Non-Hormonal Birth Control Options (Episode 330)

Full Transcript: Episode 330

Lisa Hendrickson-Jack:

Today I’m sharing an important topic with you it’s actually a little bit of sex ed if you will because we are going to be talking about non-hormonal methods of birth control this is a question I’ve been getting more and more lately I think with the growing number of women using fertility awareness and becoming aware that there are issues with hormonal contraceptives and then of course learning that there are alternatives but recognizing of course that they’re not really talked about a lot and so I know when I was growing up it was non-hormonal methods were talked about in a way that was more conducive to actually using them it wasn’t talked about in a binary type of way where it’s like either you’re on the pill or you’re pregnant and that meant that although it may not have been as actively encouraged non-hormonal methods were considered to be legitimate options and they had to be because women used them there was quite a shift I would say in the last 20 years in terms of really discouraging women from using non-hormonal options and really downplaying the effectiveness or basically making it seem like they will not work under any circumstances in any type of reliable way so in today’s episode we are going to dive into non-hormonal birth control and how they can be used with fertility awareness and also with each other in a way that actually can work and a way that can be very effective and a way that for the women who actually use non-hormonal methods so this is like my realm this is how they do it so I know you’ll appreciate today’s episode so let’s go ahead and jump right in all right so I’m really excited to actually talk about non-hormonal methods of birth control and how to use them effectively so today we will be talking about the fertility awareness method so if you’re new to the show I’m not going to be going into a ton of detail about the fertility awareness method and how to use it correctly but more so just talking about the method itself and essentially how it can be used with these other non-hormonal slash barrier methods so in addition to the fertility awareness method we’ll be talking about condoms the diaphragm the cervical cap and withdrawal and so just to be sure this episode is not meant to be kind of the be-all and end-all for every possible non-hormonal method but it’s really about how to use non-hormonal methods effectively in conjunction with fertility awareness because this is really the topic that is super important for my clients and for all women who use fertility awareness it’s it’s a really important aspect of it if you can identify with fertility awareness the window so the short period of time in your menstrual cycle when pregnancy is possible then it really isn’t that up to you for how you’re going to manage that right so that’s what we’re going to be talking about

So I thought it would actually be interesting to share some stats with you as a starting point and I wanted to start with hormonal birth control so I’m not going to go into the weeds and list every single different type of hormonal contraceptive and their you know specific efficacy rate but the vast majority of hormonal contraceptives with perfect use are somewhere in that 99 you know percent range so like 99 and higher but what’s interesting is when you look at the typical use statistics the average not hormonal contraceptive so the pill the patch and the ring for example the typical use efficacy rates are closer to say 91.6 87 for progesterone only pill users so I think that’s a an interesting place to start with because there is this notion out there that hormonal contraceptive is essentially the only option for women who are looking for birth control and it’s presented in a way as though it’s infallible and kind of like as if it never fails but the reality is that it is a highly effective method of course when used correctly but even with hormonal methods there is a rate there’s a failure rate and with every method there’s a failure rate so one of the things I’ve talked about on the podcast before is that if you are having sex with another human then you should be talking about the fact that every single method does have a failure rate and talk about how you can mitigate that and or what you would do if the unexpected happened and you became pregnant now with methods such as the iuds so the copper iud or the hormonal iud or the implant or the shot the efficacy rate is higher and of course there’s no typical use if you have an iud inserted it’s inserted if you have an implant inserted it’s inserted if you have a shot you have the shot so there’s nothing you can do to screwed up for lack of a better word and so the highest efficacy in terms of hormonal methods is actually the implant which is interesting and you know followed by then the iud and the shot and but even with the iud the iuds still have a failure rate okay so if you go back and listen to some of my pill reality series episodes I did one with a woman who did become pregnant when she was using her iud of course to the greatest shock imaginable and the reason she became aware of it I believe because of the pregnancy was actually ectopic so the reason that I’m putting that out there’s a couple reasons you know reason number one is just to ground our discussion in the fact that all methods have a failure rate so that’s something that we should just say out loud and try to get our heads around although of course you know when you’re using your hormonal method correctly depending on the type you use and the type you choose generally speaking the risk may be quite small if you don’t know the different factors that could affect the efficacy you know for instance certain antibiotics or certain drugs that you might take or even if you’re really sick and you’re throwing up a lot and you don’t realize you know that it could affect your the fact that the pill could be coming up you know for example so that’s one thing but the other thing is that with all methods of birth control I mean they fall on the scale between their degree of efficacy user efficacy versus the method of efficacy and so when you’re using something like a pill you have to take it so there is some degree of you know user error that you could skip it or miss it or not take it at the right time for example and that could lessen the effectiveness of the method whereas something like the iud or the implant or the shot you just have to go in and get it but there’s nothing else for you to do it’s totally dependent on the method and that is often why you know healthcare providers have a preference for those methods because the user can’t mess it up right like the method itself is what is giving you the efficacy now when we’re talking about something like fertility awareness