7 Contraceptive Options: An Overview

Practicing safer sex is a vital part of reproductive health and some of the best tools to support safer sex are contraceptives. There is a wide variety of types of birth control and different options suit different lifestyles best. For example, for people who want to prevent pregnancy with a low maintenance option, an implant or IUD may be a good option. Embrace Sexual Wellness has compiled an overview of contraceptive options, with information such as efficacy, pros and cons, side effects, and more. We hope this guide will aid you in figuring out which method will work best for you. Keep in mind that condoms and dental dams are the only form of contraceptive that protects against STIs and should be paired with another method to ensure the most effective protection against pregnancy and STIs. We recommend using at least two methods, one of which should protect against STIs, to ensure the maximum amount of protection.     

Note: all efficacy rates refer to perfect usage of the method and with those that require manual maintenance, human error may diminish efficacy rates

Intrauterine Devices (IUDs)

Overview

• Efficacy: 99% effective

• STI Protection: Does not protect against STIs

• How it’s used: inserted by a doctor. No manual maintenance required

• Types

  • Copper (Paragard) 

    • How it works

      • A copper IUD is a plastic body with copper wrapped around it. Copper changes the way sperm cells move so they can’t access the egg. 

    • Benefits

      • High efficacy at preventing pregnancy 

      • Lasts up to 12 years but can be removed at any time by a doctor

      • Can be used as emergency birth control if inserted within 5 days of unprotected sex 

      • Does not need manual maintenance 

    • Drawbacks

      • Insertion can be uncomfortable

      • Initial side effects can be unpleasant but for most, should subside after the first 6-12 months 

      • Does not provide STI protection

  • Hormonal (Mirena, Kyleena, Liletta, and Skyla)

    • How it works

      • Hormonal IUDs release a small amount of progestin which mimics the hormone progesterone that bodies naturally make. These hormones both make the cervical mucus thicker to block sperm from accessing the egg and the hormones can also stop ovulation, meaning there’s no egg present to be fertilized  

    • Benefits 

      • Long-lasting

        • Mirena: up to 7 years 

        • Kyleena: up to 5 years

        • Liletta: up to 7 years

        • Skyla: up to 3 years

      • For some, lightened periods and cramps

      • Can potentially manage symptoms of endometriosis and polycystic ovarian syndrome (PCOS)

    • Drawbacks

      • Insertion can be uncomfortable

      • Initial side effects can be unpleasant but for most, should subside after the first 6-12 months 

      • Hormones may worsen or complicate pre-existing mental and reproductive health conditions

      • Does not provide STI protection 

• How to Access It

  • IUDs have to be inserted by a doctor, most commonly an OB/GYN or a clinic like Planned Parenthood. 

• Potential Side Effects 

  • Longer and heavier periods and cramps for the first 6-12 months

  • Irregular periods and spotting between periods 

• Works Best For

  • People who want to “set and forget” their birth control.

  • People who, for whatever reason, can’t or don’t want to use hormonal birth control (copper only) 

  • People who are interested in birth control that has the potential to lighten or get rid of periods (hormonal IUDs only) 

• Contraindications

  • Conditions that cause pain from vaginal penetration such vaginismus

  • Mental illness (not for all; case by case basis) 

  • People who want a regular, natural period

Birth Control Pills

Overview

• Efficacy: 91% effective

• STI Protection: Does not protect against STIs

• How it’s used: Oral ingestion once a day at the same time

• Types

  • Combination (estrogen and progestin)

    • How it works

      • The hormones in the pill prevent ovaries from releasing  an egg each month, thickens cervical mucus to block sperm, and thins lining of sperm to lower risk of fertilized egg implanting in the womb.

      • The last week of the pack is hormone-free to allow a period to happen. For those interested in skipping their periods, consult your healthcare professional about not taking the hormone-free week of pills.

    • Benefits 

      • Less strict time window for taking the pill, though it’s recommended to take it around the same time everyday to help stick to the routine

    • Drawbacks

      • Does not protect against STIs

  • Progestin only

    • How it works

      • The hormones in the pill prevent ovaries from releasing  an egg each month, thickens cervical mucus to block sperm, and thins lining of sperm to lower risk of fertilized egg implanting in the womb.

