(Michal Shoenbrun is a reproductive health educator, consultant, and trainer. Read more about Michal here)

There are times in life when women and couples need to space, avoid or postpone pregnancy. This total time period, non-consecutively, can typically last anywhere between 10 and 25 years.

When trying to decide about which method/s to use, we usually prioritize those methods that will be the most effective statistically, safe, hassle-free and easy to use. We most likely consult with a gynecologist for their opinion too.

For some, it is a simple, technical decision without serious consequence. For others, it can be challenging and complicated. Couples don’t often consider how a method might affect their intimate relationship and sexual experience.

If physicians are uncomfortable discussing sexuality in general, they are not likely to talk about the sexual side-effects of common birth control methods in particular. Beyond the general discomfort, the issue is far off the clinical radar screen for most. We are not talking about something rare or unusual but actually something quite common and disturbing. Let’s just call it the elephant in the bedroom that is sometimes hard to see.

During our 35+ fertile-bearing years, most of us are focused on avoiding or postponing pregnancy for shorter or longer periods of time. While there are at least 20 different methods of contraception available, it is unfortunate to face the statistic that 40-50% of all pregnancies are actually unintended. Why is that?

Among other reasons, we know that using contraception over time correctly and consistently, is not easy to implement. The research literature shows that during these years, 30% of all women are trying up to five different methods. Up to 50% report low satisfaction with the methods they are using, so they stop or switch within the first year of use.

There are tens of thousands of research articles about contraception in the scientific literature. There are less than 100 which have examined the influence of birth control methods on the sexual experience. So it should come as no surprise that physicians ignore or dismiss this issue and women and couples often suffer in silence.

We know that doctors tend to prioritize statistical efficacy and ease of use when communicating about and recommending contraception to their patients. Gynecologists may mention the typical side effects of hormonal methods like spotting, nausea, breast tenderness and headaches while in the same breath, emphasize that these are usually short-term effects only. Not a word is uttered about how various methods might impact the “pleasure factor.”

What a paradox. We need contraception so we can separate pregnancy and parenthood from pleasure and intimacy. The whole point of contraception is to be able to separate the fear of pregnancy from pure pleasure in intimacy and “letting go”. What’s the gain of taking precautions if the sexual experience is diminished as a result?

All methods come with a price and have advantages and disadvantages that affect people differently. We are guinea pigs. We have to put a method in our bodies before we know its effect.

Women and men are often caught between a rock and a hard place because it is never easy to reach the desired goals of achieving high efficacy on the one hand, while enabling maximum pleasure on the other.

Even though its men who are fertile 24/7 and women only a few days of the month(!), most methods are for women and only a few exist for men.

The Different Kinds Of Methods Can Be Divided Into Seven Main Categories:

• Hormonal birth control (HBC), including IUDs which secrete hormones
• Non-hormonal IUDs
• Barriers like diaphragms and cervical caps
• Spermicides
• Natural methods and variations
• Male methods like condoms, withdrawal
• Sterilization methods like tubal ligation and vasectomy

All methods impact the sexual experience, in both positive and negative ways. Nearly all methods have some effect on our bodies and biology, our psychological and emotional health and our social and interpersonal interactions with sexual partners.

Read full article on Michal Shonbrun’s website here.