2What is contraception?Contraception - A chemical, physical, or surgical method of preventing fertilization of an ovum.Contraception will help prevent fertilization:Fertilization – The union of a sperm and ovum.
3IntroductionBirth control methods – Ways to alter the conditions necessary for conception or pregnancy to occur.Knowing facts about birth control methods DOES NOT give you permission to be sexually active as a teen if you or your partner use birth control methods.Two major risks of unprotected sexual intercourse are:1. Unwanted pregnancy/parenthood2. STIs
4Introduction The best way to prevent pregnancy is… ABSTINENCE!Birth control methods might involve contraception or interception.Contraception – A chemical, physical, or surgical method of preventing fertilization of an ovum.Interception – A chemical or physical method of preventing implantation of the fertilized ovum in the uterine lining.
5Kinds of Birth Control Methods Abstinence from SexOral ContraceptivesThe Combination PillThe Progestin-Only PillThe Extended-Cycle PillVaginal RingInjectable ContraceptivesInjectable progestinSkin Patch
6Kinds of Birth Control Methods cont. Barrier MethodsSpermicidesThe diaphragmThe cervical capMale condomFemale condomIntrauterine DevicesFertility Awareness MethodsThe basal body temperature methodThe calendar methodThe mucus method
7Kinds of Birth Control Methods cont. Sterilization MethodsTubal ligation (female sterilization)Vasectomy (male sterilization)
8Facts to know about birth control methods How it works: The way the birth control method works to prevent pregnancy.Instructions for correct use: Directions for using the birth control method the right way.Effectiveness: How well the birth control method works for adult users stated as a percentage.Theoretical Effectiveness: The percentage that tells how well the birth control method works for adult users if it is used every time, always used in the correct way, and used by adults who have no preexisting conditions that reduce how well it works.
9Facts cont.Actual user effectiveness: The percentage that tells how well the birth control method works for most adult users; this percentage takes into consideration adults who do not use it every time, adults who do not use it in the correct way, and adults who have conditions that reduce how well it works.Other benefits from correct use: Benefits the user gets from the birth control method that are in addition to its use to prevent pregnancy.Side effects: Unwanted changes, including health risks, that might occur when the birth control method is used.
10Facts cont.Who should not use: A list of cautions that identifies users who should not use the birth control method because it might cause health risks or might be inappropriate.Cost: An estimate of how much money the birth control method will cost.
11Oral contraceptives Different types of oral contraceptives: The Combination PillThe Progestin-Only PillThe Extended-Cycle Pill
12The Combination PillThe Combination Pill – A pill that combines estrogen and progesterone to change the natural menstrual cycle and to prevent ovulation.If a female stops taking the Combination Pill a female will resume her menstrual cycle.*The Combination Pill will:Help prevent ovulationChange the uterine lining…If fertilization does occur the change makes it difficult for the fertilized ovum to implant itself in the uterine lining.Thicken the cervical mucous making it difficult for sperm to travel through the cervix into the uterus.
13The Combination Pill cont. In theory it is effective 99.7% of the time. In reality it is effective 92% of the time…because females forget to take one or more pills, or they don’t follow directions.*The Combination Pill will keep the menstrual cycle constant…28 days.The pill reduces risk of ovarian and uterine cancers.The pill also lowers cramps and menstrual flow.Who should not use it?Heavy smokersFemales who experience migrainesFemales who suffer from depressionThe cost varies from $10-$35 depending on brand, insurance, and where the pill pack is purchased.
14Instructions for proper use A physical exam occurs. Health history, pap smear, pelvic exam, tests for HIV and STIs.A prescription is obtained from a physician.Back-up pills should be used for the 1st month.The first pill is taken either the Sunday after her period begins, or the same day her period begins.28-day pill pack = One pill is taken each day for 28 days. There are 21 pills, and 7 reminder pills. Once the pills run out, she starts the next pack.
15What to do if you forget to take a pill? If one pill is missed use the back-up birth control pill as soon as the female remembers.If two pills are missed the back-up birth control should be used while the rest of the pill pack is continued to be used.If three or more pills are missed a back-up birth control method should be used.
