Disclaimer: The type of birth control you take can have unexpected side-effects. For this reason, it is recommended that you consult your doctor or other qualified health care professionals before using any of the forms of birth control listed below.
Diaphragms are round and made of latex with a circular spring. They cover the neck of the womb and extend behind the pubic bone and also protect the interior of the vaginal wall. They block the sperm from entering the uterus. There are two types of diaphragms: one that must be fitted by a doctor (also known as the traditional diaphragm) and one that you can insert yourself. The traditional diaphragm is being withdrawn from the Australian market. Alternatively, the diaphragm that you can insert yourself is currently available in Australia. There is only one size that is estimated to fit 80% of vaginas. We do not recommend the use of spermicides containing Nonoxynol 9 because recent research shows it may increase your risk of contracting a STI or HIV. Lubricant can be used to help insert the diaphragm. The diaphragm is inserted into the vagina prior to intercourse and should not be taken out between clients. In order for the diaphragm to be effective, it must be kept in the vagina 6 hours after intercourse to ensure that sperm is killed by normal vaginal secretion. Diaphragms can be left inside for up to 24 hours at a time.
The diaphragm should be checked if you lose or gain more than 3kg in weight and after an abortion, birth, miscarriage or gynaecological surgery. If the diaphragm is uncomfortable for you or your sexual partner, if it moves during penetration, or if it increases constipation or Urinary Tract Infections, you should get it checked at your local sexual health clinic or doctor.
The diaphragm on its own does not protect you against HIV or other STIs, as the infection can still enter through tiny tears in the mucous membranes which line your vagina.
IUDs (Intrauterine Device)
An IUD is a small contraceptive device that is inserted into your uterus to prevent unwanted pregnancies. There are two different types of IUDs available in Australia: the copper IUD and the hormonal IUD. Both types of IUDs do not protect you against STIs or BBVs and can increase your chances of contracting PID as it can introduce bacteria into your cervix, though this is very rare. The string attached to the device provides infection with an ideal means of travelling up to the cervix and deep into the fallopian tubes, where they can attack the entire reproductive system. Female sex workers are generally advised against the use of IUDs alone. IUDs are particularly suited to women who have been pregnant and have difficulty with hormonal contraception, i.e. the pill. Make sure you get a vaginal/pelvic exam, and if necessary a Pap and STI test before having an IUD inserted. IUDs do not protect you from STIs or BBVs.
If you are a concession card holder or eligible for the Medicare Safety Net the price of the IUD may be reduced. Some sexual health clinics may offer low cost or free IUD insertion for sex workers.
Implanon is a small rod that is inserted under the skin of the inner upper arm. It stops pregnancy by continuously releasing the hormone etonogestrel, which resembles the hormone progesterone, into the body. The Implanon is effective for up to 3 years; however, it must be replaced no later than three years after insertion. The device is very effective at preventing pregnancy (over 99% effective). It prevents pregnancy by stopping the ovaries from releasing an egg and causing changes to the cervical mucous membrane which makes it difficult for sperm to enter the womb.
Implanon is a useful form of contraception for people who cannot tolerate oestrogen-based contraception, such as ‘the pill’. However, the Implanon can cause changes to your menstrual cycle, such as changes in frequency, duration and heaviness of your period, amongst other side effects.
Additionally, it is important to speak to your doctor or nurse about any previous or current conditions you may have before getting the Implanon as it may have interactions. Implanon does not protect you from STIs or BBVs.
If you are a concession card holder or eligible for the Medicare Safety Net the price of the Implanon may be reduced or free. Some sexual health clinics may offer low cost or free Implanon insertion for sex workers.
Contraceptive Vaginal Ring
The contraceptive vaginal ring is a soft ring that contains the hormones oestrogen and progesterone. It is inserted into the vagina, and once the hormones are absorbed into your body, prevents you from getting pregnant. The vaginal ring can remain in your vagina for three weeks. On the fourth week, it must be taken out for a week and replaced with a new one at the end of the week. The ring works in a similar way to the oral contraceptive pill, by stopping your ovaries from releasing an egg.
The vaginal ring is not subsidised by the Pharmaceutical Benefits Scheme, so it can be more expensive than other forms of contraception. Additionally, the ring has interactions with some types of medications and is not recommended for people living with conditions such as deep venous thrombosis, diabetes, lupus, heart disease, liver disease, and certain types of migraines. This is an incomplete list, and it is recommended that you talk to your doctor about your suitability for the vaginal ring before using this type of contraception. The vaginal ring does not protect you from STIs or BBVs.
Emergency Contraception (‘The Morning After Pill’)
Health providers have stopped using the term ‘morning after pill’, because people thought you could only use it the morning after. In fact, there are various emergency contraceptive options available. There are two types of over-the-counter, single dose contraceptive pills available, one of which you must take within 72 hours (three days) and the other you can take up to 120 hours (five days) after having unprotected sex. However, the sooner you take it, the more effective it is. It is recommended that you take the emergency contraception within 72 hours (three days). Emergency contraception works like the contraceptive pill, stopping sperm fertilising the egg and/or stopping a fertilised egg implanting in the womb. Like the contraceptive pill, there may be side effects like spotting, sore breasts and nausea. Emergency contraception should only be used in ‘emergency’ situations, not as a regular means of preventing pregnancy. Alternatively, copper IUDs (Intrauterine Devices) is considered the most effective method of emergency contraception, with a failure rate less than 1% if inserted within 5 days of unprotected sex. Copper IUDs also provide long term contraception.
Spermicides are contraceptives, designed to prevent pregnancy by killing sperm. It used to be thought that an ingredient of spermicide (Nonoxynol-9) could also kill STIs, including HIV. However, studies indicate that Nonoxynol-9 can actually increase the risk of STI and HIV transmission, by causing sores and irritation inside the vagina, penis or anus. Because of this, spermicides containing Nonoxynol-9 are not recommended for use in situations where the STI and HIV status of your sexual partner is unknown, such as in sex work. Where pregnancy is unlikely or impossible, spermicide has no benefit and is not recommended at all. Additionally, spermicides are not considered an effective contraceptive method when used alone.