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Birth control methods — safety and prudence

Sex has been there since forever and its two fundamental objectives are procreation and pleasure. These two, however, don’t always have to go together and the deed doesn’t always have to be about wanting to produce offspring. There’s been much debate about physical experiences between partners and sexual self-satisfaction but do we discuss contraception equally often? How to approach sex with prudence so that it’s both pleasurable and safe?

6 minreading time • Text: Dominika Gajewska

Birth control methods illustration Jarek Danilenko

Illustration: Jarek Danilenko

Sex is usually associated with lusciousness and intimacy. You can have it in a number of ways and in various configurations — with people of the same or other sexes, in missionary or spooning positions, on the bed or the worktop. What should the two people who decide to have sex take into consideration, though? Well, apart from approaching it with common sense, they should always remember about appropriate protection.

Safely and with prudence

Sexual intercourse, aside from tremendous bliss, may also result in less pleasurable consequences. There are exceptions to every rule, of course, and for people who have been trying for a baby a pregnancy would not be a problem — most often a dream come true, actually. There are some… many even, for whom sex is just a way of satisfying their needs and is treated as a nice addition to their relationship. That’s why it doesn’t have to mean the desire to have children. What’s more, intercourse carries risks of contracting venereal diseases, which is to be kept in mind, especially with one-night stands.

What is birth control?

They’re simply efforts and measures taken to avoid an unwanted pregnancy. Some of them are also methods which protect you from contracting sexually transmitted diseases. Contraception has already been known by our predecessors from antiquity and the first records of using it come from 1550 BCE Egypt. Back then, to avoid getting pregnant women resorted to all sorts of measures, like putting… acacia leaves, honey, or lint inside their vaginas. Nowadays, we’re dealing with much more advanced methods of birth control; however, despite such widespread access to contraception and according to various studies, as many as 222 million women from developing countries consciously dismiss it.

What are the results? Unwanted pregnancies (especially among teenagers), abortions, and numerous diseases. It’s crucial to take some time to educate yourself and your surroundings to avoid the unnecessary stress and problems. We also want to contribute to that learning process by presenting methods of birth control — those more but also less popular.

It’s worth remembering that when making the decision to have sex, one must be aware of and accept the possible consequences. Which is why it’s a matter of making a conscious and mature choice, disregarding the potential pressure from your partner or the society. Birth control equips us with a greater sense of safety so that we can lie back and enjoy the ride!

Types of birth control

Yikes! There’s a lot to choose from. Methods of contraception are plentiful, each with its own advantages and disadvantages. Nevertheless, anyone can find something that’ll suit them. There are a few types and, what’s important, either side can find something for themselves. So what is the best form of birth control? Currently, we distinguish natural, hormonal, but also chemical and barrier methods of contraception.

Those methods vary in terms of availability, application techniques, and effectiveness. It’s pivotal to remember that none of these methods of birth control is 100 percent infallible so there is always something that can go wrong. However, there are methods more and less effective, which is the subject of numerous studies. The effectiveness of contraception is measured with the Pearl Index, which points to the fallibility of a given method, or, to be more precise, to how many women out of a hundred will get pregnant while using this particular method of contraception. For the sake of comparisons — with no birth control at all the Index shows 85, that is this many women out of a hundred might get pregnant.

In order for the chosen birth control method to be the most efficient, first, we have to go through all the available options and analyse them with respect to their suitability in regard to our organisms. It’s also recommended to seek advice from our gynaecologists and run some routine check-ups. This way the method we finally choose will be adequately fitted to us and the risk of something going wrong will be much smaller. So what does birth control do to your body? Let’s try to work up some answers.

