There are many different kinds of birth control and even more factors contributing to decisions about the best birth control method for you or your partner. They range from those that rely on progestin or a combination of estrogen and progestin to be effective, non-hormonal methods, emergency methods, and permanent methods like tubal ligation and vasectomy. In this blog, we will discuss contraceptives that do not involve hormone use.
Misha Pangasa, MD, a family planning fellow in the Division of Obstetrics and Gynecology at University of Utah Health, says, “The most effective birth control is the one that a person feels comfortable using regularly.”
Pangasa explains that contraceptive methods are often discussed in terms of the lowest and highest failure rates. “But the methods that have the lowest failure rates, like those containing progestin or a combination of estrogen and progestin, may not be right for everybody, and if somebody doesn't feel comfortable using them, or has other reasons, it’s not going to be as effective for them,” she explains.
Some of the factors that might be considered are cost, whether the birth control method can be easily stopped if desired, stage of life, and access to birth control. Some of the methods discussed here statistically have lower effectiveness rates because they often aren’t used consistently or properly, but if used correctly and consistently can be reliable methods to prevent pregnancy.
Some of the methods discussed here rely on both partners to help relieve the sole burden of contraception.
Copper IUD (Intrauterine Device)
Method: A copper IUD is made of flexible plastic, shaped like a T, with copper wrapped around it. The copper is toxic to sperm and prevents the sperm from traveling to fertilize the egg. There is only one copper IUD sold in the U.S. under the brand name ParaGuard®.
Advantages: The copper IUD can last up to 12 years, are extremely effective, and can be easily removed by a doctor. The National Institutes of Health (NIH), reports the failure rate of the copper IUD is 1.7 pregnancies out of 100 women after three years of use. NIH suggests that the 10-year rate is comparable to sterilization: 1.9 pregnancies out of 100.
Disadvantages: The copper IUD can cause cramps and heavier periods, especially in the first three to six months of use. It does not protect against sexually transmitted infections (STIs) or sexually transmitted diseases (STDs) and must be removed by a physician if pregnancy is desired. Though removing an IUD is typically a quick, simple office procedure, IUDs can rarely migrate or embed in the uterus, making them sometimes harder to remove. Though the risk of pregnancy with a copper IUD is low, a pregnancy conceived with an IUD in place has a higher risk of being ectopic, or outside of the uterus, which can require medical or surgical treatment.
Withdrawal
Method: Withdrawal means the male partner removes his penis before ejaculation. This method must be used every single time there is intercourse and is best used with another method such as a condom. According to the Mayo Clinic, one in five couples using this method of birth control will conceive within a year.
Advantages: There is no cost involved and no side effects.
Disadvantages: It relies on the self-control of the partner with a penis to make sure ejaculation takes place away from the vagina. Because of this, and due to the presence of sperm in the pre-ejaculate, it has a higher failure rate. It also does not prevent against STIs.
Barrier Methods of Birth Control
These methods prevent sperm from entering the uterus, therefore avoiding fertilization of the egg. Some of these methods protect against STIs.
Condoms
Methods: Condoms are thin stretchy pouches that are made of latex, non-latex plastics, or lambskin that are placed on the penis. If used properly, condoms prevent sperm from entering the body. Lambskin condoms are often an option for those allergic to latex. Only water- or silicone-based lubricants can be used with latex condoms.
Advantages: Both latex and non-latex plastic condoms prevent the spread of STIs. Condoms are relatively inexpensive and easy to obtain. If used correctly, every time you have intercourse, the condom is 98 percent effective against pregnancy. In practice, the effectiveness rate is 87 percent due to improper use, tears, and accidents. You can use a spermicide with a condom to increase effectiveness.
Disadvantages: Condoms must be used consistently and properly every single time you have sex, and also rely on the partner with a penis to use them. Lambskin condoms do NOT protect against STIs or STDs.
Internal Condom
Method: There is currently only one FDA-approved internal condom. Made of nitrile, the internal condom is a pouch with rings on both ends—one open and one closed. Using a lubricant can prevent the condom from slipping.
Advantages: An internal condom protects both partners against STIs and STDs, including HIV. They can be 95 percent effective against pregnancy but in reality are 75 to 82 percent effective according to the NIH. As opposed to condoms, the internal condom can be placed up to eight hours before intercourse. They may be purchased without a prescription at most drugstores and are relatively inexpensive. They can be used during menstruation, pregnancy, and after childbirth.
