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What are the methods used and how do they work?

Abstinence is the safest choice, but some young men and women choose to engage in sex anyway. Should we simply let them take the risk and pay the price even when the price is so high? Or should we help them protect themselves? This unit is mean t for those who will need such protection against pregnancy. You may not be one of them. Yet, since most of us do ultimately engage in sex, the information may be useful for everyone at some time in his or her life.

In a sample of 13- to 18-year-olds, almost two out of three say the girls they know are very concerned about getting pregnant, as are two out of five boys. Yet this concern does not seem to help many young people protect themselves. Almost 60% of those who are sexually active say they are not using contraceptives every time they have sex. (Remember that all you need to do is skip contraception once to risk pregnancy.) Moreover, one third have not even talked to their sexual partner about preventing pregnancy, and one in five who has, has done so after having sex.

Preventive Behavior Sequence

People need two things to use contraception (methods of birth control) effectively. They need a reliable and safe contraceptive method, and they need a set of attitudes and behaviors that will allow them to make an effective “go of it.” One doesn't work without the other.

To minimize the chances of getting pregnant (remember, abstinence is the only sure method), the sexually active adolescent needs to take the following steps.

1. Accept your sexuality, which is your sense of yourself as a sexual being. The great Greek philosopher Socrates said, “Know thyself.” In all aspects of life, one must have a clear idea of who one is and what one wants. Recognizing that one is a sexual being with sexual feelings and needs is not always easy to see or accept. Since there is so much confusion and negative feeling about sexuality, it is tempting to deny that one is a sexual being. Often, adults (including parents) contribute to this denial of the adolescent's emerging sexuality because they may not know how to deal with it or may not want to deal with it, wishing that it would just go away. You can help your parents understand your conflicting emotions when you speak with them about your feelings and concerns. It is natural for parents to be concerned about this difficult time in their children's lives. Parents have many different ways of handling difficult situations. And although some parents may be too uncomfortable to discuss these topics with their children, many parents would welcome help in understanding the issues and changes their children are facing.

Ignorance or lack of acceptance of one's sexuality may lead to unplanned or unpredictable behavior. Some adolescents may engage in sex without being fully aware of what they are doing. It “just sort of happens” to them. Or they may refuse to learn about pregnancy or contraception because they are not “supposed” to be sexually active. Even some grown-ups fail to take contraceptive precautions because being “prepared” suggests that they are planning to have sex. It is as if they believe engaging in sexual intercourse spontaneously is more romantic or less immoral. These are some of the ways people kid themselves or save face with their partners. Anyone who engages in sexual intercourse, for whatever reasons, should at least know what they are doing.

2. Be informed about preventive behavior. First, learn how to assess the risk of pregnancy. As you may recall from earlier sections, a woman's risk of getting pregnant changes during the menstrual cycle. A man is always fertile, or able to reproduce. Second, be aware of the preventive options-when to abstain, how to stop short of intercourse; how to discuss pregnancy prevention with your partner, what contraceptive to use and how, how to help your partner make the right preventive decisions, and how to avoid or get out of high-risk situations.

3. Learn to make active, not passive, decisions about sex. People should not let their partner make all the decisions. It takes two to get pregnant. Therefore, both partners should share in the responsibility of making the decision. Contraception and pregnancy are not only a woman's problem. Anyone should be able to talk openly about preventing pregnancy with a sexual partner. If, for whatever reason, the partners can't do that, one or both of them are not ready to engage in sex. Furthermore, this discussion should take place ahead of time-not when they are just about ready to engage in sex. Effective contraception requires planning.

4. Preventing pregnancy requires planning and certain public activities, such as purchasing condoms or obtaining a prescription for birth control pills. These public activities can seem embarrassing. By engaging in these acts, someone knows that sex is planned. However, embarrassment should not keep people from protecting themselves.

5. Be consistent. To avoid pregnancy, one must use contraceptives correctly each and every time one engages in sex. All it takes is one weak link for the chain to break. For example, if a man is using condoms, it may only take one time when he doesn't have one or doesn't feel like using one to get his partner pregnant. Ultimately, all the knowledge, all the discussions, and all the contraceptives people have are of no use unless they use them effectively each and every time they engage in sex.

6. Be flexible. Different couples at different times in their relationship may rely on different methods to prevent pregnancy. It is important to rely on whatever works best under the circumstances. An approach that worked in the past may not work as well in the future. When a person's life circumstances change or he or she has a new sexual partner, the issue of pregnancy prevention has to be reconsidered and renegotiated. And remember that people who have been engaging in sexual intercourse and using contraceptives can still switch to abstinence.

