At this time the ideal contraceptive, i.e., the safe, simple, inexpensive, totally effective, easily reversible contraceptive without side effects and not used at the time of the sexual act, has yet to be developed. This review highlights recent improvements in standard contraceptives and the views of these physicians concerning current risk benefit ratios. The benefits of tubal ligation are obvious, for few procedures offer more relief from anxiety and have such a high chance of success. Failure rates with tubal ligation range from 1 in 200 to 1 in 1000 cases, depending on the type of operation performed. Advances in laparoscopic technique, including the use of either silastic bands or spring loaded clips, have virtually eliminated the inadvertent "burns" associated with electrocautery. Due to the fact that clips and bands produce less tissue damage, it is anticipated that there will be a higher potential for reversibility. Recent literature has emphasized a specific syndrome that develops subsequent to tubal ligation; its major components are dysfunctional uterine bleeding and pelvic pain. The true incidence of this syndrome is difficult to establish but is estimated to be 10-33% in women who have had laparoscopic tubal fulguration. Vasectomy is simpler with less immediate morbidity, less expense, and easier reversibility than tubal ligation. The failure rate is slightly less with male sterilization. The most alarming recent report in relation to vasectomy is that it may be a surgical model for autoimmune disease. The theoretical effectiveness of steriodal contraceptives is 1 pregnancy/1000 woman years of use, and the actual use effectiveness is 5-8 pregnancies/1000 woman years of use. Many review articles document the various adverse effects that have been recorded in the literature. The mortality risk from oral contraceptive (OC) use in women under age 35 is 3 in 100,000. Few authors comment on the beneficial effects of OCs. These include fewer menstrual disorders, inhibition of the development of benign breast disease and a decrease in the incidence of functional ovarian cysts, and a decrease in some medical illnesses including peptic ulcers and rheumatoid arthritis. Liver adenomas are the most prominent complication of OCs that have been related to chronic use. The IUD has several benefits including a failure or pregnancy rate of 2-3/100 woman years of use. OCs are 3 times more dangerous than the IUD in regard to mortality, but the incidence of hospitalizations is 5-10 times higher with the IUD than with OCs. As effectiveness of barrier methods depends on high motivation, in studies of all forms of vaginal contraception and condoms there is a wide discrepancy between theoretical and use effectiveness. The lowest mortality rates are associated with barrier contraceptives with a back-up of early abortion when the method fails.