An intrauterine device (IUD) is a form of birth control. It prevents pregnancy either by damaging or killing a man’s sperm or blocking it from entering a woman’s uterus. An IUD is a small, T-shaped device with a string attached to the end. The purpose of the string is to help you or your doctor make sure that the IUD is still in place. It also is how a doctor removes the device.

There are 2 types of IUDs available in the United States: hormonal and non-hormonal. ParaGard is the non-hormonal option. It has copper rings, or coils, that alter the chemicals in your uterine fluid to kill sperm. You should not use ParaGard if you are allergic to copper. Hormonal options include Mirena, Kyleena, Liletta, and Skyla. These release progestin hormones to thicken your cervical mucus and stop ovulation.

Path to improved health

Your primary care or women’s doctor can insert an IUD. They can insert ParaGard at any time during your menstrual cycle. Hormonal IUDs should be inserted in the first 7 days of your cycle. The procedure is quick and done in the doctor’s office. The doctor puts a small plastic tube with the IUD into your vagina. You may have pain or cramping during this process. Discomfort can last several hours or days. Most doctors suggest that you have someone else drive you home from the appointment.

IUDs start working immediately. You can have sex, exercise, and use tampons. An IUD is effective for 3 to 12 years, depending on the type. Your doctor can remove it at any time.

Call your doctor right away if you have the following symptoms or problems. They will check your IUD and may remove or replace it.

• You can’t find the string
• You can feel the IUD
• Your IUD comes loose or falls out
• You have a fever or chills
• You have abnormal blood, fluid, or odor coming from your vagina

Things to consider

You should not use an IUD if you have abnormal vaginal bleeding. Cancer of the cervix or uterus or the AIDS infection prevent IUD use as well. You shouldn’t use an IUD if you are pregnant or want to become pregnant. You can, however, get an IUD immediately after giving birth. The best time for the doctor to insert it is after delivery of the baby and placenta.

IUDs do not protect you from sexually transmitted diseases or infections (STDs or STIs). To reduce your risk of getting an STD, use a condom when you have sex. IUDs can affect your menstrual cycle. At first, you may have pain, cramping, or spotting (light bleeding) between periods. This can last for 3 to 6 months. Hormonal IUDs can cause your periods to be irregular. They may also cause you to miss periods. Copper IUDs can cause worse cramps and bleeding during your period.

The benefits of IUDs include:

• Pregnancy prevention success rate of 99% when used properly
• Use of 3 to 12 years, depending on the type
• Can be removed by your doctor at any time
• Convenience
• Safe for women who just gave birth and/or are breastfeeding
• Cannot be felt during sex
• Low risk of side effects

Risks are uncommon, but include:

• Injury to the uterus when the IUD is being inserted
• Increased risk of pelvic inflammatory disease if you have an STD
• Chance of getting pregnant, in which case your doctor should remove the IUD (If you become pregnant, the risk of miscarriage and health problems for you and the baby increase.)
• Chance of an ectopic pregnancy (This occurs when an egg fertilizes outside of your uterus. It is rare but can be harmful for a woman.)

Questions to ask your doctor

• How do I know which IUD is right for me, or if I should use another form of birth control?
• Are there any other health conditions that prevent me from using an IUD?
• Does my age play a factor in which type and brand of IUD I get?
• Does my insurance cover an IUD?
• How often do I need to check my IUD, either by a doctor or myself?
• What happens after an IUD expires?

Resources

American Academy of Family Physicians: Birth Control Options

Centers for Disease Control and Prevention: Intrauterine Contraception

National Institutes of Health, MedlinePlus: Intrauterine Devices (IUD)

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Natural family planning (NFP) is a form of pregnancy planning. It does not involve medicine or devices. NFP helps people observe their body’s fertility signs to know when to have sexual intercourse. It can be used if you are trying to achieve or avoid pregnancy. It involves keeping track of a person’s bodily changes throughout the menstrual cycle. People may choose NFP for religious or personal reasons, or because they are concerned about the side effects of artificial means to achieve or avoid a pregnancy.

Path to improved health

Pregnancy can occur if sexual intercourse takes place right before or after ovulation. Ovulation is when the ovaries release an egg. It usually happens at around the same time each month. The egg moves toward the uterus through the fallopian tubes. This is where conception takes place. An unfertilized egg may live for up to 12 hours. The body will shed the egg during the menstrual period if it isn’t fertilized.

There are three methods of natural family planning. The first is the mucus or ovulation method. A woman checks and tracks her cervical mucus. During ovulation, your cervical mucus is stretchy, clear, and slick. It looks and feels like an uncooked egg white. You will write down your mucus’ consistency each day.

The second is the symptothermal method. A woman takes her daily basal body temperature (BBT) using a BBT-specific thermometer. You can take it in your mouth, vagina, or rectum. A regular BBT is between 97° and 98°F. At the time of ovulation, your BBT will rise between .5 and 1 degree. You should take your BBT in the morning before you get out of bed. Ideally, it should be the same time of day. You should use the thermometer the same way each day to get accurate results.

A third approach is the rhythm method. It is based on the calendar dates of a person’s previous menstrual cycles. This method can be more difficult and is not as reliable. It doesn’t allow for changes in the menstrual cycle, which are common. A normal menstrual cycle is between 28 to 32 days. The day a person starts their period is considered to be cycle day 1. Ovulation often occurs around day 14 of the menstrual cycle.

