We review conceptual issues and theoretical frameworks related to users' acceptability of new technologies designed to protect reproductive health and prevent unwanted pregnancy. Special attention is given to distinctions among different kinds of users' perspectives regarding acceptability, as well as differentiating acceptability from assessments of the efficacy of innovative methods. Emphasis is also given to the larger context of couple decision-making and cultural variation. We argue that concern for sexual pleasure plays a central role in determining user perspectives regarding new methods. The female condom, contraceptive ring, contraceptive skin patch, microbicides, vaccines, emergency contraception, and PERSONA are discussed within the context of the identified critical issues.