Birth control: A comprehensive guide

Birth control, or contraceptives, allow you to take control of your reproductive health. Depending on the type of contraceptive, you can reduce the risk of unintended pregnancy, and you may also reduce the risk of contracting sexually transmitted infections (STIs). For birth control to be effective, it’s important to choose a method that’s the right fit for your needs.

There are several different types of birth control available, including:

1. Male condoms:

A type of barrier birth control, male condoms are sheaths that fit over the penis and capture semen when a man ejaculates. There are three main types of male condoms:

• Latex: Made out of a form of rubber, latex condoms are the most common type of birth control and come in many sizes and varieties. You can use water-based and silicone-based lubricants with latex condoms.
• Non-latex: Crafted out of plastics like nitrile and polyurethane, non-latex condoms are an alternative for people who are sensitive to latex. They are compatible with water-based and silicone-based lubes.
• Animal skin: Condoms made from the lining of animal intestines may reduce the risk of irritation in people with sensitive skin. They can be lubricated with oil, water or silicone-based products. They may help prevent pregnancy but do not prevent STIs.

Some advantages of using male condoms include:

• Spontaneity: Because condoms don’t need to be used until you’re in the moment, you can purchase them over the counter, so you’re prepared for sex at any time.
  
• STI prevention: Latex and non-latex condoms are one of the few types of contraceptives that help to reduce the risk of STIs. They can be used during oral intercourse and anal intercourse for STI prevention as well. Keep in mind that animal skin condoms don’t provide STI protection.
• Backup usage: Male condoms can be used with most other forms of birth control to increase the level of protection. However, don’t use male condoms along with internal condoms.
• Accessibility: Male condoms can be purchased in drugstores, online and at other retailers without a healthcare provider’s prescription.

Some potential downsides of using male condoms include:

• Potential for accidents: Condoms may tear, rip or slip off during intercourse.
  
• Risk for user error: To be effective, condoms must be used and stored properly. Commonly caused by user errors, the failure rate of male condoms to prevent pregnancy is about 18%. Reading the directions on the packaging can help reduce the risk of user errors.
• Side effects: Latex condoms have the potential to cause allergic reactions in some people. All kinds of condoms can cause irritation.
• Disruption: You’ll need to use a new condom each time you have sex. Some people find that stopping to put on a condom is disruptive.

2. Female condoms:

Like male condoms, female condoms work by capturing semen. However, they’re worn inside the vagina rather than on the penis. They can also be inserted into the rectum during anal intercourse. As a result, you may sometimes see them referred to as internal condoms.

Internal condoms are non-latex and consist of a nitrile outer ring and a polyurethane inner ring. They come coated with silicone-based lubricant outside and inside to aid in insertion and make intercourse more comfortable.

Advantages of using internal condoms include:

• Spontaneity: You don’t need to insert an internal condom until you’re engaging in foreplay, allowing intercourse to be more spontaneous.
  
• STI prevention: Like male condoms, internal condoms can reduce the risk of STIs.
• Backup protection: Although they can’t be used with male condoms, internal condoms can be combined with many other types of contraceptives, such as birth control pills, implants and shots, to provide secondary protection.
• Accessibility: You don’t need a prescription from a healthcare provider to purchase most internal condoms. However, there are some that do require a prescription, such as the female condom FC2.

Potential drawbacks of internal condoms include:

• Potential for accidents: Female condoms may slip out or break during intercourse.
  
• Risk for user error: Internal condoms have a failure rate of 21%, largely due to user error. Following the usage instructions carefully can increase the effectiveness of female condoms.
• Side effects: Some people may experience irritation when using female condoms.
• Disruption: Inserting an internal condom requires taking a short break from foreplay, which some people may find too disruptive.

3. Spermicide:

Available in gel, cream, foam, suppository and film forms, spermicide is a contraceptive that kills sperm to help prevent pregnancy. It does not prevent STIs. How you use spermicide varies by form, but generally, it’s placed inside the vagina prior to intercourse.

Benefits of spermicide include:

• Accessibility: Spermicide is available over the counter without a prescription.
  
• Ease of use: Spermicide is generally easy to use, and you can choose from a variety of forms to suit your preferences.
• Backup protection: Spermicides can be used with condoms, diaphragms, sponges and other forms of birth control as a secondary form of protection.
• Less disruptive: Spermicide remains in place after intercourse, eliminating the need to get up and remove a condom. It can be used prior to the start of foreplay, further reducing disruptions.

