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What is OCDRelated Symptoms & ConditionsI’m worried that my birth control will fail and I’ll get pregnant. What can I do? 

I’m worried that my birth control will fail and I’ll get pregnant. What can I do? 

10 min read
Erica Digap Burson

By Erica Digap Burson

Reviewed by April Kilduff, MA, LCPC

Sep 29, 2023

For many people, birth control is a powerful tool that gives them a sense of control over their sex life and peace of mind. However, there are almost always some lingering doubts, no matter how tried-and-true your preferred birth control method is. It’s not hard to find anecdotal stories of people becoming pregnant even while using various types of birth control, and a quick Google search will tell you that most methods of contraception aren’t 100% guaranteed. 

In this article, we’ll talk about the very real fears and anxieties that you might have about your birth control, plus what to do if your fears are getting in the way of your sex life and well-being. 

How effective is contraception at preventing pregnancy? 

There are several different forms of birth control out there. Unfortunately, though they generally have high success rates when used correctly, there isn’t a 100% guarantee for any method in protecting you from an unwanted pregnancy. 

The effectiveness of your birth control at preventing a pregnancy depends largely on the method that you are using and how well you and your partner(s) are using it. While most birth control methods in general are highly effective when used exactly as directed, there’s also the possibility of user error, which can reduce the efficacy of your birth control.

As a result, the efficacy of each kind of birth control can vary. For example, a fertility awareness-based method, which involves tracking your menstrual cycle and avoiding having sex or using extra protection during periods where you are fertile, is one of the least effective methods of contraception, according to The American College of Obstetricians and Gynecologists—if 100 people who can get pregnant were to use this method for a year, about 24 of them would become pregnant.

Meanwhile, male condoms have about an 18 percent failure rate, or about 18 pregnancies per 100 people per year, while birth control pills generally have a failure rate of about 9%. Birth control shots, which one must remember to take on time (usually every three months or so) only have a failure rate of roughly 6%. All of these forms of birth control are more effective when used exactly as instructed, but they still don’t completely guarantee your protection. 

Finally, there are also longer-term forms of birth control that are implanted into your body or change your anatomy completely, which can be significantly more effective than other methods since there is little fear of user error. For example, both the birth control implant and intrauterine devices (IUD) are more than 99% effective in preventing pregnancies. Meanwhile, sterilization methods (commonly referred to as “getting your tubes tied” or getting a vasectomy) are also over 99% effective.

The bottom line: most birth control methods can be highly effective, especially when they are used correctly. However, none of them are 100% guaranteed, which is likely where much of the anxiety and stress over an unplanned pregnancy despite taking contraception can stem from.

But it’s important to note that if you want to avoid becoming pregnant, you should still be using an effective contraceptive method despite the varying degrees of uncertainty. Taking birth control is much more effective at preventing pregnancy than taking no birth control at all. They can also offer other protection, like protection against sexually transmitted infections (STIs) or sexually transmitted diseases (STDs) in the case of barrier methods like condoms.  

How to overcome anxiety about unplanned pregnancy when you’re using birth control or other contraception methods 

If you find that you are constantly worried about your birth control method failing, you may find it very helpful to start combatting that fear by educating yourself about how to properly use it. Remember, many forms of birth control like the pill, condoms, and family planning depend largely on the way that you use them, and careful usage can significantly increase their efficacy. 

In addition to mastering the correct usage of your birth control, it can also be extremely helpful to learn more about pregnancy itself so that you can fully understand how your birth control method prevents it. 

So if you are worried, take some time to familiarize (or refamiliarize) yourself with your birth control method and how it works to prevent a pregnancy. For example, if you are taking the pill, correct usage generally means taking it at the same time every single day since it mimics natural hormone cycles. Read up on your pill’s correct usage and know what to do in case you accidentally miss a pill or accidentally take it later in the day. 

On the other hand, if you are using condoms, look up the proper way to put them on and use them to prevent accidental spills. Additionally, make sure to check on the expiration date to ensure that you are using it within its best-by date. 

It can be very helpful to talk to a doctor or medical professional here, especially if you aren’t sure where to start or want extra education on using your birth control properly. Your doctor can provide better insights into your specific birth control method and how it relates to your own health and background. They can also help by educating you more on the actual process of impregnation, which can help arm you with more knowledge so you feel better about your contraception use. 

Finally, don’t be afraid to be open with your partner when applicable. Having an open line of communication about your sex life is healthy, and you definitely want to be on the same page with your sexual partners especially when you are dealing with anxiety and fear. Together, you can learn more about the most effective ways to use your birth control to prevent pregnancy. 

Can extreme anxiety about unplanned pregnancy be a mental health issue?

While it’s normal to have some doubts and fears about your birth control, some people deal with a crippling fear of their birth control failing, even to the point that it seriously impacts their relationships and/or their ability to have the sex life they would like to have. Some people may feel so unable to cope with uncertainty about their birth control that it becomes an obsession—irrational or intrusive thoughts about the chance that their birth control could fail may negatively impact their relationships or even their overall quality of life. 

