My boyfriend and I have become sexually active over the last few months and for a number of reasons I have decided not to go on the Pill. My mum has suffered from phlebitis, and is at risk of deep vein thrombosis, so it wouldn’t really be recommended for me. Also, I feel that the relatively minor extra protection of hormonal contraception over condoms wouldn’t be worth the potential side-effects and the disruption to my natural cycle. (I’m an earthy kind of person!)
However, despite believing that I’ve come to a good decision based on solid reflection, I still get really nervous once a month that I might be pregnant. Even if I know that we always use condoms very carefully, I find it really hard to relax when my period is due. I’m sure this is normal enough for someone who has just started having sex, but I have been treated for anxiety in the past so it is in my nature to take things too seriously. (I also had friends in high school who said that girls that don’t go on the Pill are ‘irresponsible’ and who over-exaggerated the unreliability of condoms.) I would access emergency contraception straightaway if I was aware that a condom broke of course, but I live in a country where abortion is illegal.
There is a fairly good chance I won’t get pregnant using condoms properly, right? Or given my nervous nature, do you think the solution would be to go against my better instinct and settle for a hormonal method and peace of mind? I know that abstinence is the only 100% protection against pregnancy, but I would like to find the confidence to be able to have sex and not face these mini-freaks out once a month!
Well, that seems reasonable! And before we go any further, let's go ahead and state the obvious: yes, abstinence is a particularly ironclad method of avoiding pregnancy, in the same way that never going swimming is a particularly ironclad way to make sure you don't drown. And yes, there's a contingent of people who will no doubt enthusiastically insist that you shouldn't be having sex in the first place if you're not prepared for the worst-case outcome.
But because these are totally useless admonishments for anyone who, like the letter-writer, has made an informed and mature decision to become sexually active, and who considers sex to be a natural, healthy and essential part of a committed relationship, we're not going to waste our time discussing it.
And with that out of the way... birth control! Everyone put on your Sex Education hats and grab a beverage!
For starters, here's the skinny on condoms as a birth control method: if used correctly, they have a failure rate of approximately 2%. (For curious parties: using condoms correctly requires A) leaving a reservoir of space in the tip, so that ejaculate can't bleed out the bottom, and B) making sure that Mr. Johnson is wearing his raincoat on before he goes anywhere near a vagina.)
And needless to say, a 98% success rate is certainly nothing to sniff at—it's an A+ average, after all—but hormonal birth control (the pill, the ring, the patch, the shot) has a failure rate of 0.3%. So, on the one hand, we're talking a measly 1.7 percentage points of difference; on the other, we're talking about hormonal birth control being six times more reliable than condoms. You can look at it either way, but statistically speaking, it's not surprising that people consider the pill and its ilk to be a superior choice. (Also worth noting: when you use them in combination—hormonal birth control plus a barrier method—your chances of unwanted pregnancy more or less dwindle to the point of statistical insignificance.)
In short: yes, condoms are extremely reliable on their own, and yes, your chances of getting knocked up while using them are extremely slim. But here's the thing: truly effective birth control is as much about peace of mind as it is about pregnancy prevention. And if you can't achieve that with condoms, then you need to accept that they're not working for you. Maybe those two percentage points of wiggle room are enough to make you nervous; maybe your anxiety is being exacerbated by the fact that, effective as they are, they're entirely your boyfriend's responsibility to use and use correctly. (After all, one of the big draws of the Pill is that it gives women the ability to control their own fertility.)
Which is not to say that you have to choose hormonal birth control. I do think you should look into it—it's by far the most convenient and effective option, and you can always opt for medications that contain low hormone levels and/or have fewer associated risks. But there's also spermicide, cervical caps, diaphragms. Depending on your age and medical history, there's the possibility of an IUD. Or if you're feeling really adventurous (and if you have a few hundred bucks to shell out up-front), you could try using this petite computer called Lady-Comp to track your cycle naturally. (Apparently it's as effective as the pill but completely all-natural, despite sounding like something out of Star Trek.)
Basically, you have options. And what's important is that you exercise them to find an additional or alternative method of birth control which, like you said, gives you the confidence to enjoy your sex life without the monthly pregnancy panic. So do your research, talk to your doctor, and see if you can't find a solution—or several—that puts you in a better place.
Do you have birth control questions? Share 'em the comments! And to get advice from Auntie, email her at email@example.com.
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