Stanford Sexual Health Peer Resource Center

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Pregnancy

• General Information
• Pregnancy Testing

Contraception

• Fundamentals
• Choosing a Method
• Abstinence
• Non-Methods
• Current Methods
• Emergency Contraception, or Plan B

General Information about Pregnancy

One of the risks commonly associated with college students and vaginal-penile sex is pregnancy. Eighty-five percent of couples who do not use any type of contraception will get pregnant within a year of sexual intercourse. This is a huge number! Without going into either “how babies are made” or “the birds and the bees” talk, the next few pages will address pregnancy, pregnancy testing, potential complications, and infertility as they relate to both college students and heterosexual couples in general.

What is pregnancy?
Seems like a silly question, but the answer is important. Pregnancy is defined as the condition of gestation, being “with child,” or carrying young. Pregnancy occurs following the fertilization of an egg by a sperm and the implantation of the developing embryo in the woman’s uterus. This process does not occur in the space of an hour, or even a day. It is impossible to detect human chorionic gonadotropin (HCG), the hormone released by the embryo, until at least ten days after conception, and most tests won’t detect HCG for up to two weeks. More on this in the pregnancy testing section which follows.

Symptoms of Pregnancy: Any or none of the following

• Missed or scant menstrual periods (It’s important to note that some pregnant women experience a small amount of vaginal bleeding around the time of an expected period and mistake this for a regular period.)
• Breast tenderness
• Fatigue
• Nausea and vomiting (often referred to as “morning sickness”)
• Frequent urination, irregular bowel movements, constipation
• Mood swings
• Bloating and weight gain
• “Mask of pregnancy” (the slight darkening of the skin on the face)
• Softening of the cervix and enlarged uterus after one month

Importance of Early Pregnancy Diagnosis:
Early diagnosis enables a woman to begin prenatal precautions (such as cessation of alcohol, tobacco and drug consumption) AS SOON AS POSSIBLE. It also provides early detection of possible pregnancy complications, such as ectopic pregnancy (see information below). Finally, it allows a woman who may be considering abortion as an option the time for adequate counseling and decision-making, as well as undergoing the abortion when it is safest for her – within the first 10-14 weeks of pregnancy.

Pregnancy Danger Signs: If there is any possibility a woman is pregnant and any of the following occur, notify a health practitioner immediately.

• Intense abdominal pain
• Irregular bleeding or spotting paired with abdominal pain when your period is late, or an abnormally light period.
• Fainting or dizziness that lasts more than a few seconds.
• Following a late last period, heavy bleeding that possibly contains blood clots, with cramping more severe than usual.
• A period which is unusually prolonged AND heavy (6-7 days of heavy bleeding).
• Fever

Advice for Pregnant Women
No matter what decision is made regarding pregnancy (abortion, adoption, or continued pregnancy and parenting), it is important to practice prenatal precautions. First, a woman should schedule an appointment with a practitioner to discuss her pregnancy. In the meantime, however, these guidelines should be followed:
• Nutrition: maintain a balanced diet. Avoid dieting, raw meat, and unpasteurized dairy products.
• Avoid alcohol.
• Avoid exposure to illegal drugs.
• Stop smoking
• Do not take any medications (prescription or non-prescription) without first consulting your physician or nurse practitioner.
• Exercise moderately, but avoid extremely strenuous activities that could raise your body temperature.
• Avoid hot tubs and saunas.
• Use condoms if there is any chance you could be exposed to sexually transmitted diseases.

Pregnancy Testing

As mentioned before, pregnancy tests work by detecting human chorionic gonadotropin (HCG), a hormone released by the developing embryo, in the blood or urine of a woman. This hormone causes the levels of progesterone in a woman’s body to remain elevated, which allows the fetus to develop normally.

Different types of tests have different sensitivities; in other words, they can accurately detect pregnancy at different stages of gestation. Some tests are accurate as soon as 10 days after conception, while others may be negative for up to several weeks after conception. It is important to understand the sensitivity of the test performed, and to return for a retest if a normal period does not occur within two weeks.

Available Tests (appropriate for referrals at Stanford):

1. **Now Available at the SHPRC
• The SHPRC uses First Response pregnancy tests. These urine tests can detect pregnancy 5 days sooner than a missed period, or at least 2 weeks after intercourse.
• If a test comes out negative, there is STILL a chance of pregnancy, if the person has had intercourse in the two weeks prior to taking the test (or because of false negatives).
• Students may prefer to come to the SHPRC because they can obtain pregnancy tests anonymously and cheaply.

2. Vaden Student Health Center
• Urine testing is available every day (even weekends and holidays through same day emergency care), as often as the patient desires.
• All testing at Vaden is free to Stanford students.
• No appointment is necessary for a pregnancy test, however one can be made.
• Following each test, a brief consultation with a doctor or a nurse practitioner will occur, in order to discuss the results of the test (the results take approximately five minutes to read).
• Urine tests at Vaden are accurate 14 days after intercourse.
• Blood tests can be accurate 10 days after intercourse, but may only be ordered by a nurse or a physician in the case of special circumstances (such as potential ectopic pregnancies). Blood tests are not used for ordinary early diagnosis tests.
• The first urine specimen of the morning is best for the test (urine is more concentrated after sleep), so a sample should be collected as early in the day as possible in a small, clean container (provided by the nurses).

