Birth Control Methods: Facts about Pills, Gels, Vasectomy, Condoms, Rings, etc.
August 24, 2008 – 10:35 pmBirth Control Portraits
Brian and Cindy feel they are not ready to have their first child and are looking for a safe and reliable contraceptive. Knowing there is some theological controversy about birth control, they come to you in pursuit of accurate information and guidance.
Dana and her husband have four kids, and are expecting another one soon. And they could not be happier. They feel that God will give them as many kids as He wants, and they are not to tamper with God’s plan for their family.
Jenny had a good night last night, maybe too good. Thinking she might become pregnant, she looks into the newer Plan B method of birth control.
Definitions and Key thoughts
Birth control and family planning can involve a difficult set of decisions for couples
There are many methods of birth control that can be considered. The following is only a very brief overview. As a counselor, if you will be dealing with this issue regularly, you will need to keep abreast of relevant medical trends and advances as they appear (and in this field changes and advances do happen regularly).
Some basic advice to give to the couple is that no contraceptive is 100% effective all the time (except abstinence or surgery). However, many are quite good when used properly and the greatest number of contraceptive failures occur when the methods are used carelessly or improperly.
The following details some common contraception options for couples:
Barrier Methods
Male condoms. Male condoms are the most common type of barrier contraception. Most commonly, condoms are made of latex or polyurethane (though ‘natural’ pigskin and new synthetic materials do exist). Latex condoms are the most popular, being the most affordable and very effective. It should be noted that latex condoms can only be used with water based lubricants—not oil based lubricants as they harm the integrity of the latex. In addition, a small number of people have an allergic reaction to latex.
Polyurethane condoms are becoming widely available. These condoms are thinner and transmit heat more readily that latex condoms, making intercourse feel more natural. It is not clear which are stroger—latex or polyurethane condoms, though some studies suggest neither is more likely to break. However, others claim that since polyurethane condoms stretch less than latex condoms, there is an increased chance of breakage or slippage if a condom is sized too tight or too loose. Also, both oil and water based lubricants can be used with polyurethane condoms.
Condoms are probably the least enjoyable method of contraception for most men and many women. Condom size (width and length) affects both comfort and effectiveness. To be most effective, condoms should be put on before there is any genital contact. After ejaculation, during intercourse, the penis must be withdrawn before any loss of erection, and the base of the condom needs to be held in place during withdrawal.
Recent studies have found that sexually active women who use condoms have a higher rate of depression than sexually active women who do not use condoms (2). There is a current theory that semen may function as an antidepressant when absorbed by a woman’s vagina.(3)
Female condoms. The female condom has been available in Europe since 1992 and it was approved by the US Food and Drug Administration (FDA) in 1993. The female condom is a polyurethane sheath about 6.5 inches in length that is worn by a woman during sex. It lines the vagina and it helps to prevent pregnancy and sexually transmitted diseases (STDs). Female condoms have about twice the failure rate of male condoms, though are thought to be better at protecting women from STDs. At each end of the condom is a flexible ring. The closed end of the sheath, which has a slightly smaller ring, is inserted into the vagina to hold the prophylactic in place. At the other/open end of the condom, the ring stays outside the entrance to the vagina to act as a guide during penetration and to prevent the sheath from bunching up inside the vagina. Since the condom does not move with the penis the sensation is more natural and enjoyable for the man, than male condom. However, some women find female condoms uncomfortable. Note: The female condom should not be used with a male condom because the friction between the two condoms may cause them to break. For more information on the female condom visit www.avert.org.
Diaphragms, Cervical Caps, and Shields. Diaphragms, cervical caps, and shields are all similar in that they are all inserted into the vagina before sex, and cover a woman’s cervix to prevent the union of sperm and egg.
- A Diaphragm is a shallow, dome shaped cup with a flexible rim.
- A Cervical Cap is a silicone cup shaped like a sailor’s hat. It is smaller in diameter than a diaphragm though still fits securely to cover the cervix.
- A shield (e.g., Lea’s Shield) is a silicone cup similar to a cap, with an air valve and a tab to aid in removal.