Sometimes, people combine the approaches. In all 3 methods, you must use a calendar or chart to track the data and changes. This predicts when you ovulate, so you can have or avoid sex. You may notice other symptoms you can track. These include bloating, backache, tender breasts, or pain in your ovaries. It generally takes 3 to 6 cycles of charting to get an accurate idea of your ovulation pattern.

Things to consider

You may choose to find someone who teaches NFP methods. You can ask your doctor or gynecologist for a recommendation. When you follow NFP methods to prevent pregnancy, the success rate is about 90%. When you follow NFP methods to conceive, on average, 2 out of 3 couples who don’t have fertility problems become pregnant. If you do not follow instructions completely, NFP will be less effective.

There are benefits and risks of NFP. It is free, or less expensive compared to the use of birth control or condoms, which can be expensive. NFP doesn’t have side effects. It meets certain religious guidelines. You can stop NFP at any time and it won’t affect your menstrual cycle. On the other hand, NFP requires you keep a constant schedule. If you veer from it or aren’t careful, you may not be successful. You may need to use back-up contraceptives. NFP can be hard if you have abnormal menstrual cycles or are breastfeeding.

Questions to ask your doctor

• Are there any health conditions that may prevent me from using natural family planning?
• What should my cervical mucus look and feel like when I’m not ovulating compared to when I am?
• How long should it take for me to rely on NFP?
• Do you recommend working with an NFP teacher?

Resources

American Academy of Family Physicians: Natural Family Planning

American Pregnancy Association: Fertility Awareness

National Institutes of Health, MedlinePlus: Pregnancy – identifying fertile days

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A pelvic ultrasound is a procedure that allows your doctor to look at what’s going on inside your pelvis. This is the space between your hip bones that contains the large triangle-shaped bone at the bottom of your spine (sacrum), your tailbone, bladder, sex organs, and rectum.

Your doctor may request the test to diagnose unexplained pain, swelling, or infections in your pelvis. A pelvic ultrasound is the best test to examine a growth in your pelvis. It helps your doctor determine if the growth is a fluid-filled cyst, a solid tumor, or another kind of lump.

A pelvic ultrasound is a safe procedure that can be a little uncomfortable. The test is performed on men and women of all ages. The ultrasound looks at different things for men and women.

During the test, a trained medical technician will squirt a small amount of warm gel on your skin over your pelvic area. The technician will move a handheld device (called a wand) through the gel and across your pelvis. The technician will monitor the images on a nearby screen and record the images for the doctor. The probe is connected to an ultrasound machine. As the device moves across your pelvis, it produces high-frequency sound waves. Those sound waves create real-time photos and video of the inside of your pelvis. The images look like an X-ray. However, ultrasound technology picks up things that aren’t seen by an X-ray.

Path to improved health

A pelvic ultrasound can be done one of three ways:

• Abdominally (the outer stomach)
• Vaginally (inside a woman’s vagina)
• Rectally (the area between the bottom of your large intestine and your anus).

The approach your doctor recommends for your ultrasound depends on the reason for your test and whether you are a man or a woman. A pelvic ultrasound can be used to look at the bladder for both men and women. Your doctor may recommend a pelvic ultrasound of your bladder if you are having difficulty going to the bathroom. It is used on men and women to guide a doctor during a biopsy procedure (inserting a needle into the pelvis to take samples of fluid or tissue).

A transabdominal ultrasound is commonly used to monitor the development of a baby in pregnant women at or before 14 weeks in their pregnancy. For this type of ultrasound, the technician will squirt a small amount of warm gel onto your stomach and move the probe or wand back and forth over your stomach. It will check the baby’s growth, such as height, the length of the baby’s arms and legs, head size, and more.

This type of ultrasound can check several factors during pregnancy, including:

• How far along the pregnancy is
• The baby’s position in the uterus
• The number of babies the mother is carrying
• The amount of amniotic fluid that surrounds the baby
• The baby’s heart

In some cases, it may be used to screen for certain conditions, such as Down syndrome. A transabdominal ultrasound also can be used to look for tumors in your uterus and other issues related to the female body, whether you are pregnant or not.

A transvaginal ultrasound is only used on women. It uses a specially shaped probe that can fit inside a woman’s vagina. The probe is covered with a latex condom. If you are allergic to latex, tell your doctor. The probe will be inserted into your vagina. If it makes you more comfortable, you can ask to insert it yourself.

This kind of ultrasound is used in early pregnancy to determine how far along a mother is and a due date. This method brings the probe closer to the uterus. This provides a clearer view of a fetus during a mother’s first trimester.

Your doctor may recommend a transvaginal ultrasound for other reasons, including:

• Locating an intrauterine device used for birth control
• Determining the cause of infertility (or to guide your doctor during a fertility treatment or procedure)
• Looking for (ovarian) cysts or other growths in your pelvis
• Determining the cause of abnormal vaginal bleeding or problems with your menstrual period
• Diagnosing unexplained pelvic pain
• Looking for an ectopic pregnancy (when a fertilized egg begins to develop outside of the uterus)

A transrectal ultrasound is used on men. The end of the probe for this type of ultrasound is shaped to partially fit inside a man’s rectum. The end of the probe is covered with a latex condom. This can be used to examine problems with the prostate (the gland that makes semen). It can also look at the glands that secrete some of a man’s semen (seminal vesicles).