16The Progestin-Only Pill The Progestin-Only Pill is also called the mini- pill.Progesting-Only Pill – A pill that contains progesterone, which changes the natural menstrual cycle and prevents ovulation.It differs from the Combination-Pill because it contains no estrogen.How does it work?Prevents ovulationChanges uterine liningThickens lining of cervical mucus
17Progestin-Only Pill cont. In theory it is effective 99.7% of the time. In reality it is effective 92% of the time…because females forget to take one or more pills, or they don’t follow directions.The pill reduces risk of ovarian and uterine cancers.*This is the preferred pill for mothers who breast feed.The cost varies depending on brand, where the pill pack is purchased, and insurance, but can be anywhere from $10-$25.
18Instructions for proper use… A physical exam occurs. Health history, pap smear, pelvic exam, tests for HIV and STIs.A prescription is obtained from a physician.Back-up pills should be used for the 1st month.The first pill is taken either the Sunday after her period begins, or the same day her period begins.28-day pill pack = One pill is taken each day for 28 days. There are 21 pills, and 7 reminder pills. Once the pills run out, she starts the next pack.
19What to do if you forget to take it? If one pill is missed use the back-up birth control pill as soon as the female remembers.If two pills are missed the back-up birth control should be used while the rest of the pill pack is continued to be used.
20Extended-Cycle PillExtended-Cycle Pill – Combines estrogen and progesterone to change the natural menstrual cycle and to prevent ovulation.It differs from the Combination-Pill because the pills with active ingredients are taken for a longer period of time. This delays the menstrual cycle.This pill will allow a female to have her period 4 times a year, instead of 13.How does it work?Prevents ovulationChanges uterine liningThickens cervical mucus
21Extended-Cycle Pill cont. In theory it works 99% of the time, but in actuality it works 95% of the time.Why is it lower?Because females forget to take pills!This pill can be beneficial to women because it cuts down their period meaning less menstrual cramps (dysmenorrhea)This pill costs anywhere from $100-$120 for three months.
22Instructions for proper use… A female has a traditional physical or pelvic examination. A prescription is then obtained.A back-up birth control should be used for the first 7 days before beginning the extended-pill.The first pill is taken either the Sunday after her period begins, or the same day her period begins.One pill with active ingredients is taken at the same time each day for 84 days. After 84 days one pill with inactive ingredients is taken for 7 days. After the 7 inactive are up, she takes the other 84 active ingredients again.
23What to do if you forget to take it? 1 pill is missed; take it as soon as you remember. The next pill is still taken at the regular time.2 pills are missed; the female should take two pills the day she remembers, and two pills the next day. Then restart your one-pill a day cycle.3 or more are missed; don’t take the pills that were missed. Take one pill a day until all the remaining pills are taken.
25Vaginal RingVaginal Ring- A small, flexible, plastic ring that is about 2 inches wide.The ring is placed inside the vagina each month, and it releases hormones similar to those in birth control.When used properly it works 99-98% of the time.The vaginal ring will help keep a women’s menstrual cycle regular. Periods may also last shorter, and less blood flow.Each ring costs between $30-$35. A new one is needed each month.
26Vaginal ring instructions for use… A female has a traditional physical and pelvic examination. A prescription is then obtained.The female picks a day, usually during her menstrual period to insert the ring. The day should be recorded, or remembered.The ring can be inserted in any position, just as long as the female feels comfortable.The ring is left in place for 3 weeks, and after the third week the female will remove it on her own.During the 7 days when it is removed the female should experience her menstrual cycle.Then a new ring is inserted.
28Injectable ProgestinInjectable progestin – A shot of synthetic progesterone that is given every 3 months to change the natural menstrual cycle and prevent ovulation.A female will usually begin her menstrual cycle months after she stops having shots of injectable progestin.How does it work?Prevents ovulationChanges uterine liningThickens the cervical mucus
29Injectable Progestin cont. The actual user effectiveness for adults is 99%.Reduces menstrual cramps, risks of ovarian and cervical cancer.The approximate cost for these shots throughout the year ranges anywhere from $215-$545.
30Instructions for correct use… Physical exam that includes health history, pap smear, a pelvic exam, HIV and STI tests, etc.A prescription is then obtained.A shot is given within a week after a female’s menstrual period begins. A back-up birth control should be used for first 7 days after the first injection.A repeat shot of injectable progestin is needed every 3 months.
