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Safer Sex

Sex & Health: Preventing Unintended Pregnancy & Protecting Yourself from Sexually Transmitted Infections

Safer Sex, Why Bother?

Preventing Unintended Pregnancy vs. Preventing STIs

Sobriety and Sex

Contraception


Safer Sex, Why Bother?

Since the 1980’s, when AIDS was first recognized, we’ve been hearing a lot more about practicing safer sex. While it’d be great if we could just think of sex as fun & not have to worry about sexually transmitted infections or unintended pregnancy, the reality is that as enjoyable as it can be, sex in the 21st century is also risky business. Taking care of yourself & looking out for the health of your partner during sexual activity can significantly reduce the health risks involved & safer sex can still be great sex!!! In the end the choice is still yours, but hopefully the basic guide to contraception laid out below will increase your understanding of the options that are available to you & will help encourage you to try practicing safer sex.
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The Difference between Preventing Unintended Pregnancy & Protecting Yourself from Sexually Transmitted Infections

If you are interested in preventing unintended pregnancy AND protecting yourself from sexually transmitted infections (STIs), always remember to make sure that you are not forgetting to do one or the other! A common misconception that we should all be aware of for example, is thinking that the oral contraceptive pill (‘The Pill’) & other hormonal contraceptive methods prevent us from getting STIs. The Pill is meant to prevent pregnancy: it does NOT protect the woman taking it from getting STIs & it does not prevent her from giving them to her partner! If you are on the pill, you will have to take extra measures (such as condom use) to help protect you from disease.

Sober Sex is the Best Sex

Alcohol & Drugs can cloud your judgement & may make you more likely to make decisions which you will later regret. It is best to have sex when you are sober, when you know you are capable of making clear consent to the decision. Remember, under the Criminal Code of Canada, sexual consent cannot be given if you are drunk, stoned or sleeping. When drunk or stoned, you may be more vulnerable to sexual assault. There are people out there who use drugs and alcohol to help them commit rape or other acts of sexual assault. At clubs or parties, try to stick with your friends & do not leave your drink unattended. Apart from these serious dangers of sex under the influence, many people simply find that they perform better during sex if they are sober. Some men for instance, find that alcohol makes it more difficult to get and maintain an erection.

What are my Options???

Hormonal Methods:
1)Oral Contraceptive Pill
Effectiveness vs. STIs
NONE!!!
Effectiveness vs. Pregnancy
99.9% effective if used properly
How it Works
-Contain two hormones, a progestin & an estrogen which keep the hormone level in your blood high enough to prevent the ovaries from letting any eggs ripen. They also thin the lining of the uterus & thicken mucus to help stop sperm from getting to the uterus
Perks
-one of the most effective reversible methods of contraception
-can help regulate your menstrual cycle & reduce your menstrual flow
-can help decrease acne
-offers protection against certain cancers
-is well researched
Disadvantages
-can result in bleeding problems such as irregular bleeding, breast tenderness, headaches & nausea.
-If you are a smoker, the pill is probably not the right choice: women (particularly those over 35 years of age) who smoke are at increased risk for blood clots in the legs, stroke & other cardiovascular events if they take the oral contraceptive pill.

2) Progestin Only Pill
Effectiveness vs. STIs
NONE!!!
Effectiveness vs. Pregnancy
90-99% effective if used properly
How it Works
-Contains the hormone progestin which sends signals to the brain and sex organs causoing the lining of the uterus to change, creating an unfriendly environment for eggs to develop. It also thickens cervical mucus making it harder for sperm to penetrate it.
Perks
-one of the most effective reversible methods of contraception
-can help reduce menstrual cramps & flow & can offer protection against certain cancers.
-it can be used by certain women who are otherwise unable to use the pill
Disadvantages
-this method is not very forgiving if you forget to take your pills regularly
-possible irregular bleeding

