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Sexual Health

Contraception

Numerous contraception methods are available to help reduce the risk of pregnancy and some methods also help to reduce the chances of getting or spreading an STI. The method of contraception you choose should fit your needs and your lifestyle. Always be responsible for your own contraceptive and STI prevention methods—do not rely on your partner! Most methods of contraception are reversible.

Women who take generic or name brand OrthoCyclen or OrthoTri-Cyclen: WalMart and Kroger now offer these 2 oral contraceptives for $9 per month or $24 for 3 packs. Kroger has Trinessa and Sprintec; Walmart has Tri-Sprintec and Sprintec. If you have been obtaining these pills from the clinic and you wish to purchase these pills from WalMart or Kroger, use the askanurse link to send an e-mail to the NP and ask for a written prescription to take to the pharmacy. If you have a prescription for either of these pills, take it to the store of your choice.

Note for students with Aetna Insurance: the insurance plan will only pay for birth control PILLS that are purchased FROM the health clinic. Rings, patches and injections are NOT covered. If you are given a prescription from the clinic, the insurance plan will NOT pay for those pills purchased from a pharmacy. The only exception is medical students who have a co-pay for prescription coverage.

How to get birth control through the clinic

If you meet the guidelines for annual paps and you have had a pap smear within the last 12 months, bring your result with you to your clinic appointment. If you have not had a pap within the last year and a pap is recommended, please call and schedule an appointment for a pap smear. The nurse practitioner or physician will discuss your birth control options with you. A few brands of birth control are available from the campus clinic. If a brand you prefer is not stocked by the clinic, a prescription will be written. Currently, the clinic carries Ortho Tri Cyclen (generic), Sronyx (low estrogen-generic for Alesse), Solia (generic-as close to Yasmin as possible) and the Depo shot. Birth control pills are available in packs of 3 and are$10 for 3 packs for a limited time. Up to 2 packs may be purchased at one time. Several birth control companies offer patient assistance programs for free birth control (for those without prescription coverage) on their websites. A valid prescription must be submitted with the required forms.

PAP Guidelines

Pap guidelines-paps are recommended on an annual basis under the following circumstances:

Females under the age of 21 who have been sexually active for at least 3 years.
Females 21 or older.
If a female is 30 years of age or older AND in a monogamous relationship with the same partner for the last 3 years AND has had a normal pap for 3 consecutive years an annual pap may not be necessary. However, annual pelvic exams are still recommended.

Routine Contraception

Routine contraception includes those methods that you have planned ahead to use. Your healthcare provider can help you to determine which methods are right for you. Routine contraception methods include a variety of birth control pills, a vaginal ring, the Depo shot, the Ortho Evra patch, an under the skin implant and an intrauterine device (IUD) and other non-prescription methods such as emergency contraception, withdrawal, condoms, sponges, spermacides, and fertility awareness (natural family planning). The IUPUI Health Center prescribes birth control pills,rings and patches. Referrals are made to an OB/GYN office for an IUD, implants, tubal ligation, and vasectomy. Birth control pills and implants do not protect against STIs. An IUD can increase the risk of pelvic inflammatory disease (PID), therefore, it is only recomended for monogamous partners.

Options that do not require a visit to your healthcare provider

Not all forms of birth control require a visit to a healthcare provider. Not all are very reliable methods but are commonly used. Some of the following contraception options are available for over-the-counter purchase at drug stores, grocery stores, discount stores, etc.