Depending upon the type of pelvic ultrasound you are having, preparing may be different. For example, a transabdominal ultrasound to view your bladder requires a full bladder. Your doctor will tell you to drink four to six glasses of water one hour before your test. A full bladder moves your intestines aside to give the technician a better view.

If you are a woman, your only preparation for a transvaginal ultrasound is to let your doctor and technician know if you are allergic to latex. The same applies to transrectal ultrasounds for men.

Men also may need to take an enema one hour before a transrectal ultrasound to empty their bowels or intestines. This will improve the quality of the ultrasound pictures. For a prostate biopsy, men may be required to take an antibiotic to protect against an infection.

Tell your doctor if you had an X-ray that included a dye two days before the pelvic ultrasound. The dye will remain in your intestines and prevent the technician from getting quality photos and videos.

In all pelvic ultrasounds, you will be asked to put on a light hospital gown. This makes it easy for the technician to access your pelvis. You will lie on your back unless the technician needs you to turn to get a better picture. The procedure usually takes about 30 minutes. Your doctor or doctor’s office will call you with the results one to two days after the procedure. You might have mild discomfort from the pressure of the probe on your belly or near where the probe was inserted. Your body is not exposed to radiation during a pelvic ultrasound.

Things to consider

A pelvic ultrasound involves time and expense. It’s possible you may have to repeat the procedure because the first test didn’t produce clear photos. This can happen for several reasons:

• Being severely overweight may prevent the ultrasound from seeing deep enough into your pelvis
• Not having a full bladder
• Not having empty bowels, intestines, or rectum
• Having excess gas in your intestines (which blocks the view of your pelvic organs)
• Moving too much during the procedure
• Having an open wound in your belly

You may also have to repeat the procedure if you are undergoing fertility tests and treatment, which requires regular ultrasounds.

Repeat ultrasounds may also be needed if your doctor discovers a lump in your pelvis that requires further testing. Your doctor may require you to repeat the test in six to eight weeks to see if the lump has changed in size or appearance.

If you are a man, you may have to repeat a pelvic ultrasound of your prostate if your prostate is larger than normal. In that case, an ultrasound may not be an option. You may have to undergo a digital rectal exam (when your doctor inserts his glove-covered finger into your rectum), a blood test, or a biopsy.

Because they are done inside your body, there is a slight risk of infection with transvaginal and transrectal ultrasounds. See your doctor if you have abnormal discharge or fever after your ultrasound.

Questions for your doctor

• Will the probe from a transvaginal ultrasound harm my pregnancy?
• Should I take an over-the-counter pain reliever before I have a transvaginal or transrectal ultrasound to ease the discomfort?
• What else do I need to know to prepare for the test?

Resources

National Institutes of Health, MedlinePlus: Pregnancy Ultrasound

National Institutes of Health, MedlinePlus: Transvaginal Ultrasound

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Tubal sterilization (tubal ligation) is a surgical method of birth control. It is commonly referred to as “getting your tubes tied.” The surgery prevents a person from getting pregnant by closing off their fallopian tubes. These tubes carry an egg from the ovary to the uterus each month. Sperm swim up the fallopian tubes to join with the egg, resulting in pregnancy. When the tubes are closed, the egg and sperm cannot reach each other.

Tubal sterilization is a permanent form of birth control. It is one of the most effective options for preventing pregnancy. It is possible to reverse it, but it is difficult and not always successful. It doesn’t protect against sexually transmitted infections (STIs).

You don’t need your partner’s consent to have a tubal sterilization. But talking about the procedure beforehand is best for most relationships.

Path to improved health

Tubal sterilization is performed in a hospital or an outpatient surgery center. The procedure can be done on an outpatient basis at any time. Postpartum sterilization can take place right after a person gives birth, if it was a cesarean delivery (C-section). It can also be performed within hours or days of a vaginal delivery.

You will receive anesthesia before the procedure is done. You won’t feel anything. During the procedure, your doctor will likely make 1 or 2 incisions (cuts) in your abdomen. They will insert special instruments into the incisions. Using the instruments, they will seal off the fallopian tubes by blocking them with plastic clips, clamps, or rings. They may remove or destroy a small piece of each tube.

After the procedure, your doctor will close your incisions. You should be able to go home in a few hours. If the procedure follows childbirth, you shouldn’t have to spend any extra time in the hospital.

After the procedure

You may have some symptoms after the procedure, including:

• Abdominal pain, cramping
• Fatigue
• Dizziness
• Discomfort at incision site(s)
• Shoulder pain (this is due to a gas that is pumped into your abdomen to help separate your organs and give doctors room to perform the surgery)

As with any surgical procedure, problems can sometimes occur. Contact your doctor right away if you:

• Develop a fever
• Bleed from an incision
• Have severe stomach pain that won’t stop
• Have fainting spells

Recovery after tubal sterilization is usually complete in a couple of days. You may want to take it easy for a week or so. Avoid heavy lifting for 1 week.

You will still have a period after your tubes are tied. Some temporary forms of birth control, such as the pill, help irregular menstrual cycles. Sterilization does not impact your menstrual cycle. If you had irregular periods before using any type of birth control, you will likely have irregular periods again after sterilization.

