Orgasms

The orgasm is different for everyone and notoriously hard to define. Psychosexual therapist Paula Hall explains the physical and emotional factors involved for men and women, why quality matters more than quantity and why faking it is a waste of time.

What is an orgasm?

In 1953 a well-known therapist defined it as "an explosive discharge of neuromuscular tension". There are other definitions, but the word 'tension' comes up in most. Which suggests that when you have sex you deliberately wind yourself up just so that you can experience the pleasure of returning to normal afterwards. Bizarre!

What happens in the body?

The technical stuff that creates all this tension is pretty amazing.

• Your heart pumps faster and your breathing gets heavier to fuel those tensing muscles.
  
• Hormones such as endorphins and oxytocin are pumped round your brain and body, telling you this is fun.
  
• Blood is pumped to your genitals to create the tension that will ultimately trigger a pudendal reflex (muscular spasm of the genitals).
  
• That reflex will result in your pelvic-floor muscles contracting between five and 15 times at 0.8-second intervals. This is an orgasm as we know it.
  
• A wandering neural pathway that bypasses the spine has recently been discovered, explaining why some paraplegics say they can experience orgasms.

What an orgasm isn't

An orgasm should never be the objective of sex. You can have a great time with a partner, feeling aroused, sensual, intimate and loving, and not have an orgasm. Yes, it's fun - but unless you're trying to get pregnant it shouldn't be your primary goal.

You can't make someone have an orgasm. What you can do, besides physically stimulating your partner, is create a safe, comfortable and caring environment for them in which an orgasm might happen.

Orgasm is not limited to the genitals; some people can experience orgasm without their genitals being touched. Some people describe the sensation as a "tingle"; for others the feelings go all over the body.

Faking it

Why do some people - male and female - fake orgasms? Maybe because we tend to see orgasm as the signal to stop sex. If, for some reason, your mind or body doesn't fancy an orgasm you could be at it forever.

Most people who fake it do so to please their partner. They feel they're letting them down if they don't make it. Instead of pretending, try and create a relationship where, if you're not in the mood or you've lost the momentum, you can say so honestly.

Quality not quantity

We tend to make a huge fuss about orgasms in our society. Most articles about enhancing your sex life focus on improving orgasms or having more of them. But the intensity of an orgasm is not an indication of sexual satisfaction. If you want a good orgasm, you can do it yourself. If you want a satisfying sexual relationship, you'll need a lot more.

In psychosexual therapy, people are told about the 2-6-2 rule. Out of every ten times you have sex, the chances are that twice it'll be fantastic and mind-blowing, and the earth will move; six times it'll be nice but nothing special; and twice you'll wish you hadn't bothered.

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Sex when the kids are around

Most will tell you that their sex life has changed since having children. Whether you have a newborn baby in the house, toddlers, teenagers or all three, you have to get more creative and more determined. Relationship psychotherapist Paula Hall has some tips.

Sex after childbirth

This is perhaps the toughest time of all. As wonderful as your bundle of joy may be, it's difficult to avoid the exhaustion that goes with caring for the needs of a newborn, 24 hours a day. Whether you’re mum or dad, it's a tough job. It's difficult to find the time and energy for love making and biology sometimes isn't much help. For the first few months, a woman's hormones are pre-programmed for feeding and nurturing your newborn, not making rivals. In fact, 80% of new mothers report lowered desire in the first months.

The most important thing you need to remember during this time is to keep touching. Just because you don't feel like being lovers, doesn't mean you can't be affectionate and not letting the spark go out will make it much easier to fan when you're ready. It's also essential that you share how you feel about sex. Either partner may feel guilty about wanting or not wanting sex. Talking about this will help you to support each other and help you to maintain intimacy as a couple.

Toddler hood and beyond

By the time your bundle of joy has entered toddler hood, your sexual energy will hopefully be fully restored. However, now it can be even harder to find the space and time. During this period of your life, you have to get clever. You need to develop a balance between planned sexual marathons, average encounters and passionate quickies.

If at all possible, try and ship toddlers off to granny or any other responsible adult, for a whole afternoon, evening or even night of love making. You might not get many opportunities to do this, so plan well ahead, get the date in your diary and look forward to it.

Bedtime is often the favoured time for parents of kids aged between two and nine. Hopefully they're in bed by 8.30pm at the latest and that leaves you sometime alone to enjoy some 'adult activities'. It can be tempting to spend the evening catching up on chores or vegging out in front of the TV. Or perhaps you like to have supper and enjoy some uninterrupted grown up conversation before you go to bed. However you like to spend your evening is fine, but have sex first. Most people are shattered by the time they go to bed and are only fit for sleep. If you want to enjoy sex, put this as item one on your evening agenda, and then do everything else.

You can also become expert at recognising and grabbing opportunities for a quickie. This might include naptimes, when the latest Disney film has just come out on DVD, or their favourite CBeebie programme is on. In fact, whenever you can safely pre-occupy them for 15 minutes or so, grab your chance.

Teenagers

Many couples find this one of the most difficult times to keep their sex life going. The kids now stay up too late for you to wait for their bedtime and now is the time when they DO know what you're doing. But on the bright side, they're beginning to go out much more regularly and hopefully you've entered the era of the sleepover. If at all possible, you need to get your kids out-of-school activities co-ordinated. The hour when they're at youth club - is your hour to jump into bed. And if one of them is in scouts from on Thursdays, that's the day to book the other one into swimming lessons. Sleepovers are great opportunities for a whole night of uninterrupted passion. Invite their friends round on a regular basis and then sit back and wait for the return match. Remember - be creative.

Overcoming awkwardness

Some parents can feel awkward about having sex when the kids are around. It might be easier when they know they're soundly asleep, but feel different when they're awake. Particularly if you're scared that they might walk in on you. One way to avoid this is to put a lock on the bedroom door. Some parents feel uncomfortable doing this, but if it happens early enough a child will learn to knock and accept it as the norm. If you've already got a lock on the bathroom door, you can also enjoy sex in the bath or shower.

It's important that you have puts appropriate steps in place to maintain your sexual privacy. Not only does this reinforce your uniqueness as a couple, but it also sets a good model for children. There's nothing wrong with children knowing that adults have sex as part of loving relationships. A small child may not understand what sex is, but they can know that parents enjoy 'special cuddles' or whatever term you prefer to use. As children get older they will be more aware of sex and they will learn some valuable lessons about it from you. Adopting an attitude that says sex is natural, healthy, enjoyable and private is an important message. One that hopefully they'll remember when they're adults themselves.

