Behavioral Methods continued...

Coitus interruptus

Coitus interruptus involves withdrawal of the entire penis from the vagina before the man ejaculates (before sperm leaves the penis). Fertilization is prevented because sperm does not contact a woman’s egg. This method remains a significant means of fertility control in less advantaged countries.  

• How effective: This depends largely on the man's capability to withdraw prior to ejaculation. The failure rate is estimated to be about 4% in the first year of using this method exactly. In typical use, the rate is more like 19% during the first year of use. The failure rate means this method does not work to prevent pregnancy, and some couples using it will become pregnant anyway. The higher the failure rate, the more likely a woman is to have an unintended pregnancy. 

• Advantages: This method can be used at any time, with no devices, no cost, does not involve chemicals or hormones, and may offer a lower risk for other problems.   

• Disadvantages: There is a high risk for unintended pregnancy. This method does not protect against sexually transmitted diseases (STDs).   

Natural Family Planning    

Natural Family Planning (NFP), endorsed by the Couple to Couple League, is one of the most widely used methods of fertility regulation, particularly for those whose religious or cultural beliefs do not permit devices or drugs for birth control. This method involves periodic abstinence (no sexual intercourse), with couples attempting to avoid intercourse during a woman's fertile period—around the time of ovulation. (Ovulation is the process in which during a woman's menstrual cycle, one of the woman's ovaries releases an egg.)

The current method of NFP taught by the Couple to Couple League and many other teaching organizations is the sympto-thermal method. Women who use this method keep track of their cervical mucus signs, their waking temperature (basal body temperature), and their own cycle history. They may also monitor physical changes in the cervix. This method breaks a woman's cycle into 3 phases. Phase I is pre-ovulation infertility, beginning with the first day of menstruation. Phase II is the fertile period, in which conception could occur. Phase III is infertility after ovulation. It is best used by women who have consistent and regular menstrual cycles.

• The sympto-thermal method determines the first day of no sexual activity based on number of days since the first day of the menstrual period (usually 7) or the first day mucus is detected, whichever is noted first. The end of the fertile period (Phase II) is determined based on basal body temperature (body temperature at rest first thing in the morning, before getting out of bed). The basal body temperature of a woman is relatively low during the follicular phase (first half of her menstrual cycle) and rises in the luteal phase of the menstrual cycle in response so the thermogenic effect of progesterone (the second half leading up to her menstrual period beginning). The rise in temperature can vary from 0.2-0.5° C. The higher temperatures begin 1-2 days after ovulation and correspond to the rising level of progesterone. Intercourse can resume 3 days after the temperature rise. You can obtain a basal body temperature chart at 4women.gov.  
  
  
• To monitor cervical mucus, the woman examines her cervical mucus with her fingers. Under the influence of estrogen, the mucus increases in quantity and becomes progressively more stretchy and abundant until a peak day is reached. This is followed by scant and dry mucus because of the influence of progesterone, which remains until the onset of her period. Intercourse is allowed 4 days after the maximal cervical mucus, coinciding with the rise in temperature, until menstruation.