1. CONTRACEPTION 101 Gina Duggan, BScN RN
Public Health Nurse/YHC Coordinator
Sackville High School

2. Contraceptive Methods Chart
Rx Required
Where can you get it?
Who can buy it?
Cost $
Effective against pregnancy?
Effective against STI’s?

3. The Basics – The Female
A women is able to have children from the time she begins to menstruate (during puberty) to the onset of menopause (45-55 years old)
A women has a menstrual cycle that determines her fertility
Ovulation occurs on day 14 of the menstrual cycle. The egg that is released lives for hours.
Pregnancy can only occur if her egg is met by a sperm in the fallopian tube, therefore during the three days before and after ovulation.

4. The Basics – The Male
Men start producing sperm at the time of puberty. Once they begin to ejaculate, they are able to make babies.
About 50 million sperm are released every time a man ejaculates
Sperm can stay alive in a women’s uterus for 3-7 days
Men are able to father children almost until the end of their lives
They do not have a cycle to regulate fertility like women do

5. Did you know?
25% of young women who have intercourse without using a method of birth control will become pregnant within one month
85% will become pregnant within one year

6. Safe Sex… The only totally safe sex is no sex.
Pregnancy can only occur from vaginal sex (penis and vagina), however if sperm come in contact with the vulva (outside of the vagina) even without intercourse, there is a small chance of pregnancy.
The second safest sex is between partners in a mutually monogamous relationship who consistently (that means EVERY TIME!) use protection against pregnancy and STIs.

7. Contraceptive Methods
Hormonal: Oral Contraception ( the pill), Depo-Provera (The needle), Ortho-Evra (the patch), NuvaRing (the ring)
Barrier: Male Condom, Female Condom, Spermicides, Sponge, Diaphragm
Surgical: Tubal Ligation (female), Vasectomy (male)
Other: Intrauterine Contraceptive Device (IUCD), Merena
Natural: Fertility Awareness
ONLY THE CONDOM PROTECTS AGAINST STIs

8. Hormonal
Methods

9. Hormonal Methods are only available for women.
Make the body believe the ovaries produce hormones (estrogen & progesterone) while they are, in fact, resting
Hormonal Methods are only available for women.

10. Oral Contraception: The Pill
Must be taken at the same time every day
% Effective
Does not protect against STIs
Combination of hormones: estrogen and progesterone
Stops ovaries from releasing eggs, thins out uterine lining, thickens cervical mucous.
Costs approx $25-35
                  
The birth control pill (also known as an oral contraceptive) is a combination of the hormones estrogen and progestin. It prevents pregnancy by stopping your ovaries from releasing eggs.
The pill gives you very effective, non-stop protection from pregnancy. Taking the pill can make your periods shorter, lighter, less crampy, and more regular.
The pill will not protect you or your partner from STIs. You still need a male or female condom even though you are on the pill. Birth control pills work only if you follow the directions exactly. The pill’s effectiveness depends on keeping a steady supply ohormones in your body. Anything that upsets the hormone supply can make the pill less effective. This includes missing a pill or taking some kinds of medications. Some women have side effects, like headaches, moodiness, nausea, sore breasts, or irregular bleeding. These
side effects are usually mild and improve with time.
They cost around $25–$35 for a month’s supply. You can also get birth control pills from the PlannedParenthood Metro Clinic (Halifax) for about $10 for a month’s supply.
Used the right way: 99.9% effective Not used the right way:92%-94% effective

12. Depo Provera: The Shot Need hormone injection every 12 weeks.
Does not protect against STI’s!!!
Stops the ovaries from releasing an egg each month, thins out uterine lining, thickens cervical mucus
Pros
Depo-Provera is a hormone injection given once every 12 weeks. You must get another needle every 12 weeks to stay protected.
Depo-Provera stops the ovaries from releasing an egg each month.
One injection will give you continuous, extremely effective birth control for 12 weeks.
You don’t have to think about birth control between needles.
Cons
Depo-Provera does not protect you from STIs. You’ll still need to use a male or female condom. You might have side effects like depression or weight gain or loss.
Irregular bleeding is common in the first few months of using Depo-Provera. After 1 year of use, about half of all women will stop having periods. Your periods will gradually start
again when you stop using Depo-Provera.

