What is birth control, and why should you care?
Birth control (contraception) is any method used to reduce the likelihood of pregnancy as a result of intercourse or other sexual contact. Because pregnancy is a condition solely known to women (and pre-op trans men), the choice to maintain or terminate a pregnancy belongs to the woman (trans man). It is up to you to educate yourself about your sexuality and to choose what level of risk you are willing to accept when having sex with other people. To maintain your rightful autonomy as a fellow human being, you should not allow anyone else to tell you how to control or make decisions about your body. You may consider their advice, but ultimately, pregnancy and engagement in/abstinence from sex are your choices to make.
What are STIs (also known as STDs)?
STI stands for sexually-transmitted infection. STD stands for sexually-transmitted disease. Most venereal infections are easily treated and cured, or at the very least managed. As a result, medical professionals now prefer to use the term “STI” because less stigma surrounds the term infection than the term disease (UC Berkeley Sexual Health Education Program; Boston Women’s Health Book Collective 275). Check out this infographic from the Center for Disease Control for an easy summary of the latest statistics for STIs in the US.
For specific questions you might have when landing on this page, please scroll to the FAQ sections at the bottom.
|Male condoms, also known as “rubbers,” “prophylactics,” or “safes.” The male condom is one of only two types of contraception that also provides STI protection.
Methods of Contraception & Their Efficacy Statistics
Non-barrier Methods & Their Efficacy Statistics
Non-barrier methods are any form of contraception that involves a hormonal or chemical change to prevent pregnancy in the woman’s body.
|Hormonal release vaginal ring
||Insert the flexible ring once per month and leave in for 3 weeks. Take out for the fourth week to have your period. Using the ring this way provides a month of complete birth control.
||99% when used perfectly
|Hormonal birth control (“the Pill”)
||Most popular type of birth control. Comes in packs of either 28 or 21 pills. In the 28-pill packs, there are 21 active pills and 7 inert pills. You must take your birth control pill at the same time every day in order for it to be effective. The pill packs come with instructions should you miss one, two, three, or more pills in a month. If you miss two or more pills in a month, you need to use a backup method until you get back on track with the pill schedule (might take as much as long as 7 days to restore). When you start taking the pill, there is a wait time of at least one month from when you start taking the pill packs for it to be an effective form of birth control.
||99% effective when used perfectly; 95% with typical use
|Mini-pills (progestin-only oral contraceptives)
||These pills come in packs of 28 pills and do not contain estrogen. These are convenient because they avoid the side effects that taking estrogen orally can cause.
||98-99% effective with perfect use; 95% with typical use; 100% effective with nursing women without affecting milk supply
||A Can be made of copper (non-hormonal; trade name is Paraguard) or can be plastic with hormonal release (Mirena, Skyla). Inserted at the doctor’s office or at a clinic. Paraguard lasts up to 10 years and is the largest. Mirena is slightly smaller and lasts up to 5 years; Skyla is the smallest and easiest to insert and lasts up to 3 years.
||Can also be inserted within 7 days after unprotected intercourse to reduce risk of pregnancy to 1% (99% effective).
|Hormonal release suppository (implant) in arm
||Soft, hormone-filled capsules that are inserted under skin in upper arm area. Prevents ovulation and cervical fluid thickening, preventing sperm from getting into the uterus. Safe, long-term, reversible option. Types: Norplant-2 [Jadelle] (lasts up to 5 years), Implanon (lasts 3 years)
||99% effective, talk with doctor about potential side effects.
|Hormonal release contraceptive patch
||Applied to the abdomen, buttocks, upper arm, or upper torso. Changed every week for three weeks, left off for one week, and then resumed. Combination hormones (estrogen + progestin)
||99% effective in women under 198 lbs when used perfectly; less effective for women at higher weights
||This can come in a variety of forms, but all of them include the active ingredient Nonoxynol-9: canned foam, cream, jelly, vaginal contraceptive film (VCF), suppositories. The disadvantage of Nonoxynol-9 is that it actually increases the rate of HIV transmission in people who use it relative to non-users. May cause an irritation, rash, or itchiness if you or your partner are allergic to any of the ingredients in spermicide.
||94% effective when used perfectly; only 74% effective with typical use
|Monthly injection (Lunelle)
||Can be injected into the arm, thigh, or hip. Not available in the US as of 2004.
