Shoppers, brace yourselves! Your contraceptive options have expanded, and you now have so many kinds to choose from. This overview of methods will help you pick a contraceptive that is comfortable, affordable, and effective against unplanned pregnancy and/or sexually transmitted diseases (STDs). It also lists the effectiveness rates for each method.

There are two kinds of effectiveness rates:

(1) Typical Use—the effectiveness rate during typical (aka, "real world") use, when people make mistakes or don't use the method every single time (not a good idea), and

(2) Perfect Use—the effectiveness rate when the method is used perfectly, every single time it's used.

It's important to remember that most hormonal methods, like birth-control pills, provide no protection against sexually transmitted diseases (STDs). You should always make sure you're protected from STDs during oral, vaginal, and anal sex. And if a guy and girl have intercourse, they should use two forms of protection during vaginal intercourse—one to protect against pregnancy and the other to protect against STDs.

And remember to talk to a doctor or health care provider to decide which method is best for you. If you don't have a doctor or health care provider, you can see one at a family planning clinic. (To find a clinic near you, click here.)

Here are your contraceptive options:

Nonhormonal Contraceptive Methods

    * Abstinence
   * Male Condom
    * Female Condom
    * Sheer Glyde Dam (aka, "dental dam")
    * Diaphragm
    * Cervical Cap
    * Spermicides
    * Intrauterine Device (IUD)
    * Coitus Interruptus (aka, "withdrawal" or "pulling out")

Hormonal Contraceptive Methods

    * Birth Control Pill (aka, "the Pill")
    * Depo-Provera (aka, "the shot")
    * Ortho Evra (aka, "the patch")
    * NuvaRing (aka, "the Ring")
    * Seasonale
    * Emergency Contraception (aka, "the morning-after pill")

Nonhormonal Contraceptive Methods

These methods don't use hormones and don't change a woman's menstrual cycle. Except for abstinence, they prevent pregnancy in one of several ways: by creating a "barrier" against sperm, interrupting sperm movement, or creating a hostile environment for sperm.

Method: Abstinence

What it is: The act of not having sex—oral, vaginal, or anal.

How it works: You refrain from all forms of sexual intercourse.

Perfect use: 100% effective

Typical ("real world") use: 75% effective, since not every teen who says he or she is abstinent is abstinent from all forms of sex—oral, vaginal, and anal, and since some teens "slip" and end up having sex even though they planned to be abstinent. Even rubbing naked genitals together (without penetration) puts both people at risk from some STDs if one person is already infected.

Benefits: When used perfectly, you don't face any consequences or complications from intercourse, and you avoid unplanned pregnancy and/or sexually transmitted diseases.

Drawbacks: In order to really be abstinent and get all the benefits, you have to abstain from all forms of sex, even oral. It can also be hard to abstain, and pressures from friends or partners, and normal sexual desire, can be hard to deal with. Sometimes after being abstinent, young people fail to use contraception when they decide to have sex.

For more info: Abstinence Clearinghouse. Or check out this info from Managing Contraception.

Method: Male Condom

What it is: A latex or polyurethane sheath that covers the penis and collects semen.

How it works: Prevents sperm from entering the vagina, preventing conception (the joining of the sperm and the egg, which leads to fertilization). During oral, vaginal and anal sex, it prevents bodily fluids from being exchanged, limiting the risk of sexually transmitted diseases.

Perfect use: 98% effective

Typical ("real world") use: 85% effective

Benefits: It is cheap, easy to use, and can prevent unplanned pregnancy and protect against most—but not all—sexually transmitted diseases. Can prolong the time it takes to reach orgasm. It comes in a variety of textures (to enhance pleasure), flavors (for oral sex), and colors.

Drawbacks: Putting on a condom "interrupts" sex, and sometimes it can tear or slip off during removal if you're not careful.

Cost: Free (at some family planning clinics) or anywhere from .50 on up, depending on where you get them.

How to get it: Drugstores and pharmacies, or family planning clinics, like Planned Parenthood. (To find a clinic near you, click here.)

For more info: See our story "Journey to the Condom Rack." 