13. Where can I get it and how much does it cost?
You can get Depo-Provera at your doctor’s office.
Each injection costs about $30–$50. The Planned Parenthood Metro Clinic (Halifax) gives Depo shots for $30.
Used the right way: 99.7% effective
Not used the right way:97%effective

14. Ortho Evra: The Patch Works the same way the pill does
New patch every week for three weeks then without on the forth week
With prescription, about $20-$30 at a drug store.
Does not protect against STI’s
The patch provides excellent, continuous protection from unintended pregnancy.
You don’t have to remember to take a pill every day. You only need to think about birth control once a week.The patch is about the size of a matchbook and sticks to your skin. You can attach it to your abdomen,buttocks, upper arm, or anywhere on the front or back of your torso, except for your breasts. It will not wash off or come off
while swimming. You put on a new patch each week for three weeks
and then use no patch for the fourth week. Each patch is left in place for one week.
The patch prevents pregnancy in the same way the pill does. It contains estrogen and progestin that are absorbed through the skin. This stops the ovaries from releasing an egg.
You may have side effects, including headaches, menstrual cramps, nausea, or breast tenderness.
With a prescription, you can get the patch at any drugstore. It costs about $35 to $40 a month. You can get the patch at the Planned Parenthood Metro Clinic (Halifax) for about $20 for a months supply. Used the right way and used every time: 99.3% effective Not used the right way or not used every time: 98% effective

15. Where to Apply EVRA
Clean, dry, intact healthy skin. Choose a new site each week.
Buttock
Abdomen
Upper outer arm
Upper torso
In a place where it won’t be rubbed by tight clothing
Should not be placed on skin that is red, irritated or cut
Should not be placed on the breasts
The patch should be applied to clean, dry, intact healthy skin on the:
buttock
abdomen
upper outer arm
upper torso
in a place where it won’t be rubbed by tight clothing
It should not be placed on skin that is red, irritated or cut
It should not be applied to the breasts

16. NuvaRing: The Ring Use for 3 weeks, take out for 1 week
Daily release of hormones that inhibits release of egg from ovary, thins uterine lining
92-99% Effective
With prescription at drug store, costs $25-$32 per month (a bit cheaper if you buy 3 at once)
NuvaRing is a combined contraceptive vaginal ring developed by Organon. The ring is made of the plastic EVA with an outer diameter of 54 mm and a cross-sectional diameter of 4 mm. It contains ethinylestradiol (EE) and etonogestrel (ENG) uniformly dispersed in an EVA core.
Each NuvaRing is intended for one cycle of use. The regimen for each cycle is 3 weeks of continuous ring use, followed by a 1-week ring-free period.
Each ring releases 15 μg EE and 120 μg ENG per day over the
3-week ring-use period.

17. NuvaRing: The Ring HOW TO USE
Find a comfortable position
2. Squeeze the edges together
3. Insert into vagina
-exact position not important
To insert NuvaRing, the woman should find a position that allows her to insert the ring easily (for instance, standing with one leg raised, squatting or lying down). The ring is then compressed between the thumb and index finger and inserted into a comfortable position in the vagina. If it does not feel comfortable, it might be necessary to gently push the ring in a little further.
The exact position of NuvaRing in the vagina is not critical for efficacy. The ring does not need to be placed around the neck of the cervix. The circular shape and flexibility of the ring allows a good fit, minimizing the risk of expulsion.

18. ECP: Emergency Contraception
Prevents pregnancy before it happens
Works best if taken within 72 hours
A Hormonal reaction that creates poor conditions for the egg and sperm to meet
Key word is EMERGENCY!!!
(not a regular method)
Does not protect you against STIs

19. EMERGENCY CONTRACEPTION PILL
You do not need a prescription for ECP. Without a prescription it costs about $35-$50. With a prescription, it costs about $25. You can get ECP from:
Family Doctors
Community Clinics (North Preston Wellness Clinic, Youth Clinic at Cobequid, Family Focus,)
Emergency Room (Cobequid, QEII)
Halifax Sexual Health Center ($5)
Pharmacies
Emergency
Contraception
If you have had sex without using birth control you can still prevent
pregnancy by taking ECP—Emergency Contraceptive Pills or
Morning After Pills.
Even if you use birth control, accidents can happen—for example,
condoms can break, or you or your partner might miss several
birth control pills.
ECP prevent pregnancy. If you are already pregnant, they
will not cause a miscarriage or hurt the baby.
ECP work best if you take them within 3 days (72 hours) after
having intercourse without birth control. ECP might still work as
long as 5—7 days after intercourse, but the sooner you take
them, the more effective they are.
ECP are available from some clinics, doctors’ offices, and
emergency rooms.
You do not need your parents’ permission to get ECP.
To find out where to get ECP call toll-free:

20. Male and Female Condoms help protect against STIs
Barrier Methods
Physically block sperm from reaching the egg,
by not allowing semen to pass through the cervix.
Male and Female Condoms help protect against STIs

21. MALE CONDOM Effectiveness 86-97% (depends on proper use)
Check expiry date
Does not protect against all STI’s
Free at the Youth Health Center
                                                      

