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Q&A: Sex Without Barrier Methods

September 27, 2012

Each week, The CSPH answers questions that have been submitted anonymously through Formspring. This week’s question is:

If you’re in a mutually monogamous relationship, and take the pill religiously, is letting your partner ejaculate inside of you too risky?

In short: maybe, depending on the consistency of your pill-taking regimen and your definition of “too risky.”

The long answer is that the truth is, only the individual can assess their risk and their comfort with such.  While one can ensure that one’s chances of pregnancy are minimal through the use of oral contraceptives, birth control pills do not protect against the transmission of sexually transmitted diseases.  Even if partners are wholly monogamous, STI transmission can occur due to the asymptomatic nature of multiple STIs and people not receiving testing for such.  Therefore, people can contract STIs from past partners and unknowingly infect others, even up to a couple of years after the initial transmission.  Furthermore, it’s important to note that unfaithful individuals demonstrate significantly lower rates of practicing safer sex, discussing safer sex, and testing for STIs than openly non-monogamous couples, implying that professed monogamy may pose its own risks.

Nonetheless, many couples, monogamous or otherwise, opt to not use barrier forms of contraception, such as external and internal condoms.  When paired with an explicit agreement to not “share fluids” beyond the agreed upon partners, this is known as “fluid bonding.”  Fluid-bonding  is best practiced when discussed and the individuals involved are able to give their informed consent to this practice.  In this instance, informed consent requires not only that the couple communicate about their relationship style (monogamy, polyamory, etc.), but also on their known STI status.  In fact, I’d suggest that any couple discussing fluid bonding visit a health clinic together to get tested for STIs.  The reason for this is not one of trust or deception, but rather, because people are best able to care for themselves and their bodies when they know their health status.  Indeed, considering most people who have STIs—and 85% of people with herpes specifically—don’t know it, I think we could all be better at keeping ourselves informed.

With that said, it’s worth noting that while 99% of sexually active vagina-owners use at least one type of birth control, 30% of whom utilize oral contraceptives, there unfortunately exists a lot of misinformation and ignorance about birth control and human fertility.  For example, 19% of vagina-owners between the ages of 18 and 29 mistakenly believe that they are infertile and therefore cannot get pregnant, while, in truth, only about 6% of vagina-owners in this age group are infertile.  Furthermore, 34% of those not utilizing any form of contraception across all age groups do so due to the belief that they do not need birth control or are infertile.  Incorrect or misuse of birth control is also a major problem, with 43% of unintended pregnancies occurring due to inconsistent use of birth control.  This contributes to the half of all pregnancies in the U.S. that are unintended.

In terms of birth control, it should be known that there are two types of oral contraceptives: combination, and progestin-only, also known as mini-pills.  Progestin-only pills need to be taken at the same time every day.  Indeed, if someone takes a progestin-only pill more than three hours past the regular time, the person needs to use back-up contraceptives, such as a barrier method, for the next 48 hours.  Combination pills allow more leeway, although for the sake of consistency and memory, it’s best to establish a daily schedule of when to take one’s birth control.  Fortunately, both types of pills are quite effective, boasting 99% effectiveness with perfect use, and about 92% effectiveness with typical use.  To compare, condoms are about 97% effective with perfect use, and 86% effective with typical use.

Due to the risks of pregnancy with imperfect oral contraceptive use, it’s especially important to be vigilant and consistent.  One tip I find especially useful is setting a phone alarm or calendar event as a daily reminder.  There even exists a number of birth control apps for iPhones and other smart phones, which you may find useful.  Another suggestion is that people practice dual contraceptive use, meaning using more than one contraceptive method at a time.  According to this wonderful Scarleteen resource on dual contraceptive methods, most birth control combinations yield more than 95% effectiveness in protection against pregnancy.  For example, if one is using combination oral contraceptives, practicing withdrawal boosts one’s protection against pregnancy to 99.95% effectiveness with perfect use and 97.84% effectiveness with typical use.  Other combinations yields similar results, although one should not use more than one barrier method at the same time, which actually increases the chances of breakage.

Furthermore, I’d like to note that there are contraceptive methods more effective than birth control pills; intrauterine devices (IUDs) in particular has an effectiveness rate close to 100%, and unlike oral contraceptives, do not rely on the individual’s memory.  Once in place, IUDs can last for five to ten years, making them a great option for those who don’t plan to have children for several years.  This is why the American College of Obstetricians and Gynecologists recommends that IUDs be the first recommendation to teenagers seeking contraceptive options to prevent pregnancy.  Furthermore, in practice, IUDs are 20 times more effective at preventing pregnancy than oral contraceptives.  However, just as with oral contraceptives, IUDs do not protect against STIs.

Here are some other resources that you might find useful:
Medications that Lower Birth Control Effectiveness
How to Use Condoms and Prevent Condom Failure
Planned Parenthood’s Tumblr

No Responses to “Q&A: Sex Without Barrier Methods”

  1. marcy says:

    Wait, ” 99% of sexually active vagina-owners use at least one type of birth control” — that means only 1% of vagina-owners are lesbians? The math seems faulty. I get that this question probably comes from a straight woman, but don’t forget that there are vagina-owners who do not have sex with penis-owners.

  2. Leandra says:

    As a Mirena user, I have to say I have never regretted my decision to get it. When I realized I wanted to be with my now fiancé for good, I decided to get Mirena after a lot of research. I knew I didn’t want kids in the next five years, which is how long it’s good for. Having never been pregnant, the insertion hurt more than if I had given birth, but it’s also less likely to come out. I can’t recommend Mirena highly enough. It has even stopped my periods!