Hard Facts About Real Sex: STIs, Pregnancy, and Contraception

How to Avoid Sex Risks While Contraception is Still Legal.

It’s not sensational to say that it’s vital to know how to protect ourselves and our partners against STIs and pregnancies we’re not ready for. Likewise, it’s not sensational to say that the political landscape ain’t good these days when it comes to the future of contraceptive options. While we still have several reliable methods available, now seems like a good time to go over some of them and explain why they work, what they do and do not protect against, how they’re used, and how effective they are.

Doesn’t that sound like fun? Maybe not but knowing how to use protection sure increases the chances of enjoying the sex we’re hoping to have.

For a number of reasons that I won’t go into now because I’d never shut up, the vast majority of prophylactic methods have been designed under the assumption of heterosexual intercourse, with the cis female primarily responsible for the fertility of both her and her partner(s). For ease of explanation, I will begin with the least involved and progress from there.

PULLING OUT: Just don’t. Pulling out before spilling seed inside is better than nothing, I guess, but why even risk it? Just masturbate. It’s safer. More than a quarter of the people who use this so-simple-it-can’t-possibly-work method will face a pregnancy as a result.

“NATURAL” METHODS: All I can say is that I’m a Rhythm Method Baby. The success of this method of family planning depends largely upon the regularity of a woman’s menstrual cycle and her ability to consistently be aware of her hormone levels. It’s most appropriate for those who are open to pregnancy but aren’t making it a priority. An incorrect or skipped basal body temperature or cervical mucus reading can lead to unprotected fucking on a fertile day. A little less than a quarter of all women who use these methods correctly will still get pregnant. It does not protect against STIs in any way, shape, or form.

NO HORMONES, ONLY BARRIERS: Most people want something more reliable than good timing and periods of abstinence. That’s where non-hormonal barrier methods come in. Although dependability varies based on which specific barrier is used, condoms continue to score high on the effectivity chart, clocking in at 87 percent effectiveness when used correctly. Also: Hey! Something men can do to protect themselves and their partner(s)! Also Also: Do not reuse condoms. It’s once and done, fellas.

Watch out for latex allergies and know that there are non-latex condoms available for those who need them. The “female” condom is an option many do not consider but is especially good for those with latex allergies. This large, ringed condom is unfolded inside of the vagina or anus, with the penis then inserted into its polyurethane folds. At 79 percent success, it’s slightly less useful for avoiding pregnancy but, like the “male” condom, protects against STIs. Because of the way penis-bearing bodies are configured, traditional condoms are somewhat less helpful in the fight against viral STIs like HPV (tiny little viruses) or herpes (viruses not covered by condoms).

Other options include diaphragms, sponges, and cervical caps. These do not protect against STIs. The goal of any barrier method is, instead, to make sure that, like a wife and her husband’s mistress, the egg and sperm never meet. Vaginal gels and spermicides can boost the numbers in our favor and are easy to use since all you do is insert them into the vagina prior to intercourse.

HORMONES, HORMONES, HORMONES: Unlike most but not all forms of non-hormonal methods of contraception, we’re not getting hormones without a visit to the doctor. Because they need to be injected, implanted, consumed, or inserted into the uterus, a knowledgeable medical professional is required. These devices require a prescription and occasional replacement. A new packet of Pills is easy enough to pick up at a pharmacy after an initial physical exam, but the placement of either a hormonal or non-hormonal IUD necessitates time in the stirrups.

Ladies, do not believe them when they say you just need a couple of Motrin before this appointment. I nearly crawled off the exam table during one of mine. But once it’s in and settled, condoms are back up and you’re good for three to 10 years. Non-hormonal IUDs (ParaGard) can increase menstrual cramps and bleeding, while hormonal IUDs can be used to treat endometriosis. Most women who use such a hormone-infused IUD have the added luxury of seeing the end of their monthly periods. I now have two of the three Mirena IUDs I once wore inside of me in small containers at home because I’m sentimental like that. Whether copper or hormonal, for many of us, IUDs are worth the initial agony because they provide a proud 99 percent protection against pregnancy. They do not protect against STIs.

Also available to those of us with vaginas is a contraceptive injection (Depo-Provera), a skin Patch (Xulane), a Vaginal Ring (NuvaRing), and an upper arm implant (Nexplanon). Injections need to be renewed every three months and long-term use has been associated with bone loss so, as with all these methods, forewarned is forearmed. Before we try anything we’re uncertain about, we should do further research. Again, none of these protect against STIs, so are best used by monogamous couples.

For those who like to know their stats, The Pill, the Patch, and the Vaginal Ring each have a 93 percent success rate against pregnancy. The Shot presents an impressive 96 percent protection, with the Implant wracking up an awe-inspiring 99 percent. This final form of contraception can remain in the upper arm for up to five years.

DONE DIDDLEY DONE: Sterilization; the ultimate way of saying no-way to kids. For men, a vasectomy is a same-day outpatient surgical procedure wherein the sperm-carrying tubes in the scrotum are drawn out, snipped, and either cut or blocked somehow, making it impossible for sperm to escape and get everybody into trouble. Some men reverse their vasectomies in time, but it’s not fun and doesn’t always work. Likewise, after a vasectomy, it’s important to give the body time to remove all lingering sperm from the body. That takes at least two months, so keep those Pills and condoms handy! Once healed and flushed clean of sperm, vasectomies have a 99 percent effectiveness against pregnancy, although do nothing against STIs.

Those of us with internal fun bits have a more complex process to deal with if we want to permanently shut down the baby-making factory with a tubal ligation, although known as “getting our tubes tied.” For many women, the time it takes to find a doctor willing to perform the damn thing is more difficult than the procedure itself. Like a woman seeking an abortion in Texas or Georgia, women throughout the U.S. consistently report resistance from the medical field when it comes to exercising full reproductive autonomy. I had to ask three doctors for more than a decade before I could find one who reluctantly agreed to do it because I had graduated from college and was married. Once upon a time, we needed our husband’s permission. After all, we might “change our mind” or marry someone who wants kids and feel compelled to change our life’s goals because of it.

But I digress.

As with the vasectomy, tubal ligations are successful nearly 100 percent of the time. I have never regretted mine. It was a little weird having had it and then needing a hormonal IUD years later when I was diagnosed with endo, but I sure felt extra safe. What isn’t safe is any guarantee that our access to effective contraception will continue without legal challenges and market manipulation as a new morality masquerading as a traditional morality declares anything that allows us to enjoy our sexuality without “punishment” or “consequence” to be “anti-life.” As the Beastie Boys once opined, “You gotta fight for your right to party.”