Spermicides (foams, creams, gels, suppositories, and film,)
Fertility awareness-based methods
Combined pill and progestin-only pill
Single-rod contraceptive implant
—, data not available.
Source: Trussell J. Contraceptive failure in the United States. Contraception. 2011;83(5):397–404.
↵a Among typical couples who initiate use of a method (not necessarily for the first time), the percentage who experience an unintended pregnancy during the first year if they do not stop use for any other reason. Estimates of the probability of pregnancy during the first year of typical use for spermicides, withdrawal, periodic abstinence, the diaphragm, the male condom, the pill, and Depo-Provera are taken from the 1995 and 2002 National Survey of Family Growth, corrected for underreporting of abortion; see the text for the derivation of estimates for the other methods.
↵b Among couples who initiate use of a method (not necessarily for the first time) and who use it perfectly (both consistently and correctly), the percentage who experience an unintended pregnancy during the first year if they do not stop use for any other reason.
↵c Among couples attempting to avoid pregnancy, the percentage who continue to use a method for 1 year.
Source: World Health Organization. Medical Eligibility Criteria for Contraceptive Use. 4th ed. Geneva, Switzerland: World Health Organization; 2009.
↵a Fewer data are available for these newer antiepileptic drugs, but available data suggest they can decrease COC effectiveness.
↵b Advantages of COC use generally outweigh the risks.
↵c Murphy PA, Kern SE, Stanczyk FZ, Westhoff CL. Interaction of St. John’s Wort with oral contraceptives: effects on the pharmacokinetics of norethindrone and ethinyl estradiol, ovarian activity and breakthrough bleeding. Contraception. 2005;71(6):402-408.
How to Use a Condom Effectively
Before: Store condoms in a cool, dry place. Heat, including body heat from a pocket, can cause latex to degrade over time. Check the expiration date before use.
1. Use a new condom for every act of vaginal, anal, and oral sex throughout the entire sex act (from start to finish).
2. Before any genital contact, put the condom on the tip of the erect penis with the rolled side out.
3. If the condom does not have a reservoir tip, pinch the tip enough to leave a half-inch space for semen to collect. Holding the tip, unroll the condom all the way to the base of the erect penis.
4. After ejaculation and before the penis gets soft, grip the rim of the condom and carefully withdraw. Then gently pull the condom off the penis, making sure that semen does not spill out.
5. Wrap the condom in a tissue and throw it in the trash where others will not handle it.
6. If you feel the condom break at any point during sexual activity, stop immediately, withdraw, remove the broken condom, and put on a new condom.
7. Ensure that adequate lubrication is used during vaginal and anal sex, which might require water-based lubricants. Oil-based lubricants (eg, petroleum jelly, shortening, mineral oil, massage oils, body lotions, and cooking oil) should not be used, because they can weaken latex, causing breakage.
Immunosuppressant Adverse Effects and Interactions With Hormonal Contraception
Type of Medication
Adverse Effects Influencing Contraception
COCs may increase plasma concentrations of corticosteroids; monitor for increased corticosteroid effects
Severe and uncontrolled hypertension is a contraindication to COC use.
Low-dose pills have minimal impact on glucose metabolism.