The Male Condom

This is quite popular and easy obtain and use. No doctor visits or prescriptions are required, and it does not mess with hormones. The mechanism is simple and there is no mystery to how it works. It is fine if you have intercourse occasionally, but as you can see from these graphs, the effectiveness over time, is fairly low. So it is not a good long term solution.

The male condom, does however, protect against STDs and is the best option for casual sex, or in the early stages of a relationship. In these cases, it is also best to use it for anal and oral sex as well.

If you are worried that one condom may be damaged and are using 2 to be extra safe, you should know that using 2 condoms at once (double bagging as it is called) is less effective than using one since the friction between them can cause tears. The same is true for using a male and female condom simultaneously. Condoms are, however, quite effective against STDs, if properly used.

Birth Control Pills (Hormonal)

I have never personally used these but here is what I have found out

These usually refer to pills which contain both estrogen and progesterone and are quite effective as long as you remember to take the pills regularly. They are hormonal treatments and require regular check ups and prescriptions.

There is also the possibility, that they marginally increase the chances of breast cancer and significantly reduce the chances of ovarian cancer. There is also an increased risk of cervical cancer but a reduced risk of endometrial cancer.

They are likely to reduce menstrual bleeding and cramps. There are also Progestin-only pills and injections, you can find out about if you are interested. Again there are pros and cons. I don't know if these are available easily in India.

The Copper Intra-Uterine Device (IUD)

I have written a detailed article about IUDs, what they are, how they work, and what to expect, for Women's Web. Here is the gist.

This is a very popular, long-term reversible form of contraception in India. A T-shaped, copper, device is placed in the uterus that prevents fertilization, since copper acts as a natural spermicide and the copper ions create an environment, hostile to fertilization.

The insertion is usually done on the fifth day of the menstrual cycle.

Pros:

• No messing with hormones.

• User proof. Once the IUD is in, there is nothing you have to do.

• Reversible and fertility returns as soon as device is removed.

• Can be used while breast feeding.

• Very effective

• Possibly works as an emergency contraceptive

Cons:

• Increased menstrual bleeding and cramps. Personally, I found, that periods got heavier and more painful and the cycle go shorter.

• Small risk of transient bacterial infection post insertion, which can, most likely, be avoided with antibiotics. I did not face this problem. the doctor had me take a course of antibiotics, post insertion.

• There is a chance that the IUD gets expelled unnoticed. In that case, you can get pregnant.

• I had a surge in yeast infections after using an IUD, almost once a month. They started after 3 months of using the IUD. Before that, I had only had 4 or 5 yeast infections in my life. Even though the doctor told me, there was no connection between the two, I decided to drop the IUD, and then the yeast infections stopped. Later, I found this interesting article on the subject. It is possible, that an IUD does not cause yeast infections, but if you happen to contract one, the IUD, probably, makes it more likely, that it will recur, because the Candida clings to parts of the IUD.

Natural Cycles

After having trouble with the IUD, I was looking for an alternative method of contraception. That's when I came across Natural Cycles. It is an app developed by a nuclear physicist (yes that piqued my interest), that is considered a contraceptive in the European union, after it was approved as a medical device by a German based certification organization, and is now awaiting FDA approval.

Pros:

• The app closely monitors your cycle. You have to enter, your basal body temperature and you may also add ovulation test results. The app processes this data using an algorithm to predict your fertile (red) and safe (green) days. In doing this, you get to really understand your cycle.

• You don't have to take pills, medications or hormones or do anything invasive.

• There are no side effects.

• Fertility is not affected. It is simply monitored. The app can be used to plan a pregnancy as well.

Cons:

• You need to read the instructions carefully, collect the data properly, and enter it accurately and regularly. This requires some discipline. The more data you enter the better the app gets at narrowing down your fertile period.

• You need to have a fairly regular lifestyle, for the data to be meaningful. If you have erratic sleep schedules, or are intermittently sick, the data could be messed up.

• You need internet connectivity when you are entering the data.

• You need to remember to use alternative contraception like a condom, or abstain, on fertile days, when sex may be most pleasant.

• It takes, at least, a couple of weeks for the app to get to know your cycle, and a few months for it to give reliable results.

Personally, I like the app because clinical studies show it to be more effective than the pill, and it does not mess with my body chemistry in any way. Instead of fighting my body, it tries to get to know my body and work with it, and also helps me to get to know my body better.

To be honest, initially, the idea of using an app, made me very uncomfortable. What if my cycle was irregular? But over time, I have come to see, that it does not work like magic. I can see my temperature profiles and how they vary with cycles, and how much my ovulation date changes with cycles, and I can make some broad predictions myself. The app does it far more accurately. Your cycles and ovulation day can vary, and Natural cycles takes that in to account and uses the temperature data to make accurate predictions.

I feel more comfortable with the green days after ovulation, because then there is no egg left to fertilize. Since sperm can survive for about 5 or 6 days, the green days before ovulation, still make me a little uncomfortable, but the app seems to be cautious, in taking in to account sperm survival.

There are some other options like diaphragms, hormonal IUDs, Nuva-ring etc that you can look up. And then there is the permanent option of male or female sterilization too.

Image source: Natural Cycles website