    • Benefits

      • For those who want to lighten or eliminate their period, hormonal birth control may help 

    • Drawbacks

      • Must be taken in the same 3 hour window every day to be effective

      • Does not protect against STIs

• How to Access It

  • Must be prescribed by a healthcare professional 

• Potential Side Effects 

  • Spotting or bleeding between periods

  • Sore breasts

  • Nausea

  • Headaches

  • Weight gain

• Works Best For

  • People who can remember and stick to a scheduled daily routine

• Contraindications

  • If you’re prone to blood clots and strokes

  • Any condition involving regular vomiting and/or diarrhea, as the pill will not work following these functions

Nexplanon Implant

Source: New implant device provides continuous birth control for up to three years - Sudbury News

Overview

• Efficacy: 99+% effective

• STI Protection: Does not protect against STIs

• How it’s used: implanted in arm by a healthcare professional under local anesthetic. No manual maintenance required 

• Type

  • Nexplanon

    • How it works

      • Releases progesterone to prevent the release of an egg each month and thickens cervical mucus to block sperm cells. 

    • Benefits

      • Long lasting (up to 5 years)

      • Highly effective

    • Drawbacks

      • Does not protect against STIs

      • Requires minor doctor’s office procedure 

• How to Access It

  • Must be inserted into arm by healthcare professional, most commonly an OB/GYN 

• Potential Side Effects 

  • Irregular bleeding especially in the first 6-12 months

  • Headaches

  • Breast pain 

  • Nausea

  • Temporary bruising around insertion area  

• Works Best For

  • People who want low maintenance birth control 

  • People who can’t use estrogen-based contraception

• Contraindications

  • If you’ve had or do have breast cancer

Depo-Provera Injections

Overview

• Efficacy: 94%

• STI Protection: Does not protect against STIs

• How it’s used: Injected in a doctor’s office once every 3 months

• Type

  • Depo-Provera

    • How it works

      • Releases progesterone which prevents ovulation, thickens cervical mucus to block sperm, and thins lining of womb to lessen likelihood of egg implantation.

    • Benefits

      • May reduce heavy, painful periods

      • Less maintenance than the pill 

    • Drawbacks

      • Ability to get pregnant may not return for up to one year after ceasing injections

      • Does not protect against STIs 

      • Medium maintenance - requires doctor’s visit every 3 months

• How to Access It

  • Injections must be performed in a doctor’s office 

• Potential Side Effects 

  • Changes to period

    • Bleeding more than usual

    • Spotting

    • Lack of a period

    • Nausea

    • Weight gain

    • Depression

    • Sore breasts

• Works Best For

  • Those who cannot use estrogen-based birth control

  • Those who need a discreet method of birth control 

• Contraindications

  • If you want to be able to get pregnant soon after ceasing birth control

  • If you struggle with mental illness (case by case basis) 

Condoms

Source: Sexual Well-Being - Center for Health Education & Well-Being (jhu.edu)

Overview

• Efficacy: 85% effective  

• STI Protection: Yes, when used correctly, condoms protect against STIs 

• How it’s used: worn on the penis to prevent sperm from entering the vaginal canal (external condom) or inserted into vaginal canal (internal condom) 

For an extensive overview of types of condoms and tips for usage, read this Embrace Sexual Wellness article

Diaphragm and Spermicide

Source: Spermicides: side-effects, risks and how to use spermicides to prevent pregnancy (netdoctor.co.uk)

Overview

• Efficacy: 88% effective

• STI Protection: No, they do not protect against STIs

• How it’s used: the shallow, bendable cup is inserted into the vaginal canal and covers the cervix to block sperm from entering. Must be used in conjunction with spermicide 

• Parts

  • Diaphragm

    • How it works

      • Creates physical barrier between cervix and sperm

    • Benefits

      • Non-hormonal option

      • Not as intrusive as more long term contraceptives like IUDs

      • Effective immediately after it’s inserted

      • Few side effects

    • Drawbacks

      • Less effective than other options

      • Efficacy may be affected by human error 

      • Must stay inside vaginal canal for 6 hours after sex but not more than 24 hours

