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Dating and Sex
Of course, you are not out for a one night stand. But in times like these, there is more than one reason to be well-prepared when it comes to sex and sexual health. Here are some useful facts about contraception and sexually transmitted infections.
The Pill
What are Birth Control Pills?
The Pill is a so-called oral contraceptive and it is the most popular type of birth control. There are many different brands and types of the Pill and they come in packs of 21 or 28 pills. One pill is taken every day. The first 21 pills have a combination of synthetic estrogen and progesterone hormones. The Pill stops ovulation, preventing the ovaries from releasing eggs. The Pill also thickens cervical mucus, making it harder for sperm to enter the uterus. The hormones in the Pill prevent fertilization. The last 7 pills of a 28-day pack have no hormones and are called spacer pills.
How safe is the Pill?
Taken as instructed, the Pill is 98-99.8% effective as birth control. At a Pearl Index of 2, in one year 2 women of 100 sexually active women become pregnant. At a Pearl Index of 0.2, in one year 2 women of 1000 sexually active women become pregnant.
Advantages
- Highly effective with a Pearl Index of 0.2 to 2.0
- easily available with a doctors’ prescription
- The contraceptive effect is easily reversible should you decide you want a baby
Disadvantages
- As a hormonal method, it may have a number of unwanted side-effects
- It must be taken regularly to be effective
- It does not protect against reproductive tract or sexually transmitted infections, including HIV/AIDS
- The effectiveness of the Pill is lowered when taken with certain medications, including antibiotics and others
Condoms
What is a Condom?
As a barrier method, the condom presents a barrier that prevents sperm meeting an egg. There are male and female condoms. Condoms are made of latex (rubber) or polyurethane (plastic).
How safe are condoms?
That depends on how carefully you use them. Male condoms have a Pearl index of 2. This means that two women in 100 will get pregnant in a year when using a male condom as a contraceptive. Female condoms are 95 per cent effective, meaning five in 100 women will get pregnant in one year.
- Myth: Condoms are restrictive and uncomfortable
- Fact: Not true - condoms come in different textures, shapes and types. Find a brand that suits you
- Myth: Condoms may have holes in them
- Fact: Not true - all condoms are tested and carry the CE quality mark. Many brands also have a kite mark to show they are reliable
How do I use a male condom?
Male condoms fit over a man's erect penis. They should be used before any close genital contact. Once the man has ejaculated but before the penis goes soft, he must withdraw holding the condom firmly in place to avoid spilling any sperm. The condom is then removed and should be disposed of carefully.
How do I use a female condom?
Female condoms are put into the vagina and then line it loosely. The closed end of the condom is inserted far up into the vagina. The outer ring remains just outside the vagina. After sex the condom is taken out by twisting the ring to keep the sperm inside and pulling it out. Of course, it needs to be disposed of carefully.
Advantages
- Very effective
- Readily available (male condoms)
- Only need to use them when you have sex
- Help prevent some sexually transmitted infections, including HIV
- Male condoms come in various different shapes and sizes
- Female condoms can be inserted any time before sex
Disadvantages
- Can interrupt sex
- Male condoms may slip off or split if used incorrectly
- Female condoms must be used with care to ensure the penis goes inside the condom, not down the side of the condom and the vagina
- Some people are sensitive to the chemicals in latex condoms. However, this is not very common
- Lubricants containing oil, such as body oils or lotions, should not be used with latex condoms
Other things to keep in mind
- Most people can use condoms. If you have sensitivity to latex, you may choose polyurethane condoms, which may also be used with any oil-based lubricants.
- Novelty condoms are designed for fun and should not be used for contraception or STI protection. Check the packet before use.
Where can I buy condoms?
- In Britain, you can get them for free on the National Health Service.
- You can obtain male condoms free from contraception clinics, sexual health clinics, genitourinary medicine clinics and some general practices. You can buy them from pharmacies, supermarkets, vending machines and via mail order.
