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Contraception Variety of methods Categorized by methodology –Barriers –Hormonal methods –Fertility awareness methods –Sterilization Contraceptive prevalence.

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Presentation on theme: "Contraception Variety of methods Categorized by methodology –Barriers –Hormonal methods –Fertility awareness methods –Sterilization Contraceptive prevalence."— Presentation transcript:

1 Contraception Variety of methods Categorized by methodology –Barriers –Hormonal methods –Fertility awareness methods –Sterilization Contraceptive prevalence (Excel, pdf map) across the world (United Nations, 2012)Excelpdf map Contraceptive prevalence by method (United Nations, 2011)prevalence by method Contraceptive issues vary across countries Contraceptive methods in the U.S. (Guttmacher Institute, 2010)methods Contraceptive methods in the U.S., 1995 vs (CDC)methods

2 Why Does Contraception Matter? We (taxpayers) pay for many unexpected pregnancies –How much (Guttmacher Institute)How much –Rates of unintended pregnancy (Guttmacher Institute)Rates of unintended pregnancy

3 Contraception Barrier Methods

4 Barrier Contraceptive Methods Physical barriers –Prevent sperm from entering cervix –Block sperm from fertilizing ovum

5 Barrier Contraceptive Methods Historically, pessaries used –Objects or substances inserted into vagina –Pregnancy prevention effectiveness –Infection effectiveness Current barrier methods: spermicide, male condom, female condom, diaphragm, cervical cap, sponge

6 Spermicide Over the counter –$ per application Inserted into vagina Different forms –FoamsFoams –Suppositories –Creams –Jellies –FilmFilm New application for each act of intercourse Kills sperm

7 Spermicide Applied minutes before intercourse –Inserted into vagina near cervix –Can be messy Directions for insertion can vary Effectiveness: –Perfect use: 85-94% –Typical use: 74-85% Little disease protection May irritate vagina Effect of Coke on Sperm Motility Mythbusters (1:04-4:00)Mythbusters

8 Nonoxynol-9 Ingredient in spermicides Originally thought nonoxynol-9 protected against HIV In late 1990 ’ s, early 2000 ’ s, nonoxynol-9 was no longer thought to provide that protection –Among commercial sex workers in Africa, Thailand –Frequent use –Nonoxynol-9 may increase risk for disease transmission Increases vaginal irritation, which can lead to lesions/sores Lesions typically result in disease transmission vulnerability 2007: FDA required manufacturers to provide warning

9 What Other Active Ingredients Are There? Octoxynol-9 Benzalkonium Chloride Menfegol Sodium cholate Above ingredients may be difficult to find, not FDA approved Lemon juice

10 Male Condoms Over the counter Barrier placed on an erect penis Prevents ejaculate from entering vagina Also used to prevent disease transmission New condom for each act of intercourse Expiration date

11 Male Condoms Variety of colors, sizes, textures Latex –Some individuals are allergic to latex –Spermicide may worsen allergic reaction –Free-$1 per condom Polyurethane –More likely to break 4% vs.4% $1-3 per condom Lambskin –Sheep – intestinal membrane –Less effective against disease transmission –$2-5 per condom Kitemark Condom Testing (National Geographic, via YouTube; 2:33)Kitemark Condom

12 Male Condoms Lubricants may be added –Pre-packaged lubricants or self added –Oil-based may increase breakage Spermicides may be added –Nonoxynol-9 –Amazon search for condoms & spermicidalAmazon search

13 Male Condoms Effectiveness: –Perfect use: 95%+ –Typical use: 85-90% How to Use a Condom ( Planned Parenthood, via YouTube)How to Use a Condom

14 Female Condoms FC2 brand available over the counter Made of nitrile (synthetic rubber) –Older version made of polyurethane (noisier) Resembles traditional male condom –Two rings: closed, open ends Inserted prior to intercourse, up to several hours Prevents ejaculate from reaching vagina Prevents disease transmission Not to be used with male condoms

15 Female Condoms Cost: $1.25-$4 per condom New condom for each act of intercourse –WHO developed a protocol for re-use in 2002, but still recommends new condom for each use World Health Organization. The safety and feasibility of female condom reuse: report of a WHO consultation (PDF, 194 KB). Unpublished paper. (World Health Organization, 2002b) The safety and feasibility of female condom reuse: report of a WHO consultation (PDF, 194 KB). Unpublished paper. (World Health Organization, 2002b)

