Please give me birth control advice - AFTER condoms.
April 3, 2014 7:19 AM   Subscribe

My partner and I have decided to use two layers of birth control. Her doctor said it was a good idea, because condoms have a small failure rate even when used perfectly. However, she doesn't want her parents to know (she's 20) and is on their health insurance, and she has a family friend that works at planned parenthood.

Our options:

Birth Control:
1. Can't get the pills without a prescription (parents would know)
2. Might mess with her hormones (which would be terrible!)

1. Seems SUPER sketchy.
2. Barely helps at all (high failure rate), expensive for very little, you have to wait 15 minutes, uncomfortable and bad for the vagina.
3. However, this is what her doctor for her yearly checkup recommended.

Female Condom:
1. I don't think you can double up Male and Female Condoms and have a higher success rate than just a male condom.

1. Need doctor to insert/buy.
2. Family friend works at planned parenthood.
3. Kind of pricey, but not really.

We feel kind of lost about this. We both thing having a second layer of protection is necessary, but we are out of ideas. Can anyone give us any suggestions for anything? We haven't made love in over a month because we haven't figured it out yet.

Thank you so much.
posted by anonymous to Health & Fitness (35 answers total) 2 users marked this as a favorite
Go to another branch of Planned Parenthood. There are generally multiple branches even in suburban areas, and while they COULD share information, it's unlikely that they WOULD share information about routine patient care.

Also: Planned inserted my IUD for free. But even if you do have to pay, it's abundantly worth it. The copper one is a decade of nearly-foolproof birth control. That peace of mind is worth a LOT.
posted by julthumbscrew at 7:25 AM on April 3, 2014 [3 favorites]

I'm echoing the above advice, hell, even go to the Planned Parenthood where the family friend works. It's not like she could say anything to anyone anyway, that would violate HIPAA rules.
posted by Ruthless Bunny at 7:27 AM on April 3, 2014 [21 favorites]

Why would her parents know about the pill prescription? You can get the pill without getting insurance involved at PP. It's more expensive but for a generic pill it shouldn't be too bad (I think about $30/mo last I checked?). Also, you need a script for the IUD as well.

I'm getting the sense that there might be something more going on here, though, if her anxiety about this is so bad that you haven't had sex in a month(!!). Millions of people rely on just condoms and do fine.
posted by oinopaponton at 7:35 AM on April 3, 2014 [5 favorites]

Another option: contraceptive sponges
posted by kmennie at 7:35 AM on April 3, 2014

She should talk to her doctor if she is concerned about patient confidentiality. She is over 18, so I don't think there is any way her parents could find out what prescription a doctor gave her, unless she has waived privacy rights. They would only see that she had a doctor visit, which could be for anything.

The only way they would know is if she uses the insurance for the birth control itself - there are a lot of lower cost birth control pills that you might be able to afford just paying cash for.
posted by nakedmolerats at 7:36 AM on April 3, 2014

Female Condom: I don't think you can double up Male and Female Condoms and have a higher success rate than just a male condom.

Definitely don't do this. The friction between the two layers can cause holes and tears to form. You would be at more risk than if you used only one condom (female or male).
posted by enn at 7:38 AM on April 3, 2014 [3 favorites]

Her doctor already knows she's having sex - just get the doctor to prescribe a cheap BC pill and pay for it out of pocket. Pharmacies with $9 birth control prescriptions. I don't know why the doctor didn't suggest this.

Also: what about a diaphragm?
posted by mskyle at 7:39 AM on April 3, 2014 [5 favorites]

Some Birth control is covered 100% under ACA.

The poster said she didn't want to use insurance because then the parents would see the bill, right? I am sure that she has insurance, she is just worried about the bill.

I think I read somewhere about calling your insurance provider to ask that only you get sent the details of the insurance coverage.
posted by bbqturtle at 7:40 AM on April 3, 2014

you didn't say this in your answer, but is she in college? some colleges have a health clinic she could go to. at my school, it was connected to the county health clinic, but I got cheap birth control for four years.
posted by kerning at 7:40 AM on April 3, 2014 [2 favorites]

Another option: contraceptive sponges

Yes! The sponge! Available over-the-counter, easy to pair with condoms, wonderful as a backup method. I don't know why you're writing off spermacide, either; it may not have a high effective rate as a primary method, but it's another easy, cheap, effective backup method for a couple who is using condoms correctly every time.
posted by ThePinkSuperhero at 7:43 AM on April 3, 2014 [1 favorite]

Might mess with her hormones (which would be terrible!)

