What’s New in Nonhormonal Birth Control?

IUDs are available as both hormonal and nonhormonal. If you don’t want the hormones, let your doctor know about your preference.

External condom. Formerly known as male condoms, it’s the most popular type of nonhormonal birth control. You’ll need to wear a condom over the penis. It works by keeping the semen, the fluid that contains sperm, and sexually transmitted infections (STI) from entering the vagina.

It’s usually made from latex, a type of rubber. But if you’re allergic to latex, you can find condoms made from other materials.

• Effectiveness: You can use a condom only once and you’ll have to throw it away after that use. The effectiveness varies. It usually works anywhere between 80%-98% of the time
• Pros and cons: Condoms are easy to use and can usually be found at your local grocery store, pharmacy, or online. You don’t need a prescription to buy or use them. But read the instructions properly. Don’t use latex condoms with oil-based lubricants like baby oil, lotions, or petroleum jelly. This may cause it to break or tear. If it breaks during or before sex, it might increase your risk for pregnancy or an STI.

Internal condom. Formerly known as a female condom, it’s inserted into the vagina. It’s made of stretchy plastic material and contains two rings. The smaller ring is inserted inside while the larger one opens at the front of the vagina.

• Effectiveness: It’s less effective than an external condom. Research shows that it might fail to act as effective birth control around 2 out of 10 times.
• Pros and cons: Like the external condom, it’s designed to stop the sperm from meeting the egg. When used properly, it also protects you from STIs. A person can ejaculate into the internal condom after sex. It can be worn up to 8 hours before you have sex. It’s best for your partner not to wear a condom over their penis as it might tear from the friction and fail to act as birth control.

It’s packaged with lubricant, and you can probably find it at your local drugstore. An internal condom can only be used once. Remove it soon after sex or before you stand up, and throw it in the trash.

Spermicide. It’s a product that contains enzymes that kill sperm. It’s available in many forms: foam, gel, cream, pill, film, or suppository (a pill you insert inside the vagina).

• Effectiveness: It prevents pregnancy 8 out of 10 times you use it. But spermicide works best when you pair it with a condom or other forms of birth control.
• Pros and cons. You’ll have to use spermicide each time you’re about to have sex. You should use the spermicide no more than 1 hour before sex. But you can leave it inside for up to 6-8 hours after you’ve had sex. It’s easy to use and you can typically find it at your local drug store.

For some, spermicide can irritate the skin and the surrounding area. It also increases your risk for urinary tract infections (UTI).

Vaginal gel (Phexxi gel). The FDA recently approved this nonhormonal birth control in the form of a vaginal gel. It contains three ingredients: lactic acid, citric acid, and potassium bitartrate. And it comes in a prefilled tampon-like applicator.

The vaginal gel coats the walls and the cervix and makes the area more acidic. This stops the sperm from being able to swim through the uterus to fertilize an egg.

• Effectiveness: Studies have found that when the gel is used alone, it’s effective as birth control more than 8 out of 10 times. 
• Pros and cons. The gel works immediately and it’s effective for up to an hour after you apply it. But you’ll have to use it each time you have sex, even if it is within the hour you applied the first time. The vaginal gel can only prevent pregnancy. It doesn’t provide any protection against STIs.

The gel may also cause a few side effects, such as:

• Irritation, burning, or itching within the vaginal walls.
• Studies have found that 1 in 10 partners might have irritation or burning from the gel.

Surgical Methods of Nonhormonal Birth Control

If you’re looking for a more permanent option for birth control and you don’t plan to have a biological child in the future, surgery might be an option for you.

Sterilization. This surgical procedure, also called tubal ligation or “tying tubes,'' is a permanent nonhormonal birth control option. Your fallopian tubes are tied so that the egg has no possibility to meet a sperm for fertilization.

The surgery is done at a hospital or a surgical clinic. You may go home the same day, and it’s immediately effective. The failure rate is less than 1%. If you’re interested, talk to your doctor about sterilization and if it’s right for you.

Vasectomy. It’s a simple procedure in which the tubes that carry sperm from the testicles to the penis are cut. This stops sperm from traveling through the tube (called the vas deferens) into the semen or out of the penis. But the surgery doesn’t stop you from being able to have an erection or ejaculate.

This is usually done in an outpatient surgery center and a person may go home the same day. The recovery time may take up to one week.

However, it does take time for the semen to clear out of the body. Your doctor will count the sperm in your semen till it drops to zero. This may take up to 12 weeks. During this time, there’s still a risk for sperm to pass into the vagina. Until then, it’s best to use additional birth control like condoms. Once your sperm count reaches zero, it’s almost 100% effective at preventing pregnancy.

Almost all vasectomies can also be reversed. Meaning the vas deferens can be surgically reconnected to transfer sperm to the penis. But this doesn’t guarantee your ability to have a child. Talk to your doctor about all your options before you choose to get a vasectomy.

Behavioral Birth Control Options

Withdrawal. Commonly called the “pull-out method,” it simply means to remove the penis from a vagina before you’re about to ejaculate in or near the vagina. While this may sound like an effective birth control method, the issue is in the timing.

It is possible to deposit sperm before ejaculation. And this could lead to a pregnancy. Studies show that the pull-out method is only effective around 7 out of 10 times. This method also doesn’t protect you against STIs. For this reason, doctors suggest using another type of birth control.

Outercourse. You prevent pregnancy by only engaging in some sexual activities that don’t involve the penis entering the vagina, such as dry humping, kissing, foreplay, masturbation, or massages. If there’s no vaginal, oral, or anal penetration, outercourse carries a very low risk of STIs.

Lactational amenorrhea method (LAM). If you’re breastfeeding a baby, the hormones that regulate milk production also stop ovulation. This stops you from being able to get pregnant at the time.

If you’re exclusively breastfeeding, meaning your baby doesn’t have any other source of food except breastmilk, your chance of getting pregnant is about 2% if used perfectly every time during the first 6 months of the baby’s life.

But the risk is slightly higher in mothers who pump. That’s because breast pumping does not produce the same hormone signals as directly nursing. In this case, your chance of pregnancy is about 5%.

Other methods:  There are other fertility awareness methods that are available that vary in their effectiveness. Talk to your health care provider about what is right for you.