Contraceptive Methods: Preventing Pregnancy and STIs Options Choices Decisions

What are Contraceptives? Techniques used by the male or female to prevent pregnancy or sexually transmitted infections (STIs), including HIV. Contraceptives are also called birth control. Contraceptives are not 100% effective, but they can reduce the risk of STI transmission if used consistently and correctly.

Contraceptive Methods Explain: There are three methods used to protect against unwanted pregnancy and/or STI transmission The first and best is always to remain abstinent and not engage in sexual intercourse of any kind. Abstinence is the developmental norm for students at this grade level. The second are called barrier methods. These are condoms and if used correctly can reduce the risk of pregnancy and STIs. The last are hormonal methods. They are provided to a person by a medical provider and they alter the hormone levels in a female to prevent pregnancy. Abstinence Barriers Hormonal

Abstinence Choosing not to have sex or waiting to have sex 100% effective = 0 chance of pregnancy Sperm and egg have no opportunity to meet Explain: Abstinence is the choice to not have sex or waiting to have sex until you are in a committed relationship or married. Abstinence with no genital contact is 100% effective meaning there is no chance of unplanned pregnancy because a male sperm and female egg have no opportunity to meet. Abstinence also helps prevent STIs. Some STIs can spread by genital contact which is not abstinence, but abstinence reduces the likelihood of STIs. Abstinence is the developmental norm for students at this grade level. Can prevent STIs, however some STIs can spread by genital contact alone

Abstinence is… 100% effective against unplanned pregnancy and sexually transmitted infections (STIs)! Explain: The most important thing to remember about abstinence is that it is 100% effective meaning it is the safest choice to prevent unplanned pregnancy and to prevent the transmission of STIs when there is no genital contact. Abstinence is also the developmental norm for students at this grade level.

Tips on Abstinence Talk Talk to your partner Plan Plan and practice what to say before a sexual situation comes up Avoid Avoid alcohol and drugs—they affect decision making Explain: Choosing abstinence and remaining abstinent is an important decision, but also one that can be difficult. Here are some helpful tips: 1.) Talk to you partner. If they are a true partner they will support your decision. 2.) Plan and practice what to say before a sexual situation comes up. It will be easier to stick to your plan of abstinence if you have planned out what to say. 3.) Avoid alcohol and drugs which may affect your decision making.

Withdrawal – “pulling out” What is it? The male pulls his penis out of the vagina before ejaculation. How does it work? In theory, sperm does not enter the vagina. BUT some sperm leak out of the penis before ejaculation – which makes withdrawal INEFFECTIVE! How effective is it? Over 30% of couples will become pregnant after a year. That is almost 4 out of 10 couples! Does NOT protect against pregnancy or STIs! Hard to practice correctly. Explain: Other preventative methods are just not as effective as abstinence. One of these is “pulling out”.

Douching What is it? How does it work? Is it effective? Using water or other fluid to clean the vagina. How does it work? It doesn’t! Douching is not an effective method of birth control. In fact it can increase the risk of STIs and other vaginal infections! Is it effective? NO! In fact, doctors recommend that women do not douche. Explain: Another of these methods is douching.

Barrier Methods Condoms, diaphragms Places a barrier between the sperm and the egg so that fertilization can not occur. Can be private and easy to carry with you. Dental dams can be used as a barrier during oral sex to prevent the transmission of STIs. Explain: Though abstinence is the only 100% method, barrier methods are used to protect against unplanned pregnancy and STI transmission as well. The CDC reports that the consistent and correct use of latex condoms reduces the risk for many STIs that are transmitted through genital fluids (chlamydia, gonorrhea, and trichomoniasis), reduces the risk of herpes and syphilis when the infected area is protected and may reduce the risk of HPV infection. http://www.cdc.gov/condomeffectiveness/brief.html Dental Dam demo video at: http://www.youtube.com/watch?v=393m-JpPbjs

Barrier Method: The Male Condom What is it: A tube that fits over a male’s penis. It is made out of latex, polyurethane, or lambskin. How does it work? The condom catches the male semen. The sperm stay inside the condom and do not make contact with the vagina. Is it effective? Condoms are about 84% effective against unplanned pregnancy. Condoms protect against some STIs. Ask students to name some pros and cons of male condom use as a barrier method. If they need help include: Pros: does not allow sperm and egg to meet, 84% effective against unplanned pregnancy, protects against some STIs and HIV, easily purchased or available in some schools and school based health centers. Cons: not as effective at preventing unplanned pregnancy and STI transmission as abstinence, may not be used properly, can slip off or break, does not protect against the emotional, social, and relational results of sexual intercourse.

Male Condom Demonstration Activity With principal notification: demonstrate use of a male condom (see lesson plan for details regarding principal notification and condom demonstrations). If completing demonstration: Provide student groups with steps of a male condom activity sheet. Complete activity and check for accuracy.

Barrier Method: The Female Condom What is it? A nitril pouch that is inserted into the female’s vagina. How does it work? The male’s penis goes inside the pouch while it is in the female’s vagina. He ejaculates into the pouch, keeping sperm from entering the vagina. How effective is it? 79% effective against unplanned pregnancy and protects against some STIs. Can be used even if you have a latex allergy. Ask students to name some pros and cons of female condom use as a barrier method. If they need help include: Pros: does not allow sperm and egg to meet, 79% effective against unplanned pregnancy, protects against some STIs and HIV Cons: not as effective at preventing unplanned pregnancy and STI transmission as abstinence, may not be used properly, does not protect against the emotional, social, and relational results of sexual intercourse.