31Skin PatchSkin Patch – A soft, thin, plastic patch that is worn on the skin to prevent pregnancy.The patch is beige in color and the size of a match book.How does it work?The patch will release hormones to prevent ovulation from occurring.Mucus in the cervix thickens.Ovulation will begin again within three menstrual cycles after the patch is last used.The patch is 99% effective when used properly in women under the weight of 198 pounds.
32Skin Patch cont.Using the patch will help regulate the menstrual cycle once a month.Menstrual periods will also be shorter in duration and lighter in flow.A month’s supply of patches costs anywhere from $30-$35.
33Instructions for correct use… A female has a traditional physical or pelvic examination. A prescription is then obtained.The female uses the patch on the first day of her menstrual period. The patch is placed on clean dry skin on the buttocks, hip, abdomen, or upper outer arm.Remove the patch after 7 days. Replace it with a new one, but on a different part of the body.In total, a new patch is used for 3 total weeks, and then one week off. In the off week menstrual flow should occur.The patch should stay on while showering, exercising, or swimming.
34What to do if you forget to change the patch? If within 24 hours a female forgets to replace a patch, replace it as soon as she remembers.If she forgets after two days; put a new patch on and this day becomes the new patch day. Back- up birth control should be used.If a female forgets to take off the patch after the third week, the patch should be removed as soon as the female remembers.
35Barrier methods Spermicides The diaphragm The cervical cap The male condomThe female condom
36SpermicidesSpermicides – A foam, cream, jelly, film, or suppository that forms a barrier and contains a chemical that kills sperm.How doe they work?They form a barrier to reduce the risk that sperm will enter the uterus.They are effective 74% of the time. Spermicide used by itself is not an effective birth control method.Spermicides do not prevent against STIs and HIV.Cost for a pack of 12 suppositories or film is $4. Cost for tube of cream and jelly or a dispenser of foam is anywhere from $8-$17.
37Spermicides foams, jellies, and creams Always use another form of birth control with these spermicides!For foams, jellies, and creams; insert them up to one hour before having sexual intercourse.Fill the applicator, and then insert the applicator 3-4 inches into the vagina.Additional spermicide must be inserted if sexual intercourse occurs after an hour.These spermicides must be left in place for at least 6 hours after sexual intercourse.
38Spermicides film and suppositories Always use another form of birth control with these spermicides!Insert these spermicides minutes before sexual intercourse. (Instructions vary for different brands)Position the film or suppository against the cervix in the vagina.Additional film or suppository must be inserted if intercourse takes place after 1 hour.These spermicides must be left in place for at least 6 hours after sexual intercourse.
39DiaphragmDiaphragm – A dome-shaped cup that fits over the cervix to provide a barrier that helps prevent sperm from entering the uterus.The diaphragm is made of soft rubber or latex.*A spermicide should ALWAYS be used with it!In theory the diaphragm works 94% of the time, but in actuality it works 84% of the time.Lower because females don’t use it every time, don’t insert it properly, and don’t use spermicides.The cost of the diaphragm is $75-$250. The cost includes a physical examination, the diaphragm itself, visit for fitting, and the spermicide.
40Diaphragm cont. How does it work? It provides a barrier that reduces the risk sperm will enter the uterus.The spermicide that is used with it also creates a barrier.The spermicide provides additional protection in case the diaphragm is inserted wrong, or becomes dislodged during sexual intercourse.
41Instructions for correct use… A female has a physical examination.A physician then determines the correct size, and gives a prescription to the female’s Dr.The diaphragm and spermicide are inserted before any sexual contact. Approx: 1 tablespoon of spermicidal cream or jelly is squeezed into the dome. Additional spermicide is spread throughout the rim.The diaphragm can be inserted up to 6 hours before sexual intercourse.The diaphragm must be folded and inserted deeply into the vagina. The front rim must be behind and above the pubic bone.
42Instructions for correct use cont. More spermicide should be inserted with an applicator for each act of sexual intercourse.The diaphragm must be left in place for 6-8 hours after sexual intercourse.A diaphragm that is used properly will last 2-3 years. The fit should be checked each year.
