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Choosing a method of birth control is a challenging decision for women. Many women that I see are looking for non-hormonal contraceptive methods, which aim to prevent pregnancy without changing the natural balance of hormones in the body. In order to help women and their partners make an informed decision, this article will review the efficacy rates, advantages and disadvantages of the various non-hormonal methods available.

Copper Intrauterine Device (IUD)
What:
The Copper IUD is a small, T-shaped device inserted in the uterus by a health care professional. Once inserted, it creates a hostile environment that prevents pregnancy. Note: the Copper IUD is not the same as the Mirena IUD, which is hormone-based.

Efficacy: Typical use failure rate: 8/1000 women during first year of use.

Advantages: One of the most effective methods of contraception; long term use (can remain inserted for 3-10 years before needing to be replaced); nothing to do or remember after the procedure; reversible, reduces risk of endometrial cancer.

Disadvantages: Irregular bleeding or spotting may occur initially; pain/discomfort during insertion; does not protect against STIs; expensive; rare risks with insertion may include infection, perforation of the uterus or expulsion of the IUD.

Male Condom
What:
Male condoms are worn over the penis during sexual activity. It acts as a barrier to prevent the exchange of body fluids and traps the sperm so it can’t fertilize the egg.

Efficacy: Typical use failure rate: 180/1000 women during first year of use.

Advantages: Aside from abstinence, latex condoms are the best protection against HIV/AIDS and other STIs; may decrease the risk of cervical cancer; available without a prescription; inexpensive; can be used with other contraceptive methods to increase its effectiveness; non-latex options available for those with latex allergies/sensitivities.

Disadvantages: Must use every time you have sex; requires partner’s cooperation; may slip or break during intercourse; may reduce sensitivity for either partner; may reduce sexual spontaneity.

Female Condom
What:
The female condom is a thin, lubricated sheath that is inserted into the vagina up to 8 hours prior to sexual intercourse. It works by trapping the sperm and preventing it from entering the vagina.

Efficacy: Typical use failure rate: 210/1000 women during first year of use.

Advantages: Protects against STIs; available without a prescription; male partner may find it more comfortable/less restricting than male condoms; structure of female condom may increase sexual stimulation; can be used with oil-based lubricants and by those with latex allergies.

Disadvantages: Must use every time you have sex; more expensive than male condoms; can be difficult to insert correctly; may slip or break during intercourse; structure of female condom may cause discomfort during intercourse.

Diaphragm
What:
A dome-shaped flexible cap made of latex, silicone or nylon that covers the cervix and prevents sperm from entering the uterus. Must be used with a spermicidal gel.

Efficacy: Canadian statistics unknown. Data from the United States suggest 15 pregnancies for every 100 women who use this method.

Advantages: Available without a prescription.

Disadvantages: Less effective than other methods of contraception; must use every time you have sex; can be difficult to insert properly and cause irritation; does not protect against STIs; increased risk of urinary tract infections and toxic shock syndrome.

Sponge
What:
A small, disposable foam device that covers the cervix and prevents sperm from entering the uterus. Must be used with a spermicidal gel to absorb and trap the sperm. Keep in place for at least 6 hours after intercourse (but do not keep in the vagina for more than 30 hours total).

Efficacy – more effective for women who haven’t given birth:

  • Typical use failure rate for women who haven’t given birth: 120/1000 women during first year of use
  • Typical use failure rate for women who have given birth: 240/1000 women during first year of use

Advantages: Available without a prescription; provides 12-hour protection and doesn’t need to be replaced for repeated sex during this time-frame; effectiveness increased when used in conjunction with a male condom.

Disadvantages: Less effective than other methods of contraception; can be difficult to insert correctly and cause vaginal irritation; no protection against STIs.

Cervical Cap
What:
A silicone cap that covers the cervix and prevents sperm from entering the uterus. Must be used with a spermicidal gel. Keep in place for at least 6 hours after intercourse (but do not keep in the vagina for more than 48 hours total).

Efficacy: Canadian statistics unknown. Data from the United States suggest 17-23 pregnancies for every 100 women who use this method.

Advantages: Available without a prescription.

Disadvantages: Less effective than other methods of contraception; can be difficult to insert correctly; no protection against STIs; cannot be used in women with a silicone allergy; must re-apply spermicidal gel for each act of intercourse; increased risk of urinary tract infections and toxic shock syndrome

Spermicides
What
: Contains a chemical, nonoxynol-9, which kills sperm on contact. Available in the form of cream, gel, foam, and suppository.

Efficacy: Typical use failure rate: 18-28% in the first year of use.

Advantages: Available without a prescription; increases the effectiveness of other barrier methods (diaphragm, cervical cap, sponge).

Disadvantages: Less effective than other methods of contraception; application can be messy; must be inserted into the vagina immediately before intercourse and reapplied for each act of intercourse; may cause irritation to the vagina and penis; no STI protection; may increase the risk of getting HIV from an infected partner.

Fertility Awareness Based Methods
What:
Calculating your “fertile window” and avoiding sex during this time frame. Your fertile window is from 5 days before to 1 day after ovulation. It can be calculated by using ovulation predictor kits, basal body temperature graphs, noticing changes in your cervical mucous, or a combination of these methods.

Efficacy: 24/100 couples will have a pregnancy each year with typical use.

Advantages: No side effects; inexpensive; allows you to become more in-tune with your body.

Disadvantages: One of the least effective methods in preventing pregnancy; can be difficult to calculate fertile window as not all menstrual cycles are regular; can be challenging to avoid intercourse during fertile window; no protection against STIs; requires full commitment from both partners.

Note: Typical use shows how effective the different methods of contraception are with actual use (includes times when a method is used in a way that is not correct or not consistent).

References:
Society of Obstetricians and Gynaecologists of Canada. (2016). Contraception. Retrieved from https://www.sexandu.ca/wp-content/uploads/2016/09/Contraception_Methods_Booklet.pdf

U.S. Food & Drug Administration. Birth Control. Retrieved from https://www.fda.gov/ForConsumers/ByAudience/ForWomen/FreePublications/ucm313215.htm#BarrierMethods