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* Availability--Can the method be implemented without a prescription, provider visit, or, in the case of minors, parental consent? 

* Cost--Is the method affordable for the individual or couple? It may prove helpful to weigh the cost issue with the question of whether the individual or couple could afford an undesired pregnancy. 

* Effectiveness--It is important to look at the effectiveness rate.   This is expressed as number of pregnancies observed in 100 women using that method over a period of one year (pregnancies per 100 women per year of use). 

* Health risk--The potential safety of particular methods of contraception should be evaluated for each user. Some methods of birth control may not be good options because of potential health risks (for example, oral contraceptives are usually not recommended for women over age 35 who also smoke). 

* Unplanned pregnancy--The significance of an unplanned pregnancy to the individual or couple should be considered when choosing a method of contraception. If the effect of an unplanned pregnancy is viewed as potentially devastating, a highly effective method should be chosen. In contrast, if a couple is simply trying to postpone pregnancy but feels that a pregnancy could be welcomed if it occurred earlier than planned, a less effective method may be an adequate choice. 

* Partner involvement--The willingness of a partner to accept, cooperate in, and be supportive of a given method of contraception may affect options for birth control. However, one may want to reexamine the choice to initiate or continue a sexual relationship with a partner unwilling to take an active and supportive role in contraception. 
 

The male condom is a sheath placed over the erect penis before penetration, preventing pregnancy by blocking the passage of sperm.  Except for abstinence, latex condoms are the most effective method for reducing the risk of infection from the viruses that cause AIDS, other HIV-related illnesses, and other STIs. Some people mistakenly believe that by protecting themselves against pregnancy, they are automatically protecting themselves from HIV, the virus that causes AIDS, and other sexually transmitted diseases (STIs).  This is not always the case.  However,  the male latex condom is a method that is effective both in preventing pregnancy and in reducing the risk of STIs.  If you are not in a mutually monogamous relationship, you should ALWAYS use a condom during intercourse. 

A condom can be used only once.  Because it acts as a mechanical barrier, a condom prevents direct contact with semen, infectious genital secretions, and genital lesions and discharges.   

Most condoms are made from latex rubber, while a small percentage are made from lamb intestines (sometimes called "lambskin" condoms).  Unlike latex condoms, lambskin condoms are not recommended for STI prevention because they are porous and may permit passage of viruses like HIV, hepatitis B and herpes. Photo By Timothy Takemoto from Yamaguchi, Japan 

Condoms made from a type of plastic called polyurethane have been marketed in the United States since 1994.  They are a good alternative method of STI protection for those who are latex sensitive.

Most condoms are pre-lubricated. Studies show that these lubricants (including lubricating solutions containing the spermicide Nonoxynol-9) do NOT increase contraceptive or STD protection, but may prevent breakage. Non oil-based lubricants, such as water or K-Y jelly, can be used with latex or lambskin condoms, but oilseed lubricants, such as petroleum jelly (Vaseline), lotions, or massage or baby oil, should not be used because they can weaken the condom and cause it to break.

The Reality Female Condom, approved by FDA in April 1993, consists of a lubricated polyurethane sheath shaped similarly to the male condom. The closed end, which has a flexible ring, is inserted into the vagina, while the open end remains outside, partially covering the labia. It can be inserted several hours before sex.

 The female condom, like the male condom, is available without a prescription and is intended for one-time use. It should not be used together with a male condom because they may slip out of place.  Because it is a barrier method that works in much the same way as the male condom, the female condom may provide some protection against STIs. Both condoms should not be used together, however, because they may not both stay in place. 

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 so sperm can't reach the uterus, while a spermicide cream or jelly applied to the diaphragm before 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 the last intercourse but not for longer than a total of 24 hours because of the risk of toxic shock syndrome (TSS), a rare but potentially fatal infection. Signs and symptoms of TSS include sudden fever, stomach upset, sunburn-like rash, and a drop in blood pressure.

The sponge,  is a flexible foam disk containing spermicide .   When it was first on the market (from 1983 to 1995), the sponge was one of the most popular contraceptive options for women.  It was taken off the market for a few years because of contamination problems at the product's sole manufacturing plant; however,  the  contraceptive sponge (marketed under the brand name "Today Sponge") is available again today in the U.S.  It is easy to use and available over-the-counter for about $3 each.

Inserted into the vagina to cover the cervix, the sponge is attached to a woven polyester loop for easier removal.  It works by inactivating the sperm with spermicide and absorbing semen.  It also provides a physical barrier to prevent sperm from entering  the cervix.

The sponge protects for up to 24 hours and for multiple acts of intercourse within this time. It should be left in place for at least six hours after intercourse but should be removed no more than 30 hours after insertion because of the risk, though low, of Toxic Shock Syndrome. 

  The sponge is more effective for women who haven't previously given birth and it does NOT provide protection against STIs.
 