Sexual problems

If you've tried all the tricks in the book to keep your sex life sparkling but it just doesn't seem to be working, you might find it useful to look at some of the articles relating to specific sexual problems. If there are issues within your relationship that are affecting your intimacy, you can also get some further help at couples.

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The G-spot





The G-spot has always been controversial - some women say it's essential for orgasms while others say it's non-existent. Psychosexual therapist Paula Hall looks at how to find it, what to do with it - and why it doesn't matter if you haven't got one.

If you have one (and I mean if, that's a big if), it's 2.5cm to 5cm (1in to 2in) inside the vagina on the front wall. You should be able to feel it with your finger. If you're not sexually aroused it may be no bigger than a pea; once you're aroused it increases to the size of a 2p piece.

It's actually more a of a zone than a spot. If you want to explore and find out whether you have one, feel for an area that's rough, a bit like a walnut, rather than smooth and silky like the rest of the vaginal wall.

What is it?

For many women, it's a highly sensitive, highly erotic area that provides hours of pleasure. For others it's a knobbly bit that, when touched too much, creates an overwhelming sensation of needing a wee. Some women can't feel any sensation at all while others don't seem to have one at all.

There are a number of different theories about what the G-spot or area actually is. One view is that it is an area of prostatic tissue similar to the male prostate. The absence of the Y chromosome in the developing female fetus deposits the cells in a similar location and voila - the G-spot. Complete with a similar type of sensitivity to the male prostate

Another expert agrees with the prostate theory but expands it to say that this is not the only reason for sensitivity. He points to the clitoris and the urethra as other sources of pleasure, both of which can be stimulated via the front wall of the vagina. Therefore there are a number of erogenous zones and we should stop seeking the elusive g-spot and instead rename it the ‘anterior wall erogenous complex’ - catchy!

A further expert who was first responsible for publicising the G-spot has recently discovered another use. In research she has shown that stimulation of the G-spot area can increase pain threshold by up to 47%. If the stimulation is arousing, the pain threshold increases by up to 84% and a massive 107% on orgasm. Her hypothesis is that this sensitive and erogenous area is one of natures natural painkillers for childbirth.

So there you go. Basically, we still don’t know for sure - but the important thing is to find out what you’ve got and what you like.

What to do with it

Once you've established whether you've got one or not, you need to discover whether you have one that gives you pleasure or just feels a bit annoying. Stroking is usually the most enjoyable form of stimulation.

Sexual virtuosos recommend inserting the forefinger to about the second knuckle and making a 'come here' motion towards the front vaginal wall. You'll need to experiment with pressure and length of stroke to find out what feels best for you. It's important that you're sexually aroused first, and also worth noting that many women say sensitivity varies throughout the month.

During stimulation, the first sensation might be the need to go to the loo, possibly because the G-spot is on the front wall so your bladder is being pushed. You can check this out by making sure your bladder's empty first then seeing how it feels. The first couple of times it might be a bit odd, but many women say a little perseverance is more than worth it.

Feeling it during intercourse

Depending on the size and exact location of your G-spot, you may or may not be able to feel stimulation during intercourse. You're most likely to feel something if you have your pelvis raised.

Another popular position is to be on all fours or bending over from a standing position and allowing penetration from behind. You'll need to experiment.

Female ejaculation

Some women say they ejaculate when their G-spot is stimulated. Research has shown that approximately 10 per cent of women expel between 9ml and 900 ml of fluid from the urethra during arousal and orgasm. A group of scientists examined some of this ejaculatory fluid and discovered prostatic enzymes, fuelling the theory that the G-spot is the equivalent of the male prostate.

However, another group of scientists examined the fluid and said it was very similar to urine. Latest thoughts are that the fluid is an altered form of urine that changes in chemical composition due to sexual arousal. The research continues.

A final word on the subject

Remember, we're all unique. You may have a sensitive G-spot or you may not. If you want to explore, do it light-heartedly. Don't turn it into the Holy Grail; there are many, many ways to enjoy your sexuality, and the G-spot is just one of them.

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Too busy for sex?

With all the demands of modern life many couples can find it hard to schedule in time to have sex. To nurture this vital part of your relationship, says psychosexual therapist Paula Hall, you need to dispense with a few bedroom myths and make time to make love.

Sex in the early days

When you meet someone and fall in love, your whole life revolves around getting to know them better, particularly their body. After a while, however, you realise love won't pay the bills and you settle down to 'normal' life.

This is generally when sex becomes something you do at night in bed - preferably before you fall asleep. But, after a hard day's graft, sometimes there just isn't enough energy left.

Quality not quantity

At this stage, quality becomes more important than quantity. When you're having sex as often as you like, it doesn't really matter if you have the odd unsatisfactory encounter. But if you're only managing it once a week - if you're lucky - you need make the most of it. Which means making sure you're not hanging on to any unrealistic expectations.

Sex and spontaneity

It's a myth that sex is better when it's spontaneous. That holiday you've been looking forward to for the past six months - would it have been more enjoyable without any planning? Not necessarily. In fact, on the contrary, it might have been a disaster. Although a surprise sex session can be fantastic, planning builds anticipation. And anticipation builds arousal.

If you have kids or you work long hours, you'll probably need to schedule in time for sex. This means you can make sure you feel your sexiest by planning what to wear and taking a relaxing bath or shower. You can also spend days teasing each other with what you've got planned for when the time comes.

Taking turns

Another myth is that sex should be entirely mutual at all times. Apparently, you should caress one another at exactly the same moment, fuelling passion in perfect synch. But that's a bit like patting your head and rubbing your stomach. Yes, it's possible, but it means you can't concentrate properly on either activity. How can you focus your attention fully on giving pleasure at the same time as luxuriating in the sensation of being touched? It's not possible. Someone will miss out.

So take it in turns. Enjoy the look on your partner's face as you build them into a frenzy of sexual excitement. Then relax and enjoy when it's your turn. Mutual sex is great for a quick one. But if you have to plan the time together, use it to the full.

Start talking

Some people believe good sex should be instinctive. If you really love your partner, they say, and if you're really in tune with them, you'll know exactly how they like to be touched. Your bodies will writhe in mutual passion without a word being uttered.

For some reason, sex is the one arena where we expect our partners to read our minds. Rather than simply saying a word or two about what we like or don't, we go to extraordinary lengths to give encouragement by groaning and moaning at exactly the right moment. The opportunity for miscommunication with this method is huge.