Withdrawal - The withdrawal method of contraception involves the man pulling his penis out of the vagina before ejaculation. Withdrawal is not a recommended method of contraception because it requires self-control and experience. It is not for men who ejaculate prematurely. In addition, because men release a pre-ejaculate fluid that contains sperm, pregnancy is still possible. The withdrawal method can be 73-96% effective in preventing pregnancy, but the effectiveness is highly dependant on the situationand the couple. Withdrawal does not protect against STIs. Use of a condom is recommended. With a condom, withdrawal can be nearly 100% effective in preventing pregnancy.
Male Condom - The male condom is a sheath-like piece of latex or sheepskin that fits over an erect penis to prevent the exchange of body fluids during sexual intercourse. When used properly, the condom is 85-98% effective; helping to prevent pregnancy and the transfer of STIs. Be sure to follow the package instructions carefully for the most effective protection. Check the expiration date on the box before using a condom—an expired condom is more likely to break, allowing the transfer of body fluids to occur. Lubricant is also useful to prevent breakage. Planned Parenthood provides instructions for the correct use of a condom. Read package instructions carefully for information specific to the brand.
Female Condom - The female condom is a barrier method of contraception that the woman can insert into her vagina up to eight hours before sexual intercourse. The double-ringed polyurethane female condom is 79-95% effective in protecting against pregnancy and STIs when used properly. Be sure to follow the package instructions carefully for the most effective protection; and because insertion can be tricky, it might be helpful to practice inserting a female condom a few times before you attempt to use one during intercourse. The female condom can help the woman take responsibility for contraception.
Emergency Contraception - There are times when the need for emergency contraception to prevent unintended pregnancy arises. If your method of routine birth control fails (a condom breaks, for example, or you haven’t taken your birth control pills properly), if you had unprotected sex, or if you have been sexually assaulted, seeking emergency contraception might be at the top of your priority list. Emergency contracepton is not fail-proof and does not protect against STIs. It is most effective if used within 72 hours but may be used up to 120 hours after sex.

Two types of emergency contraceptive pills (ECPs) are available: combined ECPs (oral contraceptives) and progestin-only ECPs (Plan B). Combined ECPs contain both estrogen and progestin. Sometimes these pills are packaged as emergency contraception and other times they are packaged as ongoing birth control that can also be used as emergency contraception. About 50% of women who use emergency contraception with combined ECPs will become nauseated and 20% will vomit. Use of combined ECPs reduces the risk of pregnancy after unprotected intercourse by 75%. Several types of prescription birth control pills can be used for emergency contraception. See not-2-late.com for names and doses.

Progestin-only ECPs (Plan B) contain only the hormone progestin. In the United, States, these pills are sold without a prescription for women 18 years of age and older. Plan B must be requested from the pharmacist; it is not out on the shelves. The risk of nausea and vomiting is lower with progestin-only ECPs. Use of a progestin-only ECP reduces the risk of pregnancy after unprotected intercourse by 89%. Both combined ECPs and progestin-only ECPs should be taken within 72 hours (3 days) of unprotected sex to most efficiently prevent pregnancy, but may be taken up to 120 hours (5 days) after sex.
Sponge - Today is a barrier method that returned to the U.S. market in 2005 after a 10-year absence. It is a soft, disk-shaped device with a loop for removal. It is made out of polyurethane foam and contains the spermicide nonoxynol-9 (which may cause vaginal irritation). The sponge is 84-91% effect in preventing pregnancy in women who have not had a child and 68-91% effective in preventing pregnancy in women who have had a child. The sponge is effective for more than one act of intercourse for up to 24 hours, and it needs to be left in for at least six hours after intercourse to prevent pregnancy. There is a risk of Toxic Shock Syndrome if the sponge is left in for more than 30 hours. The sponge does not protect against STIs, so use of a male condom is also recommended. There is only one brand of contraceptive sponge available in the U.S. – the Today Sponge, and it can be purchased in drug stores and other pharmacies. Be sure to follow the package instructions carefully for the most effective protection against pregnancy.
Spermicide - Spermicide can be in the form of a foam, cream, jelly, film, or suppository that is inserted into the vagina before intercourse to immobilize sperm and keep them from penetrating the egg. Some male condoms are also lubricated with spermicide. While spermicides are 71-85% effective in preventing pregnancy, they are not effective in protecting against STIs. Spermicides can be used as backup contraception with birth control pills, condoms, IUDs, and other methods. Spermicides with nonoxynol-9 may cause vaginal or rectal irritation: this irritation increases the risk of acquiring STIs (including HIV transmission if your partner is infected with HIV).
Fertility Awareness - Fertility awareness methods of birth control involve carefully monitoring the woman's menstrual cycle to determine which days the woman is most/least fertile so that she can avoid intercourse on fertile days. This may involve daily monitoring of body temperature (kits available in drugstores) and cervical mucus consistency, careful and accurate recording of the menstrual cycle on the calendar, or keeping track of the menstrual cycle with CycleBeads (color-coded beads to help a woman determine her fertile days based on the start of her period). The fertility awareness method of contraception can be 75-99% effective depending on the woman's dedication to the daily record-keeping and observation that this method requires; but it is not effective in preventing transmission of STIs. Family planning centers and places of worship frequently offer classes on fertility awareness.

