By Elizabeth Akincilar, MPT, Cofounder, PHRC Merrimack
In a post-Roe world, conversations and questions about birth control options are on the rise. Currently, everyone still has a constitutional right to contraceptives. There are many ways to prevent pregnancy, including oral medications, implantable devices, injectable medications, barrier methods, surgical interventions, fertility awareness, and abstinence. There are advantages and disadvantages for each, so this blog will break each option down to help folks make informed decisions for their own birth control needs.
Hormonal birth control: Nexplanon
The birth control implant is commercially known as Nexplanon. It is a very small rod inserted under the skin in the upper arm. It is invisible and can prevent pregnancy for approximately four years. It works by releasing the hormone progestin to prevent pregnancy. Progestin makes it difficult for sperm to get through the cervix and it prevents the ovaries from releasing eggs. The implant can be removed at any time and pregnancy is possible soon after removal. Although the implant is over 99% effective at preventing pregnancy, it does not provide protection against sexually transmitted infections.
Hormonal birth control: Depo-Provera injection
The Depo-Provera injection also releases the hormone progestin. Each shot lasts three months and works in a manner similar to Nexplanon in that it prevents ovulation and inhibits the sperm from traveling easily through the cervix. To ensure the Depo shot is most effective you have to get a new shot every 12-13 weeks. That’s about every three months, or four times a year. It is approximately 94% effective in preventing pregnancy if administered correctly, but it does not provide protection against sexually transmitted infections.
Hormonal and Non Hormonal birth control: Intrauterine Device (IUD)
An intrauterine device, or IUD, is a tiny t-shaped device that’s inserted into your uterus to prevent pregnancy. It is long lasting, is easily removed, and one of the most effective birth control methods available. There are two types of IUDs, hormonal and non-hormonal. The hormonal IUD releases a small amount of progestin into the uterus which prevents the sperm from fertilizing the egg which prevents pregnancy. Hormonal IUDs last approximately four to six years. The non-hormonal IUD is a copper device, commercially called the ParaGard. It lasts up to 12 years and prevents pregnancy by releasing a small amount of copper into the uterus which prevents sperm from fertilizing an egg. Both types of IUDs are 99% effective in preventing pregnancy, but neither provide protection against sexually transmitted infections.
There are five different brands of hormonal IUDs that are FDA-approved for use in the United States: Mirena, Kyleena, Liletta and Skyla.
Hormonal Birth Control: Oral Contraceptive Pills (OCPs)
Oral contraceptive pills (OCPs) contain hormones and must be taken at the same time every day to prevent pregnancy. Currently, there are two types of oral birth control pills.
- Combination pills (aka combined oral contraceptives, or COCs). Combo pills have both estrogen and progestin and are the most common type of oral contraceptives.
- Progestin-only pills (aka POPs or mini-pills). Progestin-only pills only have progestin.
Both types of pills work by preventing ovulation and thickening the cervical mucus making it difficult for sperm to move through the cervix. They are approximately 91% effective in preventing pregnancy when taken correctly, but they are not effective in preventing sexually transmitted infections.
OCPs are often prescribed because they can reduce dysmenorrhea (painful periods) and reduce menstrual blood flow in addition to preventing pregnancy. However, OCPs reduce available estrogen and testosterone which may cause vaginal dryness, painful sex, vulvar pain, and altered vaginal pH which can increase susceptibility to vaginal infections.
Many healthcare providers fail to educate their patients of the possible consequences of OCPs. The symptoms may develop shortly after starting the pill or they could develop after taking OCPs for months or years. If you are taking OCPs and develop any of these symptoms you should discuss alternative birth control options with your healthcare provider.
Want to learn more about Oral Contraceptives? Check out our blog by Joshua Gonzalez, MD, “Jagged Little Pill: How Oral Contraceptives Wreak Havoc on the Female Body”.
Hormonal birth control: vaginal ring
The vaginal ring is a small, flexible ring inserted inside the vagina. It is replaced monthly. It prevents pregnancy by releasing the hormones estrogen and progestin into the body which prevents ovulation and sperm from fertilizing the egg. There are two kinds available in the United States, the NuvaRing and Annovera. The ring is approximately 99% effective in preventing pregnancy, however it does not prevent sexually transmitted infections.
