These methods of contraception are considered “natural” because they are non-mechanical and non-hormonal. They are not barrier methods in the sense that they kill the sperm or prevent the sperm from reaching the egg. Additionally, they do not involve the use of hormones. Instead, these methods require that a man and woman not have sexual intercourse during the time when an egg is available to be fertilized by a sperm.

The fertility awareness methods (FAMs) are based upon knowing when a woman ovulates each month. In order to use a FAM, it is necessary to watch for the signs and symptoms that indicate ovulation has occurred or is about to occur.

On the average, the egg is released about 14 plus or minus 2 days before a woman’s next menstrual period. But because the egg survives 3 to 4 days (6 to 24 hours after ovulation) and the sperm can live 48 to 72 hours (up to even 5 days in fertile mucus), the actual time during which a woman may become pregnant is measured not in hours, not in days, but in weeks.

FAMS can be up to 98% effective, but they require a continuous and conscious commitment with considerable self-control. Although these methods were developed to prevent pregnancy, they can equally well be used by a couple to increase fertility and promote conception.

Calendar Rhythm Method

The calendar rhythm method relies upon calculating a woman’s fertile period on the calendar. Based upon her 12 previous menstrual cycles, a woman subtracts l8 days from her shortest menstrual cycle to determine her first fertile day and 11 days from her longest menstrual cycle to determine her last fertile day. She can then calculate the total number of days during which she may ovulate. If a woman’s menstrual cycles are quite irregular from month to month, there will be a greater number of days during which she might become pregnant. The calendar method is only about 80% effective in preventing pregnancy and when used alone is considered outdated.

Basal Body Temperature (BBT)

The basal body temperature (BBT) method is based upon the fact that a woman’s temperature drops 12 to 24 hours before an egg is released from her ovary and then increases again once the egg has been released. Unfortunately, this temperature difference is not very large. It is less than 1 degree F (about a half degree C) in the body at rest.

The basal body temperature method requires that a woman take her temperature every morning before she gets out of bed. An accurate, sensitive thermometer must be used and the daily temperature variations carefully noted. This must be done every month. A computerized monitor for recording and charting fertility is now available on the market, but a woman still must take her own temperature and enter this information into the monitor.

To use the BBT as a birth control method, a woman should refrain from having sexual intercourse from the time her temperature drops until at least 48 to72 hours after her temperature increases again.

Mucus Inspection Method

The mucus inspection method depends on the presence or absence of a particular type of cervical mucus that a woman produces in response to estrogen. A woman will generate larger amounts of more watery mucus than usual (like raw egg white) just before release of an egg from her ovary. A woman can learn to recognize differences in the quantity and quality of her cervical mucus by examining its appearance on her underwear, pads and toilet tissue.

She may choose to have intercourse between the time of her last menstrual period and the time of increased cervical mucus. During this period, it is recommended that she have sexual intercourse only every other day because the presence of seminal fluid makes it more difficult to determine the nature of her cervical mucus. If the woman does not wish to become pregnant, she should not have sexual intercourse at all for 3 to 4 days after she notices the greatest amount of cervical mucus.

Symptothermal

The symptothermal method combines certain aspects of the calendar, the basal body temperature, and the mucus inspection methods. Not only are all these factors taken into consideration, but so are other symptoms such as slight cramping and breast tenderness. Some women experience lower abdominal discomfort (in the area of the ovaries) during release of an egg (ovulation).

Ovulation Indicator Testing Kits

A woman can use an ovulation prediction kit to determine when she is most likely to ovulate. This is a special kit that measures the amount of luteinizing hormone (LH). Because LH promotes the maturation of an egg in the ovary, the amount of LH usually increases 20 to 48 hours before ovulation. This increase is called the LH surge, which can then be detected in a woman’s urine 8 to 12 hours later. The ovulation prediction kit is designed to measure the amount of LH in the urine.

There are a number of ovulation prediction kits available on the market which range from simple to complex. In the simplest, the woman urinates onto a test stick and the amount of LH is indicated by a color change. The intensity of the color is proportional to the amount of LH in her urine. A woman begins testing her urine 2 to 3 days before she expects to ovulate based upon the dates of her previous monthly cycles.

More advanced technology assistance is now also on the market. An electronic monitor is available that not only measures the hormones in a urine sample but identifies the 6 most fertile days in a particular woman’s cycle. This electronic monitor costs about $200.00.

The optimum days for fertilization are the two days before ovulation, the day of ovulation, and the day after ovulation. The greatest chance of becoming pregnant is if intercourse occurs within 24 hours after the LH surge. Ovulation prediction kits are used primarily to increase the chance of a woman becoming pregnant, but they can also indicate to the woman that she is about to ovulate and should take appropriate contraceptive precautions.

