Contraception

If you’re avoiding falling pregnant, and you are a sex worker, it is a good idea to consider contraceptive methods besides condoms. There are different types of contraception to suit your personal situation and preferences. For more detailed information and personal advice, contact the ACS nurses for a free consult.

Different types of contraception

As a sex worker, you are insufficiently protected against pregnancy if you depend on spermicidal creams/jelly/tablets, the withdrawal method, consulting your menstrual cycle calendar or the temperature method.

The below options are a few that work more reliably:

The pill

The contraceptive pill is meant to be taken daily at a set time of the day. The pill contains artificial versions of female hormones oestrogen and progesterone (already found in a woman’s ovaries). The pill prevents the ovaries from releasing an egg (ovum). So because no ovulation occurs, you cannot fall pregnant (as sperm needs to penetrate the ovum for conception to happen.

The pills come on a blister pack for 30 days (a month). You will need to take the pill every day for 21 days (three weeks), then stop taking it for 7 days. Your uterus will flush itself out during those 7 days and you will have your period.

If you stop taking the pill, it is possible for you to fall pregnant.

Advantage:

  • You can delay your bleeding by skipping your stop week.

Disadvantages:

  • You have to think about it every day.
  • If you forget to take it or vomit it out, you can get pregnant.
  • If you are on enzyme-inducing antibiotics/medication, it can cancel out the effectiveness of the pill. (You will need additional contraception to avoid falling pregnant, so ensure a condom is always used.)

Note: While it prevents you from falling pregnant, it offers no protection against STIs.

Contraceptive ring

The birth control ring (Nuvaring®) is a flexible plastic ring with hormones. You insert the ring into the vagina once a month. It must be removed after three weeks. The following week you should have your period.

If you do not insert it back into your vagina after your period ends, you may fall pregnant.

Advantages:

  • Three weeks a month you don’t have to think about contraception.
  • You can delay your period if you skip the ring-free week.

Disadvantages:

  • The ring may slip from the vagina when you often have sex, which is the case with sex workers.
  • Some people feel the ring during sex. This is not a problem. If you find this annoying, you can remove the ring from the vagina just before or during sex for a maximum of 3 hours. You are no longer protected if you put it back in after more than 3 hours. (This has to be your choice, not your client’s.)
  • You can only buy three rings at a time at the chemist.

Note: While it prevents you from falling pregnant, it offers no protection against STIs.

Birth control patch

The contraceptive patch is a thin, square 4.5 cm strip, containing hormones, that sticks to your skin. The patches need to be replaced every week. After three weeks, you have a patch-free week where your period should start.

It is possible to fall pregnant as soon as you stop using the patch.

Advantages:

  • You only have to think about it once a week.
  • You can delay your period if you skip the patch-free week.

Disadvantages:

  • The patch is visible.
  • The patch is less reliable in people heavier than 90 kg.
Birth control injection
The contraceptive injection contains hormones which work much like the pill. The injection is given by a nurse every 12 weeks. After that, your menstrual cycle will return and it will be possible to fall pregnant. For some, this may take a while as your hormones need time to balance out again, but there is no way to predict how much time your body needs.

Advantage:

  • You don’t have to think about it for three months.

Disadvantages:

  • Irregular bleeding is common. It may stop altogether.
  • There may be side-effects (headaches, acne, hair loss, decreased sex drive and mood swings) and these normally go once the body flushes out the hormones, but this will take time.
IUD

The IUD is a small T-shaped device that is inserted into your womb by a doctor or nurse. There are two versions: plastic or copper. The plastic IUD carries hormones, much like the Pill. The copper IUD releases copper in small, safe amounts and stops you from falling pregnant. In English, it is commonly referred to as ‘the coil’ or the ‘copper coil’.

It stays in your womb (uterus) for 5-10 years and then needs to be replaced. When the IUD is no longer in your uterus, it is possible for you to fall pregnant—but this may take some time as your body takes time to flush out the hormones.

Advantages:

  • A hormone (plastic) IUD can stay in place for five years and a copper IUD for up to 10 years.
  • There are no hormones in a copper IUD. Your menstrual cycle stays normal. You also do not experience the normal side-effects of hormone contraceptives (weight gain etc).
  • With a hormone IUD, your bleeding becomes lighter and may disappear altogether.

Disadvantages:

  • With the copper IUD, your periods may be more intense and prolonged.
  • With the hormone IUD, irregular periods are common. Unpredictable bleeding (spotting) is also common.
Implant (Hormone IUD)

The hormone rod (Implanon®) is a small flexible rod containing hormones. The doctor inserts it under the skin of the upper arm. It stays in place for 3 years. After removal, it is possible to fall pregnant.

Advantages:

  • You don’t have to think about contraceptive for 3 years.
  • Your bleeding becomes less severe and sometimes it stops altogether.

Disadvantages:

  • An experienced doctor has to insert it.
  • You may have spotting or irregular bleeding.
Sterilisation (tubal ligation)

Female sterilisation involves tying/sealing/closing the fallopian tubes. This is done by a gynaecologist. It is considered to be an unreversible procedure, so you have to be sure you don’t want (anymore) children.

Advantage:

  • You never have to think about it again.
  • Tubal sterilisation will not affect your hormone status.

Disadvantage:

  • It is a permanent procedure. Undoing it is difficult, expensive and not always successful.
Condom
A condom is the only contraceptive that protects you against pregnancy, HIV and most STIs at the same time. A condom is placed on before having sexual intercourse.

Read more about using a condom here.

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Which contraception is best for you?

During a consultation with us at ACS, we work to find the best contraceptive method for you that best suits your lifestyle, your situation and your health. We can also arrange a prescription for you. Some methods will need to be placed by a doctor. This may either be your own GP (huisarts) or a doctor from the Centre for Sexual Health.

In the Netherlands, up to the age of 21, contraception is covered by your health insurance. Beyond that, contraceptives may be (partially) reimbursed with supplementary insurance.

Want to know more about costs? The nurse at ACS will always have an up-to-date price list.

Tip: it is a good idea to carry around a morning-after pill in case an accident happens (broken condom etc).

Morning-after pills

If you’ve forgotten to take the pill for the day, had a broken condom or are not sure if your contraception is working (perhaps you’ve just started or it has expired), the morning-after pill can be a source of relief. It is also called the ‘emergency pill’. It is not meant to be a regular form of contraception as it only offers a 75-80% chance of preventing you from falling pregnant.
Questions?

Do you have questions about the morning-after pill or the absence of your period after taking it? If so, contact the ACS nurse.

When do you take the morning-after pill?
Take the pill as soon as possible after unprotected vaginal sex. You can take the morning-after pill, the Norlevo®, up to 72 hours after you have had sex without a condom. Norlevo® will not work after that. Ask for ellaOne® at the chemist as it will work up to 120 hours after unprotected sex.
What happens after the morning-after pill?
Be aware that taking the morning-after pill may trigger an earlier period/menstruation cycle. It may also delay your period. You should also be aware that there is a small risk of you falling pregnant, despite having a morning-after pill within the recommended time period. It is advisable to do a pregnancy test 2-3 weeks after taking the morning-after pill. You can buy a pregnancy test yourself or from the ACS.
Where to get the morning-after pill?
The pharmacy/chemist will sell you the morning-after pill without a prescription. It is covered by your health insurance if you are under 21 years of age and with a prescription from your (GP) doctor.
Too late for the morning-after pill?
You can have a copper IUD inserted up to 5 days after unprotected sex. This prevents the foetus from implanting to the wall of your uterus and thus ensures that you do not become pregnant.
Health & Sex

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