|Three-month shot (Depo-provera)
||Injection scheduled for every 3 months, given in arm or buttock. High level of progestin.
|Female Sterilization (tubal ligation)
||A surgery that closes the fallopian tubes. This stops the egg from traveling to the uterus from the overy. The tubes are cut, burned or blocked with rings, bands, or clips. The surgery is immediately effective. Performed in a doctor’s office, clinic, or hospital, using general anesthesia.
|Male Sterilization (vasectomy)
||A minor surgery that severs the vas deferentia, the tubes that carry sperm from testes to penis; keeps the sperm from getting mixed into semen. It is possible to reverse within the first 5 years of the procedure, but should ultimately be considered a permanent form of birth control since the success rate of reversal is only ~30%.
||>99% as long as you wait a month after the procedure to start having sex without a backup method
|Experimental male “Pill”
||Not available yet, undergoing trials in 2018
||Not available yet, undergoing trials in 2018
|Withdrawal (“pulling out”)
||Removing the penis from the vagina just before ejaculation so that the sperm gets deposited outside the vagina and away from vaginal lips. However, precum (pre-ejaculate) can contain enough sperm to induce a pregnancy, so this method is widely seen as ineffective. This is a male-controlled form of birth control, which may leave the woman feeling very out-of-control and unsafe. It may keep the woman from enjoying sex due to fear of mistakes. Some men can’t tell when they’re about to ejaculate, so they don’t pull out in time to avoid getting sperm in the vagina.
||81-96% depending on how perfectly it is done; 81% with typical use.
|Emergency contraception (“morning after pill,” “Preven,” “Plan B,” “EC pill,” or “combined EC pill”)
||Use in any of the following situations:
- “The condom broke.”
- “I didn’t think we were going to have sex.”
- “I didn’t realize that I had forgotten to take my pill.”
- “I was raped.”
Take emergency contraception up to 72 hours after unprotected sex. The sooner you take the emergency contraception after having unprotected sex, the more likely it is to work at preventing pregnancy. You can buy this at any local drugstore (e.g., Walgreen’s, CVS, RiteAid) by asking for it from the cashier or pharmacist.
|75-89% if initiated within 72 hours of unprotected intercourse; can be initiated within 120 hours of unprotected intercourse
||Usually doesn’t work with partners who spend a lot of time together in a sexually-charged mood or setting. However, it does allow an opportunity to experience erotic pleasure with a partner as long as both parties agree beforehand that penile-vaginal penetration will not be part of the activities. Requires clear communication and agreement prior to initiating non-penetrative sexual activities.
||100% effective when actually practiced
|Fertility awareness method (FAM)
||Requires a lot of attention to and awareness of one’s own body, including taking your waking temperature, spotting any cervical fluid, and identifying your cervical position every day. Requires meticulous charting of these fertility signs to determine whether or not you are fertile on any given day. More effective than the “rhythm” calendar method.
||91-99% effective when done perfectly; 75% effective with typical use
|Breastfeeding as birth control
||Inhibits ovulation when breastfeeding is done in a certain way. Frequency of feedings, whether your baby uses a pacifier, whether or not liquid/food other than breast milk is given to baby, and even taking a daily nap with baby can all influence your fertility using this method. You can use the Lactation Amenorrhea Method during the first 6 months of breastfeeding if:
- Your menses haven’t come back since you gave birth
- Your baby is under 6 mos old, and
- You are fully or nearly fully breastfeeding.
|99% following the LAM method (see Description)
Source: Chapter 18, “Birth Control.” Our Bodies, Ourselves.
Barrier Methods & Their Efficacy Statistics
Barrier methods are any form of contraception that involves physically blocking the sperm from the egg to avoid fertilization. The effectiveness of barrier methods varies a lot depending on how consistently and accurately they are used. Barrier methods have the advantage of not causing as many side effects as the non-barrier methods (e.g., sensitivities, hormonal changes, immune responses, etc).
||A latex (or PU plastic blend) sheath that fits over an erect penis and keeps the sperm from getting out into the woman’s body. Comes in a foil packet. Keep out of sunlight and make sure that your pocket or wallet doesn’t have any way to puncture the package. Puncturing the package or keeping it in the light will damage the condom, making it less effective or even ineffective. Latex condoms are shown to be more resistant to breakage than PU condoms. Note that condoms are intended for one-time use. After you use one condom for a sex act, you should dispose of it and open a new one. Condoms cannot be sanitized. Although a condom goes on a penis, carry condoms with you at all times.