3) Injection (Depo-Provera)
Effectiveness vs. STIs
NONE!!!
Effectiveness vs. Pregnancy
99.7% effective.
Failure rate is 3 pregnancies in 1000 women who used the method for 1 year.
How it Works
The injection contraceptive is kinda like a vaccine: you have to get a new injection every 10-13 weeks (4times/year). It contains one hormone, a progestin (medroxyprogesterone acetate), which stops ovulation. & acts on the lining of the uterus and on the mucus at the entrance of the cervix to make it harder for sperm to get through.
Perks
-It is one of the most effective reversible methods of contraception
-no daily pill-taking routine
-women who should not take estrogen-containing contraceptives can take it
-offers contraception for 12 weeks
-some additional health benefits can occur
Disadvantages
-possible bleeding irregularities: 50% of women stop their periods within one year of use
-weight gain due to increased appetite

4) Implant
Effectiveness vs. STIs
NONE!!!
Effectiveness vs. Pregnancy
99.8% effective.
Failure rate is 2 pregnancies in 1000 women who used the method for 1 year.
How it Works
The implant is made up of 6 small plastic strips (34mm x 2.4mm) which are inserted beneath the skin under your arm. The strips release a hormone, a progestin (levonorgestrel), which sends signals to the brain and sex organs to change the lining of the uterus, making it unfriendly for egg development. It also causes the mucus at the entrance of the cervix to become thicker, making it harder for sperm to get through.
Perks
-It is one of the most effective reversible methods of contraception
-no daily pill-taking routine
-women who should not take estrogen-containing contraceptives can use it
-offers contraception for 5 years
-some additional health benefits can occur
Disadvantages
-possible bleeding irregularities & weight gain, but less than with the injection method.

Barrier Methods:
1) The (Male) Condom
Effectiveness vs. STIs
Condoms help protect you from catching STIs, but they are not 100% effective & their effectiveness depends on the type used. A latex condom will help protect you against HIV and most STIs except for herpes and Human Papilloma Virus (HPV) A sheep membrane condom will not protect against STIs/HIV.
Effectiveness vs. Pregnancy
Using a condom will help to prevent unplanned pregnancy. How good are they? Well, if you manage to use condoms perfectly, there is about a 3% failure rate for the first year during which you use them. Most people don’t do such a spot-on job in using their condoms however, and the more typical failure rate is closer to 12%.
How it Works
A condom is a membrane made of either latex or sheep intestine which is rolled on over the penis. It acts as a barrier which will stop the exchange of semen, vaginal secretions & other bodily fluids during intercourse. It is good to consider using a spermicide along with a condom if you want to increase its effectiveness against unplanned pregnancy.
Perks
Condoms are fairly easy to come by & they are relatively cheap. Some sexual health centres will give out condoms for free.
Wearing a condom can help prevent premature ejaculation
Condoms can make sex a little less messy if hygiene is a concern
Condoms are pretty compact & can easily be carried discretely
In helping to prevent you from being infected with an STI, condoms help you avoid problems associated with STIs such as infertility & cervical cancer.
Disadvantages
It takes motivation & responsible choices to consistently use condoms. If you are forgetful, or if your judgement is clouded, for instance by alcohol, you could be more likely to forget to use a condom putting you & your partner at risk.
Condoms may decrease the sensitivity of intercourse. They may interrupt foreplay or interfere with enjoyment. Condoms may also have an unpleasant taste which can put a damper on oral sex. That said, many condom brands now offer flavoured condoms.

2) The Female Condom
Effectiveness vs. STIs
The female condom does protect against STIs & HIV
Effectiveness vs. Pregnancy
Using a female condom will help to prevent unplanned pregnancy. If you use this method properly & consistently, it has a failure rate of 5%.
How it Works
The female condom is a polyurethane sheath with two rings which is worn by women during vaginal intercourse. It is placed in the vagina before any vaginal contact with the partner & will prevent semen from getting into the vagina & the exchange of bodily fluids. The outer ring of the condom also helps to protect the lips at the vaginal entrance.
Perks
The female condom is a great option if your male partner is allergic to condoms or is uncomfortable using them.
Female condoms are suitable for people with latex allergies since they are made of polyurethane.
Female condoms warm up easier & are thinner than most male condoms giving more sensitivity during intercourse.
The female condom is lubricated on the inside & outside, fitting snugly against the walls of the vagina & allowing easy entry of the penis into the condom.
You can insert this condom hours before intercourse so you don’t have to interrupt ‘the mood’ to put it in place.
You can get a female condom prescription-free in a drugstore or on the internet.
Disadvantages
There can be some difficulties with inserting the condom
Sounds may come from the condom as the ‘action’ goes on during intercourse.