Disadvantages: An internal condom can fail for the same reason that condoms do: they can slip or tear, and they may not be used every time you have intercourse or placed after the penis has been inserted in the vagina.
Diaphragm
Method: A diaphragm is a shallow saucer shaped cup made of silicone and inserted inside the vagina so that it covers the cervix. It prevents sperm from entering the cervix but is most effective if used with spermicide inside the diaphragm and spread around the edges of the diaphragm. The diaphragm must be inserted correctly no more than two hours before having sex—otherwise the spermicide won’t be effective. Then it must be left in place at least 6 hours after having intercourse but no more than 24 hours. The diaphragm is 94 percent effective if used every time during intercourse; in reality, it is 87 percent effective.
Advantages: The diaphragm is small and easy to carry. It can last up to two years with proper care. It does not affect the menstrual cycle.
Disadvantages: It takes practice to be able to insert and remove the diaphragm correctly. It must be washed and air dried after use, and checked for any holes, cracks, wrinkles, or other signs of wear. The diaphragm does not protect against STIs or STDs.
Cervical Cap
Method: Similar to a diaphragm, the cervical cap is inserted into the vagina and covers the cervix. It must be used with a spermicide and left in place after intercourse for several hours. It can stay in place longer than the diaphragm—for up to two days—and should be used with a spermicide. For those who have never had a baby, the cervical cap is about 86 percent effective, and 71 perfect effective for those that have given birth previously. You must use it every time you have intercourse for it to be effective.
Advantages: The cervical cap is small and easy to carry. It can be used for up to a year with proper care. It does not affect the menstrual cycle.
Disadvantages: The cervical cap must be placed before having intercourse and before being aroused.
Fertility Awareness Methods Can Be Useful in Avoiding or Encouraging Conception
Sometimes called “natural family planning” or the rhythm method, fertility awareness methods (FAMs) involve tracking ovulation to identify the days you are fertile. If you do not want to become pregnant, intercourse should be avoided during this time, or a back-up method of birth control, such as a condom, should be used. FAMs are often used, too, when you want to identify the times you are most fertile and want to become pregnant.
Using FAMs can be a bit complicated at first so it is best to work with a health care provider who is knowledgeable about natural family planning. FAMs include taking your daily temperature in the morning before getting out of bed and charting that temperature over time. This is because daily temperature rises after ovulation.
Another FAM includes observing cervical mucus every day. The mucus will change in color, texture, and quantity when you are going to ovulate. The third FAM is the calendar method. Using this method, you must keep track of six of your menstrual cycles. After determining your longest and shortest cycles you can determine the days that you should be ovulating. There is a second calendar method called the Standard Days method which is dependent on your cycle being 28 to 32 days in length.
These methods work best for someone who is committed to the routines necessary to track and chart the FAMs. Luckily, there are numerous apps to help you track and chart.
Permanent Methods of Birth Control
Permanent methods of birth control are called sterilization. For people with uteruses, this requires surgery under anesthesia to cut, block, tie, or remove the Fallopian tubes permanently. The surgery can be done in conjunction with another surgery such as after a Cesarian section or following a vaginal birth. The procedure to tie off the tubes is called a tubal ligation, whereas removing the tubes is called a bilateral salpingectomy. These procedures are permanent and irreversible and should only be considered if a person is 100% certain they would never like to be pregnant in the future.
People with penises can undergo a sterilization method called a vasectomy—the cutting and sealing the vas deferens, the tubes that connect to the testes and carry sperm. The surgery is outpatient and recovery is fairly quick. Most men can return to having intercourse after a week, though back-up methods of birth control should be used for several weeks after surgery until a subsequent semen analysis confirms procedural success. Vasectomies are generally reversible.
Contraception as a Health Care Journey
Given the dizzying array of birth control options available, the decision about which method to use can be difficult. Pangasa suggests that deciding on which contraceptive method to use is a “continuum or journey for people throughout their reproductive years.” She explains that although health care providers can be helpful guides and allies, ultimately patients make decisions based on their values, preferences, and health as well as where they are in their lives.