Correct me if I’m wrong, but most girls only have one vagina, right? I mean, there’s not something wrong with me, is there?

Talking sex with your doctor isn’t always easy. Whether you are afraid she or he will judge you,  you just don’t feel comfortable sharing the intimate details of your life between the sheets, or you can’t think straight with a speculum between your legs, many people get tight lipped in the doctor’s office. But that doesn’t mean you don’t have questions.

We thought we’d help and every Thursday our friend Dr. Lissa Rankin will be answering your questions. The ones you couldn’t ask your doctor in person and didn’t really trust the Yahoo community to answer for you. Just leave your questions in the comments, or send em over to us. (We’ll keep it all anonymous for you.) Dr. Lissa will answer anything – really, anything – about sex and other lady things. Don’t be shy; she’s waiting for ya!

Q: I am weighing my birth control options with my boyfriend. There are so many different choices now, so which is the least likely to fail? Any help would be appreciated!

A: In my opinion, the two reversible birth control options that are the most reliable are the Mirena IUD and Depo-Provera. Other hormonal contraceptives are also highly effective if used correctly.  Barrier methods, such as condoms and the diaphragm, are the least effective for pregnancy prevention.  To help you, I’ll go through each birth control method, one by one.

Barrier Methods
I’ve listed the barrier method options below, along with how effective they are. As you can see, in typical use, the failure rate is very high, but they’re cheap, safe, and non-hormonal. The downside, apart from the relatively high failure rate (and resulting unintended pregnancies) is that they’re messy, sometimes difficult to use, and a real pain in the rear. But because condoms are the only way to reduce your STD risk (note that I said REDUCE, not eliminate), it’s important to keep them on your radar.

Hormonal Methods
Oral contraceptive pills (OCPs) fall into this category, as does Ortho-Evra (the patch), Nuva-ring (the vaginal ring), and injectable contraceptives like Depo-Provera.  OCPs, Ortho-Evra and Nuva-ring are all just different delivery methods of basically the same hormones, which work by shutting off your own system and replacing your body with the hormones your own body would otherwise make in a way that inhibits ovulation (in addition to other mechanisms of action that I won’t get into here).  How are they different?  Ortho-Evra is a slightly higher dose and is available as a patch you can attach to your skin, which must be changed weekly. Nuva-ring is a vaginal ring you insert into the vagina (it’s easy to get in). Nuva-ring can stay in for 3 weeks, then you remove it to get a period. Nuva-ring seems to have fewer estrogen side effects than Ortho-Evra, in my experience.  Birth control pills come in all kinds of dosages and are easier to customize to the individual woman’s needs, but you must remember to take them every day.

Depo-Provera and Implanon are a bit of a different beast. While the others all contain a combination of low dose estrogen and progesterone, Depo-Provera and Implanon contain a very high dose of progesterone. Depo-Provera is an injection you get every three months, and because there is no estrogen, it can be used in women who cannot use other methods.  The down side is that it has a lot of side effects (irregular bleeding and weight gain are the biggest).  Frankly, I think Depo-Provera is great for teens who just can’t remember to use other methods correctly, but I’d never use it myself.  But that’s just me.  Some of my patients absolutely swear by it.

Implanon is an implantable form of birth control which is similar to Depo-Provera in its action and in the same family as the old Nor-Plant (but supposedly with fewer side effects). Since I have no personal experience with this contraceptive, I can’t comment on it further.

The advantage of these hormonal methods is they are all highly effective if you use them right.

IUD’s
IUD’s come in two types – the hormonal IUD (Mirena) and the non-hormonal Copper-T. I’ve been using Mirena for three years, and I LOVE it. Your gynecologist puts it in, and you’re good to go for 5 years (10 for the Copper-T).  The Mirena may have some breakthrough bleeding in the beginning, although because I put mine in when I was breast-feeding, I didn’t even have that. So I haven’t had a period in three years, which, frankly, is fine by me.

With the Copper T, you do continue to have menses, and they can be heavier and crampier because of the IUD. But some women love it because the Copper T contains absolutely no hormones.  Mirena does contain progesterone, which is released gradually and mostly acts locally on the uterine lining.  The advantage of the Mirena is that, over time, most women get very light or no menses, since the progesterone shrinks the uterine lining.  Both the Copper T and Mirena have an efficacy rate of >99%, making it a great alternative to tubal ligation.

Some gynecologists are reluctant to insert an IUD in a woman unless she is in a long-term monogamous relationship, because if a woman is at risk of STDs, the IUD may pose problems.  But if you’re interested, ask your gynecologist to help you assess whether you would be a good candidate.

Hope that helps!

We talk a lot about birth control around here (a natural progression from our daily musings about sex). We think its ability to stop babies is pretty badass, but many of us aren’t sure if that is worth all the crappy side effects: headaches, bloat, moodiness, debilitating cramps….We seriously thought we had it pretty bad until we found out that all of our suffering was nothing compared to those unlucky ladies who opted for the birth control patch.

