Family Planning (Birth Control, Conception, Sterilization)

  • Taking responsibility for your fertility has many great benefits.  Planned pregnancies are generally more healthy and result in less complicated births.  Planning to have a family or not gives you the opportunity to prepare for parenthood, life with a child, and can help assure your chosen partner is also ready to be a parent and will be emotionally invested and involved in your pregnancy and birth.

    The only 100% guarantee for not becoming pregnant is to remain abstinent (not have sex) until you reach the stage in your life when you feel parenthood is appropriate.  It is a fact however, that we are sexual beings and that after reaching puberty, it is normal for us to experience a desire for sexual pleasure.  Our hormones are released in such a way to create this desire in order to increase the chance that we will reproduce and continue the human race.  Humans also find themselves in moments where they desire a sexual experience for expressing love, deep adoration, or for relaxation and not reproduction.  Because of these inborn desires, some men and women choose to have sex before becoming involved in a committed relationship or getting married.

    For those in a committed relationship who choose to be sexually active within that relationship (when two people only have sex with each other involving no other partners), including marriage, birth control helps you to have more control over the timing of if or when you start a family together.  Contraception allows you to enjoy a sexual relationship while curbing the risk of unintended pregnancy.

    If you make the choice to become sexually active either within or without a long term relationship, it also becomes your responsibility to protect yourself and your partner/s from unwanted pregnancy and STD/STI.  If having sex without the use of birth control, there is a 90% chance that healthy couples will become pregnant within a year.  Having unprotected sex also increases your risk of contracting an STD/STI, especially if either you or your partner have had or are having multiple sexual partners.  The risk increases as the number of sexual partners increases.  It is important to discuss your sexual history with your sexual partners, and to regularly receive STD/STI screenings if you are not committed.  If you are planning to become committed, discuss your sexual history with your partner, and go for a STD/STI screening.  Share those results with your partner, and repeat the screening again in 6 months to ensure you are free of STD/STI.  It is a good idea for both partners to receive a screening if both have been sexually active.

    Ideally, sometime during puberty, females should get a health check-up with a gynecologist or midwife.  Males should see their family physician or pediatrician.  This is a must once becoming sexually active whether or not you are in a committed relationship, but it is preferred these regular check-ups begin before having sex.  Talk with your care provider about the recommended frequency of these exams.  Typically, they occur once yearly for females along with your regular pap smear (procedure to retrieve cells from the cervix to test for abnormailities).  These visits are the best time to discuss the various forms of family planning and choosing what is right for you.

    Birth Control/Contraception


    In the best case scenario, both partners in a sexual relationship would be equally invested in obtaining and using birth control.  It is realistic, however, to anticipate that the repsonsibility of either providing contraception or using it yourself will be left up to you.  Considering how your partner feels about using birth control, and whether or not he/she feels that it is their responsibility to think about it and use it, is an important thing to do before deciding whether or not this person is someone you want to become sexually involved with.  Because your partner might not be willing to participate in contraception, be sure you are always prepared yourself.  If violence is part of your situation, it may be easiest to choose a form of contraception that requires no partner cooperation at all.  (If this is your situation, please see the resources for domestic/sexual violence and emergencies for more information.)

    The form of contraception that is right for you will depend upon your individual situation, type and frequency of sexual activity, and your general health.  There are four types of contraception that are appropriate for you to prevent pregnancy without permanently affecting your fertility – combined hormone methods, barrier methods, IUD/intrauterine device, and natural family planning.

    Learn more about the various forms of birth control, and discuss your thoughts and concerns with your healthcare provider.

    For prevention of STD/STI barrier methods are most appropriate as the goal is to stop the bodily secretions from entering the body either through the genitalia, the anus, or orally.  Even small cuts can allow for STDs/STIs to enter the body.  So, this means all forms of sex puts you at risk of contracting STD/STI if your partner is infected – vaginal, anal, and oral.  “A person with an STD can pass it to others by contact with skin, genitals, mouth, rectum, or body fluids.” – ACOG (American College of Obstetrics and Gynecology)  Read more about STD/STI prevention from ACOG’s informative pamphlet. It is a misconception that those engaging in homosexual female with female sex are not at risk for STD/STI.  Anyone who is sexually active should be thinking about STD/STI prevention.