3. Planned Parenthood
• HCG urine test can be given after a missed period, or 14 days after intercourse.
• Urine tests range in price from $10-$20; no appointment is necessary; students may sign up for a state-funded program to obtain pregnancy testing for free.
• Blood tests can be given 10 days after intercourse, however they are more expensive and some Planned Parenthood offices do not have adequate blood testing facilities and thus will have to send blood samples away to an outside lab (thus results will take at least 24 hours).

4. Home Pregnancy Tests
• These are urine tests that look for the same HCG hormone that clinical tests do.
• These tests can be purchased at any grocery store, pharmacy, or Target-type location.
• Advantages include privacy, convenience, easy instructions, and anonymity.

5. Private Physicians
• Procedures and costs vary.

Additional Information
If you have a negative pregnancy test and are still going to have intercourse, you should use contraception. Even if you believe you are pregnant (i.e. you don’t believe the test results), continue to use or start to use birth control if you do not wish to become pregnant.
→ Although pregnancy tests are quite accurate, false positives and false negatives may occur for several reasons:
• False Positives: human error, LH cross reaction, drug interference
• False Negatives: human error, test performed too early in pregnancy, urine too dilute to detect HCG, drug interference
For these reasons, careful follow up with a health care provider is an important part of any pregnancy test.

Contraception Fundamentals

Contraception is the general term used for anything that works to prevent pregnancy from occurring, and many counsels at the SHPRC relate to contraception and birth control. To reiterate the importance of contraception in the arena of sexual health, it seems appropriate to repeat the statistic that the percentage of women who become pregnant after one year of unprotected intercourse is 85%. Understanding contraception is an important part of protecting your body and learning about sexual health.

Methods of Contraception:

Barrier Methods: male condom, female condom, spermicide
Hormonal Methods:
• The Pill
• Ortho Evra, aka “the patch”
• Nuva Ring
• Depo Provera, aka “the shot”
Combination Methods:
• Diaphragm, Cervical Cap, and Shield
Intrauterine Contraceptive, aka “IUC”:
• Mirena
• Paraguard

Permanent Methods:
• Tubal Ligation (for women)
• Vasectomy (for men)

Definitions:
• Contraindication: any condition that would make a particular method inadvisable
• Effectiveness (failure rate): the percentage of couples who will become pregnant after a year of using a particular method

Considerations in Choosing a Contraceptive Method

Choosing a method of contraception is a personal and individual decision for both females and couples in general. Because there are so many methods and types of contraception available today, ideally there will be one or more that meets the needs of every woman and every situation that exists.
The important thing to remember when choosing a method of contraception or when counseling someone else through their decision-making process is that communication, between the woman and her partner and the woman and her clinician or doctor, is absolutely essential. In order to make the right choices and the safest choices, this is a decision that requires information from the woman, from the couple, and in some cases from a doctor or clinician.
Basic Considerations and Questions to Address:

• Effectivity: How well does this method work?
• STI protection: Does this method protect against pregnancy and STDs, or just pregnancy? Do I need STI protection?
• Health risks or family history: Some methods of contraception require information about blood clots or heart problems, as well as family histories of cancers such as breast cancer, ovarian cancer, and colon cancer.
• Allergies: Many people have either drug allergies or allergies to latex and other materials used as contraception.
• Health considerations and affect on lifestyle: Many methods of contraception may have adverse effects when paired with smoking; in addition some methods that do not protect against STIs should not be used if a woman has multiple partners and is at risk for STI transmission.
• Side effects: Issues such as weight gain, weight loss, acne increase or decrease, and nausea are common with many types of contraception
• Cost: As students, this is always an issue and it definitely varies from method to method.
• Responsibility: Who is “in charge” of making sure contraceptives are taken or used correctly? If the outcome is possibly pregnancy, the woman may want to have greater control because a pregnancy would more directly affect her.
• Ease of use: Is forgetfulness a problem? Can you remember to take a pill every day or have a shot once every three months?
• Prescription vs non-prescription: How accessible is this method? Does a woman need a pelvic examination to get her prescription? Can you just walk up in a grocery store and buy what you need?
• Timing: How long is this method effective for? Does it need to be employed before intercourse or foreplay?
• Does it affect spontaneity? Many couples complain about having to interrupt foreplay to insert or put on various methods of contraception.
• Will it affect your future fertility? Any type of contraception that involves hormones or invasion into the cervix or uterus has a small potential of effecting fertility down the road.
• Does it contradict any beliefs or values? Many people have religious or moral beliefs that may dictate what is appropriate for methods of contraception.
• Would it be embarrassing to use? Do you feel awkward or uncomfortable with this method?
• What type of sexual relationship is it? Monogamous? Open? Communicative?

