PREVENTION OF PREGNANCY
The goal of contraception is self-evidently to prevent pregnancy. ‘Failure of contraception’ simply means that a pregnancy has occurred whilst using contraception.
Vasectomy has the lowest failure rate but remember to continue contraception until you get the all-clear after your post vasectomy sample!
All forms of contraception can fail, particularly condoms and the pill. 326 Australian women were interviewed about unexpected pregnancy in a 2018 study. Just 41% were using contraception at the time of the pregnancy, and of these:
- 64% were using the contraceptive pill
- 27% of couples were using condoms
- 9% were using ‘the rod’ (hormoneal device that is inserted in the upper arm)
CONTRACEPTION – YOUR CHOICES
Men select vasectomy as the preferred choice of contraception for one of three reasons:
- You want contraception that has the lowest failure rate.
- You want to share the burden of contraception with your partner.
- You want to take control of contraception.
The following table gives an overview of the pros and cons of each form of contraception – including the failure rate.
|Risk of Pregnancy PER YEAR||Main Benefits||Main Risks||Issues|
|Combined Pill||9% per year (normal use)||Low Failure Rate, can reduce period bleeding, can have cycles back-to-back. Often Beneficial for conditions like acne or hirsutism.||Deep Vein Thrombosis & Cardiovascular Risk Factors to evaluate include Body mass index, Smoking, Migraine with aura, Family history, increasing age, high BP, Cholesterol, Diabetes, kidney disease etc.||Can forget to take the pill.|
|Progestogen Only Pill||9% per year (normal use)||Used as a 2nd line oral contraceptive when the combined pill is not recommended. No increased cardiovascular or thrombotic risks.||Australian licensed mini pills need to be taken in a 3 hour window each day.||The minipill is unforgiving when forgotten – failure rates are high.|
|Progestogen Injection||6% per year||No increased cardiovascular or thrombotic risks. Periods often disappear completely within 12 months.||Progestogenic side effects are usually manageable but women may sometimes report weight gain, mood or changes. Periods often erratic to start with.||3 monthly visits to your doctor & practice nurse to get the injection. Need a pregnancy test if late for your next injection.|
|Progestogen Implant (rod)||0.05% per year||Periods often disappear completely within 12 months.||Persistent bleeding beyond 6 months in around 15% of women may require the implant to be removed.||3 yearly implant in the inner side of the left upper arm.|
|Intrauterine Device – Mirena||0.2% per year||Periods usually disappear completely within 12 months – often good for heavy or painful periods.||Risk of uterine perforation is around 1 in 1000. Rarely infection or migration of the device.||5 yearly re-insertion. Few GPs currently provide this service & most women need a referral to a gynaecologist.|
|Condom, Cap, Ring||Condom 18% Cap 12%||Caps, Diaphgragm & Vaginal Ring.||no systemic risks. Higher rate of failure than many other methods of contraception.||Suits only a few women and couples – comes down to personal preference & guidance on use from a health practitioner.|
|Female Sterilisation||0.5% lifetime risk||Low failure rate at around 1 in 200||Higher failure rate & risks (surgical + Anaesthetic) than The Snip.||Day Case in a hospital.|
|Vasectomy||1 in 3000 lifetime (after test)||The lowest failure rate. Men can get involved!||Post vasectomy discomfort affects around 1 in 50 guys.||The most important thing is to continue contraception until you get the all-clear after the semen analysis.|