Confidential (18+)

CHOICES IN CONTRACEPTION

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Of all things that you want to discuss about sex with your partner, this is probably not going to be on the top of the list. But it is something you should consider very important.

Yes, you love your partner, you love to get it on, but one thing you may not be ready for is a child or a sexually transmitted infection! As the way in which we view sex and the circumstances when we get sexually active are in a flux, having safer sex with minimum complications becomes a priority for us. Well, at least it should be! Premarital and casual sex is rising in popularity. Even married couples are not always ready to start families. This is when contraceptives or birth control come into the picture. As with all things related to sex, you should talk about birth control and contraceptives as well.

Before choosing a birth control method you should take into consideration factors like you and your partner’s overall health, how often you have sex, the number of partners you & your partner have, if you want children someday, how well each method works to prevent pregnancy, the possible side effects, how comfortable you and your partner are with using the method.

There are so many different types of contraceptive methods segregated in the basis of the way they work. Some act as barriers to sperm, others control a woman’s hormones, some are physical devices placed in a woman’s body and make the uterus think there already is a baby in place. There are also permanent birth control methods and the very – much- used (and often abused) emergency contraceptives.

I will give you a run through of these methods and some information on what you might want to choose especially if you are in a committed relationship. If you are still exploring your sexuality and not ready to settle to just one partner then the best bet is the condom, it protects you from sexually transmitted infections and pregnancy! Remember BYOC (Bring-your-own-condom, regardless of your gender). But just to be on the safest side, take your partner to a doctor who can advise you properly on the type of contraceptive that might best suit her overall health.

There is only one absolutely fool proof way to prevent pregnancies and that is abstinence, it can get boring when you are not doing anything, so let’s forget about that!

All other birth control methods come with some risk or inconveniences.

THE RHYTHM METHOD

There is the rhythm method, where couples calculate the days in which the woman is most fertile (i.e. most likely to get pregnant) and avoid sex during those days. A woman is usually able to get pregnant for about 9 or more days during each month. The most fertile days are about 5 days before and 3 days after ovulation. So if you want to succeed with this method as a couple you have to learn about your woman’s cycle. Use protection a few days before and after, and during the 9-day window. And if you want to make a ‘couple thing’ of it keep record of when your girl gets her period and count the days together.

If you are super kinky or just plain nerdy you can check her mucus discharge daily. When it is clear and slippery like raw egg whites she is at her most fertile and her body temperature will rise about 0.4 to 0.8 °F on the first day of ovulation. Of course the downside of this is that you could both lose track of her cycle and end up taking unsafe chances and invariably end up with unwanted kids.

BARRIER METHODS

The easiest are the barrier methods of birth control. Basically this blocks your sperm from reaching her eggs. Some of those devices you can use are the contraceptive sponge (which is pretty tedious to insert and remove and comes with a bunch of rules you might not want to follow!) The diaphragm, the cervical cap and shield all fit in the opening of the womb and prevent sperm from entering. The diaphragm and the cervical cap come in different sizes and you will have to go to a doctor to get one fitted. These too come with instructions on how long they need to be in your body to prevent pregnancies and a time limit on how long they can stay in your partner’s body. Basically she will have to visit a doctor every time you want to get it on and go back the next day to get it removed. Not to run diaphragms and cervical caps down, but your general physician does not need to know your love-making schedule (every time or even ever).

The female condom has been widely advertised and distributed in Nepal at most health centers. It provides similar protection as that of the male condom but it should never be used along with a male condom. A woman has to have a new condom every time she has intercourse.

Now, for one of the most common and probably most convenient of barrier birth control methods the male condom! Depending on the kind of material used to make them they will all prevent pregnancy but ‘natural/lambskin’ condoms do not protect from sexually transmitted infections. You can get lubricated or non lubricated condoms. The lubricated ones make sex more comfortable and you can always supplement the non lube ones with water based lubricants (very important to have only water based lubricants). If you use oil based lubricants even during foreplay make sure that you wipe off well before penetration so that the oil in the lube will not weaken and tear or break the condom. Condoms should always be stored and kept in a cool dry place. As cool as it looks, your wallet is the worst place to have it and so is the glove compartment of your car (because of the heat and the friction). Buy yourself a small case (like a cigarette case) to store your condoms.

CONDOMS SHOULD ALWAYS BE STORED AND KEPT IN A COOL DRY PLACE. AS COOL AS IT LOOKS, YOUR WALLET IS THE WORST PLACE TO HAVE IT.

HORMONAL METHOD

On to what you might consider your favorite form of contraceptive because as long as the girl takes care of her ‘responsibilities’ it leaves you free. Well not quite! The hormonal method of contraceptives like the pill will interfere with a woman’s menstruation cycle during ovulation, fertilization, and/or implantation of the fertilized egg. The patch, injection/shot and vaginal ring work in similar ways hormonally. They stop the ovaries from releasing egg and also thicken the cervical mucus, which does not let the sperm join the egg. Depo provera, which is available in Nepalese health centers, is an injection which has to be given every 3 months. It is advised to not to use it for more than 2 years in a row because it can cause temporary loss of bone density and if used for long periods of time increases risk of fracture and osteoporosis.

IMPLANT DEVICES

There are also implant devices, which can be left in a woman’s uterus for a few years. There are both hormonal and non-hormonal intra uterine devices. Those that work hormonally are similar in function to the other hormonal methods but can be active for longer periods of time. The Copper device prevents the sperm from reaching and fertilizing the egg and if there is fertilization it does not allow the fertilized egg to attach itself to the uterus.

PERMANENT METHODS

And then there are the permanent birth control methods like male and female sterilization. So this might be something to consider if you don’t want any children. If you do want to go this direction then it would be good to discuss it in further detail with your doctor.

THE MORNING AFTER PILL

Which one of us has not had that moment of unplanned, unexpected sex? So in times like that you want to make sure your partner does not get pregnant. This is when you go for plan B the morning after pill, which should be taken within 72 hours of having unprotected sex.

Happy selecting and best wishes to you & your partner! Stay safe & Enjoy!

Chari is a Public Health consultant who has a special interest and work experience in the field of reproductive and sexual health. She also hosts a radio program on rvlradio called turn it on.

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