Method: Female Condom

 

What it is: A barrier method of birth control worn inside the vagina. It is a polyurethane sheath with flexible rings at each end.

How it works: It is inserted into the vagina. The ring at the closed end holds the sheath in the vagina; the ring at the open end stays outside the vaginal opening. It collects semen before, during, and after ejaculation and keeps sperm from entering the vagina.

Perfect use: 95% effective

Typical ("real world") use: 79% effective

Benefits: Like the male condom, it can prevent unplanned pregnancy and protect against most—but not all—sexually transmitted diseases. It lets women share responsibility for preventing infection. The external ring may stimulate the clitoris, too, and give women added pleasure.

Drawbacks: The outside ring may slip into the vagina during intercourse or it may cause vaginal irritation. It can take practice to insert it correctly.

Cost: About $2.50

How to get it: You can get them at family planning clinics, drugstores, and some supermarkets.

For more info: Check out the official site for the Reality Female Condom.

 

 

Method: Sheer Glyde dental dam

 

What it is: A thin, natural rubber latex sheet, 10 inches by 6 inches, which is used during oral sex on the vagina (aka, "cunnilingus") and/or oral sex on the anus (aka, "rimming").

How it works: Before performing cunnilingus, you lay the Dam flat against the entire vulva—the vaginal opening and the clitoris. For rimming, you lay it against the anus. Always use a new Dam for each act of oral sex. Placing lubricant on the side of the sheet that will touch the vulva or anus makes this more pleasurable.

Perfect use: 94% effective.

Typical ("real world") use: Effectiveness rate not available.

Benefits: It's the only dental dam approved by the U.S. Food and Drug Administration for protection against many sexually transmitted diseases during cunnilingus and/or rimming. Comes in different flavors, like vanilla, wildberry, cola, and strawberry.

Drawbacks: Does not protect against pregnancy and can't be used during oral sex on a male. Can't be used by anyone who's allergic to latex. Can take some practice to get used to it.

Cost: You can order a dozen for $9.50 at the official site, or three for $6.99 at Drugstore.com (see links below).

How to get it: Order online through the Sheer Glyde Dam official site or by calling the manufacturer, GLYDE USA, at 1-206-284-1636. Or go to the "sexual well-being" section at Drugstore.com and click on "condoms," then "female dams."

For more info: Check out the Sheer Glyde Dam official site or call 1-206-284-1636.

Method: Diaphragm

What it is: A soft, flexible rubber or latex cup that must be fitted for size by your doctor or health care provider.

How it works: Before intercourse, a woman puts spermicide in the center of the diaphragm and around its edges, then inserts the diaphragm into her vagina so it fits over her cervix and creates a barrier, so semen can't get past it. The spermicide also kills sperm before they can enter the uterus and fertilize an egg. After intercourse, the diaphragm has to be left in for at least six hours.

Perfect use: 94% effective

Typical ("real world") use: 84% effective

Benefits: Since it is inserted before intercourse, it doesn't interrupt the spontaneity of sex. Easy to carry and immediately effective.

Drawbacks: Provides no protection against sexually transmitted diseases. Puts women at a higher risk for vaginal infections, like urinary tract infections. It always has to be checked for small tears or holes.

Cost: Can cost anywhere from $15-$75. Cost of a doctor's visit for a prescription can be anywhere from $50-$200, depending on the doctor or clinic and if they offer sliding-scale fees.

How to get it: You need a prescription and must be fitted for a diaphragm by your private doctor or health care provider or at a family planning clinic. (To find a clinic near you, click here.)

For more info: Check out Planned Parenthood's info. Or go to Ortho-McNeil's diaphragm site.

Method: Cervical Cap

What it is: Smaller version of the diaphragm made of slightly thicker rubber and fitted by your doctor.

How it works: The cap is held in place by suction and is partially filled with contraceptive jelly or cream, covering the cervix, which is inserted before intercourse.

Perfect use: 91% effective

Typical ("real world") use: 84% effective

Benefits: Can also protect against pelvic inflammatory diseases. Easy to carry and immediately effective.