I have friends that have had to switch birth control pill methods for several times before finding one that worked will with their chemistry. I understand the feeling of wanting to avoid personality/daily comfort changes.
posted by bbqturtle at 7:43 AM on April 3, 2014

She should take the time to read and understand how her fertility cycle works, and track her cycle. If she has a regular cycle, she can find out when she's ovulating and when she is not. If she doesn't have a regular cycle, you can buy a big pack of ovulation test kits on Amazon for $20. These are mostly used by people who are trying to conceive, but they can easily be used in the opposite way, to ensure you don't conceive. There are also apps to help you track your cycle- I liked My Days (for iOS).

I literally never had a health class when reproduction was taught, so I'm sorry to say it was only last fall that I understood how my cycle really worked (like, technically). It turns out that it's just a matter of a few days that conception is possible, about a week each month (if she's regular). You can skip P-in-V sex entirely while she's ovulating, and then wear condoms the rest of the time. That would be plenty adequate to handle the ghost of a chance that you'd conceive when she is not ovulating.

If she's already discussed this with her doctor, I presume she trusts her doctor not to blab to her parents. Any chance she can get birth control pills and tell her parents it's for one of the myriad reasons that a woman might need the pill, other than to protect against pregnancy?

She's 20 and a legal adult. I was out with my parents about my use of birth control by that age. Is she going to tiptoe around them until she's 27 and off their health insurance? Maybe trust that doctor, get an IUD, and if her parents read their health insurance statements super closely, it might be time just to have the conversation.
posted by aabbbiee at 7:44 AM on April 3, 2014 [6 favorites]

Following the above comment, she can read Taking Charge of Your Fertility which helps understand the cycles, and the signs the body gives when a woman is fertile (she'll have egg-white textured cervical fluid that a friend of mine lovingly calls "baby batter"). For tracking software I recommend kindara.

BUT - you need to be VERY RESPONSIBLE if you use those methods. Since you are relatively young & uncomfortable with this whole affair, try to get your hands on the pill first, but do read that book since it is a good general resource.
posted by St. Peepsburg at 8:06 AM on April 3, 2014 [4 favorites]

Depending on how you feel you could also get a vasectomy. It can be revered later in life with a fairly high % of success.
posted by edgeways at 8:18 AM on April 3, 2014

Seconding mskyle. Tri-sprintec is $12 at my Walmart with no insurance, her regular doctor can do her pap smear and write her prescription and then she'd be good to go.
posted by julie_of_the_jungle at 8:21 AM on April 3, 2014 [1 favorite]

She should check out a different Planned Parenthood or another sexual/reproductive health center to find out about alternative insurance coverage which is often available for young people looking to keep their sexual health private from their parents. Where is she? In New York State, for example, there is a program called the Family Planning Benefit Program (FPBP) that provides confidential coverage for sexual health care.

In terms of what birth control method she should use, there is a great guide available here with a side by side comparison of different birth control methods and videos of real birth control user discussing their preferred methods (including the ones you mentioned here and many more.) In terms of the pill - while some people have negative side effects from using hormonal birth control, many people use it effectively with no negative side effects. It's worth discussing with a doctor to see if it would be right for her to try out.

As enn stated, definitely do not use a male and female condom at the same time - using two condoms actually increases the risk of the condoms breaking. A vasectomy doesn't seem like the best option either, with so many other options available, unless you're sure you don't ever want children. There are other methods that are extremely effective, and temporary.

If you end up just using condoms, it might reassure you to learn a little about emergency contraception so that you have a backup plan should a condom break.

I presume she trusts her doctor not to blab to her parents
Her doctor can't legally blab to her parents. Sharing this information would be a breach of patient confidentiality.

I've worked in a sexual health related field - OP, feel free to memail me.