      • Learning curve for inserting it 

  • Spermicide

    • How it works

      • Chemicals stop sperm movement, held in place by the diaphragm 

    • Benefits 

      • Increases efficacy of diaphragm

    • Drawbacks

      • May cause irritation and/or UTIs

      • If you have sex again after applying it, you still must apply it again 

• How to Access It

  •  Must be prescribed by your healthcare practitioner

• Potential Side Effects 

  • Frequent UTIs

  • Irritation from spermicide can make vaginal canal more susceptible to STIs 

• Works Best For

  • Those who cannot use hormonal birth control 

  • Those who don’t mind a high maintenance option 

• Contraindications

  • If you can’t commit to consistently using the diaphragm properly

  • If you’re allergic to silicone, latex, or spermicide

  • If you have vaginal abnormalities that disallow a proper fit or placement

Patch

Source: Contraceptive Patch: Quick guideline for use and safety (drseb.com)

Overview

• Efficacy: 99% effective

• STI Protection: Does not provide STI protection

• How it’s used: Must be stuck to either the belly, buttocks, back, or upper outer arm (latter option for Xulane only) and replaced once a week 

• Types

  • Xulane

    • How it works

      • The patch transdermally introduces the hormones estrogen and norelgestromin, a form of progestin, which suppress ovulation. The patch needs to be replaced every 7 days for the first three weeks of the month and no patch is worn on the last week of the month.

    • Benefits

      • Potentially may help acne and make periods lighter

      • High effectiveness

      • Only needs to be replaced once a week 

      • Possible to get pregnant immediately after ceasing use

    • Drawbacks

      • Only works effectively for those with a BMI below 30

      • Patch may be susceptible to falling off

  • Twirla

    • How it works

      • The patch transdermally introduces the hormones estrogen and levonorgestrel, a form of progestin, which suppress ovulation. The patch needs to be replaced every 7 days for the first three weeks of the month and no patch is worn on the last week of the month.  

    • Benefits 

      • Potentially may help acne and make periods lighter 

      • High effectiveness

      • Only needs to be replaced once a week

      • Possible to get pregnant immediately after ceasing use

    • Drawbacks

      • Only works effectively for those with a BMI below 30

      • Patch may be susceptible to falling off 

      • Requires manual maintenance 

• How to Access It

  •  Must be prescribed by a healthcare professional

• Potential Side Effects 

  • Nausea

  • Headache

  • Skin irritation around patch 

• Works Best For

  • Those with a BMI under 30

  • Those who want a less invasive contraceptive that doesn’t require as frequent maintenance as the pill

  • Those who are not regularly submerged in water because it may compromise the adhesion of the patch

• Contraindications

  • People with a BMI over 30

  • Smokers over the age of 35 

Vaginal Ring

Source: Contraceptive Vaginal Ring. Causes, symptoms, treatment Contraceptive Vaginal Ring (dxline.info)

Overview

• Efficacy: 99%

• STI Protection: The ring does not protect against STIs

• How it’s used: The ring needs to be inserted into the vaginal canal. The NuvaRing needs to be replaced every 5 weeks while ANNOVERA lasts a full year.

• Types

  • NuvaRing

    • How it works

      • The NuvaRing releases a continuous low dose of the hormones etonogestrel and ethinyl estradiol to prevent pregnancy 

    • Benefits

      • Has the potential to reduce acne and make periods lighter

      • High effectiveness

      • Option to skip period altogether

    • Drawbacks

      • Requires remembering to replace the ring 

      • Possible for ring to fall out 

      • Cheaper options than ANNOVERA ring

  • ANNOVERA

    • How it works

      • The ANNOVERA releases a continuous low dose of the hormones segesterone acetate and ethinyl estradiol to prevent pregnancy 

    • Benefits

      • Lasts a full year

      • Has the potential to reduce acne and make periods lighter

      • High effectiveness

      • Option to skip period altogether

    • Drawbacks

      • More expensive than NuvaRing because no generic exists currently

      • Cannot be used while breastfeeding

• How to Access It

  •  Must be prescribed by a healthcare professional

• Potential Side Effects 

  • Headaches

  • Nausea 

  • Sore breasts

• Works Best For

  • Those who want total control over their birth control but don’t want the frequency of maintenance of the pill

  • Those who want a less long term hormonal option than the IUD

• Contraindications

  • Smokers over 35

  • Breastfeeding people

It may take a few tries to find the best contraceptive method for your life. If you’re still unsure of where to start, try this Planned Parenthood quiz about what types of birth control might work for you. Make sure to consult your healthcare professional about the pros and cons of different contraceptives within the context of your life. Remember to use at least two contraceptive methods with one that protects against STIs every time you have sex. Sex can never be 100% risk-free but contraceptives greatly increase safety for everyone involved. 

