If you have read the previous chapters with some care, we hope you are getting the message that for improved protection it is better to double up or treble up—use two or three forms of birth control. Using more than one method at a time provides overlapping and complementary protection and greatly improves your chances of avoiding an accidental pregnancy and disease.
A man, for example, can use condoms plus a spermicide or withdrawal. For a woman, condoms plus a LARC may offer the best option.
Even if you use only FAMs (fertility-awareness methods), you can combine the temperature method with the mucus method and with test sticks for hormones that coincide with ovulation. Withdrawal might be a good option too. An electronic device to keep track of it all will also improve your chances of success with FAMs.
Methods that typically cannot be combined are those methods that use the same space, such as male and female condoms, the diaphragm and ring, or different types of IUDs. Also, the various hormonal methods should not be combined.
As you can see there are many contraceptive options to choose from, and if you include FAMs in your arsenal of protection, you can even use different methods at different times.
Unfortunately, we don’t have very good studies on the actual failure rates of various combined methods of birth control. There are mathematical predictions of effectiveness, but we would like to see actual failure studies rather than theory.
Also, some people suggest that doubling up will do. That may suffice if your only concern is pregnancy, but STIs are a concern too. While pregnancy is well handled by a LARC, such as the implant or IUD, it offers no protection against STIs. That is why we suggest the simple message: “Treble up.”
A few things to keep in mind as you make these decisions is that only condoms protect against disease, and that while all barrier methods should be used with spermicide, spermicides cannot be used too often. Furthermore, some methods cannot be combined, including the male and female condom, the ring and diaphragm, the different IUDs, or different hormone-based methods.
If you are a newlywed couple, and you both practiced abstinence before marriage, do you still need condoms to protect against STIs?
Probably, yes—unless you test first to confirm there are no STIs.
STIs can be passed through other nonintercourse intimate contacts, and some are passed through needle use. Even babies can be born with HIV or STIs. Further, many STIs can be present without showing any symptoms, and you or your new spouse may not realize there is an infection if there are no symptoms.
It is a good idea to have a full panel of tests, including an HIV test, before marriage, and test for HIV again after the HIV window has passed. The HIV window is a period of time after exposure when HIV cannot yet be detected, and the length of the window varies with the sensitivity of the test. If you and your spouse pass both tests, and neither of you is stepping out, it is probably safe to discontinue condom use.
Another wise precaution is to obtain vaccines before marriage. Right now, the HPV and hepatitis vaccines are available, and in the future, more vaccines will become available. Someday there may even be an HIV vaccine.
We also encourage you to have a contraceptive kit to protect your contraceptives and ensure that you are prepared for any emergency. A man’s kit should contain:
- A strong protective and discreet case
- condoms (male or female or both)
- water-based lubricant
- emergency contraceptive pills
- hand sanitizer
- nail brush
A woman’s kit can contain the same things, plus whichever of the ring, pill, patch, sponge, cap or diaphragm she is using, unless a LARC (implant or IUD) is being used.
Remember, treble up: use three forms of birth control to give you the best in family planning and disease protection.