fertility awareness is entirely user dependent so it’s the complete opposite end of the spectrum you’ve pulled the goalie so there’s nothing there and it’s really up to you to identify which days are fertile and not and then how you’re going to handle that and other barrier methods such as condoms and the diaphragm or cervical cap there’s a combination because you have to actually you know use them when you’re having sex and then they also have to work so there’s a combination there and similar with withdrawal which we will talk about even though I know that it can be controversial to even say the word we’ll get into that but similarly withdrawal it’s entirely user dependent right if your partner doesn’t withdraw you have no method so that’s just to kind of get our feet wet and start thinking about the differences between these methods and I’ve you know I’ll highlight in the show notes page you know for this episode a previous episode that I recorded with dr miranda naylor I’ve referenced that episode so many times it’s it’s found its way into the fifth vital sign but it’s because we actually talked about this and got into the concept of why it is that doctors are more prone to recommend hormonal methods over say non-hormonal methods and that user failure option for barrier methods and things like that knowing that the efficacy is entirely up to the user for many you know practitioners they’re trained that the best thing to do for their patients is to really eliminate that margin of error and so you’ll notice a trend to really pushing not just hormonal birth control but the long-acting methods that you actually input in your body and are there for long periods of time so that’s just a little bit of background

So in terms of the fertility awareness method so in terms of the stats when you look at perfect use and that’s a term that I should define because it’s something that I’ll be talking about a lot in this episode so perfect use or correct use is a term that refers to you know the perfect situation where you’re actually using your method correctly every single time you have sex and what’s interesting is that it is possible to use your chosen method of birth control correctly every single time so it is actually possible to use your method perfectly every single time but that you know obviously in the real world it doesn’t always work that way depending on the person and then we have the typical use which is what you know it tends to look like and so I think that the important thing to keep in mind is that you are the one that gets to decide how you’re going to manage your fertility so for some that concept of like oh wow the typical use is much lower can be very discouraging because it makes it seem like I couldn’t do that but what I would say is that it really depends on your motivation so from that you know medical perspective often why doctors are so discouraging is because they see the general public and there’s plenty of individuals who it’s you know non-hormonal methods that are dependent on the user they’re not necessarily for everybody in fact there’s no method that is effective for everybody and so with that in mind when you’re trying to decide what method is right for you that’s really the key you know what method is right for you what method is satisfactory to both you and your partner and how is this going to work okay so keep that in mind as we go through so with fertility awareness you know based on the peer-reviewed science the perfect use efficacy is as high as about 99.4 percent and that stat comes from the frank hermann study where the participants were trained in a very specific method of charting and so these participants were using the method correctly and so a 99.4 efficacy rate puts fertility awareness on par with hormonal methods and so that means that it is possible to use this method accurately and effectively and have no unplanned pregnancies or the chance being very slim but typical use I mean with the typical use statistics you have a variety of different ways that this is calculated so ideally you would have a one specific method of fertility awareness that people are following and you would look at how it works out typically versus the perfect use in the study but we often have data that is lumped in so you might have women who have been trained in a specific method of charting you know combined with women who use adapt combined with women who say they you know track their periods and so obviously that efficacy might be a bit misleading but with that said the typical use ranges as low as about 79.6 again depending on the study that you’re looking at and as high as 96.2 so with fertility awareness like I said it’s entirely user dependent and so it’s really going to be as effective as you are so the key to being successful with fertility awareness and using the method perfectly is really taking the time to learn it so I’ll quickly go through I mean I could talk about this for like six hours so I’ll quickly go through and give you kind of like the overview rundown of what to do if you want to be successful using fertility awareness for birth control so the first thing you want to do is make sure that you take the appropriate time to learn the method and there is no one fertility awareness method there are fertility awareness-based methods so there’s like an umbrella of fertility awareness-based methods and there’s multiple methods underneath that umbrella and so there’s some methods that are you know mucus only tracking there’s methods that are symptothermal so mucous basal body temperature and cervical position there are methods that are temperature only there are apps that use algorithms there are the marquette method that uses the you know clear blue fertility monitor so there’s a lot of different ways to do this so step one would be deciding what method is appropriate for you after you know doing some research reading some books taking the time to really understand the method itself so the method is based on what’s happening in your body so you have to understand you know how the cycle works what part of the cycle is fertile what part of the cycle is not and why and then you have to start charting so you know when I’m talking about this with my clients I divide it into phases so phase one the learning phase is the phase where you are learning not having unprotected sex because before you can move on to having a protective sex you have to learn first learning means a combination of reading and understanding the underlying you know biological basis for the method and then it also means charting and so you need to take the appropriate time to learn how to chart so that you are confident in understanding your cervical fluid observations basal body temperature and cervical position if you’re using the symptom thermal method and even if you’re using