Our Bodies, Ourselves (46 page)

One of the greatest obstacles to women's use of contraception is the fear of possible negative health effects from the use of hormonal methods or the IUD. Some women hear alarming stories that may be based on half-truths, bias, isolated cases, or old information, so it is important to seek out accurate and balanced information before making a birth control decision. It's also important to consider the health risks of being pregnant, which are higher than those of using any form of birth control.

You may have heard that using some methods of birth control can affect your ability to become pregnant even after you stop taking the contraceptive.

No method of birth control, except sterilization, permanently interferes with your ability to become pregnant, nor does birth control reduce your ability to have children later in life. In fact, an unintended pregnancy or a sexually transmitted infection can occasionally impact future fertility, so birth control methods, especially those that protect against STIs, may protect your ability to get pregnant in the future.

Some methods may continue to prevent
pregnancy for a short while after you stop taking them. Depo-Provera, for example, may continue to work for some women up to eighteen months after the last injection, though it has no proven long-term effects on fertility. (However, to reliably prevent pregnancy you must get Depo-Provera injections every three months.)

Barrier methods prevent pregnancy by blocking sperm from reaching the cervix. They are often used in combination with spermicides. The effectiveness of barrier methods varies a great deal depending on how correctly and consistently they are used. Because they don't enter the bloodstream and are used only intermittently, barrier methods have fewer side effects than other methods. In addition, condoms prevent the spread of sexually transmitted infections, including HIV/AIDS.

The condom is typically a latex sheath that fits over the erect penis and prevents sperm from entering a woman's body. It is sold rolled up and stored in a foil or plastic packet. For those who are sexually active, condoms offer the best protection against sexually transmitted infections; only abstinence protects you better. Condoms come in different sizes, colors, and textures.

While most condoms sold are made of latex rubber, some are made from a thin polyurethane (plastic) or polyisoprene material. They, too, protect against STIs; they may also provide more sensation for men who have difficulty maintaining an erection when using latex condoms; and they can be used by people sensitive to latex. However, they break more often than latex condoms.
2
Natural “skin” condoms (made of lamb membrane) protect against pregnancy but contain pores (microscopic holes) that are large enough to let viruses pass through (but not large enough to let sperm pass through). Therefore, skin condoms do not protect against some STIs, including HIV.

Condoms are a good way for the man to share responsibility for birth control. When you don't know whether you will be having intercourse,
condoms can be very convenient. Although some men carry condoms, you should not expect it. Protect yourself by carrying condoms with you. Condoms usually have an expiration date marked EXP on the package. Generally, condoms without spermicide are good for up to five years. Condoms with spermicide last about two years. Keep condoms in a cool and dry place, and throw away condoms past their expiration date. If you are not sure how old a condom is, throw it away and use a new one. Never use condoms that are brittle, sticky, damaged, or discolored. And never reuse a condom.

Courtesy of Ibis Reproductive Health

Male condom

The contraceptive effectiveness of condoms varies from 85 to 98 percent depending on how well they are used. If used correctly
for every act of intercourse from start to finish
, condoms are 98 percent effective at preventing pregnancy. This means that if a hundred couples use condoms correctly every time they have intercourse for a year, two women will become pregnant. In real life, issues such as not putting the condom on properly, not always using one, or putting it on too late are common, so condoms have a typical use contraceptive effectiveness of 85 percent. That means that about one in seven women will become pregnant in one year of using condoms.

Some condoms (“spermicidal” or “spermicidally lubricated”) contain spermicide, a chemical that kills sperm. The concentration of spermicide is so low in these varieties, however, that they appear to be no more effective at preventing pregnancy than condoms that don't contain spermicide. If you combine using condoms correctly at every act of intercourse with a spermicidal foam, cream, film, or jelly in your vagina, you will have more effective birth control.

The effectiveness of condoms in preventing transmission of STIs—such as HIV, chlamydia, gonorrhea, trichomonas, and hepatitis B—is similar to the effectiveness rate for pregnancy protection, or 80 to 98 percent. Protection from STIs that cause genital sores, such as syphilis, herpes, and chancroid, or from human papillomavirus (HPV)—genital warts—is decreased because the condom may not cover all of the areas that could transmit the infection. Nevertheless, condoms provide the best protection currently available against these infections.

• Does not require advance planning, clinic visits, or a prescription.

• Inexpensive and readily available.

• Can be carried easily and discreetly by men and women.