Natural methods

Otherwise referred to as fertility awareness methods, these are measures which rely primarily on observing your body and analysing any changes thereof. Natural methods usually require no money but, unfortunately, their effectiveness is quite low — in this case, the Pearl Index oscillates around 2.5-28. Here are some natural contraceptive methods described:

The rhythm method

One of such methods relies on deciding the time when you have sex by determining your fertile days with the help of a calendar (which is why the method is also referred to as the calendar method; although some discourteous ones call it the “Vatican roulette”). By observing your menstrual cycle, on condition that it’s super regular, you may easily determine the days in which you have your fertile days and ovulation. It’s the time of the cycle when the chances of getting pregnant are the highest. For this contraceptive method to be the most efficient, it is required for you to continuously monitor your temperature, as well as any secretions coming out of your vagina (cervical mucus). The poor effectiveness of this method stems from the fact that if you get ill, you might have a fever or other health-related aberrations, which may render the results of your measurements unreliable. To help you keep track of your temperature, as well as your fertile and infertile days, a device has been developed. Cycle computers, because that’s what we’re talking about, are the apparatuses that take your temperature with a little sensor, attached to the devices, that you put under your tongue. They then record the results and “learn” your cycle displaying a calendar with days marked in green or red (the latter indicating your fertile days). A major inconvenience is that you must always measure your temperature at the same time of the day, after you wake up, and without getting out of bed, having slept for at least five hours.

The withdrawal method

Another natural contraceptive method is coitus interruptus (also known as the withdrawal or pull out method). This is still an amazingly popular method of birth control, albeit with an extremely low effectiveness rate. What’s more, some doctors don’t even recognise this method as contraception. The withdrawal method relies on ending penetration before ejaculation, that is the discharge of semen. It requires some practice as well as a great deal of reflex. Unfortunately, it also doesn’t guarantee a high-level efficiency, as far as contraceptive methods go. Moreover, it often induces stress which may lead to sexual neuroses in the future, as well as impotence or premature ejaculations. Why is this method so ineffective? It has to deal with the semen leakage. This is the discharge of small amounts of semen before the proper ejaculation, which contains sperm conducive to fertilisation.

Intrauterine contraception

This type of birth control is known for its longevity, which can be counted in years. The method relies on placing an intrauterine device inside your uterus, which prevents the sperm from combining with the egg. There are two types of IUDs (intrauterine devices), namely copper IUD and hormonal IUD. The former, as the name suggests, contains trace amounts of copper ions (they may also include other metals’ ions), which impair the glycogen metabolism in sperm, causing it to function in an inadequate way. The latter discharges tiny amounts of progestin, which causes the increase in the viscosity of the cervical mucus. In such conditions the sperm’s journey is severely impeded. As was mentioned above, this type of contraception is especially noteworthy for its durability. The hormonal IUD can be functional for up to 6 years and the copper one up to 10, with a failure rate oscillating around 0.1-0.8%. Additionally, you can remove both types of IUDs at any time and get pregnant immediately after doing so.

Hormonal birth control

This is one of the most popular and widely used methods of contraception, with a number of options listed below.

Contraceptive pills

The first thing that comes to mind when you think of hormonal birth control is probably “the pill” — and rightly so. This is actually the go-to option for most of those who consider using hormonal contraception. However, contraceptive pills also differ from one another. Most often, doctors prescribe the so-called combined oral contraceptives, which contain both estrogen and progestin to maximise the effectiveness of this method. They impede ovulation and influence the viscosity of the cervical mucus. The other type is the progestin-only pill for those who need or wish to avoid estrogen. They also impede ovulation and transform the mucus to be more viscous and, what follows, less penetrable for the sperm. Additionally, the progestin-only pills influence changes in the endometrium so that it’s not as susceptible to accommodating the fertilised egg.

As far as oral birth control goes, the inevitable question to ask yourself is whether you're able to remember about taking them at the same time of day everyday. It seems to be dead easy; you just have to set an alarm for the appropriate hour. In reality, it often appears to be extremely problematic. Each and every one of us has different schedules and responsibilities. It may so happen that we cannot take the pill at a given time because we don’t have it on us or there’s no water to wash it down with. Then we have a problem. According to various producers, the time frame to take the pill is 12 hours. However, we have to remember that with low-dose pills the recommended time frame is 3 to 4 hours. Will you be able to keep that in mind at all times? If not, save yourself the stress and choose a method that won’t use up your precious grey matter.

Patches

If you’re the forgetful type and you know that taking contraceptive pills at a given time will be a problem for you — go with patches. This method relies on sticking a special patch for 7 days anywhere on the skin, really — most often on your arm, underbelly or lower back. Those patches contain synthetic hormones corresponding to the female reproductive ones. They penetrate the skin and block ovulation which impedes the release of a fully-grown egg. They act similarly to birth control pills, however, they do not ruin your liver and you only have to remember about them once a week!