||87-98% when used consistently and correctly for every sex act
||Also intended for single use only. Push the back inner ring into vagina and back and up towards cervix. The front will lay on the outside of the vagina, over the labia. When the penis is erect, guide the penis into the female condom so that it doesn’t get pushed aside while you’re trying to have sex.
||95% when used consistently and correctly for every sex act
||A thimble-shaped rubber or silicone cap that snugly fits over the cervix. Held in place by suction. Fill the cap with spermicidal jelly before use. May need a fitting appointment at a clinic. Can be inserted up to 6 hours before sex. Some types can be left in for up to 3 days at a time, allowing for greater sexual spontaneity.
||A shallow, dome-shaped, soft rubber cup that has been fitted to you by a doctor/clinician to securely cover the cervix. Place spermicidal jelly (cream) in the cup to kill or immobilize sperm. This will keep the sperm from reaching the egg. There are three types of fittings (flat, arcing, or domed). Choose the one that fits your anatomy by consulting the doctor or clinician during the fitting appointment. Can insert up to 6 hours before sex.
||94-98% when used properly and consistently; 80% effective with typical (non-vigilant and non-proactive) use
Source: Chapter 18, “Birth Control.” Our Bodies, Ourselves.
The bottom line: Talk with your partner(s) about STI protection before having sex. The greatest love and respect you can show for yourself and your partner(s) is to be open and honest about what you all feel comfortable with regarding sexual health risks, safer sex practices, and contraception.
STI Protection FAQ
- I can’t actually get pregnant. Should I still use STI protection?
Yes! You should use protection (condoms or dental dams) even when you have no reason to conceive (e.g., confirmed infertile, sterile, or trans pre- or post-op). This will greatly reduce your chances of getting a STI.
- Should we use a condom or dental dam when performing oral sex on a partner?
Yes. This is the safest form of either kind of oral sex.
- Where can I go to get free or low-cost STI testing?
Look for a Planned Parenthood or free sexual or women’s health clinic in your area. You may have to travel a bit to reach it, but it is definitely worth your time to go. I’ve compiled a Google Maps result localized to your region here.
- I had sex with an untested partner. What is the likelihood I would have gotten any STIs?
You can look through the statistics at the Center for Disease Control Web site.
- What kind of testing should I ask my doctor for to make sure I don’t give anything to my partners?
Doctors are notorious for not recommending HSV-1 and -2 (herpes) testing, which is why these viruses are so widespread among sexually active people. You should really ask your doctor to add AT LEAST HIV/AIDS, HSV-1 and -2, gonorrhea, and chlamydia to the test panel order. This will give you the cleanest and clearest picture to your test results so that you can ensure you get proper treatment and can be transparent with your partners.
- Should I trust my sex partner to have my best interest when it comes to protection and contraception?
You should never trust your partner above your own ideas and intuition regarding your body and your sexual health. It is your responsibility to ensure that you communicate with your partner about the level of risk you are will to accept before initiating sex with them.
- I’m a teenager and all of my friends are having sex. What should I do?
You should only start experimenting with sex when YOU feel that it is the right time. It does not matter what any of your friends are doing; only what will satisfy you and make you feel like you’ve done right by yourself. Sex has consequences, just like any major decision. Consider the many consequences that will result from deciding to have sex before you agree to engage in it.
Some example questions to ask yourself:
- Do I feel ready to start having sex?
- Why do I want to start having sex?
- With whom do I want to have sex for the first time? Why?
- Do I feel in love/safe around/sure about the person I’d like to have sex with for the first time?
- Is self-pleasure (masturbation) enough for me right now, or do I really feel a need to experience partner sex at this time?
- What would be the worst that could happen if I started having sex using safer sex methods?
- What would be the best that could happen?
- What would having sex do to my standing or reputation with others? Would I potentially jeopardize my status in my religious or other community? Does that matter to me?
- Do I feel like I know enough about my own body, the process of pregnancy, methods of contraception, and how to protect against and treat for STIs that I will not harm myself or my future by starting to have sex?
