Patient Care

Family Planning

Birth Control

Many birth control options are available, and making a decision about which method best fits your lifestyle can be confusing. Choosing birth control is a personal choice, and it is important to learn as much as you can about the various methods – both hormonal and non-hormonal. Make sure you know all the facts – such as use, side effects, advantages, disadvantages, health risks and drug interactions – and be sure to discuss any concerns you may have with your doctor.

Hormonal Contraceptives

Hormonal contraceptives work by preventing the release of an egg from your ovaries into your uterus. These methods are available by prescription only.

Contraceptive Injections (Depo-Provera)

Depo-Provera is a hormonal injection administered every three months. The injection contains synthetic progesterone and is usually given in your arm or hip, delivering a high level of progesterone into your body. Depo-Provera prevents the ovaries from releasing eggs, causes the cervical mucus to thicken and changes the uterine lining, which makes it more difficult for sperm to enter or survive in the uterus.

Contraceptive Implants

IMPLANON is a type of implantable birth control for women. It is a flexible plastic rod the size of a matchstick that is put under the skin of your arm. IMPLANON contains a hormone called etonogestrel. You can use a single IMPLANON rod for up to three years.

Contraceptive Patch

The Contraceptive Patch looks like a square Band-Aid® and is applied to your abdomen, buttocks, upper arm or upper torso. The Patch is applied once a week for three weeks. During the fourth week, no patch is used. The Patch works by slowly releasing a combination of estrogen and progestin hormones through your skin. These hormones prevent ovulation and thicken the cervical mucus, creating a barrier to prevent sperm from entering the uterus.

Oral Contraceptives (The Pill)

The Pill is available in different doses, and it is dispensed in packs of 21 or 28 pills. The first 21 pills contain a combination of synthetic estrogen and progesterone hormones. The last seven pills of a 28-day pack have no hormones and are called “spacer” pills. You should take your pill everyday at approximately the same time each day. The Pill works by stopping ovulation. It also thickens cervical mucus, making it more difficult for sperm to enter the uterus.

Progestin-Releasing Intrauterine Device

An intrauterine device (IUD) is a small object inserted through the cervix and placed in the uterus. A small string hangs down from the IUD into the upper part of the vagina. IUDs affect the movement of eggs and sperm, preventing fertilization. They also change the lining of the uterus and prevent implantation. One hormone-releasing IUD, called the Mirena®, is currently available. This IUD releases small amounts of a synthetic progesterone hormone. The suggested length of use for progestin-releasing IUDs is five years or less.

Vaginal Ring

The vaginal ring is a thin, transparent, flexible ring you insert into your vagina. The ring is left in place for three weeks. During the fourth week, you do not wear the ring. The vaginal ring slowly releases estrogen and progestin hormones into your body, which stop ovulation and thicken the cervical mucus – creating a barrier to prevent sperm from fertilizing an egg. The vaginal ring provides one month of birth control.

Non-Hormonal Contraceptives

Non-hormonal contraceptives prevent pregnancy by providing a barrier against sperm or by interfering with the movement of sperm.

Condom (Female)

A female condom is a thin, loose-fitting, flexible plastic tube worn inside your vagina. A soft ring at the closed end of the tube covers the cervix during intercourse and holds it inside the vagina. Another ring at the open end of the tube stays outside the vagina and partially covers the lip area. A female condom can be inserted up to eight hours before sexual activity; a new condom must be used every time you have sex. A female condom provides a barrier, preventing the exchange of bodily fluids, such as semen, blood or saliva. It helps protect you from pregnancy as well as sexually transmitted diseases (STDs) and is the only female-controlled device offering this protection.

Condom (Male)

A male condom must be applied when the penis is erect, and a new condom must be used every time you have sex. A condom works by providing a barrier so bodily fluids are not shared, which helps protect you from pregnancy and STDs. Currently, male condoms are the only reversible birth control method for men.