Ask your doctor how long you should wait after the procedure before having sex. Don’t have sex until you feel comfortable. You usually need to wait about a week after surgery. You’ll have to wait at least 4 weeks if sterilization is done shortly after childbirth.

Things to consider

Tubal sterilization is a permanent form of birth control. If you think you might want to reverse the procedure someday, you should not have it done. Reversal is possible, but it’s a complicated, major surgery. Even a successful reversal doesn’t guarantee that you can get pregnant again. If you do get pregnant, you have an increased risk of complications, such as ectopic pregnancy. Plus, the surgery is expensive and is usually not covered by health insurance.

Remember that sterilization won’t protect you against sexually transmitted infections (STIs). Always use a condom during sexual activity to prevent STIs.

Some people worry that sterilization will change them, but it doesn’t. It won’t make you less feminine. It doesn’t cause weight gain or the growth of facial hair. It won’t decrease your sexual pleasure or cause menopause to start.

Talk to your doctor anytime you’re thinking about a new form of birth control, especially a permanent one. You have many choices. Make sure it’s the best choice for you.

Questions to ask your doctor

• Does permanent birth control offer the best choice for me?
• Are there other forms of permanent birth control?
• What if I want to reverse the procedure later on?
• When is the best time for me to have the procedure done?
• What are the risks involved with the procedure?
• Could I get pregnant after having a tubal sterilization?
• Does the procedure increase the risk of ovarian cancer?

Resources

National Institutes of Health, MedlinePlus: Tubal Ligation

S. Department of Health and Human Services, Office on Women’s Health: Birth control methods

U.S. Food and Drug Administration: Birth Control

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Whether you’re actively planning to become pregnant or not, preconception care during your childbearing years is essential. About half of all pregnancies in this country are unplanned. Unplanned pregnancies are at higher risk for preterm birth and low-birth-weight babies.

Preconception care means taking good care of your body and mind during the period when you can have a child. Everybody can benefit from this healthy living lifestyle. So if you’re trying to have a baby or just have an inkling you might want to in the future, here are some things you should focus on.

Path to improved health

The following are important steps to help you get ready for the healthiest pregnancy possible.

Up your folic acid. Folic acid is a B vitamin that our bodies use to make new cells. Folic acid is especially important at times like pregnancy when the cells are dividing and growing rapidly. Getting adequate folic acid can help prevent two common and very serious defects: spina bifida and anencephaly. Both occur as early as 3 to 4 weeks after conception, which is before many women even know they’re pregnant.

• Anencephaly is when a baby is born without the front part of the brain (forebrain) and the thinking and coordinating part of the brain (cerebrum). The remaining parts of the brain are often not covered by bone or skin.
• Spina bifida can happen if the backbone that protects the spinal cord does not form and close properly. This often results in damage to the spinal cord and nerves. It might cause physical and intellectual disabilities that range from mild to severe.

The U.S. Public Health Service and Centers for Disease Control and Prevention recommend that all women of childbearing age (between 15 and 45 years of age) consume 0.4 mg (400 micrograms) of folic acid every day.

Schedule a preconception checkup. It’s important to get any chronic conditions under control before you become pregnant. Identifying them now can help up your chances of having a healthy pregnancy for both you and your baby. Your visit should include discussions of:

• Your medical and family history. If you have certain conditions, such as diabetes, hypertension, asthma, seizure disorders, or maternal phenylketonuria, you’ll need to learn how to manage them during your pregnancy.
• Any vaccines or boosters you may need. Some vaccines can be given during pregnancy, but the rubella (German measles) and varicella (chicken pox) vaccines should be given before you get pregnant.
• All over-the-counter and prescription medicines you take. This includes vitamins, dietary and herbal supplements. Certain medications can cause serious birth defects, so be sure to mention everything you’re taking.

Stop smoking, vaping, using marijuana, and drinking alcohol. All of these can increase the risk for preterm birth, NTDs, fetal alcohol spectrum disorders, and sudden infant death syndrome (SIDS). If you need help to stop, speak to your healthcare provider about what types of support is in your area. You can also call 1-800-QUIT-NOW (784-8669) to be connected to your state’s “quit line.” For help with drug abuse, 1-800-662-HELP (4357) provides referrals to local treatment facilities, support groups, and community-based organizations. Having supports in place will increase your chances of quitting successfully.

Get to a healthy weight. Being overweight can make it more difficult to conceive. It also increases your risk of certain issues during pregnancy, including high blood pressure, gestational diabetes, having a stillbirth, and increasing the chances of needing a cesarean delivery. Shedding the weight before becoming pregnant can help improve your chances of conceiving and delivering a healthy baby.

The Centers for Disease Control and Prevention’s adult body mass index (BMI) calculator can help you determine your BMI and figure out whether you’re in the healthy range. Always talk with your doctor about the best way to achieve your weight loss goals.

Stay away from certain fish. Some fish, including swordfish, tilefish, king mackerel, and shark, contain a metal called methylmercury. Exposure can be harmful to a developing fetus. If you regularly eat these fish, methylmercury can build up in your bloodstream. Stay away from these four fish while you’re thinking of getting pregnant.

