Abstaining from penis-in-vagina sex is the only surefire way to prevent pregnancy 100% of the time. But long-acting reversible methods of birth control and surgical sterilization are a close second.
Intrauterine devices (IUDs) and implants are the most effective forms of reversible birth control. Once inserted, the implant and IUD are more than 99% effective at preventing pregnancy.
Other forms of birth control can be equally effective if used perfectly — which means correctly, consistently, and on time, every time.
Human nature, however, often means that this won’t always happen. For example, a condom may be forgotten, a birth control pack started late, and a birth control shot skipped.
So-called “typical use” ultimately makes the actual success rate of each method much lower.
| How many people typically become pregnant? | |
|---|---|
| Tubal ligation | Fewer than 1 out of 100 |
| Vasectomy | Fewer than 1 out of 100 |
| IUD | Fewer than 1 out of 100 |
| Implant | Fewer than 1 out of 100 |
| Lactational amenorrhea method | 2 out of 100 |
| Shot | 6 out of 100 |
| Pill | 9 out of 100 |
| Patch | 9 out of 100 |
| Ring | 9 out of 100 |
| Sponge | 14 to 22 out of 100 |
| Cervical cap | 14 to 29 out of 100 |
| Diaphragm | 17 out of 100 |
| External condom | 18 out of 100 |
| Internal condom | 21 out of 100 |
| Spermicide | 21 out of 100 |
| Pull-out method | 22 out of 100 |
| Fertility awareness methods | 24 out of 100 |
IUD
The hormonal IUD is over 99% effective. Depending on the brand, it can last from 3 to 8 years. It must be replaced on time to remain effective.
Implant
The implant is over 99% effective for up to 3 years. It must be replaced on time to remain effective.
Shot
The shot is over 99% effective with perfect use and about 94% effective with typical use. To remain fully protected against pregnancy, you must receive a shot every 12 weeks.
Pill
The pill is over 99% effective with perfect use and about 91% effective with typical use.
Efficacy data is generally combined for combination and progestin-only pills. In general, the progestin-only pill is considered to be less effective than the combination pill.
The pill may be less effective if you:
- don’t take it at the same time (within the same 3-hour window) every day
- vomit within 2 hours of taking it
- take certain antiseizure medications or medications to treat HIV
- take certain herbal supplements, such as St. John’s Wort
Patch
The patch is over 99% effective with perfect use and about 91% effective with typical use. To remain effective, it must be replaced on the same day every week for three consecutive weeks.
You may choose to take the fourth week off to allow for period-like withdrawal bleeding. If you do, be sure to replace the patch on the same day at the end of every fourth week.
Ring
The ring is over 99% effective with perfect use and about 91% effective with typical use. It must be replaced after three weeks of use to remain effective.
You may choose to take the fourth week off to allow for period-like withdrawal bleeding. If you do, be sure to replace the ring on the same day at the end of every fourth week.
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Copper IUD
A copper IUD is over 99% effective for up to 10 years. It must be replaced on time to remain effective.
Sponge
If you’ve never given birth, the sponge is 91% effective with perfect use and 86% effective with typical use. If you’ve given birth, it’s 80% effective with perfect use and 78% effective with typical use.
The sponge may be less effective if it’s:
- used too soon after giving birth
- inserted incorrectly
- dislodged during sexual activity
- removed too soon after penis-in-vagina penetration
Cervical cap
If you’ve never given birth, the cervical cap is 86% effective with perfect use. If you’ve given birth, it’s 71% effective with perfect use. Typical use estimates aren’t available.
Applying spermicide to the outside of the cap prior to insertion and during sexual activity can increase its effectiveness.
The cervical cap may be less effective if it’s:
- used too soon after giving birth
- too small to completely cover your cervix
- inserted incorrectly
- dislodged during sexual activity
- removed too soon after penis-in-vagina penetration
- showing signs of wear and tear, especially if it’s been more than a year since you first started using it
Diaphragm
The diaphragm is 94% effective with perfect use and about 83% effective with typical use. Applying spermicide to the outside of the diaphragm prior to insertion and during sexual activity can increase its effectiveness.
The diaphragm may be less effective if it’s:
- used too soon after giving birth
- too small to completely cover your cervix
- inserted incorrectly
- dislodged during sexual activity
- removed too soon after penis-in-vagina penetration
- showing signs of wear and tear, especially if it’s been more than a year since you first started using it
External condom
External condoms are up to 98% effective with perfect use and about 82% effective with typical use.
The external condom may be less effective if it’s:
- worn incorrectly
- used with an oil-based lubricant
- too large or loose around the penis
- torn when opening the wrapper
- nicked by teeth, nails, or jewelry during oral or manual stimulation
- stored improperly
- expired
Internal condom
Internal condoms are up to 95% effective with perfect use and about 79% effective with typical use.
The internal condom may be less effective if it’s:
- inserted incorrectly
- used with an oil-based lubricant
- nicked by nails or jewelry during internal stimulation
- stored improperly
- expired
Spermicide
When used alone, spermicide is 82% effective with perfect use and 79% effective with typical use. It must be inserted 10-15 minutes before penetration and reapplied every hour during sexual activity to remain effective.
Spermicide may be less effective if it’s:
- inserted incorrectly
- stored improperly
- expired
Abstinence
Abstinence means different things to different people. If your definition includes abstaining from penis-in-vagina penetration, and you commit to this fully, it’s 100% effective.
Any changes or slip-ups can increase your risk of pregnancy.
Outercourse
Outercourse generally refers to sexual activity that doesn’t involve penetration. Depending on your definition, this may mean avoiding vaginal or anal penetration with fingers, sex toys, or a penis.
Avoiding penis-in-vagina penetration is the only way to prevent pregnancy. If you stick to it, it’s 100% effective.
Lactational amenorrhea method
The lactational amenorrhea method is over 99% effective with perfect use and 98% effective with typical use. To be effective, you must nurse at least once every 4 hours during the day and every 6 hours at night.
The lactational amenorrhea method may be less effective if you:
- pump instead of nursing
- do not nurse as frequently as required
- are more than 6 months postpartum
Pull-out method
Also known as withdrawal, the pull-out method is up to 96% effective with perfect use and 78% effective with typical use.
The penis has to completely pull out of the vagina before pre-ejaculate or ejaculate comes out in order to be effective. If pre-ejaculate or ejaculate enters the vagina, the risk of pregnancy increases.
Fertility awareness methods
Fertility awareness methods are up to 91% to 99% effective with perfect use and 76% effective with typical use. You must track your daily body temperature, vaginal discharge, and menstrual period to be effective.
Fertility awareness methods may be less effective if you:
- have an irregular cycle that’s difficult to track
- don’t use a secondary method or abstain for the first three months of tracking
- aren’t calculating your cycle correctly
Tubal ligation
Tubal ligation is over 99% effective at permanently preventing pregnancy.
Vasectomy
A vasectomy is over 99% effective at permanently preventing pregnancy. You must use a secondary method or abstain until a semen analysis confirms that the procedure was successful.
It may take several months for your ejaculate to be sperm-free.
Work with a doctor or other healthcare professional to choose the best method for your individual needs. They can explain any associated risks and help you understand how to use your chosen method correctly.
Condoms are the only method that prevents pregnancy and sexually transmitted infections. Consider using condoms as a secondary method, and make regular testing a part of your safer sex routine.