Spermicides

A variety of spermicides are available, including foams, jellies, creams and vaginal suppositories. Spermicides must be inserted no more than one hour before sex and must be used every time you have sex. Spermicides prevent pregnancy by killing (or disabling) sperm. They are most effective when used with a vaginal barrier method of birth control, such as a diaphragm or cervical cap.

Cervical Cap

A cervical cap is a latex, thimble-shaped device you insert into your vagina. The device fits snugly over the cervix, and suction keeps it in place. It must be used every time you have sex, and spermicide must be applied when it is inserted. A cervical cap provides continuous protection for up to 48 hours. After intercourse, it should be left in place for eight hours. A cervical cap provides a barrier, blocking sperm from entering the uterus and preventing fertilization. This method of birth control is available by prescription only, and you must be fitted for a cervical cap by your doctor.

Diaphragm

A diaphragm is a thin, rubber dome with a flexible rim. The device is inserted into your vagina, fits over the cervix and is held in place by your vaginal muscles. A diaphragm can be inserted six to eight hours before sex. It must be used every time you have sex, and fresh spermicide must be applied each time. A diaphragm holds the spermicide in place over the opening of the uterus. After intercourse, it should be left in place for six to eight hours. This method of birth control is available by prescription only, and you must be fitted for a diaphragm by your doctor.

Intrauterine Device

Please see the description of an intrauterine device above under “Hormonal Contraceptives.”

One copper IUD, called the ParaGard®, is currently available. This IUD has a tiny copper wire wrapped around the plastic body and should not be used by anyone who is allergic to copper. Once inserted in the uterus, this type of IUD can be left in place for up to 10 years. Unlike the Mirena® IUD, copper IUDs do not release hormones.

Sterilization (Tubal Ligation)

Female sterilization, or tubal ligation, is a surgical procedure that involves tying, cutting or blocking the fallopian tubes so eggs cannot travel down the tubes to be fertilized or to implant in the uterus.

Resources

If you choose to have sex, you must take precautions to avoid pregnancy and STDs. It is important to remember that while birth control protects you from pregnancy, most methods do not protect you from STDs. If you have questions or concerns about which birth control method is best for you or how to protect yourself from STDs, please talk to your doctor.

Vaginal Infections

Vaginal infections are sometimes difficult to recognize because they can cause similar symptoms. If you are experiencing vaginal discomfort, such as itching, burning, redness or abnormal discharge, you should be examined by your doctor. He or she can perform tests to determine the type of infection you have and the best way to treat it.

Bacterial Vaginosis

Bacterial Vaginosis (BV) is a condition in which the normal balance of “good” bacteria in the vagina is disrupted and replaced by an overgrowth of “bad” bacteria. BV is the most common vaginal infection among women of childbearing age.

Signs and Symptoms:

Some women with BV may have no signs or symptoms.

Treatment: The primary goal in treating BV is to relieve vaginal symptoms and signs of infection. Your doctor will prescribe an antibiotic and/or a vaginal cream. Make sure you take all of the pills or use all of the cream in order to prevent a recurrence.

Candidiasis (Yeast Infection)

Yeast infections are caused by one of several types of fungus known as Candida, which may be found in small numbers in the normal vagina as well as in the mouth and digestive tract. Candidiasis is the second most common vaginal infection.

Signs and Symptoms:

Male sex partners may develop a rash on the penis.

Treatment: Your doctor will perform a pelvic exam to collect vaginal samples for examination under a microscope. He or she will then prescribe an antibiotic and/or a vaginal cream. Although over-the-counter medications are available, it is important to see your doctor to make sure you have a yeast infection and not some other condition. Male partners should get tested and treated by their health care providers.

Sexually Transmitted Diseases (STDs)

Chancroid

Chancroid is a bacterial infection characterized by genital ulcers.