Barriers to Effective Birth Control

There are many external, or social, as well as internal, or psychological, barriers that may make it difficult for a young person to take the preventive measures described above.

Among external barriers are social attitudes that make it hard for young people to learn about pregnancy prevention or to have access to contraceptives. Some people think that to allow young people such freedom encourages them to have premarital sex. However, sexual knowledge and sexual behavior are two very different things. So gaining information about topics as important as reproduction and contraception can help people make informed decisions.

Young people who abstain from sexual intercourse are absolutely safe from pregnancy. Those who engage in it fully informed, knowledgeable about methods of prevention, and prepared are at risk, but are safer than people who use no prevention. Those who engage in sex with no protection or who use protection inconsistently run the highest risk of pregnancy and disease.

Often, younger adolescents have trouble linking an action with its consequences. They know sex leads to pregnancy. But they often take refuge in false beliefs or are misled by inaccurate information. For example, only half of adolescents questioned know when the fertile period is during the menstrual cycle. Some think of the time of ovulation as the “safe period.” Some think they are “too young” to get pregnant. Others believe if they do not reach orgasm, they will be safe. Still others believe that if you have sex standing up, you won't get pregnant; or if you urinate right after sex, you will be safe. These are just some of the misconceptions believed by many adolescents. Adolescents owe it to themselves to conduct the research and ask questions about topics as important as these, if they are basing their actions on these beliefs.

Mixed Messages Spend one week evaluating messages about sex that you come across in songs, movies, on TV, in magazines, etc. Chart the messages under the following categories:

  • Discourages sexual behavior
  • Encourages sexual behavior
  • Mentions contraception
  • Mentions consequences of sexual activity.

Draw some conclusions about the messages you receive, and sh are them with the class.

Other obstacles arise from exaggerated or false fears about contraceptives, such as birth control pills will cause cancer, or contraceptive devices are messy or lessen sexual sensations, and so on. Learning the true and accurate information about sex and sexual reproduction is the best way to contradict these misconceptions.

The portrayal of sexual relations in movies, on TV, in magazines, and through exposures to other media further confuse young people. Although constantly exposed to sexual themes, young people rarely see any hint that people try to prevent pregnancy in any way. This helps to create a world of sexual behavior that is far from the real world in which we live.

Obviously, preventing pregnancy requires a commitment to not getting pregnant. It also requires good decision-making skills and a thorough and accurate knowledge of the choices available such as abstinence.

Contraceptives are devices used to prevent pregnancy. Birth control, which is at the core of family planning, is a somewhat broader term that refers to avoiding pregnancy and deciding when to have children.

What is the difference between an unplanned and an unwanted pregnancy?

Did You Know?

The word contraception comes from contra -against-and ception-act of becoming pregnant. It refers to various methods of avoiding pregnancy.

People use birth control to engage in sexual intercourse with less risk of pregnancy. Before learning about the specifics of each kind of contraceptive, consider the following facts.

  • For those who do not choose abstinence, contraception can work to avoid pregnancy only if a safe, effective method is used each time, every time, with no ifs, ands, or buts. A physician, parent, or health worker can help with information about contraceptives and decision making.
  • Since no birth control method except abstinence is foolproof, using more than one method decreases risk. For example, condoms add extra protection in combination with any other birth control method.
  • While it is better to use something than nothing, some methods are better than others. Hormonal methods such as the birth control pill give better protection than condoms. Condoms with spermicide give better protection than condoms alone. Withdrawal is better than unprotected sex. The most important approach is to use common sense, think, and plan.
  • Like most things in life, having sex involves cost and risk. Anyone who decides to engage in sex must be prepared to accept the consequences of his or her decisions and actions.
  • Birth control methods vary in their degree of effectiveness and in the side effects, the negative consequences, resulting from their use. So both effectiveness and side effects must be considered when making decisions that are this important. This is an area in which a physician, other health-care professionals, and/or a responsible and trusted adult can help you discover the most accurate information about contraceptives.

Did You Know?

Contraception has been practiced throughout human history. In fact, the ideas used long ago are the same as the ideas used today; only the materials have changed.

Spermicides used long ago (ancient Egyptians):

  • wine, garlic, and fennel
  • crocodile dung, sodium bicarbonate, and honey

Barrier methods:

  • pastes made from absorbent plants, especially roots and herbs (ancient Greeks and Romans)
  • clay (Native Americans)
  • paper (Japanese)
  • balls of silk (French)

Other methods used

  • magic
  • superstitions about clothing, jewelry, washing

Methods of Birth Control

Birth control involves more than knowledge about contraception. Birth control is part of a sexual relationship. It involves making good choices, following effective decision-making processes, and dealing rationally with psychological and moral concerns.

