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Birth Control

Making the decision to have sex can be difficult. You should make up your own mind when the time is right for you. If you are not ready for sex, say so. If you think you are ready to have sex or if you are already having sex—even only now and then—you should take steps to avoid pregnancy and sexually transmitted infections (STIs). Thousands of teens get pregnant each year because they do not use birth control or they do not use it correctly.
This pamphlet explains

types of birth control
how to choose a birth control method that is right for you
which birth control methods protect against STIs

TEENS AND BIRTH CONTROL

There are many reasons teens may not use birth control, even if they do not want to have a baby. They may

think they will not get pregnant
be afraid to go to a health care professional or clinic to ask for birth control
not know how to get birth control or think they cannot afford it
worry about their parents finding out
be afraid of what their partner thinks about birth control
think that birth control might hurt their ability to get pregnant in the future
have sex that was not planned
think that they will not get pregnant the first time they have sex

Some of these reasons are based on myths.
You can get pregnant the first time you have sex. And birth control does not affect your ability to get pregnant in the future.
If you have any of these concerns, talk with a healthcare professional. Many teens are deciding to protect themselves from pregnancy and STIs, and you can too.
You may have heard about "tricks" you can use to not get pregnant (read the box
"What Does Not Work"). Do not depend on them, they do not work.

What Does Not Work

The following things DO NOT stop you from getting pregnant:

Douching: Squirting water or any other liquid into the vagina after sex does not kill sperm or prevent pregnancy and may cause infections.
Plastic wrap instead of a condom: Plastic wrap or a plastic bag can tear and let sperm escape.
Urinating right after sex: Urine does not pass through the vagina, so it does not get rid of the sperm.
Having sex for the first time: You can get pregnant from just one act of unprotected sex.
Having sex in a special position: No matter what position you have sex in, if the penis enters the vagina or comes close to the vagina, you can get pregnant.

SEX AND REPRODUCTION

Knowing how pregnancy happens can help you understand how the different methods of birth control work. A woman has two ovaries, one on each side of the uterus.
Each month, one of the ovaries releases an egg into a fallopian tube. This is called ovulation. It usually happens about 12 to 14 days before the start of menstruation (the menstrual period).

During sexual intercourse (vaginal sex), the penis goes into the vagina. When the male partner ejaculates ("comes"), the penis releases semen into the vagina.
Semen contains millions of sperm.
Sperm can swim up into the uterus and then the fallopian tubes. If a sperm meets an egg in the fallopian tube, fertilization-joining of an egg and sperm-can happen. This can lead to pregnancy, even if it is your first time having sex.

TYPES OF BIRTH CONTROL

When choosing a type of birth control, it helps to know all your options. Questions to think about before choosing a method include the following:
• How well does it prevent pregnancy?
(Read Table 1.)
• How easy is it to use?
• How easy is it to get?
• Does it protect against STIs?
• Do you have any health problems?
Some types of birth control require a prescription, and you have to see a health care professional or go to a clinic to get them. A pelvic exam is not needed to get most forms of birth control, except for the intrauterine device (IUD), diaphragm, and cervical cap. If you have already had sex, you may need to have a pregnancy test and STI test before birth control can be prescribed.
If you have certain diseases or medical conditions, some birth control methods may not be recommended. Talk with your health care professional about the safety of each method to find the best option for you.
If you are having sex (vaginal, oral, or anal sex), you also need to protect yourself from STIs. Condoms made from latex or polyurethane provide the best STI protection for both partners. You can also use a dental dam to protect against STIs during oral sex.

Condoms are not the best protection against pregnancy. You can use condoms and another method of birth control to protect against STIs and pregnancy.

Hormonal Methods
Hormonal methods of birth control contain hormones that prevent pregnancy. Hormones are made by the body to control its functions.
The hormones in birth control prevent your body from releasing an egg each month. If your body does not release an egg, you cannot get pregnant.
Some methods also thicken the mucus in front of the cervix, which helps prevent
sperm from entering the uterus, and thin the lining of the uterus.
There are many types of hormonal methods. They are safe for most people and work well when used as directed. To begin using any hormonal method, you need to see a health care professional.
Hormonal birth control methods do not protect against STIs. You need to also use a condom to protect against STIs.

Birth Control Pills

Birth control pills, often called "the pill," are the most popular hormonal method. You have to take a pill at the same time every day.
If you miss a pill, read the directions that came with your pills. You can also contact your health care professional.
There are many types of birth control pills. Your health care professional can help you choose the right one for you.