• Best currently available method of protection against STIs, including HIV, and may help prevent cervical cancer (see
Chapter 11
, “Sexually Transmitted Infections”). By preventing STIs, condoms can protect the ability to get pregnant in the future.

• Allows men to participate in preventing pregnancy and infections.

• May decrease premature ejaculation and prolong intercourse.

• Catches the semen, so nothing drips from the vagina after intercourse.

• No systemic side effects.

• Does not affect menstrual cycles.

• Requires a brief pause to put on.

• Can reduce sensitivity.

• Some men cannot maintain an erection when using a condom.

• Some men and women can develop an allergy or sensitivity to latex (in this case, condoms made from other materials
can be used
.

Many of the disadvantages of condoms can be overcome with practice and experience or by switching to a different brand or type of condom.

Condom use can be fun for both partners when it is made part of sex. Discuss condom use
before
you have sex. Have more than one condom on hand, in case one is torn or damaged before use or is put on incorrectly, or you have repeat intercourse or change from anal to vaginal sex. Use a condom before the penis comes in contact with your mouth, anus, or vagina, as your partner may discharge a few drops of fluid long before ejaculating. While this pre-ejaculatory fluid is unlikely to cause pregnancy, it may expose you to HIV or other infectious organisms.

1.
Carefully open the packet.

2.
Unroll the condom a short distance to be sure you are unrolling it in the right direction. If you accidentally put the
outside
of the condom against the head of the penis, discard the condom and open a new one.

3.
Squeeze the tip of the condom and unroll it down to the base of the erect penis. The tip will hold the man's sperm. If you do not leave space for the sperm, the condom is more likely to break. If your partner's penis is uncircumcised, pull back the foreskin before putting on the condom.

4.
It is important to have enough lubrication. If you do not use a lubricated condom, use a water-based lubricant such as K-Y or Astroglide to prevent tearing or discomfort. If you are using a latex condom, the most common type of condom, never use Vaseline or other oil-based lubricants such as massage oils, suntan lotion, hand cream, or baby oil, as they can weaken the latex. With polyurethane or polyisoprene condoms, any type of lubricant can be used.

5.
Soon after ejaculation, the man should carefully withdraw his penis while it is still erect. Hold the condom firmly against the base of the penis to prevent leakage or slipping.

6.
Check the condom for visible damage, such as holes or tears, then wrap it in tissue and discard. Do not flush condoms down the toilet; this can cause plumbing problems. Condoms cannot be reused, so use one condom for each time you have sexual intercourse and then throw it away.

7.
If the condom breaks, slips off, or was not used, discuss the possibility of pregnancy or infection with your partner. Emergency contraception (EC) can be used after unprotected intercourse to
prevent pregnancy
.

The only contraindication for using a condom is if you or your partner has a latex allergy. Severe swelling or difficulty breathing may indicate a
latex allergy; if this happens to you or your partner, see a health-care provider immediately.

© Casserine Toussaint

Some people develop a mild, local irritation or a rash after using a condom. This may be a reaction to the lubricant, spermicide, or perfumes used on the condom. If this happens to you or your partner, try using a different brand, or a condom without lubrication. If you still have a reaction, try switching to a nonlatex condom; or if you need protection only against pregnancy, you can try natural skin condoms.

You can find condoms in drugstores, in supermarkets, online, in bathroom vending machines, and on many college campuses. Many family planning clinics, youth organizations, and HIV prevention programs offer condoms for free. The cost in other places varies, depending on the brand and the store, so shop around. Nonlatex condoms are more expensive than latex condoms.

Some men experience decreased sensitivity with condoms. To enhance sensitivity, try different types of condoms, or add a water-based or silicone lubricant to the outside of the condom, or even a few drops to the inside tip of the condom.

•
Can HIV get through a condom?
No. Latex, polyurethane, and polyisoprene condoms, if used correctly, prevent the spread of HIV. Condoms also protect against other STIs. Don't use oil-based lubricants with latex condoms, as they can cause the latex to break down and could allow HIV to pass through. Natural membrane condoms may also allow the HIV virus to pass through.

•
Do condoms make intercourse less enjoyable?
This varies from person to person. Some people dislike them because they can interrupt spontaneity, and some men find they decrease sensitivity. Condoms can also have some positive effects. For instance, both partners may enjoy intercourse more if they don't have to worry about getting pregnant or contracting an STI. Using condoms also may prolong an erection and increase sexual communication.