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Women's Health

Safer Sexual Practices and Birth Control Methods

NetWellness receives many questions about safe sex and birth control.

Safe Sex

Safer sex is a term that means to reduce your risk of exposure to a sexually transmitted infection. You can do this by limiting the number of partners you come into contact with. However, the term "safe sex" is a bit of a misnomer. There is always the risk of contracting a sexually transmitted infection because you can't guarantee the fidelity of your partner. The risks of a sexually transmitted infection range from the mild: itching, burning or discharge to the more severe: infertility, chronic pain or death.

What You Can Do

Birth Control

There are many different options now available to protect against unplanned pregnancy. Each method of protection has its own pros and cons which are listed below. Talk to your healthcare provider about your options and what is best for you.

Combination Hormonal Methods are those methods that contains hormones that prevent pregnancy by preventing ovulation. It can be taken as a daily pill, weekly skin patch or monthly vaginal ring.

Pros: 97 to 99% effective (typical versus perfect use) at preventing pregnancy. Regulates menstrual cycle and decreases likelihood of cramps. Provides protection against ovarian and endometrial cancers, pelvic inflammatory disease, non-cancerous growths of the breast, ovarian cysts, acne and may protect against osteoporosis (thinning of the bones).

Cons: Does not protect against sexually transmitted infections and diseases. The pill requires daily use and must be taken as close to the same time as possible. The patch is not discrete as it can be seen. The vaginal ring is not generally felt by the patient and rarely by her partner. Women who use this method may be at a slightly higher risk for heart attack, stroke and blood clots.

Progesterone Only Pills are similar to the combination pills except that they only contain progesterone. It can prevent ovulation, but primarily works by thickening the cervical mucous and preventing sperm from asending into the upper reproductive tract.

Pros: 97% to 99% effective (typical versus perfect use.) Acceptible to women who can't take an estrogen because of other medical conditions. Prevents uterine cancer. No increased risk of blood clots, strokes or heartattack.

Cons: Does not protect against sexually transmitted infections and diseases. Must be taken at the same time every day. Greater chance of irregular bleeding or no bleeding.

Male Condom is a sheath made of latex, polyurethane or rubber that covers the penis before intercourse to prevent sperm from entering the female reproductive tract.

Pros: 88 - 98% effective (typical versus perfect use) at preventing pregnancy when used correctly with every act of vaginal intercourse. Provides protection against most sexually transmitted infections. Condoms are easy to buy and are relatively inexpensive.

Cons: Some people are allergic to latex and/or spermicide contained in many condoms. Some partners make dislike using condoms. Condoms can break. It requires motivation since it can only be applied immediately before the act of intercourse when many couples lack the motivation to interrupt foreplay to place a condom.

Female Condom is a latex or polyurethane pouch inserted into a woman's vagina before vaginal intercourse that prevents sperm from entering the female upper reproductive tract.

Pros: 82-94% effective (typical versus perfect use) at preventing pregnancy. Provides protection against sexually transmitted infections. May be used by women whose partners may be unwilling to use male condoms. May be used by those with allergies to latex. Easy to buy and relatively inexpensive

Cons: May be difficult to insert correctly. May slip inside vagina during intercourse. The polyurethane may make noise during intercourse.

Depo-Provera® is an injection (shot) of the hormone progestin given to a woman every 12 weeks. This hormone prevents the release of an egg, and thickens cervical mucus preventing the entry of sperm into the uterus.

Pros: 99.7% effective (typical and perfect use) at preventing pregnancy. No daily medication or hormone to take. Protects against pregnancy for 12 weeks. Can be used by some women who cannot take estrogen containing birth control methods. Protects against cancer of the lining of the uterus and iron deficiency anemia. Many women have changes in their monthly periods, which can include missing periods.

Cons: Not effective at preventing against sexually transmitted infections and diseases. Side effects may include weight gain and irregular bleeding. Return to fertility may be delayed as long as twelve months after last shot.

Diaphragm or Cervical Cap is a shallow latex cup (diaphragm) or a thimble-shaped latex cap (cervical cap). This cap is placed over the cervix to prevent sperm from entering the upper reproductive tract. These methods are used along with spermicidal cream or jelly. These methods must be left in place for 4 hours after intercourse.

Pros: Diaphragms and cervical caps are 82-94% effective (typical versus perfect use) against pregnancy when used correctly with every act of vaginal intercourse. Because both diaphragm and cervical cap can last for many years, they are very inexpensive .Women who cannot use hormonal methods of birth control can usually use one of these methods.