Skin Patch

The patch is a small (1.75 square inch) adhesive patch that is worn on the skin. A new patch is worn for a week at a time for 3 weeks in a row. During the fourth week, a patch is not worn, and you have your period.
The patch can be worn on the buttocks, chest (excluding the breasts), upper back, arm, or
abdomen.
The patch can be worn while bathing, exercising, and swimming.

Vaginal Ring

The ring is a flexible plastic ring that you insert into the upper vagina. It is left inside the vagina for 21 days and then removed for 7 days. During those 7 days, you have your period. Then you insert a new ring.

Birth Control Shot

This shot (depot medroxyprogesterone acetate [DMPA]) is given in the upper arm or buttock every 3 months. The birth control shot may be a good choice if you do not want to remember to take a daily pill.

Implant

The implant is a small plastic rod about the size of a matchstick.
Your health care professional inserts it under the skin of the upper arm.
It releases hormones. The implant is approved for 3 years of use. It may be a good choice if you do not want to remember to take a daily pill.

Intrauterine Device
The IUD is a small, T-shaped, plastic device that is inserted into and left inside the uter-us. The IUD must be inserted and removed by a health care professional. Three types of hormonal IUDs are available in the United States. There is also a copper IUD.
There are different brands of hormonal
IUDs that last for different lengths of time.
Depending on the brand, they are approved for up to 3 to 8 years of use. The copper IUD is approved for up to 10 years of use.
Once the IUD is inserted, nothing else needs to be done to prevent pregnancy. The IUD has a string that can be checked to be sure the device is in place.
The IUD does not protect against STIs.
Use a condom in addition to the IUD to protect against STIs.

Barrier Methods
Barrier methods keep sperm from reaching the egg. These methods include spermicide, condoms, diaphragms, cervical caps, and sponges. You must use barrier methods each time you have sex.
Birth Control | acog.org/WomensHealth
Condoms, sponges, and spermicides can be bought in drugstores. A diaphragm or cervical cap must be fitted to your body and requires a prescription.

Spermicides

These are chemicals that are put into the vagina to make sperm inactive. There are many types of spermicides: foam, gel, cream, film (thin sheets), or suppositories (solid inserts that melt after they are inserted into the vagina).
Follow the directions carefully. For many spermicides, you need to wait 10 to 15 minutes after insertion for them to start to work. But spermicides are effective for only 1 hour after they are put in the vagina. If more than 1 hour goes by, you need to reinsert the spermicide.
You must reinsert spermicide for each act of sex. The spermicide needs to stay in place for 6 to 8 hours after the last act of sex.
When used alone, spermicides do not protect against STIs, including infection with human immunodeficiency virus (HIV). Frequent use of spermicides may increase the risk of getting HIV from an infected partner. Spermicides should only be used if you are at low risk of HIV infection (read the box "A Warning About Using Spermicides.)

Condoms

Condoms come in male and female versions. The male condom ("rubber") covers the penis and catches the sperm after the male partner ejaculates (read the box "How to Use a Condom").Male condoms are easy to use and can be bought in many places, including drugstores, without a prescription. Condoms that are made of latex or polyurethane are the best way to reduce the risk of getting an STI. They can be used alone or with other birth control methods to protect against STIs. For example, you may decide to use the IUD or ire lant which me bot very efective in protect against STIs.The female condom is a thin plastic pouch that lines the vagina. It may be put in place up to 8 hours before you have sex.It can bought in drugstores. The female condom is a good choice if your partner will not use a male condom. It provides some protection against STIs.Condoms work better to prevent pregnancy when used with spermicide.Spermicides should only be used if you are at low risk of HIV infection (read the box "AWarning About Using Spermicides").

Diaphragm

The diaphragm is a small dome-shaped device made of latex or silicone that fits inside the vagina and covers the cervix. Diaphragms are available by prescription only.
With one type of diaphragm, your health care professional needs to do a pelvic exam to find the right size. Another diaphragm is "one size fits all."
Diaphragms are always used with a spermicide. Birth control methods that need spermicides to work should only be used if you are at low risk of HIV infection (read the box "A Warning About Using Spermicides").
The diaphragm does not protect against STIs. A condom should be used with the diaphragm to protect against STIs.
A diaphragm must be left in place at least 6 hours after sex, but not more than 24 hours total. If you have sex again within this time frame, you need to add more spermicide and wait another 6 hours before removing the diaphragm.