Potential drawbacks of spermicide include:

• Advanced planning: With suppositories, films and tablets, you need to insert spermicide at least 10 to 15 minutes before intercourse and no sooner than one hour before sex. While these forms require some advanced planning, other types like gels, foams and creams don’t require any wait.
  
• Effectiveness: On its own, spermicide has a relatively high failure rate. As a result, healthcare providers typically recommend using spermicide with condoms, diaphragms or sponges.
• Side effects: Spermicide can cause skin irritation and allergic reactions in some people. It may also increase the risk of urinary tract infections (UTIs). There is also some evidence to suggest that frequent use of spermicides as a sole method of birth control may increase the risk of HIV.

4. Phexxi:

A newer form of nonhormonal birth control, Phexxi is a gel that you insert into the vagina prior to sex. It works by maintaining your vaginal pH to reduce sperm motility, thus preventing sperm from reaching an egg.

Benefits of Phexxi include:

• Ease of use: Phexxi comes with an applicator that makes it easy to insert into the vagina.
  
• Effectiveness: When used correctly, Phexxi is 93% effective at preventing pregnancy.
• Compatibility: You can use Phexxi with latex and non-latex condoms as well as with a diaphragm and most hormonal contraceptives, such as birth control pills and rings.
• Less disruptive: You can use Phexxi immediately before intercourse but also up to one hour before.

Potential drawbacks of Phexxi include:

• Accessibility: You’ll need to get a prescription from your healthcare provider to purchase Phexxi.
  
• Side effects: The most common side effects of Phexxi are vaginal discharge and burning, itching and irritation of the vagina. It can also increase the risk of urinary tract infections, yeast infections and bacterial vaginosis. If you have a history of recurring vaginal or urinary tract infections, your healthcare provider may recommend that you use a different type of contraceptive.

5. Diaphragm:

Fashioned out of flexible silicone, rubber or latex, a diaphragm is a saucer-shaped cup that you insert into the vagina. Once in place, it covers the cervix to prevent sperm from reaching an egg. Diaphragms must be used with spermicides for peak efficacy. Although diaphragms don’t protect against STIs, they can be used with condoms for STI prevention.

Benefits of diaphragms include:

• Effectiveness: When used with spermicide, diaphragms can be an effective barrier method of birth control, with a failure rate of 12%.
  
• Less disruptive: You can insert a diaphragm with spermicide up to one hour before intercourse, and it must be left in place for at least six hours after intercourse, reducing disruptions.
• Cost-effective: Diaphragms can be washed and reused, and most last for about one to two years. As a result, they can reduce the ongoing costs of using birth control.

Some potential drawbacks of diaphragms include:

• Accessibility: You’ll need to undergo fitting from a healthcare provider before obtaining most diaphragms. If you lose or gain weight, have pelvic surgery or get pregnant, you’ll usually need to be refitted, and you may need to get a new diaphragm. However, there is a newer diaphragm that can be prescribed without a fitting or an in-person visit.
  
• Learning curve: It can be difficult to use a diaphragm at first, but once you learn the technique, the contraceptive is generally simple to use.
• Side effects: Diaphragms can cause irritation and allergic reactions, and they may increase the risk of UTIs and vaginal infections. Although rare, a serious condition called toxic shock syndrome may occur if a diaphragm is left in place for more than 24 hours.
• Risk for accidents: A diaphragm can become dislodged during intercourse.

6. Sponge:

Another barrier form of birth control, the sponge is a soft, flexible plastic contraceptive that’s inserted into the vagina to cover the cervix. The sponge contains spermicide, so it works by killing sperm and preventing it from reaching an egg. Sponges don’t provide protection against STI transmission, but they can be combined with condoms.

Some benefits of the contraceptive sponge include:

• Accessibility: The sponge is available for purchase over the counter without a prescription.
  
• Spontaneity: You can insert a sponge up to 24 hours before intercourse, and it must remain in place for at least six hours afterward, reducing disruptions.
• Convenience: You don’t need to apply a separate spermicide to a sponge.

Some drawbacks of the contraceptive sponge include:

• Effectiveness after childbirth: Although the failure rate of the sponge is 12% among women who have never given birth, the rate increases to 24% for women who have a history of childbirth.
  