Abstinence

Abstaining from intercourse is the only 100% effective method of contraception. Nothing else guarantees complete protection from pregnancy or from sexually transmitted diseases. While there are many methods of contraception that will be discussed later on, abstinence is important to begin with because it brings up the fact that having sexual intercourse is a choice, and a very personal one at that. There is no reason that anyone should ever feel pressured to have a sexual relationship that they are uncomfortable with or not ready for. Choosing not to have sex is as viable a contraception option as is choosing condoms or pills or an IUC. This is a choice that many college students grapple with and it is important to know that there are as many reasons that people choose not to
have sex as there are reasons that people choose to have sex.

• What is abstinence?
• Abstinence is more than the clichés of “Just say no,” “Wait until marriage,” or “You’re too young to have sex.” While those are all very valid reasons, most decisions about abstinence go deeper than that. Abstinence essentially means waiting to choose the right person, the right time, and the right place to have sex. You can choose to abstain for an evening, for a month, or for years, as well as for any time in between. People may choose not to have sex with a particular person, or at a certain time, or in different circumstances.
• Isn’t abstinence boring? No! Sexual behavior isn’t just an all or nothing thing. Abstinence can be defined however you choose it to be. It can include hugging and kissing. It can include intimacy. It can allow for everything except sexual intercourse. Abstinence really is whatever you make of it. There are plenty of other forms of sexual expression that allow affection, intimacy, and love to be demonstrated. See the pages in the beginning about alternatives to sex for a better general idea of the range available!
• When is abstinence right for someone? Just like other forms of contraception and other decisions regarding sexual health, abstinence requires communication and an understanding of one’s self and one’s goals and values. It is important to ask questions about values and morals, future plans and expectations, and about the relationship in question. As with everything, communication is extremely important.
• Is it too late to abstain if sex has already occurred? Just because a previous relationship may have been sexual doesn’t mean that every new relationship had between two people has to become sexual. Nor does it mean that a current relationship has to remain sexual or intimate if you have changed your mind. It is totally normal to reevaluate choices and comfort levels, and communication about these thoughts is an important aspect of any relationship.
• After deciding to abstain, how can someone avoid pressure to have sex?
  • Be clear about your decision.
  • Make sure words and actions express your limits clearly and consistently.
  • Plan ahead. Intimate circumstances often lead to intimate behaviors, so be sure you are prepared for this to occur.
  • Speak up. If feeling pressured, make your feelings known. Make sure your decision is respected.
  • Listen to your partner. Respect your partner’s views and acknowledge their opinions and limits, too.
  • Stay in control of the situation. Remember that impaired judgment may have a negative affect on your ability to control your actions and assure that you are comfortable with the situation.

Non-Methods of Contraception

We call the following methods of contraception “non-methods,” because they are either legends about sex that are completely outdated, or because they basically don’t work very well.

While most of these methods have a higher effectiveness than, say, nothing or no protection, they are far inferior to the rest of the methods covered in this course reader because of their failure rates. We will treat them as comparable methods of contraception for the sole purpose of demonstrating that they are both unpredictable and unsafe, and that other methods of contraception should definitely be considered before resorting to these.

WITHDRAWAL: (also known as “pulling out”)

How it works: Withdrawal of the penis before ejaculation occurs, thus limiting the number of sperm that enter the vagina.

Effectiveness (failure rate): 7%-22% (Note that the typical failure rate exceeds 1 in 5.) In 100 users who use withdrawal correctly and consistently, the lowest estimated failure rate would be 7 pregnancies in one year. In 100 typical users, however, the estimated failure rate is 22 pregnancies in one year. This is because before ejaculation occurs, a substance known as pre-ejaculate or “pre-cum,” which may contain sperm, is issued from the penis. Most men cannot even feel when pre-cum is secreted and thus cannot withdraw in time to avoid this.

Contraindications:
- Lack of self control.
- Lack of ejaculatory control.
- Strong desire to avoid pregnancy.
- It is not an appropriate method for couples who wish to have repeated acts of intercourse because sperm may be retained in the penis following ejaculation.

Possible side effects, risks, and considerations:
- Diminished pleasure, frustration, anxiety.
- High risk of pregnancy.
- Provides NO protection from STDs.

Benefits:
- Requires no devices or chemicals.
- Available in any situation.
- It is free.

DOUCHING: (Does anyone even DO this anymore? Let’s hope not.)

How it works: Douching washes some sperm out of the vagina by flushing it out with scented liquid.
Effectiveness (failure rate): 40% (Note that this failure rate approaches 1 in 2.)
In 100 users who douche correctly and consistently, the lowest estimated failure rate would be 40 pregnancies in one year. It has actually been argued that douching may increase the risk of pregnancy by flushing sperm up against the cervix and into the uterus. In addition, douching makes the pH in the vagina become imbalanced, thus increasing the risk of vaginal infections and possible STI transmission. THIS IS WHY DOUCHING IS VERY BAD AND WE COMPLETELY CONDEMN THE ENTIRE PRACTICE. NOT ONLY DOES IT SUPPORT NEGATIVE IMAGES OF FEMALE SEXUALITY AND SEXUAL HEALTH (by suggesting that vaginas are dirty or smell bad, and thus need to be washed out with perfume) BUT IT CAN HAVE REALLY ADVERSE EFFECTS ON WOMEN.

