Safer Sex

There is no such thing as 100% safe sex. The methods outlined below, when used properly, can help prevent pregnancy and the transmission of STIs.
Communication with your partner is also an important part of safer sex. Being able to talk about your sexual history and honestly disclose any concerns will help you figure out what kinds of methods are right for you (as well as help you and your doctor determine appropriate STI testing methods).

Abstinence

Abstinence is a choice. It’s the decision not to engage in some kind of sexual activity right now.
Abstinence is the only way to be 100% safe from sexually transmitted infections. This means abstaining from all activities that involve intimate contact. This means abstaining from intercourse, oral sex and anal sex. It also means abstaining from touching someone else’s genitals and then touching your own genitals without washing your hands first. It means abstaining from touching someone else’s genitals if you have cuts on your hands.
There are many different levels of abstinence. Every time you make a choice not to engage in sexual activity right now, you are abstaining.

Barriers

There are two barrier methods that can protect you and your partner from pregnancy: “male” condoms and reality or “female” condoms. Male condoms, reality condoms, dental dams, and gloves are all barrier methods that help prevent STI transmission.

(Male/Phallic) Condoms

  • Usually made out of latex, but can be made out of polyurethane, polyisoprene or sheep skin for those who are allergic to latex. The SHRC carries Lifestyles Skyn condoms, which are made of polyisoprene.
  • Condoms are worn by a male (or on a phallic sex toy) and can be used for vaginal, oral or anal sex. To prevent breakage, use lots of water or silicone based lubricant (though not necessarily for oral sex, in which saliva acts as an excellent lubricant all on its own). Be sure that your condoms fit properly, or they will be uncomfortable, possibly impact performance, and be more likely to break. For additional birth control, use hormonal birth control. There are ten steps to putting on a condom.

Reality/Female Condom

  • The Reality/Female Condom is a non-latex, polyurethane pouch with a small ring on one end and a larger ring on the other. In vaginal intercourse, the smaller ring fits over the woman’s cervix allowing the pouch to hang out of the vagina. The larger ring remains outside the vagina protecting the vulva. In anal intercourse the small ring is removed and the large ring remains outside to protect the external anal tissue. The penis is inserted into the opening of the pouch. This contraceptive method protects against STIs such as herpes or venereal warts that may have been outside of the barrier area with a male condom.
  • Water-based lubricant is recommended for use with a reality/female condom to prevent friction and tearing.

Dental Dams

  • Dental dams are small flavoured sheets of latex that are used for safer oral sex. Place one side down on the vulva or anus and touch the other side with your tongue and mouth. This ensures there is a barrier between the genitals and mouth, preventing transmission of STIs.
  • Some STIs can be passed by direct skin-to-skin contact. Cut a hole in a dental dam and place it around an erect penis, coupled with a male condom to provide more protection.
  • If you don’t have a dental dam available, you can make one using a condom or glove.

Gloves

  • Gloves can be used for manual stimulation of the genitals or anus, fingering, or fisting. Latex or alternatives can be found at most drug stores.

Condoms and Lubricant: The Perfect Couple!
The more lubricant you use with a condom, the less the chance of breakage and the greater the chance of increased pleasure for both partners.

  • Safe with condoms: water-based lubes, silicone lubes, and saliva!
  • May weaken condoms: Monistat/Estrace/Femstat/Vagisil vaginal creams
  • Do not use: anything oil-based, for example Vaseline (petroleum jelly), massage oils, baby oil.

Hormonal Contraception

There are a number of hormonal methods to choose from, including the birth control pill, the mini-pill, EVRA, the Nuva Ring, and Depo-Provera. Hormonal birth control methods provide no STI protection. All hormonal contraception involves the hormones (estrogen, progesterone, or both) being released into the body. They mimic a pregnancy, thus preventing ovulation. If no egg is released, then sperm have nothing to fertilize and pregnancy is avoided.

All hormonal contraception (except for Emergency Contraception, see below) must be prescribed by a doctor. Costs of hormonal birth control are not covered by the Ontario Health Insurance Plan (OHIP), and are covered by private health insurance do differing degrees. Many insurance plans will only partially cover oral contraceptives (birth control pills) and may not cover other forms of hormonal contraception (e.g. Nuva Ring, Depo Provera). Please click to find out information on the AMS Health & Dental Plan and the SGPS Health & Dental Plan.

Birth Control Pill (BCP)

The Pill should be taken every day at about the same time (within 1 hour) to ensure that the hormone levels remain the same. For example: when you put your underwear on in the morning or just before dinner/bed etc. Follow the markings on the packaging of the Pill to ensure you are taking the correct one on the correct day. On the 21st day you will either finish your pack (21-day pack) or start taking the placebo pill (28 day pack) for seven days. During this time, you will have your period. After seven days you will start a new pack of Pills.

