BARRIER METHODS. should notice the spermicide unless you have an allergy or irritation. Sponge is less effective for women who have given birth.

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1 BARRIER METHODS Cervical Cover or Cap Diaphragm Spermicide (Cream, Gel, Foam, Film, Suppository, Sponge) Female Condom Male Condom Barrier Methods work by placing a short-term physical or chemical wall between egg and sperm. They can be awkward at first, but get much easier and more natural with practice. If you use them every time according to the instructions, they can be very effective. What is it? A small, soft silicone cup holding spermicide. Designed to fit snugly over cervical opening. Keeps working for almost 2 days, which is longer than other barrier methods. How to use: Put about a teaspoon of gel or cream spermicide in the cap, slide it deep into your vagina, and then check with a finger to be sure it is covering your cervix. Protection from pregnancy lasts for 42 hours. It needs to stay in at least 6 hours after sex. Health Impacts: Some women are allergic to spermicide. Less effective if you have given birth. You need to get re-fitted after giving birth. should feel it. If you do, see your health provider. Access: Clinic visit Not all providers know how to fit it. Effectiveness: 77% What is it? A soft silicone dome with a flexible rim that holds spermicide. The spermicide kills or immobilizes sperm and the diaphragm holds spermicide in place over the cervix. Keeps working for 2 hours. How to use: Put about a tablespoon of spermicide in the diaphragm, slide it into your vagina, and then check with a finger to be sure it is covering your cervix. Protection from pregnancy lasts for 2 hours. For subsequent intercourse, add more spermicide to vagina without removing diaphragm. Needs to stay in at least 6 hours after sex. Health impacts: Some women are allergic to or become irritated by spermicide. Get re-fitted if you gain or lose more than 15 pounds. should feel it. Some increased risk of bladder infection. Access: Clinic visit Not all providers know how to fit it. Effectiveness: 88%-94% What is it? There are several forms of spermicidal chemical; all go in your vagina before sex. Immobilizes or kills sperm. Most types work for 1 hour; sponge works for 24 hours and How to use: Put in your vagina carefully following the package instructions. Most types need to be in at least 10 minutes before intercourse, but the sponge starts working immediately. Health impacts: Bad taste can interfere with oral sex unless you gently wipe it off with a damp cloth first. If you usually have intercourse more than once a day, spermicide is not recommended because Nonoxynol9 can weaken your cell membrane allowing transmission of HIV and sexually transmitted infections from male to female. should notice the spermicide unless you have an allergy or irritation. Sponge is less effective for women who have given birth. Access: Easy to buy in a pharmacy or online. Effectiveness: 72%-91% What is it? A soft, loose pouch that you put inside your vagina. Flexible rings at each end hold it in place. Sperm get trapped in the pouch. You can put it in up to 8 hours before sex. Made of nitrile. How to use: The small ring goes deep inside and the larger ring stays outside partially covering your vaginal lips. As intercourse begins, holding the outer ring in place ensures the penis goes into the pouch. Health Impacts: Also protects against HIV and other sexually transmitted infections. You can use it if you are allergic to latex. Note: Unlike with male condoms, men usually feel no reduction in sensation. The outer ring can make a rustling sound during movement. This can be lessened by using extra lubricant. Access: Available at many pharmacies, clinics and online. Effectiveness: 79% to 95% What is it? A thin covering that you unroll over the hard penis. Made of latex, polyurethane or animal membrane. How to use: Put on before any genital contact. At withdrawal, hold the rim in place at the base of the penis so it doesn t slip off. Health Impacts: Some men and women are allergic to latex (rubber); they may try polyurethane. Animal membrane condoms do not protect against HIV/STI s but the others do. Note: May decrease sensation for men. Increased moisture from personal lubricants or from sexual arousal makes condoms less likely to break. To maintain arousal and encourage continued use, be creative and playful. Access: Easy to buy in a pharmacy or online. Inexpensive. Can be found for free. Effectiveness: 82%-98% Page 1 of 5 Cedar River Clinics, December 2011, see: sponsored by - last update:

