Dear MKE SEX,

So, basically, I’m just a guy in high school who wants to have sex with my girlfriend and not be a dad yet. My girlfriend would also like to have to sex with me and not get pregnant. (We’ve talked about it. A lot.) She’s willing to get on the pill, but I just think I should do something, too. Like, it’s not just her responsibility. We both really want to do this. But when I look up what methods of birth control are the best, I usually see two different sets of numbers. One will say, “Used as intended” and the other will say “Typical use.” And the numbers are VERY different! Like take condoms. The kind of condom I’d wear is 98 percent effective when “used as intended,” but only 82 percent effective with “typical use.” But, like, what’s the difference? How do I use it “as intended” and get the best protection?

Thanks,
Concerned About Condoms

Dear Concerned,

In general, I don’t like to tell people there’s a right or wrong way to do sexy things (assuming that consent has been established). But when it comes to using birth control, there is often a right way and a less right way to do it. “Used as intended” (also called “perfect use” in some places) means that you follow the directions for that method of birth control exactly, every single time you use it. “Typical use” means the way that most folks use that method of birth control, which usually varies a lot from the directions. But, if you really want to make sure your birth control is as effective as possible, following the directions is the best place to start.

Since you and your girlfriend are willing to share the work of preventing pregnancy, you should definitely check out Scarleteen’s Buddy System. It shows how to combine forms of birth control to increase their effectiveness. For now, let’s look at the most popular forms of birth control* on their own, and what it means to “use as intended.”

Contraceptive injection (like Depo-provera)
When used as intended: more than 99 percent effective
With typical use: around 94 percent effective

Injectable birth control uses hormones to prevent the release of eggs in the uterus (ovulation). If there’s no egg, there’s no way to get pregnant. The shots need to be given on time, every time, in order to be the most effective. If folks are late for their next shot, or skip a dose altogether, there is a chance of ovulation which leads to a chance of pregnancy.

Contraceptive patch (like Ortho Evra) and contraceptive ring (like NuvaRing)
When used as intended: 99 percent effective
With typical use: around 91 percent effective

Like the shot, both the patch and the ring suppress ovulation to prevent pregnancy. Additionally, they thicken cervical mucus which in turn allows fewer sperm into the uterus. Also like the shot, both the ring and the patch need to be applied at the right time, every time. Delaying putting on a new patch or inserting a new ring increases risk of pregnancy while also decreasing the thickness of the cervical mucus.

Oral contraceptive pills (also known as the pill, or birth control pills)
When used as intended: 99 percent effective
With typical use: around 91 percent effective

There are two big categories of oral contraceptives. Most of them are known as combination pills, meaning they have two kinds of hormones in them. They work the same way that the patch and the ring work (by suppressing ovulation and thickening cervical mucus). Combination pills can be taken at any time, as long as you take one every single day. If you miss a day, you increase the risk ovulation. Some other oral contraceptives only have one hormone (progestin), and are often known as the mini pill. They work the same way as the shot (only suppressing ovulation). Mini pills have to be taken at the same time every day to be effective. If you’re late taking it, you increase your risk of ovulation.

Male condoms (also known as wearable condoms, or external condoms)
When used as intended: 98 percent effective
With typical use: around 82 percent effective

Wearable condoms are a sheath of latex, polyurethane, polyisoprene, nitrile, or something similar. The sheath should cover the entire penis, as far down the shaft as possible. It acts as a barrier, keeping sperm inside and away from your partner. To reach 98 percent effectiveness, the condom must be on the penis *before* there’s any contact with your partner’s vulva or vagina and stay on until after you have ejaculated. Then, you must come out of the vagina as soon as possible, while you’re still at least semi erect. The condom should be removed and disposed of, and the penis washed to get all of the semen off before any cuddling resumes.

Female condoms (like FC2, also known as internal condoms)
When used as intended: 95 percent effective
With typical use: around 79 percent effective

Internal condoms are a little pouch made of nitrile with a semi-firm ring at the opening. They go inside the vagina and act as a barrier to prevent sperm from entering the uterus. They can be a great choice for folks having sex with a penis that might not fit well in a wearable condom (bigger, smaller, wider, or more narrow). For maximum effectiveness, the internal condom needs to be in place before the penis has any contact with the vulva or vagina, just like with a wearable condom. It needs to stay in place throughout the sexy encounter, and be removed and disposed of as soon as possible after penile ejaculation.

*This article is focused on preventing pregnancy only. The contraceptive injection, ring, patch and pill do not prevent the transmission of STIs. They are also only available by prescription, and not every option will work well for every person. If you are considering hormonal birth control like the shot, ring, patch or pill, talk with a doctor, nurse practitioner, or midwife about the right choice for you.

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.

About The Author

Lucky Tomaszek
Contributor

Lucky Tomaszek is the education coordinator at The Tool Shed: An Erotic Boutique, Milwaukee's only mission-driven, education-focused sex toy store. Most mornings you can find her balancing her cat and her keyboard in her lap, working to make the world a smarter, safer place for people of all genders and orientations.

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