like an app or something else I would strongly encourage you to learn the biological basis and understand how to track those signs in conjunction with whatever app you know device that you’re using so that’s step one and if you’re learning on your own I recommend a minimum of three to six fully charted cycles so you are charting you are relying on a you know something else you’re not relying on this method and you’re allowing yourself the opportunity to really understand how your cycle works you’re comfortable with identifying your main fertile signs you’re comfortable with confirming ovulation you know the rules and you know exactly how everything works all right so that’s step one phase or step one phase one whatever so phase two would be when you actually are comfortable confident you have your minimum three to six cycles charted if you’re charting on your own if you’re working with an instructor a minimum of one fully charted cycle and then once you feel comfortable you move on to phase two which is sex in the post ovulatory phase only and so before you can really move on to the full cycle you really want to understand how the cycle works and you want to ease into it because the pre-ovulatory phase is the only part of the cycle where pregnancy can happen so before you can have unprotected sex in the pre-ovulatory phase you really need to understand how your cycle works you need to understand mucus you need to understand the rules and basically you need to be able to identify which days are fertile which versus which days are not fertile and how to really accurately identify that window of fertility so that is in a nutshell you know the phase one two and three so phase three would be after you’ve actually gone through all the steps you’ve taken the appropriate time I certainly do recommend you know working with someone even if it’s a few sessions but every woman I’ve worked I’ve never worked with a woman who didn’t have questions and didn’t have questions as she was charting in initial phases and even down the line so I’ve seen many clients at the beginning of their journey when they’re first learning and they come back to me several months later for a session or to jump into one of my kind of alumni graduate programs just for a couple of months here and there to check in because this is a process it’s like learning to drive a car it’s not something that you just like read once and you’re good to go I’m not trying to say that it’s so hard but I’m just trying to say that in today’s landscape with you know many of my clients coming off of birth control and many of my clients having other challenges it can be very helpful so that you can feel confident to have that extra support okay but plenty of women do you know learn fertility awareness I wouldn’t say on their own what I would say is the women who have not necessarily gone to instructors tend to find groups of women whether it’s online or in person who are also charting and they kind of share information and learn that way okay so that is in a nutshell you know how to use fertility awareness perfectly it’s really taking the time to learn and understand so that you can be clear on which days of your cycle are fertile and which days are not and then when it comes to how to manage your fertility on those days so then you have to decide what’s going to work for you and your partner so some people will opt to abstain entirely from sex or sexual contact during their fertile window some will opt for alternative sex meaning no penis and vagina contact and so you’re just doing other sexual activities during those fertile days and by ensuring there’s no contact then that is your chosen method of birth control or specific contact I should say another option of course is to use barrier methods like what we’ll be talking about momentarily condoms cervical cap diaphragm and or withdrawal and so that kind of sums up then the fertility awareness method and how you manage it so you’re really identifying the periods of time when you can get pregnant because from a scientific standpoint there are only six days in your cycle when pregnancy is possible that’s because as you approach ovulation you produce cervical fluid that can keep sperm alive for up to five days so during the five days before ovulation plus the day of ovulation if you have unprotected sex pregnancy is possible of course to use fertility awareness as a method you have to learn the rules so that you are putting in a buffer period after that to confirm ovulation and there’s a lot of different scenarios that can pop up so you just want to make sure you understand how to manage those different situations

So the pros of fertility awareness so I’m not necessarily going to go through all the present possible pros and cons so I’m sure you could think of others I’m just going to go through the ones that came to mind but the pros of using fertility awareness method or fertility awareness-based methods is that it’s a non-hormonal method so it’s not disrupting your natural hormones it’s allowing you to cycle naturally to preserve your fertility naturally normal cycling is essential for optimal health for women of reproductive age and so this really allows you just to for your body to just continue to be in rhythm and flow it preserves the health of your breasts heart health bone health and there’s so many other just general benefits for cycling naturally and in addition to that if you did have any cycle irregularities or issues or underlying health issues that were interfering with your cycle not being on hormones allows you the opportunity to see those issues and to correct them if you happen to notice them when you’re charting so I also listed there like because I’m so generally you know overall health monitoring and one of the other benefits of fertility awareness is that if you are not using hormonal methods so I’ve worked with many women who don’t use hormonal methods and haven’t ever used hormonal methods and we’re using say condoms or other methods throughout their sexual you know history and when you use fertility awareness and start to understand your cycle you can I from my perspective you can use fertility awareness to improve the effectiveness of your other non-hormonal methods I mean if you can identify the specific parts of your cycle where pregnancy is possible then that gives you the opportunity to be very strict with your you know non-hormonal method barrier method of choice during that time because you know exactly when that method could fail other you know pros that come to mind are that it fosters communication with your partner because you can’t really use this method without having conversations with your partner without having your partner on board so many you know couples who use fertility awareness find that they are talking a lot more and really just exploring