Can I Use the Pill By Itself?

As someone who grew up with Ms., I’m incredibly humbled and delighted to be coming in as their first online sexuality advice columnist. I’ve been providing sexuality education and advice from an inclusive, feminist perspective since the ’90s, primarily working with young people in their teens and 20s. But in a media climate in which discussions of sex tend to be essentialist, pat, simplistic or shallow, I find that people of all ages and identities are seeking advice that treats sexuality as a complex, highly individual issue. I couldn’t think of a better venue in which to do my best to fulfill that need.

I’ve long felt that sexuality is a core feminist issue. Inequalities can have a real impact on our sexualities; in turn, unhealthy sexual dynamics or negative feelings about our sexuality can derail our lives. At the same time, healthy and affirming sex can be a way to explore and high-five our bodies, our identities and our relationships. This is one of the ways in which, ideally, equality provides us quality of life. My goal here and in all of my work is to do what I can to help support the healthiest, happiest sexuality possible for each of us as individuals and for all of us as a whole.

In honor of World Contraception Day (September 26), I’m starting with a very common question I get about the Pill and condoms.

Q: I take the combination birth control pill. Sometimes my boyfriend and I don’t use a condom in the beginning, but later we put one on. When on the Pill do you have to use condoms? They say every time you have sex you NEED to use a condom. I know it is the most effective way, but I thought one of the points of the Pill is so you don’t need to use a condom.

A: All methods of contraception can prevent pregnancy, but some are more effective than others. If you had to choose between condoms and the Pill solely based on which was more effective, you’d choose the Pill: It’s more effective in both perfect use (99 percent effective in preventing pregnancy over the course of a year) and typical use (92 percent).

But usually, effectiveness is not the only factor in contraception choices, and usually you don’t have to choose just one.

First, you need to evaluate your own risk of pregnancy. More people are typical users than perfect users of the Pill, especially through a whole year. Assuming you’re a typical user, how comfortable do you feel with an 8 percent-in-one-year risk of pregnancy? If you’re on the fence, let’s do the math about adding a condom. Condoms are 98 percent effective in perfect use; 85 percent effective in typical use. So, the theoretical combined effectiveness rate for both methods is 99.99 percent if each is used perfectly and 98.8 percent if each is used typically. That’s a big difference for typical users compared to either of those methods alone.

I can’t say how much that difference matters to you. If it feels like the world would end if you became pregnant, and you’re not using a more effective and more goof-proof contraceptive than the Pill (like an IUD or implant), you’ll probably want to use dual contraception. If pregnancy isn’t something you want, but is something you feel you could handle, and you want to only use the Pill, you’ll probably feel okay about using it alone.

Of course, one of the biggest differences between other methods of contraception and condoms is that only condoms reduce the risk of sexually transmitted infections; the Pill does not. Just remember: For condoms to work well to prevent pregnancy or STIs, they must be used correctly. That includes having them on from start to finish.

This is all something to talk with your partner about. How that person feels about a potential pregnancy and how much protection he wants also matters, certainly to him but probably also to you. You might also consider how much you tend to worry about pregnancy or STIs. Anxiety can impact the quality of our sex lives, so if using just one method produces more worry, during or after sex, that may not be ideal.

There are no need-to‘s here: Just use what you want and what best supports your life. This also isn’t a choice you have to make once and forever–if and when your feelings or your life changes, you can always adapt your contraception choices.

Have a sex, sexual-health or relationships question you want answered? Email it to Heather at [email protected]. By sending a question to that address, you acknowledge you give permission for your question to be published. Your email address and any other personally identifying information will remain private. Not all questions will receive answers.

Photo of condoms from fickr user robertelyov under Creative Commons 2.0

About

Heather Corinna is the executive director of Scarleteen, the inclusive online resource for teen and young adult sexuality education and information she founded in 1998. She is the author of S.E.X.: The All-You-Need-to-Know Progressive Sexuality Guide to Get You Through High School and College; a co-founder of the All Girl Army; and director of the CONNECT sexual health outreach program for King County, which primarily serves homeless and transient youth. She is on the editorial board of the American Journal of Sexuality Education, a writer and contributing editor for the 2011 edition of Our Bodies, Ourselves, a member of the Board of Directors for NARAL Pro-Choice Washington, and her sexuality advice is also syndicated weekly at RH Reality Check. Heather was the winner of The Champions of Sexual Literacy Award for Grassroots Activism from the National Sexuality Resource Center/SFSU in 2007; in 2009 the winner of the Society for the Scientific Study of Sexuality, Western Region's Public Service Award and the Our Bodies, Ourselves' Women's Health Heroes Award. In 2011, Scarleteen won a Seattle Web Award for Best Nonprofit Website. A Chicago native, she now lives and works on an island in the Pacific Northwest.