Birth Control

Making the decision to have sex can be difficult. You should make up your own mind when the time is right for you. If you are not ready for sex, say so. If you think you are ready to have sex or if you already are having sex—even only now and then—you should take steps to avoid pregnancy and sexually transmitted infections (STIs).

Thousands of teens get pregnant each year because they do not use birth control or they do not use it correctly. Many teens are deciding to protect themselves from pregnancy and STIs, and you can too.

A woman has two ovaries, one on each side of the uterus. Each month, one of the ovaries releases an egg into a fallopian tube. This is called ovulation. It usually happens about 12 to 14 days before the start of menstruation (the menstrual period).

During sexual intercourse (vaginal sex), the penis goes into the vagina. When the male partner ejaculates ("comes"), the penis releases semen into the vagina. Semen contains millions of sperm.

Sperm can swim up into the uterus and then the fallopian tubes. If a sperm meets an egg in the fallopian tube, fertilization—joining of an egg and sperm—can happen. This can lead to pregnancy, even if it is your first time having sex.

To choose the right birth control method for you, consider:

• How well it prevents pregnancy—Read Effectiveness of Birth Control Methods.

• How easy it is to use—Learn what is required for each method below.

• How easy it is to get—Some types of birth control require a prescription, and you have to see a health care professional or go to a clinic to get them.

• Whether it protects against STIs—If you are having sex (vaginal, oral, or anal sex), you also need to protect yourself from STIs.

• Whether you have any health problems—If you have certain diseases or medical conditions, some birth control methods may not be recommended. Talk with your health care professional about any possible risks and the safety of each method to find the best option for you.

A pelvic exam is not needed to get most forms of birth control, except for the intrauterine device (IUD), diaphragm, and cervical cap. (Read Pelvic Exams to learn more.) If you have already had sex, you may need to have a pregnancy test and STI test before birth control can be prescribed.

The intrauterine device (IUD) and birth control implant are the most effective birth control methods that can be reversed. Read Effectiveness of Birth Control Methods for information about the effectiveness of each method.

Latex or polyurethane condoms give the best protection against STIs. You can also use a dental dam to protect against STIs during oral sex.

Condoms are not the best protection against pregnancy. You can use condoms and another method of birth control to protect against STIs and pregnancy.

Hormonal methods of birth control contain hormones that prevent pregnancy. Hormones are made by the body to control its functions. The hormones in birth control prevent your body from releasing an egg each month. If your body does not release an egg, you cannot get pregnant. Some methods also thicken the mucus in front of the cervix, which helps prevent sperm from entering the uterus, and thin the lining of the uterus.

Hormonal methods are safe for most people and work well when used as directed. To begin using any hormonal method, you need to see a health care professional.

Birth control pills, also known as "the pill," are the most popular hormonal method. You have to take the pill every day at the same time each day. There are many types of birth control pills. A health care professional can help you choose the right one for you.

If you miss a pill, read the directions that came with your pack of pills. You may also want to contact your health care professional.

The skin patch is a small (1.75 square inch) adhesive patch that is worn on the skin. It contains hormones that prevent pregnancy. The hormones are slowly released into your body through the skin.

A new patch is worn for a week at a time for 3 weeks in a row. During the fourth week, a patch is not worn, and you have your period.

The patch can be worn on the buttocks, chest (excluding the breasts), upper back, arm, or abdomen. The patch can be worn while bathing, exercising, and swimming.

The vaginal ring is a flexible plastic ring that you insert into the upper vagina. It releases hormones that prevent pregnancy. The hormones are slowly released into your body.

The ring is worn inside the vagina for 21 days and then removed for 7 days. During those 7 days, you have your period. Then you insert a new ring.

This shot (DMPA, or depot medroxyprogesterone acetate) is given in the upper arm or buttock every 3 months. It contains hormones that prevent pregnancy. The birth control shot may be a good choice if you do not want to remember to take a daily pill.

The implant is a small plastic rod about the size of a matchstick. A health care professional inserts it under the skin of the upper arm. It releases a hormone that prevents pregnancy.

The implant is approved for up to 3 years of use. It may be a good choice if you do not want to remember to take a daily pill.

The IUD is a small, T-shaped, plastic device that is inserted into and left inside the uterus. The IUD must be inserted and removed by a health care professional.