 The cervical cap is a soft rubber cup with a round rim, sized by a health professional to fit snugly around the cervix. It is available by prescription only  and, like the diaphragm, is used with spermicide cream or jelly.

It protects for 48 hours and for multiple acts of intercourse within this time.  Insertion may take place anywhere up to two days prior to intercourse, and the devise must be left in place for six to eight hours after intercourse.  Wearing it for more than 48 hours is not recommended because of the risk, though low, of TSS (toxic shock syndrome). Also, with prolonged use of two or more days, the cap may cause an unpleasant vaginal odor or discharge in some women.

Because the device can become dislodged during intercourse, placement must be checked frequently.  It cannot be used during the menstrual period because of the risk of TSS.
 

Vaginal spermicides are available in foam, cream, jelly, film, suppository, or tablet forms. All types contain a sperm-killing chemical, usually nonoxynol-9.

Studies have not produced definitive data on how well spermicides alone prevent pregnancy, but according to the authors of Contraceptive Technology, a leading resource for contraceptive information, the failure rate for typical users may be as high as 26 percent per year.

Package instructions must be carefully followed because some spermicide products require the couple to wait 10 minutes or more after inserting the spermicide before having sex. One dose of spermicide is usually effective for one hour. For repeated intercourse, additional spermicide must be applied. And after intercourse, the spermicide has to remain in place for at least six to eight hours to ensure that all sperm are killed. The woman should not douche or rinse the vagina during this time.
 

 
An IUD is a mechanical device inserted into the uterus by a health-care professional. Two types of IUDs are available in the United States: the Paragard Copper T and the Mirena IUD which releases progestin. The Paragard IUD can remain in place for 10 years, while the Mirena IUD must be replaced five years.

It's not entirely clear how IUDs prevent pregnancy. They seem to prevent sperm and eggs from meeting by either immobilizing the sperm on their way to the fallopian tubes or changing the uterine lining so the fertilized egg cannot implant in it.

IUDs have one of the lowest failure rates of any contraceptive method. "In the population for which the IUD is appropriate--for those in a mutually monogamous, stable relationship who aren't at a high risk of infection--the IUD is a very safe and very effective method of contraception," says Lisa Rarick, M.D., former director of FDA's division of reproductive and urological drug products.

The IUD's image suffered when the Dalkon Shield IUD was taken off the market in 1975. This IUD was associated with a high incidence of pelvic infections and infertility, and some deaths. Today, serious complications from IUDs are rare. Side effects can include pelvic inflammatory disease (an infection of a woman's reproductive organs), ectopic pregnancy (in which a fertilized egg implants in the fallopian tube instead of the uterus), perforation of the uterus, heavier-than-normal bleeding, and cramps. Complications occur most often during and immediately after insertion.
 
 

Combined oral contraceptives.
Typically called "the pill," combined oral contraceptives have been on the market for 50 years and are the most popular form of reversible birth control in the United States. This form of birth control suppresses ovulation (the monthly release of an egg from the ovaries) by the combined actions of the hormones estrogen and progestin.

(Click HERE to see a animated graphic of how the pill actually works.)

If a woman remembers to take the pill every day at the same time of day as directed, she has an extremely low chance of becoming pregnant. But the pill's effectiveness may be reduced if the woman is taking some medications, such as certain antibiotics.

Besides preventing pregnancy, the pill offers additional benefits. As stated in the labeling, the pill can make periods more regular and lighter. It also has a protective effect against pelvic inflammatory disease, an infection of the fallopian tubes or uterus that is a major cause of infertility in women, and against ovarian and endometrial cancers.

The decision whether to take the pill should be made in consultation with a health professional. Birth control pills are safe for most women--safer even than delivering a baby--but they carry some risks.

Current low-dose pills have fewer risks associated with them than earlier versions. But women over age 35 who smoke and women with certain medical conditions, such as a history of blood clots or breast or endometrial cancer, may be advised against taking the pill. The pill may contribute to cardiovascular disease, including high blood pressure, blood clots, and blockage of the arteries.
 
 

One of the biggest questions has been whether the pill increases the risk of breast cancer in past and current pill users. The link between hormonal contraceptive methods and breast cancer is not clear.  However, long-term use can increase a woman's risk for cervical and liver cancer.  On the positive side, pill use can decrease a woman's risk for ovarian and endometrial cancer.

Side effects of the pill, which often subside after a few months' use, include nausea, headache, breast tenderness, weight gain, irregular bleeding, and depression. 
 

Minipills
Although taken daily like combined oral contraceptives, mini-pills contain only the hormone progestin. They work by reducing and thickening cervical mucus to prevent sperm from reaching the egg. They also keep the uterine lining from thickening, which prevents a fertilized egg from implanting in the uterus. These pills are slightly less effective than combined oral contraceptives.