22. FEMALE CONDOM Made from polyurethane
95% effective if used properly (79% effective if not)
Box of three = $13
Can be inserted 8 hours before sex
Should NOT be used with a male condom as well
                                                     
FEMALE CONDOM
The female condom is a thin polyurethane pouch with a flexible ring at each end. You put the closed end of the condom into your vagina and the inside
ring holds it in place. The ring at the open end of the condom rests on the vulva outside of your vagina. The female condom stops sperm from entering your vagina.
Male and female condoms can’t be used at the same time because they stick together. If you are using a male condom, you don’t need a female condom. If you are using a female condom, you don’t need a male condom.
Female condoms are easy to get. You can buy female condoms at any drugstore. You don’t need a prescription. A box of three costs about $13.
Female condoms are a good choice if you are allergic to the latex in male condoms.
You can insert a female condom up to 8 hours before you have sex.
Female condoms reduce your risk of getting STIs as well as male condoms do, and they are less likely to break. When using it, you might need to help guide your partner’s penis
into the condom to be sure it doesn’t slip around the side.
You might need to put extra lubricant inside the condom or on the penis to make using the female condom more comfortable for both partners.
• Female condoms can be tricky to put in. Read the package directions and practise until you’re sure you know how to put it in. Many women find it helpful to get advice and counselling on how to use the female condom. You can do this through a youth health centre or Planned Parenthood. • Female condoms are not reusable. Use a
new one each time you have intercourse. After you take one out, throw it away.

23. SPERMICIDE May be cream, foam, gel or suppository Destroy sperm
Usually put in the vagina right before sex,and must be left in 6-8 hours after sex
Does not protect against STI’s.
74-94% Effective
No prescription needed; costs $9-$15.
A spermicide is a chemical that kills sperm. Spermicides come in many forms—foams, creams, films, suppositories, gels, and tablets. Most spermicides are put into the vagina right before sex. Spermicides are fairly cheap and easy to get. You can get them without a prescription at any drugstore or supermarket.
They cost between $9 and $15 per package. Spermicides must be left in place for at least 6 to 8 hours after you have sex. This means that you should not douche or have a bath for at least 6 to 8 hours after you have sex. (You can wash the outside of your pubic area.) If you have sex more than once in a single night, you need to put in more spermicide before each act of intercourse. Spermicides will not protect you from STIs. Your partner will still need to use a condom. Some people are allergic to spermicides. If you or your partner notice any itching, swelling, or burning after using a spermicide, go to a doctor or health clinic to get advice on finding another birth control method or another brand of spermicide.
If possible, use spermicides that don’t contain nonoxynol-9. N-9 can irritate the vagina,
which can increase the risk of getting an STI.
Used the right way and used every time: 94% effective
Not used the right way or not used every time: 74% effective

24. THE SPONGE Blocks the sperm and the spermicide kills them.
Will work for 12 hrs. and must be left in for 6 hrs. after sex
Does not protect from STI’s
84%-91% Effective
No prescription required; costs $10-$15 for 3-4 sponges
NOT REUSABLE
The sponge is made of soft polyurethane foam. It is about 5 cm (2 inches) across and contains spermicide. You insert the sponge into the vagina
before sex. The sponge blocks the sperm, and the spermicide kills them.
You can insert the sponge in advance. The sponge will work for 12 hours and must be left in place for 6 hours after intercourse. This means that you can insert the sponge up to
6 hours before you have sex. You can have sex more than once after inserting a
sponge, but the sponge must stay in for 6 hours after the last time you have sex.
Some people are allergic to the spermicide in the sponge. If you or your partner notice any burning, itching, or swelling after using the sponge, try another method of
birth control.
A sponge can become dislodged during sex. Read the package directions carefully so you’ll know how to put it in correctly and how to check to be sure it stays in place.
A sponge will not protect you from STIs. Your partner should still use a condom.
Preventing Pregnancy 85
Used the right way and used every time:
89%-91% effective
Not used the right way or not used every time: 84%-87% effective
Does the sponge work?
Sponges are not reusable! After you take one out, throw it away.

