Using emergency contraception as a queer person

Too often, the LGBTQ+ community gets left out of the emergency contraception conversation because many assume that only “straight women'' can get pregnant. But that is not true. Pregnancy can occur in a variety of gender identities (including female, trans men, nonbinary, and gender non-conforming individuals) and sexualities (like heterosexual, queer, bisexual, lesbian, pansexual, and asexual). All it takes is a vagina and sperm.

A study published in Am J Public Health found that compared with their heterosexual peers, people who identify as LGBTQ+ (e.g., queer, bisexual, lesbian, pansexual) have an elevated risk for unintended pregnancy. This is because the heteronormative world doesn’t include queer people in contraceptive discussions, and for this reason, women in the sexual minority don’t often consider contraception as an option for themselves. Some might also feel a sense of fear or judgment since they have infrequent penis-in-vagina intercourse; there can be a perception that long-acting birth control options are “overkill.” This can result in an underestimation of the pregnancy risk in a single occurrence of penis-in-vagina sex, which is one of the most common causes of unintended or mistimed pregnancies.

In order to help prevent unwanted pregnancies in the LGTBQ+ community, we must be open to sharing knowledge and starting conversations, so we can make contraception resources accessible and inclusive to all.

Can individuals identifying as LGBTQ+ use the morning-after pill?

Of course! Emergency contraception (EC) is not limited to any specific sexual orientation or gender identity. If you have a uterus, you can use EC methods like the morning-after pill (Julie, Plan B, etc.) to help prevent pregnancy.

EC is an option available to anyone who wishes to prevent pregnancy after having unprotected sex or if your contraceptive method fails (i.e., condom broke or slipped off).

What types of emergency contraception are available for LGBTQ+ individuals?

There are three different types of emergency contraception available, including over-the-counter options and prescription-only methods:

• Morning-after pill (levonorgestrel): Morning-after pills, like Julie, are available over-the-counter at your local Walmart, Target, CVS, and on Gopuff. The morning-after pill is most effective when taken ASAP or within 72 hours (3 days) of unprotected sex. All morning-after pills, regardless of cost or brand, contain 1.5 mg of levonorgestrel, which delays or prevents the release of the egg from the ovary. When there’s no egg, there can be no pregnancy. The morning-after pill is not the abortion pill, meaning it won’t end or affect an existing pregnancy.
• Ella (ulipristal acetate): Similar to the morning-after pill, Ella is a pill that can be taken up to 120 hours (5 days) after unprotected sex to prevent pregnancy. But unlike Julie and other over-the-counter morning-after pills, Ella is only available by prescription.
• IUD: Two types of intrauterine devices (IUDs) can also be used as emergency contraception — copper and high-dose hormonal IUDs. An IUD is a small, T-shaped device inserted into the uterus by a healthcare professional. While it is a very effective form of regular birth control, the IUD can also be used as emergency contraception when inserted up to five days after unprotected sex or contraceptive failure. It also has the benefit of working as well on day five as it would on day one. When left in place, it will continue to serve as a regular birth control method for 8 to 10 years. However, like Ella, the IUD requires an appointment and insertion procedure.

BMI can impact the efficacy of emergency contraception, so it’s important to consider this when choosing the right option for you. Learn more about BMI and EC here.

When should someone in the LGBTQ+ community use EC?

The sooner you take EC, the better it works. Julie and other morning-after pills are most effective 72 hours (3 days) after unprotected sex, though some efficacy has been reported when taken within 120 hours (5 days).

Take the morning-after pill if:

• No form of birth control was used during intercourse
• You missed 2-3 active birth control pills in a row
• Your partner did not pull out in time
• You had unprotected sex
• A condom broke or came off during intercourse.

If you’re unsure if you used birth control or another contraception method failed, take the morning-after pill to be safe. It won’t impact your ability to get pregnant in the future, and if you are pregnant, it won’t impact the fetus.

Do trans men need the morning-after pill?

Transgender men (trans men) with a uterus that engage in penetrative penis-in-vagina sex may need to consider taking emergency contraceptives after contraceptive failure. A 2018 study concluded that trans men “use contraception and can experience pregnancy and abortion, even after transitioning socially and hormonally.”

If you identify as a trans man and have a uterus, there is a chance you can become pregnant through penetrative sex or if sperm (found in ejaculate or cum) comes in contact with your vagina. Even if you’re not regularly having penetrative sex, it only takes one instance of unprotected sex to potentially become pregnant. If this happens — or if you’re not sure if the sex you had was protected — you can use emergency contraception if you do not want to become pregnant. Julie and other morning-after pill options can be found at your local CVS, Target, and Walmart. You may also want to consider long-term birth control options like the pill, patch, IUD, or shot.

Can someone on testosterone therapy still get pregnant?

Yes. Even though some think of it as contraception, testosterone therapy is not a form of contraception. Testosterone therapy can impact fertility in transgender men but does not guarantee infertility.

It's critical to understand that pregnancy can still occur, especially if you stop testosterone therapy or if you’re not consistently taking it as prescribed.

Can someone with a vagina get pregnant from anal sex?

Technically, no. Anal sex does not lead to pregnancy because the anus is not connected to the reproductive organs.

However, in some instances, sperm can find its way from the anus into the vagina or near the opening, which could lead to pregnancy. Although rare, it is possible for sperm to leak from the anus into the vagina, especially if you lie on your belly after sex. Semen can also spread from the anus into the vagina with fingering or oral sex after ejaculation. That’s why it’s always best to use a barrier method of contraception, like a condom, when having anal sex. Practicing safe anal sex can also reduce your chances of contracting or passing on an STI to your partner.

Emergency contraception was designed to help anyone with a uterus feel empowered to prevent pregnancy after unprotected sex. And everyone, regardless of their sexual orientation or gender identity, deserves the right to have safe sex and make informed decisions about their reproductive health. It’s up to all of us to dismantle the narrative that only “straight women” can get pregnant and recognize how and when we perpetuate this harmful misconception

When people feel empowered to embrace both their queer identity and contraceptive usage, they can actually enable others to use contraception, too. Helen, a 29-year-old queer femme interviewee in the Sexual Minority Women and Contraceptive Use: Complex Pathways Between Sexual Orientation and Health Outcomes Study, said, “I think a big part of queer identity is, like, owning and feeling control over your experience of having sex with another person. . . . And I actually think that contraception is a tool that enables that. Historically, birth control has been a really important tool for women to own their sexuality. Not just queer women, but including queer women.”

By advocating for contraceptive usage in the LGBTQ+ community, everyone can have access to, and the knowledge of, all the options available. And most importantly, they can feel empowered to make the right decisions for their body and lifestyle.

Now that’s something we should all be fighting for.

Please note that this article is for informational purposes only and should not replace professional medical advice. If you have specific questions or concerns, it’s always best to consult with a healthcare professional.