Birth Control Effectiveness, Libido, And Pleasure

Dear Madame X,

I’d like to know about which contraception methods (except for sterilization) are most effective? I also wonder what their potential effects on libido (for chemical methods) and on sexual pleasure (for physical methods) are. How likely would unprotected sex result in actual pregnancy?

-Always Good To Know

Dear Always Good To Know,

Thanks for your email. There are a few things you ask and I will try to be clear about the differences.

In terms of effectiveness it is important to look at actual use versus theoretical use. Actual use is usually less effective than theoretical use (ideal conditions, as prescribed), because people often make mistakes, for example forgetting to take pills.

There is a list here that shows the rates of effectiveness for many methods.

In general, birth control methods that have to be inserted/injected by a doctor are the most effective as there is less room for error, as well as hormonal methods. These are things like an injection of hormones for the woman called Depo-Provera (99.95%), or the IUD (99.4-99.9%). The birth control pill is also highly effective at 99.7%.

As you can see, these all rely on the woman taking the initiative to prevent pregnancy.

There is very little difference between their effectiveness and they each have pros and cons that different people would value in different situations. Because of this, it is very important for you to examine your situation and your health, and talk with a health professional about what the best options are for you and/or your partner.

If you don’t want to use hormonal methods there is an IUD that does not use hormones. There is also the cervical cap and diaphragms, good old condoms (male and female), the fertility awareness method, and withdrawal.

Speaking of withdrawal, you ask what the chances are that unprotected sex would result in a pregnancy. Assuming the man does ejaculate, it is only 15% effective at preventing pregnancy. If the man tries to withdraw before ejaculating, it is between 73 and 96% effective. But we all know that withdrawal can sometimes be difficult to do and it is definitely something I would not recommend if it is possible for you to use something else.

If you are really dedicated and committed to natural methods (so no barriers and no hormones) the fertility awareness method can be up to 97% effective. This would involve monitoring the woman’s ovulation and not having sex during fertile times.

In terms of libido, many women say that being on a hormonal method lowers their libido. As each hormonal method will have a different cocktail of hormones and each woman’s body will react differently (some lots of problems, some none at all) the only way to know for sure is for the woman to try it out and see what happens. If there is a problem she can ask her doctor to try a different hormone combination and see if that works better.

In terms of limiting sexual pleasure, a lot of people say this is one reason they don’t like using condoms. Well I have to say that condoms don’t have to be this way. There are some that are so thin that you can still feel the heat between the partners. Experiment with the ones that claim to be thin and see what works for you.

As condoms are also the only way to prevent most STIs, sometimes not using them is not an option. However, if couples are monogamous and have both been tested for STIs, they won’t be necessary.

There’s a lot of information here so I hope it all makes sense. Again I must stress that it is important to talk with a health professional about your situation and your medical history and they can help find something that works for you and/or your partner. GPs and family planning associations are great for this kind of help. You don’t say where you live, but if you want help finding help, please do email again.

This column will appear every Wednesday to spice up your week.

Please email me with any and all questions about sex and relationships and I will answer them in this column.