- Could I wait a bit longer? What’s the worst that could happen if I waited till x time? (x = college, after college graduation, after grad school, after graduating high school, till marriage, etc.)
- I’m a teenager who feels ready to start having sex. How should I proceed?
First of all, equip yourself with the knowledge you need to feel like the sex you are going to engage in is in agreement with the level of risk you are willing to accept. Are you ready to accept the consequences of becoming a sexually active person? Have you considered how this will affect your future as a now sexually active person?
Have you Googled enough to feel safe and like you have a plan for getting protection, treatment, etc? What is your contingency plan if you somehow still manage to become pregnant or get a STI? Do you have the funds you need to take care of that should that issue arise?
You may want to talk to an adult whom you trust – perhaps a pastor, school counselor, therapist, older sibling, cousin, parent/guardian, role model, or parental figure. Since they are older than you, they can provide more perspective about the consequences you are trying to judge before engaging in this new life decision. You’ll probably need to get multiple perspectives.
Are you ready to have safer sex conversations and lay out boundaries with the person(s) you intend to start having sex with? If you find this too difficult or gross, maybe you shouldn’t be having sex yet. Sex is a mature behavior, and you must be mature about communicating about sex. The conversation should not be pressuring but rather open, clear, honest, and direct.
- I’m feeling a spasming pain where I pee. I may have experienced incontinence, and it really hurts to pee right now. What is going on?
You are likely suffering from a urinary tract infection (UTI). This is very common for women to develop after having sex with a new sex partner. Foreign bacteria from the anus, penis, and/or mouth or fingers gets trapped in the urethra and multiplies quickly, creating an infection there. The urethra swells due to inflammation, creating the spasming or painful sensation upon urinating.
What to do if you think you have a UTI:
Don’t panic, but you will need to get antibiotics. You will need to see a doctor in the next day or two to get the right kinds of antibiotics to cure your infection. The doctor will also be able to select an antibiotic that you neither are allergic to nor will experience negative interactions with any other prescription medications you might be taking. You MUST finish the entire prescription for the antibiotics to be effective. If you stop once you start feeling better and don’t finish the whole pack, you put yourself at great risk for developing an antibiotic-resistant infection which is much more serious and much more difficult to treat. You also MUST see the doctor within the first day or two that you recognize that you are experiencing UTI symptoms to avoid allowing the infection to spread into your bladder and kidneys. Bladder and kidney infections are also much more serious to treat and may require hospitalization to resolve.
Note that you likely want to consume probiotic yogurt (yes- there are actually vegan options for this too!) to promote the growth of “healthy” bacteria that normally flourish in your bladder, urethra, and kidneys while you are simultaneously taking antibiotics to kill off the “foreign” bacteria.
Ways to avoid getting a UTI:
- Urinate immediately after sex (10 min up to an hour after sex). The flow of urine will push out much of the harmful bacteria, keeping them from surviving and reproducing in the urethra.
- Drink cranberry juice or take Azo Cranberry tablets. Take either 1 glass or 2 caplets per day with water. Try to avoid sugary cranberry drinks, since sugar feeds bacteria. Go to your local Whole Foods or Sprouts to get the juice that is literally just cranberry juice and water. You can further dilute it, add other fruit juice to it, or add erythritol, Splenda, or stevia to the juice to sweeten it and make it tolerable.
- Drink lots of water each day. Choose water over sugary drinks, caffeinated, or carbonated beverages.
- Avoid caffeinated or carbonated beverages (e.g., energy drinks, coffee, tea, soda, diet soda). These types of drinks irritate the urinary tract and make it harder to heal the infection.
- Should I use a female condom with a male condom for double protection?
Although it may sound like a good idea to have “double-protection,” really what happens when you combine a male condom with a female condom is that you create too much friction by rubbing the two condoms together, increasing the likelihood of a tear. You should just pick one or the other, never both at the same time.
- Can I use any lube with my toys or condoms?
You should only use water-based lube with toys or condoms, since they will dissolve in the presence of silicone-based lubes. Silicone-based lubes will eat away at the finish on your toys, making them impossible to sanitize over time.
- Should I use a condom on my toys?
