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She's on the pill, but the condom slipped! Is there a risk here?

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Justin asks:

My girlfriend and I have recently just started having sex. We were both virgins, but still knew a lot about safe sex. We have used condoms every time. She's on the pill. I withdraw every time just to be safer. But once I forgot to hold the condom while withdrawing and it slipped off at the same time as I ejaculated. I'm pretty sure that I didn't get any sperm inside of her because there was sperm throughout the condom and a little on me. She just finished her last pill on Sunday before having to start the sugar pills. She usually gets her period on the Wednesday around noon but today is Wednesday night and she still hasn't gotten her period. She also sometimes forgets to take her pill on the exact hour and I think once or twice has forgotten to take it that day but took it the next day. Is it normal to have late periods such as this? I am very nervous that she might be pregnant because of that one incident with the condom slipping off as I withdrew. Would it be possible for her to get pregnant if a little bit got in her vagina even though she's on the pill?

Sarah replies:

First of all, good for you and your partner for educating yourselves about safer sex and wanting to be as safe as possible! The first step in having safer sex is deciding on and using some form (or forms) of birth control. The second, really important step then is making sure that you are using your chosen forms of protection correctly.

So first off, with the condoms you want to make sure that you are using them completely correctly. This means storing them in a safe place, using them for all genital contact, using extra lube, etc. Condoms are meant to contain ejaculation, so trying to pull out rapidly right before or during ejaculation actually increases your risks of condom failure because slips like you've described are really likely to happen. The best bet is to make sure that you are using good quality, correctly stored condoms with extra lube and then waiting until after ejaculation to withdraw while holding the base. For more information on correctly using condoms, you may want to check out our Condom Basics: A User's Manual.

The next issue to consider is your partner's pill use. Using the pill to backup your condoms is a fine idea, especially if pregnancy just really isn't an option for you right now. Just like using condoms, your partner needs to take the pill correctly if she wants to be sure that it will protect her. A big part of that is taking the pill at the same time each day. Now what does that mean exactly? One of our other Sexperts, Heather, addressed that issue in another question not too long ago...


What's taking it on time and what isn't?

You want to do your level best to take your pill as close to the same time every day as is possible, ideally within a window of a few hours: if you do that, every day, then you're a perfect pill user -- that doesn't mean you get a gold star (unless you want one, in which case, by all means, star yourself!), but it does mean that unless you have any other misuse you can rest assured you have the highest effectiveness in terms of pregnancy protection possible from your pill.

To simplify that, what's important is not that you take the pill at the EXACT same time every day (as in, "Oh god! I usually take it at 10:32, and it's 11:03!"), but at the same time of day: for instance, always in the morning, or always before you go to bed. That gets pill-taking into your regular routines so that you're most likely to remember to take them. For instance, Gail says she's not a perfect user, but, in fact, she is, and it sounds like our user with the first question is, too. For that matter, even Hockeylover isn't that far off: with combination pills, while you probably don't want to get in the habit of taking them with a 12-hour difference, just because it can be easier to space out pills that way, but she hasn't put her effectiveness at risk.

A "missed" pill is one that was not taken within 24 hours of the last pill you took. A missed pill should always be taken as soon as you realize you have missed it, but there is likely no risk from one missed pill or a need for EC. A "late" pill varies more in definition amoung various sources, and to some degree from pill to pill, but with any type of pill, if you have taken a pill more than 12-24 hours late, you may want to consider using a backup method of birth control for the rest of your cycle to play it safe.

With ALL pills if you have missed a pill, the right thing to do is to take that pill as soon as you know you missed it. If it's on that same day, take it when you realize. if you realize you missed a pill when you go to take the next day's pill, take both pills at the same time. If you realize you messed up and missed a pill days later -- while still taking the other pills on time -- then take that pill then. The same goes if you've missed two or three pills rather than just one. When you miss a pill, we advise using a backup method of birth control for the rest of that cycle.

If you've missed more than three, with most pills, you'll want to wait to take any more pills until the following Sunday, then just start a new pack entirely, but use a backup for that cycle as well as the time in between. If you have missed several pills and have had sex in that cycle without a backup method, we advise emergency contraception. When in doubt, always contact your healthcare provider or pharmacist and ask what to do.

(...)

With ALL pills, read your pill packet information. Pills -- how they're taken, when effectiveness is compromised, what side effects and risks are most prevalent, and the best ways to take them -- can ALL differ from pill to pill. So, be sure if you're on the pill, to read those inserts and to talk to your healthcare provider prescribing the pill for you and ask ANY questions you have: there's just no reason to fly blind with your birth control.



I'm not sure based on your description exactly how your partner usually takes the pill. If she's late with her pill on a regular basis or misses several pills in each pack, then her protection may be compromised. It's really hard to tell exactly how much though. (Especially as we're not sure whether she actually came into contact with your ejaculate when the condom slipped or not, it's impossible to give you an exact percentage of risk here.) If, however, she is generally taking her pill correctly, then it should provide excellent protection in the case of a condom failure. (Also, if the two of you haven't had recent STI testing, now would be a good time to go ahead and get that checked out since you've had a condom failure that could result in an STI risk.)

Please know as well that even though she's on the pill and usually gets her withdrawl bleed on a certain day at a certain time, it's not all that unusual to have some variations on that (and even more so if she's not really on-time taking the pill all the time). She will still have some hormonal variations, even though she's on the pill, and things like stress, diet changes, etc. can also impact that as well. So a difference of a few hours or even a day or so isn't really a big deal.

If you're worried, taking a pregnancy test is the easiest thing in the world and it can really take some of that stress off you and your partner. Tests are relatively inexpensive (anywhere from $3.99-$5.99 for the generic to $13.99-$19.99 for the fancy digital readout ones) and easy to take (who can't pee on a stick?). It won't make her pregnant, but it can take some stress off and allow you both to relax.

written 28 Sep 2007 . updated 18 Jan 2009

Information on this site is provided for educational purposes. It is not meant to and cannot substitute for advice or care provided by an in-person medical professional. The information contained herein is not meant to be used to diagnose or treat a health problem or disease, or for prescribing any medication. You should always consult your own healthcare provider if you have a health problem or medical condition.