Wrap It Up or Pull It Out? Tips to Figure Out What Type of Contraception Works Best for You

Choosing a form of contraception can be quite the pre-dick-ament (ba-dum-tss, we’ll show ourselves out now). 

But in all seriousness, there are many birth control methods available, each with its own pros and cons. And what’s best for one person isn’t necessarily best for another, since there are many factors to consider—from side effects to cost to access to whether or not you’ll actually use it correctly every time. 

We tapped Dr. Mary Jacobson, Chief Medical Officer of Hello Alpha, for an answer. Below, she breaks down the basics of choosing a form of contraception. (Ofc, you should always speak with your doctor.)

Examples: IUD, implant, vasectomy, bilateral tubal ligation or removal

“The most effective contraception is the one people consistently use,” Dr. Mary says. That’s one reason long-acting reversible options like the IUD and the implant are so effective. ”People do not have to actively manage their contraceptive choice,” she says. Read: these are the low-maintenance, set-it-and-forget-it options. 

Vasectomy and bilateral tubal ligation or removal are other long-acting contraceptive methods, but she says these should be considered irreversible, so “don’t do them if you want to retain your fertility.”

One downside of all of these methods is that they require a procedure, so you need the means and the ability to go to the doctor. And if they aren’t covered by your insurance, they can have a high up-front cost. 

Examples: the pill, patch, ring, and progestin-only, self-injectable shot

“The pill, patch, ring, and progestin-only, self-injectable shot are simple and convenient forms of hormonal contraception,” Dr. Mary says. “Like the implant and progestin-only IUDs, these methods treat painful periods, endometriosis, and heavy menstrual bleeding. The combination of estrogen-progestin pills lower the risk of ovarian and uterine cancers, decrease PMS and PMDD symptoms, and improve acne.”

Many of these options can be prescribed via telehealth, making them good options for those who are unable to see a doctor in-person.

According to Dr. Mary, the downsides to these methods are that you have to remember to:

• Take the pill every day,
• Replace the patch and the ring every month, and
• Self-inject the shot every three months.

Examples: condoms, the diaphragm, vaginal gel, the rhythm method, and withdrawal (the “pull-out method”)

Dr. Mary calls these methods “simple and convenient,” noting that “only the condom is protective against STIs.” However, a major downside of all these methods are their failure rates. “The pull-out method has about a 22% failure rate, according to the Centers for Disease Control (CDC),” she says. “In other words, 22 out of one hundred females at birth will get pregnant. This compares to about an 18% failure rate for condoms, 17% for the diaphragm, 9% for the pill, patch, and ring, 7% for the vaginal gel, 6% for the shot, and less than 1% for the IUD, implant, bilateral tubal ligation, and vasectomy.” She notes that the diaphragm also increases the risk of bladder infections. 

You ask, we answer. Send your relationship questions to [email protected], and one of our experts may just answer them in an upcoming column.