Dear MKE SEX,

I swear to god, I have tried every form of birth control out there and nothing works for me. The shot, the implant, the Mirena, the ring, the patch, almost every kind of pill—they all make me feel like I’m losing my grip. Some stuff makes me fat, and other stuff makes hairy. I get acne, my hair falls out, and I don’t even feel like having sex most of the time. I’m in a new relationship, and we absolutely do not want kids right now. So I’m pretty much ready to commit to him, and to some kind of birth control. What’s a hormonal, finicky, sexually active girl to do?

HELP!
Cheerfully Child-Free

Dear Child-Free,

This a topic I’ve covered so many times recently. I think most of Milwaukee must be afflicted with spring fever. Everybody wants to get busy, and they want to be careful. It’s the best of all worlds. Interestingly, when people insist that there are no good options, they often only discuss hormonal birth control methods. But until the 1960s, hormonal birth control wasn’t even available, and people have been using contraceptives for more than 500 years. There are still several non-hormonal alternatives out there. While none are quite as effective as the pill et al., many have a very high rate of preventing pregnancy. If you combine two of them, you’ll achieve the same level of prevention as the other methods that haven’t worked for you. Here’s a great article which gives effectiveness rates when two birth control methods are combined.

Fertility Awareness – I strongly encourage every person with ovaries to figure out when you’re fertile and keep track of it. Given that we can only get pregnant when we’re fertile, avoiding penis-in-vagina sex for a few days each month is a great first step in preventing pregnancy. Fertility awareness shouldn’t be relied on as your only form of birth control, but it’s quite effective when paired with a second method.

For most of us, it’s not as difficult as you might think. For folks with regular periods, you can expect ovulation 14 days before the start of your next period. If your cycle is 28 days from the first day of one period to the first day of the next, you’ll likely ovulate on day 14. If your cycle is 30 days, ovulation is likely on day 16. Whether you’re regular or not, there are several hard-to-miss signs of ovulation, even without tracking your temperature. There is usually a distinct increase of very slippery vaginal discharge about 48 hours before you ovulate. Many people notice a low ache or heaviness in their pelvis, on one side or the other. And it’s quite common to have a marked increase in appetites (for food and sex) immediately before and during ovulation. If that still feels like a lot to keep track of, get a good app for your phone. Assuming your periods are fairly regular, your app can warn you when ovulation is approaching.

Condoms – Rubbers, prophylactics, second skin, love glove, raincoat—whatever you call them, they’re very effective (98 percent when used correctly and consistently). I know some people feel like they reduce sensation, but isn’t it worth it if you don’t have to experience an unplanned pregnancy? Seriously. We’re grown-ups. We have to learn how to compromise.

Internal Condoms – Also known as Female Condoms, internal condoms are a barrier birth control and STI prevention method inserted into the vagina. When used correctly, they are 95 percent effective. They are latex free, much roomier than the other sort of condom, and are an especially good choice for folks with smaller-than-average and larger-than-average penises. Internal condoms also cover a portion of the vulva, which makes them more effective at preventing STI transmission.

Diaphragm – Somehow, for some unknown reason, diaphragms have fallen out of style. I find this perplexing as they are easy to use, cheap to acquire ($15 – $50 without insurance), and last a couple of years. When used correctly, they’re also 94 percent effective in preventing pregnancy. (They do not prevent STIs, however. You should know your status before adopting this method.) A diaphragm is a soft, flexible silicone dome (about 3 to 4 inches across) that you fill with spermicide and insert into your vagina before penis-in-vagina sex, and it can stay there for up to 24 hours. It covers your cervix to keep sperm out, and the spermicide catches any little swimmers that make it past the barrier. You will need a doctor to fit and prescribe the diaphragm, but once you pick it up from the pharmacy, you can use it as often as you need to.

Cervical Cap – This is an especially good choice for someone who hasn’t had a baby. A cervical cap is a small (about an inch across), firm silicone dome that fits snugly against the cervix, and prevents sperm from traveling into the uterus. Like a diaphragm, it does not protect against STIs, and is used with spermicide. It can be left in place longer, though. Once properly inserted, it can stay there for up to 48 hours. If used correctly, it is 91 percent effective for people who’ve never been pregnant and 84 percent effective for folks who have.

Spermicide – Spermicide is available in many forms to be used in the vagina. You can get it in a thin film (similar to a Listerine breath strip), a gel that you use with an applicator, or in a sponge that you place as close to the cervix as possible. When used correctly, spermicide is 83 percent effective at preventing pregnancy. There is a caveat to using spermicides, though. Like any topical treatment, it has the ability to cause irritation to the skin. If that irritation leads to any nicks or abrasions, risk of HIV transmission is increased. Therefore, spermicides should only be used by monogamous couples who are well aware of their HIV status, and are committed to being honest about any sexual contact outside of their relationship. (Spermicides do not prevent other STIs either. You should know your status before adopting this method.)

Curious about cunnilingus? Anxious about anal? Do you have questions about queefs or problems with your prostate? Lucky Tomaszek is the education coordinator at The Tool Shed: An Erotic Boutique, Milwaukee’s only mission-driven, education-focused sex toy store. Send her an email at mkesex@gmail.com and she’ll get back to you with an answer.