certain conversations that wouldn’t come up wouldn’t necessarily happen if they were using hormonal methods for example so I’m sure there’s tons of other benefits but I’m going to move on to the cons so the con again it really depends on the personality because you may not see it as a con and it you know but I’ll just kind of go through so one of the potential cons for fertility awareness is that it is entirely user dependent so it does require a degree of commitment because you need to understand what’s going on you need to know what you’re doing and you basically have to take responsibility for all of it because there’s no goalie you have pulled the goalie so you’re the goalie and you have to be the one to know what you’re doing so it does require that you take the time to learn it does require that you take the time to chart and to understand your cycles and you know for many women it does take several months of charting and learning before you actually start to feel really comfortable and confident now again for many women that’s not a con for many women it’s actually this fantastic process that’s really exciting as they’re learning but you know just to put that out there for some women it’s like okay that’s too much or at this point in my life that’s not going to work for me so that’s why it’s there it does require the cooperation of your partner so if you have a super uncooperative partner who’s not willing to play ball at all then this wouldn’t necessarily be the method for you because it does require that there are periods of the cycle where you can’t have unprotected sex period if you’re trying to avoid pregnancy so you do have to have the cooperation of your partner and so those would be I’m sure that other cons could possibly rise up but those are kind of the main ones that I would say that it really does depend on the person but one thing I always say about fertility awareness is that no one’s forcing anyone to use it so fertility awareness as much as it’s a user-dependent method it’s also a method that women self-select the women who choose to use fertility awareness are fully choosing it even though society tells them that they’re crazy and that it’s not going to work and all those myths about fertility awareness and so for a woman who if you’re listening to this and you’re this it really calls to you and you really feel that this is the method for you and you’re willing to take the time because you’re super excited to learn about your body and you’re thrilled to take some time learning to chart then absolutely it’s for you so I feel like the fact that it’s a method that women self-select to it kind of overcomes some of that and I also feel that the discouragement that women often feel related to charting I recently just posted on instagram a question box and I had so many responses and the question was you know have you ever talked to your doctor about fertility awareness and if so you know what did your doctor say and it was really incredible to see how many women have been laughed at or told that it’s not going to work or just get on the prenatal you know you’ll be pregnant in a year come back and come back to me you know when you’re pregnant like all of these kind of really condescending things and so women who choose to chart their cycles and go ahead and use fertility awareness these are the ones who are choosing that because it’s right for them and I feel like what’s really missing in that conversation with the professionals is that motivated women who want to do this can do it we can do it and we can do it effectively of course it means that we have to take the time to learn in my perfect world I would rather see instead of doctors really discouraging women to have a legitimate conversation about it so I would say like I would say this to anybody fertility awareness is not necessarily for everybody it’s a method that women self-select to if they feel really called to it and it’s certainly possible to use it effectively provided that you take the time to learn and if you’re if it coming from a doctor you know I would recommend you consider working with a fertility awareness practitioner who’s certified so that you can really be set on the right track I feel like that would be a more appropriate response a more empowering response and that really just acknowledges that for an adult woman who chooses to do this she is more than capable to doing it provided that is what she wants to do all right off the soapbox so now that we’ve established kind of fertility awareness let’s move on to some of the other non-hormonal methods

Okay so condoms now one of the things I’ve said about condoms quite a bit is that when I was growing up it was the tail end of the 90s so I grew up in the 80s and 90s and this was really the era when the media wouldn’t stop talking about hiv so this was a time when condoms were really pushed and talked about quite a bit so when I was growing up condoms were taught to us to be an effective method of birth control condoms still remain basically the only method of birth control that also protects against stis and it’s effective so condoms are up to 98 effective with perfect use and typical use brings them down to around 87 so the thing about condoms is that perfect use is not complicated perfect use is actually quite simple to figure out so this is why I would say that I wouldn’t be discouraged by the typical you statistic sometimes especially in this time this interesting period of time that we find ourselves in I find that condom use or in general non-hormonal birth control use is heavily discouraged and I’m definitely going to come out and say that I feel that this is heavily influenced by the pharmaceutical industry there’s just so much money in hormonal contraceptives and it really feels like this push that has come in the last 20 years that is coming so apparent to me especially when I’m working with clients who are younger than me whether it’s like 10 years younger than me or you know 15 years younger than me even five years younger than me basically women who came up after me it really feels like the landscape has changed and whereas when I was growing up condoms were you know described as effective and talked about as a legitimate you know alternative birth control option these days it just feels like it’s heavily discouraged so I just want to say that because I really do see a difference I mean it makes me feel a little bit old but for what it’s worth in a generation you can’t have a birth control method all of a sudden not be effective anymore when it was effective for a really long time so with that said as I mentioned perfect use is not difficult but there are certain basic pieces of the education that are definitely missing okay so in order to use condoms correctly you start first of all by making sure that you are using the right