All about emergency contraception & the LGBTQ+ community
Anyone with a uterus—regardless of gender identity or sexuality—can use the morning-after pill to prevent pregnancy after unprotected sex. Options include OTC pills like Julie (most effective within 72 hours), Ella (prescription, up to 5 days), and IUDs (from a provider, up to 5 days). Testosterone is not birth control; trans men with a uterus can still get pregnant with penis-in-vagina sex.
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. 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 an egg and sperm!
A study published in Am J Public Health found that compared with their heterosexual peers, people who identify as LGBTQ+ have an elevated risk for unintended pregnancy. There are a number of reasons why this is, including concern over judgment from the healthcare community and, for those who have infrequent penis-in-vagina intercourse, a perception that regular birth control is “overkill” or doesn’t align with their gender identity. 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 is not limited to any specific sexual orientation or gender identity. If you have a uterus, you can use a morning-after pill (the Julie Morning After Pill, Plan B One-Step®, 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’s are available over-the-counter at your local Target, CVS, Walmart and Amazon or get it delivered now through GoPuff, UberEats, Instacart and Doordash. The morning-after pill is most effective when taken ASAP or within 72 hours (three days) of unprotected sex. All over-the-counter morning-after pills 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 (five days) after unprotected sex to prevent pregnancy. But unlike the Julie Morning After Pill, 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 up to 10 years. However, like Ella®, the IUD requires an appointment as well as an 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 the morning-after pill?
The sooner you take it, the better it works. The Julie Morning After Pill™ is most effective 72 hours (three days) after unprotected sex, though some efficacy has been reported when taken within 120 hours (five 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 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 to prevent pregnancy. The Julie Morning After Pill™ and other OTC options can be found at your local Target, CVS, Walmart and Amazon or get it delivered now through GoPuff, UberEats, Instacart and Doordash without an ID, credit card, parent or insurance. 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. Testosterone therapy is not a form of contraception. While it can impact fertility in transgender men, it does not necessarily 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.
By advocating for contraceptive usage in the LGBTQ+ community, everyone can be knowledgeable and have access to all available options. And most importantly, they can feel confident in making the right decisions for their body and lifestyle. Now that’s something we should all be fighting for.
While we love to share useful and helpful information, the above shouldn’t replace the advice of your healthcare professional. For questions about birth control and other women’s health issues, please talk to your doctor.
Julie wants to keep young women in the driver’s seat of their own stories and provide them with the tools necessary for a happy, healthy sex life.
We know (and have lived!) through the ups and downs of young adulthood firsthand, and we aim to normalize the events, conversations, and questions that come during this period to help destigmatize sexual health. We believe women should live life with total freedom — starting with their ability to choose how, when, and if they become pregnant.
We know that women can make the best choices for themselves when equipped with the right information. We don’t take sexual education lightly and are committed to sharing accurate and factual information through rigorous planning and QA processes. In fact, all Julie content is reviewed by at least two board-certified doctors on our medical board. Learn more about them here.
For more details on our editorial process, see here.
Tessa Commers, MD, FAAP, MS is a board-certified pediatrician based in the Seattle area with a particular interest in adolescent health and sexual education. In addition to clinical practice and serving as Head of Medical at Julie, Tessa also founded AskDoctorT — an education platform with over a million followers across Instagram, TikTok, and YouTube — aimed at improving adolescent health literacy and body confidence. She also hosted and wrote the puberty podcast “That’s Totally Normal!” and has contributed to peer-reviewed publications and educational initiatives focused on child and adolescent wellbeing.
Education: Children’s Mercy Hospital, Kansas City – Pediatric Residency; University of Nebraska Medical Center – Doctor of Medicine (MD); University of Nebraska Medical Center – Master of Science (MS, Genetics, Cell Biology and Anatomy); New York University – Bachelor of Arts (BA)
Cordelia Nwankwo, MD, FACOG is a native of Dallas, Texas. She graduated from Texas A&M University with a Bachelor of Science in Biomedical Engineering. She then earned her medical degree from The University of Texas Southwestern Medical School. Dr. Nwankwo completed her training in Obstetrics and Gynecology at UT Southwestern Medical Center and Parkland Hospital. She currently is in private practice in Washington, DC. Dr. Nwankwo’s goal as a provider is to make sure every patient feels heard and able to achieve optimal health.
Education: UT Southwestern Medical School – Doctor of Medicine (MD); Texas A&M – Bachelor of Science (BS)
