A woman can often avoid an unwanted pregnancy by inserting one of several prescription forms of birth control, such as the diaphragm, the ring, or the implant. Women who use internal birth control appreciate that it is not felt by either partner, nor does insertion interfere with sex play. On the other hand these forms all require a doctors prescription to obtain and are initially more expensive than over-the-counter methods. The most common of these, the diaphragm, is a dome-shaped cup with a flexible rim made of latex or silicone. This barrier method is used with a spermicide cream or jelly. The diaphragm is inserted into the vagina and fits securely over the cervix. This blocks entry to the uterus, while the spermicide immobilizes wayward sperm. The diaphragm should be inspected under a light before insertion to be sure that no punctures have developed. Two hours or less before intercourse, squirt spermicide in the cup and spread the extra around the rim. Find a comfortable position and separate the vaginal labia. Fold the cup in half, then push the device back in the vagina. The front rim should be wedged behind the pubic bone and the cup should be covering the cervix entirely. Leave a diaphragm in place for six hours after intercourse. If properly cared for, a diaphragm can often be used for about two years. But because changes, such as weight gain, can alter the fit of the diaphragm, bring your device with you to every ob-gyn appointment. Both the contraceptive vaginal ring, called the NUVA-ring, and the progestin implant, called Implanon, are hormonal methods which protect against pregnancy by suppressing ovulation. For this reason, they are more than 99 percent effective with perfect use, compared to the diaphragms 94 percent. The implant, or Implanon, is a plastic device which is the size of a match. Once inserted, it begins releasing the hormone etonogestrel, a progestin, immediately. A doctor inserts Implanon into the arm after numbing the area with local anesthesia. It can be left in place and be effective for up to three years, or can be removed earlier if pregnancy is so desired. Women who use the implant may experience irregular bleeding, but some wind up not menstruating at all. The vaginal ring, on the other hand, contains estrogen and progesterone and encourages a normal 4-week cycle. NuvaRing is a small, flexible ring that is inserted into the vagina once a month. Its then left in place for three weeks, and taken out for one, during which time menstruation occurs. Insert the ring by pressing the sides together and sliding it gently into the vagina. Unlike with the diaphragm, exact placement is not crucial, since the ring releases hormones through the vaginal mucous. Because both the ring and the implant alter a womans hormones, some side effects, like irregular bleeding, weight gain, or breast tenderness may result. All of these methods are effective, but require more of a commitment than over-the-counter birth controland NONE of them protect against sexually transmitted diseases. If youre considering internal methods of birth control, talk to your doctor about the pros and cons of each before making a decision!