Other cooked fish and seafood are fine if you eat a variety of different kinds of fish. Choose up to 12 ounces (2 average meals) a week of fish and shellfish that are lower in methylmercury. These include shrimp, canned light tuna, salmon, pollock, and catfish. Keep in mind, albacore (“white”) tuna has more methylmercury than canned “light” tuna. So, when choosing your 2 meals, you may eat up to 6 ounces of albacore tuna per week.

Things to consider

Genetic counseling may be something you want to think about if certain conditions run in your family or your partner’s family. You also will want to know if a member of your family was born with a genetic condition, birth defect, chromosomal disorder, or cancer. Other reasons to see a genetic counselor include having had trouble getting pregnant, experiencing several miscarriages, infant deaths, or a birth defect with a previous pregnancy. Or if you or your partner are older than age 35.

A genetic counselor can meet with you to discuss potential genetic risks. At your appointment, you’ll discuss your medical, family, and pregnancy history. The counselor will explain what genetic conditions your future children may be at risk for depending on your history and recommend tests that can help diagnose any conditions. Once you gather all the information, you and your partner can make an informed decision about whether genetic testing is right for you.

Questions for your doctor

• What kinds of vitamins should I take that include enough folic acid?
• Are there any foods I shouldn’t be eating while trying to get pregnant?
• Are there any activities I shouldn’t be doing while trying to get pregnant?
• Could any of my current health conditions affect my pregnancy?
• Could any of my history (STDs, miscarriages, abortions) affect my future pregnancy?
• When should I stop using birth control?

Resources

Centers for Disease Control and Prevention: Planning for Pregnancy

National Institutes of Health, MedlinePlus: Steps to Take Before You Get Pregnant

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Using a diaphragm is a form of birth control. It prevents pregnancy by creating a barrier between a woman’s uterus and a man’s sperm. A diaphragm is a reusable dome-shaped cup. It fits over the opening of the cervix. It is common to use a diaphragm with spermicide. This is a gel, cream, or foam that kills sperm.

There are 4 types of diaphragms. They are made of either latex or silicone. The most common type is the arching spring diaphragm. It has a firm rim and is easiest to insert. It works best for women who have weak vaginal muscle tone. The coil spring diaphragm has a soft rim that is flexible. It works best for women who have average vaginal muscle tone. The flat spring diaphragm is similar but has a thin rim. It works best for women who have strong vaginal muscle tone. You can use a diaphragm introducer tool to insert both the coil spring and flat spring types. The wide seal rim diaphragm is a silicone option. It is best for women who are allergic or sensitive to latex. It comes in arching spring or coil spring shapes.

See your primary care doctor or gynecologist to get a diaphragm. They will help you decide which type of diaphragm is best and prescribe it for you. They will do an exam to measure you and find the correct size. If it is too small, it may fall out or not block sperm. If it is too big, it will cause discomfort. The most common size is 75 millimeters (mm). It is important that your diaphragm fits right. Your doctor will show you how to insert it properly and help you practice. It should rest right behind your pubic bone.

Path to improved health

Once your doctor fits you and you’ve practiced inserting your diaphragm, you are ready to use it.

Get your diaphragm ready. Before you insert your diaphragm, you should apply spermicide to it. Put about 1 teaspoon of it in the cup, or dome. Spread it around the rim of the diaphragm. Do not use petroleum jelly or oil-based vaginal creams, such as Monistat. These can make tiny holes in the diaphragm. You also can put some spermicide in your vagina.

Insert your diaphragm. You can do this from several positions. It is best to lie down, squat, or stand with one leg propped up. Your legs need to be open wide. Bending your knees can help. Once you’re in position, follow these steps:

• Use one hand to fold the diaphragm in half with the dome pointing down. Hold your vagina open with your other hand.
• Put the diaphragm into your vagina and aim for your tailbone. Push the diaphragm as far back into your vagina as you can.
• Use one finger to push the front rim of the diaphragm up behind your pubic bone. Aim for your belly button.

Check the placement of your diaphragm. With your finger, feel for your cervix through the dome of the diaphragm. The cervix will feel firm, but not bony. It feels a bit like the tip of your nose. If you cannot feel your cervix or if it is not covered, then the diaphragm is out of place. You need to remove the diaphragm, apply more spermicide, and insert it again. The diaphragm should not fall out when you cough, squat, sit down, or walk. The diaphragm is in place if it is above your pubic bone.

Use your diaphragm. You must use your diaphragm correctly each time you have sex. With spermicide, this method can prevent pregnancy. You should never use a diaphragm during your menstrual period. You will need to use another form of birth control at this time. Do not douche while you use a diaphragm. Do not leave a diaphragm in your vagina for more than 24 hours. This can cause irritation, infection, or a medical condition called toxic shock syndrome.

You need to apply more spermicide if you have sex more than once. Put some in your vagina, but do not remove your diaphragm. After sex, leave your diaphragm in place for at least 6 hours. To remove your diaphragm, hook your finger on the front rim. Gently pull it down and out. Try not to tear a hole in it with your fingernails.

Take care of your diaphragm. Wash your diaphragm with mild soap and water after each use. Rinse it off and allow it to air dry. Store the diaphragm in a container that is cool and dry. Check your diaphragm often for holes, tears, or leaks. To do this, fill the dome with water and look for damage. If you find any, do not use the diaphragm again. Get a new one from your doctor. If you keep using it, you increase your risk of getting pregnant.