Contraindications:
- Allergy to douche.
- Strong desire to avoid pregnancy.
- Strong desire to avoid vaginal infections, such as yeast infections.
- Strong desire to avoid increasing STI transmission.

Side effects:
- pH imbalance.
- Possible allergies.

Benefits:
- Now really…let’s be honest. There aren’t any. You might smell all flowery for a while. Otherwise, that seems to be it.
- Does not require a prescription. (See, we found ONE.)

METHODS THAT PROVIDE *NO* PROTECTION FROM PREGNANCY:

• “Doing everything but…”   Pregnancies have been reported (even in virgins, although not often) when ejaculation occurred near the vaginal opening.
• “But we only did it once…”  Many women have become pregnant after having sex only once. Women can and do become pregnant the first time they have sex.
• Special Positions:  Sperm can swim against gravity. Having sex standing up or in other positions will not prevent pregnancy.
• Avoiding “the one” dangerous day per month:  See fertility charting. This doesn’t work. We promise.
• Urinating after intercourse:  This helps avoid UTIs, definitely. This does not have any affect whatsoever on preventing pregnancy. Wrong orifice!

Current Methods in Contraception: Barrier Methods

Barrier methods are methods of contraception that work by preventing contact between male sperm and female vaginal secretions (or any sexual fluids).

Using some form of plastic, usually latex or polyurethane, fluids are blocked, thus preventing transmission of STIs as well as pregnancy. The main types of barrier methods are the male condom, the female condom, and dental dams. In addition, there are combination methods which combine barrier methods with chemical methods, but these will be discussed later on.

MALE CONDOM

How it works: A condom is a sheath made of latex, polyurethane, or animal tissue that fits over the penis. Polyurethane and animal tissue condoms are available for those allergic to latex. However, animal tissue condoms are not recommended for protection
against STDs. The condom acts as a physical barrier by preventing sperm from entering a woman’s vagina. Some condoms are lubricated, some also come with spermicide (but the SHPRC does not carry these condoms any more, see below for more information).

Effectiveness (failure rate): 3%-14%
In 100 users who use a condom correctly and consistently, the lowest estimated failure rate would be 3 pregnancies in one year. In 100 typical users however, the estimated failure rate is 14 pregnancies in one year. The large difference between these two failure rates can be attributed to incorrect and inconsistent use of the condom. Therefore it is crucial that a condom is used every time one has intercourse, and is used correctly. The condom is even more effective when used with additional spermicide.

Contraindications:
- Allergy to latex (polyurethane condoms are an alternative)

Possible side effects, risks, and considerations:
- May cause some loss of feeling. (Lubrication may lessen this effect.)
- Approximately 1 in 165 condoms tear during vaginal intercourse.
- Using a condom may be considered an interruption, but partner participation can
make condom usage more pleasurable.
- Animal tissue condoms have been shown to be permeable to the AIDS virus and therefore should not be considered protection against HIV.

How to use it:
1. Some packaging is difficult to open. Practice this so that you don’t tear the
condom. In addition, be sure to check the packaging for damage and look for the
expiration date.
2. Wait until the penis is erect before putting on the condom. Put the condom on
before any genital contact occurs.
3. Place the rolled condom over the tip of the hard penis
4. Leave a half-inch space at the tip to collect semen
5. Pinch the air out of the tip with one hand; unroll the condom over the penis with
the other hand. Roll it all the way down to the base of penis.
6. After intercourse, remove the penis before it softens. Hold the condom against the base of the penis while it is pulled out.

How to get it:
Condoms are available at heavily subsidized prices at the SHPRC, located on the second floor of the Vaden Health Center. They can also be purchased over the counter at a drug store, Tresidder Express, or at the student health pharmacy.

Cost:
The average cost is $2 for a dozen condoms at the SHPRC. At drugstores, the average cost is $6 for a dozen. Prices range up to $25 for a dozen polyurethane condoms.

Important:
- Oil-based products (Vaseline, lotion, Monistat) cannot be used with latex
because they degrade it and make it more likely to break. Water-based lubes
should be used instead.
- Spermicidal condoms do not have enough spermicide on them to make them any more effective. Actually, studies have shown that spermicide may increase the transmission of some STIs because it causes micro-abrasions in the vagina or the anus. Spermicide should only be used to prevent pregnancy.

FEMALE CONDOM

How it works: The female condom is a polyurethane pouch with a flexible ring at each end. The ring at the closed end holds the female condom in the vagina. The ring at the open end stays outside the vaginal opening. Female condoms prevent sperm from entering the vagina by acting as a physical barrier.

Effectiveness (failure rate): 5%-21%
Of 100 women who use female condoms, 5 will become pregnant after perfect use. During the first year of typical use, 21 out of 100 will become pregnant. The high failure rate with typical use indicates that care must be taken to use the female condom correctly every time.

Contraindications:
- Discomfort with touching genitals to insert condom.