Kudos to you both for taking care of yourselves!
posted by one little who at 8:37 AM on April 3, 2014 [3 favorites]

Pulling out, while rarely a good practice in and of itself (though pretty effective if done correctly), works well combined with condoms.
posted by Candleman at 9:09 AM on April 3, 2014 [4 favorites]

The easiest way to go about this would be for her to go to a clinic of some sort to get a prescription for birth control. A student health center or one of those doctor's offices that does semi-emergency appointments should work. Call first to ask for their cash price for an appointment. She should definitely request the prescription have 11 refills.

If she makes sure that the prescription is a fairly cheap generic (no birth control with iron combo or the like), you shouldn't need to worry about insurance. Go to a different drug store than her parents for an extra layer of protection.

If she does need to use her prescription insurance, below is an article which discusses how to maintain privacy.
posted by Trifling at 9:10 AM on April 3, 2014 [1 favorite]

2. Might mess with her hormones (which would be terrible!)

It would definitely mess with her hormones - that's how it works, by adding synthetic hormones to hers so that ovulation doesn't happen. So if she's against anything disrupting the natural balance of her hormones at all, the pill is not the way to go.

On the other hand, if what she's afraid of is potential negative side-effects of her hormone levels being affected artificially, she might find comfort in the fact that many many many women get along with the pill just fine. Plus, if she finds she's one of the unlucky ones who it really doesn't suit, she can just stop taking it - it's not like one of the long-acting hormonal contraceptive methods which are much more of a hassle to stop immediately.
posted by Catseye at 9:43 AM on April 3, 2014 [4 favorites]

Also, given the high reliability (higher than condoms, since it's completely user-proof once inserted), an IUD isn't really a backup method as much as a primary method, which is great if your only concern is preventing pregnancy.
posted by ThePinkSuperhero at 9:46 AM on April 3, 2014 [3 favorites]

1. Planned Parenthood visits are private and protected under federal law. Everyone I know who's worked at Planned Parenthood is really interested in keeping patients' information private, and I seriously doubt the family friend would say anything - to her or to anyone. And like was mentioned upthread, there are often many locations within a short drive.

2. There are lots and lots of reasons to use hormonal birth control that have nothing to do with having sex. "Regulating my cycle" is a good enough reason for your girlfriend to give to anyone who's nosy enough to ask.

3. The health insurance company probably can't say anything to her parents either. My husband is the plan holder for our insurance and I am a dependent, but he can't see my explanations of benefits (the run-down of what services I've received) on the insurance website because I am of majority age. It's annoying as heck, because we have to log in with his username to see his and our daughter's expenses, and log in with my username to see mine.

4. Even if her parents DID see the explanation of benefits, my EOBs are never so specific as to say "birth control" or even the name of the medication. And now that they are covered by the ACA, I don't even get EOBs for my birth control prescription anymore, or if I do, they are so inscrutable that I don't realize that's what they're for. (And I actually read my EOBs very carefully, because we have a high-deductible plan and I want to know what I'm paying for.)

5. Her doctor has dealt with this before. She should ask what options she has to receive confidential birth control.

6. She's 20, and she's having or considering having sex with you. She needs to be able to stand up to her parents about this if it comes out, because being an adult means taking responsibility for your actions. I know that's really tough, and I was once a 20-year-old terrified that my parents would find out I was having sex. I went to Planned Parenthood (where a family friend worked) and other local clinics that used a sliding scale for payment. It's great that you guys are taking precautions up front, but if she's not ready to have this conversation if necessary, she's not ready to have sex.
posted by peanut_mcgillicuty at 10:15 AM on April 3, 2014 [8 favorites]

I had trouble finding sponges regularly, but used a diaphragm (with spermicide) for some time. It's a removable barrier method that's condom friendly. Planned Parenthood will prescribe and fit it. Wash between uses, so cheaper than sponges, and it came with a plastic case like a retainer (the kind for your teeth). Yes, she should go to PP and talk to somebody! Medical confidentiality is A Thing, esp since she is a legal adult!

