Girlfriend on the pill still worried about pregnancy

Dear Lover,

It sounds like you're both using your knowledge about how the birth control pill works to inform your thoughts on this! You're right that when the pill is used correctly, the chance of pregnancy is pretty slim, so concerns around ejaculation could be smaller. Still, any possibility of pregnancy, however small, may be worrisome to your partner. Ejaculation without a condom is a higher risk than when using the birth control pill and condoms together. Talking openly and honestly about safer sex may ease concerns and help you more fully enjoy getting down to business!

If pregnancy is the primary concern, the pill's low failure rate may provide reassurance. With perfect use both the combined and progestin-only mini- pills prevent pregnancy more than 99 percent of the time. "Perfect use" means taking the pill at the same time every day, without skipping a dose. Although setting an alarm on a watch or cell phone may help your partner remember to take the pill on schedule, life is often less than perfect. Typical adherence results in pregnancy prevention about 93 percent of the time, which some may consider to be too low of a success rate to stand alone. Long-acting reversible contraception (LARC), such as intrauterine devices (IUDS) and progestin implants, prevent pregnancy over 99 percent of the time in both "typical" and "perfect" use. Insertion of these devices are medical procedures and must be performed by a licensed health care provider. These devices don't protect against STIs but can be used in conjunction with barriers such as external or internal condoms.

A second birth control method, more colloquially known as a "backup method," provides extra pregnancy protection—a prudent practice if your partner is just starting the pill or is taking a medication that could make the pill less effective. Using spermicide gel or foam in tandem with a diaphragm, a plastic disc that fits over the opening of the cervix, can provide yet another layer of protection from pregnancy. Condoms (both internal and external) have the added benefit of guarding against sexually transmitted infections (STIs), including HIV, and some couples enjoy them for the visual proof that ejaculate has remained inside the prophylactic and outside of the vagina. A back-up method may provide emotional reassurance so that focus can remain on other, more-exciting tasks.

In the heat of the moment, it may seem preferable to sweep any uncertainty about pregnancy under the rug. To better understand where your partner is coming from (no pun intended!), you may want to talk with her about why ejaculation makes her uneasy. Is she concerned about STIs? A reaction to semen? Does she find that taking the pill as scheduled is a challenge for her? Something else entirely? If you haven't already, you and your partner may consider discussing contraceptive options together with a health care provider. They can help you decide which method is right for both of you.