Female Condom Demonstration Activity With principal notification: demonstrate use of a female condom (see lesson plan for details regarding principal notification and condom demonstrations). If completing demonstration: Provide student groups with steps of a female condom activity sheet. Complete activity and check for accuracy.

*Some people prefer to remove the The Female Condom Can Also Be Used For Anal Sex Squeeze the inner ring between your thumb and middle finger. Insert the inner ring into the anal opening and use your finger to guide it inside. Put your finger inside the condom and push it into the anal cavity. The inner ring should be inserted past the sphincter.* *Some people prefer to remove the inner ring once it has been inserted into the anus. HOWEVER, for vaginal sex, the ring must be kept inside.

Barrier Method: Condoms Pros Protects against STIs and pregnancy Easy to carry Does not require a doctor’s visit Can be bought at a drugstore Free at most school based health centers or community centers! Cons Not as effective as abstinence Latex allergies (male condom) Can only be used once Can be used improperly Lambskin only protects against pregnancy

Condom Do’s and Don’ts NEVER… ALWAYS… Always check condom expiration date Always use a new condom every time - do not reuse condoms Always use only water- based lubricants - KY jelly Always leave room at the tip for semen. Always wear condom when penis is erect Always hold onto condom while pulling out NEVER… Never use oil-based products like Vaseline as a lubricant Never wear 2 condoms -- this does not double protect! Never leave air bubbles in condom while on

Barrier Method: Diaphragm What is it? A small dome-shaped cup of silicone or latex that a woman inserts into her vagina before having sex. How does it work? The diaphragm covers the cervix and keeps sperm out of the uterus. It needs to be used with spermicide. How effective is it? 88% Effective. NO STI protection! Requires a doctor’s visit Explain: Another barrier method is a diaphragm.

Hormonal Methods What is it? How does it work? How effective is it? The Pill, Patch, Shot, Ring, and Implanon How does it work? Change the hormone levels so no egg is released, cervical mucus increases, and lining of uterus thins. How effective is it? 99% effective – 1/100 women will get pregnant a year. NO protection against STIs Require a doctors visit Explain: Hormonal methods are different than barrier methods.

Hormonal Methods PATCH RINGG DEPO SHOT IMPLANON Explain: All of these hormonal contraceptive methods require a doctor’s visit. Depo- Requires injection every 3 months Effectiveness > 99% with ongoing use. Side effects include: Increased apatite irregular bleeding possible risk of bone density loss Good method for younger adolescents Ring- The ring is insterted into the vagina by the female worn for 3 weeks and discarded, and a new ring is inserted 1 week later (28 day cycle) Patch- A new patch is worn each week for three weeks, during the 4th week a patch is not worn Implanon- A small flexible rod inserted under the skin by a medical provider. Can be used for 3 years. DEPO SHOT IMPLANON

Differences The Pill- Take one pill every day at the same time The Patch-Wear one patch for 7 days, 3 weeks in a row, 4th week off The Ring – Insert ring into vagina for 3 weeks, remove for 4th week

Differences The Shot (Depo Provera) – Get one shot every 12 weeks Implanon - Plastic rod inserted in arm by health care professional, every 3 years

Intrauterine Devices (IUD) What is it? A small T-shaped piece of plastic or copper that inserts in the woman’s uterus. How does it work? Prevents the sperm from fertilizing the egg. How effective is it? Over 99% effective. NO STI protection. Requires a doctor’s visit.

85-90% of couples will become pregnant. True or False? If no birth control is used, 75% of sexually active couples will become pregnant after one year. False! 85-90% of couples will become pregnant.

True or False? A girl can get pregnant the first time she has sex. True! Pregnancy can occur at any time, even while a girl has her period.

All birth control protects against STIs. True or False? All birth control protects against STIs. False! Only abstinence with no genital contact can protect against STIs. Male and female condoms reduce the risk STI transmission.

Hormonal Method + Condom= STIs or Pregnancy

What if….? Condom breaks A pill is missed Patch falls off You missed a shot Ring falls out Diaphragm slipped A person was forced to have sex Explain: A person should get medical care (go to the doctor or call) if one of the following situations occurs. A medical provider will be able to offer the correct next steps for what that person should do. They may need to get tested for pregnancy, STIs, HIV and/or receive counseling services.

Emergency Contraceptive (EC) “Morning After Pill”- Plan B and Ella Take ASAP: within in 3 days (Plan B), within 5 days (Ella) of unprotected sex Stops or delays ovulation, prevents fertilization or implantation Prevents at least 75% of pregnancies that would have occurred NOT “The Abortion Pill”- Mifepristone Persons 12-16 need a prescription, 17+ can purchase over the counter

Your Rights… You have the right to…. Know your own body and make decisions about what happens to it. Require your partner to use birth control. Talk to a parent, guardian, or trusted adult about birth control . Talk to a doctor or medical professional about your birth control options. Change your birth control method.

What you need to know… *Exceptions do apply. A doctor’s visit for hormonal birth control is required. The pharmacy can provide emergency contraception (peoples 12-16 need a prescription, 17+ can purchase) Youth 12 years of age or older can receive sexual health and reproductive services without parental consent. *Exceptions do apply. Notes: Youth 12 years or older can seek sexual health services without a parent’s consent. However, certain forms of emergency contraception, abortion procedures and results of tests that inform the patient of possible danger may be reported to a parent or legal guardian with informed consent of the minor.

Set your sexual limit Talk to your medical provider Tell your partner Plan ahead!