Throughout recorded history, people have been using one form or another of birth control. Probably the oldest and most commonly used method has been withdrawal. Withdrawal involves the removal of the penis from the vagina before ejaculation, which is the release of sperm during orgasm. Ancient methods, such as withdrawal, did not and still do not work very well. However, they were better than nothing at all. Today's contraceptives have much higher rates of effectiveness.

Currently, about half of the world population has access to good contraceptive methods. The best methods are both effective and safe. Usually, the more developed the country, the more likely it is that couples can get and will use contraceptives, and that the population will grow more slowly.

What is the difference between contraception and abortion?

Activity 7-1: What Will They Choose?

Introduction

It is difficult to make an important decision under the best of circumstances, when you have time to think things through, time to consider the consequences, input from reliable and unbiased sources, and no pressures on you to decide. It becomes much more difficult to make or stick to a decision when emotion, desire, or outside pressures are present. Imagine that the person you have dreamed about is holding your hand, the setting is perfect, and you are alone. Things are moving quickly. Will you be able to make the right decision in this type of romantic situation? Will your ability to think clearly be swayed by emotion?

Materials

  • Activity Report

Procedure

Step 1 Your teacher will give you an Activity Report to read.

Step 2 This sheet contains two scenarios in which couples are about to make sexual decisions. Read the scenarios carefully so that you can answer several questions.

Step 3 Your teacher will then divide the class into small groups for discussion.

Step 4 The groups will report their conclusions to the class.

What Do You Think?

How does the phrase “Know thyself” relate to avoiding pregnancy?

Preventing Ovulation

Without an egg (or sperm), pregnancy cannot occur. Birth control pills prevent the ovaries from producing mature eggs. The pill is a form of oral contraception (birth control taken by mouth). There are different types of pills, but they all consist of the hormones (chemical substances) estrogen and progesterone used singly or together in various combinations.

How many pills are there in the box? Why not less or more?

Figure 7.1 Birth control pills.

The hormones in the Pill prevent ovulation, or the release of an egg from the ovary. Progestin also makes a mucous plug at the cervix and changes the lining of the uterus so that a fertilized egg cannot implant itself. The Pill therefore works in a variety of ways to prevent pregnancy.

Did You Know?

The Pill became available in the 1960s and is based on the 1930s finding that progesterone could prevent ovulation. In the United States, 10.7 million women use the Pill as a method of contraception. Of the 5 million sexually active teens, 1.7 million, or 34% use the Pill.

These actions make the Pill one of the most effective contraceptive methods available. Under ideal conditions, no more than 1 in 1,000, or 0.1%, of users become pregnant during a given year. However, the actual or typical failure rate, including the factor of human error, is 6%. This means that if 100 sexually active women use the Pill for one year, an average of 6 out of 1,000 will become pregnant. Human error (forgetting to take the Pill) accounts mainly for the difference between the typical (actual) failure rate and the ideal failure rate, when the method is used absolutely correctly and consistently.

As with most chemicals and drugs, the Pill has some side effects. Side effects are unpleasant or harmful reactions to a drug other than the intended effect (in this case, contraception). The minor side effects of the Pill include temporary and mild nausea, weight gain, breast tenderness, and skin discoloration. These side effects mimic symptoms of early pregnancy, a time when the body also has high levels of estrogen. Not all Pill users experience these side effects.

Did You Know?

One-third of women in the United States using contraception use the Pill.

Although serious risks or side effects of the Pill are rare, its use can lead to an increased chance of heart attack, stroke, hypertension (high blood pressure), and blood clots. Smokers and women 35 or older risk these complications more than other users. The Pill may also increase the chance of breast cancer for some women. The Pill can be expensive over long periods of time and places all the responsibility for contraception on the woman. It requires a prescription and therefore may be, for some people, more difficult to get.

These possible side effects of the Pill should be considered by anyone thinking about using them. However, the Pill is considered to be a reasonably safe and highly effective form of contraception, if taken correctly and consistently.

Bear in mind that pregnancy itself is not free of risk. It has its own “side effects,” as well as the potential of more serious complications, including death. On balance, the health risks of pregnancy are higher than the health risks of using the Pill. The Pill has much lower levels of hormone in it than it did 20 years ago. It was the high levels of hormone that were riskier.