LGBTQIA+ Affirming Health Care: Tips for Professionals and Patients

Doctors’ appointments aren’t necessarily something that most people actively look forward to but when the patient in question is LGBTQIA+, the prospect can be downright terrifying. Receiving healthcare is often a vulnerable position to be in and when the risk of discrimination is that much higher, many LGBTQIA+ folks hesitate to take the chance even if it means denying themselves critical care. 

According to a report by Lambda Legal, “almost 56% of lesbian, gay, or bisexual respondents had at least one of these [various negative types of interaction with healthcare professionals] experiences; 70% of transgender and gender nonconforming respondents had one or more of these experiences.” Those kinds of numbers make it abundantly clear that LGBTQIA+ individuals are consistently discriminated against in healthcare environments and this discourages them from seeking needed care; not to mention that in some U.S. states, healthcare professionals can legally turn away an individual for being LGBTQIA+. 

These systemic issues need to be addressed but at the same time, LGBTQIA+ people are suffering at the hands of healthcare discrimination which has potentially life threatening consequences. There is room both to critique the system and recognize that it needs to be overhauled, as well as to acknowledge that people need access to compassionate care now. Both healthcare providers and LGBTQIA+ patients can take measures to make healthcare a more accessible and affirming experience. There are strategies to mitigate discrimination and exposure to it despite the fact that it may not be entirely unavoidable. 

For Healthcare Professionals: Curating an LGBTQIA+ Welcoming Environment   

Change starts on an individual level and all healthcare professionals should strive to address the unique hurdles LGBTQIA+ people face when seeking care. Here are some ways to practice LGBTQIA+ affirming care:

• Ask patients’ pronouns and default to gender neutral language if their pronouns are unknown. Additionally, make space for patients to disclose both their legal name and the name they identify with as sometimes they are different, especially for transgender people. 

• Explicitly display support for LGBTQIA+ people and their health

  • Display brochures (multilingual when possible and appropriate) about LGBT health concerns, such as breast cancer, safe sex, hormone therapy, mental health, substance use, and sexually transmitted infections.

  • Hire LGBTQIA+ staff members

  • Attend and support local LGBTQIA+ events and businesses 

  • Publish a non-discrimination statement such as this example. 

• Allow for a wide variety of identities and boundaries on intake forms 

  • This may include replacing the strict male/female options with blank spaces for both “gender” and “sex” categories.

  • Add room for patients to specify what name they’d like to be called, in addition to their legal name 

  • Allow people to disclose boundaries for the doctor such as not wanting to be weighed or not wanting a genital exam (unless explicitly necessary to the health concern at hand) 

• Commit to continually learning and improving, especially in instances when you have made a mistake. 

  • Read our blog post with a round up of LGBTQIA+ education resources 

• Don’t assume anyone’s gender, anatomy, or sexuality

• Listen to how patients describe their own sexual orientation, partner(s), gender, and relationship(s), and use their language. Although many LGBT people may use words such as “queer,” “dyke,” and “fag” to describe themselves, these and other words have been derogatory terms used against LGBT individuals. They are not appropriate for use by health care providers unless and until explicit consent is given by the patient. If you are in doubt as to how to refer to a patient, ask what word or phrase they prefer.

• Ensure there is a gender neutral restroom option for patients

For LGBTQIA+ Individuals: How to Protect Yourself

• When searching for doctors, utilize resources such as a local LGBTQ+ clinics and centers for recommendations, or a directory like the one from the Gay and Lesbian Medical Association.

• Look up reviews of a potential doctor to learn more about their patients’ experiences.

• Explore the practice’s website to see if they explicitly display support for LGBTQIA+ people.