Cervical Cap

The cervical cap is a small, thin latex or plastic dome shaped like a thimble. It fits tightly over the cervix.
Like the diaphragm, it is available by prescription only. A health care profession. al needs to do a pelvic exam to find the right size for you.
The cervical cap must be used with a spermicide. After sex, the cap should be left in place for 6 hours but not longer than 48 hours total. You do not need to add more spermicide if you have sex again within this time frame.
Birth control methods that need spermicides to work should only be used if you are at low risk of HIV infection (read the box "A
Warning About Using Spermicides").
The cervical cap does not protect against STIs. Use a condom with the cervical cap to protect against STIs.

Sponge

The sponge can be bought without a prescription at pharmacies and other stores. It is a round device made of soft foam that is coated with spermicide. It is pushed up into the vagina to cover the cervix.
The sponge is effective for up to 24 hours.
It is good for more than one act of sex during this time. It must be left in at least 6 hours after the last act of sex. It must be removed within 30 hours of the time it is inserted.
Birth control methods that need spermicides should only be used if you are at low risk of HIV infection (read the box "A Warning About Using Spermicides').

A Warning About Using Spermicides
Nonoxynol-9 (N-9) is a chemical found in all spermicides sold in the United States.
Frequent use of N-9 may cause changes in the vagina and rectum that increase the risk of getting HIV from an infected partner.
You should only use a spermicide for birth control-by itself or with another barrier method—if you are at low risk of HIV infection. You are at high risk of HIV infection if you
• have had more than one sexual partner since your last HIV test or a sexual partner who has had more than one partner since the partner's last HIV test
• have been diagnosed with an STI in the past year
• have a history of exchanging sex for money or drugs, or of injected drug use
• have had a past or present partner who is HIV positive or who injects drugs
• have a history of invasive cervical cancer
• live in an area where there is a high rate of HIV infection
• are entering a detention facility

Birth Control in an Emergency
If you have sex without using any birth control, if your birth control method did not work (for example, the condom broke during sex), or if you are raped, you can use emergency contraception (EC) to prevent pregnancy. It should only be used in an emergency-not for regular birth control.
EC can prevent some, but not all, pregnancies. It is most effective when taken as soon as possible after having unprotected sex.
There are two main types of EC:1) the copper IUD and 2) pills.

You must have the IUD inserted by a health care professional or take the pills within 5 days of having unprotected sex. Some EC pills are available at pharmacies to anyone of any age without a prescription.

Copper IUD

The copper IUD is the most effective form of EC. A health care professional must insert the IUD. You can call your health care professional or go to a family planning clinic to have the IUD inserted. Then you can rely on the copper IUD for long-term birth control (for up to 10 years). You can have the IUD removed at any time if you wish to get pregnant.

EC Pills. There are three types of EC pills:
1) ulipristal, 2) progestin-only pills, and
3) combined birth control pills taken in certain amounts.
Ulipristal is the most effective EC pill.
You need a prescription to get it. You can ask your health care professional to give you a prescription in advance. This way, it is there when you need it.
All of the progestin-only pills are available over the counter in pharmacies and other stores to anyone of any age. The progestin-only pill can usually be found in the family planning section. Not all stores carry it, so it is best to call ahead to see if it is available.
Combined birth control pills are the least effective type of EC. The number of pills needed for EC differs for each brand of pill. A health care professional can tell you how many pills you should take for the type that you have.

YOUR PARENTS AND YOUR PRIVACY

In most states, minors (people younger than 18) have the right to make choices about birth control without their parents' permission. Ask your health care professional if the visit will be kept private.
Be aware that if you use your parents' health insurance to pay for birth control or a special health care professional's visit, it may appear on the bill that your parents receive. You may want to talk about birth control with your health care professional at a visit for something else, such as a physical exam.
Often, the best way for a teen to have privacy and to afford birth control is to go to a family planning clinic. Some clinics may provide free birth control.

TALK TO YOUR PARTNER

Before you have sex, talk to your partner about using condoms. This is the best way to prevent STIs. Do not be shy-be direct.
Be honest about your feelings and needs.
You can talk about it in many ways. These are some examples:
• "You know, it makes sex even better for me knowing that both of us are protected. Let's use a condom."
• "I'd really like to have sex with you as long as we use condoms. Condoms protect both of us."
Make sure that you feel safe with your partner. No one should force you to have sex. If you feel scared of your partner or have experienced physical, emotional, or sexual abuse, tell a trusted adult.

FINALLY...

As a teen, you face many decisions. To help you make choices that are right for you, talk with someone you trust, such as your parents, your health care professional, or
Birth Control | acog.org/WomensHealth
your school counselor. If you decide to have sex, use birth control and protect yourself against pregnancy and STIs. No matter which method of birth control you choose, be sure that you know how to use it correctly.