SEXUAL HEALTH
About Safer Sex
Safer sex means enjoying sex to the fullest without transmitting, or acquiring, sexually related infections. There are numerous sexually transmissible diseases; the consequences of some, like HIV and syphilis, may be deadly.
All of them are caused by microorganisms which pass between partners during particular sexual activities. Safer sex means reducing the chance of acquiring sexually transmitted diseases, including AIDS.
Sexual intimacy does not necessarily include sexual intercourse. People may choose varying levels of sexual intimacy. You should not feel pressured to engage in sexual intercourse or any other sexual activity; what is right for you is the level of sexual intimacy with which you feel comfortable, whether than means none, intercourse, or any of a mind-boggling variety of other forms of sexual activity. It's up to you.
For those who wish to be sexually active, the important thing is to take care of yourself. Recent evidence from student surveys carried out in Trinity and on a national basis show that 80% of college students are sexually active. Of those, fifty percent of students always use condoms, 25% of students sometimes use condoms and an alarming number of students never use condoms. Condoms aren't completely safe, but they are the most effective defence again many sexually transmitted infections.
For more information on condoms, and many other forms of contraception, please click on the links below (This information was adapted from information provided by the North Western Area Health Board)
- Male condom
- Female condom
- Combined pill
- Contrceptive injection
- Diaphram
- Vaginal ring
- Progesterone only pill
- Morning after pill and IUD
Male Condom
What is the male condom?
A condom is a thin sheath that fits over a man's erect penis during sexual contact. They act as a physical barrier preventing bodily fluids from passing between sexual partners and so preventing pregnancy and/or the transmission of STIs.
What are the benefits of male condoms?
- They are easily purchased without prescription at chemists, family planning clinics or from vending machines in many bars/nightclubs.
They reduce the risk of STIs, including HIV
What are the drawbacks to male condoms?
- They must be put on the penis as soon as it becomes erect and before any contact takes place with the vagina.
- They also have to be used with care as they can slip off or split.
- Men should withdraw as soon as they have ejaculated and be careful not to spill any semen.
- They cannot be used with oil-based products, as these will damage the rubber.
How effective are male condoms?
Approximately 94-98% effective for preventing STIs with correct and careful use. The failure rate can be much higher if condoms are not used properly or consistently. Only use condoms approved with the BSI kitemark on the packet.
Female Condom
What is the female condom?
Female condoms are seven-inch-long pouches of polyurethane with two flexible rings. They are inserted into the vagina before intercourse and cover the cervix, vagina and the area around the vagina. They act by preventing sperm from entering the vagina.
What are the benefits of female condoms?
- They can be inserted at any time before sex.
- They are stronger than the male condom and can be used with oil-based products.
- They are particularly useful for women who suffer from allergic reactions to the spermicidal lubricants used with condoms.
- They reduce the risk of contracting STIs, including HIV.
What are the drawbacks of female condoms?
They can slip, so you need to be sure that the penis enters the condom and is not inserted between the condom and the vaginal wall.
How effective are female condoms?
Approximately 95% effective for preventing STIs, if used correctly. If not used correctly, the chance of pregnancy can be much higher
Combined Pill
What is the combined pill?
The combined pill is a hormonal method of contraception. It contains two hormones (oestrogen and progestogen), which prevent an egg from being released by a woman's ovary each month.
What are the benefits of using the combined pill?
- The combined pill is an effective contraceptive method.
- The combined pill can reduce pre-menstrual syndrome (PMS) and period pain and heavy periods.
- It protects against cancer of the ovary and womb.
- No devices or spermicide are necessary, so it does not restrict spontaneity of sex.
- The combined pill is suitable for healthy, non-smokers up to the menopause.
What are the drawbacks of the combined pill?
- The combined pill is not suitable for women who have high blood pressure, circulatory disease, or diabetes or some other medical conditions.
- It is not suitable for smokers over 35 years. Women who are overweight may be advised to use another method of contraception.
- It is not reliable if taken more than 12 hours late, after vomiting and diarrhoea, or if taking other drugs, such as antibiotics
- It may cause some side effects. However, these are generally temporary.
- There is no protection against STIs.
How effective is the combined pill?
Approximately 99% effective, if taken correctly. If pills are forgotten and no precautions are taken it is less effective.
A recommended approach when appropriate, is to use the 'double dutch' method of contraception - the pill to prevent pregnancy and condoms to prevent STIs.
Contraceptive Injection
What is a contraceptive injection?
This is an injection of hormones that provides a longer acting alternative to the pill. It works by slowly releasing the hormone progestogen into the body to prevent ovulation.
What are the benefits of the contraceptive injection?
- An injection lasts for 12 weeks and is a very reliable method of contraception.
- It offers some protection against cancer of the womb.
What are the drawbacks to contraceptive injections?
- You must have the next injection on time, every three months, or it becomes ineffective.
- You may experience irregular bleeding.
- It is likely to cause changes in your periods. Periods often become irregular or stop entirely.
- Regular periods and fertility may take a year or more to return after stopping the injections.
- There is no protection against STIs.
- Some women may gain weight on the injection.
- It is not recommended for more than 2 years in young women because it may interfere with build up of bone mass
How effective is a contraceptive injection?
More than 99% effective, if taken correctly.
Diaphragm
What is the Diaphragm/cap with spermicide?