- Female condoms are free from some contraception and sexual health clinics. You can buy them from some pharmacies and via mail order.
The Contraceptive Patch
What is a contraceptive patch?
Similar to a band-aid, they come as small, thin, beige, sticky skin patches containing estrogen and progestogen (the same hormones as the pill). These are similar to the hormones produced by women in their ovaries.
How does it work?
In this hormonal contraceptive method, a constant daily dose of hormones is delivered by the patch into the bloodstream through the skin. This stops the ovaries from releasing an egg each month. In addition, the contraceptive patch also thickens the mucus in the cervix, making it difficult for sperm to reach an egg and makes the lining of the womb thinner so a fertilised egg is less likely be accepted by it.
Is it reliable?
Again, effectiveness depends on the care taken when using it. The patch is more than 99 per cent effective when used as instructed. Using this method, fewer than one woman in 100 will get pregnant in a year. It is not as effective in women weighing 90kg (14st) and over.
- Myth: The contraceptive patch is more reliable than the pill
- Fact: Not true - the effectiveness of the patch is equal to the pill
- Myth: It comes off easily
- Fact: Not true – it is very sticky
How do I use a contraceptive patch?
The patch is used for three weeks out of every four. A new patch is applied each week.
The patch may be started in a period, up to and including the fifth. If used at this time it's effective right away. If started at any other time, another contraceptive method must be used for seven days.
After 21 days you stop wearing a patch for seven days when you have a bleed. Such a withdrawal bleed is usually shorter and lighter than your normal period.
You can use the contraceptive patch on most areas of the body where your skin is clean, dry and not too hairy. You should not put it on sore skin or on skin that is liable to be rubbed by tight clothing. Avoid putting it on your breasts.
Advantages
- Replacement necessary only once a week
- It does not interfere with sex
- The hormones in the patch do not need to be absorbed by the stomach (unlike those in the pill), so the effectiveness of the patch is not affected if you vomit or have diarrhoea
- Bleeds are usually regular, lighter and less painful
- May reduce premenstrual symptoms (PMS)
- May lower the risk of cancer of the ovaries, womb and colon
- May lower the risk of fibroids, ovarian cysts and non-cancerous breast disease
Disadvantages
- It is visible
- It may cause skin irritation, though instances are rare
- May have temporary side-effects like the pill: at first may include headaches, nausea, breast tenderness and mood changes
- Breakthrough bleeding (unexpected bleeding during patch use) and spotting may occur
- The contraceptive patch can have serious side-effects, but these are not common. They may include:
- Raised blood pressure
- In rare instances, women may develop a blood clot, which can block a vein or an artery
- The risk of being diagnosed with breast cancer may increase
- The risk of cervical cancer may increase if the patch is used continuously for more than five years
Can anyone use the contraceptive patch?
The patch may not be the ideal contraceptive for all women. Most women say the benefits of the patch outweigh the possible risks.
It may not be suitable for you if you have
- an overweight problem
- a heart abnormality, circulatory disease or high blood pressure
- active liver or gall bladder disease
- breast cancer now or within the past five years
- diabetes with complications, or have had diabetes for more than 20 years
- had a previous thrombosis
- very severe migraines or migraines with aura
or if you
- Smoke beyond 35, or are over 35 and quit smoking less than a year ago
- Take specific medicines - always check
- Think you may be pregnant
What if the patch comes off?
It is very sticky and is supposed to stay on when bathing, taking a shower or sauna, swimming or exercising.
If the patch has come off less than 48 hours ago, just put one back on as soon as possible, then continue as before.
If it came off for over 48 hours ago, start a whole new patch cycle by applying a new one as soon as possible. Use additional contraception for seven days. See your doctor regarding emergency contraception if you had sex in the previous few days without using a condom.
Other things to consider
At first, you will get three months' supply of the patch. If you do not experience any problems, you will be given up to a year’s supply.
You do not need a cervical screening test or an internal examination to have the patch
The patch does not prevent sexually transmitted infections like HIV.
