Penetrating Questions | Emergency contraception a safe, effective option

Jiná Ashline Columnist

My best friend was afraid that she was pregnant last week after her partner’s condom broke, so she took emergency contraceptive pills. I had never heard of them before. How safe and effective are they?
—Preventing an ejaculate conception

Dear Preventing,

Emergency contraceptive pills (ECPs) are a safe and effective way to prevent pregnancy as long as they are taken up to five days after unprotected sex. They have been used worldwide for as long as 30 years and are a viable option if a condom breaks or slips off, if you weren’t using any birth control or if you had unprotected sex.

The development of modern emergency contraception (EC) began in the 1920s when researchers discovered that estrogen extracted from the ovaries interfered with pregnancy in mammals. As early as the 1940s, there were reports of use of postcoital (after-sex) estrogens on women as a method of preventing pregnancy, but there were no published cases until the 1960s, when doctors in the Netherlands tried the method on a young girl who had been raped. Soon after, emergency contraception pills (ECPs) were approved for use in several countries. It was not until the end of the 1990s, however, that ECPs were widely recognized in the United States as a safe and effective method for preventing unplanned pregnancy.

In July 1999, the Food and Drug Administration approved the first ECPs in the United States Before that time, some doctors already practiced “off-label” use of oral contraceptive pills to achieve the same effect. Today, ECPs are also known by the brand name Plan B (the most commonly used kind of ECP in the Unied States). ECPs are sometimes called “morning after pills,” but that name can be misleading because ECPs can be taken up to five days after unprotected sex, not just the morning after. You may also need to take two or more pills, depending on the type of ECP.

ECPs contain a higher level of estrogen and progestin, the same hormones found in hormonal birth control pills. They prevent ovulation and thicken cervical mucus, which blocks sperm from fertilizing an egg. ECPs may also prevent fertilized eggs from attaching to the lining of the uterus, but there is no proof that this happens. Some sources incorrectly claim that ECPs cause abortion, but ECPs are not the same as the abortion pill (called RU-486 or Mifepristone.) ECPs cannot terminate or damage a pregnancy if an embryo has already implanted on the uterine wall.

Plan B is very effective at preventing pregnancy when used properly. Studies show that it reduces the risk of pregnancy by 89 percent when it is taken within 72 hours after unprotected sex. Plan B can be used up to 120 hours after unprotected sex, but it is more effective the sooner it is taken.

ECPs will not prevent pregnancy if you have unprotected sex after taking the pills, so you need to use ECPs to prevent pregnancy after each time you have unprotected sex. Also, as with any method of hormonal birth control, ECPs do not provide protection against sexually transmitted infections (STIs).

If there is any possibility that unprotected sex will put you at risk of contracting an STI, you should consider being tested.

ECPs are safe and have fewer risks and side effects than other hormonal birth control methods because they are not taken continuously and the hormones are not in your body as long as those in ongoing birth control. The most common side effects experienced are nausea and upset stomach.

Rarely, women may experience breast tenderness, irregular bleeding, dizziness and headaches. Side effects typically subside in a day or two, and a doctor can recommend ways to reduce them.

ECPs are an effective form of back-up birth control, but they should not be used as a primary form of birth control. As their name suggests, they should be used only in emergencies when your primary method of birth control fails. Frequent use of ECPs may make your period irregular. Ongoing use of hormonal methods is more effective when they are used correctly. Women concerned with preventing pregnancy should consider using hormonal birth control, which can be purchased at a reduced price the Women’s Health Center or at Planned Parenthood.

Plan B is available at pharmacies and health care centers without a prescription for people 18 and older. For those younger than 18, a prescription from a health center or private doctor is needed.

The cost of Plan B greatly varies from place to place. On average, it costs $10 to $45. Family planning clinics like Planned Parenthood usually charge less than private doctors or pharmacies. Locally, Plan B costs about $40 at nearby pharmacies. $25 at Baldwin’s Women’s Health Center, and it is currently free at Planned Parenthood.

Finally, as to condoms breaking, the primary reason why condoms fail is human error in their use.

There are some ways to help prevent condom breakage. Be careful opening the package so the condom is not torn—try not to get the condom caught in the tear of the package, and never use teeth, scissors or nails. Also, check the expiration date of the condom and store them in a cool (but not cold!) dry place—not in the sun, a car, a pants pocket or anywhere else where they could be damaged. Make sure there are no air bubbles in the condom by smoothing along the shaft and pinching the nipple-like tip to get all of the air out. You should also make sure that the condom is not pulled too tight (make sure you leave room at the tip for ejaculate). Be sure not to “double bag”, using two condoms, whether you’re using two male condoms or a male and a female condom—the friction causes breakage. Also, use plenty of lubricant. If there is not enough lubricant, the friction can cause breakage. With latex condoms you should only use water- or silicone-based lubricants because oil breaks down latex, rendering your condom ineffective.

Furthermore, if pregnancy is a concern when you are having sex, it is best to always use two methods of birth control. In cases of emergency when your primary methods fail, ECPs are a wise choice. Keep a box of Plan B handy, and practice prevention!

The Women’s Health Center is located on the second floor of Baldwin, ext. 5815. Planned Parenthood is located at 17 Noxon Street in Poughkeepsie and can also be accesed by calling 1-800-230-7526 or visiting ppfa.org.

—Jiná Ashline ’08 is a religion major with a women’s studies correlate. She is also president of C.H.O.I.C.E. Each week she will answer a question about sex and sexuality. Send your questions to jiashline@vassar.edu or by dropping a note in Box 2172.