Possible side effects, risks, and considerations:
- Female condoms are less effective at preventing pregnancy than male condoms.
- Female condoms are more expensive and harder to find than male condoms.
- The condom may squeak during intercourse; this can be remedied by using more lube.
- Female condoms may cause vaginal irritation in some women.

Benefits:
• Women who use female condoms do not have to depend on their partners to wear condoms.
• Female condoms can be inserted up to 8 hours before intercourse.
• Female condoms are suitable for those women with latex allergies because they are made of polyurethane.

How to Use it:
• Lubricate the closed end of the condom.
• Squeeze together the sides of the inner ring at the closed end and insert it into the vagina like a tampon. Push it in as far as the ring can go, until it reaches the cervix.
• When removing, pinch the open end to hold the semen inside the condom.
• Pull out the female condom and discard, do not reuse.

How to get it:
Female condoms are available at some drugstores, and are available at reduced cost at the SHPRC.

Cost:
Typical cost is around $2.50 per condom.  The SHPRC sells them for $0.50 per condom.

Spermicide: NOT sold or supported by the SHPRC

When addressing chemical methods, the main component is usually spermicide (which has numerous forms and types).

How it works: Contraceptive foams, creams, jellies, and suppositories contain
spermicides, which are chemicals that immobilize sperm and prevent them from joining with an egg. They are inserted deep within the vagina shortly before intercourse. They are used to increase the effectiveness of other methods such as the condom. These products should not be relied on alone to prevent pregnancy.

Effectiveness (failure rate): 6%-26%
Of 100 women who use spermicides, 26 will become pregnant during the first year of typical use. 6 will become pregnant with perfect use.

Contraindications:
- Allergic reaction to spermicidal products.
- Strong desire to avoid pregnancy (failure rates are high).

Possible side effects, risks, and considerations:
- Spermicides have high failure rates when used alone.
- Some women find them messy.
- Some women and men may develop allergic reactions to the products.
- People who enjoy oral sex may object to the taste of contraceptive foam.

Benefits:
- Sold over the counter and does not require medical supervision.
- Inexpensive and easy to use.
- Offers some protection against non-viral STIs.
- Does not affect a woman’s hormonal balance.
- Immediately effective and reversible.

How to get it: Spermicides are available over the counter at most drug stores.

Costs: Single applicators of foams, creams, and jellies typically cost about $1 per application.

WHY WE DON’T SELL IT AT THE SHPRC:
Many spermicides contain a chemical called nonoxynol-9, which is a detergent that can cause rashes or sores on the vaginal wall. These rashes increase the likelihood of contracting STDs/STIs. Nonoxynol-9 can also wash away the natural mucus and bacterial layer in the vagina that protects against germs, which can lead to yeast and bladder infections. Many Trojan brand condoms contain spermicide with nonoxynol-9, which is why the SHPRC does not carry Trojan brand condoms.

Hormonal Methods: all of the following information is taken from the Planned Parenthood website, which you can visit to find out more.

The Pill

The most popular reversible contraceptive method in the U.S. – the pill – was developed under the guidance of the founder of Planned Parenthood, Margaret Sanger, and her friend, Katharine Dexter McCormick, who was one of the first women graduates of MIT. Sanger’s pill now ranks among the safest and most carefully studied medications in U.S. history.

“The pill” is the common name for oral contraception. There are two basic types — combination pills and progestin-only pills. Both are made of hormones like those made by a woman’s ovaries. Combination pills contain estrogen and progestin. Both types require a medical evaluation and prescription. Both can prevent pregnancy.
Combination pills usually work by preventing a woman’s ovaries from releasing eggs (ovulation). They also thicken the cervical mucus, which keeps sperm from joining with an egg.
Progestin-only pills usually work by thickening the cervical mucus, to prevent sperm from joining with an egg. Less often, they prevent ovulation.
The hormones in combination and progestin-only pills also thin the lining of the uterus. In theory, this could prevent pregnancy by interfering with implantation of a fertilized egg. But there is no scientific evidence that this occurs. Taking the pill daily maintains the level of hormone that is needed to prevent pregnancy.
Effectiveness: The pill is one of the most effective reversible methods of birth control. Of 100 women who use the pill, only eight will become pregnant during the first year of typical use.* Fewer than one will become pregnant with perfect use.** Maybe slightly less effective for overweight women.
It is very important to remember that the pill does not protect against sexually transmitted infections. Use a latex or female condom along with the pill to reduce the risk of infection.

Advantages: Taking the pill is simple, safe, and convenient. Many women who take the pill have fewer menstrual cramps and lighter periods. The pill also offers some protection against pelvic inflammatory disease, which often leads to infertility when left untreated.
The pill does not interfere with having sex. Many women say it has improved their sex lives. They say it helps them feel more spontaneous.
The combination pill offers many other benefits, including some protection against
• acne
• cancer of the lining of the uterus
• cancer of the ovaries
• ectopic pregnancy
• excess body hair
• iron deficiency anemia that can result from heavy menses
• noncancerous breast growths
• osteoporosis
• ovarian cysts
• premenstrual symptoms, as well as related headaches and depression
• vaginal dryness and painful intercourse related to menopause

In fact, protection against developing cancer of the ovary or the lining of the uterus (endometrium) can last up to 30 years after stopping the combination pill. Protection against both of these types of cancer increases with each year of use:
• Eight years of combination pill use reduces the risk of endometrial cancer by up to 80 percent.
• Ten years of combination pill use reduces the risk of ovarian cancer by up to 80 percent.