Where can I get the patch?
In Britain, the patch is available on the NHS from contraception clinics, sexual health clinics or general practice.
Diaphragms and caps
What are they?
Like Condoms, diaphragms and caps represent barrier methods that prevent sperm meeting an egg. They fit inside the vagina and cover the cervix (entrance to the womb). They are made of rubber (latex), or of polyurethane (plastic) and come in different shapes and sizes.
Vaginal diaphragms are circular domes with flexible rims. Caps are smaller than diaphragms. In order to work effectively, they need to be used with spermicide - a cream or pessary to kill sperm.
- Myth: This method can only be used by women who have had children.
- Fact: Not true - diaphragms and caps come in different sizes and types to suit all women
- Myth: It is not neccessary to use spermicide with the diaphragm
- Fact: Not true - to be effective they need to be used with a spermicide
How safe are they?
As with all contraceptives, the effectiveness of diaphragms depends on how carefully they are used. They are 92-96 per cent effective when used as instructed, or, have a Pearl Index of 4 to 8. That is, using either method, between four and eight women in 100 will get pregnant in a year. The silicone cap, so-called Femcap, has a higher Pearl Index, which means that it is less safe.
How do I use them?
Diaphragms and caps are used each time you have sex. The diaphragm or cap is covered with spermicide and
then inserted into the vagina, where it covers the cervix. It can be inserted any time before sex. If it is inserted more than three hours
before sex, you need to reapply spermicide.
The cap or diaphragm needs to be left in place for at least six hours after the last time you had sex. It can be left in
longer if necessary.
Advantages
- You only have to use it when you have sex
- There are no serious health risks
- It comes in different types
- It can be put in at any convenient time before sex
- It may protect against cervical cancer to a certain extent
Disadvantages
- Putting it in at the time of sex can be an interruption
- Some people dislike the spermicide
- Some diaphragm users may get cystitis (then try changing to a smaller diaphragm or cap)
- Sensitivity to the chemicals in latex diaphragms or caps or to the spermicide may occur
- Body oils, other oils, or lotions should not be used with latex diaphragms or caps
Can anyone use them?
Diaphragms and caps do not suit everyone. They may not be suitable if:
- Your vaginal muscles can not hold a diaphragm
- Your cervix is of an unusual shape or in an awkward position or you cannot reach it
- You have repeated urinary infections
- You have suffered from toxic shock syndrome in the past
- You do not feel comfortable touching your genital area
Other things to consider
You can buy diaphragms and caps if you know your size
You may need a different size if you gain or lose more than 3kg (7lb) in weight, have a baby, miscarriage or abortion
Where can I get a diaphragm or cap?
In Britain, they can be obtained from contraception clinics, sexual health clinics and from your General Practitioner. In order to buy them from a pharmacy, you must know your size.
Male and female sterilisation
What is it?
Sterilisation prevents conception permanently. It is suitable for women or men who are sure they definitively want no or no more children. Male sterilisation is called vasectomy.
How does it work?
In women, the fallopian tubes are blocked to keep the egg and the sperm from meeting. (The fallopian tubes carry the egg from the ovary to the womb). In men, the sperm flow in the vas deferens is intercepted. (The vas deferens is a tube carrying sperm from the testicles to the penis).
Men
Most commonly under local anaesthetic, a small cut is made in the skin of the scrotum. The vas deferens are cut and tied or sealed with heat. The operation takes about 15 minutes and can be done in a clinic, hospital outpatient department or some general practice settings.
Vasectomy is very effective - around one in 2,000 sterilisations in men fails.
- Myth: It can easily be reversed
- Fact: Not true - vasectomy or female sterilisation is difficult to reverse, involving major surgery that, in Britain for example, is not available on the National Health Service
- Myth: Vasectomy is like castration
- Fact: Not true - vasectomy only means cutting the tubes that carry sperm to the penis, nothing else is touched
Women
Under local or a light general anaesthetic, a small cut is made in the lower abdomen. The fallopian tubes are cut and tied, or sealed or blocked, usually with clips.