Drawbacks: Must be inserted each and every time. Insertion can be hard for some girls and women. Cannot protect against most sexually transmitted diseases. Can increase risk of vaginal infections.

Cost: Can cost anywhere from $15-$75. Cost of a doctor's visit for a prescription can be anywhere from $50-$200, depending on the doctor or clinic and if they offer sliding-scale fees.

How to get it: You need a prescription and must be fitted for a cap by your private doctor or health care provider or at a family planning clinic. (To find a clinic near you, click here.)

For more info: Check out Planned Parenthood.   

Method: Spermicides, used alone

What it is: Spermicides come in several forms: foams, creams, films, jellies. They contain Nonoxynol-9.

How it works: About 15 minutes before intercourse, a woman inserts the spermicide into her vagina. It prevents pregnancy by killing sperm so that none can reach and fertilize an egg.

Perfect use: 82% effective

Typical ("real world") use: 71% effective

Benefits: Can be purchased without a prescription and costs relatively little.

Drawbacks: Correct timing and placement are crucial. Must be applied before a penis is placed anywhere near the vagina. Spermicide must be reapplied if intercourse is repeated, and it has been known to cause allergy and irritation in many women. It can also increase the risk of painful urinary tract infections in some women. Does not protect against sexually transmitted diseases.

Cost: Varies upon product; usually from $8 to $10.

How to get them: Drugstores or family planning clinics. (To find a clinic near you, click here.)

For more info: Check out product info here.

Method: Intrauterine Device (IUD)

What it is: A small "T"- or "S"-shaped object that is inserted through the cervix and placed in the uterus to prevent pregnancy. A small string hangs down from the IUD into the upper part of the vagina. There are two types: ParaGard, which is copper, and Mirena, which releases small amounts of a synthetic progesterone.

How it works: Stays in place for up to 10 years and affects the movements of eggs and sperm to prevent fertilization. Also changes the lining of the uterus to prevent an egg from implanting (attaching itself) to the uterine wall.

Perfect use: 99% effective

Typical ("real world") use: 98-99% effective

Benefits: Allows sexual spontaneity, requires no daily attention, immediately effective, and long lasting.

Drawbacks: Does not protect against sexually transmitted diseases; insertion and removal require clinic visits; can cause menstrual difficulty and possible side effects. Typically not recommended to teens. If you are interested in the IUD talk to your doctor.

Cost: Exam, insertion, and a follow-up visit can cost anywhere from $175-$400. But some family planning clinics offer sliding-scale fees (pay what you can).

How to get it: Must be inserted by a doctor of health care provider at a family planning clinic. (To find a clinic near you, click here.)

For more info: Check out this info from Planned Parenthood. Or go to Mirena's Web site.

Method: Coitus Interruptus (aka, "withdrawal" or "pulling out")

(Um... sorry, no photos!)

What it is: The man withdraws his penis from the woman's vagina before he ejaculates ("cums").

How it works: No sperm enters the woman

Perfect use: 96% effective

Typical ("real world") use: 73% effective

Benefits: Can be used when no other method is available.

Drawbacks: Leaves both partners at great risk for sexually transmitted diseases. Men need a great deal of self-control to successfully withdrawal on time and know exactly when they are about to ejaculate, and many teen guys don't have that much self-control yet. There is a risk that the male will ejaculate while he is pulling out or he may ejaculate right outside the vaginal opening, increasing the risk of pregnancy. May interfere with sexual pleasure for both partners.

Cost: None

For more info: Check out this info from Managing Contraception.

Hormonal Contraceptive Methods

These methods use hormones to prevent an egg from being released from an ovary into the fallopian tube and uterus. They also work by making it difficult for sperm and egg to join.

Method: Birth Control Pill (aka, "the Pill")

What it is: An oral contraceptive, usually made from two types of hormones (estrogen and progestin).

How it works: A woman takes a pill every day at about the same time for 21 days and then stops for seven days, so she gets her period. The pills stop the release of eggs, to prevent pregnancy.

Perfect use: 99.7% effective

Typical ("real world") use: 92% effective

Benefits: If taken correctly (every day at around the same time), it provides nonstop pregnancy protection, makes a woman's period more regular and shorter in length, and reduces menstrual symptoms (cramps, bloating, etc.). May reduce mild acne.