3) The Contraceptive Sponge
Effectiveness vs. STIs
The sponge protects against STIs & HIV to an extent. For full protection, you should always use a sponge along with a male condom. The sponge has some spermicides in it that can help protect against certain STIs; its effectiveness against HIV is still unclear.
Effectiveness vs. Pregnancy
If you use a sponge properly, the probability that it will fail to prevent pregnancy in the first year of use is 11%.
How it Works
The sponge is a disposable barrier made out of polyurethane foam. Sponges are placed at the cervix, where it absorbs & captures sperm. It also has three spermicides to help wipe out sperm.
Perks
The two in one deal: you get a barrier & a spermicide in a single product.
It is unlikely that spermicides in the sponge will irritate the vagina since they are in low concentration.
The sponge offers 12 hour protection against pregnancy.
If you are going to have repeat intercourse within 12 hours, you don’t need to replace your sponge.
You can get a sponge prescription-free in a drugstore, family planning clinic or on the internet.
Disadvantages
There can be some difficulties in removing the sponge.
Forgetting to take out the sponge can be an issue.
Some people are allergic to the foam or the spermicides.

4) The Lea Contraceptive
Effectiveness vs. STIs
The contraceptive device itself will not protect you against STIs-if you add spermicide to it, this will help protect you against bacterial infections. There is no proof of the Lea Contraceptive protecting against HIV.
Effectiveness vs. Pregnancy
If you don’t use the Lea Contraceptive with spermicide, its failure rate in preventing pregnancy is 12.9%. If you use it in combination with spermicide however, the failure rate is 8.7%.
How it Works
This contraceptive is a soft silicone barrier that looks like a cup-shaped bowl with a valve and a loop which is used for insertion/removal. It should be used with spermicide. You insert this device into the vagina, to the point where it surrounds the front of the cervix without resting on it It prevents sperm from getting into the cervix. It comes in only one size. You can insert this contraceptive hours before intercourse & it should be left in place at least 8 hours after the last act of intercourse. Also, do not wear this device for more than 24 hours in a row.
Perks
The Lea contraceptive gives you lasting protection for 8 hours.
You can reuse the device for 6 months if you look after it
It is easy to carry & easy to get on.
You do not need to be fitted by a physician.
Insertion can be done hours in advance of intercourse so foreplay isn’t interrupted.
There are no systemic reactions or effects of this device.
You can use the Lea contraceptive when you are on your period.
Disadvantages
There is a change you may have an allergic reaction to the silicone or the spermicide you use.
Some people may have troubles inserting the device.
If you notice a bad odour when the contraceptive is inserted or after you take it out, you should contact your doctor as an infection may have happened.
Leaving the contraceptive in longer than 24 hours puts you at risk for toxic shock syndrome.

5) The Diaphragm
Effectiveness vs. STIs
The device itself will not protect you against STIs-if you add spermicide to it, this will help protect you against bacterial infections. There is no proof of the diaphragm protecting against HIV.
Effectiveness vs. Pregnancy
If you use a diaphragm correctly, it will have about a 4-8% failure rate in pregnancy prevention during the first year you use it.
How it Works
The diaphragm is a cap made of latex which covers the cervix. A flexible steel ring covered with rubber surrounds its edge to keep its shape. You should use a diaphragm in combo with a spermicide. The diaphragm is inserted into the vagina to the front of the cervix where it prevents sperm entry. It should be left in the vagina for at leat 8 hours after intercourse & should not be worn more than 24 hours.
Perks
The diagphragm can be inserted prior to intercourse so you don’t have to be bothered with it when you are in the middle of things.
Disadvantages
During intercourse, the vagina is moving & so the diaphragm can be slightly displaced meaning it doesn’t always keep a good seal on the cervix-this is why spermicide is important.
You have to see your physician for a pelvic exam & medical history-taking before you get a diaphragm-the size & type will depend on your build & whether or not you have had children.
The diaphragm is not suitable for individuals with latex allergy.
Some people have difficulty inserting the diaphragm.
You may need to be refitted periodically for your diaphragm
The device can increase the risk of urinary tract infections
There is a risk of toxic shock syndrome if you leave the diaphragm in place for more than 24 hours.