While it was marketed as every woman’s dream birth control option (“Lower estrogen! Lasts all month! No need to remember those pesky daily pills!”), it has recently become every woman’s worst nightmare.

“The patch actually delivered much higher doses of estrogen than the pill; Johnson & Johnson failed to reveal this to the public for six years. At least fifty deaths have been attributed to the patch because of this, with thousands more women reporting alarming symptoms.”

The people behind the patch have been dealing with major lawsuits from patch users who experienced blood clots, strokes and heart attacks!

We love our ability to enjoy sex without the worry of havin’ a baby (and getting those awful stretch marks), but really? Stroke? Death? Does Johnson & Johnson really think women are willing to risk their lives for a little no-strings-attached booty?

If you are on the patch, get off of it NOW. There are plenty of other options for you: the pill, the Nuva Ring, an IUD, condoms, or, the tastiest option, Diet Coke? Just tear that thing off and call your doc. Fo realz.

Up = no babies.

Downs = weight gain, extreme emotions and severe migraine headaches.

For a while, the ups far outweighed the downs, but it soon got to a point where the headaches became debilitating (thus making me unable to have sex anyway), and I had to call it quits with the little pill. I tried other forms of birth control – the Nuva Ring, which was just too weird, and abstinence, which was just not realistic – and none of it worked.

I figured I was doomed to be sans BC forever, until my doctor told me about the IUD.

What is an IUD?

Basically, it’s a small object that is inserted through the cervix and placed in the uterus to prevent pregnancy. The doctor inserts the IUD onto your cervix where it stays for up to 10 years. If you want to get pregnant, you simply head back to the doctor and have it removed and your period and ovulation schedule return to normal. The IUD is 99.9% effective at preventing pregnancy and you never have to remember to take a pill again!

It sounded too good to be true, but my doctor assured me that it was safe, covered by insurance and the best option for someone like me. So I did it.

The strange thing about the IUD is that it has to be inserted when you are on your cycle. So, not only do you feel kinda gross and bloated, but you have to hop into the stirrups and lay spread eagle in front of the doc. Not your finest hour.

I got a little squeamish when I went into the room and saw the equivalent to a wee wee pad lying on the table. “It gets a little messy,” the nurse told me. Barf. I laid on the table, gripping my sweatshirt nervously, and the doctor went to work.

The procedure took all of 5 minutes, but they were probably the longest and strangest five minutes of my life. There was a speculum, some very long Q-Tips and the IUD itself. I felt extreme cramps (the kind that usually require a heating pad, my couch and Season 1 of Friends on DVD), and extreme embarrassment as I wondered how messy things were getting down there. And before I knew it, the whole thing was over.

No more pills, no babies, and, in about a year, no more periods at all!

The idea of having a strange plastic thing inside my body is a little weird, but it is far outweighed by the fact that I can enjoy my sexual freedom without the monthly fear that I may be a mom sooner rather than later.

If the pill works for you, then stick with it. But if you are like me and can’t handle the hormones in the birth control pill, an IUD is definitely worth looking into. And don’t worry; when the whole thing was done, my wee wee pad was perfectly clean.

In fact, with all the horrible side effects like the migraines and weight gain I feel like the only reason the pill is even working is because it is preventing me from going out to find someone to have sex with. And I am not so sure that is how it is supposed to work.

I have attempted to stick it out for the past six months, but, considering I have been sans sex for quite some time, I am about ready to throw in the towel. My doctor – always the optimist – didn’t like that idea.

“Lauren, I know you joke about being a crazy cat woman, but you will have sex again someday and you might regret your decision to stop taking birth control.”

She had a point. Maybe one day I might again have the urge to do something besides catch up on my TiVo on a Friday night. You know; like go out and meet a man. And have sex. She recommended a different form of birth control that minimized the side effects that have been haunting me for months.

Unfortunately, this one presents a whole new slew of problems.

It is called the Nuva Ring and the name alone already grosses me out. Basically, this little guy is a plastic ring that is inserted into the va-jay-jay and left there for three weeks. While hanging out inside of your body, the ring dispenses a steady flow of hormones that prevent pregnancy. After three weeks, you take it out and get your period. Then you stick another one in.

Now, I don’t know about the rest of you, but the idea of sticking the equivalent to the plastic thing that comes off when you open a gallon of milk inside of me and then leaving it there for three weeks is far from comforting. I don’t even know how to comprehend this. I have so many questions:

Where exactly does this thing end up?

Can my potential partner feel it during sex?

How do I know if it is working?

Most importantly, how the hell am I supposed to get that thing out!?

Also, since the heat of the body activates the ring to work, it must be stored in a cool place until it is time to use it. “Cool place” being the refrigerator. Because nothing says normal like a fridge stocked with beer, butter, bread and birth control.

I really don’t know what to do. I know I do not want migraines. I know I do not want to be fat. And I am absolutely positive that I do not want to be a mom. But I also know that I don’t want to stick my hand into my cervix every three weeks to fish out a pony tail holder.

Maybe my current state of celibacy is the way to go. I’ll see you at the Cat Emporium.

Have you ever tried an alternative form of birth control?