This is where it gets down and dirty and dicey—and quite a bit more hands-on.
The most common choice is the condom, the Ford truck of contraception. Of course, you can get the Lamborghini and Ferrari versions with different colors, flavors, ribs, and ticklers, but flesh tones are the most convenient and accessible. While some couples complain about the decrease in sensitivity when using a condom, plenty of couples find it the no-muss, no-fuss solution. There is always the risk of breaking a condom, but even its failure is straightforward so you know immediately if and when to worry. In this situation, emergency contraception, sold as Plan B®, can serve as safe effective backup, especially when used within three days. It is not recommended to replace a regular form of birth control.
The intrauterine device (IUD) is an out-of-sight, out-of-mind kind of deal. When first introduced, they came in some interesting forms—the copper swirl, the question mark, or the thing that looks like it is made to scramble eggs. The two forms currently available in the United States are the Mirena® and the ParaGard®. After insertion [by a physician], two arms spring up to make a capital T—a traffic cop for pesky, unwanted sperm. The Mirena acts as a barrier and releases low doses of a progestin hormone. The ParaGard provides a barrier without hormones and releases copper to make sperm inactive. While the IUD seems to be gaining in popularity now that the infection and embedding issues have been largely remedied, some women still do find that the ParaGard puts them on the bench a couple of days each month. Overall the IUD option gives total freedom with maximum sensation. It is a draw, especially for women whose partners are taking any sort of medication that tweaks erectile dysfunction.
The newest insertion method, a vaginal ring called NuvaRing® (a.k.a. The Ring), is rising in popularity. It is a flexible, transparent vaginal ring two inches in diameter that releases a continuous low dose of estrogen and progestin. Reports from the trenches say it works well without noticeable side effects, but it does require being comfortable enough with your body to insert and remove it every three weeks.
Lest you think all these methods sound daunting and invasive, consider what many women went through when the diaphragm was in its heyday. The old trampoline is still an option for the brave and the tactilely adventurous. The man is not usually privy to diaphragm insertion, which is best categorized as an event, because he is in bed dutifully trying to maintain an erection.
For the enlightenment of all men, this is what goes on while you are holding down (or rather holding up) the fort. The woman scurries to the bathroom, quickly unwraps her latex mini-tramp, and decorates the disc's outside ring and inner cup with spermicidal goo. Truly, one needs an hour of yoga before trying to insert a diaphragm, but company is waiting at attention in bed, so even the Warrior Pose is out of the question at that point in the game. As she carefully folds and squeezes the slimy, gel-covered thing in preparation for cramming it into its tight parking spot, the diaphragm suddenly zings out of her hand and flies across the room like a liberated Frisbee in the park. These suckers can fly, so by the time you retrieve it you most likely have to blow off the dog hair before reloading. One woman's diaphragm was so crafty that it sailed right through the hole where the bathroom door's knob was supposed to be. Once inside, the trampoline pops back into shape, all the while reefing on the walls of the vagina until finally it slurps into place around the cervix. You're not done until you ream your fingers around Up There to be sure it is in place.
If your partner has managed to maintain an erection through all that, you get to have sex, but only once. No double dipping unless you take another Time Out with a small turkey baster–like rig to squirt a dose of sperm-killer goop back in there for Round Two. This routine helps explain why the diaphragm is also known as the Conception Accelerator.
In general, the responsibility for a particular form of birth control falls exclusively to either the man or the woman—with the man taking charge of and tolerating the effects of reduced sensitivity in condom territory, and the woman taking charge of and enduring the effects (mood swings, pulled muscles, blood loss) of all the other options. Rare is the opportunity for sharing the burden.
The Female Condom
The one exception is the female condom, an equal-opportunity inconvenience that takes the hands-on factor up one notch further. The concept of condoms made for women is empowering, and it reflects creativity on the part of our pharmaceutical and scientific community. Ideally, both partners should share the responsibility of contraception, but as Cindy's first and last experience with the method demonstrates (see Voices of Experience below), it is unrealistic to expect such an interactive contraption to sweep a nation of largely uncommunicative sex partners. The female condom doesn't dominate the birth control section at pharmacies, but, ironically, it may be the best form of birth control because no man is going to want to have sex with a woman wrapped up in the female condom, unless he is turned on by mounting up on a Hefty garbage bag.