Options from your healthcare provider

The following routine contraception methods are available only through prescription, administration, or a procedure by your healthcare provider. Your healthcare provider can help you to determine which method is best for you. Some of these contraception methods include:

Birth Control Pill - Many birth control pills (BCP) are available through prescriptions. Birth control pills prevent spikes in a couple of hormones to prevent ovulation. BCPs use synthetic hormones (similar to the estrogen and progesterone made in a woman’s body) to prevent the ovaries from releasing an egg. Different brands of pills use different types of estrogens and progesterones. Birth control pills are 92-99.7% effective in preventing pregnancy; but they do not prevent STIs. It is important to use a barrier method in addition to the pill to prevent STIs. The range in effectiveness depends on how many pills a women takes at the appropriate time. Birth control pills, especially low estrogen pills, must be taken daily at approximately the same time to be most effective. No more than a 4 hour variance is recommended for low estrogen pills (Ortho Tri-Cyclen lo, Alesse, Aviane, or Loestrin etc). As with all medications, there exists the possibility of side effects, such as irregular bleeding, weight changes, or nausea; more serious side effects such as blood clots and hypertension. Women who are 35 or older and/or who smoke are at greatest risk. The pill is not without risk of side effects.

Some side effects of bcps are helpful. Usually the pills lighten periods, meaning lighter flow, fewer days of bleeding, and less cramping. Some are advertised to help clear up acne. They also regulate your cycle so you can predict when your period will occur.