6) The Cervical Cap
Effectiveness vs. STIs
The device itself will not protect you against STIs-if you add spermicide to it, this will help protect you against bacterial infections. There is no proof of the cervical cap protecting against HIV.
Effectiveness vs. Pregnancy
If used correctly, the cervical cap has a failure rate in preventing pregnancy of 10-13% in the first year of use. There is a slightly higher failure rate in women who have already had children.
How it Works
This device is a small latex cap that has a flexible ring around its edge. It covers the entrance of the cervix to prevent sperm entry into the uterus. Spermicide should be used with the cervical cap.
Perks
The cap can be inserted hours before intercourse
Disadvantages
You will have to see your physician for a proper fitting of the cervical cap. A history & pelvic exam will be necessary.
The cervical cap is not suitable for people who have sensitivities or allergies to rubber or spermicide.
There can be difficulties inserting the device.
The cap may go out of place during sexual intercourse.
If you leave the cap in place for too long (more than 24 hrs), you may be at risk of infection or toxic shock syndrome.
You may need to have your cap refitted if your cervical shape changes as with birth, abortion or certain surgeries.

7) Spermicides
Effectiveness vs. STIs
Spermicides do offer some protection against STIs. They will protect you from bacterial infections, but their effectiveness against viruses like HIV is still questionable.
Effectiveness vs. Pregnancy
Spermicides are between 79-94% effective in preventing unplanned pregnancy. They can be used in combination with other barrier methods to further increase the protection.
How they Work
Spermicides are chemicals (ie. nonoxynol-9) in the form of creams, gels, foams, films or suppositories which, when placed in the vagina in front of the cervix, will destroy sperm on contact.
Perks
Apart from acting as contraceptives, spermicides offer some health benefits. They can help decrease the risk of pelvic inflammatory disease (PID) in women, prevent bacterial infections like gonorrhea & help prevent cervical cancer. They also lubricate the vagina making for smoother intercourse.
In the event of a condom breaking or leaking or a cervical cap or diaphragm moving during intercourse, spermicides can be used as an emergency measure to try to decrease the chance of pregnancy.
Disadvantages
Certain spermicides must be used well in advance to be effective. Foams, gels or creams are more fast acting.
Certain people have allergic reactions to the active agent in spermicides.
These products may have unpleasant odours or tastes & can be messy.

Surgical Methods:
These methods of contraception are permanent or else difficult and quite costly to reverse. It is important that both partners discuss these procedures and their downstream consequences carefully before any decisions are made.

1) Tubal Ligation
Effectiveness vs. STIs
This procedure does not protect against STIs.
Effectiveness vs. Pregnancy
With monitoring over a 10 year period, there is an approximately 1-2.5% rate of pregnancy in women who have had tubal ligations.
How it Works
Tubal ligation is a permanent surgical procedure performed in women which interrupts the journey of the female egg to the uterus by disconnecting the fallopian tubes. It is generally an option chosen by women who have already completed their families. After the procedure, women will still have their female cycle with hormone production, ovulation and menstrual periods. There are a few different surgical approaches to this procedure which will vary depending on the physician and timing of the surgery. The most common method is operating through a very small incision in the bellybutton which is called laparoscopy and which can be done under local anaesthetic in some cases.
Tubal ligation is a good choice if:
You and your partner are certain you wish to have no children at all or no more children
You want an effective long term method
You want a private method
You want a method which is not related to intercourse
Other reversible methods are not an option for you
Tubal ligation is not a good choice if:
You are not positive that you want permanent contraception
Your partner agrees to have a vasectomy which has fewer complications
After tubal ligation, you may experience pain at the surgical site, bleeding, nausea & lightheadedness, hematoma or infection.