43Cervical capCervical cap – A rubber or plastic dome that fits snugly over the cervix to provide a barrier that helps prevent sperm from entering the uterus.A spermicide should always be used with a cervical cap.For females that have not had a child the effectiveness is 80%-90%, and for those that have had children it is 60%-80%.How does it work?It provides a barrier that stops sperm from entering the uterus.The spermicide used with it also forms a barrier.The approx: cost is $75-$250. This includes an exam, the cap, a visit for fitting, and spermicide.
44Instructions for correct use. A female has a routine physical exam. Thephysician then determines the correct size.The physician determines correct size and gives a prescription.The cap with spermicide must be inserted into the vagina 30 minutes before sexual intercourse.The spermicidal cream or jelly is squeezed into the dome, and the cap is inserted deeply into the vagina so it covers the cervix.It must be left in place for 6-8 hours after intercourse, and no longer than 48 hours because of the risk for TSS (Toxic Shock Syndrome)
45The Male CondomMale Condom- A thin sheath of latex, natural skin, or polyurethane that is placed over the erect penis to collect semen during ejaculation.Also called a rubber or prophylactic.A spermicide should ALWAYS be used with it.Other than abstinence from sex, the male condom with spermicide is the most effective way or preventing HIV or STI transmission.*The male condom, even when used with spermicide, IS NOT 100% effective in preventing STI’s, HIV, or pregnancy.
46The Male Condom cont.In theory, when used with a spermicide the male condom is 98% effective. In actuality it is 85%. The ratings is for reducing the risk of conception, not STIs.Some males are allergic to polyurethane or latex, and some females, which can lead to irritation and burning. These individuals should seek out other contraceptives.The cost for a male condom is $5-$15 for a package of 12.Should be used before ANY sexual contact because of pre-ejaculation, and the risk of sperm.
47Instructions for correct use… The male condom should be purchased from a pharmacy, and stored in a cool, dry place.The condom is placed on an erect penis before sexual contact.The tip of the condom should be pinched as it is placed on the erect penis. The tip will collect semen during ejaculation. The tip should not contain air because it increases the likelihood that the condom will break.The condom is then unrolled towards the shaft.A spermicide should be inserted into the female vagina before intercourse.
48Instructions for correct use cont… The vagina should be lubricated before insertion. Petroleum based products and oils should not be used for lubrication since they can damage the condom.After intercourse, the rim of the condom should be grasped at the base, and withdrawn before erection is lost.Never re-use a male condom. Never use a male condom at the same time of a female condom.
49The Female CondomFemale condom – A soft, polyurethane pouch that is inserted deep into the vagina to collect semen during ejaculation.It is about 7 inches long and has flexible rings at both ends.The female condom should always be used with spermicides.By combining both it reduces the risk of developing some STIs and HIV, as well as pregnancy.The female condom with use of a spermicide is not as effective as a male condom with the use of a spermicide.
50Female condom cont…In theory if used with a spermicide it is 95% effective. In actuality it is 79% effective. These rates are for reducing the risk of conception.The proper use of the female condom will reduce the risk of transmitting STIs.Some females and females are allergic to polyurethane which can lead to irritation, burning, and an allergic reaction. These individuals should seek out other contraceptives.The approximate cost for the female condom is a package of three is $7-$14.
51Instructions for correct use… Should first be purchased at a pharmacy.It should be stored in a cool, dry place. Do not use it past its expiration date.It should be placed inside the vagina before any sexual contact.A spermicide should be inserted into the vagina up to one hour before intercourse. The condom can be inserted up to 8 hours before.The female condom is inserted into the vagina past the pubic bone. The outer ring must stay outside the vagina, and it must not be twisted.Never re-use the female condom.
53Intrauterine DeviceIntrauterine device (IUD)– A small device that fits inside the uterus and helps prevent pregnancy.There are currently two types approved by the FDA, the progestin-releasing IUD, and the Copper T.The IUD causes cervical mucus to become thicker, acting as a barrier for sperm.The copper IUD works because the copper is a spermicide itself, not allowing sperm to reach the ovum.Both IUDs are effective for 10 years.They are recommended in women in monogamous relationships since they increase the risk of PID.