In cases like these, it’s possible that you might be dealing with a mental health condition like obsessive-compulsive disorder (OCD). People with OCD experience obsessions, which are intrusive and unwanted thoughts, worries, sensations, images, or urges that cause intense intense anxiety and distress. They then engage in compulsions, which can be both observable behaviors or unobservable mental actions that are intended to alleviate that distress or prevent something bad from happening—like an unwanted pregnancy. 

In the case of a fear of unwanted pregnancy, someone with OCD might experience obsessions that center on pregnancy, like intrusive thoughts that their birth control didn’t—or won’t—work. But while everyone might stress about this possibility from time to time, someone with OCD might not be able to move on from this fear-provoking thought easily, finding that it nearly takes over their lives. They may then engage in compulsive behaviors like avoiding sex, repeatedly checking for possible signs of pregnancy, repetitively seeking reassurance that they are not pregnant, or even overusing emergency contraceptives, which could be potentially damaging to their health. 

“Many times, people with OCD are the ones who actually unfold that paper in the birth control packet and read all of it on both sides, wanting constant reassurance that it’s going to work or that it’s not going to cause bad side effects,” explains Dr. Patrick McGrath, Chief Clinical Officer of NOCD. “They want the guarantees and the percentages. Even if they’ve read it before, they’ll look at it again just in case the ideas have changed.” 

Additionally, someone with OCD can exhibit more irrational fears surrounding pregnancy outside of wondering about their birth control, Dr. McGrath explains. For example, someone with this kind of OCD might fear sitting on a chair in a public space, due to an imagined chance that their seat may be contaminated with sperm from someone who sat there previously. Conversely, someone with OCD who ejaculates might fear the possibility of accidentally impregnating someone from using a hotel towel, for instance.   

How can I tell if it’s OCD rather than a phobia? 

OCD is not the only explanation for an extreme fear of pregnancy. If you suffer from a persistent, repetitive, and perhaps irrational, fear of pregnancy, there is also the possibility that you might have tokophobia

Tokophobia is an extreme fear of pregnancy. People who deal with tokophobia may have similar thoughts and fears about accidentally becoming pregnant, and they may also deal with those fears by seeking reassurance that they aren’t pregnant, taking frequent pregnancy tests, not letting anyone who can produce sperm sit on their bed, or avoiding sexual interaction by any means necessary to avoid their fear. 

However, the biggest difference between OCD and a phobia is the presence of obsessions and compulsions. People with untreated OCD are often stuck in a cycle of these obsessive thoughts and repetitive, ritualistic compulsive behaviors that are intended to ease their distress or provide a sense of certainty. 

Meanwhile, people with a phobia are more likely to only react to this fear when they come face-to-face with it. While some of their reactions might look similar to reactions by those with OCD, they would not be considered compulsive in the case of tokophobia. People with phobias can also experience symptoms like panic and physical reactions as part of their extreme reactions to their triggers. 

How to overcome a fear of pregnancy in OCD or tokophobia 

Whether you believe that your fear of becoming pregnant may be linked to OCD or tokophobia, exposure and response prevention therapy (ERP) can help. ERP is considered the gold standard for OCD treatment, and it is highly effective in treating phobias as well. 

In ERP therapy, a licensed therapist will work with you to confront your triggers in a safe and controlled environment, starting with the triggers that evoke less intense reactions and then working up to the triggers that cause you the most fear and anxiety. As your therapist exposes you to these triggers, they also work with you to prevent you from responding to that fear and anxiety with your usual compulsive behaviors. 

Dr. McGrath explains that, in the case of a fear of pregnancy, your therapist might work with you to resist the urge to get into checking routines. “If you check the condom package once and the expiration date is good, then you don’t need to check it again,” he explains. “Use the condom or take your birth control pills, and trust the pharmacy that they got it right.” 

The same treatment can also be applicable to the other ways that a fear of pregnancy can manifest in OCD, as might be the case for someone who fears accidental pregnancy or impregnation from sitting on a public seat. “I’ve urged people to go sit in places, even if they didn’t feel that those seats were clean enough,” says Dr. McGrath. “Stay in the seat, don’t do any rituals, don’t put any barriers down.” 

Ultimately, the goal with ERP therapy is to help you sit with the anxiety and fear that your obsessions might bring, rather than turning to compulsions that just reinforce your fear over time.

The bottom line 

At the end of the day, it’s only natural to feel some trepidation about your birth control method. Because there are no guaranteed methods of contraception, it can be scary to trust your birth control alone, and many different people feel this fear at some level or other. However, you can increase its effectiveness by educating yourself on how it works and following instructions closely. 

On the other hand, if your fears of becoming pregnant despite using birth control are affecting your relationships and your sex life, there might be something else at play. Extreme and/or irrational fears of pregnancy might be a sign of a specific phobia or OCD. 

But the good news is that you don’t have to deal with it alone, and there is help out there. If you believe that your fears might be tied to a mental health disorder, NOCD can help. To learn more about how our ERP-trained therapists can help you manage your fears and find confidence in your sex life, schedule a free 15-minute call with the NOCD Care team. 

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