2 KNOWLEDGE-BASED METHODS Sex Without Intercourse Fertility Awareness Withdrawal Pulling Out Breastfeeding (Lactation Amenorrhea) Knowledge-Based Methods rely upon your understanding, awareness and action to prevent pregnancy. With attention, these methods are very effective. What is it? You can experience intimacy, closeness, pleasure and orgasms when you engage in touching that does not include vaginal intercourse. This opens the door for a better understanding of your own and your partner s bodies which can bring better communication and more satisfaction. How to use: Examples include kissing, petting, use of sex toys, oral or anal sex, manual stimulation, masturbation, same-sex sex, telephone or talking sex, fantasizing, play-acting, reading or writing your own erotic literature. If release of sperm occurs, make sure it is far away from your vaginal opening. Waiting to have sex, taking a break from sex, or saying no to sex are also ways you can assert your personal power to prevent pregnancy. Health Impacts: Use condoms to prevent spread of STI/HIV for anal or oral sex, or when using sex toys. What is it? When you understand your fertile time (days you can get pregnant), you can prevent pregnancy by avoiding intercourse or using a barrier method or withdrawal on fertile days. How to use: With a calendar and special charts, keep a written record of first and last days of periods, monitor and document changes in your vaginal fluid, position and appearance of cervix daily, and take your basal body temperature daily (at rest, first thing in the morning). It is easier with support from a partner. Health Impacts: No health risks or side effects. Increases knowledge and awareness of your body. Note: Takes time and effort daily, especially at first. Many couples say this method is rewarding and brings them closer. Knowing your fertile time can help you become pregnant when you want to. Access: Learn this method from books, classes or online. Tools like thermometers, charts, and ovulation tests are easily available. What is it? The man takes his penis out of his partner s vagina before climax and ejaculation (before he comes). He needs to ejaculate away from the woman s body. Even sperm on her legs or vaginal lips can travel into her vagina. Depends on a man s self knowledge and self control. How to use: To remove any stray sperm from previous ejaculations, the man should urinate and wipe the tip of his penis before intercourse. Contrary to public perception, preejaculate usually does not contain sperm. Health Impacts: Drugs, alcohol, young age or lack of sexual experience can reduce success. It is less effective for men who have multiple orgasms. Note: It can be much more effective than many health providers realize. Reduces, but does not eliminate risk of transfer of HIV from male to female. Access: Free and available anytime. What is it? Breastfeeding stops egg development if the following three things are true: the baby feeds solely on mother s breast milk, the mother hasn t had a menstrual period since childbirth, and the baby is six months old or less. How to use: If you infrequently give the baby small amounts of liquid or solid, the method is still effective as long as you breastfeed every four to six hours, including at night. Health Impacts: Breast milk has positive health effects for the baby including protection from many different illnesses and allergies. Note: If the mother has HIV, breastfeeding can pass the infection to her baby. Access: If you need help, contact your local midwife, doula or lactation consultant. There are many online resources and hotlines you can call. Effectiveness: 98% Access: Free and available anytime. Effectiveness: 76% % Effectiveness: 78% - 96% Page 2 of 5 Cedar River Clinics, December 2011, see: sponsored by - last update:

3 IUD: Progesterone LONG TERM OR PERMANENT IUD: Copper Sterilization USE AFTER SEX Emergency Contraception Lasts 5 years Lasts 10 years Once. Permanent. Not reversible Use after unprotected intercourse Longterm methods are very effective. They offer convenience, privacy and do not impact sex play or lifestyle. What is it? A small plastic T with a string. Releases synthetic progestin hormone. Inserted through the cervix into the uterus. How it works: Changes the cervical mucus, fallopian tubes and the lining of the uterus. It stops or slows the sperm and egg. Health Impacts: Usually decreases cramping, but sometimes causes cramps. You can check that it hasn t come out by feeling for the string at your cervix. Note: Lasts 5 years. Although insertion can cause a few minutes of pain, removal is usually fast and easy. Access: Clinic visit needed for insertion and removal. It is your right to have it removed at any time. Effectiveness: 99.8% What is it? A small plastic T wrapped in copper with a string attached. Inserted through the cervix into the uterus. How it works: Changes the cervical mucus, fallopian tubes and the lining of the uterus. It stops or slows the sperm and egg. Health Impacts: Usually causes more painful, heavier periods. Should not be used by women who are allergic to copper. You can check that it hasn t come out by feeling for the string at your cervix. Note: Lasts 10 or more years. Although insertion can cause a few minutes of pain, removal is usually fast and easy. Access: Clinic visit needed for insertion and removal. It is your right to have it removed at any time. Effectiveness: 99.2% % What is it? For Females, the fallopian tubes are blocked or cut, either through a small incision or by injecting a substance into the tubes. For the non-surgical options, a follow up test is important to be sure it was successful. For Males, a vasectomy closes or cuts the vas deferens or tubes inside scrotum to prevent sperm from being released. The man s erection and ejaculation stay the same but semen contains no sperm. A sperm count about 30 days after the procedure is important to be sure all the sperm have cleared. Health Impacts: Excellent choice if you don't want to reproduce or