Hormonal birth control: patch
The birth control patch is a transdermal contraceptive patch (worn on certain parts of your body: belly, buttocks, or back). It must be replaced weekly. It works similarly as a combination birth control pill in that it releases both estrogen and progestin which prevents ovulation and sperm from fertilizing the egg which prevents pregnancy. There are two kinds available in the United States, the Xulane patch and the Twirla patch. When used perfectly it is 99% effective in preventing pregnancy, but in reality, due to improper use, it is realistically approximately 91% effective. It is not effective in preventing sexually transmitted infections.
Non Hormonal birth control
The following birth control methods must be used at every sexual encounter to prevent pregnancy if they are the only method being used.
External condoms are considered a barrier method and help to prevent sexually transmitted infections (STIs) in addition to pregnancy by placing a soft plastic barrier over the penis. Condoms, if used correctly, prevent sperm from entering the vagina. If they are used correctly they are 98% effective in preventing pregnancy, however, most people do not use them correctly.
Internal condoms are nitrile (soft plastic) pouches that are placed inside the vagina. They cover the inside of the vagina, creating a barrier that stops sperm from reaching an egg. They need to be replaced every sexual encounter.
Learn all about condoms in a previous PHRC blog by Elizabeth Akincilar, MPT.
The diaphragm is a small device that is inserted into the vagina. It covers the cervix to prevent sperm from reaching the egg. The diaphragm is most effective when used with a spermicide. It is approximately 92-96% effective in preventing pregnancy when used correctly, however it does not protect against sexually transmitted infections.
Spermicide is a non-hormonal option available over the counter that inhibits the mobility of the sperm making it harder for it to reach the egg. It is inserted into the vagina prior to sexual contact. It is approximately 72% effective in preventing pregnancy, however it does not prevent sexually transmitted infections.
Birth control sponges are inserted in the vagina up to 24 hours before sex. It covers the cervix and contains spermicide making it difficult for sperm to fertilize the egg. It is approximately 80% effective in preventing pregnancy, however it does not prevent sexually transmitted infections.
Alternative birth control methods
Many couples do not like the barrier methods for varying reasons. A few more options exist that come with their own risks and advantages.
People practicing fertility awareness become aware of their fertile days and either abstain from intercourse on these days or use a barrier method of birth control to prevent pregnancy. Fertility awareness is approximately 76-88% effective in preventing pregnancy, however does not prevent sexually transmitted infections.
The four most common methods of fertility awareness are:
- Standard Days: knowing which days during one’s cycle are the most fertile
- Cervical mucus: recognizing the changes in the cervical mucus
- Basal Body Temperature (BBT): monitoring one’s basal body temperature
- Symptothermal: combines the BBT and cervical mucus methods
The withdrawal method is when the penis is removed from the vagina and ejaculation occurs outside of the vagina. The withdrawal method is approximately 80% effective in preventing pregnancy, but is not effective in preventing sexually transmitted infections.
Outercourse prevents pregnancy because penetration and ejaculation inside the vagina are avoided. Examples of outercourse are kissing, massage, masturbation, dry humping with clothes on, anal sex, and oral sex. Outercourse is virtually 100% effective in preventing pregnancy. Some examples of outercourse prevents sexually transmitted infections but others do not. If utilizing this form of birth control, it is important to speak to your healthcare provider to understand which types of outercourse pose a risk for sexually transmitted infections.
Surgical birth control: medical sterilization
Surgical intervention (aka medical sterilization) is available for both sexes to either prevent the release of sperm or block an egg. In cis females medical sterilization is called tubal ligation. This is a surgical procedure that either cuts or blocks the fallopian tubes preventing fertilization. This is considered a permanent form of birth control being over 99% effective in preventing pregnancy. For cis males, medical sterilization is called a vasectomy which is a surgical procedure that prevents sperm from leaving the body. It is virtually 100% effective in preventing pregnancy. Although medical sterilization is extremely effective in preventing pregnancy, neither will prevent sexually transmitted infections.
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Are you unable to come see us in person in the Bay Area, Southern California or New England? We offer virtual physical therapy appointments too!
Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.
In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page.
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FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.