhibits the arrival of sperm to the ovule and thus its fertilisation, it thins the uterine lining, causes the cervical mucus to swell and could even prevent the ovaries from releasing ovules. The hormonal IUD can remain in the body for up to 5 years. This makes it a safe and effective method of long duration.

Permanent contraceptives

  • Vasectomy: it is a simple surgery to which the man is subjected and it means cutting the seminal ducts so that the sperm can not leave the testicle and the ejaculate does not contain sperm. It is a definitive alternative that involves going through the operating room and, after surgery, it can take up to three months for the procedure to reach its full effectiveness. There is the option of performing a reversible vasectomy, making a tie instead of a cut.
  • Tubal ligation: through a surgical intervention or through an endoscopic approach, it consists of a procedure in which the doctor ties, seals or cuts the fallopian tubes in the woman's body. This creates an obstruction between the ovaries and the uterus, so that the sperm can not reach the egg, and this one can not reach the uterus.

 Alternative methods

  • Menstrual calendar: also known as “The Ogino Method", it is famous for its very low effectiveness. This system is based on calculating the most fertile days of the cycle in order to know the days of greatest probability of pregnancy. Taking into account a multitude of exceptions such as hormonal variations due to stress, trips with time changes, even the practice of sports, this is a very, very unreliable method.
  • Interrupted intercourse: the Ministry of Health recommends to avoid it, and for very good reasons. It means removing the penis from the woman's body just before ejaculating. The problem comes when this is not done in time, or if you take into account that the pre-cum contains small amounts of sperm. It is a method of very high risk.
  • Cervical mucus: it means to figure out the most fertile period through observation of the cervical mucus, which a few days before ovulation becomes more elastic. For obvious reasons, this is not a reliable or recommended method.
  • Breastfeeding: contrary to what popular belief may suggest, breastfeeding is not a contraceptive. This is one of the many myths that science constantly tries to disarm. It is true that during lactation there is an inhibitory effect on ovulation, but there is no way to know for sure that ovulation hasn’t happened. There are many factors that influence its effectiveness, so it is not a recommendable method either.

Once you have all the information about the different methods available and their functioning and characteristics, it depends on the circumstances and preferences of each person to know what their optimal method is. To be sure that your choice is the most appropriate one and to obtain personalised advice, it is ideal to visit a health professional regularly, in the women’s case to the gynaecologist.

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