Rather than gambling with your sexual satisfaction, start talking. You'll find it builds far more intimacy than a silent romantic failure. And it's not just in the midst of an ecstactic encounter that it's good to talk. Next time you realise you haven't had sex for weeks, get your diaries out and make a date. And as the date gets nearer, talk about what you're going to do to each other and how you're going to make sure it's a night (or day) to remember. For more ideas see Make a date

Tips for talking

• Whoever is doing the touching should do most of the talking
• Next time you're caressing your partner, ask for feedback. Would they like it harder or softer? Longer or shorter strokes? Up a bit or down a bit?
• For more ideas, see Bedroom talk

Reasons to make time for sex

Still not convinced it's worth pencilling in a bedroom session? Research shows that regular sex can make you feel and look healthier. When you make love, your body releases substances in the brain that reduce stress and anxiety. It also produces chemicals that create stronger feelings of affection between couples; stimulates growth hormones that reduce fatty tissue and increase lean muscle; and burns off more than 100 calories per hour.

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The power of sexual fantasy

Is sexual fantasy a useful way to enhance relationships and build intimacy or the last resort of the lonely and desperate? Psychosexual therapist Paula Hall examines why people fantasise and the safest ways to explore these desires.

What are sexual fantasies?

Fantasies are daydreams. Imaginary visions. Whimsical speculations. Wishful thinking. Everybody fantasises at some level. If you've ever imagined what you'd do if you won the lottery, you've used fantasy.

Fantasy is a fundamental part of human nature. We see active imagination as healthy in children (watch them playing and you'll see them lost in a world of their own) but something adults should grow out of. Most people never do, however. Even if we manage to suppress our imagination during the day, all those unconscious passions emerge while we're sleeping.

Understanding fantasies

There's a huge range of personal taste in sexual fantasy, just as there is in everything else. But many people feel uncomfortable with their own fantasies, fearing they're somehow weird if they're turned on by things that are unacceptable to others.

Sexual fantasies may express an aspect of our unconscious mind. For example, fantasies about being submissive or passive may be linked to a desire to experience high sexual arousal without personal responsibility.

But fantasies are simply somewhere we can act out things we might never do in real life, such as having sex in a public place or with a particular person. And sometimes they turn us on precisely because they're not real.

Fantasising about other people

Some people worry that fantasising about someone other than their partner is an act of betrayal, revealing either a desire to be unfaithful or that they are longer turned on by their partner alone.

In fact, this is very rarely the case. Evidence suggests that those who fantasise the most are in happy, loving, trusting relationships. It's in this kind of context that the mind explores places the body has no intention of visiting.

The benefits of fantasy

Sex generally starts in the brain. So an active imagination can mean you're ready for sex before anything physical has happened. Therefore, desire is heightened and arousal is much quicker.

Some people find an active fantasy life can add novelty to a long-standing sexual relationship. This can be particularly helpful if your partner is not as sexually adventurous as you are.

But conversely, if you find it embarrassing to experiment in bed, fantasy offers an opportunity to give your imagination free rein and to play out roles. It can be used as a practice arena where you can build confidence before embarking on something new.

In psychosexual therapy, fantasy is often used to block out negative thoughts. If you find during sexual encounters your mind wanders to unhelpful images or thoughts, fantasy can help you to refocus on your sexual pleasure.

Learning to fantasise

If you don't find sexual fantasy comes easily, you can learn. Erotica can help; try exploring bookshops for erotic books and art. There's also a wealth of magazines available to suit any taste. And your local video store will stock a range of films, from romantic and slapstick to thrillers and more explicit 18-rated movies.

Find out what turns you on. Then with the help of relaxation techniques, lie back and allow your mind to build your personal favourite.

The most common male fantasies include:

• having sex with an existing partner
• giving and receiving oral sex
• having sex with more than one person
• being dominant
• being passive and submissive
• reliving a previous experience
• watching others make love
• trying new sexual positions

The most common female fantasies include:

• having sex with an existing partner
• giving and receiving oral sex
• having sex with a new partner
• romantic or exotic locations
• doing something forbidden
• being submissive
• reliving a previous experience
• being found irresistible
• trying new sexual positions

Caution about sharing fantasies

Although some couples find that sharing and acting out their fantasies has increased trust and intimacy, others have not.

Fantasies are extremely personal. There are risks involved in disclosing them, especially to someone you care for. Consider how you'll manage if they don't like your fantasy or if you try acting it out and it just doesn't work.

Sharing fantasies can be liberating, but it's risky. Talk to your partner first about the general theme, then approach with caution.

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Communicating about sex

Talking with your partner about what you like and what you want can take your sex life in new and fulfilling directions and deepen your relationship as a whole, says sex and relationships counsellor Suzie Hayman.




No one is a mind reader

In many couples, one or both partners feel that the other doesn't understand how to satisfy them sexually. And I know from my work at a sex and relationships counsellor that this can knock the confidence of both people.

The problem is that when it comes to sex we expect to be instant experts, with instinctive knowledge of what pleases us and a partner. But actually, sex is just like any other skill. If we want to learn how to drive a car or ride a bike, we have to start as beginners and take lessons. And with sex, to understand your own responses and your lover's, you have to learn and practice.

This is because everyone responds differently to sex and sexual arousal. Some like gentle touches, others prefer heavier, rougher contact. One person will be turned on by something another finds unpleasant or uninteresting. Unless you're psychic, the only way to get to know your partner's tastes, and for them to get to know yours, is by communicating.

Say what you'd like to try

Talking about what you like and dislike has several benefits. Not only can simply talking about sex add to your excitmement, but the more you talk, the more relaxed and confident you'll be with your partner. I know from my work that most people would like more variety in their love lives, but they're held back from suggesting whatever they'd like to try, whether it's oral sex, bondage or new positions, by embarrassment or fear of rejection.

But you don't have to come out with a bald request. One good technique is to find the option you fancy on the web or in a magazine or a book, and point it out, saying, "That looks fun. Want to try it?" The chances are that, far from being put off, your partner will jump at the chance to experiment. (For more ideas see I'd like you to...).

Non-verbal cues

Communication is vital but there's no need to subject each other to a commentary or a barrage of instructions. You can make your needs known with a range of non-verbal cues. (For more ideas see Bedroom talk).

Let them know when they've hit the spot

Next time you have sex, make sure your partner knows when they've found the right place. If they need a bit of guidance, gently move their hands to demonstrate what turns you on. Make the communication two-way; listen and notice the movements and sounds your partner makes, so you can pick up their likes and dislikes, too.