Hormonal IUDs release a small amount of a hormone called progestin into the uterus. Three types of hormonal IUDs are available in the United States. There are different brands that last for different lengths of time. Depending on the brand, they are approved for up to 3 to 8 years of use.

There is also a copper IUD. The copper IUD releases a small amount of copper into the uterus. It is approved for up to 10 years of use.

IUDs work mainly by preventing fertilization of the egg by sperm. The progestin in the hormonal IUD thickens mucus found in the cervix. Thicker mucus makes it harder for sperm to enter the uterus and reach an egg. Progestin also thins the lining of the uterus.

The copper released by the copper IUD stops sperm from moving and reaching an egg.

Once the IUD is inserted, nothing else needs to be done to prevent pregnancy. The IUD has a string that can be checked to be sure the device is in place.

Barrier methods keep sperm from reaching the egg. These methods include spermicide, condoms, diaphragms, cervical caps, and sponges. You must use barrier methods each time you have sex.

Condoms, sponges, and spermicides can be bought in drugstores. A diaphragm or cervical cap must be fitted to your body and requires a prescription.

Spermicides are chemicals that are put into the vagina to make sperm inactive. There are many types of spermicide: foam, gel, cream, film (thin sheets), or suppositories (solid inserts that melt after they are inserted into the vagina).

Follow the directions carefully. For many spermicides, you need to wait 10 to 15 minutes after insertion for them to start to work. Spermicides are effective for only 1 hour after they are put in the vagina. If more than 1 hour goes by, you need to reinsert the spermicide.

You must reinsert spermicide for each act of sex. The spermicide needs to stay in place for 6 to 8 hours after the last act of sex.

Frequent use of spermicide may increase the risk of getting human immunodeficiency virus (HIV) from an infected partner. Spermicide should only be used if you are at low risk of HIV infection.

Condoms come in male and female versions. The male condom covers the penis and catches the sperm after the male partner ejaculates. Male condoms are easy to use and can be bought in many places, including drugstores, without a prescription.

Condoms that are made of latex or polyurethane are the best way to reduce the risk of getting an STI. They can be used alone or with other birth control methods to protect against STIs. For example, you may decide to use the IUD or implant, which are both very effective in preventing pregnancy, with a condom to protect against STIs.

The female condom is a thin plastic pouch that lines the vagina. It prevents sperm from reaching the uterus. It may be put in place up to 8 hours before you have sex. It can be bought in drugstores. It provides some protection against STIs.

Condoms work better to prevent pregnancy when used with a spermicide. Spermicides should only be used if you are at low risk of HIV infection.

The diaphragm is a small dome-shaped device made of latex or silicone that fits inside the vagina and covers the cervix. You need a prescription for it. With one type of diaphragm, a health care professional needs to do a pelvic exam to find the right size for you. Another diaphragm is "one size fits all."

Diaphragms are always used with a spermicide. Birth control methods that need spermicides to work should only be used if you are at low risk of HIV infection.

A diaphragm must be left in place at least 6 hours after sex, but not more than 24 hours total. If you have sex again within this time frame, you need to add more spermicide and wait another 6 hours before removing the diaphragm.

The cervical cap is a small, thin latex or plastic dome shaped like a thimble. It fits tightly over the cervix. You need a prescription for it. A health care professional needs to do a pelvic exam to find the right size for you.

The cervical cap must be used with a spermicide. Birth control methods that need spermicides to work should only be used if you are at low risk of HIV infection.

After sex, the cap should be left in place for 6 hours but not longer than 48 hours total. You do not need to add more spermicide if you have sex again within this time frame.

The sponge is a round device made of soft foam that is coated with spermicide. It is pushed up into the vagina to cover the cervix.

The sponge can be bought without a prescription at pharmacies and other stores. Birth control methods that have spermicides should only be used if you are at low risk of HIV infection.

The sponge is effective for up to 24 hours. It is good for more than one act of sex during this time. It must be left in at least 6 hours after the last act of sex. It must be removed within 30 hours of the time it is inserted.

If you have sex without using any birth control, if the birth control method did not work (for example, the condom broke during sex), or if you are raped, you can use emergency contraception (EC) to prevent pregnancy.

EC should only be used in an emergency—not for regular birth control. EC can prevent some, but not all, pregnancies. It is most effective when taken as soon as possible after having unprotected sex.

