Sarah Lawrences the ins and outs ...

So, I went to this clinic to learn about birth control. It was kinda cool. The woman took me into this little room that had comfy couches and pictures of ovaries on the walls. She had this large plastic container that held the keys to my questions.

She asked me what I knew about birth control and I decided to play dumb. I wanted to get the full spiel from her.

She told me that there are two types of birth control:

First she talked about "barrier methods." These include condoms, diaphragms, female condoms, and let's not forget about the Lea Shield! Essentially, all these methods are like walls between the sperm and the cervix and are most effec- tive when used in combination with spermicidal gel, foam, and/or cream. Although spermicide reduces the risk of pregnancy, it also contains nonoxynol-9, a chemical which may cause irritation, allergic reaction, and increase the risk of STIs.

Condoms are the number one invention of all time! Condoms are probably the best form of contraceptives out there for us young gals. Not only do they protect you from pregnancy but also from STIs — BUT you gotta learn to use them properly. They are 85% to 98% effective; condoms with a spermicide are most effective. Many condoms are made of latex (but there are many other kinds), which is a thin plastic- like material. You slide the condom over the penis before you have sex and it catches all the cum when he ejaculates.

A diaphragm is a shallow cup made of rubber, shaped like a dome. You have to be fitted by a doctor and it can be reused for up to a year. It's made of soft material so that you can fold it and place it up inside your vagina. You need to be refitted if you have an abortion, get pregnant, or gain or lose weightof4.5kg(10lbs)ormore.Thediaphragmcanbeused while you are on your period. You put it in with spermicidal jelly and bonk away. Six hours after the bonking is done, you remove it.You have to squirt more gel up your vagina periodi- cally. Oh, and you have to use a condom with it to help protect you from those nasty STIs and HIV!

To use a diaphragm, you have to be very comfortable touch- ing your vagina. I thought about my friends using it. There are a few that would, but on the whole it seems like some- thing suited for older women who have had some time to get used to tampons without applicators and the like.

The female condom is a long plastic baggy that is made of polyurethane or plastic. It has a ring at the top and at the bottom. You insert the closed side in and it sits up against your cervix, like a diaphragm, while the other ring sits out- side of your vagina. Apparently it can be rather noisy while you are having sex. It lies over top of your clitoris; some women find it reduces the pleasure, while other women find it increases it, with the ring being there and all.

Next is Lea's shield. This is the most bizarre thing I have ever seen. It looks kinda like the space ship Enterprise, from Star Trek. It was designed by this guy and he named it after his wife LEA. (I thinks that's really funny!) It goes up inside your vagina against your cervix and it blocks the sperm, BUT it has this valve that allows some vaginal fluid to be released, which helps with the lubrication. Pretty cool, eh? You need to use spermicide with it and keep it in six to eight hours after sex. In Canada, this is something you can buy in a drug store. In the US, you need a prescription. Lea's shield is made of silicone and it lasts for a long time, but you have to be super comfortable with touching yourself and sticking objects up your vagina!

OK so then there are the various spermicides—creams, gels, films, and foams. These all work to prevent sperm from getting to your eggs by killing the sperm before it reaches your cervix. You use them with other barrier methods, especially condoms or a diaphragm, for extra protection. Some women have uncomfortable reactions to the chemicals in spermicidal gel and foams; film can be less irritating. Spermicides should not be confused with lubri- cants such as K-Y or Astroglide. Lubricants don't kill sperm; they help make a condom safer (as long as they are water- based!) and more pleasurable by making sure everything is slippery enough and won't tear as easily.

After the woman at the clinic showed me all the barrier methods, she took out all these little packages of pills. Some packages of hormones were round, others square.

The Pill is something most of us have heard about. There are a lot of pros and cons when it comes to the Pill and it's a really personal decision.

How the Pill works is that you take it every day at the same time and it tricks your body, with hormones, so that you don't ovulate (see Chapter 2 for more information). When you have sex, there is no egg to fertilize so you can't get preggers! If you forget a Pill you have to take it right away or double up the next day and use condoms for sure for the rest of the month. Some women don't use condoms when they are taking the Pill and so are putting themselves at risk for STIs, including HIV/AIDS.

Other drawbacks are that not everyone can take it. You shouldn't take it if you have high blood pressure or a family history of severe high blood pressure. There are potential side effects with the Pill: some women retain water, their breasts get bigger, and it can affect your skin (more or fewer acne pimples). Some women feel less interested in sex, some are more interested in sex, some have headaches. Many women don't experience any side effects.

Besides being really easy to use, the positive aspects of the Pill are: it reduces the risk of endometrial and ovarian cancer, and it makes your period shorter and less painful.

To get the Pill, you need to make an appointment to see a doctor. The doctor will check your blood pressure and review your family history. It's a good idea to have an internal exam and a breast exam either before you start the Pill or within the first three months, especially if you're sexually active. The doctor may ask you to return in three months to check to see if you are OK and to check your blood pressure. Sometimes you have to try different types of Pills before you find one that works for you. If you find the Pill you are on is causing bad side effects, you can be switched to another type. You have to be patient.

Nuva Ring is a flexible contraceptive ring that is made of vinyl acetate and magnesium sterarate. It is about five centimeters (two inches) in diameter and is used to prevent pregnancy. You insert it into your vagina just once a month. The muscles in your vagina wall will keep it in place for three weeks. During this time, it will slowly release a low dose of the hormones estrogen and progesterone that prevent pregnancy. When 21 days are completed, remove Nuva Ring to let your body have its menstrual cycle (period), and after 7 days, you put in a new ring. You need to use a condom with this one too 'cause it doesn't protect against STIs and HIV/AIDS.

Ortho Evra, better known as "the patch", releases a steady dose of estrogen and progestin hormones that prevent preg- nancy. A new patch is worn every week (in a different spot each week) for three weeks. The patch is 4 cm x 4 cm (1.5 in. x 1.5 in.), beige or brown, and can be applied to the lower abdomen, buttocks, upper back, or outside upper arms, but not to the breasts. The skin must be healthy and clean of lotion, perfume, make-up, and powder. The patch is extremely sticky and will stay on your body even if you shower, sweat, swim, or go to a sauna. Your first patch should be applied on the first day of your period – if you apply it 24 hours after, you won't be protected against pregnancy for the next week. During the fourth week, you don't wear the patch. This is the week you'll have your period. Some women may feel sore breasts and/or itchy skin around the patch. The patch is just as effective as the Pill, and has a 98% stick-on rate. Remember those condoms! No STI or HIV/AIDS protection here either.

I had also heard about something called Depo-Provera, so I asked the woman about it. Yikes! Good thing I did. Depo- Provera is a long-acting progestin (hormone) form of birth control. It is injected into the deltoid muscle (in your arm) every 11 weeks. It starts being effective 24 hours after your first injection if given in the first 5 days of a normal menstrual period.You will need to receive your injection promptly every 11 weeks in order to continue your contraceptive protection. The woman said Health Canada had issued an official warning against Depo-Provera due to research that shows it may cause irreversable loss of bone mass density and can contribute to osteoporosis. Doctors were encouraged not to give D-P to teens.