Be honest, positive and demonstrative

If you're going to say what you'd like and ask what your partner wants, there are three important points to keep in mind.

• Be positive. Don't tell your partner they're terrible in bed. Remember something they did that you really liked and say, "When you did that, I really..." They'll get the message.
• Be honest. There's no point in faking it or saying you like something you don't, because that gives your partner no incentive and no guidance to do better.
• Be demonstrative.

Erogenous zones

The most sensitive sexual areas are

• Breasts, nipples, genitals and lips
• Ear lobes, fingers, toes
• The soft skin inside the elbows and knees, the small of the back and the nape of the neck

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Making sex exciting


Making sex exciting Sleeping with the same person can become predictable in time, but that doesn't mean it's all over. Sex and relationships counsellor Suzie Hayman explains why the fire can fade even if you're still in love - and how to reignite the spark.


Bringing back the buzz

Once the honeymoon's over and you settle into the humdrum pattern of everyday life, it's easy to get bored. Sex might go from something you do because you can't keep your hands off each other to free entertainment on a Friday night because there's nothing on TV.

Most of us assume the sex we enjoy in the first heady days of a relationship is the best we can expect, and it's all down hill from there. But here's the good news. It can get better over time rather than worse, and it's easy to put the freshness back. In fact, if you've been together for some time, it can even become more exciting and
adventurous than early-days sex.

The one big advantage an established couple has over a new one is the increased level of trust. This makes it more comfortable to ask for something different and new that might be embarrassing with a relative stranger.

To keep things exciting, you'll have to go out of your way to make romantic gestures and suggest new approaches, but it's worth it. You can put fire and excitement into an established relationship far more easily than you can put trust into a new one.

In fact, people who have affairs often say they're looking for the love and sexual satisfaction they felt they weren't getting at home. But, according to research, even couples who said their sex life was unsatisfactory tended to admit it was still better than extra-marital sex.

Going back to the good bits
The feeling that the magic is fading is caused by the adrenaline charge wearing off. Sooner or later it becomes clear which way your shared love-making is going to go, and the knowledge that you both have a well-worn repertoire of sexual practices kills
expectation and excitement.

One couple I counselled had exactly this problem. They still loved each other but felt their sex life had become stale and disappointing. I recommended that they start again. They realised that all the things they did to each other when they made love were based on discoveries from the first year or so of their relationship.

Starting over
Each had found touches, techniques and preferences that the other seemed to enjoy and had developed a well-worn routine, from first kiss to final hug. But their tastes had changed. Things they once liked were now boring, and they were ready to try things they would have been too shy to suggest in the early days.

Practical exercises
The exercises I asked this couple to try are in our practical exercises section. There are lots of ideas to help you revitalise your sex life, and tips and techniques to print out and try.

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Aphrodisiacs

Certain special foods and drinks are said to enhance sexual desire but do they work? Sex and relationships counsellor Suzie Hayman looks at the facts and fantasies behind aphrodisiacs - and warns that some could actually have far from the desired effect




Foods believed to have aphrodisiac qualities

Rhino horn is said to make men sexually unstoppable, and asparagus, bananas, eels, oysters, figs and ginseng are all reputed to get you going.

Most of these foods are believed to have aphrodisiac qualities because of their smell, taste or appearance. This is based on the idea of 'sympathetic magic'. Rhino horn, asparagus, bananas, eels are all phallic in shape. Believers hope that, by eating them, they will make their members similarly firm, long and strong. Oysters and figs smell or look like a woman's vulva or vagina when she is aroused. By slurping and swallowing them, diners hope their sexual parts will become just as plump, slippery and tasty.

Hot foods such as onions, ginger and pepper are thought to be effective because they make you hot and sweaty, with the flushed appearance of sexual excitement. And any sweet or spicy taste puts you in a relaxed, pampered state of mind, ready for further indulgence.
So do aphrodisiacs work?

In a word, no. None of these substances, nor any other you might hear of, works in the way aphrodisiacs are said to. They can't affect your sexual organs or sexual desires to make you more aroused, desiring, desirable or long-lasting in bed. But suggestion can be a powerful thing, and using aphrodisiac foods or drinks as part of your seduction technique can add to your sex life and spice up your relationship in several ways.
Fast boosts and slow effects

Some substances obviously have an immediate effect on our moods. A small amount of alcohol relaxes you emotionally and physically. It increases your confidence, as well as opening small blood vessels, making you feel flushed and warm. Caffeine and sugar will give you a quick boost, too, making you feel energetic and ready for action.

On the whole, however, what we eat and drink long-term has greater effect. A healthy diet with plenty of fish and fresh vegetables will have a genuine benefit, increasing your well-being and so your sexual desires and abilities
Sexy food

If you really want to give your lover the message, invite them to prepare a meal with you. Choose foods you both like that you can eat by hand and feed each other across the table. (For more ideas see Make an aphrodisiac meal.)

A dozen oysters or quail's eggs with champagne, followed by asparagus and a platter of exotic fruit, vegetables and cheese, followed with figs and chocolate, can leave lovers feeling cherished and in the mood to carry on spoiling each other.
Ancient aphrodisiacs

Most of the ancient books on the arts of love include recipes that claim to make users "strong for the act of love and disposed to lying together".

'The Perfumed Garden', a 16th-century treatise, says onion seeds and honey, peas boiled with onions and spiced with cinnamon and ginger, cardamom, honey, almonds and pine nuts are all effective aphrodisiacs.

'The Kama Sutra' suggests a ram's or goat's testicle boiled in sweetened milk, and sparrows' eggs and rice with butter and honey.
A warning about Spanish fly

Spanish fly, a substance made from the dried-out bodies of beetles, is reputed to be a powerful sexual aid. Taken as a powder, solution or tablet, it's understood to heat up the sexual organs and make you insatiable. On the contrary, Spanish fly is toxic and can actually be dangerous.

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Male and female sterilisation

The ultimate form of contraception - sterilisation - is available to both men and women. It's a big step to take - find out more from this factsheet by fpa.
What is it and how does it work?

Sterilisation is the only permanent method of contraception and involves cutting, blocking or sealing the tubes in men and women that carry either the sperm or eggs.

It's more than 99 per cent effective. Failure is uncommon, but can happen when the tubes that carry the sperm or eggs rejoin.
Men
Male sterilisation

Male sterilisation is called a vasectomy. Under local anaesthetic, a small cut is made in the skin of the scrotum. The tubes that carry the sperm from the testicles to the penis are then cut. The operation can take between 10 and 15 minutes.