are finished having children. Does not protect against HIV/STI. Note: Young adults with no children may have difficulty finding a doctor to perform sterilization. Access: Hospital or clinic. Effectiveness: % Hormone-like substances that affect ovulation, movement of sperm, or other conditions necessary for pregnancy to develop. What is it? A pill or combination of pills you take after sex to prevent pregnancy. It gives you a short burst of a high dose of a hormone-like drug that affects your body s ability to get pregnant. Various formulas exist. You may buy specially labeled pills or use a large dose of specific brands of regular birth control pills. Access: One type is easy to buy in a pharmacy if you are 17 or older; under 17 need a prescription. Others require a prescription for all ages. Call your health care provider. How to use: Take as soon as possible after unprotected sex. Health Impacts: Very safe. Usually safe for women who can t use other hormone methods due to health risks. Your next menstrual period should begin on time. If not, get a pregnancy test. Note: Won t stop an existing pregnancy. Effectiveness: Depends on the type and how soon you take it. Page 3 of 5 Cedar River Clinics, December 2011, see: sponsored by - last update:

4 The Pill (Oral Contraceptive) HORMONE METHODS The Patch Vaginal Ring The Shot Implant IUD: Progesterone Emergency Contraception (E.C. or Morning After Pill) Daily Weekly Monthly Every 3 Months Lasts 3 years Lasts 5 years Use after unprotected sex Hormonal Methods add chemicals similar to hormones to your body. These added hormones stop egg development and weaken sperm to prevent fertilization. The hormones change your cervical mucus and the lining of your uterus, slow sperm, and reduce ability of fertilized egg to implant into your uterine wall. Hormones may cause high blood pressure, mood changes or headaches. May increase chance of breast cancer. Decrease chance of ovarian cancer. Not recommended if you had breast cancer, stroke or severe heart disease. Estrogen + Progestin Menstrual cramps and bleeding usually become lighter. May cause nausea and breast tenderness. Not recommended for smokers over 35 years old, women who have high blood pressure, blood clots, migraine headaches or liver disease. Not recommended for women at high risk for heart attack or stroke. Some antibiotics and anti-epilepsy drugs make the hormones less effective. What is it? A pill you take orally every day at about the same time. Note: There are many different brands. If you have bad reactions to one, work with your health care provider to find another that works well. Smokers or women with high blood pressure can use the Mini-Pill (Progestin Only Pill) but it is a little less effective and needs to be taken at exactly the same time daily. Your period can occur monthly, every 3 months, or not at all, depending on when you stop taking hormone pills. What is it? A bandagelike patch that sticks to your skin. Hormones are absorbed through your skin. You change it weekly. How to use: Apply one Patch per week for three weeks. No Patch on the fourth week. Health Impacts: May cause skin irritation. Possible higher risk of heart attack and stroke than with other hormonal methods. Note: Less effective if you weigh over 198 pounds. What is it? A clear, soft, flexible 2-inch circle worn in vagina. Your body absorbs hormones from the Ring through your vaginal wall. How to use: Fold and slide into your vagina. Leave in for 3 weeks then remove. Your period can occur monthly, every 3 months, or not at all, depending on how you soon you insert the next Ring. Health Impacts: May cause vaginal irritation. Note: One size fits all. Neither partner usually feels the Ring. Progestin Only Smokers can use these methods. Affects menstruation differently in everyone. You might have no bleeding, light irregular bleeding, or very heavy bleeding. May cause lowered sex drive, increased appetite or weight gain; these are more common with The Shot. What is it? A longacting hormone injection. Health Impacts: More chance of weight gain than with other methods. May cause loss of bone density and risk of osteoporosis. May increase chance of HIV transmission. Not recommended if you have high blood pressure or are high risk for heart attack or stroke. Note: It is not reversible. Once a woman gets the shot, the hormone is in her system for at least three months. It may take a long time to get pregnant after last shot. Access: Clinic visit needed every 3 months. Effectiveness: 94% % What is it? A soft rod 1½ inches long that is placed under the skin in your upper arm and slowly releases hormone into your system. Health Impacts: Irregular, light bleeding is common. Rare side effects include allergy or infection of the skin when inserted, weight gain or mood changes. Rarely, minor surgery is needed for removal. Note: The implant prevents pregnancy for 3 years. It is your right to have it taken out at any time. Effectiveness has not been tested on heavier women. Access: Clinic visit needed every 3 years. Effectiveness: 99.95% What is it? A small plastic T with a string. Releases synthetic progestin hormone. Inserted through the cervix into the uterus. How it works: Changes the cervical mucus, fallopian tubes and the lining of the uterus. It stops or slows the sperm and egg. Health