What if the Pill is Not for You? Reversible Contraceptive Choices
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Condoms confer excellent protection against pregnancy and STDs, but only when they are used carefully, consistently, and correctly. Condoms are an effective, inexpensive form of birth control, although their actual usage effectiveness rate is much worse than birth control pills. Of 100 women whose partners use condoms inconsistently or imperfectly, 14 will become pregnant in the first year of use. Only three will become pregnant if condoms are used appropriately. Based upon these numbers, one group of researchers calculated that if all women in the US who are currently using the Pill switched to condom usage tomorrow, there would be up to 687,000 additional unintended pregnancies within one year! Common excuses for not using condoms include that it just doesn't feel as good as having sex without a condom. The risks of not using a condom, however, may make you feel much worse-and may wipe out your sex life altogether, whether it's an unwanted child to care for or an unwanted disease. One person is infected with HIV every 13 minutes-other common infections include gonorrhea, chlamydia, syphilis, herpes and genital warts.

Even though their main purpose is to prevent unplanned pregnancy, condoms can also help protect fertility by preventing transmission of STDs that cause infertility, such as chlamydia and gonorrhea. Women whose partners use condoms are at much lower risk of hospitalization for pelvic inflammatory disease (PID) - a condition that causes infertility - as well as much less at risk for infertility than those whose partners do not.

The Reality Female Condom (FDA approved in 1993) consists of a lubricated polyurethane sheath with one closed end and one open end. The closed end is inserted into the vagina. The open end remains outside, partially covering the labia. Like the male condom, it is available without a prescription and is intended for one-time use. Like a male condom, it may slip, in which case intercourse should be stopped and an emergency contraceptive may be considered.

While the female condom offers women another contraceptive option that they can control, it has not been popular. Drawbacks include:

• A failure rate higher than the male condom.
• Complicated and uncomfortable to insert.
• More expensive than a male condom -- $2 to $2.50 each, versus as low as 25 cents for a male condom.
• Unattractive and usage often makes "squeaky" noises.
  
  

Available by prescription only and sized by a health professional to achieve a proper fit, the diaphragm is a dome-shaped rubber disk with a flexible rim that works in two ways to prevent pregnancy. It covers the cervix to block sperm entry, and the spermicide cream or jelly applied to the inside diaphragm before insertion or outside after insertion kills sperm. The diaphragm protects for six hours after it is inserted. For intercourse after the six-hour period, or for repeated intercourse within this period, fresh spermicide should be placed in the vagina with the diaphragm still in place. The diaphragm should be left in place for at least six hours after last intercourse and women should not douche, rinse the vagina, or bathe during this time. The diaphragm should not be left in for longer than a total of 24 hours because of the risk of toxic shock syndrome (TSS), a rare but potentially fatal infection.

Diaphragms are designed to be used repeatedly and do not need to be replaced so long as a woman's size hasn't changed and the rubber is intact. They have few side effects, are relatively comfortable, and more than 90% effective in preventing pregnancy when used properly.

Cervical caps and diaphragms are not recommended for use during menstrual periods because of an increased risk (albeit slight) of toxic shock syndrome (TSS). Doctors generally advise condoms and spermicide use for contraception and STD protection during menstrual periods.