Only you know when it is the right time to have a baby. Dr. Monica Agarwal is here to advise you on both temporary and permanent birth control methods, and to help you choose the one that is right for you.
Birth control, or contraception, is the term used to describe a medication or device used to prevent pregnancy. Choosing the “best” type of birth control requires that you know a little about each method, how it works and whether you and your partner will use that method. Some types of birth control are reversible, meaning you can get pregnant when you stop using it. Other methods are permanent, which means that you cannot usually get pregnant again.
To decide which birth control method is right for you, read about each type and discuss the options with your physician.
The couple should be able to deal easily with the method, which should interfere as little as possible with the spontaneity of the sexual intercourse. Unlike condoms and natural methods, the pill and the IUD do not interfere with the spontaneity of the relationship.
The natural regulation of fertility is based on abstention from sexual relations during the fertile period of the female cycle, which is identified with specific techniques. These methods include:
- The rhythm method (also known as Ogino Knauss) is based on the calculation of the fertile days and assesses the ovulation to be likely to happen on the 14th day before the future menstruation, which is assumed by averaging the previous 6 cycles. This method has a high failure rate (10%) especially in subjects who have hormonal cycles exceeding 32 or shorter than 26 days.
- The measurement of basal body temperature should be done with a special thermometer every morning before getting out of bed and written down in a special chart or on your phone using a tracking app. At about half of the cycle the temperature increases of about one degree due to ovulation. Since the average survival of sperm in the female genital tract is 5 days and the egg survival time is about 24 hours, the days after the rise of the temperature, i.e. after ovulation, are considered non-fertile days.
- The Billings method or cervical mucus method involves the observation of cervical mucus, that around ovulation becomes abundant and more fluid. The fertile period is the one that includes the first day from the onset of this feature up to 4 days from the end of it.
- Household kits have been developed to identify the fertile days using several variables: the rovumeter is a small device capable of sucking the vaginal mucus at the level of the posterior fornix and to evaluate its volume. Indeed, the volume of cervical-vaginal secretions varies significantly during the fertile phase, reaching the highest level 48-24 hours before ovulation. Another device proposed by Freundl is capable of measuring the electrical resistance of saliva and vaginal secretions and their variations during the menstrual cycle, thus signaling the fertile periods. Recently a device called Persona® has been proposed, it measures urinary levels of LH and estrone-3-glucuronide, a metabolic of estradiol. The detection lasts a few seconds and is performed by means of a stick which must be kept in the flow of the first urine of the day, and is then analyzed by the device, which is capable of storing the hormonal values recorded, the length of each cycle and the first day of fertile period. A red or green light communicates the data processing results (red = fertile, green = infertile). The Pearl index of this method is about 2.
- The sympto-thermal method combines the Ogino Knaus method to that of basal temperature and cervical mucus achieving a failure rate of 2% (if done correctly).
- The male condom is the most widespread mean of contraception and the safest for the prevention of sexually transmitted diseases, with a failure rate mainly due to breakage associated with incorrect use. Some important steps can prevent this complication, such as usage before expiration date, proper storage, i.e. away from heat sources, and a correct application according to the instructions. Also it should be noted that the use of vaginal creams, both therapeutic and lubricants, can damage the surface of the condom and increase the risk of breakage. In case of allergy to latex, there exist specific condoms free of this substance. The condom has the advantage of being easy to use, requires no medical prescription, has a lower cost per single use, but high if used for a long time, and is the best protection for sexually transmitted diseases. On the other hand, it has the drawback of possible breakage, it entrusts the control of contraception to the male partner and interferes with the spontaneity of sexual intercourse, finally, Roman Catholic Church was opposed to its use, especially in the past.
- The diaphragm is an element, usually made of latex, which is to be introduced into the vagina to cover the cervix. On the inner surface it is covered with spermicidal cream for extra protection. It can be placed some time before the start of sexual intercourse and should be removed 8 hours after the intercourse itself. It is an inexpensive method, but has a high failure rate, and many of the failures are due to incorrect insertion. Also exerting pressure on the urethra increases the risk of urinary tract infections, and does not protect against sexually transmitted diseases.
- Spermicides are substances in the form of suppositories, creams, jellies or sponges, readily available and not subject to medical prescription. They should be introduced deeply in vagina shortly before intercourse and are effective for about one hour. They have the advantage of providing a certain vaginal lubrication, useful in the period of perimenopause, and of being inexpensive and easy to use. On the other hand, the Pearl index is high (10-20); they can cause local allergic or irritant reactions, do not protect against sexually transmitted diseases and can be associated with other barrier methods.
- The intrauterine device (IUD) is placed by the gynecologist at the level of the fundus of the uterus. It is usually used in women who have already given birth. It creates a situation of local sterile inflammation that hinders sperm function.
Sterilization is a permanent method of birth control. Women undergo a process called tubal sterilization that closes off the fallopian tubes, preventing the egg from traveling down the fallopian tube to the uterus as well as the sperm from reaching the egg. It does not affect a woman’s menstrual cycle or sexual function.