The scrotum recovers quickly. Feelings, sex drive, erections and climax remain the same as before. Sperm are still produced, but are naturally absorbed by the body. About eight weeks after the vasectomy, a test will be done to make sure there are no sperm left in the semen. When all the sperm are gone, the vasectomy is effective.

Lifetime failure rate is 1 in 2,000.
Women
Female sterilisation

In female sterilisation, the tubes that carry the egg from the ovary to the womb are cut, sealed or blocked in an operation done under general or local anaesthetic.

The ovaries, cervix and womb are all left in place. Feelings, sex drive and climax remain the same as before. An egg is still released each month, but is naturally absorbed by the body.

Sterilisation is effective from the first menstrual period after the operation.
Advantages

* Sterilisation is permanent, so you won't have to think about contraception again.
* It doesn't interfere with sex.
* Vasectomy is simpler and more effective than female sterilisation.


Disadvantages

* The tubes may rejoin and fertility return.
* Sterilisation is hard to reverse. The reversal operation is complicated, can be expensive and may not be successful.
* It takes several months for sperm to disappear from the semen, so an extra method of contraception must be used until then.


Can anyone be sterilised?

Sterilisation is only for people who don't want any (more) children. You and your partner should consider all other long-term contraceptive options with a health professional before choosing this option. Some are more effective than female sterilisation.

You shouldn't be sterilised as the result of a stressful event, such as birth, miscarriage, abortion or a relationship crisis.
General comments

Once the operation has worked, you won't need any further check-ups.

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The progestogen-only pill
f you can't take the combined pill, the progestogen-only version may be more suitable. This factsheet from fpa explains how it differs from the Pill in how you take it, its advantages and possible side effects.
What is it and how does it work?

The progestogen-only pill (POP) contains a hormone called progestogen. It's different to the combined pill, which contains two hormones: oestrogen and progestogen. There are different types of POP.

If taken according to instructions, the POP is 99 per cent effective. This means that using this method, one woman in 100 will get pregnant in a year.

If the POP is usually started on the first day of a period it immediately protects against pregnancy. Some women can start taking the POP up to the fifth day if they don?t have short menstrual cycles. If started on any other day, an extra method of contraception must also be used for two more days.

The POP works by:

* stopping sperm reaching the egg by thickening the mucus from the cervix
* stopping the egg from settling in the womb
* sometimes stopping the ovaries releasing an egg (this is the main action of a POP called Cerazette)


A pill is taken every day until the pack is finished. The new pack is started immediately, without any break, which means pills are taken during your period.
Advantages

* It doesn't interfere with sex.
* There are no serious side effects.
* Can be used if you're a smoker over 35.
* Can be used while breastfeeding.
* Can help with premenstrual tension and period pain.


Disadvantages

* Periods may be irregular, light or more frequent. This should settle down and isn't harmful.
* Temporary side effects can spotty skin, headaches, tender breasts. These should settle down after a few months.
* Some women develop cysts on their ovaries. These aren't dangerous, often have no symptoms and usually disappear without treatment.
* If you become pregnant using the POP, there's a small risk of ectopic pregnancy (where a baby develops outside the womb). This is uncommon but dangerous.
* Some prescription and complementary medicines affect how the POP works.


Can anyone use the progestogen-only pill?

The POP doesn't suit everyone. Some conditions that may stop you from using it are:

* you think you might be pregnant
* you don't want any changes to your periods


You have now, or have had in the past:

* a heart attack or stroke
* active liver or gall bladder disease
* breast cancer
* cysts on the ovaries
* unexplained bleeding from the vagina


What to do if you forget a pill

It's important to take it at the same time every day, but if you forget, here's what to do:

If you're less than three hours late. Take it as soon as you remember, then take the next one on time. You'll still be protected against pregnancy.

If you're more than three hours late. You won't be protected against pregnancy. Continue to take the POP as usual and use an extra method of contraception for the next two days to protect yourself from pregnancy.

If you are using the POP called Cerazette, you have up to 12 hours to remember to take your pill. If you are more than 12 hours late, follow the advice above.

If you've been sick or had diarrhoea. If you vomit within two hours of taking the POP or have severe diarrhoea, you must use an extra method for the next two days.
General comments

Initially you'll be given three months' supply of the POP to see if it suits you. After that, you must go back for regular supplies. Some medicines affect how the POP works, check with your doctor, nurse or pharmacist.

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The contraceptive patch

A contraceptive method that works like the Pill but with the added advantage that you don't have to remember to take it every day. This factsheet from fpa explains how it works.

What's the contraceptive patch?

It's a thin, beige, sticky patch measuring 5cm x 5cm. It contains the same hormones as the combined pill: oestrogen and progestogen.
How does it work?

It delivers a constant daily dose of hormones into the bloodstream through the skin. It works like the combined pill to stop the ovaries releasing an egg every month.
How effective is the patch and how is it used?

When used according to instructions it's more than 99 per cent effective. Research shows it's less effective in women weighing 90kg (14 st) and over.

The patch lasts for seven days and is used for three weeks out of every four.

* When applied on the first day of your period it provides immediate protection from pregnancy.
* The next two patches are applied on day 8 and day 15 of the cycle.
* After three weeks you have a patch-free week and during this time you get a bleed. A new patch is applied after seven patch-free days and the process starts again.


The patch is very sticky and should stay on during bathing, swimming, saunas or exercise. If it does come off, reapply it as soon as possible.

* If it's been off for less than 24 hours, just reapply or use a new one.
* If it's been off for longer than 24 hours, use an additional method of contraception for the next seven days.


Advantages

* You only have to remember to replace the patch once a week.
* It's highly effective when used correctly.
* It doesn't interfere with sex and is easy to use.
* As the hormones go straight into the bloodstream, the effectiveness of the patch isn't affected by vomiting or diarrhoea.


Disadvantages

* It's visible.
* It may cause skin irritation in a small number of women.
* Like the Pill, temporary side effects when you first start may include headaches, nausea, breast tenderness, mood changes, bleeding between periods and weight gain or loss.
* More serious side effects would be similar to those seen with the Pill.


Can anyone use the patch?

The patch won't suit everyone. Reasons not to use it include:

* you think you might be pregnant
* you smoke and are 35 or older


You also shouldn't use it if you have now, or have had in the past:

* blood clots in any vein or artery
* circulatory disease or heart abnormality
* diabetes or severe migraine
* breast cancer
* active liver or gall bladder disease


General comments

The patch can be worn anywhere except the breasts or any area that's sore or irritated.