Impacts: Usually decreases cramping, but sometimes causes cramps. You can check that it hasn t come out by feeling for the string at your cervix. Note: Lasts 5 years. Although insertion can cause a few minutes of pain, removal is usually fast and easy. Access: Clinic visit needed for insertion and removal. It is your right to have it removed at any time. Effectiveness: 99.8% Hormone-like substances that affect ovulation, movement of sperm, or other conditions necessary for pregnancy to develop. Several options exist. You may buy specially labeled pills or use a large dose of specific brands of regular birth control pills. What is it? A pill or combination of pills you take after sex to prevent pregnancy. It gives you a short burst of a high dose of a hormonelike drug that affects your body s ability to get pregnant. Various formulas exist. How to use: Take as soon as possible after unprotected sex. Health Impacts: Very safe. Usually safe for women who can t use other hormone methods due to health risks. Your next menstrual period should begin on time. If not, get a pregnancy test. Note: Won t stop an existing pregnancy. Access: One type is easy to buy in a pharmacy if you are 17 or older; under 17 need a prescription. Others require a prescription for all ages. Call your health care provider: many clinics will call in a prescription or give you one ahead of time. You can buy it to keep on hand just in case. Also available online. Effectiveness: Depends on the type you take and how soon you take it. Page 4 of 5 Cedar River Clinics, December 2011, see: sponsored by - last update:

5 Birth Control gives women the freedom to enjoy sex without worry about pregnancy. Birth control makes it possible to prevent pregnancy and gives a woman the power to control her future. A woman may use birth control to delay pregnancy until she is ready, space out the births of her babies, determine the size of her family, or never get pregnant. This chart explains your birth control options. Making Your Decision No one method is best for everyone. Women may use several methods over the course of their lifetimes. The various methods affect people differently. People who use birth control can learn a lot from each other. Open conversation with your partner, parents and friends can help you choose a method that works for you. Effectiveness Effectiveness is a measure of pregnancy avoidance rates over one year of use. 99.5% means that, out of 1000 women who used that method for one year, 995 avoided pregnancy and 5 got pregnant. When a range is given, the higher number is how well the method worked when used perfectly every time. The lower number is based upon typical use. For comparison, 85% of sexually active women will get pregnant in one year if no birth control is used. Double Up Simultaneous use of two methods dramatically reduces chance of pregnancy. Some good combinations are a male condom and a cervical cap, spermicide and a male condom, or withdrawal and spermicide. If pregnancy occurs A woman decides between parenting, adoption or abortion. Human Rights Birth control and abortion are personal decisions. Government, parents, friends and partners should respect and support your decisions. If someone attempts to stop you, force you, or undermine your use of birth control or abortion, it is a violation of your human rights. You have a fundamental human right to make your own decisions about your body and your reproduction. Sexuality Everyone gets to express their own sexuality. Though same sex partners do not need to worry about pregnancy, many people who identify as lesbian or gay may, at times, engage in heterosexual intercourse and use birth control to prevent pregnancy. HIV/AIDS and STI Despite many choices for birth control, there is only one way to prevent the spread of HIV/AIDS or Sexually Transmitted Infections (STI). To prevent blood, semen or vaginal secretions from passing from one partner to another during vaginal, anal or oral sex, partners use a female or male condom, dental dam or plastic wrap, and cover shared sex toys. Cedar River Clinics created this website for women who want to take charge of their reproduction and for their male partners. It is also often used by health educators, clinicians, students and parents. We cover all forms of birth control approved by the Food and Drug Administration for use in the United States. There may be other methods in other countries. Primary Sources: U.S. Medical Eligibility Criteria for Contraceptive Use published by the U.S. Centers for Disease Control and Prevention and the book Contraceptive Technology. Cedar River Clinics (a charitable nonprofit organization) provide women s reproductive health care (birth control, first and second trimester abortion, the abortion pill, STI/HIV tests, pregnancy tests and well-woman care) in Renton and Tacoma, WA, USA. We have a vision of a world where all women freely make their own decisions regarding their bodies, reproduction and sexuality - a world where women can fulfill their own unique potential and live healthy, whole lives. We trust you to decide what is best for you. Contact Cedar River Clinics: info@cedarriverclinics.org East E Street, Yakima, WA See for greater details about each method. Page 5 of 5 Cedar River Clinics, December 2011, see: sponsored by - last update: