Vaginal Spermicide

Fifty percent to 95 percent effective (among typical users in the first year).

Vaginal spermicide use two different mechanisms to prevent pregnancy. Their placement in the vagina prevents sperm from penetrating the cervix, and the chemicals in them are directly toxic to sperm. The gap in effectiveness is so large because of levels of consistency when using the spermicide. Spermicide costs $0.50 to $1.50 per use. Spermicide come in foam, jelly, cream, film and suppositories.

This method is even more effective when used with a barrier method of birth control, such as a condom or a diaphragm.

Pros: Relatively inexpensive, available over the counter, a good backup method for women who are waiting to start other methods (such as the pill), provides lubrication during intercourse especially with condom use (which increases pleasure).

Cons: Allergic reactions or hypersensitivity to ingredients may occur. They can be difficult to insert, messy, have a bad taste during oral sex and interrupt foreplay. You must put them in 15 minutes to 20 minutes before intercourse.

Diaphragm

Eighty percent to 94 percent effective during the first year of use; effectiveness varies depending on whether or not a woman has had a child.

A diaphragm is a dome shaped rubber cup with a flexible rim that covers the cervix that is inserted into the vagina before intercourse. It should always be used in combination with spermicidal jelly or cream. Diaphragms require a prescription and typically costs $30 to $50 at a doctors office. Family planning clinics often charge less, and the diaphragm has to be replaced every 2 years. There is also a doctor’s visit and fitting cost.

Pros: Decreases risk of some sexually transmitted diseases. Diaphragms can be inserted up to 6 hours before intercourse, and they catch blood before it leaves the vagina (meaning the messiness of period sex is no longer an issue).

Cons: People who are allergic to latex or spermicide can not use diaphragms. They increase the risk for developing urinary tract infections and must be left in vagina for at least 6 hours after intercourse. Repeated sexual intercourse requires additional spermicide. The diaphragm must be removed with in 24 hours to avoid risk of toxic shock syndrome. They can be difficult to insert correctly at first, and the diaphragm may not fit after weight gain or loss.

Cervical Cap

Sixty percent to 90 percent effective

A cervical cap is a latex, thimble-shaped device that is inserted into the vagina and fits snugly over the cervix. The cervical cap provides a barrier to prevent sperm from entering the uterus. Similar to a diaphragm, it is used with vaginal spermicide.

About 60 percent of women cannot be fitted for a cervical cap. It costs $30 to $50 and should be replaced every year. There is also the cost of the doctor’s visit and a fitting fee. Many health insurance plans cover these costs, and family planning clinics, such as Planned Parenthood, charge much less.

Pros: Decreases the risk of some sexually transmitted diseases, provides protection for up to 48 hours with no need to apply additional spermicidal no matter how many times you have intercourse.

Cons: People who are allergic to latex or spermicide can not use it, and there is a risk of toxic shock syndrome if worn for more than 48 hours straight. Vaginal odor may occur with prolonged use, and after intercourse it should be left in the vagina for 8 hours, oil based lubricants and some vaginal creams and yeast infection medicines can damage the rubber, can be knocked out of place during intercourse.

Female Condom

Seventy-nine percent to 95 percent effective

The female condom is a polyurethane (plastic) sheath that is about 6.5 inches long with an inner ring that fits inside the vagina, around the cervix (similar to a diaphragm) and an outer ring that covers the outside labia. It works similar to the male condom, but after the man ejaculates you have to twist the end closed and gently pull it out from the vagina. Female condoms cost $0.58 per condom on average.

Pros: Female condoms can be inserted into the vagina up to 8 hours before intercourse. They protect against some sexually transmitted infections and can be used by people who are allergic to latex or spermicide or by those who use hormone methods of birth control. They can be purchased without a prescription.

Cons: The outer ring, or frame, is visible outside the vagina, which can make some women feel self-conscious. Spillage or leakage of sperm is possible if the condom breaks or is put on incorrectly. Female condoms reduce the amount of feeling and consequently pleasure. They are not reusable and can make noises during intercourse, although adding more lubricant can lessen this problem. It can be difficult to insert and remove and cannot be combined with male condoms.

Depo Provera (The Shot)

More than 99 percent effective

Depo Provera is a hormone injection given every 3 months to prevent pregnancy. The injection contains synthetic progesterone and no estrogen. It is usually given in the arm.

It stops the ovaries from releasing eggs and causes the cervical mucus to thicken and changes the uterine lining, making it harder for sperm survive in the uterus. Nationwide, the cost for an exam, if needed, ranges from $35 to $125. Further visits cost $20 to $40. Each injection costs $30 to $75. The total cost for each year of use ranges from $235 to $585. Many health insurance plans cover most or all of these costs.

Pros: The shot requires only four injections a year and may stop menstruation or decrease the amount of bleeding you have on your period. Women on Depo Provera have a decreased risk of endometrial cancer, ovarian cancer and pelvic inflammatory disease, effective 24 hours after the first shot.

Cons: Causes loss of bone density and an increased risk of osteoporosis. There is a delay in return to fertility. Seventy percent of women using Depo Provera gain weight, and almost half of the women using Depo Provera gain more than 5 pounds after one year of use. Many women gain more than 10 pounds. It may cause heavy bleeding, and someone women bleed for a month or longer.

Possible Side Effects: Headaches, nervousness, mood change, bloating, breast tenderness, backaches and heavy or no bleeding.

Ortho Evra (The Patch)

Ninety-five to 99 percent effective (1 to 5 of 100 women become pregnant if it is not used as prescribed)

Ortho Evra is a thin, beige, plastic patch that sticks to the skin. A new patch should be placed on the buttocks, stomach, upper outer arm or upper torso once a week for three continuous weeks. No patch is used the fourth week. The patch releases synthetic estrogen and progestin to protect against pregnancy for one month. The patch needs to be replaced on the same day. If the patch falls off for more than 24 hours, or the same patch is used for longer than a week, it is ineffective. The patch costs $30 to $40 a month.

Pros: You only have to change the patch once a week. It reduces menstrual flow and cramping, reduces outbreaks of acne, and pregnancy can occur immediately after stopping the patch. Bathing, showering, swimming and exercise will not cause the patch to fall off.

Cons: There may be slight skin irritation near the patch site. There is an increased risk of heart attack, stroke and blood clots( in arms, legs and lungs), especially if you smoke more than 15 cigarettes a day. Certain medicines and herbs may make the patch less effective These include the antibiotic rifampin, antifungals that are taken orally for yeast infections, anti-HIV protease inhibitors, St. John’s wort and medicines used to treat seizures, mental illness, or headache. Using lotion near the site of the patch may cause the patch to fall off.

Possible Side Effects: Mood swings, depression, nausea, bleeding between periods and breast tenderness.

Nuva Ring (the Ring)

Ninety-nine percent effective

Nuva Ring is a small, flexible ring that is inserted into the vagina once a month. It is left in place for three weeks and taken out for the remaining week. The ring releases synthetic estrogen and progestin to protect against pregnancy for one month. The ring costs $30 to $35 a month, and can be obtained through family planning clinics with a prescription.

Pros: It reduces menstrual flow and cramping and can reduce acne.

Cons: There is an increased risk of heart attack, stroke and blood clots (in lungs, legs, or arms), especially if you smoke more than 15 cigarettes a day. It may cause light bleeding between periods, vaginal discomfort and vaginal discharge.

Possible Side Effects: Weight gain or loss, nausea, headaches and mood swings.

— Edited by Dianne Smith

—Edited by Dianne Smith