There are two main types of EC: 1) the copper IUD and 2) pills. You must have the IUD inserted by a health care professional or take the pills within 5 days of having unprotected sex.

Some EC pills are available at pharmacies to anyone of any age without a prescription.

The copper IUD is the most effective form of EC. A health care professional must insert the IUD. You can call your health care professional or go to a family planning clinic to have the IUD inserted. Then you can rely on the copper IUD for long-term birth control for up to 10 years. You can have the IUD removed at any time if you wish to get pregnant.

There are three types of EC pills: 1) ulipristal, 2) progestin-only pills, and 3) combined birth control pills taken in certain amounts.

Ulipristal is the most effective EC pill. Combined birth control pills are the least effective type of EC. The number of pills needed for EC differs for each brand of pill. A health care professional can tell you how many pills you should take for the type that you have.

Ulipristal and combined birth control pills are available only by prescription. You can ask your health care professional to give you a prescription in advance. This way, it is there if you need it.

All of the progestin-only pills are available over the counter in pharmacies and other stores to anyone of any age. The progestin-only pill can usually be found in the family planning section. Not all stores carry it, so it is best to call ahead to see if it is available.

If you need more information about emergency birth control or you need to find a local clinic, visit www.womenshealth.gov/a-z-topics/emergency-contraception.

You can also read Emergency Contraception to learn more about EC.

In most states, minors (people younger than 18) have the right to make choices about birth control without their parents’ permission. Ask your health care professional if the visit will be kept private.

Be aware that if you use your parents’ health insurance to pay for birth control or a special health care professional’s visit, it may appear on the bill that your parents receive. You may want to talk about birth control with your health care professional at a visit for something else, such as a physical exam.

Often, the best way for a teen to have privacy and to afford birth control is to go to a family planning clinic. Some clinics may provide free birth control.

Before you have sex, talk to your partner about using condoms. This is the best way to prevent STIs. Do not be shy—be direct. Be honest about your feelings and needs. You can talk about it in many ways. The following are some examples:

• "You know, it makes sex even better for me knowing that both of us are protected. Let’s use a condom."

• I’d really like to have sex with you as long as we use condoms. Condoms protect both of us."

Make sure that you feel safe with your partner. No one should force you to have sex. If you feel scared of your partner or have experienced physical, emotional, or sexual abuse, tell a trusted adult. Read Healthy Relationships to learn more.

Birth Control Implant: A small, single rod that is inserted under the skin in the upper arm. The implant releases a hormone to prevent pregnancy.

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Dental Dam: A thin piece of latex or polyurethane used between the mouth and the vagina or anus during oral sex. Using a dental dam can help protect against sexually transmitted infections (STIs).

Egg: The female reproductive cell made in and released from the ovaries. Also called the ovum.

Ejaculates: The release of semen from the penis at the time of orgasm.

Emergency Contraception (EC): Methods that are used to prevent pregnancy after a woman has had sex without birth control, after the method has failed, or after a rape.

Fallopian Tube: A tube through which an egg travels from the ovary to the uterus.

Fertilization: A multistep process that joins the egg and the sperm.

Hormones: Substances made in the body that control the function of cells or organs.

Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body’s immune system. If left untreated, HIV can cause acquired immunodeficiency syndrome (AIDS).

Intrauterine Device (IUD): A small device that is inserted and left inside the uterus to prevent pregnancy.

Menstrual Period: The monthly shedding of blood and tissue from the uterus.

Menstruation: The monthly shedding of blood and tissue from the uterus that happens when a woman is not pregnant.

Ovaries: The organs in women that contain the eggs necessary to get pregnant and make important hormones, such as estrogen, progesterone, and testosterone.

Ovulation: The time when an ovary releases an egg.

Pelvic Exam: A physical examination of a woman’s pelvic organs.

Penis: The male sex organ.

Progestin: A synthetic form of progesterone that is similar to the hormone made naturally by the body.

Semen: The fluid made by male sex glands that contains sperm.

Sexual Intercourse: The act of the penis of the male entering the vagina of the female. Also called "having sex" or "making love."

Sexually Transmitted Infections (STIs): Infections that are spread by sexual contact.

Sperm: A cell made in the male testicles that can fertilize a female egg.

Spermicide: Chemicals (creams, gels, foams) that inactivate sperm.

Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus. Also called the womb.

Vagina: A tube-like structure surrounded by muscles. The vagina leads from the uterus to the outside of the body.