Contraception methods

In these days of ready discussion of sexual matters one may think that everyone knows about contraception, but this is not altogether true. Many people are not fully aware of the basis for contraception and of those who are, not everyone uses contraception every time it is needed. The vast number of abortions being carried out every year bears witness to this. The reasons people fail to use contraception are many and varied – we cannot go into them all here, but we have to remind you that if you want to enjoy sex to the full and at the same time avoid the risk of an unwanted pregnancy, you must remember to use effective contraception. Even a single act of intercourse at around the middle of the monthly cycle (i.e. two weeks before a period is due) has roughly a 10 per cent chance of producing a pregnancy. Multiply this several times and you will soon see how readily an unwanted pregnancy may arise.

There are several effective methods of contraception available, but not every one will suit every couple, and the doctor will advise if you have any doubt about the best one for you.

The pill is now widely known and used. It works by stopping the production of eggs from the woman’s ovaries. It is the most effective form of contraception available at present, apart from sterilisation. Taken as directed, there is a negligible risk of pregnancy. A doctor must prescribe the pill and should first check the medical history of the patient to ensure there are no contra- indications. There are occasional mild side effects which are usually trivial, but there is also a very small risk of thrombosis and other more serious problems. For younger women the risk of serious side effects is very small indeed, but it appears to be greater for a woman over 35 or anyone who smokes.

The coil is a small plastic, or plastic and metal device which is fitted into the uterus by a doctor. Its main effect is probably to stop fertilised eggs from being implanted in the uterus. It is almost as effective as the pill, but not quite. About two women out of every one hundred using the coil become pregnant each year. There are few side effects although there is a very small increased risk of infection in the uterus and Fallopian tubes which can lead to lowered fertility in the future. For this reason some doctors are cautious about recommending it for women who have not had children. Periods may be heavier after the device has been fitted than before.

The diaphragm is a rubber dome which fits into the vagina and is inserted with a chemical cream or jelly before intercourse. It prevents any live sperm getting to the uterus and so prevents conception. Its potential effectiveness is as great as that of the coil but depends to a large extent on the care with which the woman uses it. The right size has to be selected by a doctor, who will instruct in its uses. It does, however, have the advantage that no pills have to be taken and there is nothing left permanently inside the body.

The sheath is also a reasonably efficient method of contraception; we discuss its use below.

Sterilisation is a permanent method of contraception for either the man or woman. The procedure in a man is called vasectomy. Under local anaesthetic, a small incision in the scrotum is made and the tubes carrying sperm from the testicles are divided. This procedure is usually performed in an out- patient clinic. Female sterilisation is a more complicated operation and may require a few days in hospital. It is always carried out under a general anaesthetic. Both procedures are available without charge in NHS hospitals. The patient’s GP must make the referral and there is usually a waiting list before the operation is performed. Some surgeons will also carry out vasectomies privately. The charge is usually very moderate, as the expense of a private hospital bed is avoided. Sterilisation procedures should only be considered when a couple have finally decided that they do not want any more children, no matter what circumstances may arise in future. Then it can be a most useful method of contraception. Occasionally sterilisation can be surgically reversed, but this is by no means always possible, so it should be regarded as permanent.

The rhythm method. For those who have religious scruples about using any drug or mechanical device, the ‘temperature’ version of the rhythm method may be used. This method is a way o{ timing intercourse so that the fertile times of the month are completely avoided. Anyone who wishes to use this method should go to a Family Planning Clinic or the Catholic Marriage Advisory Council for instruction in its use. The details are complicated and vary with the individual so personal advice is required.

Other methods of contraception in general cannot be recommended. Do not rely on withdrawal (or ‘being careful’). This is an unsatisfactory method. It is not only unreliable because sperm are present in the fluid produced by a man before ejaculation, but it is also sexually unrewarding for both partners. Chemical creams, jellies, pessaries, foams or films cannot be recommended for use on their own, whatever the manufacturers say in their literature, if you definitely do not want to get pregnant. They kill off sperm, but are only really effective if used with a diaphragm or sheath. Used on their own, they reduce the chance of pregnancy very little.

Some may say they are better than nothing for occasional use, but we do not advise you to rely on them alone. Douching after intercourse is totally ineffective. Amazingly, some people still seem to believe some of the old wives’ tales; e.g. ‘You can’t get pregnant if you… have intercourse standing up, hold your breath during orgasm, urinate or jump up and down afterwards’. Needless to say all these are totally useless.

Home Treatment

The only method of contraception we can recommend for use without seeing the doctor is the sheath used together with a chemical ‘spermicide’. Sheaths (condoms, johnnies, French letters) may be bought from chemists, barbers’ shops or slot machines but are often cheaper by mail order. Buy well- known brand names such as Durex, Premier or Horizon, or check that the brand you buy has the British Standard ‘kite- mark’ on the packet. Rumours of sheaths splitting or having holes in them may have been true when standards of manufacture were not so high as today, but these events are rare with properly made sheaths. Used correctly, the sheath is an effective method of contraception but slight carelessness in use can result in failure. The sheath should be unrolled onto the erect penis before any sexual contact takes place and care taken to ensure that there is no air inside – otherwise it is more likely to come off during intercourse. One reason for failure is leakage of semen around the base of the sheath after ejaculation, so the penis should be withdrawn from the vagina with the sheath in place immediately after ejaculation to avoid this happening. It is also important for the woman to use a chemical spermicide in addition to the sheath. The spermicide should be inserted in the vagina before intercourse and should deal with any spillage of semen. The simplest and most convenient type of spermicide is the pessary, which can be bought from the pharmacy (e.g. Ortho- Forms, Gcncxol, Staycept). Pessaries are like large cone- shaped tablets and should be inserted high into the vagina just before intercourse.