Vaginal contraceptive rings

This method is based upon putting a 5 cm-wide plastic ring in your vagina once in three weeks (then you have to remove it for a week — that is the duration of your period). It releases hormones (estrogen and progestin) into the endometrium which impedes ovulations and protects you from getting pregnant. Its effectiveness is comparable to the one of birth control pills and oscillates around 91-99%. The obvious advantage is that you can insert it entirely on your own; however, it’s also super important to follow the pattern of three weeks in, one week out for the method to be most effective. The application procedure is quite easy and painless: straddle a bit, squat, or rest one of your legs on the toilet or a chair, anything that’ll feel most comfortable for you. Then take the ring between your thumb and index finger and gently slip it inside your vagina. How to know if it’s in the right place? You shouldn’t be able to feel it. The ring should be inside so far as to touch the endometrium, so it doesn’t have to be slipped very far. Most importantly, it shouldn’t cause any discomfort.

Implants

This method relies on implanting a very soft and flexible rod with the progestin hormone under the patient’s skin, usually on the arm. Then the hormone is gradually released into the system. It’s “operational” after only 24 hours and can last for about three years. After this time, it’s safe to implant another one without further ado. Moreover, the implant may be removed at any time and fertility resumes in just a few days, although it’s recommended to wait until next menstruation before recommencing to try for a baby. The implant is 4 cm long and 2 mm wide. The procedure is not surgical as it only takes a special needle (quite thick, which may be a downside for some) to place it under your skin. The tiny container with the progestin hormone is placed under your biceps, roughly 8-10 cm above the inner side of the elbow bone. The effectiveness of this method is comparable to, if not higher than, the use of the birth control pill. The superiority of implants over oral contraception is that the former bypass the digestive system, which renders them impervious to any intestinal disorders, like vomiting or diarrhoea, making them an almost perfect method of contraception.

Injections

Otherwise known as “the shot”, this method of birth control is based on receiving a jab into your buttock or arm every three months. At first, it was designed to constrain the rocketing numbers of pregnancies in third-world countries and to control the fertility of people with mental disorders. Nowadays, the popularity of this method grows among those who wish to use hormonal contraception but don’t want to, or are unable to, remember about taking pills every day. The shot works pretty much the same as the progestin-only pill — blocking sperm from combining with the egg and constraining ovulation. Although it’s a reversible method of contraception, regaining fertility may take up to several months after the last injection, which is why those who plan to have children soon after going off birth control should consider another form of contraception. The Pearl Index for the shot oscillates around 0.2-0.5, so the effectiveness is rather high. Some pros of injections include lower risk of endometrial cancer and lighter menstrual bleedings; on the other hand, the cons involve possible headaches, nausea, and acne.

Barrier methods

These methods aim at creating a physical barrier which is to prevent sperm from reaching the egg. There are several types of barrier contraception, each with a different failure rate. 

Condoms

Generally, there are two types of condoms — external and internal. The former is designed to be put on a penis during intercourse in order to catch any fluids coming out of it (i.e. pre-ejaculate, semen, and sperm). They are usually made of latex; however, there are also synthetic condoms for those who may show symptoms of an allergy. The greatest advantage of external condoms is that they don’t influence hormonal balance and constitute a protection against sexually transmitted diseases. The Pearl Index for those is between 3-7. There are numerous variants of such condoms on the market — take your pick! Not only do they come in different sizes, but also with various flavours and textures, allowing for differentiation in sensations. They are to be used once and only with water-based lubricants, as oil-based ones may weaken the condom’s structure, thus making it susceptible to tears and breaks.

The internal condom has an entirely different design than the previous one. It’s made of polyurethane, which also constitutes a protection against sexually transmitted diseases. It’s usually very lubricated. An internal condom is a loose transparent pouch with two elastic rings on each end. The inner ring, placed on the closed side of the condom, is to be put inside the vagina, keeping it in the right position. The open end remains outside and covers the vulva partially. The important thing is to not use both internal and external condoms at the same time, so as not to cause any friction between them, which might result in tears. It’s less effective than its external counterpart, with a failure rate at 5-21%.