• If you have questions for the doctor before you feel comfortable going in for an appointment, try emailing or calling the office and ask them questions about their experience working with LGBTQIA+ patients. Listen to your gut feeling about them after your call.

• If possible, consider bringing a trusted friend, someone you feel safe and comfortable around, to your appointment. 

• Your doctor’s job is to take care of you; the best way you can help them do that is by being upfront about your boundaries and any pertinent information about yourself, including your identity. Any good doctor will appreciate the guidance and unless your requests go against medical necessity, they should respect it.   

• If you have a negative experience with a healthcare professional, make sure to practice self-care and process it with a trusted therapist if you have access to one. If not, talk with a consenting loved one about your experience.  

Hopefully these tips will assist both healthcare professionals and LGBTQIA+ patients to make LGBTQIA+ healthcare affirming, compassionate, and accessible. No one’s health should suffer because of ignorance. Healthcare is a human right for all, not just those who conform to arbitrary societal standards. LGBTQIA+ people deserve equitable access to proper healthcare. 

Sexuality Professionals Series: An Interview with Haley Hasen

Embrace Sexual Wellness is conducting a multipart spotlight series of interviews with sexuality professionals. If you missed the previous installments, check them out on our blog. For the final installment in our interviews, we spoke to Haley Hasen, educator and erotic laborer (Haley/Haley’s).

Haley Hasen is the founder of Haleyhasenuncensored, LLC. Haley is an artist, sex educator, certified crisis interventionist, erotic laborer, and sex toy enthusiast. Haley is involved with a federal work-study with RAINN, and is an art therapy intern at the nonprofit Clean and Sober Street based in DC. Haley is studying to receive a Master’s Degree in Art Therapy at George Washington University through a trauma-informed lens. 

Erotic labor refers to any kind of sex work. This could be stripping, full service sex work, selling erotic photographs and videos, or any other kind of work that involves sex or eroticism in some capacity. The word “prostitution” is an outdated and generally disparaging term which should be avoided unless someone explicitly identifies themself as such. Erotic labor is highly stigmatized which can make these careers risky because of the lack of safeguards and regulation. At the end of the day, everyone under capitalism has to sell some part of themselves and erotic laborers are no different. Erotic labor is an entirely legitimate and valid career that does not deserve the flack it receives.

What inspired you to pursue your career path? 
I feel I came about this career path while working on healing and unlearning my sexual trauma. I really appreciate Carl Jung's idea of being a "wounded healer." I hope to create a safer space for individuals to be able to process, heal and unlearn aspects of themselves. I decided to do erotic labor as a way to reclaim my autonomy and sensuality after my sexual trauma. I wanted to have full control over that identity and I feel empowered by this aspect.   

How does your field differ from that of other sexuality professionals?
My field is different due to what I choose to disclose, educate, and advocate for. I am working within the here and now framework. I am also transparent in certain spaces about my identity as an erotic laborer; however, in most spaces I keep this identity hidden due to societal views and protection of myself. I feel I overlap in all aspects of myself and I try to formulate a truer self with one identity instead of being a multi-hat person. 

What is the most rewarding part of your career?
Empowering and creating a safer and healing space for sex workers and individuals who have and are experiencing sexual trauma. I enjoy learning from others and how they present themselves in these spaces. 

What's the most misunderstood thing about what you do?
I am not always turned on and I do not only think about sex. Furthermore, while I have gone through trauma that is not the reason I entered this space. I entered it to empower and reclaim aspects of me that were taken away without my consent. 

What's the most common question you receive from others about your career?
”Can you teach me how to have sex?” is usually peoples’ go-to question on various dating apps and it always makes me roll my eyes. 

What advice would you want to share with aspiring sexuality professionals?
You cannot educate everyone! I learned this from a dear colleague, Lindsay Wynn. 

If you had to describe your work in one sentence, what would you say?
Relevant.

Is there anything you’d like to add? 
Pay, support and uplift Black and Brown Trans Sex Workers; they are the foundation of the sexuality field and are rarely credited. 

Thank you to Haley for sharing their knowledge and expertise with us! We encourage you to visit Haley’s social media and websites, linked below. 

• Instagram: @haleyhasenuncensored

• Website: haleyhasen.com