About one in 200 sterilisations in women fails. The clip method is more effective.
Women considering sterilisation should also collect information about long-acting reversible contraception as these methods can be as effective as, or more effective, than female sterilisation.
When can I stop using other contraception after sterilisation?
Women should use contraception up to the operation and for four weeks afterwards.
Men will need to use contraception after vasectomy until a semen test shows there are no sperm. This test is usually done around eight weeks after vasectomy.
Advantages
- After sterilisation has worked you never need to think about contraception again
- No known serious long-term health risks
Disadvantages
- The tubes may rejoin and thus make you fertile again - this is uncommon
- Cannot be reversed easily
- You must allow at least two months for vasectomy to be effective
Can anyone be sterilised?
Sterilisation is permanent and thus only for women and men who are sure they don't want children or any more children.
You should not consider sterilisation if you are unsure, under any stress (for example after birth, miscarriage or abortion) or have any family or relationship crisis.
Research shows that more women and men regret sterilisation if they were sterilised when they were under 30, had no children or were not in a relationship.
Other things to consider
Sterilisation is no protection against sexually transmitted infections. After sterilisation, your sex drive and enjoyment of sex should not be affected.
Where can I be sterilised?
Sterilisation is free on the British National Health Service from contraception clinics, sexual health clinics or general practice.
Natural family planning
What is it?
Natural family planning, or NFP, involves being able to identify the signs and symptoms (fertility indicators) of fertility during the menstrual cycle, so you can plan or avoid pregnancy.
How reliable is it?
Again, its effectiveness depends on how carefully the method is applied. If used as taught and instructed, it is over 98
per cent effective. In other words, with this method as contraception, fewer than two women in 100 will become pregnant in a year.
It's most effective when taught by a specialist NFP teacher and when more than one fertility indicator is monitored.
- Myth: Natural family planning is ineffective
- Fact: Not true - NFP is highly effective when used correctly
- Myth: Natural family planning is difficult to use
- Fact: Not true - NFP is easy to use once you have been taught correctly and have good support
There are also a number of different fertility monitors that work by observing changes in temperature, urine or saliva. In the UK, the leading product is called Persona. It is about 94 per cent effective. This means, using this method, at least six women in 100 will become pregnant in a year.
How do you use it?
NFP works by observing and recording your body’s different fertility indicators on each day of your menstrual cycle. The most important fertility indicators are:
- Recording your body temperature - your body temperature changes through the menstrual cycle under the influence of estrogen and progesterone. It rises slightly after ovulation. Recording these changes each day will show when ovulation has occurred.
- Observing cervical secretions (cervical mucus) - the amount of estrogen and progesterone varies during the menstrual cycle, altering the quantity, texture and appearance of cervical mucus, seen as vaginal secretions. Recording these changes can help you identify the start and end of your fertile time
- Calculating how long your menstrual cycle lasts - Recording how short or long your menstrual cycles are over six months can give you an idea of your cycle length.
Combining these different fertility indicators increases the effectiveness of Natural Family Planning.
Advantages
- Makes you more aware of your fertility and helps you plan or prevent pregnancy
- Does not involve any hormones or devices
- No physical side-effects
- Acceptable to all faiths and cultures
- Can help recognise normal and abnormal vaginal secretions
Disadvantages
- It takes time to learn to use the method
- You have to keep daily records
- Some events such as travel, illness, lifestyle or stress can make fertility indicators harder to interpret
Who can use NFP?
Most women can as long as they are carefully instructed and supported. It can be used at all ages and at all stages of the reproductive life.
It may take longer to identify your fertility indicators and to start to use Natural Family Planning if you have irregular menstrual cycles, or after hormonal contraception, after having a baby or when close to reaching menopause.
Other things to consider
Natural family planning does not prevent sexually transmitted infections.
Advice and support
Ask about NFP at contraception clinics, sexual health clinics or GP surgeries.