54Intrauterine Device cont… In theory it is effective 98-99% of the time, and in actuality it works 99% of the time in adults.It will decrease menstrual flow and reduce menstrual cramps.Pelvic inflammations can occur during use in the first 3 weeks.The cost of the IUD, including insertion, ranges from $150-$450. The cost will vary depending on the kind of IUD and your insurance.
55Instructions for correct use… A female has a routine female examination.The IUD is inserted by a physician during the first few days of her menstrual cycle.The IUD is inserted high into the uterus. A small string will protrude about 1 inch from the cervix.A female should have a follow-up appointment after her first menstrual period following insertion of the IUD. At this time, the position of the IUD will be checked.A female should check the position of the string after each menstrual cycle to be certain the IUD has not been expelled.
56Fertility Awareness Methods The Basal Body Temperature MethodThe Calendar MethodThe Mucus Method
57The Basal Body Temperature Method Basal body temperature (BBT) – A birth control method in which a female uses her basal body temperature to predict ovulation.BBT is based on a slight rise in temperature shortly before, during, and after ovulation. The slight rise is caused by secretion of progesterone.A female practices abstinence the first day of menstrual bleeding until her BBT has been elevated for three consecutive mornings.In theory it works anywhere from 75-99% of the time, but in actuality it works 80% of the time in adults.
58BBT cont…By keeping a record of your BBT you will know when you will ovulate. She will also know how to recognize her fertile period when she wants to conceive.Fertile Period – A span of days in a female’s menstrual cycle during which sexual intercourse can lead to conception.The cost for a BBT kit is $15-$30. A kit includes a BBT thermometer and charts that can be used to graph changes in the BBT.
59Instructions for correct use… A female should take her BBT upon waking after at least three hours of sleep. A female can’t eat, drink, smoke, or urinate beforehand.Her BBT should be recorded on a special graph starting on day 1 of her menstrual cycle.There is a slight rise in the BBT (.4 degrees F to .08 degrees F) in the middle of the menstrual cycle, which is a sign of ovulation.Abstinence from sex, or another birth control method should be used from day 1 of menstrual bleeding until there is a slight rise in BBT for 3 consecutive days.
60The Calendar MethodCalendar method – A birth control method in which a female records the length of her menstrual cycle on a calendar to predict her fertile period.The calendar method helps a female predict the days in her menstrual cycle when she might conceive if she has sexual intercourse.In theory the calendar method is 91% effective, but actuality is 75%.The cost is free.
61Instructions for correct use… A female’s menstrual cycle should be recorded for 8 months.The shortest and longest menstrual cycles in that 8 month span must be found.Shortest is fewest days and longest is most days.A female can then predict when conception could take place.To predict the first fertile day, subtract 18 days from the number of days in her shortest cycle.The predict the last fertile day, subtract 11 days from the number of days in her longest menstrual cycle.Abstinence must be practiced during the predicted fertile period.
62The Mucus MethodMucus method – A birth control method in which a female records changes in the mucous discharge from her vagina to predict her fertile period.The mucus method helps a female predict when she will ovulate.In theory it is 75%-99% effective, but in actuality it is 80% effective for adults.It is the cost of a calendar.
63Instructions for correct use… A female learns to carefully observe and keep track of the appearance and consistency of the mucous discharge.Toward the middle of the cycle, the mucus becomes more clear. There are 2 days when the mucus becomes clear, slippery and stringy. A drop of this mucus will stretch between an open thumb and forefinger.Ovulation will occur within 24 hours of the last peak day. It is unsafe to have sexual intercourse without a backup birth control method when the mucus discharge is clear, slippery and stringy.
64Sterilization methods Tubal Ligation (Female Sterilization)Vasectomy (Male Sterilization)Sterile – The inability to produce offspring.
65Tubal LigationTubual ligation – A surgical procedure in which the fallopian tubes are closed off, cauterized, or cut.Ova can’t move through the fallopian tubes if they are cut, cauterized, or closed off, and sperm can’t travel up them.*A tubal ligation makes a women sterile.