size condom so just like men wear different size shoes they’re going to need different size condoms right if you know every man’s penis isn’t the same size essentially is what I’m saying here so you there are companies so many more than when I was really young but there’s so many companies now you can even measure you know your p his penis he can measure his own penis but you know length girth whatever and get the appropriate size so that there’s a less lesser chance of it slipping off or being too tight or uncomfortable or those types of things so that’s step one step two is making sure that the condom hasn’t expired if the condom has expired or if it’s like in your purse or your wallet for years then it wouldn’t there’s a higher potential that it wouldn’t work so you want to make sure that it is it is not expired so you open the condom carefully making sure not to wreck it when you’re you know putting the condom over his penis you would pinch the tip of the condom and roll it down you pinch the tip first so that there’s enough space you know at the tip of the condom for the ejaculate so that it doesn’t burst and of course in a perfect use scenario you would he would be putting on the condom before there’s any contact and I’m saying that for a reason because everyone uses protection in different ways but if we’re talking about perfect use you would put it on before there’s any contact at all so that’s important but I would say the most important thing to know with condoms is that you want to use them with water-based or silicone-based lubricant because oil-based lubricant it doesn’t matter if it’s like crisco vaseline or you know expeller pressed coconut oil disintegrates condoms whether it’s latex or lamb skin you don’t want to use that and I’m sure because I know that at least half of you who are listening right now didn’t know that and to me that just blows my mind it makes me wonder like now sex education is so bad that we’re not even teaching people how to use condoms correctly every time I do a class every time I’ve done a talk and I bring this up it’s literally like half of the women who I’m speaking to didn’t know that and many of them are like adults who’ve been having sex for you know long periods of time and many of my clients will be like wow I’ve been getting away with it for a while and see that’s what happens so if this is news to you know youtube it look it up because there are there’s plenty of videos on youtube where a person might put a condom over their hand or something and you know apply the oil the oil literally eats the condom like it degrades it and eventually the condom will snap so if you didn’t know before now you know so that is perfect use with condoms so let’s talk about the pros and cons of condoms so pros non-hormonal it does allow participation of the male partner so I put this in the pro category because you know in a world where birth control is primarily considered to be a woman’s problem I think it’s really helpful and useful to have opportunities for men to participate because plenty of men are fantastic and wonderful I really haven’t worked with clients whose partners are completely unsupportive and working with women in this setting has really made me celebrate men so much more because you know men they love their partners and they want their partners to be happy and you know enjoy sex and all these things and so overall my experience at least on my end has been that men are quite supportive for the most part of course there are always exceptions but yeah so it allows the participation of the male partner you would only be using it during sex so unlike hormonal methods where you are constantly kind of taking something that’s suppressing your fertility you’re only using it at the time and of course they’re also effective in preventing sti transmission and so condoms can of course be used alongside fertility awareness and the only caveat I would say which is what I say to all my clients is that if you use fertility awareness to identify your fertile window and then in your fertile window you use a condom then you are relying on the efficacy of the condom when you have sex during your fertile window so technically if you want to be like super technical with the wording if you are actually having protected sex during your fertile days you are using the method so you’re using a condom so just if that makes sense to you’re relying solely on the efficacy of the method that you choose and of course this is why a certain percentage of women who use fertility awareness will opt to abstain entirely during their fertile window but of course the great thing about you know this method and this conversation is that you get to choose what’s going to work best for you and your partner so some of the cons about condoms so you do have to remember to use it every time it is something that you have to put on and you know for many it would involve disrupting that you know natural kind of mood it does reduce the sensation or changes the sensation so you know some couples are totally fine with condoms and love condoms and use them all the time and other couples don’t love the feeling of it and really would prefer not to use them so that’s again a personal choice and you know obviously if you have a latex allergy or something like that’s not necessarily going to work so I mean the theme here really as we go through all these methods is that there is no one method for everybody or every couple and it’s really up to you to decide what’s going to work best for you and your partner

Okay so let’s move on to the diaphragm or cervical cap so there was a time when diaphragms were much more common when it was very commonplace for women to go to their doctors and be custom fitted with diaphragms and doctors were well trained in that skill of fitting and this you know it was it was a lot easier so these days it’s a lot harder to get say a custom fitted many doctors don’t even have that skill anymore but fortunately there are diaphragms that are available without having to be custom fitted like the kaya diaphragm and it’s not necessarily an advertisement but just to say that there are certain brands of diaphragm that you can buy and similar with the cervical cap so there’s different brands like the femme cap and again this isn’t an advertisement or necessarily an endorsement but just to get you started if this is something that interests you so with the diaphragm and the cervical cap the diaphragm the diaphragm is designed to go in to the vagina so that the device can completely cover the cervix and it actually fits behind the pubic bone and the cervical cap is often fitted on the end of the cervix so actually fitting over the cervix itself and diaphragms and cervical caps are intended to be used with spermicide so when you’re using the diaphragm if we’re talking about