Birth Control
Patient Education

Doctors to Talk to About Birth Control

There are several types of physicians that can give thorough examinations including pelvic assessments and offer contraceptive techniques, and are listed in this patient education guide. The main issue should be consulting with a healthcare provider that one is completely comfortable with so that frank discussions about birth control may ensue.

For some, that describes a relationship they already have with a particular professional. Many will be establishing a relationship for the first time. The following can be consulted:

• Gynecologist - Concentrates on the health of the female genital system and associated conditions. They often work in the capacity of primary care doctor for women.
• Nurse Practitioner - Focuses on prevention, wellness and education of patients about health and health choices
• Family Physician (General Practitioner) - Deals with prevention, discovery and treatment of illnesses in all age categories
• Endocrinologist - Doctors who focus on glands and hormones, which control the body's metabolism including the treatment of thyroid dysfunction, diabetes and pituitary gland problems. Because of this, they are fully capable of treating patients desiring hormonal contraceptive techniques, especially when in conjunction with the above medical problems.

There are many settings available when it comes to seeking examination and consultation for contraception. Each has its own benefits reflecting personal preference, cost and convenience.

• Private Practice - Site where diagnosing, prescribing and treating individuals is performed and is affiliated only with the healthcare providers themselves.
• Medical Home - Healthcare site that promotes teamwork between patients and their healthcare providers as well as families when desired. Complete care is given and enables improved health access and enhanced patient experiences.
• Planned Parenthood - Leading healthcare centers providing sexual and reproductive care and information. They are often more affordable and have sliding scales for payment.
• Free Standing Clinics - Site for those who don't need further hospitalization. These sites often accept patients with no appointments and often have sliding scales of payment or accept a broader range of insurance, as well as public assistance.
• Hospital Clinic - Center within a hospital that is focused on diagnosis and care of the patient that does not need admission for further treatment.

How to Prepare to Discuss Birth Control With Your Doctor

During your doctor visit, you will likely have a gynecological examination. You can prepare for it by taking the following steps outlined in this patient education guide.

• Avoid douching for 48 hours
• Avoid sexual intercourse for 48 hours
• Avoid use of vaginal creams for at least two days
• Wear comfortable clothing that can easily be changed.

Your doctor will also discuss several aspects of your medical history. Be prepared for this consultation by preparing the following:

• Family history
• Significant past medical history
• Past contraceptive history and any side effects experienced
• Allergies
• Any lab results in possession from the last year

Questions to Ask Your Doctor About Birth Control

From time to time, you may want to discuss your birth control options with your doctor. Our patient education guide provides questions for you and your doctor to discuss so you can make informed decisions about your birth control choices.

Questions About My Needs

• Which method would be best for my age and living situation?
• Is there a pill for birth control that will also take away my painful periods?
• Can I get pregnant if I am breast-feeding?
• Do cheaper generic birth control pills work as well?
• Must I always use condoms if I have a history of Herpes or HPV?
• If I have never had a baby, can I still get an IUD inserted?
• Would over-the-counter spermicides work for me?
• Is cycle timing or withdrawal effective?
• What should I do if I forgot to use contraceptives during intercourse?

Questions About Choice of Birth Control Method

• Do I need to take a break from hormonal control periodically?
• Are there any types of contraceptives that would be contraindicated for me with my other medications or medical history?
• What type of contraception should I use if I am nursing my baby?
• If I don't want hormones, what method would work well for me?

Questions About My Lifestyle and Family

• Will I still be able to have children in the future with this method?
• How long will it take to become fertile after I stop this method of birth control?
• If there is stroke or breast cancer in my family history, can I still take the birth control pill?
• Are vasectomies or tubal ligations reversible?

Common Tests or Exams for Your Birth Control Discussion

Prior to a discussion of birth control methods, a thorough evaluation and examination is performed.

The past medical, family and social history is discussed. Social history includes use of alcoholic beverages, smoking, any drugs and marital or living arrangements. This is the opportunity to discuss any concerns you may have.

A typical gynecological examination will follow this pattern:

• Ask you to remove all of your clothes in private and don a gown with the opening in the front. You may then have a seat on the examination table.
• Measure and record your blood pressure, pulse and weight, as well as height if this is a first visit.
• Examine your breasts and assess your lungs and heart as well as the abdomen.
• Have you bend your knees and position your feet in the stirrups (holders at the table end), then slide down further on the table.
• Insert a speculum (metal or plastic clamp) into the vagina by the examiner after viewing the vulva (vaginal lips), which is then opened for better viewing of vagina and cervix.
• Perform a Pap smear where a small brush or plastic spatula wipes the surface of the cervix to take cell samples. If there is evidence of infection, a culture swab will be taken as well.
• Remove the speculum and perform a bimanual examination. The doctor or nurse practitioner places the second and third finger into the vagina and gently presses down with the other hand in areas being felt and evaluated for correct organ size and shape. Tumors and cysts are discovered at this point.
• Perform a rectal examination (sometimes) where the examiner inserts a gloved index finger into the rectum to discover any abnormalities, hemorrhoids or tumors.
• Ask you to then get dressed in privacy and then have a discussion.

Common Birth Control Methods

Birth control techniques although many and varied, can be classified under barrier methods, hormonal methods, devices or natural methods for the most part.

Some are more convenient than others but provide more spontaneity in lovemaking or have other benefits. For a delineation of these, please refer to the patient education charts.