Withdrawal

Withdrawal is also called coitus interruptus. The man withdraws his penis from a woman’s vagina before he ejaculates so that the sperm released from his penis does not enter her vagina.

There are problems with using withdrawal as a contraceptive method. First, a man may release sperm before he has an orgasm. Secondly, a man needs self-control and a precise sense of timing to be able to withdraw his penis from the woman’s vagina before he ejaculates. Because this can be difficult for the man to do successfully, the withdrawal method is only about 75-80% effective in preventing pregnancy.

Lactational Infertility

Lactational infertility is based upon the idea that a woman cannot become pregnant as long as she is breastfeeding her baby. It is true that a woman may not ovulate quite as soon after giving birth as she would if she were not breastfeeding. Women who are breastfeeding usually start ovulating again between 10-12 weeks after delivery.

A nursing mother may start ovulating again and not realize she is fertile, as ovulation can occur prior to the return of her menstrual period. If this happens and the mother has unprotected sexual intercourse, she can become pregnant at the same time she is still breastfeeding her previous baby. If a nursing mother does not wish to become pregnant again, she must again start to use an appropriate method of contraception. (See Depo-Provera, the minipill, barrier methods).

Douching and Urination

Vaginal douching is the use of a liquid solution to wash out mucus and other types of bodily debris from a woman’s vagina. Many women make regular douching a part of their routine for maintaining vaginal hygiene.

Regardless of whether a woman does it for hygienic reasons, vaginal douching does not work as a contraception method. During intercourse, active sperm can reach a woman’s cervix and even the upper part of her uterus within 5 minutes of ejaculation. Douching after intercourse cannot be done soon enough to have any contraceptive benefits and the douching could force sperm higher up into the uterus. In addition, if a woman douches within a 6-8 hour period after using, for example, a spermicide, she will actually reduce the effectiveness of this contraceptive method.

Some women used to think that standing up and urinating immediately after sexual intercourse might reduce the chances of them becoming pregnant. They hoped that gravity might make it more difficult for sperm to swim “uphill” to the uterus and that the stream of urine running over their vaginal area would wash away sperm, similar to the process of douching. However, just like douching, urination after intercourse does not have any contraceptive value.

Abstinence

Abstinence from sexual activity means not having any sexual intercourse at all. No sexual intercourse with a member of the opposite sex means that there is no chance that a man’s sperm can fertilize a woman’s egg.

A man or a woman can practice abstinence from sexual activity for a specific period of time, or continuously throughout one’s lifetime. Abstinence is essentially 100% effective in preventing pregnancy. Another significant benefit of abstinence is that it markedly reduces the likelihood of contracting a sexually transmitted infection. In this context, abstinence means refraining from all vaginal, anal and oral sexual activity because sexually transmitted infections can be passed from one person to another in any and all of these ways. It should be noted that sexual activity such as mutual masturbation and touching of the other partner’s genitals can, in some instances, transfer sperm during heavy mutual foreplay possibly leading to pregnancy. Oral sex will not cause pregnancy. However, if we are trying to prevent sexually transmitted infection, then any contact can transmit organisms, from kissing on down the line.

Contraceptive Measures After Unprotected Sex

Emergency contraception is that which is used after the fact - after sexual intercourse has occurred. These measures are utilized if there is a possibility that fertilization of the egg has occurred.

Emergency contraception can be applicable if intercourse was unprotected, which can happen for a variety of reasons. The couple may not have used any contraception because they were overwhelmed by sexual passion. Or perhaps a method of contraception was misused because of lack of knowledge about the proper technique. Maybe there was failure of a contraceptive device, such as a hole or tear in a condom, or the condom accidentally came off the man’s penis. Perhaps intercourse was violent and forced, such as in the act of rape.

Emergency contraception, if it is to be effective, must be initiated within 72 hours after unprotected sexual intercourse. This can be difficult if the clock on this 72- hour period starts ticking at the beginning of a weekend or a holiday, or if a woman is unable to see a health care professional within this time frame.

Emergency Hormonal Contraception

Emergency hormonal contraception is sometimes called “the morning after pill.” It is actually a short course of oral contraceptives taken at a high dose. The exact regimen (the number of pills and the number of days) depends on the type of oral contraceptive used. All oral contraceptives contain hormones.

This high dose of hormones blocks the implantation of the fertilized egg in the uterus. In turn, this action reduces the chances of a woman becoming pregnant after unprotected sexual intercourse by 75% or more if the woman is not already pregnant, adequate doses are prescribed, and the woman follows the regimen as directed. To be considered a possible candidate for emergency contraceptive pills a woman should receive medical attention within 72 hours of unprotected intercourse. (In contrast, emergency contraception with an IUD may be possible 5-7 days after intercourse, see below.) The only known contraindication to emergency contraception is pregnancy.

