For the Times of Being Not So Socially Distant

As we continue finding ways to adjust during the COVID-19 pandemic we understand that relationships do not get put on hold and want to make sure you all continue to be safe to protect yourself from coronavirus but also to be safe to prevent any unwanted pregnancies or sexually transmitted infections (STIs). There are many MANY different contraception options that may be offered for free or for low prices through insurance and we want you to find the one that best fits you and your lifestyle.
Let's cut to the basics that you may remember from high school Sex Ed. Obviously the best way to not get pregnant or get an STI is abstinence and while this may work for some people we also know that is not for everyone so here is an overview into all your options. Our non-hormonal options are barrier techniques including condoms (male and female), diaphragms, cervical caps, and sponges (and these all can be used with spermicides if you would like). Our hormonal options include the oral birth control pills (either progestin only or combination of estrogen and progestin), the patch, the vaginal ring, the injection or intra-uterine devices. See! Look how many options I just gave you! Now let's break this down so you really understand the differences between each of these.

1. Condoms. These are a great choice to help prevent transmission of STIs including HIV because like I mentioned earlier they are a physical barrier therefore this decreases the risk from anything going from one partner to another. First, female condoms. These condoms can be used for both vaginal or anal sex and there are multiple different brands being sold. Moving on to male condoms. If you have ever walked down the family planning section of a grocery store or pharmacy you know there are many different options. There are latex condoms, synthetic condoms, and natural condoms, and then there are many other options including different lubricants and types of ribbing so you can stand there all day to figure out what you would like best. Latex condoms are probably the most common to use but for those with latex allergies you have the option to use synthetic or natural (lambskin) condoms. The big difference in this is that lambskin condoms will not let sperm pass through but these pores are actually still 10x larger than hepatitis B, herpes virus and HIV therefore you still have a risk of STIs. So while lambskin condoms can be used to prevent pregnancy they are not a good option to prevent STIs. Another thing to keep in mind is what type of lubricant you are using. For latex condoms you can only use water-based lubricants because oil-based lubricants can weaken the latex, whereas for synthetic condoms you can use either types. So next time you are out shopping make sure to check the labels!!!
2. Diaphragms, cervical caps, sponges and spermicides. In general these non-hormonal techniques including condoms having higher failure rates in preventing pregnancy than the hormonal options, but these options in particular are also not good at preventing transmission of infections. If you do choose to use any of these products just remember to keep that in mind and maybe make sure to use other options as well. Another thing, with the vaginal sponges that contain spermicides you can insert it 6 hours prior to intercourse and it is important to continue to leave it in 6 hours after intercourse, but make sure to take it out and discard it within 24 hours to decrease your risk of toxic shock syndrome.
3. The pill. This one seems to be pretty common, but what many people don't realize is how many different types of combination pills are available. An easy way to think of these pills is that by giving your body the extra hormones, it is tricked into thinking you are consistently pregnant therefore you will no longer ovulate. The progestins will also cause cervical mucus thickening to make it harder for sperm to penetrate as well as slowing sperm motility and making your uterus less homey for an egg to implant. Interesting eh? The pill can be a great option for many women to have a consistent schedule of taking a pill everyday at a time that best fits their schedule, but make sure to take it at the same time every day within 1-2 hours to make sure you are getting the full efficacy. To name a few we have Yasmin, Alesse, Ortho Tri-Cyclen (and many many more) and these all have varying levels of estrogens and progestins in them. A doctor will typically start you on one with a standard dose and then depending on how you feel they can switch you to different pills for a dose that best works with your body. For example, if you are continuing to have spotting/bleeding after your placebo week then you may need an increase in estrogen, but if you are having spotting/bleeding before your placebo week you may need a higher dose of progestin. As for side effects, you may have nausea, bloating, breakthrough bleeding or breast tenderness for 1-3 months after starting, but these typically go away on their own once your body has adjusted. Due to taking estrogen there is a small risk of developing a blood clot with these medications. This is just something to keep in mind for if you experience any extreme pain in your arms, legs, chest or have the worst headache of your life because you need to seek medical attention immediately. Oral birth control pills also do not protect against STIs and also may not be the right fit for everyone (Ex: patients with high blood pressure, patient who smoke, patients with migraines with aura, or patients with a history of blood clots. This is especially in patients that are older than 35 years old). Last but not least is the progestin only pill. Due to some of the risks above this may be a better option for a patient, but one thing to keep in mind is it is very important to take this one at the same time everyday!
4. The patch. It is pretty similar to the pill as it still gives you hormones, just instead of your mouth, through your skin. Like the pill you have a patch on for 3 weeks and then you go patch free for a week to have withdrawal bleeding. These can be applied to your abdomen, buttocks, upper torso or back of your upper arm. Again like the pill these are not effective against STIs and carry a risk of blood clots, but sometimes can be more convenient for people.
5. The ring. You may have heard of the brand NuvaRing which is a fancy purple ring that is inserted into your vagina and stays there for 3 weeks and is removed for 1 week for withdrawal bleeding. Some of you may be thinking can you still have sex with this? Absolutely. You can keep the ring in during vaginal intercourse, but you don't have to. You can take it out for sex and if it has been less than 3 hours from removal you can insert a new ring and keep it in for the remainder of the scheduled 3 weeks, but if it has been more than 3 hours you should insert a new ring immediately and use a secondary backup birth control for 7 days (such as a condom). Lastly, these are also not effective to prevent STIs.
6. The shot. This can be an option for women who are not tolerant to estrogens or have difficulty remembering to take a pill/change a patch/switch a ring. The Depo-Provera injection is given once into your upper arm every 3 months. The downside to the injection is it can only be given for up to 2 years due to the risk of bone loss and after stopping the injections, the median time to ovulation is 10 months. The side effects also include weight gain, loss of monthly period as well as other similar side effects to the pill.
7. The IUD. These have become much more popular over the past number of years as new options continue to come to market. Many people used to think of an IUD as only the Copper IUD which can be left in for up to 10 years and does not have hormones in it. The disadvantage to the Copper IUDs are heavier periods and larger size (a better option to people who have already given birth). Now we have many newer hormonal IUDs such as Mirena, Kyleena, Liletta and Skyla. All IUDs must be inserted and removed by a healthcare professional, but these offer an option of long term pregnancy prevention ranging from 3-5 years depending on the device. These are also very effective (>99% effective at preventing pregnancy), but again do not protect against STIs. As for side effects many women stop having a period while having an IUD (which sounds like more of an advantage in my opinion), and can experience cramping especially the days following insertion. Since these only give progestin these do not have the same risks of blood clots as some of the other products.
8. Emergency contraception. Because sometimes the condom breaks or you get caught up in the heat of the moment. There are now multiple options for emergency contraception (but we do still recommend using one of the above items as your first choice). There is Plan B which can be bought without a prescription and is important to take as soon as possible, but can be taken up to 72 hours unprotected sex. Our other two options are inserting a Copper IUD ASAP or getting a prescription for Ella which is similar to Plan B but can be taken up to 5 days after unprotected sex. So remember if you are ever in a pickle, you still have options!

So 8 long paragraphs later and that is just the brief overview of your many different options to keep yourself protected. We hope this gives you a starting point for choosing what is best for you. Have questions about one? Wondering what to do if you miss a pill or forget to replace your patch/ring? Curious about STI protection? Or any other questions please feel free to email us at info@greencrestrx.com or call us at 204-415-3404!