perfect use they are intended to be used with spermicide which we’ll talk about in a moment so the efficacy will be going through perfect use efficacy is around 92 and then typical use fluctuates between you know anywhere from 88 percent to 75 percent and so as I mentioned you know it these devices are meant to be used with spermicide so the diaphragm and the cervical cap it’s intended to actually put the spermicide inside and then you would insert the diaphragm or cervical cap into your vagina and put it in place so when you’re using a diaphragm or cervical cap and you’re using spermicide you do want to make a point of looking for non-toxic spermicide so there’s a common basically toxin called nanoxinoline that can be very damaging and can cause all kinds of problems not least of which irritation and you know susceptibility to other variety of issues so when you’re looking for spermicide you do want to look for a non-toxic non-irritating vagina friendly but yet still effective spermicide that you can use with these products so in terms of perfect use with a diaphragm or cervical cap you have to insert your diaphragm or cervical cap before you have sex so you certainly want to make sure that it’s inserted and inserted correctly before sexual contact and then and then once you’ve had sex you would make sure to actually leave the diaphragm or cervical cap in for a minimum of six to eight hours afterwards and so that ensures that everything is gone and dead before you remove it to you know reduce the chance of any sperm kind of making its way through so the pros of the diaphragm of cervical cap again non-hormonal that’s the theme here so all of these methods that I’m talking about are not disrupting your natural hormones these methods don’t require your partner’s participation so that’s a pro for them because you can insert your cervical cap a diaphragm you can do that well before and so it doesn’t require any cooperation on your partner’s part and of course it can be used in conjunction with fertility awareness and we’ll talk I’m gonna go through them all first and then talk about how they can be used together so the cons obviously the effectiveness rate isn’t as high we’re not looking at like a 99 effectiveness rate but with that said the effectiveness rate is still it’s still up there with perfect use of course another con depending on the situation the person you must insert it prior to sex so again it could be disruptive to the flow depending on if it’s spontaneous it can kind of detract from that to some degree you must use it with spermicide in order to have that ideal efficacy and you do have to leave it then inserted after sex for that minimum of six to eight hours if you want to have sex multiple times then you would have to reapply the spermicide because if not it may not be as effective so without removing it you would have to put more spermicide in so that’s the overview then of the diaphragm cervical cap and now we’re just going to talk about

Withdrawal for a minute so withdrawal I call withdrawal you know the dirty little secret so on my end I spend my days talking to women about their sex lives about their cervical fluid so I have all of these conversations about very intimate aspects of people’s lives that most of you don’t most of you don’t have the same experience as I do and so what I can tell you is a lot of people use withdrawal so I’m not promoting it I’m not saying yay or nay or anything I’m I’m just being objective and I’m just sharing information so just to be clear I’m not saying do it or don’t do it or whatever I’m literally just saying that a lot more people use withdrawal than you probably think and whenever someone mentions to me that they use withdrawal it’s like they look down and they’re like I use withdrawal and like kind of apologize and all that because we were taught that it’s not a method you know I can remember that being taught that withdrawal is not a method of birth control it’s it’s basically just like they call it the pull and pray right because it’s like who knows if it’s gonna work but it turns out that it is a method and it has an efficacy rate so you know with withdrawal the perfect use efficacy rate is 96 right that’s like high you wouldn’t think that for a non-method and typical youth would be closer to about 85 so what that means is that there’s a lot of couples who then use it and they start to wonder if they’re just infertile because they you know don’t get pregnant so to be clear it doesn’t necessarily work for everybody and the big question with withdrawal is whether or not men contain sperm in their pre-ejaculatory fluid because that would really be the downfall of withdrawal so in terms of that question when you look at the research and so I cover all of this in a lot more detail in the fifth vital sign in case you’re wondering and if you’re wanting like the stats and like the studies and all that stuff but in terms of the question of whether or not men have sperm in their pre-ejaculatory fluid when you look at the research the research is inconclusive and one of the reasons why the research is inconclusive is because the studies that are available are often using quite small sample sizes and I mean why would that be why would a you know free method that’s available to everybody that there’s no way to monetize you know why wouldn’t giant companies want to study this so I think it’s it’s a challenge really it would be wonderful to have a lot more research done on withdrawal so that couples could really have that information and have this a much better understanding of whether or not it would work for them but the research that we do have would indicate so first of all from a biological standpoint men aren’t supposed to have sperm in their pre-ejaculatory fluid because the pre-ejaculatory fluid is actually released from the calpers gland so it’s not actually the same place as where the semen comes from so theoretically there shouldn’t be any sperm in the pre-ejaculatory fluid but when we look at the studies there are some studies that show that none of the men who are tested have any sperm in their prejaculatory fluid and there are other studies that show that some men have sperm in their pre-ejaculatory fluid but other men do not and the men who do not they just don’t and the men who do so that literally means that it’s inconclusive so with that said I mean withdrawal then does work for many couples but then of course there’s a possibility that it’s just not going to work for some couples and you wouldn’t necessarily know that unless you had the means to test your partner’s prejudice fluid or you know gave it the good old pull and pray try okay so with that said perfect use so this is something that again if it’s not even if you don’t even think it’s a method first of all then our culture isn’t necessarily going to talk about