Cons: Does not protect well against sexually transmitted infections and diseases although it does decrease the incidence. Should not be used by women who have latex allergies as there may be some irritation. The diaphragm can increase the risk of urinary tract infections, and may only be left in place for 24 hours. They can't be place more than 6 hours prior to the act of intercourse.

Emergency Contraception (or EC) is medication taken by a woman up to 72 hours after unprotected vaginal intercourse. The mechanism of action by which EC works may include altering the function of the fallopian tube, hormonal levels or preventing a fertilized egg from implanting in the uterus. It can be effective up to 5 days after unprotected sex and should therefore should not be refused to women greater than 72 hours but less than 5 days.

Pros: EC is –93-98% effective at preventing pregnancy. The sooner a woman starts EC, the more effective it may be. Taking EC will not effect a current pregnancy.

Cons: EC does not provide any protection against sexually transmitted infections and diseases. Nausea, vomiting, and cramping are common side effects of EC, although women who use Plan Bâ experience these side effects less frequently. Dosage involves taking a single pill as soon as possible after unprotected vaginal intercourse, and taking a second pill 12 hours later, making timing important. EC is not effective at stopping a pregnancy that has already implanted in the uterus.

Fertility Awareness (also known as periodic abstinence) involves monitoring a woman's physical signs to predict times of fertility and avoiding intercourse or using another method of birth control during "unsafe" times. Predicting fertility includes checking body temperature daily with a basal thermometer daily checking of cervical mucus or timing of the calendar.

Pros: 80-99% effective (typical versus perfect use) at preventing pregnancy. Low cost. Avoids use of medication or hormones.

Cons: Provides no protection against sexually transmitted infections and diseases. Requires months of practice before effective use. May lead to risk-taking during "unsafe' times. Many things such as illness may affect body temperature, leading to inaccurate planning. Women who have irregular periods may not be able to use this method effectively.

IUD (Intrauterine Device) is a small plastic device placed in the uterus. The IUD contains copper or hormones that keep sperm from joining an egg either by creating an intrauterine environment that is hostile to sperm (copper) or by thickening the cervical mucous and preventing sperm from entering the uterus. It can also prevent inplantation of a fertilized egg, but this is rarely the mechanism for its action.

Pros: 97.4-99.2% effective. IUDs may be kept in place for 1-10 years depending on the type of IUD. No daily pills to take. Some IUDs may help reduce menstrual cramps and the amount of menstrual bleeding. Immediately reversible.

Cons: IUDs are not effective protection against sexually transmitted infections and diseases. Some women experience an increase in cramps, spotting between periods or heavier and longer periods (primarily with copper). Pregnancies, which rarely occur, are more likely to be ectopic (in fallopian tubes).

Spermicide is a cream, film, jelly, foam or suppository that is inserted into a woman's vagina before having vaginal intercourse. Spermicide contains medications that immobilize and kill sperm, preventing them from joining an egg.

Pros: 79-93% effective (typical versus perfect use) at preventing pregnancy. Easy to buy in supermarkets, drugstores, etc. May provide some protection against sexually transmitted infections.

Cons: These products are not effective protection against sexually transmitted infections and diseases. Spermicide can be messy. Some people are allergic to it. It may irritate vagina or penis - which may increase risk of infection. Requires interruption in foreplay for proper use. This lends to its higher failure rate for less motivated users.

Sterilization occurs when a man or woman have an operation to prevent the sperm from joining an egg. This includes:

Pros: 99.5 – 99.9% effective at preventing pregnancy. Permanent method of birth control without any lasting side effects for women or men.

Cons: Not effective at protecting against sexually transmitted infections and diseases. Reversibility cannot be guaranteed. Rarely, tubes reopen, allowing pregnancy to occur, and these pregnancies are more likely to be ectopic (occur in the fallopian tube). Typical risks from having surgery.

Outercourse is any form of sexual pleasure or stimulation between partners that does not include insertion of the penis into the vagina, anus, or mouth. Activities may include masturbation, erotic massage, rubbing together of body parts, and erotic fantasy.

Pros: Nearly 100% effective at preventing pregnancy. Can be effective at preventing sexually transmitted infections if no bodily fluids are exchanged. Avoids the use of medications or hormones. No financial cost.

Cons: People often forget to protect themselves against pregnancy or sexually transmitted infections and diseases if intercourse takes place. It may be difficult for many people to abstain from vaginal intercourse for long periods of time.

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Last Reviewed: Feb 23, 2009

Thomas  A deHoop, MD Thomas A deHoop, MD
Formerly Associate Professor of Clinical Obstetrics and Gynecology
Director, Medical Student Education
No longer associated