You really should not buy toys that are made of either toxic or porous materials. In the which case, if you’re purchasing body-safe toys, you will have purchased a medical-grade silicon, stainless steel, or glass toy. You should not need a condom with any of these because these materials are all non-porous. This means that you can completely sterilize them by boiling them in a pot of water on the stove for about 10-15 min.
References for more information about safe versus unsafe toys: toxic toys, porous toys, and this LikeAFemmeBoss.com article (coming soon).
- I just had unprotected sex. How can I reduce my likelihood of getting pregnant?
You can take emergency contraception (“morning after,” “Preven,” “Plan B,” “EC pill,” or “combined EC pill”) up to 72 hours after unprotected sex. The sooner you take the emergency contraception after having unprotected sex, the more likely it is to work at preventing pregnancy. You can buy this at any local drugstore (e.g., Walgreen’s, CVS, RiteAid) by asking for it from the cashier or pharmacist.
- I just missed my period. How do I know if I’m pregnant?
You should purchase a pregnancy test from your local drugstore (e.g., Walgreen’s, CVS, RiteAid) by asking for it from the cashier or pharmacist. A pregnancy test requires you to urinate on the “brush” side of the stick that comes in the package. Your urine will contain hormones that are only present during pregnancy, which is why this test works.
- I just missed my period. What can I take to reduce my likelihood of keeping a pregnancy?
As soon as you determine that you’ve missed your period, you can take Vitamin C (ascorbic acid) tablets that do not contain the stabilization agent you normally find in the tablets you get at the drugstore. Raw Vitamin C has been shown to cause spontaneous abortion in some women by causing menstrual extraction, keeping the zygote (egg + sperm) from being able to implant in the uterine lining. You can read more about this here or check out this book.
- I just found out I’m pregnant, but I’m not in a position to be able to bear or raise a child. What can I do?
You can call or visit a Planned Parenthood near you to schedule an appointment to talk with one of their counselors and/or to schedule an abortion. Planned Parenthood has many different options for dealing with this exact situation, and they can give you the information you need to make the best decision for your own life.
- I just found out I’m pregnant, and I don’t have a Planned Parenthood or other abortion clinic nearby and I know that I need to terminate the pregnancy. What can I do?
Schedule an appointment with the nearest clinic you can find. You may need to book a flight or borrow a car to get there. It’s very important that you take action on this very quickly, since the window between knowing you’re pregnant and when it is no longer legal to have an abortion performed is only about 4 weeks. You may need to ask a friend or family member for financial or other help to make this happen. Know that what you decide to do with your body is your choice. No one else has to live with the consequences except you – therefore they should have no say.
In the meantime between scheduling the appointment and travel arrangements and actually getting to the appointment, you can take Vitamin C (ascorbic acid) tablets that do not contain the stabilization agent you normally find in the tablets you get at the drugstore. Raw Vitamin C has been shown to cause spontaneous abortion and can also keep the zygote (egg + sperm) from implanting in the uterine lining. This prevents pregnancy.
- Where can I get contraception?
From the Planned Parenthood Web site:
“You can get birth control pills at drugstores, health clinics, or Planned Parenthood health centers.
You need a prescription for birth control pills. You can get a prescription from a private doctor or nurse, a health clinic, or your nearest Planned Parenthood health center. In a few states, you may even be able to get a prescription online.
During your visit, a nurse or doctor will talk with you about your medical history, check your blood pressure, and give you whatever medical exam you may need. Most people don’t need pelvic exams in order to get birth control pills. Your nurse or doctor will help you decide what you need based on your medical history.”
- Where can I buy emergency contraception?
You can buy this at any local drugstore (e.g., Walgreen’s, CVS, RiteAid) by asking for it from the cashier or pharmacist. **Remember: the sooner you take the emergency contraception after having unprotected sex (within 72 hours of unprotected sex), the more likely it is to work at preventing pregnancy.
- Boston Women’s Health Book Collective. Our Bodies, Ourselves: A New Edition for a New Era. New York: Touchstone, 2005.
- UC Berkeley Sexual Health Education Program Resources and Web site.
- Stevie Boebi‘s YouTube Channel.
- Arielle Scarcella‘s YouTube Channel.
- Planned Parenthood Web site.
Hannah Stringfellow is a freelance blogger and world traveler. She holds an M.S., Chemistry, from the University of California, Berkeley. Her interests include women’s empowerment, health and wellness, and cross-cultural competency.