2) Vasectomy
Effectiveness vs. STIs
This procedure does not protect against STIs.
Effectiveness vs. Pregnancy
After a vasectomy, there is a pregnancy rate of 0.2-2%. Within a three month period, the disconnected vas deferens may grow back together in about 2.6% of cases.
How it Works
A vasectomy is a permanent surgical procedure performed on a male which blocks the right & left vas deferens so sperm can’t get into the ejaculate. Men can still ejaculate, but they will not get a woman pregnant since the ejaculate will not contain sperm. Vasectomy will not affect your desire or ability to make love.
Vasectomy is a good choice if:
You and your partner are certain you want no children or no additional children
You want an effective, long term method which is safe, easy & not related to intercourse
You want to remove the burden of contraception from your partner
Your partner can’t use other reversible methods
Your partner is considering tubal ligation-vasectomy is easier & less risky.
Vasectomy is not a good choice if:
You are uncertain whether you want permanent contraception & may regret the decision.
After vasectomy, you maybe experience pain at the surgical site, swelling, dizziness (during surgery), haematoma or infection.

Natural Methods:
Natural methods mean there are no medications used. The effectiveness of these methods will depend mostly on the abilities of you & your partner: you need to underdstand your body, how fertilization works & understand the female cycle.

1) Abstinence
Effectiveness vs. STIs
Abstinence is the best way to prevent STIs and HIV
Effectiveness vs. Pregnancy
Abstinence is the most effective method of preventing pregnancy.
How it Works
In abstinence, there is no entry of the penis into the vagina; in fact, the penis should not even get close to the vagina. There is no exchange of bodily fluids including: pre-ejaculatory fluid, semen, vaginal secretions, blood.
Perks
Abstinence is your safest bet in terms of preventing STIs and unintended pregnancy. It is also a good approach if you are unsure about your partner or the status of your relationship. There are other sides to sexual intimacy which can still be enjoyed if abstinence is practiced:
-hugging
-kissing
-massaging
-masturbating
-rubbing
-looking at erotic material
-breast/nipple stimulation
There are no side effects with abstinence!
Disadvantages
Your idea of what abstinence is may differ from that of your partner
Sometimes other sexual acts may lead you to spontaneously change your mind and to engage in sexual intercourse-you should consider use of protection in such a case. This might mean having a condom & spermicide nearby just in case.

2) Withdrawal
Effectiveness vs. STIs
Withdrawal does not protect you from STIs!
Effectiveness vs. Pregnancy
Withdrawal is not too great at preventing pregnancy. Pre-ejaculate can contain sperm. There is a failure rate of about 19% in the average users of this method & a 4% failure rate when people have perfectly ‘mastered’ the technique.
How it Works
In withdrawal, the male removes his penis from the vagina before he ejaculates. The method requires a lot of practice & will power.
Perks
This method allows you to practice self-control & it requires the cooperation of both partners.
Withdrawal is certainly ‘better than nothing’ if there are no other methods available.
Disadvantages
The inexperience of both partners can lead to ineffective technique.
Having control over the time of ejaculation is difficult-the male may pull out too late.
The interruption at withdrawal can be frustrating.