Some prescription drugs or complementary medicines can affect the way the patch works.

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Natural family planning


NFP is a completely natural way to prevent or plan a pregnancy, and has the added bonus of getting you more in touch with your body. Find out more from this factsheet by fpa.
What is it and how does it work?

Natural family planning (NFP) helps women recognise the fertile and infertile times of their menstrual cycles to plan or avoid a pregnancy. A woman's fertile time (when she can get pregnant) lasts for eight to nine days in each menstrual cycle.

An egg lives for up to 24 hours and is released 12 to 16 days before the next period. Sperm can live for up to seven days. This means if you have sex seven days before you ovulate (release an egg), you could get pregnant.

NFP teaches you to recognise and record the different natural signs or indicators of fertility each day of your menstrual cycle.

It must be taught by a specialist teacher to be effective. If used according to teaching and instructions, it's up to 98 per cent effective. This means that using this method as contraception, up to two women in 100 will get pregnant in a year.
Indicators

NFP is most effective when two or more fertility indicators are used to identify the fertile time.

Temperature. Your body temperature rises after ovulation. If you record your temperature every day when you wake up, you'll know when ovulation has happened.

Cervical secretions. During the menstrual cycle, changes occur in the cervical mucus. These cause feelings of dryness, moistness or wetness in the vagina. When the secretions are clear and slippery, you're at your most fertile.

Other changes. The position of the cervix changes during the menstrual cycle. Some women notice pain around ovulation, changes to their moods, skin, breasts or sexual desire.
Advantages

* There are no physical side effects.
* Effective if well taught and instructions are followed.
* No hormones or physical devices are used.
* Improves understanding of fertility and how the body works.
* Couples share responsibility.
* Can be used to plan or avoid pregnancy.


Disadvantages

* Takes up to six cycles to learn and daily records must be kept.
* Requires commitment of both partners.
* Sex must be avoided (or a barrier method used) during the fertile time.
* Illness, stress or travel make it more difficult to recognise signs of fertility.


Can anyone use it?

Most people can use NFP if they receive good teaching and support. It's acceptable to all faiths and cultures.
General comments

Fertility devices are now available that measure changes in temperature, urine or saliva to predict fertility. These can be bought from pharmacies. They're not as effective as using taught NFP methods.
Where to get advice

Family planning clinics or GPs often don't teach NFP. For a specialist teacher, see Fertility UK's website, www.fertilityuk.org.

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The intrauterine device


Intrauterine devices, or IUDs, are a long-term method of birth control. This factsheet from fpa explains how it works, the advantages and disadvantages and whether one could be suitable for you.

What is it and how does it work?

The IUD is a small, plastic and copper device that used to be known as the coil. It's inserted into the womb by a doctor or nurse.

One or two soft threads are attached to the end and hang down a little way into the vagina so you can check it's in place. It works for three to ten years, depending on the type used.

The IUD is around 99 per cent effective, depending on the type. This means using this method, less than one woman in 100 may become pregnant in a year.

An IUD can be fitted at any time if it's certain you're not pregnant.

The IUD works by:

* stopping the sperm reaching the egg
* stopping the egg from settling in the womb


Advantages

* It's very effective.
* It doesn't interfere with sex.
* It works as soon as it's fitted.
* It works for three to ten years, depending on the type used.
* You don't have to think about contraception for as long as it works.
* Fertility returns as soon as it's removed.
* If you change your mind, it can easily be removed.


Disadvantages

* Periods may be heavier, longer or more painful.
* It's not suitable for women who are at risk of getting a sexually transmitted infection (STI).
* There's a small risk of infection after fitting.
* The IUD can be pushed out of the womb (expulsion), move or perforate (go through) the lining of the womb or cervix. This is uncommon when fitted by an experienced doctor or nurse. Check the threads every month to make sure it's still in place.
* If you become pregnant using the IUD, there's a small risk of ectopic pregnancy (where the baby develops outside the womb). This is uncommon but dangerous.


Can anyone use an IUD?

The IUD doesn't suit everyone. Reasons not to use it include:

* you think you might be pregnant
* you have an untreated STI, a pelvic infection or are at risk of getting one


You also should not use an IUD if you have now, or have had in the past:

* heavy, painful periods
* unexplained bleeding from the vagina
* problems with your womb or cervix


General comments

You'll need a check-up four to six weeks after it's put in. Do contact your doctor or nurse if you have any problems. You will be taught to feel the threads regularly too.
Where to get it

Contraception is free on the NHS. An IUD can be fitted by a trained GP, nurse or at a family planning clinic.

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The contraceptive injection


You can now prevent pregnancy with a quick injection every eight to 12 weeks. Find out from fpa how this contraceptive method works and whether it could be suitable for you.

What is it and how does it work?

The contraceptive injection contains a hormone called progestogen and is a long-term method of contraception. It's injected into a muscle and the hormone is released very slowly into the body.

There are two types of injection:

* Depo-Provera provides contraceptive protection for three months (12 weeks).
* Noristerat provides contraceptive protection for two months (eight weeks).


Contraceptive injections are more than 99 per cent effective. This means that using this method, fewer than one woman in 100 will get pregnant in a year.

The hormone is injected into a muscle in your bottom. It's usually given during the first five days of a period when it provides immediate contraceptive protection. If given on any other day, an extra method of contraception must be used for seven days.

The injection works by:

* stopping the ovaries releasing an egg each month
* stopping sperm reaching the egg by thickening the mucus from the cervix
* stopping the egg settling in the womb


Advantages

* It's highly effective.
* It doesn't interfere with sex.
* The injection provides some protection against both cancer of the womb and pelvic inflammatory disease.
* It can be used by women who are breastfeeding.
* You don't have to think about contraception for as long as it works.


Disadvantages

* The injection can cause irregular bleeding or longer periods. Some women find their periods stop completely, while others have frequent, light bleeding. Irregular bleeding can continue for some months after stopping the injections.
* Some women experience side effects including weight increase, headaches, acne, breast tenderness, mood swings and bloating.
* The injection cannot be removed from the body. If side effects occur, they'll last as long as the injection does and sometimes longer.
* Your fertility and periods can take a while to get back to normal after stopping Depo-Provera.


Can anyone use the contraceptive injection?

Contraceptive injections don't suit everyone. Reasons not to use them include:

* you think you might be pregnant
* you don't want any changes to your periods


You also shouldn't use this method if you have now, or have had in the past:

* cancer of your reproductive organs, for example breast or womb cancer
* unexplained bleeding from the vagina
* a heart attack or stroke
* severe depression
* active liver disease


General comments

Contraceptive injections can be less effective if you don't have the next one on time.