Disadvantages:
• Does not protect against STIs
• Risk of some cardiovascular disease (heart attack)
• Increased hunger, which can cause weight gain (the pill does not directly cause weight gain)
• Some cases of depression
• Possible decreased sex drive

Combination pills come in 28-day or 21-day packs. Both types have 21 “active” pills — they contain hormones that prevent pregnancy. The last seven pills in 28-day packs of combination pills are called “reminder” pills. They do not contain hormones. They are taken during the fourth week.
In 21-day packs, the pills are taken for three weeks. A new pack of pills is started eight days after the last pack is completed.
The hormones in the active pills prevent pregnancy throughout the month — even during the fourth week when taking either no pills or reminder pills.
Progestin-only pills come only in 28-day packs. All progestin-only pills are “active.”
Menstruation usually occurs during the fourth week, no matter what type of pill is used — unless a woman decides to avoid menstruation by using active combination pills during the fourth week, as well.

How to Get it: The pill is only available through prescription. Students can obtain a prescription by making an appointment to see a clinician at Vaden – each pack of pills costs between $30-$50. Or, students can sign up for a program through Planned Parenthood to receive packs of pills for free.

Ortho Evra: The Patch

The patch — Ortho Evra — is a reversible prescription method of birth control. It is a thin, beige, plastic patch that sticks to the skin. A new patch is placed on the skin of the buttocks, stomach, upper outer arm, or upper torso once a week for three weeks in a row. No patch is used in the fourth week. The patch releases synthetic estrogen and progestin to protect against pregnancy for one month.
The hormones in the patch work by preventing a woman’s ovaries from releasing eggs (ovulation). They also thicken the cervical mucus, which keeps sperm from joining with an egg. The hormones also thin the lining of the uterus. In theory, this could prevent pregnancy by interfering with implantation of a fertilized egg. But there is no scientific evidence that this occurs.
The patch works best when it is changed on the same day of the week for three weeks in a row. Pregnancy can happen if an error is made in using the patch — especially if
• it becomes loose or falls off for more than 24 hours
• the same patch is left on the skin for more than one week

Advantages:
• No medicine to take every day
• Nothing to do before sex to make it work
• Ability to become pregnant should return quickly
• More regular periods, fewer menstrual cramps
• Some protection against cancers of the ovaries and uterus
• Less acne

Disadvantages:
• Some women may forget to apply and remove it on schedule
• Does not protect against STIs
• Nausea, breast discomfort, skin irritation at patch site, headache
• Risks include blood clots at the patch site, some chance of heart attack
• Much more expensive than pills or other methods.

Effectiveness:
The patch is a very effective reversible method of birth control. With typical use, although no studies have yet been published, it is assumed that the patch will be more effective than the pill — eight out of every 100 pill users become pregnant with typical use. Fewer than one woman out of every 100 women who use the patch will become pregnant with perfect use.**

The patch does not protect against sexually transmitted infections. Always use a latex or female condom with the patch to reduce the risk of infection.

How to Get it: The patch is more expensive than other methods, such as the pill. It can cost up to $60 per month ($20 per patch, 3 per month), but students can sign up for state-funded programs at clinics such as Planned Parenthood, in order to receive the patch for free.
Nuva Ring: “The Ring”

The Ring — NuvaRing — is a reversible prescription method of birth control. It is a small, flexible ring that is inserted into the vagina once a month. It is left in place for three weeks and taken out for the remaining week. The ring releases synthetic estrogen and progestin to protect against pregnancy for one month.
The combination of hormones works in two ways. Usually, it keeps the ovaries from releasing an egg (ovulation). Less often it thickens the cervical mucus, which prevents sperm from joining with an egg. The hormones also thin the lining of the uterus. In theory, this could prevent pregnancy by interfering with implantation of a fertilized egg. But there is no scientific evidence that this occurs.
Pregnancy can happen if an error is made in using the ring — especially if
• the unopened package is exposed to very high temperatures or direct sunlight
• it slips out of the vagina and is not replaced within three hours
• it does not stay in the vagina for three weeks in a row
• it is left in the vagina for more than three weeks
If any of these things happen, follow the directions in your package insert, and call your clinician.
Effectiveness: The ring is a very effective reversible method of birth control. With typical use,* although no studies have yet been published, it is assumed that the ring will be more effective than the pill — eight out of every 100 pill users become pregnant with typical use. Fewer than one woman out of every 100 women who use the ring will become pregnant with perfect use.**
Advantages:
• Only needs to be changed once a month
• Very low dose of hormone, so the health risks are lower as well as other symptoms (nausea, etc)
• Same health advantages as other hormonal methods (can lower risk of ovarian cancer)

Disadvantages:
• Same disadvantages as other hormonal methods, but these disadvantages may be less severe/serious because it’s a lower dose of hormone
• Does not protect against STDs/STIs
• It is expensive relative to other methods such as the pill.

