Contraceptives, brush up on your knowledge

Until the birth control pill hit the market 58 years ago, attempting to avoid an unwanted pregnancy was not an easy task– abstinence or withdrawal being the main options for couples or the use of primitive forms of contraception. With the evolution of birth control, everything changed, giving people more sexual freedom. 

How contraception works

Few people give this a second thought, but according to the National Institute of Child Health and Human Development (NICHD), birth control methods work in various ways.

One way that it works is by killing sperm cells or preventing sperm from reaching the egg cells. Types of contraceptives that fall into this category include condoms, diaphragms, cervical caps, contraceptive sponges and intrauterine devices (IUDs). Another contraceptive is stopping a woman’s ovaries from releasing eggs that can be fertilised through hormonal manipulation or preventing the fertilised egg cell’s implantation on the uterine wall. These forms of contraceptives include birth control pills, patches, injections, hormone-releasing vaginal rings and hormone-releasing IUDs.

Then there is sterilisation, permanently preventing a woman from falling pregnant or a man from impregnating a woman. This entails women having their tubes tied (tubal ligation) and men undergoing vasectomies.

With contraceptives playing an instrumental role in minimising unwanted pregnancies, we now look at some of the most common types of contraceptives and their respective pros and cons, as reviewed by Dr P.S. Steyn and Dr P. Roets, Tygerberg Hospital and Stellenbosch University.

Coitus interruptus (withdrawal)

This relatively simple contraceptive involves removing the penis from the vagina immediately before the male ejaculates—thereby preventing sperms from entering the vagina, ensuring fertilisation does not occur.

However, the effectiveness of this method depends on the male’s ability to withdraw before ejaculation. Often, some sperms are deposited in the vagina before or during withdrawal, making this method unreliable.

Disadvantage of this method: It does not provide any protection against sexually transmitted infections (STIs). STI-organisms can be transmitted by direct contact with surface lesions in both partners and from vaginal and pre-ejaculatory fluid.

Male condom

While it prevents direct contact with disease-causing organisms during intercourse, it can be used only once. Other disadvantages include the possibility of the condom breaking or slipping off during intercourse.

However, it has a slight tourniquet effect on the outer veins of the penis, which may benefit men who have difficulty maintaining an erection.

Female condom (Femidom)

This resembles a male condom but is larger. It is also available without a prescription, but only in a few clinics and some pharmacies. Such as the male condom, it is intended for singular use only but is less effective protection than the male condom against some STIs, including AIDS.

Advantages of this contraceptive, it is less likely to rupture than the male condom and is more resistant to chemicals. It also allows the woman to take responsibility for pregnancy and disease prevention.

It is important to note that its disadvantages include a minimally higher failure rate than the male condom.

Intrauterine device (IUD)

This is a small, plastic, often T-shaped device, surrounded by a copper wire, containing hormones, inserted into the uterus.

The IUD changes physical and the chemical environment of the uterine cavity, thereby preventing sperms from fertilising an egg or possibly inhibiting implantation of a fertilised egg. It is usually inserted by a medical professional. One of the advantages of this product is that depending on the type; it is worn from one to five or even seven years before requiring replacement.

IUDs are a highly effective method of contraception. So much so, that only eight out of every 1000 women wearing an IUD will become pregnant in the first year of use. Fewer pregnancies occur with continued use.

However, disadvantages may see the IUD causing heavy, extended periods or abnormal bleeding. It does not protect against contamination with micro-organisms causing STI and pelvic inflammatory disease (PID).

Oral contraceptives (the “pill”)

This contraceptive is highly effective if taken consistently, preferably at the same time each day. If a pill is missed or vomiting occurs soon after taking the pill, another form of contraception until the onset of the next menstrual period should be used.

It is important to note; certain drugs may cause the pill to become less effective. For this reason, a doctor needs to be consulted for the prescription. While it is a reliable form of birth control, it does have disadvantages, which include the following:

  • Breast tenderness due to fluid retention—improves after a few months.
  • Vaginal candida infection. This used to be more common with pills having a higher oestrogen content.

Before making your decision, it is imperative to discuss your options with your local GP to ensure your selection will be beneficial to your long-term health.

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