Things to consider

Once a year, your doctor should check the fit of your diaphragm. It should be replaced about every 2 years. You will need a new one if you have a baby, have pelvic surgery, or gain or lose more than 15 pounds.

When you use a diaphragm and spermicide together, the prevention rate ranges from 70% to 99%. The large range leaves room for misuse. Diaphragms do not protect you from sexually transmitted infections (STIs). They also can cause urinary tract infections (UTIs).

Call your doctor if you have any of the following problems:

• Vaginal pain
• Trouble urinating
• Painful or frequent urination
• Vaginal itching
• Abnormal vaginal discharge
• This can be a sign of toxic shock syndrome

Questions to ask your doctor

• Why should I use a diaphragm over another form of birth control?
• Are there any reasons why I can’t use a diaphragm and/or spermicide?
• Does my insurance cover a diaphragm?

Resources

American Family Physician: Diaphragm Fitting

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Deciding to have a baby can be an exciting time for a woman. However, for women of any age trying to prevent a pregnancy, birth control (also called contraception) can help.

Path to improved health

There are many options for preventing a pregnancy. Whether it’s a method, a medicine, or a device, each has its pros and cons. Some choices are permanent. Others are reversible.

Abstinence: This means not having sexual intercourse. This is the only foolproof method for preventing a pregnancy.

Birth control pill: This is a popular form of birth control. Taken every day by mouth, the pill is 99% effective in preventing pregnancy when used as prescribed. If you miss a does, the effectiveness decreases. There are two types of birth control pills: the combination pill and the mini pill. The combination pill works by combining the hormones estrogen and progestin to prevent ovulation (which is necessary for a pregnancy to happen). This means your ovaries don’t release eggs. The hormones also make your cervical mucus thicker, which makes it harder for sperm to move. They also thin the lining of your uterus, which makes it harder for an egg to attach there.

Women who are sensitive to estrogen can take the mini pill. The mini pill only contains the progestin hormone. While it thickens cervical mucus and thins the lining of the uterus like the combination pill, it also slows the path of eggs traveling through fallopian tubes during ovulation. This helps prevent pregnancy.

Other hormone-based methods: These include a patch, shot, implant (under the skin in the arm), and a vaginal ring that releases the hormones. These methods are 93% to 99.95% effective.

Intrauterine devices (IUDs): This method requires a doctor to insert a small, T-shaped device into the uterus. There are two kinds: copper and hormonal (progestins). You may have pain and cramping when inserting and removing IUDs. Copper IUDs might increase menstrual cramping, as well. IUDs change the mucus inside a woman’s cervix (the lower end of a woman’s uterus). This prevents the sperm from meeting with the egg. They are more than 99% effective when used properly.

Vaginal barriers: Several birth control products can create a barrier between sperm and the uterus. This includes condoms (male and female), diaphragms, cervical caps, and contraceptive sponges. Male condoms are worn by the man. A woman can insert a female condom, diaphragm, cervical cap, or contraceptive sponge directly into her vagina. These methods are between 79% to 87% effective.

Sterilization: Both women and men have surgical options to prevent pregnancy. One option women have is a tubal ligation (some people refer to this as having their tubes tied). This procedure surgically blocks a woman’s fallopian tubes. This prevents sperm from entering the fallopian tube.

For men, a vasectomy is a form of birth control. This surgical procedure prevents sperm from mixing with a man’s semen when he ejaculates. This doesn’t interfere with sexual intercourse and is considered a permanent method of birth control. In some instances, the procedure can be reversed. However, it depends on age, circumstances of the first surgery, and potential health complications. Sterilization is more than 99% effective.

Spermicides: These foam or gel-like substances kill sperm. A woman can apply them directly into the vagina. These are around 79% effective.

Natural family planning: There is no medicine or device with this form of birth control. It relies on avoiding sexual intercourse in the days leading up to when you are more likely to be ovulating. Ovulation is the time when a woman is most likely to become pregnant. Sperm can live for a short period of time in the vaginal area. Ovulation kits and fertility monitors can help you determine if you’re ovulating. Even the visual presence of vaginal discharge (clear or cloudy, stretchy mucus) can mean you’re ovulating. However, natural family planning isn’t an exact science. This is effective about 76-98% of the time, depending on the method used.

Emergency contraception: This isn’t considered a typical method of birth control. It’s used in cases where no birth control was used during sexual intercourse. It also is used in cases when a woman knows that birth control has failed (such as when a condom breaks). It is available in the form of a pill (taken up to 5 days after unprotected sex). These are up to 87% effective in preventing pregnancy. A copper T IUD is another form of emergency contraception. This must be inserted by a doctor within 5 days of unprotected sex. This is 99% effective.

Things to consider

When choosing a birth control method you should consider your age and overall health. You also should consider the risks and possible non-contraceptive benefits of the method, medicine, or device. Estrogen-containing contraceptives, for example, can increase your risk of blood clots. Some hormonal methods can help with painful periods or heavy menstrual bleeding. You should consider how well your choice works for your needs. That includes thinking about whether or when you might want to start a family in the future.