3) Fertility Awareness
Effectiveness vs. STIs
This method does not protect you from STIs.
Effectiveness vs. Pregnancy
Fertility awareness is not so great at preventing pregnancy. You should consider that pregnancy is fairly likely to result. The rate of pregnancy can be up to 20% in the first year that you use this method.
How it Works
To practice fertility awareness, knowledge must be gained about the female’s fertile days & you should not have sexual intercourse on these days without use of other contraceptive methods. You can find information about the female menstrual cycle in just about any basic biology or physiology text book, but the “safe days” are generally considered to be from day 2 after ovulation until the new period starts. Some types of methods used in fertility awareness are:
Calendar Rhythm Method-keep track of your cycle using a calendar
Basal Body Temperature Method-body temperature rises on the day of ovulation & stays 0.5 degrees higher two days after ovulation.
Ovulation or Billings Method-one day before, during and one day after ovulation, the cervical mucus becomes slippery, elastic and clear.
Ovulation Predictor Kits-kits you can get at the drugstore to help predict ovulation
Breast-feeding-it suppresses ovulation for about 6 months after the baby is born.
Fertility Awareness is a good idea if:
You like a natural perspective on things.
You enjoy being more in tune with your body
You want a guarantee of no side effects
You like the budget-it’s free
Disadvantages
Stress and illness can change the menstrual cycle & the cycle can be fairly irregular in adolescents.
This method gives you no protection against STIs & is not too effective in preventing unintended pregnancy.

Intrauterine Method:
1) Intrauterine Device (IUD)
Effectiveness vs. STIs
The IUD does not protect you from STIs
Effectiveness vs. Pregnancy
The IUD is 98% effective in preventing pregnancy.
How it Works
The IUD is a plastic, T-shaped device with a copper wire that is placed in the uterus by a doctor. The copper alters the chemistry of the uterus and will destroy sperm. This method offers long term contraception (5-8 years).
Perks
Safe and effective
Good for women who have already had children, who are at low risk of getting STIs and who want long term contraception.
IUD is independent from intercourse
No negative impact on fertility after it is taken out.
Does not affect breast milk
It can be used as an emergency contraceptive method up to 7 days after unprotected sex.
Good for women who can’t use other methods of contraception such as hormonal methods.
Disadvantages
There can be pain & bleeding after the insertion
Increased risk of pelvic inflammatory disease (PID) in the three months following insertion of the device
Rarely, some women reject & expel their IUD
Some women experience heavier menstrual cycles & cramp pain
The partner may feel the strings associated with the IUD during intercourse
If you do get pregnant while an IUD is in place, it should be removed immediately as there is a high risk of spontaneous abortion.
If you do become pregnant, there is a greater change it will be an ectopic pregnancy (fetus is somewhere other than the uterus) if you have an IUD in place.

REFERENCE: SEX SENSE CANADIAN CONTRACEPTION GUIDE (The Society of Obstetricians and Gynaecologists of Canada)


PROPER USE OF A CONDOM.


Basic Instructions:

Check the expirary date. Do not use after the date shown on the box or package.


Open carefully. Rough tearing, bitting, twisting, or long fingernails can damage the condom.


Lubricate. Use a water-based lubricant (i.e.; K-Y jelly or Lubafax) and apply a drop to the inside of the condom's tip, not directly to the penis.


Place and pinch. Put the condom at the end of the penis (if uncircumcised, pull back the foreskin first) and pinch out the air in the tip of the condom. This leaves space for the semen. (If the condom doesn't have a tip, leave a half-inch free at the head of the condom - and make sure there's no air in it.)


Roll it on. Unroll the condom right down to the base of the penis. Smooth out any air bubbles as you do - air trapped inside the condom could make it break.

Lubricate. Use lots of lube - the more slippery the condom, the less likely it is to break or come off during sex. Make sure you use a water-based lube. Oil-based lubricants (i.e.; vaseline, baby oil, handcream, mineral/vegetable oil) are out as they weaken the latex and may cause the condom to break.

Recommendation: use a foam containing nonoxynol-9 (a spermicidal agent) as a lubricant.


Pull out. Afterwards.... pull out soon after ejaculation. Hold the condom at the base of the penis to make sure it doesn't slip off and no semen spills out.


Throw away. Use a condon only once. Using the same condom increases the chance of breakage OR using the same condom to have sex with more than one partner can help spread STDs and other infections from one person to another.


Complicated? Not really. And not all at once do you get comfortable with condoms. You and your partner will be more comfortable with each other, knowing you care enough to keep each other healthy.

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