Depo-Provera and affects on bone density and growth Women who use Depo-Provera have been shown to have lower bone mineral density than women who don't use it. It is not known if this effect increases the risk of osteoporosis and fractures in later life. Because of this all women, especially young women under 19 should be informed of all other contraceptive choices.
Where to get it

Contraception is free on the NHS. Your GP or family planning clinic can provide contraceptive injections.

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The contraceptive implant



Do you want a contraceptive method that frees you from having to take a little pill every day? Then perhaps the long-term contraceptive implant is the answer. This factsheet from fpa explains how it works.

What is it and how does it work?

The contraceptive implant is a small, flexible tube that's inserted under the skin in the upper arm. It slowly releases a hormone called progestogen and works for three years. The implant must be fitted by a trained doctor or nurse and is about the size of a hairgrip. It provides a long-term method of hormonal contraception.

The implant is more than 99 per cent effective. This means that using this method, fewer than one woman in 100 will get pregnant in a year.

An implant is usually put in during the first five days of your period and provides immediate contraceptive protection. If put in on any other day, an extra method of contraception must be used for seven days.
Implants work by:

The main way the Implant works is by stopping the ovaries from releasing an egg each month (ovulation). The implant also works by stopping sperm from reaching the egg by thickening the mucus from the cervix and stops an egg from settling in the womb.
Advantages

* It's highly effective.
* It doesn't interfere with sex.
* Fertility returns quickly once it's removed.
* It can be used by women who are breastfeeding.
* Offers some protection against pelvic inflammatory disease.
* You don't have to think about contraception for as long as it works.
* If you change your mind, it can be removed.


Disadvantages

* Many women experience irregular bleeding and changes to their periods. This should settle down after the first year, but it continues for longer in some women.
* Some women experience side effects including weight increase, headaches, acne, breast tenderness and bloating.
* Some women may develop cysts on their ovaries. These aren't dangerous, often have no symptoms and usually disappear without treatment.
* Rarely, having an implant can cause an infection in the arm and sometimes the implant is difficult to remove.


Can anyone use contraceptive implants?

Contraceptive implants don't suit everyone. Reasons not to use them include:

* you think you might be pregnant
* you don't want any changes to your periods


You also shouldn't use an implant if you have now, or have had in the past:

* cancer of your reproductive organs, for example breast or womb cancer
* active liver disease
* unexplained bleeding from the vagina
* a heart attack or stroke


General comments

You'll need a check-up three months after the implant is put in and then once a year after that. Some medicines can affect how the implant works, check with your doctor, nurse or pharmacist.
Where to get it

Contraception is free on the NHS. Implants are available from family planning clinics and some GPs.

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Emergency contraception



if you have unprotected sex or your normal contraceptive method fails, there are two methods of emergency contraceptive that might still prevent a pregnancy. Find out more from this fpa factsheet.

What is it and how does it work?

Emergency contraception can be used if your usual method of contraception has failed, or if you've had sex without using contraception (unprotected sex). If you act quickly, emergency contraception usually prevents pregnancy.

There are two methods:

* Emergency contraceptive pills contain the hormone progestogen. They must be taken within three days (72 hours) of unprotected sex.
* The intrauterine device (IUD) must be fitted within five days of unprotected sex. The IUD used to be known as the coil.


The emergency contraceptive pill

Emergency pills are more effective the sooner they're taken after sex. If taken within 24 hours, they prevent more than nine out of ten pregnancies that would have happened had no pills been taken. The IUD is 98 per cent effective if inserted up to five days after sex.

Emergency pills must be taken as soon as possible after sex.

The pills work by:

* stopping an egg being released (ovulation)
* delaying ovulation
* stopping an egg settling in the womb


Usually, your period arrives within a few days of when you expect it.
The IUD

IUDs must be fitted in the womb by a trained doctor or nurse. They work by:

* stopping an egg being fertilised
* stopping an egg settling in the womb


It can be removed during your next period if you want.
Advantages

* Neither method has any serious side effects, and most women can use emergency pills.
* IUDs are helpful if you're too late to take pills, if you don't want to take hormones or a long-term method of contraception.


Disadvantages

* With emergency pills, some women experience headaches, breast tenderness or abdominal pain. A few feel sick or vomit.


Can anyone use emergency contraception?

Not everyone can use an IUD. See the feature on IUDs.
General comments

Some prescribed and over-the-counter medicines can affect the way the emergency pills work. Ask your doctor, nurse or pharmacist for advice.

Emergency pills can be taken more than once, but they are not as effective as using a regular method of contraception. If you don't want to get pregnant, use contraception.
Where to get it

Contraception is free on the NHS.

Emergency pills are available free from GPs, family planning clinics, young people's clinics or Brook centres, genitourinary medicine (GUM) clinics, most NHS walk-in centres in England, some pharmacies, and some hospital accident and emergency departments (phone ahead).

You can buy hormonal emergency contraception at some private clinics and from most pharmacies if you are 16 or over

The IUD is available free from some GPs and family planning clinics.

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Diaphragms and caps


Find out from this factsheet by fpa how contraceptive diaphragms and caps work, how effective they are at preventing pregnancy and their advantages and disadvantages.

What are they and how do they work?
Diaphragms and caps fit inside the vagina and cover the cervix (entrance to the womb). They are barrier methods of contraception and stop sperm meeting an egg.
Both methods are made from rubber or silicone and come in different shapes and sizes. Caps are smaller than diaphragms and both need to be used with spermicide, a special gel or cream that kills sperm.
Their effectiveness depends on how carefully they're used. Diaphragms and caps are 92 to 96 per cent effective if used according to instructions. This means that using either method, between four and eight women in 100 will get pregnant in a year. The silicone cap, Femicap has a higher failure rate.
Diaphragms and caps must be used every time you have sex. Spermicide is applied to the diaphragm or cap, which is inserted into the vagina to cover the cervix. If this is done more than three hours before sex, more spermicide must be used when you have sex. Spermicide needs to be put into the vagina every time you have more sex. The diaphragm or cap must be left in the vagina for at least six hours after sex. It's then removed, washed and stored away.
Advantages
• They're only used when you want to have sex and can be put in at any time.
• They have no serious health risks.
• They may help protect against cancer of the cervix.