Each method must be used with spermicidal cream or jelly. The spermicidal ingredient kills sperm, while the inserted device prevents sperm from entering the woman’s cervix.
Diaphragms, caps and shields are reusable items that must be fitted to the woman’s body by a doctor. A new fitting is required if the woman gains or loses weight, or has a vaginal birth. Moreover, caps are more difficult to fit in women who have given birth, and failure rates are higher. Accordingly, Sixteen out of 100 women who use a diaphragm will become pregnant during the first year of typical use. Fourteen out of 100 women who have never been pregnant and use a cervical cap (FemCap brand) will become pregnant during the first year of typical use. 29 of 100 women who have given birth vaginally and use FemCap will become pregnant during the first year of typical use. Fifteen out of 100 women who use the shield will become pregnant during the first year of typical use (4).
Regarding user satisfaction, some people find using diaphragm, cap or shield to be a major interruption before sex, while others see it as a minor issue. Once in place, these methods are very comfortable for both the man and the woman, as neither should be aware of the product during intercourse. (5)
Sponges: Made infamous by a Seinfeld episode, the contraceptive sponge is a doughnut shaped piece of polyurethane foam containing spermicide that is inserted into the vagina and placed over the cervix. Because of the spermacide, sponges work both as a block and by killing sperm. Similar to diaphragms and caps, a sponge can be left in place for 24 hours and is good for multiple acts of intercourse (though more spermacide may need to be applied). Also similar to caps, the sponge must be left in the vagina for 6 hours after the last act of intercourse. On the negative side, some men claim they can feel the sponge, or its removal tab, during intercourse. Also, the failure rate with sponges is high: 9% for women who have not had a child, and up to 20% for women who have. Note: In 1995, the Today® Sponge was removed from the US market by its manufacturer. However, according to the Today® Sponge website; “The Sponge is Back! The Today® Sponge, once the most popular over-the-counter female contraceptive, has won re-approval for marketing in the U.S. and Canada. Soon it will be available in the UK and the EU.” For more information visit www.todaysponge.com.
Hormonal Methods
Pills. Birth control pills, despite their widespread use are quite controversial for some Christians. This is because, while some birth control pills (as well as the other hormonal contraceptives listed below) prevent fertilization of an egg, others prevent implantation on a fertilized egg (which to some is sacred life). To further complicate the topic, with some hormonal methods, there is considerable debate about which prevent fertilization, and which prevent implantation. Basically, all hormonal methods of contraception contain a progestin, a synthetic form of progesterone (that prevents implantation), and some also contain a synthetic estrogen (that prevents ovulation/fertilization). These two chemicals are presented in different amounts and strengths depending on the contraceptive being used.
There are two common types of birth control pills, progestin only pills (POPs) and combined oral contraceptives (COCs) that contain both progestin and estrogen. POPs allow ovulation at least some of the time. This means that fertilization is possible, while implantation is inhibited. Therefore, if a person understands life to begin at fertilization, POPs are a poor choice. In contrast, COCs are so effective at preventing ovulation that fertilization cannot occur. Theoretically, the progestin in the pills could interfere with implantation, but if fertilization never occurs this is irrelevant. Hence, COCs should be an acceptable form of contraception, even for couples that believe life begins at fertilization.
The Birth Control Shot. The birth contron shot, also know as Combined Injectable Contraceptives, are injections that are given monthly. This method is gaining populatiry because of the ease of use (one does not need to remember to take a daily pill), low side effects, and efficacy of the contraceptive. CIC’s contains both estrogen and progestin, and it’s likely that they are very effective at preventing ovulation, but because of the newness of CICs conclusive data is not available. (6)
Implants: Implants consist of about 6 match-sized tubes containing progesterone that are surgically inserted, by a physician, under the skin in a woman’s upper arm. The rods slowly release progesterone into the woman’s blood stream. Even though this method is progestin only, which thins the uterine lining making implantation impossible, because the delivery system provides a constant secretion of the progesterone hormone, ovulation is fully suppressed. Therefore, fertilization cannot occur. Implants, in general, work for between 3 to 5 years. They are 99% effective, and are literally user-error free. Also, the cost of an implant is quite reasonable at 450-900 dollars, for 5 years, as well as a removal charge of around 100-300 dollars. After an implant is removed, women generally experience a fairly quick return of fertility.