Signs and Symptoms:

Treatment: Your doctor will examine the ulcer and take a culture to confirm the diagnosis. He or she may also order some blood work. Chancroid is treated with antibiotics. Successful treatment cures the infection, clears up the symptoms and prevents you from infecting others.

Chlamydia

Chlamydia is the most frequently reported bacterial STD in the United States.

Signs and Symptoms:

Even though symptoms of chlamydia are usually mild or absent, serious complications can occur, causing irreversible damage – including infertility – before a woman recognizes a problem. If symptoms do occur, they usually appear within one to three weeks after exposure and may include the following:

As the disease progresses, some women may experience the following symptoms:

Treatment: Laboratory tests to diagnose chlamydia are available. Your doctor will collect a urine sample or take a sample of discharge from your vagina to be tested. Chlamydia can be easily treated and cured with antibiotics. All of your sex partners should be evaluated, tested and treated. You should abstain from sexual intercourse until you and your sex partner(s) have completed treatment to prevent re-infection.

Genital Herpes

Genital herpes is a common STD caused by the herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). Most cases of genital herpes are caused by HSV-2.

Signs and Symptoms:

Many women have either no symptoms at all or minimal signs or symptoms from herpes infections. When signs of the infection do occur, they typically include the following:

Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over a period of years.

Treatment: Your doctor can diagnose genital herpes by visual inspection and by taking a culture from the sore(s) to be tested in a laboratory. Blood tests, which detect HSV-1 or HSV-2 infection, may be helpful. But the results are not always accurate. No treatment can cure herpes, but antiviral medications can shorten and prevent outbreaks.

Genital Warts

Genital warts are sexually transmitted skin lesions caused by the Human Papilloma Virus (HPV).

Signs and Symptoms:

Treatment: Your doctor can diagnose genital warts by visual inspection. For some women, a Pap smear may indicate the presence of HPV; a special microscopic test (called a colposcopy) is used to diagnose flat warts that are difficult to see. Several treatments are available for genital warts – all of which involve applying medication directly to the warts. However, despite treatment, genital warts may recur.

Gonorrhea

Gonorrhea is a common STD caused by the bacterium Neisseria gonorrhoeae, which grows and multiplies in the warm, moist areas of the reproductive tract, including the cervix, uterus and fallopian tubes, as well as the urethra.

Signs and Symptoms:

Many women do not know they are infected with gonorrhea because they have no symptoms. When symptoms do occur, they may include the following:

An undetected gonorrhea infection can lead to pelvic infections and infertility.

Treatment: Laboratory tests for gonorrhea are available. Your doctor will collect a urine sample or take a sample of discharge from your vagina to be tested. Several antibiotics can successfully cure gonorrhea. Be sure to take all of your medication to avoid a recurrence. All of your sex partners should be evaluated, tested and treated. You should abstain from sexual intercourse until you and your sex partner(s) have completed treatment.

Hepatitis

Hepatitis is a serious virus affecting your liver. There are many forms of Hepatitis; Hepatitis B is the most common form and is often spread through sexual contact. Hepatitis C is spread through intravenous drug use, but it may also be spread though sexual contact. Hepatitis B is the only sexually transmitted disease that can be prevented with a vaccine.

Signs and Symptoms:

Sometimes no visible symptoms are present.

Treatment: Hepatitis can be detected with a blood test. There is no specific therapy for Hepatitis B; your doctor will treat the symptoms. Hepatitis C is treated through a series of injections to decrease damage to the liver.

HIV/AIDS

HIV (Human Immunodeficiency Virus) is the virus that causes AIDS (Acquired Immunodeficiency Syndrome). HIV may be passed from one person to another when infected blood, semen or vaginal secretions come in contact with an uninfected person's broken skin or mucous membranes.

Signs and Symptoms:

People may not seek medical attention until they have AIDS. They may have some of the following symptoms:

Treatment: Although there is no cure for HIV, you can learn to live with and manage the disease. If you are infected with HIV, your doctor will design a medical care plan for you. He or she will inform you about the risks and benefits of the drugs for HIV and when you need to start taking them. Several drugs are used together to treat HIV, including anti-retroviral medicines. Make sure you take all of your medications exactly as prescribed.