The diaphragm or cap is a circular dome made of rubber, which is fitted by the woman over her cervix (neck of the womb) before sex. It acts as a barrier to stop sperm getting through to the uterus. It should be used with a spermicide. Spermicides are sperm-killing chemicals available as foam, jelly, foaming tablets, vaginal suppositories, or cream. A doctor or nurse will fit a diaphragm initially to check which size you need and teach you how to use it.
What are the benefits of a diaphragm and spermicide?
- The diaphragm does not affect your menstrual cycle.
- You need only use it when you are sexually active.
- It may protect against cancer of the cervix.
- Protects against some types of STIs.
What are the drawbacks to a diaphragm and spermicide?
- The diaphragm must stay in place for six hours after sex, more spermicide must be inserted again if you have sex within six hours.
- Spermicides may cause irritation or an allergic reaction.
- Cystitis (inflammation of the bladder) may be a problem for some users.
How effective is a diaphragm and spermicide?
Approximately 92 - 96% effective, if used correctly. If not used correctly, the chance of pregnancy can be much higher.
Vaginal ring
A recent arrival in Ireland is a flexible and transparent contraceptive vaginal ring which releases low doses of oestrogen and progestogen, absorbed directly through the lining of the vagina into the blood stream.
The ring is inserted into the vagina by the woman herself and remains in place for three weeks, after which it should be removed. After a one-week ring free period, a new ring is inserted. The ring does not offer protection against sexually transmitted infections.
Progestogen-only pill
What is the progestogen-only pill?
The POP or mini pill contains only one hormone, progestogen. This encourages the cervical mucus to form a thick barrier to stop sperm entering the womb and makes the lining of the womb thinner to prevent it accepting a fertilised egg.
What are the benefits of using the POP?
- Useful for women who are breast feeding, older women, smokers and women who cannot use the combined pill.
- It can help to relieve PMS and painful periods.
What are the drawbacks to the POP?
- It has to be taken at the same time or within three hours every day.
- It is not reliable if taken more than three hours late or following vomiting and diarrhoea
- It can cause irregular bleeding or periods may cease completely.
- There is no protection against STIs.
How effective is the POP?
Approximately 98% effective, if taken correctly.
Emergency Contraception
Morning After Pill & IUD
Emergency contraception is also known as post coital contraception and can prevent pregnancy after unprotected intercourse. It is not quite true to say 'the morning after the night before' as it can actually work up to 72 hours after unprotected sex.
There are two forms of emergency contraception - one is by way of hormonal contraceptive tablets and the other is by insertion of a copper coil or intrauterine device (IUD).
The emergency contraceptive pills (e.g. Levonelle) are progesterone pills that are taken together. These must be taken within 72 hours of unprotected intercourse. It is important to make sure that there were no previous bouts of unprotected intercourse prior to this 72-hour window. If this was the case the woman could already be pregnant and the pills would be contraindicated. The IUD can be inserted up to five days after unprotected intercourse in the hope of preventing pregnancy.
It must be stressed these are emergency forms of contraception and do not replace the ever popular effective methods of regular contraception.
Principle indications for emergency contraception
- Unprotected sex: where consensual sex occurred with no contraception; rape or sexual assault with risk of pregnancy; withdrawal method.
- Potential barrier method failures.
- Potential pill failure when alternative methods have not been used or have failed, eg. antibiotics used with pill.
Mode of action of emergency contraception pills
These high dose hormones act by delaying or inhibiting ovulation and/or by altering the transport of sperm along the tubes. They may also alter the lining of the endometrium so preventing implantation.
Intrauterine emergency contraception
A copper IUD is inserted up to five days after unprotected intercourse. Again this must be fitted by a trained doctor. Awareness of post insertion pelvic infection must be considered. Some centres do testing for sexually transmitted disease before fitting an IUD. Obviously if positive, appropriate management must be followed.
Efficacy of IUD
This is in fact, higher than emergency contraceptive hormones with a failure rate of less than 0.1%.
Side-effects
These include pain and heavier bleeding. However, an IUD fitted post coitally can be removed at the beginning of the next period if a woman does not wish to continue with it as a form of contraception.
Contraindications
Again established pregnancy is a contraindication for fitting an IUD. If a copper IUD is being fitted sensitivity to copper would contraindicate its use. Again expert fitting is advised.
How an IUD works
The IUD alters tubal and uterine transport and affects the sperm and ovum so fertilisation does not occur. Post coital use of an IUD does involve the same mechanism in some cases, but is more likely to interfere with implantation.
Failed emergency contraception
Since both methods may fail, women should discuss with their doctors any signs of pregnancy after use of either method. Signs include a missed period, nausea, inexplicable fatigue, sore breasts, headaches and frequency of passing water. If pregnant, women should attend their doctors for advice. Emergency contraception does not prevent ectopic pregnancy, where the pregnancy develops outside of the womb and such a pregnancy should be seen by a doctor at the earliest possible signs. This includes pain on either side of the abdomen with spotting, especially after a light or missed menstrual period and associated dizziness.
Ongoing contraception and other follow-up
It is important that these visits for emergency contraception are used as a forum for discussing future contraception. Options should be discussed, and even prescribed - depending on the consultation. Obviously, precautions must be taken or intercourse avoided until the next period when the appropriate form of contraception is started.
Availability of emergency contraception
Your college or local GP in many cases will prescribe emergency contraception. Phone the student health centre to check in advance. Family planning clinics around the country also prescribe emergency contraception.
