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Total sexual abstinence is the most effective method of birth control, but incomplete commitment can result in high rates of unintended pregnancies. Periodic abstinence and fertility awareness methods rely on menstrual calendars, CycleBeads, BBT, the Billings method, or the symptothermal method to detect at-risk fertile days. has failure rates similar to the female barrier methods. LAM is very effective for up to 6 months postpartum. Other practices, which admittedly may not even be characterized as sex, also provide sexual pleasure without incurring the risk of pregnancy but do not protect against STIs.

Emergency contraceptives (ECs) offer a “second chance” to prevent an unin-tended pregnancy. It is estimated that if the general population had better knowl-edge and easier access to ECs, their use could potentially cut the number of abortions performed each year in the United States in half. There are three major options available for emergency contraception: progestin-only pills (POPs), combination oral contraceptives (OCs), and insertion of an intrauterine device (IUD). Currently, there are 2 POPs and 18 combination pills (estrogen plus progestin) available that must be taken within 72 hours of unprotected sex according to treatment protocols listed in Table 1. The third option is insertion of a copper IUD within 5 days of unprotected sex. The progestin-only products, Plan B® and Ovrette®, are associated with less nausea than combined estrogen plus progestin EC products. Plan B is the only product designated and packaged as an EC.

Although the first tubal sterilization was performed more than 125 years ago, it took many years before it gained widespread acceptance. Today surgical sterilization is a simple, safe, and cost-effective method of achieving long-term contraception. It remains the second (behind oral contraceptives [OCs]) most widely used form of contraception in the United States (Chapter 1). The emergence of sterilization as a popular method of avoiding pregnancy paralleled the introduction of OCs. Both methods became readily acceptable at the time of the “sexual revolution.”

In 2004, the Department of Health and Human Services estimated that about 47% of female and 46% of male teenagers had had sexual intercourse at least once (). Sexually active teenagers report that they use a contraceptive method only 75 to 90% of the time. Among the developed countries, the United States continues to have one of the highest adolescent pregnancy rates (up to 90 per 1000).

The risk of pregnancy in many women with a chronic medical disease generally far exceeds the risks associated with use of an appropriately selected contraceptive method. The primary goal of prescribing a contraceptive method in women with medical conditions is to select the method with the least risk relating to her specific disease process, the one with the greatest efficacy, and the one that is tailored to her lifestyle and reproductive history. Although the selected method may not be risk-free, individualized counseling, lifestyle interventions, and adequate control of her disease process generally can minimize these risks to an acceptable level.