it and tell you how to use it correctly right because it’s not even like we’re not even thinking that it’s a method so why would you be talking about using it correctly so many people are embarrassed even to say that they use it so let’s talk about it so if you want if you if you want to know you know how to use withdrawal effect or perfectly like air quotes perfect use withdrawal so the important thing is that before you have sex just in case he may have ejaculated earlier in the day or something like that his semen and his urine pass through the same urethra so it’s like a corridor or something and so before you have sex just have him go pee so have him urinate before sex and then if there happened to be any sperm from a previous ejaculation just hanging out then he’s clearing that and so then you have sex and of course he would have to withdraw before ejaculation so however long before that is and he would have to ejaculate away from your vulva away from your cervical fluid make sure those things are not joining no contact there and so then if you decide to have sex a subsequent time then you would want to make sure that he does urinate in between wash his hands wash his penis type of thing to make sure that any sperm that were in the urethra are cleared flushed so that’s essentially perfect use so what are the pros about withdrawal so again the same theme non-hormonal free and available to everybody it does involve your partner which can be a positive or negative depending of course it can be used in conjunction with other methods which we’ll get to in a moment and it does allow you to have sex without you know the barrier in between you so for many couples that might offer an option where they’re actually you know couples who potentially don’t love condoms it allows this option to not have a barrier between you so the cons we talked about the research being inconclusive so we don’t have like a definitive like 10 000 men study if anyone wants to do it I’d love to see the results so that we can get a more definitive answer on this question of you know do men have sperm in the pre-ejaculatory fluid so that’s one of the cons of course it does require your partner’s participation so again that can be a pro and a con depending on your relationship but your partner has to know his body he has to be able to withdraw you know on time and all that and it really does put the ball in his court you know so there’s got to be some trust there and he’s got to be up to that and so of course the big con with withdrawal is that if it fails like if he doesn’t withdraw like you literally have no method so that’s something to consider as well so like any of the methods like all of the methods that we’ve talked about it’s going to work for some couples and not for others and it’s really up to you to decide what level of you know risk you’re comfortable with and all of those things so now that we’ve gone through basically the main non-hormonal options and we’ve gone through how to use them correctly we’ve gone through the efficacy of all of them we’ve gone through the pros and cons and of course I’m sure there’s other pros and cons that I didn’t mention but at least these are kind of giving you an idea and having you think about what would make more sense for you in these types of situations

Now we can talk about combining methods and so especially when I have clients who are learning fertility awareness and they’re still in those beginning stages and of course women who are learning on their own during that first three to six months before they are you know really there with their learning and practice to feel confident using the fertility awareness method having an option like condoms or withdrawal or the diaphragm cervical cap is certainly really helpful and important so that you can really take that time to learn how to chart your cycles but of course you are relying on the efficacy during your fertile window of the method that you choose so I will always say that because if you have sex using a condom and the condoms are 98 effective you are relying on the efficacy of a condom if you have sex during your fertile window now what one of the great things is with non-hormonal methods is that you can combine say condom with a diaphragm and or cervical cap so one of my issues that I mentioned already with non-hormonal methods is that they’re often really heavily discouraged because some of the methods don’t have a 99.99 efficacy rate or a typical use rate however if you were to use a diaphragm or cervical cap correctly with the spermicide and you were to also use a condom you are now using two methods of birth control and you can feel a lot more confident in the combined efficacy of those two methods versus you know if you do have some concerns about the one method and similarly with withdrawal if you combine withdrawal with a diaphragm or cervical cap you know then you have an additional measure you’re using two methods of birth control during that time and so for many women that is how they manage for many women who are really on top of their charting who are really just you know I talk about the intention scale so 10 being you want babies you’re already trying for babies and you may already be pregnant and zero being like really it’s just not the time and you and your partner are absolutely not trying and you are not ready for a baby and so you’re really open to no risk at all and so I think the good news and the hope part of this episode I mean the whole episode is good news but it’s really that it is possible to be responsible and to be very effective and intentional with your use of non-hormonal methods and it is entirely possible for you to successfully prevent pregnancy without hormones and it’s not like you just have like one kind of crappy option you have multiple options that are effective on their own to you know the degrees that we talked about that can also be combined with other methods to improve overall efficacy and so if you really don’t want to be on hormones the message is that you don’t have to be afraid you know the opposite of fear is probably not education I think it’s love but education is the bridge you know between being really afraid of unplanned pregnancies and feeling really out of control like you’re just at the mercy of whatever could happen to really taking back the control and feeling like you have a plan and a strategy that you can follow and especially when you bring these types of topics to your partner I’m sure some of you might play this episode for your partner so that you can kind of then start that conversation on the same page when you’re able to do that then it just changes everything because when you have this knowledge you can really empower yourself so that it doesn’t feel like it’s like hormonal contraceptives or nothing right hormonal contraceptives