Because there are so many pill options available, your healthcare provider can help find the one that causes the least side effects. Many health clinics (including IUPUI Health Services) offer some birth control pills at a reduced cost.
- The 28 day type of birth control pills have at least 2 different colors of pills in the pack depending on the type of pill. The first 3 weeks of monophasic pills contain active hormones. The last week of pills contain no hormones. The pills with no hormones are a different color. That week of pills is included simply to maintain the habit of taking a pill. The inactive pills do not need to be taken, but if you skip them, you must remember that after 7 days you must begin taking active pills again.
- There are 2 basic types of bcps. One is a monophasic, meaning each active pill contains the same amount of hormones. The other is a triphasic, meaning each week, the amount of progesterone is different. A pill with 'tri' included in the name is a triphasic (Tri-Sprintec, TriPrevifem, OrthoTri-Cyclen)
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  Some of the newer birth control pills have more active pills which decreases the number of periods. Seasonale contains 84 active pills. Its advertisements tout the benefit of having only 4 periods per year. The disadvantage to taking active pills for so long, is that many women will have unplanned spotting. Another brand, Seasonique, has 84 pills with usual hormones levels and 7 with less estrogen (no inactive pills). The week of low hormone pills is supposed to decrease the risk of spotting. Some pills include iron (FE) in the last week of pills. The benefit of having fewer inactive pills is fewer or lighter periods. The same thing can be accomplished by skipping the week of placebo pills (in a 28 day pack) and going directly to the active pills in another pack. However, spotting may occur due to the changed hormone levels in the body. If a woman wants to skip the week of placebo pills on a regular basis, some women must gradually decrease the number of inactive pills that are taken each month to avoid spotting.
Birth Control Patch - The Ortho Evra patch is a prescription method that works similarly to birth control pills by using synthetic hormones (estrogen and progesterone) to prevent the ovaries from releasing an egg or. To use, a thin hormone-coated adhesive patch is placed on the dry skin (free of lotions, creams and sweat) of the upper arm, buttocks, stomach, or upper torso. The patch remains in place for one week, and then is replaced by a new patch. After three weeks of wearing a patch, the woman goes without a patch during the fourth week (similar to the placebo week when using birth control pills). The patch is up to 99.7% effective in preventing pregnancy when used correctly, but it is not effective in preventing STIs; therefore, a barrier method should also be used. The patch may be more effective than the pill because women forget pills. The side effects of the birth control patch are similar to those of birth control pills (with special concern for women age 35 or older and/or women who smoke); but they place the user at higher risk for stroke. An additional side effect might include irritation of the skin in the location where the patch is placed. Some family planning clinics may offer the patch at a reduced cost.
Vaginal Ring - Like the pill and the patch, the Nuva Ring (a prescription brand), uses synthetic hormones similar to estrogen and progesterone to prevent the ovaries from releasing an egg. To use, a small, flexible ring is inserted deep into the vagina for three weeks and is taken out for the fourth week. The ring is up to 99.7% effective in preventing pregnancy when used correctly; but it is not effective in protecting against STIs so a barrier method should also be used (diaphragms, caps, and shields cannot be used with the ring). The side effects of the vaginal ring are similar to those of the patch and the pill (with special concerns for women who are age 35 or older and/or women who are smokers). Additional side effects might include increased vaginal discharge and vaginal irritation or infection.
Injection - The injection (shot) Depo method of birth control uses a progesterone-only hormone to prevent the ovaries from releasing an egg or, sometimes, to thicken the cervical mucus to prevent the joining of sperm and egg. Using this method requires visits to your healthcare provider every 12-13 weeks for an injection. The shot is 97-99.7% effective in preventing pregnancy; but it does not protect against STIs so use of a barrier method is recommended. Side effects might include weight changes, depression, skin rash, headache, dizziness, and others that might last 12 weeks until an injection wears off. An increased risk of osteoporosis has been linked to use of the injection method but appears to be reversed once the Depo shot is discontinued. Return of fertility can take up to 18 months after the last injection.
Implants - Contraceptive implants are again available in the United States. Implanon is a non-estrogen hormone which is effective for up to 3 years. This method involves the implantation of a small rod in the upper arm by a trained healthcare provider. The rods continuously releases synthetic hormones similar to estrogen and progesterone to prevent the ovaries from releasing an egg, or, sometimes, to thicken the cervical mucus to prevent the joining of sperm and egg. Implants are 99.95% effective in preventing pregnancy, but they do not protect against STIs so use of a barrier method is recommended. Side effects of implants are similar to the side effects described for other prescription contraception methods. Women who are currently using implants and who have questions should contact their healthcare providers.
IUD - The IUD (intrauterine device) is a small T-shaped device that is placed in the uterus by your trained healthcare provider. There are two types of IUDs—one releases hormones (levonorgestrel, a form of progestin, is effective for 5 years) and the other uses copper (which is toxic to sperm; effective for 10 years) as a means of contraception. Both types of IUD prevent implantation of the egg into the lining of the uterus. The IUD is 99.4-99.9% effective in preventing pregnancy. It can increase the risk of STIs; use of a barrier method is recommended. Side effects can include an increase in cramps, longer, and heavier periods. The IUD is not recommended for women who have never been pregnant or who have multiple sex partners.
Diaphragm, Cap, and Shield - The diaphragm, cap, and shield are all prescription barrier methods of birth control that your healthcare provider fits to your body. The diaphragm is a shallow latex cup that fits into your vagina and is 84-94% effective at preventing pregnancy. The cervical cap is a silicone cup shaped like a sailor’s hat that fits into the vagina and is about 86% effective in preventing pregnancy in women who have never been pregnant or who have never given birth vaginally. It is about 71% effective in preventing pregnancy in women who have given birth vaginally. (After childbirth, the cervical opening is larger). The shield is a silicone cup with an air valve to the vagina and is about 85% effective in preventing pregnancy. Note that none of these methods are effective in preventing STI transmission, and thus, use of male or female condoms in addition to these methods is recommended. These barrier methods can all be put in place in preparation for sexual intercourse (the diaphragm can be worn for up to 24 hours, the cap for up to 48 hours, and the shield for up to 48 hours). Use of barrier methods do not lead to major health concerns, but they are attributed to an increased risk of bladder infection, they can be messy, and they should not be used during vaginal bleeding or infection. Most barrier methods can be used in combination with spermicide or the morning after pill.
Permanent Methods - Vasectomies for men and tubal ligation or tubal implants (ESSURE) are permanent methods of birth control. A vasectomy or tubal ligation may sometimes be reversed. These methods are recommended for men/women who are sure they do not want any or anymore children.

With so many varieties, it is important to consider factors that are important to your lifestyle. Those factors may include cost, reliability, frequency of use, length of use, reversability and risks.