2.1 Contraceptive methods
Contraceptive methods provide a wide array of resources that adapt to a couple's needs and allow them to control their fertility and enjoy sexuality in each stage of their lives. However, they all have advantages and disadvantages, there is still no perfect method, and consulting with professionals will contribute to the best choice.
Hormonal methods: these are based on the action of one or two synthetic steroids (estrogen and progestogen) that inhibit ovulation, they are similar to a woman’s natural hormones and highly effective (less than 1% failure rate). Among these is the classic birth control pill (taken daily or 21 days on and 7 days off, with two or just one hormonal component, the latter also called mini pill), the vaginal ring (it is self-placed into the vagina where it stays for 21 days and then 7 days without, with two hormonal components), the contraceptive hormone patch (applied once a week to the skin during 3 weeks, and 1 week off, with two hormonal components), the hormonal implant (1 to 2 plastic rods that a doctor inserts under the skin and they stay from 3 to 5 years depending on the product, with one hormonal component) and the contraceptive injection (once a month, containing two hormonal components, or every three months, with one component). They are all compatible with the use of condoms to prevent sexually transmitted diseases (double safety).
The Intrauterine Device (IUD): is an object made of plastic (polyethylene), it comes in different shapes (anchor, T, spiral) that has a fine copper wire on the surface or a hormone inside it (progestogen), that is inserted by the doctor into the uterine cavity through the cervix, and it remains there from 3 to 5 years, depending on the type of IUD. It is highly effective (failure rate around 1%) and compatible with condoms.
Barrier methods: these are made of latex or polyurethane with a silicone lubricant that are placed over the erect penis or in the vagina and they retain the semen, preventing the sperm from entering the uterine cavity, such as (male or female condom) preservativo masculino o femenino or the diaphragm. These methods are not as effective as the above ones (failure rate between 5 and 15%) and they require a certain learning process to use them. However, they are highly recommendable for protection against sexually transmitted infections and as “double safety”, along with hormonal methods, IUD and others (safe sex).
Natural methods: these are based on monitoring ovulation by watching the menstrual cycle Calendar Knaus-Ogino method or body temperature measured daily basal temperature or assessment of the cervical mucus in the pre- and ovulating stages Billings method to determine which days are fertile. The effectiveness is quite lower than the above methods and it is difficult to quantify. In general, they will not work if the menstrual cycles are irregular. Interrupted intercourse is not considered a recommendable contraceptive method due to its high rate of inefficiency and low rate of acceptance during sexual activity.
Definitive or irreversible methods: among these are surgical methods, which avoid sperm from accessing the uterine cavity by tubal ligation, by laparoscopy or in the man’s vas deferens vasectomy. As outpatient surgery (major and minor) both procedures do not require hospital stay, but the vasectomy is easier and entails lower risk (it does not require surgically penetrating the abdominal cavity) and thus it also has a lower cost. The tube occlusion or Essure method is the placement, by hysteroscopy (insertion of a fine optic tube into the cavity, through the cervix) of small titanium devices or springs into the fallopian tubes. It is performed on an outpatient basis in a specialized doctor’s office, with no need for surgery. These methods are equivalent to sterilization, they are highly effective (rate of failure 1 to 4 per 1000) and they are generally irreversible. In some cases the latest advances in microsurgery allow the reconnection of the fallopian tubes or vas deferens by means of anastomosis, with a variable rate of success, between 30 and 70% of cases, depending on the method of sterilisation.