The Ring: The ring method, the most popular being NuvaRing ®, is a flexible circle of about two inches in diameter which is worn in the vagina for three weeks each month, then removed for one week (in which menstruation usually takes place). The ring is not felt by the women once inserted, and most men report they cannot feel the ring during intercourse. The hormones contained within the ring, which are a combination of estrogen and progestin, are absorbed directly into the blood stream through the vaginal wall. This method is very effective at preventing ovulation. In addition, with the use of the NuvaRing the uterine lining also becomes thinner than usual, which would inhibit implantation of a fertilized egg—if an egg were to become fertilized.
The patch: Patches are becoming increasingly popular for many kinds of medication, from smoking cessation meds to antidepressants. Their popularity is rooted in the possibility of receiving medication in a convenient form, with less chance of missing a dose. With a birth control patch, the woman wears a small patch of approximately 1 inch, for about 3 weeks a month. From this patch the same hormones from traditional pill contraceptives are delivered into the woman’s body.
Plan B® (levonorgestrel) prevents pregnancy (by 89%) if taken within three days of intercourse, though efficacy increases the sooner the pill is taken after intercourse. Though it is intended to be used after intercourse has occurred Plan B® is not RU-486 (the abortion pill); it will not work if one is already pregnant. Still, because the method destroys fertilized eggs, the method has been widely condemned by Christians. However, there is growing scientific evidence that Plan B stops ovulation, but does not have any effect on a fertilized egg.(7) Plan B® is considered an emergency contraceptive that can prevent a pregnancy after contraceptive failure (such as forgetting to take a pill, or having a condom break), unprotected sex, or sexual assault. You can learn more about Plan B by visiting their website at www.goplanb.com.
Intrauterine Device: An Intrauterine Device (IUD) is a small object that is placed in the uterus to prevent pregnancy. IUDs can last 1-10 years. The IUD is not noticeable during intercourse. While some claim that IUDs work by affecting the movements of eggs and sperm to prevent fertilization, generally they function by making the uterine liner unsuitable for implantation of a fertilized egg.
Sterilization Methods
Spermicides. Spermicides have been around for a long time, some claiming they have been used in some form since 1850BC. Today there are a number of spermicides available as suppositories, gels, creams, foams, and even a plastic film.( 
Many women and men like to use spermicides, either alone or in combination with some other form of birth control, because they are relatively inexpensive, easy to use and can be purchased without prescription. Also, spermacides have gained gain favor for they do not cause a physical separation of the male and female genital organs, as do condoms.
However, spermacides do have disadvantages; the foremost is that they have limited reliability when used alone. Hence, many persons who use spermacides use them in conjunction with condoms or a cervical cap type device. Other downsides include timing issues. That is, spermicides are only effective for a limited time–typically an hour–and some need to be applied up to fifteen minutes before intercourse can occur. In addition, some persons are irritated by nonoxynol-9, a common active ingredient in spermicides available in the USA. It has been found that for women, frequency of use significantly increases the chance of irritation (9), and that when use is limited to no more than every other day irritation is rare (only 3% over placebo).
Vasectomy. The vasectomy has been described as the most reliable form of birth control available. For example, the UK national sterilization guidelines came to the conclusion that “The failure rate of vasectomy should be quoted as approximately 1 in 2000 (0.05%)”.(10) On rare occasion a vasectomy can reverse itself, however it occurs in only.025% or one in 4,000 vasectomies.(11)
A vasectomy involves cutting (and more recently blocking) the vas deferens, which are the tubes that transport sperm from the testicles. Procedure failure is very rare, and complications uncommon. In addition, no change in sex drive is caused by vasectomy, although a few men seem to develop a psychosomatic response that interferes with normal sexual function. Also, since the testicles provide less than 5% of the seminal fluid with is ejaculated during orgasm, no difference in ejaculation is felt or noticed. Although vasectomies can sometimes be reversed, this is never assured and the operation should be considered a permanent fix.