Human Papilloma Virus

The Human Papilloma Virus (HPV) is the most common viral STD in the United States. It is estimated up to half of all sexually active young women are infected with the virus that causes HPV. Certain types of HPV cause genital warts; other types of HPV infection cause no visible warts, and many people do not know they are infected. In addition, HPV is the number one cause of abnormal Pap smear results and may lead to pre- cancerous changes on the cervix. HPV is also the primary cause of cervical cancer.

Signs and Symptoms:

Treatment: Regular genital self-examinations may be helpful in detecting visible genital warts. If you notice unusual changes in your genital area, the only way to determine if you have HPV is to see your doctor for a physical exam. He or she will check for visible warts and can also check for subclinical HPV (HPV with no symptoms) by performing a Pap smear. An abnormal Pap smear may be the first sign HPV is present. If your Pap is abnormal, you should be examined further for cervical problems and closely monitored by your doctor.

HPV is a persistent condition – even when there are no symptoms. Since it is difficult to cure HPV, the goal of treatment is removing the visible genital warts and relieving any symptoms. Treatments for visible genital warts include patient-applied therapies and doctor-administered therapies.

Pelvic Inflammatory Disease

Pelvic Inflammatory Disease (PID) is a general term referring to infection of the uterus, fallopian tubes and other reproductive organs. It is a common and serious complication of some sexually transmitted diseases, especially chlamydia and gonorrhea. PID can damage the fallopian tubes and tissues in and near the uterus and ovaries. If left untreated, PID can cause serious consequences, including infertility, ectopic pregnancy, abscess formation and chronic pelvic pain.

Signs and Symptoms:

Treatment: Because there are no precise tests for PID, a diagnosis is usually based on clinical findings. If symptoms such as lower abdominal pain are present, your doctor should perform a physical examination to determine the nature and location of the pain. He or she should also check for fever, abnormal vaginal or cervical discharge and for evidence of gonorrheal or chlamydial infection. If the findings suggest PID, treatment is necessary. PID can be cured with several types of antibiotics. Your doctor will determine and prescribe the best therapy for you. However, antibiotic treatment cannot reverse any damage to the reproductive organs, which may have already occurred.

Syphilis

Syphilis is an STD caused by the bacterium Treponema pallidum.

Signs and Symptoms:

Treatment: Your doctor may be able to diagnose syphilis by examining material from a chancre under a special microscope. A blood test can also detect syphilis. Syphilis is easy to cure in its early stages. A single injection of penicillin will cure a person who has had syphilis for less than a year. Additional doses are needed to treat someone who has had syphilis for longer than a year. If you are allergic to penicillin, other antibiotics are available to treat syphilis. Treatment will kill the syphilis bacterium and prevent further damage. However, it cannot repair any damage that has already occurred.

Trichomoniasis

Trichomoniasis is a common STD affecting both women and men – although symptoms are more common in women. The disease is caused by a parasite.

Signs and Symptoms:

Treatment: Your doctor must perform a physical examination and a laboratory test to diagnose trichomoniasis. A pelvic examination can reveal small, red ulcerations on the vaginal wall or cervix. Trichomoniasis can usually be cured with a prescription drug given orally in a single dose. Both partners should be treated at the same time. You should abstain from sex until you and your sex partner(s) complete treatment and have no symptoms.

Resources

Although abstinence is the only way to prevent your risk of becoming infected with an STD, you can protect yourself by using condoms every time you have sex. It is important to be proactive about your health. Make sure you have a Pap smear once a year, ask your doctor to test you for STDs and discuss any concerns you may have regarding your sexual health.

You can obtain more information about STDs at: Centers for Disease Control and Prevention (CDC).

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