You should both read Taking Charge of Your Fertility too. Make sure you know exactly how everything works!
posted by jrobin276 at 11:14 AM on April 3, 2014

Oh yeah... Just because she's on her parents plan doesn't mean she has to see their doctor too. She can see someone else, as long as they accept that insurance policy.
posted by jrobin276 at 11:22 AM on April 3, 2014

There's also the cervical cap. Like a diaphragm, but a little different, can be worn for many hours. Just an option I haven't seen mentioned...
posted by wyzewoman at 11:45 AM on April 3, 2014

I would recommend that she look into a copper IUD. The Mirena IUD is hormone based (though in much smaller amounts than pills). Different IUDs have different pros/cons, and she should really speak to a professional or do her own research. Maybe just talk to the Planned Parenthood people?

IUDs have the advantage of having extremely low failure rate (and usually only at the end of the lifespan or if inserted incorrectly). They are low in hormones or have no hormones. You can't forget it somewhere or get too lazy to use it. They are extremely inexpensive over the lifetime of their usage, even if you have to pay a significant portion out of pocket. And of course, no preparation (unlike spermicide and cervical cap) means you don't kill the sexy spontaneity when you feel like getting down to business.
posted by ethidda at 12:48 PM on April 3, 2014 [1 favorite]

Following the advice that she should learn how to track her cycle, a word of warning. It is a wonderful and powerful thing to become familiar with how the body works. However relying on this awareness for contraceptive effect is not easily done. Highly motivated couples with a lot of self control might be able to avoid pregnancy by avoiding having sex, or only having super-protected sex, during the fertile period - and it might still be hit-and-miss for them. It's easy to misinterpret the signals and get the timing wrong. Young ardent couples should not gamble on being able to avoid the fertile period.
posted by glasseyes at 1:03 PM on April 3, 2014

"Millions of people rely on just condoms and do fine."

The typical use failure rate of condoms is 18%, so out of those millions of people relying on condoms there are a few hundred thousand unplanned pregnancies per year. Condoms are actually one of the WORST methods of birth control -- they're only slightly more effective than pulling out.

IUDs are best. They last for 10+ years and she can have it removed earlier if/when she's ready to get pregnant. She can even get one without hormones (speaking from experience, a copper IUD may make her periods heavier but IMO it is a small price to pay for a less than 1% failure rate). Most Planned Parenthoods charge on a sliding scale based on income, which should cover most of the cost of the IUD. Go to a different branch if you're really that worried about the family friend being willing to violate HIPAA and lose her job just so she can gossip about your girlfriend's birth control choices.
posted by Jacqueline at 1:34 PM on April 3, 2014

For what it's worth, I used my father's insurance all throughout college, and to my knowledge, he never received any notification that I was using it for birth control. I'm on my own insurance now, and I look at the statements they send carefully because I've gotten screwed over on a couple of things in the past (related to a hospital visit, nothing to do with reproductive health). I've never received anything that indicated I was using birth control or that referred to my prescription. You could call the information line for your insurance plan (which is on your insurance card) to ask for the specifics of how they do things.

I will also point out that there are a HUGE number of reasons that people use birth control besides, you know, birth control. My sister was on it for a long time solely to regulate her cycle (she would often randomly skip periods otherwise and generally get her period at totally random times rather than on a set schedule...quite inconvenient). A good friend of mine uses the pills because otherwise she has incredibly painful/horrible cramps with every period. So, in the unlikely event that your parents a) found out from their insurance company that you were taking birth control pills and b) decided it would be a good idea to ask you about it (I truly think this is unlikely!), there are plenty of excuses that would be very easy to pull out of your pocket. Although I'm never a huge advocate of lying, I think it is justified at the point that ANYONE is attempting to get involved in policing an adult's sex life.

I also think your girlfriend might want to start thinking about how to deal with the anxiety she's having around this issue. I totally get it that it can be awkward to think about/talk to your parents about anything involving sex. At the same time, she is TWENTY. At some point, you guys are probably going to want to move in together, at which point, her parents will know, right... So, better to start thinking about how to get over this issue now rather than kick it down the road.
posted by rainbowbrite at 2:04 PM on April 3, 2014 [1 favorite]

There are usually multiple branches of planned parenthood in an area, so I encourage you to try more than one, both to avoid the family friend or to find one that you are the most comfortable with.
One of the most valuable things they can do with you, short of providing the actual birth control, is counseling and educating you about all of the options.
Short of that, they have a very, very helpful anonymous online chat that you can use to get all your questions out before committing to a trip.