Finally, consider how often you will have to manage your birth control. For example, birth control pills must be taken daily. If you can’t take a pill at the same time each day, you may want to consider another form. Some options (such as hormonal injections and vaginal rings) will last for up to a few months. Spermicides must be applied at least 1 hour prior to having sex. If you can’t plan ahead or wait, that method would likely not be good for you. Some vaginal rings can be left in for a few months. Barrier methods, such as diaphragms and cervical caps, must be removed after 6 to 8 hours. Condoms are immediately removed. However, intrauterine devices can stay in place for 3 to 10 years before having to be changed.

Questions to ask your doctor

• How do I know which method is best for me?
• Do certain birth control options cause cancer or other chronic diseases?
• Are certain forms better based on a woman’s age?
• Other than a male condom, can any other form of birth control prevent sexually transmitted disease?
• Are certain forms of birth control uncomfortable?
• Can I get free or low-cost birth control?
• How soon will this method protect me from pregnancy?
• How long do I need to use a backup birth control measure?

Resources

Centers for Disease Control and Prevention: Contraception: Birth Control Methods

National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development: Other Contraception and Birth Control FAQs

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According to the Centers for Disease Control and Prevention (CDC), the teen birth rate in 2020 was 15.4 births for every 1,000 females ages 15-19. This birth rate is down from previous years. However, many teenage pregnancies are unplanned and can be prevented.

Path to improved health

The CDC and the American Academy of Family Physicians (AAFP) support an evidence-based approach to sexual health education. This includes education that is comprehensive. The AAFP doesn’t recommend abstinence-only sexual education. Family physicians are trained to discuss all matters on sexual health. Teens should be able to talk to doctors, parents, or other trusted adults for information on how to prevent pregnancy.

There are two main ways to prevent pregnancy.

• Abstinence: The only way to prevent pregnancy 100% is to not have sex.
• Birth control: There are many types of birth control. Females can use a pill, patch, or shot. Another option is an intrauterine device (IUD). Both males and females can use condoms and/or spermicide.

Teenagers can get a prescription for birth control from their family doctor. Some local clinics, such as Planned Parenthood, also can provide access to birth control.

If you decide to be sexually active, you should use condoms even if you use other birth control. This is the only way to prevent sexually transmitted infections (STIs).

Keep in mind, birth control only works when used consistently. If you forget to take a pill or use a condom, there is still a chance of becoming pregnant. In this case, you can talk to your doctor about emergency contraception as a potential option. Also different states have different laws regarding parental approval of birth control, depending on the child’s age. Your family doctor can provide more information about the laws in your state.

Things to consider

Pregnancy health risks are greater for teenage girls and their babies. These risks include:

• Premature birth
• Low birth weight
• High blood pressure

When to see a doctor

Contact your doctor if you are or are thinking of becoming sexually active. He or she can talk to you about your options to prevent pregnancy and STIs. If you can’t see a doctor, visit a local clinic, such as Planned Parenthood, for assistance for sexual health.

If you become pregnant, see your doctor right away. It’s important to begin prenatal care as early as possible. Teenagers who are pregnant also should:

• Avoid alcohol, tobacco, and other drugs.
• Take a prenatal vitamin to support healthy growth and help prevent birth defects.
• Use condoms, if still sexually active. Condoms protect against STIs that could harm the baby.

Questions to ask your doctor

• Can anyone get birth control?
• What is the best type of birth control for me to use?
• How effective is birth control?
• What are the side effects of birth control?
• Do my parents need to know if I want to use birth control?
• What are my options if I become pregnant?
• What should I do if I miss a dose of my oral contraceptives?

Resources

American Academy of Family Physicians: Sex: Making the Right Decision

National Institutes of Health, Medline Plus: Teenage Pregnancy

Planned Parenthood

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A vaginal pessary is a plastic device in the shape of a circle that fits into your vagina. The device is used to support uterine prolapse. This means your uterus is drooping. A vaginal pessary holds your uterus in place.

Uterine prolapse happens because the muscles and ligaments that support your uterus are weak. Muscles weaken after giving birth or having pelvic surgery. Prolapse of the uterus is usually fixed with surgery. But you can also use a vaginal pessary to help keep the uterus in place.

A pessary can help if you have a cystocele. This is when your bladder droops down into your vagina. It can also help if you have a rectocele. This is when the wall of your rectum bulges into the bottom of your vagina.

In addition, a pessary can help many women who have stress urinary incontinence. This is the leaking of urine when you cough, strain, or exercise. Pregnant women who have incontinence can also use a vaginal pessary.

Path to improved health

Your doctor will decide which type of pessary you should use depending on the problem you have. The pessary must be fitted to work correctly and be comfortable. Your doctor will fit you with several different sized pessaries until he or she finds one that fits best.

After the first fitting, you’ll need to go back to the doctor’s office in a few days to have the pessary rechecked. Then you will probably be checked every few months. Sometimes the size or shape of the pessary will have to be changed.

How do I care for my vaginal pessary?

It’s important that you follow your doctor’s instructions about caring for your pessary. You can wear most pessaries for many days before taking them out to clean. They can be cleaned with simple soap and water. You may be able to take out, clean, and reinsert your pessary yourself. Your doctor may want you to come into the office so he or she can do it. Be sure to keep your check-up appointments and clean the pessary as your doctor tells you.