Drawbacks: Does not protect against sexually transmitted diseases; side effects may occur, and you have to remember to take the pill every day. Takes seven days for it to become effective.

Cost: $15-$40 dollars for a one-month supply, plus the cost of a doctor or clinic visit, which can range from $35-$125, depending on your doctor, your insurance, and/or if the clinic offers a sliding-scale fee (pay what you can).

How to get it: You need a prescription from your private doctor or health care provider at a family planning clinic. (To find a clinic near you, click here.)

For more info: Check out this info from Planned Parenthood, or from Ortho-McNeil.

Method: Depo-Provera (aka, "the shot")

What it is: An injection of the hormone progestin that a woman gets every three months (four times a year).

How it works: A woman gets an injection in either the arm or upper buttocks/lower back one time during the first five days of her period. After the initial shot, she gets a shot every 11 to 13 weeks. The shot stops eggs from being released, so she can't get pregnant.

Perfect use: 99.7% effective

Typical ("real world") use: 97% effective

Benefits: It prevents pregnancy for three months at a time. You do not have to remember a daily pill. It is very private, immediately effective, and gradually reduces menstrual bleeding and may stop periods altogether.

Drawbacks: Does not protect against sexually transmitted diseases. May also cause irregular periods or spotting, slight weight gain, possible decrease in bone density, and side effects do not wear off until 12 to 14 weeks after a woman stops getting the shot.

Cost: About $35 per shot, plus the cost of a doctor or clinic visit, which can range from $35-$125, depending on your doctor, your insurance, and/or if the clinic offers a sliding-scale fee.

How to get it: You need a prescription from your private doctor or health care provider at a family planning clinic. (To find a clinic near you, click here.)

For more info: Check out the official Depo-Provera Web site or call 1-866-554-DEPO (3376).

Method: Ortho Evra (aka, "the patch")

What it is: A thin, beige, smooth patch that contains the hormones progestin and estrogen. A woman puts the patch on her upper shoulder, buttock, abdomen, or upper arm once a week for three weeks. During the fourth week, no patch is used to trigger menstruation.

How it works: Hormones are released into the body, preventing the release of mature eggs.

Perfect use: 99.7% effective

Typical ("real world") use: 92% effective

Benefits: Easy to use and non-invasive.

Drawbacks: Does not protect against sexually transmitted diseases. Side effects can include nausea, breast tenderness, and headaches.

Cost: $30-$35 for a one-month supply, plus the cost of a doctor or clinic visit, which can range from $35-$125, depending on your doctor, your insurance, and/or if the clinic offers a sliding-scale fee (pay what you can).

How to get it: You need a prescription from your private doctor or health care provider at a family planning clinic. (To find a clinic near you, click here.)

For more info: Check out the official Web site.

Method: NuvaRing (aka, "the Ring")

What it is: A flexible, ring-shaped hormone contraceptive that is two inches in diameter and inserted into the vagina once a month.

How it works: It contains estrogen and progestin, which prevent the ovaries from releasing eggs. A woman keeps the NuvaRing inside her vagina for 21 days and then removes it, so her body can menstruate for seven days. After that, she inserts a new ring to begin the cycle again.

Perfect use: 99.7% effective

Typical ("real world") use: 92% effective

Benefits: Provides month-long protection against pregnancy. No daily pill taking, only have to remember to place a new ring in once a month.

Drawbacks: Does not protect against sexually transmitted diseases, may be uncomfortable to insert at first, and irritation in the vagina and cervix can occur. There may also be increased discharge, and the ring may slide out and need to be reinserted.

Cost: $35-$40 for NuvaRing, plus the cost of a doctor or clinic visit, which can range from $35-$125, depending on your doctor, your insurance, and/or if the clinic offers a sliding-scale fee.

How to get it: You need a prescription from your private doctor or health care provider at a family planning clinic. (To find a clinic near you, click here.)

For more info: Check out the official Web site or call 1-877-NuvaRing (688-2746).

