Where can I find basic information about emergency contraception?

1) Dear Alice,

My girlfriend and I had sex twice one night — the second time, we had to change condoms because she was dry and the lubricant had run out. Before I put the second condom on, she asked me to "put it in" without it on for a few seconds; which I did — not entirely all the way though. I instantly realized the mistake and withdrew. Naturally, as I expect, there is a small chance this could have gotten her pregnant. However, this was four days after her period ended, and the condoms we were using had nonoxynol-9 on the inside and outside. I had not ejaculated yet, as a matter of fact, I never did... and I had wiped the tip of my penis prior to doing this to avoid any pre-cum. My question is this: I'm hoping I'm right in assuming the chance of pregnancy is minimal — however, we are considering emergency contraception. What could you suggest?


2) Alice,

My boyfriend and I had sex last night and we saw that the condom had broke. We don't know when it happened and I've been looking all over for the 72 hour correction thing that the commercials say — just in case. Can you help me?


Dear Reader 1 and K, 

It sounds like you're both searching for emergency contraception (EC). EC can help to prevent pregnancy if used after sex when a birth control method failed or wasn't used. Reader 1—while the chances of becoming pregnant from pre-ejaculate fluid (or precum) is low given that it contains little to no sperm, it may still be beneficial to consider EC if you’re worried. From what you've described, it seems like various methods were used to prevent pregnancy including spermicide, which alone is around 80 percent effective at preventing pregnancies. That said, there are a few EC options you might consider. 

If using EC is in fact something you’re both interested in, some options for this include: 

  • Levonorgestrel pills (more commonly known by the brand name Plan B): These one-dose progestin-only hormonal pills works by delaying or stopping ovulation and therefore preventing fertilization of an egg by a sperm. Alternatively, these pills can also help to keep a fertilized egg from attaching to the uterine wall. 
  • Ulipristal acetate pills (more commonly known by the brand name ella): ella is another one-dose hormonal pill that works similarly to Plan B. 
  • Copper Intrauterine Device (IUD) (commonly known by the brand name Paragard): Copper IUDs are nonhormonal and work by disrupting sperm function, preventing them from fertilizing an egg. 

Each EC works a little differently. When choosing an option, you might consider other factors that could influence which EC may be right for you, such as: 

  • Timeframe. Levonorgestrel is most effective within 72 hours (three days) and tends to lose efficacy the longer you wait. Ulipristal acetate is highly effective if taken within 120 hours (five days) after sex, but like levonorgestrel, the sooner you take it, the more effective it is. The copper IUD is the most effective option (it has a success rate of greater than 99 percent!) and works equally well throughout the five-day window. 
  • Your weight. Levonorgestrel may be less effective if you weigh over 165 pounds, while ulipristal acetate may be less effective if you weigh over 195 pounds. IUDs work well for any weight. 
  • Whether you're on hormonal birth control methods or breastfeeding. Levonorgestrel and IUDs won't interfere with hormonal birth control or breast milk. However, after taking ulipristal acetate, you may need to pause your hormonal birth control for five days and use a barrier method (such as condoms) until your next menstrual period. Additionally, you may be advised to pump and throw away breast milk for 24 hours after taking it to ensure your breast milk hasn’t been contaminated. 
  • Accessibility and costs. The price of EC methods largely depends on where you buy it from and whether or not you have insurance coverage. 
    • Levonorgestrel is available over the counter in the United States, so you may be able to avoid having to speak with a pharmacist or other medical professional. This also means that you may not have to show proof of age or have a prescription. This option usually tends to be the cheapest of the ECs options. 
    • Ulipristal acetate requires a prescription and can be a little pricier. You may choose to call a health care provider for a prescription, go to a Planned Parenthood health center, or buy it online from organizations like Nurx, PRJKT RUBY, or the Planned Parenthood Direct app
    • IUD insertion requires an appointment with a health care provider, which may be difficult to get within that 120-hour window. If you decide to go this route, it may be a good idea to call a health care provider as soon as possible. Although the IUD is the most expensive option, it may save you money in the long run due to its long-term efficacy of between eight to twelve years. 

An important note about cost—if you have health insurance or Medicaid, your plan may cover these ECs at a reduced or no out-of-pocket cost. However, if you're on someone else's health insurance, they may be able to see your prescription EC on their insurance bill. For those without insurance or who choose not to use it, EC can sometimes be found at reduced rates at family planning clinics such as Planned Parenthood, public hospitals, and government agencies. While you're at it, you might also consider getting another dose of EC to have on hand for the future. 

Apart from EC, another thing to consider is the risk of sexually transmitted infections (STIs). K, you mention that the condom broke, and Reader 1, you mention that you used spermicide. While condoms are highly effective in preventing STI transmission when used properly, you may be exposed to STIs through a broken condom. Additionally, spermicide often contains an ingredient called nonoxynol-9 that may irritate genital tissues. When the tissues are irritated, germs can more easily enter your body, increasing the risk of STI transmission. That said, you may consider making an appointment with a health care provider to get tested for STIs if you believe you may be at risk. When it comes to future condom use, you might also consider using condoms with water or silicone-based lube to make sex more pleasurable and reduce the chances of the condom breaking. 

Remember that you typically have between three to five days after unprotected sex to use EC depending on the type you use. Choosing between levonorgestrel pills, ulipristal acetate pills, and copper IUDs may feel overwhelming, but hopefully these considerations regarding timeframe, weight, compatibility, cost, and accessibility will help you make an informed decision. 

Best of luck, and great job staying informed and on top of your health!

Last updated Dec 08, 2023
Originally published Dec 06, 1996