New methods of a vasectomy include Vasclip, a method where a small plastic clip, about the size of a grain of rice is clipped over the vas deferens, effectively closing off the vas deferens. You can learn more about this procedure, and see pictures of the Vasclip, at www.vasclip.com.
Female tubal ligation. Female tubal ligation, sometimes referred to as “getting your tubes tied,” is a permanent birth control option in which women undergo a surgical procedure to close off their fallopian tubes. A completed procedure stops the egg, during ovulation, from traveling to the uterus from the woman’s ovary. The procedure also prevents sperm from reaching the fallopian tube. Hence, the surgery is 99.5% effective in preventing pregnancy.
Female tubal ligation involves cutting and tying, burning, or blocking (with bands, rings, or clips) a woman’s fallopian tubes. This is abdominal surgery and carries far more risk than a vasectomy. For this reason, a female tubal ligation seems a poor choice unless the woman already cut open, such as with a cesarean section—however some sources maintain female tubal ligation is a minor outpatient surgery.
One rare but serious complication of a tubal ligation is an ectopic pregnancy. In an ectopic pregnancy the fertilized egg implants in a fallopian tube rather than in the uterus. This is an extremely dangerous situation that results in death of the mother unless the pregnancy is identified and terminated. The overall rate of ectopic pregnancy for traditional tubal ligations is low as 0.7%. The age of the woman has an impact on the chances of an ectopic pregnancy; women having a tubal ligation under the age of 30 having double the risk, when compared to older females (12).
Timing Methods
Natural Family Planning/Fertility Awareness Method: The idea behind natural family planning (NFP) and the fertility awareness method (FAM) is this: A woman is fertile during only a small window of time each month. This small window is believed to be between 100 to 120 hours. Hence, if a couple is to avoid sexual intimacy during this time, pregnancy can be avoided. Conversely, NFP/FAM could be used to help achieve pregnancy by couples who are wishing to have a child.
The question that various NFP/FAM ask is “How can I determine exactly when the window of fertility is?” If the time-frame could be determined with 100% accuracy, then NFP/FAM would be a perfect method of birth control. However, the window can only be estimated–though with high probability if done correctly. Couples using NFP/FAM methods correctly have a much lower failure rate than condom users, and close to that of users of birth control pills.
To determine the window of fertility, NFP and FAM involve knowing when the woman is fertile by charting factors such as menstrual cycle length, morning body temperature, and cervical mucous. NFP is the only birth control method approved by the Roman Catholic Church. However, some persons have theological problems with NFP because it violates the Biblical command to only abstain from sex for the purpose of fasting and prayer (see 1 Cor 7:1-5, and Wise Counsel, below). To help with NFP/FAM there are numerous devices on the market to help determine when a woman is fertile.
(2) Research from New York University, published in Archives of Sexual Behavior May 20, 2002
(3) Birth Control, Paul & Lori Byerly, 2005, July, retrieved from http://www.themarriagebed.com/pages/biology/birthcontrol.shtml
(4) Planned parenthood, Diaphragms, Caps, and Shields: What They Are and How They Work, retrieved from http://www.plannedparenthood.org/birth-control-pregnancy/birth-control/diaphragms-caps-and-shields.htm
(5) Birth Control, Paul & Lori Byerly, 2005, July, retrieved from http://www.themarriagebed.com/pages/biology/birthcontrol.shtml
(6) IBID.
(7) ‘Emergency Contraception’s Mode of Action Clarified’ Population Briefs May 2005, Vol. 11, No. 2 link
(8) Birth Control, Paul & Lori Byerly, 2005, July, retrieved from http://www.themarriagebed.com/pages/biology/birthcontrol.shtml
(9) Roddy, R., et al. (1993). “A Dosing Study of Nonoxynol-9 and Genital Irritation. International Journal of STD & AIDS, 4(3), 165-70
(10) RCOG. UK national sterilisation guidelines 2004.
(11) Harvard Medical School “Well connected”, 2001.
(12) “The Risk of Ectopic Pregnancy After Tubal Sterilization” March 13, 1997 issue (336:762-767) of The New England Journal of Medicine.