66Tubal ligation cont.In theory it works % of the time, but in actuality it is 99.5% effective in adults.Failure could occur if the fallopian tubes rejoin, or through surgical error.The cost ranges from $1000-$2500. The cost depends on a person’s insurance.If a woman has a tubal ligation:Her hormone levels stay the sameShe continues to ovulateShe has a menstrual period
67Instructions for correct use… A female has a routine physical examination.A female must sign an informed consent. The physician must then explain other types of birth control to the female, and the physician must make it clear she can change her mind.The procedure is performed under general anesthesia. The physician makes an incision through the abdomen and locates the fallopian tubes.The physician then cuts off, cauterizes, or closes off the fallopian tubes.A back-up birth control must be used throughout a women’s first menstrual cycle after surgery.
68VasectomyVasectomy – A surgical procedure in which the vas deferens are cut, tied, or cauterized.When the vas deferens are cut sperm cannot pass through the male body.If a vasectomy is successful sperm will not pass in an ejaculation, only semen.*A vasectomy makes a man sterile.In theory the effectiveness of adult vasectomy’s is % effective, and in actuality it is almost 100%.The cost ranges from $250-$1000 and varies depending on your insurance.
69Instructions for correct use… A physical examination is first needed.A male will discuss it and sign an informed consent form. The physician then discusses other options for birth control with the male, and the physician must make it clear that a male can still change his mind now.The physician locates the vas deferens and inject a local anesthetic.One or two small incisions on either side of the scrotum are created, and then each vas deferens is isolated.Each vas deferens is cut, and removed. The physician then ties the vas deferens together.The vas deferens are returned to the scrotum.A male must use a back-up birth control for 20 ejaculations after having a vasectomy.
70Unreliable birth control methods Can you think of some unreliable birth control methods.DoucheBreastfeedingWithdrawalRhythm
71Douche*Douche – A douche is a solution used to rinse out the vagina. If used after sexual intercourse, it may rinse some sperm out of the vagina. However, it cannot rinse all sperm from the vagina. Once sperm are inside the vagina, they can move into the uterus within 90 seconds. The actual user effectiveness for adults is less than 60 percent. The douche is an unreliable birth control method.
72Breastfeeding*Breastfeeding – Lactation is the production of milk in the mother’s breast following childbirth. Physiological factors associated with lactation might prevent normal menstrual cycles for the first few months after childbirth. Breastfeeding may act to inhibit ovulation in some females, especially if they breastfeed their babies both day and night. However, lactating females also might have normal cycles, in which case they are capable of becoming pregnant again. Breastfeeding is not a reliable form of birth control.
73Withdrawal*Withdrawal – Withdrawal is the removal of the penis from the vagina before ejaculation of semen occurs. During sexual intercourse, the male withdraws his penis from the vagina before ejaculation to keep sperm from entering the vagina. However, removing the penis before ejaculation does not guarantee that no sperm will enter the vagina. This is because there are sperm in pre- ejaculatory fluid. Pre-ejaculatory fluid is secreted on the tip of the penis as soon as the male is aroused. Pre-ejaculatory fluid might contain sperm. Therefore, conception can occur even if the male does not ejaculate. The actual user effectiveness for adults is about 80 percent. Withdrawal is not an effective birth control method.
74Rhythm methodRhythm - The rhythm method is based on three ideas. Firstly, that women ovulate 14 days before menstruation begins, give or take two days. Secondly, that sperm can survive inside a woman for three days. And lastly, that an egg can only be fertilized within 24 hours of being released from the ovaries. Based on these assumptions, the rhythm method requires a woman to count back 14 days from the first day of her period. This will presumably be the day on which she ovulated and will ovulate the following month. In order to avoid pregnancy, she will need to abstain from sex or use another form of birth control, like condoms, around this time. While this method is fairly simple to follow, it is not necessarily applicable to all women.
75Rhythm method cont.The first problem lies in the assumption that ovulation will always occur at the same time every month. While it would make life a lot easier for women if this were true, the reality is that the majority of women ovulate at a different time every month. Although they may follow a similar pattern, no woman has a menstrual cycle that is identical every month. Another issue with the rhythm method is the belief that sperm are only viable inside a woman for up to three days. It has been found that sperm may be able to survive for as much as seven days inside a woman. Therefore, it would be necessary to avoid having sex for at least a week prior to when a woman believes ovulation will occur.