Things to consider

Many vaginal pessaries can be worn during intercourse. Your doctor will tell you if yours cannot. Be sure to tell your doctor if you have any discomfort with the pessary. Also let him or her know if you have trouble urinating or having a bowel movement.

You may notice more vaginal discharge than normal when using a pessary. Your vaginal discharge may also develop an odor. Certain vaginal gels can help with these side effects. Cleaning your pessary more often may also help with foul-smelling odor.

Vaginal irritation is another possible side effect. Women who are past menopause may need to use estrogen cream to help relieve the irritation.

Can the pessary get lost or fall out?

The vagina is a closed tube. The pessary can’t go anywhere else inside the body. However, it can fall out of the vagina if you strain too hard or lift something heavy. This usually means that your pessary is too small. Check with your doctor if your pessary keeps falling out.

Questions to ask your doctor

• Am I a good candidate for a vaginal pessary?
• Why should I choose a vaginal pessary over corrective surgery?
• Will a vaginal pessary make having sex uncomfortable?
• Will using a vaginal pessary put me at risk for urinary tract infections or vaginal infections?
• How will I know if the vaginal pessary slips out of place?

Resources

National Institutes of Health, MedlinePlus: Uterine Prolapse

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A Pap smear is a medical exam used to determine if a woman has cervical cancer. A Pap smear is also called a Pap test. It’s performed by a doctor, usually as part of a general pelvic exam. During a Pap test, the doctor collects cells from your cervix (located at the bottom of your uterus). These cells are then analyzed by a lab. The lab looks for anything unusual about the cells.

Why should I have a Pap smear?

Pap smears are an important part of women’s health. They are your best method for catching cancer early. In fact, a Pap smear can even detect pre-cancerous changes to your cells. If you do have these changes, your doctor can treat what’s causing them. Doing so may prevent the cancer from developing.

Path to improved health

When should I begin having Pap smears?

The American Academy of Family Physicians (AAFP) does not recommend Pap smears for women who are under the age of 21.

The AAFP recommends Pap smears for women ages 21 to 65.

The AAFP recommends against screening for cervical cancer (Pap smears) in women older than age 65 years who have had adequate prior screening and aren’t otherwise at high risk for cervical cancer.

How often do I need a Pap smear?

The AAFP recommends screening for cervical cancer in women ages 21 to 65, with a Pap smear every 3 years. Women ages 30 to 65 who want to lengthen the screening interval can opt to do a Pap smear with human Papillomavirus (HPV) testing every 5 years. This is because newer medical evidence suggests that there is not benefit to performing these tests more often.

Is there anything I should do to get ready for my Pap smear?

Be sure to tell your doctor about all medicines you’re taking. Some birth control medicines can alter the test results.

There are some things you should avoid before your Pap smear. For two days before your Pap smear, do not:

• Have sex
• Douche
• Use spermicides
• Use vaginal creams
• Use tampons
• Use vaginal deodorants

You also shouldn’t have a Pap smear during your menstrual period. Any or all of these things could make abnormal cells harder to identify.

What will my doctor do during the Pap smear?

Your doctor will insert a speculum into your vagina. A speculum is a tool that holds the vagina open so that the doctor can examine your cervix. The speculum does that by spreading the vaginal walls apart. Then your doctor will collect cells from your cervix using a long cotton swab or small soft brush.

Will it hurt?

The exam can be uncomfortable, but it’s not usually painful. When your doctor collects the cells from your cervix, you may feel slight pressure or a quick pinch. The entire exam takes only a few minutes.

How will I feel afterward?

You should feel completely normal after your Pap smear. But you may have some spotting (a small amount of bleeding) for a short time.

How long will it take to get my results?

You may hear from your doctor in as little as 1 week, but it may take up to 3 weeks to get your results. It depends on your doctor and the lab.

Do I need a Pap test after menopause?

You should continue to have Pap smears, even after menopause. You should have them until you are 65 years of age unless you fall into one of the other categories.

What if I’ve had a hysterectomy?

The AAFP doesn’t recommend Pap smears for women who have had a hysterectomy, with removal of the cervix, for a non-cancerous disease.

Things to consider

If you are notified that your Pap smear is abnormal, it doesn’t mean you have cancer. There are many reasons that your Pap smear results may be flagged as abnormal. Most of the time, an abnormal result is caused by an infection of your cervix. Or it could be a poor sample.

Your doctor may perform another Pap smear right away. Or your doctor may have you wait several months before doing another Pap smear. In these cases, they could be waiting for the abnormal cells to clear themselves. Even though it can be scary, know that an abnormal Pap smear is most often nothing to worry about.

If your results are still abnormal or not conclusive (certain), your doctor may perform a colposcopy. A colposcopy is a procedure where your doctor will use a small microscope to look at your cervix. He or she also may remove a piece of tissue during this exam. This is called a biopsy. The tissue will be examined in a lab to determine if cancerous cells are present.

If your doctor finds cancer, they will discuss treatment options with you. These will depend on the stage of cancer you have. Cervical cancer is treatable—and curable—if caught in the early stages.

Questions for your doctor

• Should I have a pap smear?
• Can my doctor perform a pap smear?
• Is there anything I can do to prevent cervical cancer?
• Am I at greater risk for cervical cancer if it runs in my family?
• What are the symptoms of cervical cancer?

Resources

National Institutes of Health, MedlinePlus: Pap Test

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