Sometimes called the FemCap, the cervical cap is a small plastic cap with a strap attached for easy removal. It prevents pregnancy by covering the cervix to keep the sperm from passing into the uterus where the egg is released. It’s used with spermicide gel or cream which immobilizes sperm, providing backup protection. This method requires a prescription from a healthcare provider.
Effectiveness: 86% (perfect use); 71% (typical use)
Proper Usage: Put spermicide on the brim of the cap, inside the dome of the cap and on the folded area between the outer brim and dome. Insert the cap deep into the vagina, making sure it completely covers the cervix. For multiple acts of intercourse, check that the cap still covers the cervix and put more spermicide deep into the vagina between each time, or if more than 1 hour has elapsed since your first application of spermicide. The cap should not be removed less than 6 hours after the last intercourse, and should not be kept in the vagina for more than 48 hours. It may be inserted up to 6 hours ahead of time.
A diaphragm is a shallow silicone cup that is inserted into the vagina and covers the cervix. It is used with spermicide and protects against pregnancy like the cervical cap. This method requires a prescription from a healthcare provider.
Effectiveness: 94% (perfect use); 88% (typical use)
Proper Usage: Put spermicide into the cup of the diaphragm and on the rim of the diaphragm. Fold the diaphragm, keeping the spermicide in, and insert it into the vagina, tucking the front rim behind the pubic bone and making sure it covers the cervix completely. Like with the cervical cap, the diaphragm can be for multiple acts of intercourse as long as you make sure the diaphragm stays in place, and put more spermicide deep into the vagina between each act of intercourse or if more than 1 hour has passed since your last application of spermicide. The diaphragm should be left in place at least 6 hours after the last intercourse, but no more than 24 hours total. It may be inserted up to 6 hours ahead of time.
Spermicides are chemicals that prevent pregnancy by immobilizing sperm. They come in a variety of forms – creams, gels, foams, films and suppositories and are available without a prescription.
Effectiveness: 85% (perfect use); 71% (typical use)
Proper Usage: Each type of spermicide is used differently, so check the package instructions before you use it. You may need to wait 10 minutes for the chemicals to be effective, and they are generally only good for 1 hour. More spermicide should be added for every act of intercourse.
Some men and women experience irritation or allergic reactions from spermicide. Changing brands might help with this problem. According to Planned Parenthood, "The most commonly used spermicide in the U.S. is called nonoxynol-9. Nonoxynol-9 has certain risks. If it is used many times a day, or if it is used by people at risk for HIV, it may irritate tissue and increase the risk of HIV and other sexually transmitted infections."
This method is also called the copper T or ParaGard® (brand name). The mechanism of how it prevents pregnancy is yet unclear, but it has been found to be safe, and one of the most effective methods of birth control. It requires a prescription.
Effectiveness: 99+% for up to 10 years while the copper IUD is inserted
Proper Usage: Like with the Mirena IUD, a copper IUD must be inserted by a healthcare provider. Make sure to check the string ends periodically to ensure the IUD is still in place. If it has slipped out, or has been pushed deeper into the uterus, tell your healthcare provider and he or she can reposition or remove it.
The copper IUD may be used as emergency contraception if it is inserted by a healthcare provider within 120 hours (5 days) of unprotected sex.
Using two different methods of birth control, like condoms and a hormonal method or cervical barrier, at the same time, is the way to go. “Dual contraception is an excellent strategy, always assuring there is a backup method should a primary method fail,” said Corinna. She emphasized that if condoms are one of the methods used, STD risk reduction is an added benefit.
“Of course, we also always need to remember that knowing how to use methods properly and doing so makes a huge difference,” she continued. “The difference between perfect use and typical use with all user-directed methods is usually major.”
Get help from your health care provider if you don’t know what to do. “In the work I do with young people, there's rarely a day that passes that we don't have someone coming in who has made an error in using a method, or who doesn't understand how to use their method, and who is in that spot because they didn't get any patient education, or what they got was so brief or disengaged as to be useless.”
If you are sexually active, the best way to protect yourself from getting an STD is a three-pronged approach: use a condom for any kind of genital sex, get tested regularly for STDs (and follow all treatment, when needed) and make certain lifestyle choices, says Corinna. “Those lifestyle choices can be things like mutual monogamy, limiting partners, avoiding the highest-risk sexual activities (like intercourse), and taking good care of one's general health (after all, the strength of our immune systems matter when it comes to illness of any kind).”
Corinna emphasized that there’s not a “one-size-fits-all” method to STD prevention. “I think it's really important to support the reality that people's lives and situations are not all the same. For the very best prevention, doing everything on [the list is] ideal, obviously. But in reality, doing anything on there, or just some things, is also excellent.”
Eirish Sison is a health writer based in the San Francisco Bay Area.
Published August 9, 2011