• Learning curve: It can take some practice to learn how to insert a sponge correctly.
• Side effects: The sponge can cause irritation and allergic reactions in some people. In rare cases, leaving the sponge in place for more than 30 hours may result in toxic shock syndrome.
• Risk for accidents: A sponge may become dislodged during intercourse.

7. IUD:

An intrauterine device, or IUD, is a small T-shaped device that a healthcare provider places inside the uterus to prevent unwanted pregnancy. IUDs don’t protect against STIs, but they can be used with condoms for STI prevention.

There are two main types of IUDs:

• Copper IUD: The copper IUD works like spermicide, preventing sperm from reaching an egg. Once in place, it can protect against pregnancy for up to 10 years.
• Levonorgestrel intrauterine device: Also called a hormonal IUD, this type of IUD works by releasing small amounts of the hormone progestin, which thickens cervical mucus and may prevent ovulation to reduce the risk of pregnancy. Depending on the type, a hormonal IUD may last for three to eight years.

Some advantages of IUDs include:

• Effectiveness: The failure rate of IUDs is less than 1%.
• Longevity: IUDs last three to 10 years, depending on the type.
• Convenience: IUDs eliminate disruptions from intercourse and allow for sex to occur spontaneously, with no advanced planning required.

Some disadvantages of IUDs include:

• Accessibility: A healthcare provider must insert an IUD for you. This is usually done in the office as a short outpatient procedure.
• Menstrual changes: Copper IUDs can cause heavier periods and bleeding between periods. Hormonal IUDs may cause irregular, light and missed periods.
• Side effects: You may experience cramping for a few days after the insertion of a copper IUD. Both copper and hormonal IUDs may raise the risk of pelvic inflammatory disease (PID), and they may be expelled from the uterus or go through the wall of the uterus, though these side effects are uncommon. Hormonal IUDs may cause ovarian cysts in some women.

8. Birth control shot:

Also known as Depo-Provera or DMPA, the birth control shot is an injection of the hormone progestin. It inhibits ovulation, increases the thickness of cervical mucus and slows tubal motility to prevent pregnancy. Birth control shots don’t protect against STIs, but they can be combined with condoms to reduce the risk of transmission.

Benefits of the birth control shot include:

• Effectiveness: The failure rate for the birth control shot is about 4% to 6%.
• Convenience: With the birth control shot, you won’t have to plan ahead before intercourse or stop to insert or remove a contraceptive.
• Noninvasive: Birth control injections are quick and don’t require an invasive medical procedure.

Potential drawbacks of the birth control shot include:

• Accessibility: You’ll need to visit your healthcare provider once every three months to get the birth control shot.
• Use of needles: Women with a fear of needles may prefer another type of birth control.
• Side effects: The birth control shot may cause bleeding between periods, weight gain, nausea, changes in mood and headaches. Less commonly, the birth control shot has been shown to contribute to bone loss, but this is sometimes reversible if a woman stops getting the birth control shot.

9. Birth control implant:

Sold under the brand name Nexplanon, the birth control implant is a tiny rod that looks similar to a matchstick. A healthcare provider inserts it into the upper arm, and it releases the hormone progestin once in place. Progestin makes cervical mucus thicker, inhibits tubal motility and may prevent ovulation to stop pregnancy from occurring. Birth control implants don’t protect against STIs, but you can use condoms with them for STI protection.

Some pros of the birth control implant include:

• Effectiveness: The failure rate of the birth control implant is less than 1%.
• Convenience: The implant eliminates interruptions during intercourse and allows for spontaneity.
• Longevity: Birth control implants can last for three to five years.

Some cons of the birth control implant include:

• Accessibility: You’ll need to visit your healthcare provider for a birth control implant.
• Side effects: The birth control implant may cause headaches, irregular periods, breast tenderness, acne and weight gain.
• Possible complications: Although uncommon, there is a risk of encountering difficulties when it comes time to remove and replace the implant.

10. Oral contraceptives/birth control pills:

Oral contraceptives, also known as birth control pills, are oral medications that you take once daily at the same time every day to prevent pregnancy. Oral contraceptives don’t prevent STIs, but they can be combined with condoms for STI prevention.

There are two main types of oral contraceptives:

• Combination birth control pills: Combination pills contain both estrogen and progestin, which work together to prevent ovulation and thicken cervical mucus to lower the likelihood of pregnancy occurring.
• Progestin-only birth control pills: Also called mini-pills, progestin-only birth control pills don’t contain estrogen. They also work by thickening cervical mucus and stopping ovulation. One of these progestin-only birth control pills is available over the counter, OTC norgestrel 0.075-mg tablet, which is sold under the brand name Opill.

Some combination birth control pills include:

• Alesse (levonorgestrel and ethinyl estradiol)
• Altavera (levonorgestrel and ethinyl estradiol)
• Amethia (levonorgestrel and ethinyl estradiol)
• Apri (desogestrel and ethinyl estradiol)
• Aviane (levonorgestrel and ethinyl estradiol)
• Beyaz (drospirenone, ethinyl estradiol and levomefolate)
• Camrese (levonorgestrel and ethinyl estradiol)
• Caziant (desogestrel and ethinyl estradiol)
• Cyclessa (desogestrel and ethinyl estradiol)
• Desogen (desogestrel and ethinyl estradiol)
• Enpresse (levonorgestrel and ethinyl estradiol)
• Enskyce (desogestrel and ethinyl estradiol)
• Estrostep Fe (norethindrone acetate and ethinyl estradiol)
• Gianvi (drospirenone and ethinyl estradiol)
• Introvale (levonorgestrel and ethinyl estradiol)
• Jasmiel (drospirenone and ethinyl estradiol)
• Jolessa (levonorgestrel and ethinyl estradiol)
• Kariva (desogestrel and ethinyl estradiol)
• Lessina (levonorgestrel and ethinyl estradiol)
• Levora (levonorgestrel and ethinyl estradiol)
• Lo Loestrin Fe (norethindrone acetate and ethinyl estradiol)
• Mircette (desogestrel and ethinyl estradiol)
• Ocella (drospirenone and ethinyl estradiol)
• Ortho-Cept (desogestrel and ethinyl estradiol)
• Reclipsen (desogestrel and ethinyl estradiol)
• Safyral (drospirenone, ethinyl estradiol and levomefolate)
• Seasonale (levonorgestrel and ethinyl estradiol)
• Seasonique (levonorgestrel and ethinyl estradiol)
• Solia (desogestrel and ethinyl estradiol)
• Sprintec (norgestimate and ethinyl estradiol)
• Tydemy (drospirenone, ethinyl estradiol and levomefolate)
• Velivet (desogestrel and ethinyl estradiol)
• Yasmin (drospirenone and ethinyl estradiol)
• Yaz (drospirenone and ethinyl estradiol)

Some progestin-only birth control pills include:

• Camila (norethindrone)
• Errin (norethindrone)
• Heather (norethindrone)
• Jolivette (norethindrone)
• Lyza (norethindrone)
• Nora-BE (norethindrone)
• NOR-QD (norethindrone)
• Opill (norgestrel)
• Slynd (drospirenone)

Some key benefits of birth control pills include:

• Effectiveness: The failure rate of birth control pills is 7% to 9%. Using your pills as prescribed can increase effectiveness.
• Convenience: Birth control pills don’t lead to disruptions before or after intercourse and allow for spontaneity.
• Affordability: Compared to other hormonal birth control methods, birth control pills are one of the most affordable options.
• Noninvasive: Birth control pills don’t require you to undergo any type of medical procedure or receive an injection or implant.

Some potential drawbacks of birth control pills include:

• Accessibility: There is one progestin-only birth control pill available over the counter, OTC norgestrel 0.075-mg tablet, sold under the brand name Opill. All other birth control pills require a prescription.
• Minor side effects: Both types of birth control pills can cause breast tenderness, headaches, upset stomach and changes in menstrual periods. Changes in mood are also associated with combination birth control pills.
• Serious side effects: Combination birth control pills can increase blood pressure. They can also increase the risk of heart attack, stroke and blood clots, particularly in smokers and people over the age of 35.

11. Birth control patch:

Sold under the brand names Xulane and Twirla in the U.S., the birth control patch is a form of hormonal birth control. It contains both estrogen and progestin and prevents pregnancy by increasing the thickness of cervical mucus and preventing ovulation. The patch doesn’t protect against STIs, but it can be combined with condoms.

Outfitted with an adhesive backing, the patch adheres to the skin and may be worn on the lower abdomen, buttocks or parts of the upper body besides the breasts.

Benefits of the birth control patch include:

• Convenience: The birth control patch allows for spontaneous sex.
• Noninvasive: Patches don’t require medical procedures or injections.
• Effectiveness: The failure rate of the birth control patch is about 7% to 9%. Using the patch correctly can increase effectiveness.

Potential drawbacks of the birth control patch include:

• Frequent changes: You’ll need to put on a new patch once per week for three weeks. During the fourth week, you won’t use your patch so that you can have your menstrual period. Keeping up with the replacement schedule is necessary to ensure effectiveness.
• Visibility: Depending on where you place your patch, it may be visible to others.
• Effects of weight: The birth control patch may not be as effective for women who weigh more than 198 pounds.
• Side effects: The most common side effects of the birth control patch include skin irritation, menstrual changes, mood changes, headaches and breast soreness. Less commonly, it may raise blood pressure and the risk of blood clots, heart attack and stroke, especially in smokers and women over 35.

12. Birth control vaginal ring:

Often referred to by its brand names, NuvaRing and Annovera, the birth control vaginal ring is inserted into the vagina. It contains both estrogen and progestin and prevents pregnancy by stopping ovulation and thickening cervical mucus. The birth control ring doesn’t protect against STIs, but it can be used with condoms for STI protection.

Benefits of the birth control vaginal ring include:

• Effectiveness: The failure rate of the birth control ring is 7% to 9%. Using it correctly can increase its effectiveness.
• Convenience: The birth control ring doesn’t require interruptions before or after intercourse, allowing for spontaneity.
• Self-placement: You don’t need to visit your healthcare provider to have the birth control ring positioned. It may take some time to learn how to use it properly, but once you master the technique, the ring is simple to use.

Drawbacks of the birth control vaginal ring include:

• Accessibility: The birth control ring is available only with a prescription.
• Frequent replacements: You’ll typically wear a birth control vaginal ring for 21 days and then remove it for seven days to get your menstrual period. With Nuvaring, you’ll need to replace the ring with a new one each month. Annovera rings can be reused for up to one year.
• Side effects: The most common side effects associated with the birth control vaginal ring are headaches, nausea, breast soreness, vaginal irritation, vaginal discharge and changes in menstrual periods. Less commonly, the ring may raise blood pressure, and it can increase the risk of blood clots, heart attack and stroke. The risk of these complications is higher in women who smoke and are over 35.

13. Emergency contraception:

If you have unprotected sex or have reason to believe your birth control method failed, emergency contraception may help prevent pregnancy. Unlike other contraceptives, emergency contraception is used after sex. There are several types of emergency contraception:

• IUDs: Copper and hormonal IUDs may be inserted by a healthcare provider up to five days after unprotected sex to prevent pregnancy.
• Levonorgestrel: Sold over the counter as Plan B and in generic forms, levonorgestrel is a progestin-only oral medication. The pill is most effective when taken within three days of sex, but it may work for up to five days.
• Ulipristal acetate: Available under the brand name Ella, ulipristal acetate is a prescription medication that can prevent pregnancy when taken within five days of unprotected sex.
• Combination birth control: Some birth control pills that contain estrogen and progestin can work as emergency contraception when taken at higher doses than the standard amount used for routine birth control. Your healthcare provider will tell you how much to take and when to take it. Don’t attempt to prevent pregnancy by taking extra birth control pills on your own.

Side effects of morning-after pills like levonorgestrel and ulipristal acetate include:

• Changes in menstrual periods
• Spotting
• Vomiting
• Nausea
• Fatigue
• Dizziness
• Headaches
• Abdominal pain
• Breast pain

Morning-after pills may be less effective for women who have undergone gastric bypass surgery or who are overweight or obese. Even though you can purchase some
morning-after pills over the counter, it is a good idea to consult your healthcare provider about which form of emergency contraception is the right choice for you. Because emergency contraception doesn’t protect against STIs, your healthcare provider may recommend that you undergo testing and/or treatment for certain sexually transmitted infections.

14. Vasectomy and tubal ligation:

People who are certain that they don’t want to have children can opt for permanent forms of birth control, known as surgical sterilization. There are two main procedures, one for men and one for women:

• Vasectomy: During this procedure for men, a physician cuts the vasa deferentia, the two tubes that transport sperm from the testicles to the penis.
• Tubal ligation: During this procedure for women, a physician removes all or part of the fallopian tubes or occludes the tube to prevent eggs from traveling from the ovaries to the uterus.

The failure rate for these procedures is about 1%. There are risks associated with all forms of sterilization. Your healthcare provider can help you weigh these risks with the benefits of permanent contraception.

Published August 2024.