How to Get it: The Nuva Ring can be obtained through a prescription given by a health care practitioner. It can cost up to around $60/month, but students can sign up for a state-funded program through Planned Parenthood to obtain the Nuva Ring for free.

Depo Provera: The Shot
THIS IS NOT PRESCRIBED BY VADEN: READ to find out why

“The shot” is an injectable progestin-only prescription method of reversible birth control. It contains a hormone that is similar to the progesterone made by a woman’s ovaries to regulate the menstrual cycle. The shot is also known as DMPA. The D stands for “depot,” the solution in which the hormone is suspended. The hormone is medroxyprogesterone acetate. The common brand name for the DMPA shot is Depo-Provera.
A shot of DMPA can prevent pregnancy for 12 weeks. It
• usually, prevents the ovaries from releasing an egg (ovulation)
• less often, thickens cervical mucus to prevent sperm from joining an egg
• alters the lining of the uterus, which, in theory, may prevent implantation of a fertilized egg

Effectiveness: The shot is one of the most effective reversible methods of birth control. Of every 1,000 women who use it correctly and consistently, only three will become pregnant during the first year of use. Three in 100 women will become pregnant with typical use.
Protection is immediate if you take the shot during the first seven days of your period. Otherwise, use a backup method of contraception for the first week. Protection lasts for 12 weeks.
The shot is not effective against sexually transmitted infections. Use a latex or female condom to reduce the risk.
Advantages
• can be used by women who cannot take estrogen
• can be used while breastfeeding
• effective for 12 weeks
• helps prevent cancer of the lining of the uterus
• no pill to take daily
• nothing to put in place before vaginal intercourse
• very private method — no packaging or other evidence of use that might embarrass some users.
Disadvantages
• must receive shot every three months
• pregnancies, which very rarely occur, are more likely to be ectopic (in a fallopian tube)
• takes an average of nine to 10 months — or sometimes more than a year — to get pregnant after getting the last shot

Possible Side Effects
Irregular bleeding is the most common side effect for women using DMPA. It is more common in the first six to 12 months of use.
• Periods become fewer and lighter for most women, and often stop altogether. The longer a woman uses the shot, the more likely her periods will stop. It may take up to a year for periods to return after a woman’s last shot.
• Some women will have longer, heavier periods.
• Some may have increased light spotting and breakthrough bleeding.

Why Vaden does not prescribe DMPA:
Studies have shown that after even one year of use, the Depo shot can cause SIGNIFICANT loss in bone density and the minerals in bone, causing very early-onset osteoporosis. Although this bone density loss may be reversible, it is still very troubling that bone loss happens in the first place, especially because peak bone mass is developed in a woman’s teens and early twenties. Because of this reason, Vaden does not prescribe DMPA, and counselors at the SHPRC do not recommend that students obtain it elsewhere. It is still available at outside community clinics, such as Planned Parenthood.
Diaphragms, Cervical Caps, and Shields

Diaphragms, caps, and shields are soft latex or silicone barriers that cover the cervix.
• The diaphragm is a shallow, dome shaped cup with a flexible rim. It fits securely in the vagina to cover the cervix.
• FemCap is a silicone cup shaped like a sailor’s hat. It fits securely in the vagina to cover the cervix.
• Lea’s Shield is a silicone cup with an air valve and a loop to aid in removal. It fits snugly over the cervix.

Each method must be used with spermicide cream or jelly. Diaphragms, caps, and shields keep sperm from joining the egg. They block the opening to the uterus. The contraceptive cream or jelly stops sperm from moving.
Effectiveness:
Sixteen out of 100 women who use the diaphragm will become pregnant during the first year of typical use.* Six will become pregnant with perfect use.**
Fourteen out of 100 women who have never been pregnant or given birth vaginally and use FemCap will become pregnant during the first year of typical use. Of 100 women who have given birth vaginally and use FemCap, 29 will become pregnant during the first year of typical use.*** Effectiveness rates for perfect use are not available.
Fifteen out of 100 women who use the shield will become pregnant during the first year of typical use. Effectiveness rates for perfect use are not available.
Protection may be increased by
• making sure the cervix is covered before each act of intercourse
• making sure spermicide is used as recommended
• using a latex condom
***Diaphragms, caps, and shields offer no protection against sexually transmitted infection. Use a latex condom to reduce the risk of infection.
Advantages:
• Cannot be felt by either partner during sex
• Can be inserted hours ahead of intercourse

Disadvantages:
• Does not protect against STIs
• Need to be used with spermicide, which Vaden and the SHPRC do not promote.
• Odor if left in too long
• Increased risk of Toxic Shock Syndrome, HPV (if already existent), UTI, PID, or vaginitis
• Possible allergic reaction to latex or spermicide
• May be disloged during intercourse
• Time and effort to insert and remove cap

How to Get it: The cervical cap cannot be obtained without a prescription, given after a pelvic exam and a cap fitting. The fitting is free at Vaden for students with Cardinal Care. The diaphragm and cap are available at Vaden for approximately $40.