Persuade the Class! Should prescription contraceptives be available without parental consent for people under age 18? Why or why not?

The Pill is the main, but not the only, form of hormonal contraception. The most recently approved and available form is not a pill, but an implant. A doctor implants several thin matchstick-like rods containing progestin under the patient's skin. The implant is called Norplant. The implanted rods can stay for up to five years and provide 99% protection from pregnancy. Statistics show that if 100 women use Norplant for one year, only one will become pregnant. If the woman wants to become pregnant, the implants are removed. Fertility returns in a couple of months. Norplant is currently the most effective contraceptive (except for sterilization, which is discussed later). It eliminates human errors such as forgetting to take the Pill.

Is there a pill for males? It is possible to depress the production of sperm through hormonal methods. However, since men produce billions of sperm, it is harder to completely shut off their production. Over time, a pill may also interfere with a man's ability to have an erection. It is possible that someday an effective male hormonal contraceptive will be available.

Natural Methods

If we could stop sperm from reaching an egg, no one would get pregnant. Ovulation occurs in the middle of the menstrual cycle (about day 14) and the ovum survives for about a day in the Fallopian tube (see Section 3). So why not avoid intercourse for a day or two at the time of ovulation and prevent pregnancy in this natural way? This method, known as the rhythm method, costs nothing and has no harmful side effects.

This sounds great, but unfortunately there is one hitch. It is difficult to know exactly when ovulation takes place. This is why the method is not very effective. Its failure rate is about 20%. That means that 20 out of 100, or lout of 5 women, (over the course of a year) who rely only on the rhythm method will become pregnant. Ovulation does not always occur on day 14, and it is not easy to detect exactly when it does take place, even with techniques such as ovulation test kits. If doctors find accurate ways that easily detect when ovulation is about to occur, the rhythm method may well become the best form of birth control. That day may come, but it is not here yet.

Meanwhile, a lot of young women get pregnant because they think they know when it is “safe” to have sex. Some people think the middle of the cycle (when they ovulate) is the safe period. However, the middle of the cycle is actually the least safe period. Some girls think that during or just after menstruation is a safe time, but that is not always true. A woman should not think of various times in menstrual cycles as “safe” or “unsafe,” but as “lower risk” and “higher risk.” The lower- and higher-risk times are indicated in Figure 7.2, which shows a 28-day cycle. (Note that not everyone has 28-day cycles. There may be 36 days between two menstrual periods. The length of the cycle may change. But there is almost always 14 days between ovulation and the next menstruation.)

Figure 7.2 Risks of pregnancy during menstrual cycle. The rhythm method works only if you know exactly when ovulation occurs (not when it is supposed to occur). One cannot count on the lower-risk times as being completely risk free.

Not everyone has 28-day cycles. There may be 36 days between two menstrual periods. The length of the cycle may change. But there is almost always 14 days between ovulation and the next menstruation. It's the first part of the menstrual cycle (days 1-14) that varies. If a woman has a 36-day cycle, on what day would she be likely to ovulate? If a woman has a 21-day cycle, on what day would she be likely to ovulate?

The other natural contraceptive method is withdrawal of the penis before ejaculation. Again, this method is not very reliable. As with the rhythm method, withdrawal has a failure rate of about 20%. During sexual arousal, men cannot be safely relied upon to withdraw (which means stopping intercourse). Also, it is possible for some sperm to escape before ejaculation. Therefore, it is essential that the penis avoid all contact with the vagina before contraceptive devices are in place.

Barrier Methods

Stopping sperm and ova from contacting each other can be more effectively done by barrier methods, which prevent pregnancy by blocking the union of sperm and egg. The most commonly used barrier is the condom, which is a sheath, often made of latex, that covers the penis and collects the sperm.

The condom is placed on the penis before the penis comes into contact with the vagina. The condom has other benefits as well. For example, condoms guard against some sexually transmitted diseases. However, only latex condoms protect against viral infections such as HIV, or AIDS. Also, condoms are inexpensive, don't require a prescription, require the male partner to take responsibility, and have essentially no health risks or side effects. However, condoms can break; they need to be put on correctly during sexual arousal, and new users may find them difficult to put on at first. In addition, condoms can interrupt the process of sexual intercourse. Used alone without spermicides, condoms have a 2% ideal failure rate, and a 16% typical failure rate.

Figure 7.3 Condoms.