Barrier Method Contraception

Type	What is it?	How It Works and How Effective	Benefits	Side Effects/Risks
Condom	Sheath of latex or lamb skin worn over penis during intercourse	87-90% effective -Blocks sperm from entering cervical canal	-Convenient-can be purchased in any drugstore without Rx -Easy to use -Comes in colors -Lubricated, dry or with spermicide *Protects against sexually transmitted diseases (STD)	-Effective for 5 yrs. -Must fit properly over erect penis
Sponge	-Soft, 2-inch round foam with spermicide inside that is inserted into the vagina	-80-91% effective -Blocks sperm from entering cervix -Inhibits sperm motion with spermicide	-Convenient-can be purchased in any drugstore without Rx -One size fits all -Easy -Can be inserted up to 30 hours before sex -Can be used while nursing	-May be difficult to remove -May fragment -Can irritate -May cause dryness -Must remain in vagina for 6 hours after intercourse -Can't use with sulfa allergy -Can't use with history of toxic shock syndrome -Can't use with infection -Can't use with bleeding
Cervical Cap	Small, thimble-shaped dome -Latex or rubber -Used with a spermicide	-80% effective -Inserted over cervix -Prevents sperm from entering cervical canal and killing sperm	-Can remain for 48 hours -Spermicide does not need to be added with each sexual encounter	-Requires fitting by M.D. or N.P. -May be difficult to insert -May be inserted improperly -Does not protect against STDs
Diaphragm	Soft, flexible dome-like cup of various sizes, inserted into the vagina	-82% effective -Spermicide is added to both sides of cup -Blocks sperm from entering cervix -Inhibits sperm motion	-Reversible -Safe	-Need to be fit by M.D. or N.P. -Need prescription -May not be inserted properly -Can't use with latex allergy
Spermicide	Many forms available-jellies, foams, creams, films, suppositories	-74% effective -Inserted into vagina and melts to coat entire surface -Kills sperm or prohibits motion of sperm -Creates barrier between sperm and cervix	Convenient-can be purchased in any drugstore without Rx	-Needs to be in vagina at least 15 minutes prior to intercourse -must be inserted each time coitus is planned -2-4% allergies -Can be messy

Hormonal Methods

Hormonal methods rely on delivery of estrogen or progesterone or a high dose of progesterone. They decrease a women's fertility by preventing ovulation, thinning uterine walls and thickening cervical mucus.

Contraception type	What is it?	How it Works and How Effective	Benefits	Side Effects/Risks
Birth Control Pills	-Daily pill by mouth -Comes in packs of 28 with estrogen and progesterone	-92-99.7% effective -Pill taken same time daily -Prevents ovulation -Thins uterine lining -Prevents fertilization	-Decreases menstrual flow -Decreases period cramps -Decreases risk of ovarian cancer -Increases spontaneity	-Headaches -Nausea -Weight gain -Increased blood pressure
Vaginal Ring	Flexible 2 inch ring inserted vaginally	-92-99.7% effective Kept in for 3 wks each month -Prevents fertilization -Thickens cervical mucus -Prevents ovulation	-Decreases menstrual flow -Decreases period cramps -Increases spontaneity	-Nausea -Headaches -Weight gain -Breast tenderness -Increases blood pressure -Vaginal irritation
Depo-Provera	-Injection of synthetic progesterone -Given every 3 months	-97-99.7% effective -Deters output of estrogen and progesterone -Prevents ovulation Thickens cervicalmucus Thins uterine lining -Prevents fertilization	-Lighter or no period -Spontaneity -Decreases ovarian and uterine cancer risk	-Weight gain -Irregular bleeding -Acne -Mood swings -Depression -Headaches -May increase risk of osteoporosis
Contraceptive Patch	Adhesive Band-Aid with estrogen and progesterone	-92-99.7% effective -Rx for weekly application -Prevents ovulation -Thins uterine lining -Thickens cervical mucus -Prevents fertilization	-Easy to use -Period flow and cramps decrease	-Headaches -Breast tenderness -Nausea -Weight gain -Fluid retention -Skin irritation possible -May increase risk of breast cancer

Other Methods

Type	What is it?	How it Works and How Effective	Benefits	Side Effects/Risks
Intrauterine Device (IUD)	-Small plastic device (often 7 or T-shaped) with string attached -Inserted in professional office by M.D. or N.P.	-99% effective -Decreases the possibility of fertilization -Changes uterine lining to prevent implantation if fertilization occurs	-In place for 3-5 years -Offers spontaneity	-Rx and clinic visit required -May cause irregular bleeding -Slight risk of ectopic pregnancy -Increased risk of pelvic infection
Withdrawal	Removal of erect penis from vagina before ejaculation	-73% effective -Also known as pulling out or coitus interruptus	-Free -Convenient -No side effects	-Ejaculation may not be properly timed -Sperm may still be present on penis from first encounter
Natural Family Planning (NFP)	-Rhythm method -Daily temperature taken to determine ovulation dates. -Abstain from coitus for 7 days each month (around ovulation time)	-75% effective The basal body temperature is taken each morning at rest. Fertility occurs 2-3 days before the temperature rises. By tracking the temperature daily you may be able to predict ovulation time. Then you can avoid unprotected sex during this fertile time.	-Free after initial purchase of thermometer -Healthy and natural -Abides by some religious beliefs	-May not take accurate reading -Cannot take temperature if you forget and then remember after rousing -May not gauge correctly
Sterilization	Male: Vasectomy - Surgical closure of tubes that carry sperm Female: Tuba legation - Fallopian tubes are blocked so that the eggs can't travel and unite with sperm	Male: Vas deferens from each testicle is clamped or cut preventing semen from containing sperm -99.98% effective Female: Fallopian tubes are cut and sealed on both sides during surgery preventing eggs to travel for fertilization. -99.5% effective	-Permanent -Allows spontaneity	Male: -Permanent -Surgical risks -Inflammation -Takes several months after surgery for all sperm to be ejaculated or absorbed Female: -Permanent -Surgical risks -Tiny risk of ectopic pregnancy -Risk of adhesions