Cervical caps

A less popular barrier contraception method is the cervical cap (also known as diaphragm). It’s inserted in the birth canal — the inside of the cervix. They come in different sizes, which is why it’s important to visit a gynaecologist to make sure the cap is fitted accordingly. It’s advisable to use the cervical cap together with spermicides in order to maximise the efficiency of this method. A possible contraindication concerning diaphragms is an allergy to silicon (the material these caps are made of). Its effectiveness is lower than this of condoms and amounts to 20 in the Pearl Index.

Chemical methods

Spermicides

Spermicides are a considerably cheap and easily accessible method of birth control. They come in the form of cream, gel, foam, or tablet, and contain chemical substances (most often nonoxynol) that constrain sperm while simultaneously increasing the viscosity of the cervical mucus, hindering the sperm’s journey to the egg. Spermicides are easy to use (you place them inside the vagina) but they’re not as effective as other birth control methods and they increase the risk of irritation in your private parts. They are an interim contraception which requires no prior medical examination. This method’s effectiveness is very low (71-82 in the Pearl Index) and should be used with other birth control methods — condoms, for instance.

Contraceptive sponges

This method belongs to both barrier and chemical contraception methods. The latter because the sponge is soaked with chemical substances (benzalkonium or nonoxynol) in order for it to work pretty much the same way as the aforementioned spermicides; however, the sponge also constitutes a physical barrier for the sperm. It looks like a ring with a small dimple in the middle. It has a string (much like the one in tampons) for easier removal. It’s important to remember that a sponge is to be placed in the vagina shortly before intercourse and may stay there for about 30 hours. It’s not necessary to replace the sponge when having sex with the same partner multiple times; however, it’s crucial to use a different sponge when changing sexual partners. Importantly, the sponge must remain in place for about 14 hours since the last ejaculation. This way it can do its job of killing off sperm. The Pearl Index for the contraceptive sponge is 9-25.

Permanent methods

More commonly known as surgical sterilisation, the method includes vasectomy and tubal ligation. It’s a permanent solution which is both an advantage as well as a disadvantage. Some regret having undergone the procedure and express the desire to have children. There are ways of restoring the patency of the fallopian tubes and deferent duct but the chances of getting pregnant then oscillate around 31-88%. Sterilisation does not contribute to any long-lasting side effects — it even reduces the risk of having ovarian cancer.

Birth control not so black as it is painted

Myths concerning contraception abound, perpetuated for years, which, unfortunately, successfully dissuades people who have sex regularly from using it. This is why condoms are still the most popular method of contraception — seen as safe and bearing no effects on the hormonal balance. At this point, you’re probably asking yourself what birth control method has the least amount of side effects. Well, you’re not the only one! Many people do fear the side effects of contraception — some are afraid of getting fat, having problems with their skin, or suffering from some of those possible side effects: headaches, stomachaches, and even decrease in sex drive.

What birth control do doctors recommend?

Well, it depends on so many different conditions. Which is why it’s important to get an understanding of the contraception market and go to your gynaecologist who’ll help you choose the safest, most suitable, and most comfortable method fitted to your organism. So what is the most effective method of birth control? Well, it’s to be determined during your appointment! So why wait? Keep in mind that birth control is significant as far as our, as well as our sexual partner’s, physical and mental health are concerned. What mustn’t be forgotten is the fact that none of the aforementioned contraceptive methods is 100% reliable and that there’s always a potential risk of getting pregnant. This is why starting your sex life should be an informed decision — you should consider all the dos and don’ts and perhaps not listen to your one-drink-too-many brain telling you it’s time.

Support groups

Remember that we’re here for YOU! If you want to dig even deeper into the world of menstruation, meet exceptional people, and get some support in the form of a virtual group hug, check out our Facebook group #mensTRUEacja by Your KAYA. Although you might hit a linguistic wall (we use Polish there), there’s no wall we can’t smash together if we want to. So you better hide, walls! We can guarantee a considerable number of helping hands on the subject of sexuality, womanhood, and interpersonal relations. But that’s not all! It’s a safe space where you can open up and find out about our newest products and discounts. But don’t stop at that — find support groups in whatever country you’re from, be it online or IRL. It’s up to you!

References

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