Spermicides contain chemicals that kill sperm. Rather than working as a mechanical barrier like the condom, spermicides provide a chemical barrier. In other words, pregnancy is prevented through chemical action. Unfortunately, spermicides used alone are not very effective. Using spermicides alone, 30% of women will get pregnant in a year's time. However, when used with a barrier method, such as a condom, diaphragm, or cervical cap, spermicides work more effectively. When used with a spermicide, condoms can be very reliable. The lowest observed failure rate is 2%. However, a typical (average) use still results in a 12% failure rate.

Debate! Should condoms be available in high schools?

Spermicides come in different forms, and they are usually put directly in the vagina in the form of tablets, foams, jellies, or creams. All work within some time constraints-some last longer than others. Some need to be inserted at least 10 minutes before intercourse. All need to be used each time sex occurs, no matter how soon a person might have sex again. Spermicides come with detailed instructions that help the user identify the most effective way to use the spermicide.

For the following two contraceptive methods, give an example of how the contraceptive method might be used in correctly, thus contributing to the “typical” failure rate.

  • condoms
  • spermicides

Some people find spermicides messy, hard to use, or irritating to the skin. But spermicides may protect against some sexually transmitted diseases as well as against unwanted pregnancies. And like the condom, spermicides have essentially no harmful side effects. This barrier method is inexpensive and available without a prescription.

The diaphragm is an example of another barrier method. The diaphragm is a thin latex dome prescribed and fitted by an physician. Prior to sex, it is filled with spermicidal jelly and then inserted into the vagina to block the cervix (and the uterus). The diaphragm has an ideal failure rate of 6%, and a typical failure rate of 18%.

Figure 7.4 Diaphragm.

The diaphragm also relies on spermicide for it to function effectively. It may be inserted up to six hours in advance. However, any additional acts of intercourse require more spermicide, which can be added without removing the diaphragm. There are few negative side effects, except for occasional reactions to the spermicides.

What are three benefits to using a condom? What are three drawbacks to using a condom? What are two benefits to using a spermicide? What are two drawbacks?

Figure 7.5 Cervical cap.

The cervical cap is nearly identical to the diaphragm except that it is smaller and fits more snugly against the cervix, remaining there through suction. Used with spermicide, it is as effective as the diaphragm, with a 6% ideal rate of failure and an 18% typical failure rate. It can be left in place twice as long as the diaphragm, or up to 48 hours.

Finally, the most certain and permanent way of stopping sperm and egg from reaching each other is sterilization. In the male, a physician performs a simple operation to tie off the vas deferens (vasectomy). Though the testes continue to produce sperm, none will get through to the penis (sperm get reabsorbed into the body). In women, the operation involves tying off the Fallopian tubes, so that the egg and sperm can't meet. Sterilization does not affect production of hormones by the testes and ovaries, nor does it affect sexual function.

Did You Know?

The diaphragm, cervical cap, and condom were invented in the mid 1800s after the invention of mass produced rubber. All have been in use since then.

Sterilization is now the most common method of birth control in the United States. Sterilization accounts for about one-third of all birth control methods. In women, 30% have their Fallopian tubes tied surgically. In men, 13% have vasectomies. However, both procedures are often irreversible. Although surgical procedure can try to repair the tubes, they work only in 60% of cases. Such procedures involve complicated operations. Sterilization is appropriate for people who are quite sure they do not want to have any more children.

Activity 7-2: Review of Methods

Introduction

Implant, rhythm, condom-There are many methods of contraception. Yet the choice one makes about contraception can seriously affect one's life. Do you know enough about contraceptives to make the right choice?

Materials

  • Activity Report

Procedure

Step 1 You will receive an Activity Report listing the various types of contraception.

Step 2 Write down the rate of effectiveness, the advantages and disadvantages, and an explanation of HOW each type of contraceptive works.

Step 3 How many can you accurately complete without referring to the textbook?

Your friends have been dating each other for quite a while and their physical relationship is getting more intense. They absolutely do not want to become parents but can't seem to bring up the topics of contraception, having sex, or abstinence. Write a letter to your friends suggesting how you think they might handle their situation. Explain what you think they should do.

Review Questions

  1. What are the six steps in the preventive behavior sequence?
  2. What are the elements of good birth control?
  3. Why is birth control part of a sexual relationship?
  4. What are three reasons in favor of the Pill as a form of contraceptive? What are three reasons against the Pill as a form of contraceptive?
  5. What is the difference between chemical barriers and mechanical barriers?
  6. What are two natural birth control methods, and why are they unreliable?
  7. What are three similarities and differences between the condom, diaphragm, and cervical cap?

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