In my personal experience, as a late teen, I was not ready (mentally or physically, comfort wise) for the procedure involved in getting an IUD. I may be wrongly jumping to the conclusion that she hasn't had/isn't used to pelvic exams (since it appears she isn't consulting a gynecologist with these questions) but it is an EXPERIENCE to say the least. I got about 5 minutes into the procedure and threw in the towel.

I have the Implanon, which, like the IUD, distributes hormones at a constant level throughout your body and lasts for years with no user intervention needed, but it's in your arm right under the skin. It is extremely effective and the piece of mind is awesome. They gave me a couple shots to numb the site and I didn't feel a thing.
posted by rubster at 4:32 PM on April 3, 2014

I also agree with some posters above that you should give a shorter term hormonal method (pill or patch) a shot before committing to a long term implant, to see how it reacts with your body.
posted by rubster at 4:36 PM on April 3, 2014

I'm sure some people would consider this bad advice, but if your concern is simply your lack of comfort with the failure rate of condoms, and the negative side effects of other birth control options, I would recommend condoms + pulling out + checking the condom afterwards. Familiarize yourself with emergency contraception options in case you have an instance where the condom isn't intact afterwards (most 'morning after pills' are essentially high-dose birth control pills). Note that pulling out is surprisingly effective (but I would never recommend it as the only means of birth control). Also, the "perfect use" statistics for condoms simply mean that you use a condom every time, whereas the "typical use" stats mean there are some times that you fail to use a condom. If you use a condom every time AND pull out AND check whether the condom has broken, taking appropriate measures if it has, the chances of failure should be pretty darn low.

Birth control pills/nuvaring/patch etc: These options will mess with her hormones (that's exactly what makes them work) but for some people this can have positive side-effects, such as easier periods and being able to control when you have your period. Anecdotally, I know several women who had a terrible time on birth control pills - it messed with their moods really badly - but there are also lots and lots of women who have a positive experience. And, as mentioned, at least pills can be stopped immediately if there are negative side-effects.

I'm not sure whether her parents would actually need to know about the prescription to use their health insurance, but if they do and she has a valid reason to avoid letting her parents know that she's sexually active, she can emphasize the other uses of birth control (lighter bleeding etc.). For example, if she's anemic, the side effects alone might be a good reason to use birth control.

Also, pills should be available relatively inexpensively through Planned Parenthood or a school health clinic.

IUD: Lasts a long time and the copper IUD can be pretty inexpensive, plus it doesn't mess with hormones. It could cause worse periods though - it's an individual thing whether this is a dealbreaker or not.
posted by ersatzhuman at 5:08 PM on April 3, 2014 [1 favorite]

This article: The girls' guide to getting some privacy on your parents' health insurance gives some great advice and information (with support from the National Women's Law Center). It includes some good specific tips and language to use when calling your insurance company to get the specifics on their privacy policies (which it looks like can vary a bit depending on which company it is, and what state you're in). You are definitely not alone in having this concern. You have the right to ask questions! Write down a list ahead of calling the insurance number (it's the 800 number on the card) or talking to your doctor, it can make it easier to remember everything in a conversation you feel anxious about.

Adding another anecdotal voice saying that I get my pills for $0 (thanks Obama!) and I have never noticed it being specifically referenced on my explanation of benefits. It is also not unusual to have to try a few different hormone options to find one that works well. Knowing all of her options and getting some peace of mind on the privacy aspect will hopefully give your partner what she needs to make the choice that works best for her right now.
posted by Atalanta at 5:32 PM on April 3, 2014

(Sorry Trifling! I missed that you had already linked that article. Seconding that it is useful!)
posted by Atalanta at 5:45 PM on April 3, 2014

edgeways: "Depending on how you feel you could also get a vasectomy. It can be revered later in life with a fairly high % of success."

Vasectomy should not be considered a reversible form of protection. While there is a procedure to reverse it pregnancy rate afterwards is around 55% (the longer before reversal the lower the rate) and the procedure is fairly expensive.
posted by Mitheral at 4:43 PM on April 5, 2014

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