    Conception

    Conception means to conceive a child (become pregnant).  If you would like to become pregnant in the near future, the first step is to go in to your midwife or gynecologist for a reproductive health check-up.  You should then discuss with them your wish to become pregnant and ask if you are healthy enough to do so.  Discuss with your care provider any habits or lifestyle changes you may need to make before becoming pregnant such as quitting smoking, ending or changing a medication you are taking that might not be safe for pregnancy, alcohol use, or dietary changes.  Read under the Fertility tab to learn more about how conception happens and some things you should consider before deciding to become pregnant.  Make sure that your desire to be pregnant is known to your sexual partner whether or not you are in a committed relationship, married, or planning single parenthood.  Men wishing to become fathers should also get a health check-up from their family physician and address any health issues that they may have that could interfere with their fertility or a child that they father.  The healthier the situation in which the child is conceived the greater is the chances that the pregnancy, birth, and baby will be healthy and uncomplicated.

    Only when it is clear that you are both okay with becoming pregnant, or an agreement is worked out between you and your partner, should you stop using birth control.  Depending on the type of birth control you were using, there may be a time period while your body adjusts to the hormonal shift caused by ending the birth control that you will have irregular cycles or be infertile.  If you were using barrier methods of birth control or natural family planning, there will be no waiting period before conception is possible.  Talk with your care provider about what to expect after ending use of birth control.

    Learn more about how conception happens by visiting WebMDBe sure to view their slideshow showing conception from egg to embryo.  The pictures are spectacular and you will see an explanation of each picture in the upper right hand corner.

    Sterilization (Permanent Birth Control)

    If you decide before reaching menopause that you no longer wish to be fertile, there are several methods of sterilization to choose from, most of which are relatively safe and effective at preventing pregnancy.  If you are married or in a committed relationship, this may need to be a mutual decision between you and your partner.  If you are not in a relationship, know that going through any sterilization procedure will not protect you against STD or STI, and barrier methods of contraception may be necessary regardless of your likelihood of getting pregnant.  Read more about some things to consider when making this decision from WebMD.

    For women there are two options for permanent birth control:

    • Tubal Ligation (Getting Your Tubes Tied) – This is the most common form of permanent contraception in the US.  There are risks to consider with this procedure as it is the most invasive of all the options for both men and women as well as the most expensive, but is a good option for some women.  It involves small incisions in the abdomen to access the fallopian tubes where they are then cut/tied and/or cauterized.  Some form of light anthesia is usually necessary for this procedure.  Tubal ligation is typically an outpatient surgery.  It is almost 100% effective and in most cases is not reversible.
    • Tubal Blocking (Essure) –  This is a procedure that is done in your doctor’s office without the use of anesthesia or need of incision.  Women who undergo this procedure are usually back to regular activity within a day.  The healthcare provider goes in through your vagina to insert a small, tightly coiled, spring-like device into your fallopian tube.  The body then develops scar tissue around the coils which in about 3 months time will block the fallopian tube and any egg from reaching the uterus much like a tubal ligation.  It is almost 100% effective and it is not reversible.

    For men there is one safe option for permanent birth control:

    • Vasectomy –  Also an outpatient procedure, the vascetomy is the more simple and less cost option between tubal ligation and vasectomy.  You will be given a sedative.  The doctor will make small incisions in the scrotum to reach the vas deferens, where they will be clipped and/or cauterized to prevent sperm from mixing with the semen.  You will be able to return to work in about 1 to 2 days.  Vasectomy does not affect ejaculation.  There is a time period where you will still need birth control as you wait for your follow-up sperm count test to see if the procedure was effective (about 2 months).  A vasectomy is reversible, though it is very difficult to reverse.
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