Intra-Uterine Contraceptive (IUC) or Intra-Uterine Devices (IUD)

IUCs are small, T-shaped pieces of plastic that are placed in the uterus. There are two types: the Paraguard contains copper, and the Mirena contains a synthetic progesterone. IUCs prevent sperm from joining with an egg, and in theory they could prevent implantation of a fertilized egg.

IUCs are inserted after a pelvic exam. Some clinicians may offer medicine to soften the cervix beforehand. The vagina is held open with a speculum, and the IUC will be inserted through the opening on the cervix, into the uterus. A short length of plastic “string” will hang down into the vagina, which can be used to check occasionally to make sure that the IUD is still in place.

Effectiveness: For every 100 women who use the IUC, fewer than one will become pregnant during the first year.

Advantages:
• Most effective reversible birth control
• Economical
• Can be used while breastfeeding
• Works immediately upon insertion
• Nothing to do right before sex to make it work
• Ability to become pregnant should return quickly when removed
o Advantages of the Mirena (progesterone IUD)
• Good for FIVE YEARS
• Fewer menstrual cramps
• Lighter periods/less blood loss: often periods stop after a few months
• Less iron deficiency anemia
o Advantages of the Paraguard (copper IUD)
• Good for TWELVE YEARS
• No hormones
• Can be used for emergency contraception

Disadvantages:
• Some possible side-effects that usually clear up after a few weeks/months include heavier periods, cramping or backache, and spotting between periods
• It requires visits to a healthcare provider, because it must be inserted and removed by a clinic
• Mild to moderate discomfort with insertion
• Substantial up-front cost (but over the long run it’s more economical than other methods)
• Using Paraguard can cause heavier periods and worse menstrual cramps in some women
• Very rare risks include perforation of the uterine wall or expulsion of the IUD

How to Get it: The IUC can be obtained through a consultation with a health care provider. It can cost up to $600, but Stanford students with Cardinal Care can obtain the IUC for a heavily reduced price. Additionally, students can sign up for a state-funded program at Planned Parenthood to obtain the IUC for free.

Tubal Ligation

Tubal sterilization is intended to be a permanent method of birth control. More and more women today choose sterilization. They know that this single procedure can provide highly effective protection against pregnancy for the remainder of their reproductive years. They also know that there is an increased chance of failure with many temporary methods, that some temporary methods have bothersome side effects, and that some may be inconvenient.
Sterilization does not decrease a woman’s sexual pleasure. It is often the answer for women who have completed their families and for women who do not want children.

How Tubal Sterilization Works
Tubal sterilization closes off the fallopian tubes, where an egg is fertilized by a sperm. When the tubes are closed, sperm cannot reach the egg, and pregnancy cannot happen.
Sterilization does not affect femininity. It is very unlikely that sterilization will affect your sex organs, or your sexuality. No glands or organs will be removed or changed. All of your hormones will still be produced. Your ovaries will release eggs. Your menstrual cycles will most likely follow their regular pattern.
Effectiveness
Sterilization is more than 99 percent effective in the first year. In following years, there is a limited possibility that tubes may reconnect by themselves. Up to one out of 100 women become pregnant each year after sterilization. About one out of three of these pregnancies are ectopic (develop in a fallopian tube) and may require emergency surgery.

Vasectomy

Vasectomy is permanent birth control for men. It is a medical procedure that is intended to cause sterility. About 500,000 men in the U.S. choose vasectomy every year. It is chosen by men who have completed their families or by men who do not want children. These men want birth control that is intended to be permanent. They prefer vasectomy because most reversible methods are less reliable, sometimes inconvenient, and may have unpleasant side effects for the women in their lives. Vasectomy is nearly 100 percent effective. It is intended to be permanent. It is safe. It doesn’t limit sexual pleasure.

How Vasectomy Works
Vasectomy is a simple procedure. It makes men sterile by keeping sperm out of semen — the fluid that spurts from the penis during sex. Sperm are the reproductive cells in men. Pregnancy can happen if a sperm joins with a woman’s egg.
Sperm are made in the testes. They pass through two tubes called the vasa deferentia to other glands and mix with seminal fluids to form semen. Vasectomy blocks each vas deferens and keeps sperm out of the seminal fluid. The sperm are absorbed by the body instead of being ejaculated. Without sperm, your “cum” (ejaculate) cannot cause pregnancy.
Vasectomy does not affect masculinity. And it will not affect your ability to get hard and stay hard. It also will not affect your sex organs, sexuality, and sexual pleasure. No glands or organs are removed or altered. Your hormones and sperm continue being produced. Your ejaculate will look just like it always did. And there will be about as much of it as before.
Effectiveness:

Vasectomy is not immediately effective. Sperm remains in the system beyond the blocked tubes. You must use other birth control until the sperm are used up. It usually takes about three months. A simple test — semen analysis — shows when there is no more sperm in the seminal fluid. Very rarely, tubes grow back together again and pregnancy may occur. This happens in about one out of 1,000 cases in the first year.