Note: The pill must be taken for at least a month before it becomes fully effective. If you miss a pill, be sure to use an additional method of contraception to protect yourself from unwanted pregnancy. If you forget to take your pill, take it as soon as you remember. Read the insert provided with your pills for further instructions. Many women ask about taking the pill continually in order to avoid getting a menstrual period. It is okay to do this depending on the brand (talk to your doctor) but not for many months in a row. This means that if one month you want to avoid getting your period, because of a vacation for example, you can start a new pack the day after the last pack. However, if you do this repeatedly the lining of your endometrium (the wall of your uterus that you shed during your period) will continue to grow and you may have breakthrough bleeding. When you finally do take the week off or the week of placebo pills, your period will be heavier due to thicker build up of the endometrial layer.

Depo-Provera

This is an injection of hormones that is given once every 3 months by a nurse. This is a progestin-only method that does not contain estrogen, and may be suitable for people who have adverse reactions to the hormone estrogen.

Patch

The patch releases hormones into the body though the skin. It is placed somewhere on the body where it will not be rubbed off by friction. A new one is applied every week for three weeks. On the fourth week no patch is applied and breakthrough bleeding occurs.

The NuvaRing

The NuvaRing is a ring of silastic tubing filled with slow release hormones that are released into the body through the vaginal wall. The ring is inserted into the vagina and sits around the cervix for three weeks. It is removed for the fourth week at which point you will get you will experience breakthrough bleeding. After one week a new ring is inserted. This method requires you be comfortable inserting, removing and adjusting the placement of the ring in the vagina. It can be worn during sexual activity.

The IUD

The intrauterine device is a small t-shaped device that is composed of some copper wire and it releases progesterone. A physician inserts it into the uterus, and two small wires remain outside the cervix to help verify position and placement. The progesterone release prevents pregnancy in a similar method to the pill. Non-hormonal versions of an IUD use copper wiring, which makes the uterine wall inhospitable to implantation. The IUD has to be removed by a physician and is not a commonly recommended contraceptive method for younger women. The hormonal IUD is approved for up to 5 years of use, while the copper one for 7-10 years.

Natural Family Planning

This method is not recommended for people who are may not want to risk pregnancy. There are four methods:

  1. Calendar Method: Examination of past menstrual cycle length and timing are used to estimate fertile period.
  2. Temperature method: Daily temperatures recordings are used to estimate fertile period.
  3. Cervical mucus method: Changes in cervical mucus are monitored to determine the fertile period.
  4. Sympto-thermal method: Monthly temperature changes and cervical mucus are monitored to determine the fertile period.

These methods can be used to increase or decrease chance of pregnancy. Contraceptive effectiveness is very low since sperm can live in the female body for at least 48 hours.

Emergency Contraceptive Pill (ECP)

This is NOT a form of birth control or a form of abortion. ECP can be taken within 72 hours of unprotected intercourse to prevent pregnancy for occurring. It consists of 2 large hormone doses (taken 12 hours apart) that prevent the egg from implanting in the uterus. You do not need a prescription for ECP, and you can get ECP over the counter at most pharmacies.

The emergency contraceptive pill can be taken within 72 hours of unprotected sex, sex where contraception fails (e.g. a condom breaks, missed birth control pills), or sexual assault to prevent an unwanted pregnancy. The ECP is also known at Plan B or “the morning-after pill”.

When should I take ECP?
ECP can be taken if you have had unprotected sex one or more times within the last 72 hours (three days). It is more effective the sooner the pills are taken. Plan B (a kind of ECP) consists of two pills. The first pill needs to be taken within 72 hours of unprotected sex/contraception failure. The second pill is taken exactly 12 hours later. If it has been more than 72 hours, Plan B may still work but the risk of pregnancy increases as time passes.

What are possible side effects?
Plan B can cause temporary side effects in some women. These side effects generally don’t last more than 24 hours. Common side effects may include: nausea, vomiting and/or irregular menstrual bleeding. You should see a doctor immediately if you experience itching all over your body or cramping or severe pain in your belly/abdomen before your next normal period.

How will taking the ECP affect my period?
Taking Plan B will not bring on your period. Some women may experience spotting a few days after taking Plan B, but this is not your period. Your next period should come on time but it may be a few days early or a few days late. If your period is delayed more than a week, we advise you take a pregnancy test.

Where can I get ECP?
A doctor’s prescription is no longer required to get ECP. It is available over the counter as most pharmacies (try Shopper’s Drug Mart Midtown, 445 Princess St., right at Division or the Queen’s Centre Pharmacy). Expect to pay $20-$40 as price varies from pharmacy to pharmacy and brand to brand.

ECP is NOT birth control. Repeated use of the ECP may cause your menstrual cycle to change, and ECP becomes less effective the more frequently you take it. If needed, a sexpert would be happy to discuss a regular birth control method with you at the centre, or over the phone.