Disadvantages
• Inserting a diaphragm or cap in can interrupt sex if you don't do it beforehand.
• Some people find spermicide messy.
• It takes time and practice to use either method easily and correctly.
• Some diaphragm users find they get cystitis (changing to a smaller cap or diaphragm can help).
• Some women or their partners find that rubber or spermicide can cause an irritation.


Can anyone use them?
Diaphragms and caps don't suit everyone. Reasons not to use them include:
• you're not comfortable touching your vagina
• your cervix is an unusual shape or you can't reach it
• you're sensitive to rubber or spermicide
• you have frequent urinary infections


General comments
Once you have a diaphragm or cap you are happy with, you only normally need to see a doctor or nurse once a year to replace it. You may need a different size if you gain or lose more than 3kg (7lb) in weight, have a baby, abortion or miscarriage.
Where to get them
Contraception is free on the NHS. You can get diaphragms and caps from family planning clinics and some GPs. You'll be fitted with the correct size of practice diaphragm or cap to see if the method's right for you. To start with you'll be give a practice diaphragm or cap to make sure you like the method and it's suitable for you.

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Male and female condoms



in order to prevent sexually transmitted infections as well as pregnancy, you must use a barrier method of contraception. Here fpa give the facts about the most popular: condoms, for men and women.

What are they and how do they work?
Male and female condoms stop sperm meeting an egg and are called barrier methods of contraception. They're made of very thin rubber or silicone.
The effectiveness of condoms depends on how carefully they're used.
Male condoms are 98 per cent effective if used according to instructions. This means that using this method, two women in 100 will get pregnant in a year. They fit over a man's erect penis. They should be used before any close genital contact. Once the man has 'come' but before the penis goes soft, he withdraws holding the condom firmly in place to avoid spilling any sperm. The condom is then removed and should be disposed of carefully.
Female condoms are 95 per cent effective if used according to instructions. This means that using this method, five women in 100 will get pregnant in a year. They're made from thin, soft, lubricated silicone, which lines the vagina when in place. The closed end of the condom is inserted high into the vagina. The open, outer ring lies just outside your vagina. To remove the condom after sex, the outer ring is twisted to keep the sperm inside and the condom is pulled out and should be disposed of carefully.
Advantages
• They're very safe and effective.
• You only need to use them when you have sex.
• They protect against some sexually transmitted infections, including HIV.
• Male condoms come in many different varieties, shapes and sizes.
• Female condoms can be put in at any time before sex.


Disadvantages
• Using condoms can interrupt sex.
• Male condoms can slip off or split if used incorrectly.
• They're easily damaged by sharp fingernails or jewellery.
• You must take care that the man's penis goes inside the female condom and not down the side between the condom and the vagina.
• Female condoms are not widely available for free.


Can anyone use condoms?
Some people are sensitive to the chemicals in latex condoms.
General comments
Spermicides (chemicals that kill sperm) do not need to be used with condoms, as they do not offer any added protection.
Keep condoms where they can't be damaged by strong heat, light, damp or sharp objects.
Don't use oil-based lubricants such as body oils, lotions or petroleum jelly with male condoms as they make them more likely to split. Use water-based lubricants instead.
Where to get male and female condoms
Contraception is free on the NHS.
Male condoms are free from family planning clinics, sexual health clinics and some GPs. They can be bought from pharmacies, supermarkets, vending machines and via mail order.
Female condoms are free from some family planning clinics and some sexual health clinics. They can be bought from pharmacies and via mail order.

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The combined pill
The combined pill is one of the most popular forms of contraception. This factsheet, by fpa will help decide if it's the right birth-control method for you.



What is it and how does it work?
The combined pill is also known as the Pill. There are many different types, but all contain two hormones: oestrogen and progestogen.
The Pill is more than 99 per cent effective if taken according to instructions. This means that using this method, fewer than one woman in 100 will get pregnant in a year.
The Pill can be started up to and including the fifth day of a period and immediately protects against pregnancy. If started on any other day, an extra method of contraception must also be used for seven days.
The main way the Pill works is by stopping the ovaries releasing an egg each month (ovulation).
It also stops sperm reaching the egg by thickening the mucus from the cervix and stops an egg from settling in the womb. A pill is taken every day for 21 days until the pack is finished. Then you have a seven-day break when you get a bleed. The next pack is started on the eighth day. Every day (ED) pills have 21 active pills and seven placebo tablets. These are taken all the time without a break.
Advantages
• Doesn't interfere with sex.
• Makes periods shorter, lighter and less painful.
• Protects against cancer of the ovary and womb.
• Protects against some pelvic infections.
• Can help with premenstrual tension.
• Reduces the risk of fibroids (non-cancerous tumours in the womb) and ovarian cysts.


Disadvantages
• Temporary side effects include headaches, weight gain, breast tenderness, mood changes, nausea and bleeding between periods.
• May increase blood pressure.
• Rare but serious side effects can include blood clots.
• There is a very small increased risk of breast cancer and cervical cancer.
• Some prescription drugs or complementary medicines may affect how the Pill works.


Can anyone use the combined pill?
TThe Pill doesn't suit everyone but for the vast majority of women the benefits outweigh any risks. Reasons not to use it include if you think you might be pregnant or you are a smoker aged 35 or older.
You also shouldn't use it if you have now or have had in the past:
• blood clots in any vein or artery
• circulatory disease or a heart abnormality
• very severe migraine or migraine with aura
• diabetes with complications
• breast cancer
• active liver or gall bladder disease


What to do if you forget a pill
It's important to take the combined pill at a regular time every day.
You should not take your pill later than 24 hours after your chosen time. If you do, you must treat this as a missed pill day. Do not stop taking your pill and take your next pill at the normal time.
Missing one pill anywhere in your pack or starting your pack one day late is not a problem. Depending on which type of Pill you take, missing more than one pill or starting the packet more than one day late could affect your contraceptive cover. If this happens seek advice.
If you're sick within two hours of taking the pill it will not have been absorbed properly. Take another pill as soon as you feel well enough. If you continue to feel sick, seek advice. If have very severe diarrhoea for more than 24 hours this makes your pill less effective. Seek advice.
General comments
Initially you'll be given three months supply of the Pill. You don't need a cervical smear test or internal examination to use the Pill. Some medicines affect how well the pill works, check with your doctor, nurse or pharmacist.
Where to get it
Contraception is free on the NHS. GPs and family planning clinics can prescribe the pill. Call fpa's helpline on 0845 310 1334 (Monday to Friday, 9am to 6pm) for advice on the Pill or visit www.fpa.org.uk.

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