16 Female Condom Cost: $1.25-$4 per condom Effectiveness Perfect use: 95% Typical use: 75-80% –Alabama STI study, 1990s –11% slipped during first use –3% slipped after practice & nurse ’ s assistance –< 1% slipped if used more than 15 times Source: Guttmacher Institute, Perspectives on Sexual and Reproductive Health, Vol. 37, Number 2, June 2005Source: Guttmacher Institute, Perspectives on Sexual and Reproductive Health, Vol. 37, Number 2, June 2005

17 Female Condom In 2008, experimental study showed skills training increased likelihood for female condom use [San Francisco area; four-session trainings; AJPH: 98 (10) ] Animation (Female Health Company, via YouTube)Animation Although approved by FDA for disease protection in vaginal intercourse, the female condom has also been used for protection during anal sex –FC for MSM (YouTube, sign- in required)FC for MSM

18 Female Condom Removal

19 Female Condom Global Use Largely coordinated by PATH (Program for Appropriate Technology in Health) –Sustainability –Culturally relevant –Health improvement –Headquarters in Seattle, WA –PATH female condom versionfemale condom PATH version research: Thailand, Mexico, South Africa, Seattle Sold production to China company Female condom promotion research across world, esp in Africa

20 Female Condom Global Use At right = O’Lavie condom, Dahua Medical Company, previously created by PATH Panty condom Other female condoms in production (Female Condoms Market Intelligence)Other female condoms in production

21 Diaphragms Requires fitting in a clinic Made of latex or silicone Variety of styles (cervicalbarriers.org)Variety of styles –Ortho All-Flex no longer available –Milex available Refits are necessary –Significant weight change –Childbirth –When new diaphragm needed –If diaphragm slips/feels uncomfortable

22 Diaphragms Inserted up to two hours before intercourse Spermicide applied –New spermicide application for each act of intercourse Leave diaphragm in for six-eight hours Blocks sperm from entering cervix Spermicide kills sperm Effectiveness (via Planned Parenthood) : (via Planned Parenthood) –Perfect use: 94% –Typical use: 78%

23 Diaphragms Video (Illumistream via Youtube, 0:41- 1:45)Video Toxic shock syndrome May increase risk of urinary tract infections

24 Future Diaphragm: Caya (formerly SILCS) Researched by PATH No fitting required Silicone Per PATH, color was important component across cultures in feedback Research in Thailand & South Africa showed women could easily use Caya Plan is to offer Caya in Europe and U.S. –FDA granted market clearance in 9/2014 (PATH.org)granted market clearance –Available within year (?) Video (through 4:15)Video

25 Cervical Caps Traditional cervical cap was Prentif; no longer available Four sizes, smaller than diaphragm (thimble size) Required fitting More difficult to insert Like diaphragm, required spermicide application, could be inserted a couple hours prior to intercourse, removed hours afterward More spermicide with each act Effectiveness: 91/60-80%

26 Current Cervical Caps: FemCap FDA approved in 2003 Made of silicone Three sizes Inserted prior to intercourse, with spermicide More spermicide with new act of intercourse Can remain in place Women should not be able to feel FemCap TSS

27 Cervical Caps: FemCap FemCap blocks sperm from entering cervix Spermicide kills sperm Cost: $0-75 (Planned Parenthood) (Planned Parenthood) Video (via YouTube, 7:00)Video Effectiveness: PP does not provide “ perfect use ” statistics; typical effectiveness: 71% Increased risk for slippage, difficult removal vs. diaphragm* Replace in two years *FemCap™ with removal strap: ease of removal, safety and acceptability Christine K. Mauck,a,* Debra H. Weiner,b Mitchell D. Creinin,c David F. Archer,d Jill L. Schwartz,c Helen C. Pymar,c Susan A. Ballagh,d Deborah M. Henry,d and Marianne M. Callahana Contraception January; 73(1): 59–64.

28 The Sponge Polyurethane foam Non-oxynol-9 spermicide within foam Loop on bottom side of contraceptive Today sponge has been on and off the market since 1995 –Distributed again in May 2009 via Mayer Labs (Alvogen owns rights)

29 The Sponge Cost: $0-15 for three-pack Effectiveness: 91% with perfect use, more typically 76% (Planned Parenthood) (Planned Parenthood) TSS Risk

30 Contraceptive Methods: Advantages & Disadvantages Effectiveness Side effects Availability Reliability Accessibility Cost Suitability/appropriate ness Education/awareness Religion STI


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