Mini-pills, like combined oral contraceptives, can decrease menstrual bleeding and cramps and lower the risk of endometrial and ovarian cancer and pelvic inflammatory disease. Because they contain no estrogen, mini-pills don't present the risk of blood clots associated with estrogen in combined pills. They are a good option for new mothers who are breast feeding, because combined oral contraceptives may decrease the quantity and quality of breast milk. They are also a good option for those who get severe headaches or high blood pressure from estrogen-containing products.

Side effects of mini-pills include menstrual cycle changes, weight gain, and breast tenderness

Injectable progestins
Depo-Provera, approved by FDA in 1992, is injected by a health professional into the buttocks or arm muscle every three months. Depo-Provera prevents pregnancy in three ways: It inhibits ovulation, changes the cervical mucus to help prevent sperm from reaching the egg, and changes the uterine lining to prevent the fertilized egg from implanting in the uterus. The progestin injection is extremely effective in preventing pregnancy, in large part because it requires little effort for the woman to comply: She simply has to get an injection by a doctor once every three months.

The benefits are similar to those of the minipill and another progestin-only contraceptive, Norplant. Side effects are also similar and can include irregular or missed periods (which is not harmful and does not mean that the method isn't working), weight gain, and breast tenderness.
 

Implantable progestins
Norplant, approved by FDA in 1990, and the newer Norplant 2, approved in 1996, are another type of progestin-only contraceptive. Made up of matchstick-sized rubber rods, this contraceptive is surgically implanted under the skin of the upper arm, where it steadily releases the contraceptive steroid levonorgestrel.

The six-rod Norplant provides protection for up to five years (or until it is removed), while the two-rod Norplant 2 protects for up to three years. Norplant failures are rare, but are higher with increased body weight.

Some women may experience inflammation or infection at the site of the implant. Other side effects include menstrual cycle changes, weight gain, and breast tenderness.

Vaginal Ring (NuvaRing)
Available only by prescription, the NuvaRing is a small, bendable ring that is inserted into the vagina.  It releases a low dose of progestin and estrogen, which prevents ovulation and thickens the cervical mucus.   Users insert the ring into the vagina for a three-week period and then remove it for a week.   A new ring is then inserted for the next three-week cycle.  The NuvaRing has an effectiveness rate and side effects comparable to other the hormonal methods.

Skin Patch
Hormonal contraception is also available  as a skin patch that is replaced weekly and provides similar protection as other forms of hormonal contraception.
 

Fertility Awareness
Also known as natural family planning or periodic abstinence, fertility awareness entails not having sexual intercourse or using a barrier method of birth control on the days of a woman's 
menstrual cycle when she is more likely to become pregnant.

Because a sperm may live in the female's reproductive tract for up to seven days and the egg may remain fertile for about 24 hours, a woman could get pregnant from intercourse that occurred from seven days before ovulation to 24 hours or more after. Methods to approximate when a woman is fertile are usually based on the menstrual cycle, changes in cervical mucus, or changes in body temperature.

"Natural family planning can work," Rarick says, "but it takes an extremely motivated couple to use the method effectively."

Withdrawal
In this method, also called coitus interruptus, the man withdraws his penis from the vagina before ejaculation. Fertilization is prevented if the sperm don't enter the vagina.

Effectiveness depends on the male's ability to withdraw before ejaculation. Also, withdrawal doesn't provide protection from STIs, including HIV. Infectious diseases can be transmitted by direct contact with surface lesions and by pre-ejaculatory fluid.
 
 

Surgical sterilization is a contraceptive option intended for people who don't want children in the future. It is considered permanent because reversal requires major surgery that is often unsuccessful.  

Female sterilization
Female sterilization blocks the fallopian tubes so the egg can't travel to the uterus. Sterilization is done by various surgical techniques, usually under general anesthesia.

Complications from these operations are rare and can include infection, ectopic pregnancy, hemorrhage, and problems related to the use of general anesthesia. 

Male sterilization
This procedure, called a vasectomy, involves sealing, tying or cutting a man's vas deferens, which otherwise would carry the sperm from the testicle to the penis.

 Vasectomy involves a quick operation, usually under 30 minutes, with possible minor postsurgical complications, such as bleeding or infection.
 
 

Sometimes referred to as the "Morning After Pill", emergency contraception (EC) is currently available over-the-counter under the brand names, Plan B, Next Choice, Ella and Teva.   EC is effective up to 72 hours after unprotected sex and prevents pregnancy by tricking the body into believing that a pregnancy has already occurs.  It can prevent ovulation, fertilization , or implantation. 

EC is NOT an "abortion pill" and if a pregnancy has already occurred, Plan B is ineffective.  Plan B reduces the risk of pregnancy by 89 percent when started within 72 hours after unprotected intercourse. It continues to reduce the risk of pregnancy up to 120 hours after unprotected intercourse, but is less effective as time passes.

In June 2013, a U.S. Appeals Court ordered that the two-pill version of Plan B be made available over-the-counter to anyone who wants it, regardless of age.  Currently the FDA requires that a person provide proof of being at least 15 years old to purchase one-pill Plan B version, Teva.  However, that requirement is being challenged in court.