Method: Seasonale

What it is: An oral contraceptive pill, the same as the birth control pill, with a combination of low-dose hormones (estrogen and progestin).

How it works: Works on a 91-day cycle. A pink, active pill is taken every day for 84 days followed by seven days of white, inactive pills to allow for menstruation to begin. On this method, a woman will only get her period every three months, or four times a year.

Perfect use: 99.7% effective

Typical ("real world") use: 92% effective

Benefits: Periods only come every three months or four times a year, and they do not become heavier. It provides consistent protection against pregnancy.

Drawbacks: Does not protect against sexually transmitted diseases. Possible side effects include headaches, nausea, and breast tenderness; hassle of taking a pill every day.

Cost: Varies, but it includes the cost of a doctor or clinic visit, which can range from $35-$125, depending on your doctor, your insurance, and/or if the clinic offers a sliding-scale fee.

How to get it: You need a prescription from your private doctor or health care provider at a family planning clinic. (To find a clinic near you, click here.)

For more info: Visit the official Web site or call 1-800-719-FOUR (3687).

Method: Emergency Contraception (aka, "the morning-after pill")

What it is: Contraception that prevents pregnancy after unprotected vaginal intercourse—for instance, if birth control (like a condom) isn't used, or in the case of rape.

It comes in two forms: (1) hormone-based emergency contraceptive pills (ECPs), also known as "the morning-after pill," or (2) the IUD.

ECPs are either a combination of estrogen and progestin, or progestin-only. They can be taken up to 120 hours (five days after unprotected intercourse, but work best when taken within 72 hours (three days). The most common ECPs are Plan B.

The copper-T intrauterine device (IUD) can be inserted within five days of unprotected intercourse and removed after the next menstrual period or remain inside for 10 years, providing long-term pregnancy prevention.

How it works: For ECPs, a woman takes one dose right away and another 12 hours later. If she is already pregnant, ECPs will not affect the pregnancy. (They are not RU-486, aka, the "abortion pill.")

The IUD is inserted within five days of unprotected intercourse. The hormones act to prevent ovulation, fertilization, or implantation of a fertilized egg.

Perfect Use: ECPs—75-89% effective. IUD—99.9% effective

Benefits: Can prevent unplanned pregnancy after unprotected intercourse, eliminating the worry over what to do in case of pregnancy, and reducing the overall number of unplanned pregnancies and abortions.

Drawbacks: EC does not protect against sexually transmitted diseases. In most states, you have to get a prescription for ECPs first, so it can take time to get the prescription. (But you can get a prescription before an emergency occurs by "backing up your birth control" with ECPs; to learn how, click here.)

ECPs can cause side effects like nausea, which usually disappears after the first 24 hours; other side effects include breast tenderness, irregular bleeding, and headaches.

The IUD is not good for women who have more than one partner and are at risk for sexually transmitted diseases, since insertion of the device can lead to pelvic infection.

Cost: Varies depending on what kind of emergency contraception you get and where you get it. Some family planning clinics, like Planned Parenthood, use a sliding-scale fee. Without sliding-scale, cost of ECPs ranges from $8-$25, and the average cost of a clinic visit for the prescription is $35-$150. Cost of the IUD can total $400, including the exam, IUD, and its insertion.

How to get it: On August 24, 2006, the FDA approved the emergency contraceptive pill Plan B for sale without prescription to women 18 and older. Girls of any age can get a prescription for emergency contraception from a clinic or doctor. If you live in Alaska, California, Hawaii, Maine, Massachusetts, Montana, New Hampshire, New Mexico or Washington State, some pharmacies will provide emergency contraceptive pills without a prescription no matter your age.

IUDs require a doctor's visit. To find a clinic click here.

For more info: Check out Not-2-Late.com or call the Emergency Contraception Hotline at 1-888-NOT-2-LATE (668-2528). To learn more about the most common ECPs, go to Plan B.

Sources: Hatcher, et al., Contraceptive Technology, Eighteenth Revised Edition. New York, NY: Ardent Media, 2004; Planned Parenthood Federation of America; Henry J. Kaiser Family Foundation; and the official sites of many of these contraceptive manufacturers.