or pregnancy like that’s such a lie obviously you know not impressed by that I don’t know this turn that our society has taken to convince women that it’s really hormonal contraceptive or nothing and again it’s not because there’s one method that I think is right for everybody but I think even after breaking down the different birth control methods I’m sure some of you are like oh my gosh I wish I would have known this like this makes sense to me and even though I’m really you know on the zero end of the intention scale I feel like there’s some combination in here that would actually work for me and I didn’t even know that I didn’t think about it that way so I’m sure some of you are thinking some of those things one other thing I’ll mention is that it’s not uncommon for couples to use condoms and withdrawal together meaning that you have sex with the condom on and then when it’s time for him to ejaculate he pulls out with the condom on and so again it’s like combining two methods of birth control and now for some of you who are listening you might think oh my gosh that’s kind of overkill but remember we have people of all different ages of all different relationships of all different comfort levels of all different life situations and so this offers the you know the levels of protection and everything like everywhere in between so I have plenty of clients who are really comfortable using withdrawal and they’ll use withdrawal by itself in their fertile window I have plenty of clients who are not comfortable with that and they will use condoms and withdrawal you know and I have clients who will use a diaphragm with withdrawal or a cervical cap with condoms or just condoms or just a diaphragm or you know the options are endless but this allows you the opportunity so to combine fertility awareness charting so first of all when you understand your cycle and you know how to identify your fertile window then it allows you if you are more on that zero end of the intention scale to really combine double up your methods during that time learn about perfect use and use your methods perfectly during that time and I also have clients that will identify the fertile window and so maybe they will then use condoms throughout their cycle or use withdrawal you know throughout their cycle and then use condoms in the fertile window or something like that and if you chart your cycles and you identify your fertile window let’s say after ovulation you’ve confirmed ovulation you know the rules you can’t get pregnant after you’ve confirmed ovulation when you follow the rules it’s biologically impossible but we don’t have enough time to go into that today there’s plenty of episodes where we talk about that a little bit more depth but let’s just say for example that you’re in the post-ovulatory phase so if you also use a condom or if you also use withdrawal during the time of your cycle where pregnancy is not possible you are using two methods of birth control you are actually doubling up right so this just gives you lots of different options for how to manage it and especially for those of you who are super terrified of coming off of contraceptives or you’ve kind of been easing your way into fertility awareness I feel like this conversation just opens up some possibilities and it really makes it so that it’s more approachable conversations you can have with your partner and also hopefully my biggest goal or hope I guess I should say not goal but my biggest hope for you is that it’s less scary and that we can move away from being so afraid of you know feeling really out of control and feeling like your fertility is something really scary that is just going to betray you to feeling more in control and feeling more comfortable with your choices

So that brings us to the end of today’s episode that’s really it’s like I had to get it off my chest but I really wanted to go through that was a topic that I’ve I have been getting a lot more questions about recently and it’s something that yeah I haven’t done this particular episode on the podcast so I’m glad that we that all of you who did reach out and asked for this episode I’m glad that you did I think I had someone reach out recently actually too and that was like you know adding to the list of people who asked for this episode so it was a good reminder and it’s so important and as you can tell it’s for me it’s really about reducing the fear around not being on hormones and being at least one person in the world or in your life maybe who has basically told you that no it is actually possible to avoid pregnancy successfully and effectively without hormones if that’s what you want if that’s really what you want and you’re willing to take the time to learn and understand and to you know learn about fertility awareness learn about the other non-hormonal methods learn about how they can work together use them correctly every time involve your partner you know have these adult conversations right and then if you’re willing to do the work then it’s completely possible I you know all of my clients have really complicated jobs and really busy complex lives and so it’s just insulting to think that we couldn’t figure this out if we you know if we really want to figure it out so that’s like my cheer for you today you can do this if you want to just make sure to take the time that you need to learn and of course take the time to get the support that you need if you do need that extra support so if you’re learning fertility awareness of course I would encourage you to seek support from an instructor of course I have programs but there’s plenty of instructors who teach and this is how you can get to that place that you feel really confident so that you can really just leave that fear behind and start enjoying the you know these wonderful intimate moments with your partner so with that said thank you so much for tuning in you’ll find the show notes page for today’s episode over at fertilityfriday.com 3 30. that is a lot of podcast episodes that means this is episode for 330. it’s actually kind of wild it’s it’s incredible what can happen just doing one episode a week for almost six years but that is where we’re at I know that this episode since I was getting a lot of requests for it I know that people want to hear it so if you know someone who could really benefit from today’s episode please do share it because obviously there’s not a lot of places that people are talking about all these things in this way and so yeah please do share it far and wide because like I said I know people are asking for it that’s why I listened and I shared it so and then tag me if you share out on social make sure to tag me and let me know and so with that said have a wonderful week weekend whenever you’re tuning in to today’s show and of course as always until next time be well and happy charting