There are no serious side effects, but the pills may cause nausea in 30 to 50% and vomiting in 15 to 20% of women. These side effects may be controlled by taking an anti-nausea drug such as dimenhydrinate (Dramamine). Frequently a doctor will give a prescription nausea medication, such as Compazine, at the same time as the emergency contraceptive pill. A woman may also experience breast tenderness and a temporary disruption of her menstrual cycle.

Both current products on the market include the progesterone hormone levonorgestrel. Preven uses four hormone pills, each of which supply estrogen alone with levonorgestrel. The other emergency contraception treatment approved by the Food and Drug Administration (FDA) is Plan B, which consists of two tablets of levonorgestrel only. This lower dose results in less nausea and vomiting. Levonorgestrel-only medication may be more effective and causes less nausea compared to the Preven product.

Emergency hormonal contraception has the same restrictions as the hormonal contraceptive pill. A woman with a history of stroke, heart attack, liver tumor, or breast cancer needs careful evaluation and counseling before taking emergency hormonal contraception. The pills do not protect a woman from sexually transmitted infections.

This strategy is not meant to be a long-term contraception. Once the emergency is over, a woman should receive proper counseling so that she can select an effective and appropriate contraceptive method to use on a regular basis if she continues to be sexually active.

Emergency Intrauterine Device (IUD)

Emergency IUD insertion can also be used to prevent a pregnancy after unprotected sex. If the copper IUD (Paragard) is inserted within 5 to 7 days, it is 99% effective in preventing pregnancy. The copper IUD has the lowest failure rate of all emergency contraception options (less than 1%).

Like the high dose of oral hormonal contraceptive, an IUD blocks the implantation of the fertilized egg in the uterine wall. Emergency IUD insertion does increase the risk of pelvic inflammatory disease (PID).

An added advantage of emergency contraceptive use of an IUD compared to pills is that once the IUD is in place, it will provide the woman with a long-term contraceptive method, so that in the future, she can avoid having to resort to emergency contraception.

Permanent Methods of Contraception (Surgical Sterilization)

Sterilization is considered a permanent method of contraception. In certain cases, sterilization can be reversed, but this is not guaranteed. For this reason, sterilization is meant for men and women who do not intend to have children in the future.

Vasectomy

A vasectomy is a form of sterilization for a man. A vasectomy ensures that no sperm will exit from his penis when he ejaculates during sexual intercourse.

A vasectomy is usually performed by either a urologist or a general surgeon. Under local anesthesia, the spermatic duct (vas deferens), which carry the sperm from the testicles, are cut and the open ends closed off. After a vasectomy, the man may feel tenderness or bruising around the incision site.

A vasectomy does not interfere with the ability of a man to have an erection or the quantity of his ejaculation fluid. After a man has a vasectomy, another second form of birth control should be used until his ejaculate fluid is found to be free from sperm. This usually takes 10 to 20 ejaculations. A vasectomy is over 99% effective if a man has two sperm-free ejaculates (as determined by laboratory testing) to confirm his sterility.

Vasectomy reversals are possible, but they tend to be expensive and are not always successful. A vasectomy should be considered a permanent form of birth control. For more, please read the Vasectomy article.

A vasectomy does not protect a man or his partner from sexually transmitted infections.

Tubal Ligation

Tubal ligation is also known as “having ones tubes tied,” or having a “tubal.” Tubal ligation is for women, and like a vasectomy, should be considered a permanent form of birth control.

A tubal ligation is performed under general, regional, or local anesthesia and can be performed as an outpatient procedure. The surgeon or ob/gyn uses one of several procedures in order to access a woman’s Fallopian tubes (which run from the top part of her uterus to each ovary). A laparoscopy is a procedure in which a small incision is made just below the navel. A scope can then be inserted through this incision to view and reach the Fallopian tubes. A minilaparotomy is a small incision in the lower abdomen. A laparotomy is a long incision that is made through the muscle layers of the abdomen.

Once the physician has access to a woman’s Fallopian tubes, they are closed off by using a clip, cutting and tying, or cauterizing (burning) the tubes. The procedure takes anywhere from 10 to 45 minutes.

Side effects of a tubal ligation may include infection, bleeding (hemorrhage), and those associated with being under general anesthesia.

A tubal ligation blocks a woman’s Fallopian tubes - about 1 inch of each tube is blocked off. An egg can no longer travel down the tube to the uterus and sperm cannot make contact with the egg. Tubal ligation should have no effect on a woman’s menstrual cycle or hormone production.

A woman’s tubal ligation can be surgically reversed, usually with more success than in men who have had a vasectomy.

A tubal ligation does not protect a woman or her partner from sexually transmitted infections (sexually transmitted diseases, or STDs). It is also not an absolute method of birth control because about 2% of women become pregnant after a tubal ligation.

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SOURCE: Archives of Pediatrics & Adolescent Medicine