25. DIAPHRAGM CERVICAL CAP
Block sperm from entering cervix; ALWAYS used with spermicidal jelly
Will not protect against STI’s
Reusable
CERVICAL CAP
May insert 6 hours prior to sex and must leave in 6 hours after sex
80%-94% effective
Requires fitting and prescription. Costs $45-$75
The diaphragm and the cervical cap are soft latex barriers that block sperm from entering the cervix. Both are always used with spermicidal jelly. You
insert the diaphragm or the cervical cap into the vagina before sex. You can insert a diaphragm or cervical cap as long as 6 hours before you have sex. Both must be left in place for 6 to 8 hours after having sex. Both the diaphragm and the cervical cap are affordable and reusable. A diaphragm or cervical cap will not protect you from
STIs. Your partner should still use a condom. Some people are allergic to spermicides. See a doctor if you or your partner notice any itching, swelling, or burning Used the right way and used every time: 94% effective Not used the right way or not used every time: 80% effective

26. Intrauterine
Devices

27. ICUD: INTRAUTERINE CONTRACEPTIVE DEVICE
Is inserted by a physician, goes through the cervix to sit in the uterus
Contraceptive effect is immediate and lasts for 5 years
Does not protect against STI’s
Very effective…about .02% failure rate.
                                                      

28. PERMANENT SURGICAL METHODS
FEMALES: TUBAL LIGATION
MALES: VASECTOMY

29. Natural Methods Knowing your body
Means that there are no medications involved, depend on skill and cooperation between partners
For natural methods to work (except abstinence) you have to:
Understand your body
Understand how fertilization works
Understand the female cycle
Understand and accept unplanned pregnancy
You have to discipline yourself, and is not for the spontaneous amongst you!

30. Natural Methods (Not recommended)
Withdrawal: male partner withdraws penis from the vagina before ejaculation
Fertility Awareness: women keeps track of cycle, and during fertile period abstain from intercourse
These natural methods are:
Not very effective…failure rate is about 20-30%
Do not protect against STIs
These methods are better suited to natural family planning for adults in long term relationships (ie; mom and dad who don’t want any more kids/ don’t want to take hormones or have surgery)

31. Abstinence: The most effective method of birth control on earth!
Abstinence means choosing not to have any kind of sexual activity that leads to an exchange of body fluids
This includes:
oral sex
anal sex
vaginal sex
any activity that involves skin to skin contact in the genital area.

32. ABSTINENCE: THE PROS
Most effective method of preventing both pregnancy
and STIs
It’s FREE!!!
Can have a positive influence on the relationship, because
it promotes communication and helps to test understanding
and feelings for each other
Also promotes creativity, as partners find other ways to
pleasure each other: kissing, hugging, masturbation, etc.

33. ABSTINENCE: BARRIERS
You and your partner may not agree on what abstinence means
May face pressure from your partner/peers to start having sex
Chance of getting carried away in a moment of passion… you might want to have intercourse. Always have a barrier method with you just in case!
Abstinence from drugs and alcohol helps you keep control.

34. Abstinence is a good choice for you if…
You have not found the right partner yet
You are unsure about the state of your relationship
You are unsure about your partner
You want the safest contraception method on earth
You want to prevent pregnancy and be protected from STIs
You don’t want to make an appointment with your doctor
You want a method of contraception that has no side effects
You like it “au natural”

35. Yeah, but…Everybody’s doing it!
This is simply NOT TRUE! The fact is, most teens choose NOT to have sex. In 2002, a study found that 70% of teens in Nova Scotia had NOT had sexual intercourse!
The sexual feelings you begin to have during your teen years can be exciting, and it can be easy to let yourself get carried away…remember that the decisions you make DO have consequences!

36. Any method of birth control will work only if
you use it the right way and use it every time you have sex.

37. HELP!!! My period is late. I think I might be pregnant!
FREE ADVICE: If you are sexually active and your period is 5–7 days late you might be pregnant and should have a pregnancy test.
This can be done confidentially in the YHC.
Missing a period doesn’t guarantee that you are pregnant.
You might also miss a period due to stress,
poor nutrition, or an illness. Irregular periods can
Also just be a part of being a normal teenager!

38. If a male and female have sex, a pregnancy can happen: • The first time they have sex • No matter what position they have sex in • During the woman’s period • Even if he pulls out of her vagina before he ejaculates •Even if he doesn’t put his penis inside, but ejaculates near her vagina
True or false
All True

39. WHERE TO GO Kingfisher Nest, Youth Health Centre
Provides information, condoms, and pregnancy testing
Cobequid Youth Health Clinic
Phone:
Halifax Sexual Health Center
Phone:
Family Doctor or Family Focus Walk-in Clinic (Sackville Superstore)

40. Sexuality Is More Than Just Sex You matter.
Take care of yourself
Think about what is right for you
and
Enjoy your developing sexuality.

41. Information and photos for this presentation were
taken in July, 2008 from the following internet and print sources:
Medline Plus Online Medical Encyclopedia;
Nemours Foundation;
NuvaRing Online;
Ortho Evra Online;
Sex? A Healthy Sexuality Resource [Halifax]: Nova Scotia
Department of Health Promotion and Protection, 2006
Sex Sense Canadian Contraception Guide, 2nd ed [Toronto]: Society of
Obstetricians and Gynecologists of Canada, 2005.
Sexuality and U.ca;