SURGICAL INTERVENTIONS VASECTOMY VASECTOMY TUBAL LIGATION Stoppage of the passage of sperm
VASECTOMY The vas deferens are cut and ligated. The ends may be buried in the scrotal fascia. Sperm can no longer get from testes to penis. Semen no longer contains sperm.
VASECTOMY Has no effect on potency Male hormones are still produced, so male secondary sex characteristics are not affected Sperm production continues
Vasectomy Patient Teaching: Apply ice to scrotum Moderate activity for two days Sterility is not immediate --some sperm will remain in the sperm ducts so, the male must have ejaculations to rid the ducts of these sperm After he has 2 negative sperm counts, he then can resume sexual activity without use of another contraceptive.
Tubal Ligation The fallopian Tube is ligated and sperm and ovum can no longer meet.
TUBAL LIGATION Clips or Rings Prevent passage of sperm or egg in the fallopian tubes by Cautery Remove part of tube
Tubal Ligation May be done immediately following delivery or at a later date Side effects: – Infection, Hemorrhage, Perforation of intestines – Reversal is only 15% success rate
Tubal Sterilization Use of non-surgical method Insertion of small coil (Essure) into the fallopian tubes Tubes become blocked as tissue grows
Consents and Regulations All states have regulations for informed consent which include: Explanation of risks Benefits Alternatives Statement regarding it as a permanent, irreversible method of birth control ** There is a 30 day waiting period between giving consent and the sterilization. Many states permit sterilization without reference to her marital status or mates consent. If federal funds are used, the person must be 21 years old. Minors cannot be sterilized.
Progestin Injection Depo Provera --progestin injection that inhibits ovulation, alters endometrium. Effective for 3 months – so must teach patient importance of getting re-injections Can be used during breast feeding Nursing Implications: Do NOT massage site after injection. It can accelerate absorption, and shorten period of effectiveness. Increases risk for osteoporosis – teach about calcium and vitamin D intake and weight-bearing exercise
Contraceptive Skin Patch Ortho Evra is a hormonal birth control method whereby synthetic hormones are delivered directly through the skin and into the bloodstream via a thin patch. Women can wear the Ortho Evra contraceptive patch on the buttocks, abdomen, upper torso (front and back, excluding the breasts), or upper outer arm.
Contraceptive Skin Patch Ortho Evra is replaced on the same day of the week for three consecutive weeks, and the fourth week is "patch- free." The patch remains attached and effective while exercising, bathing or in hot, humid conditions. It contains the same synthetic hormones as combined oral contraceptive pills (estrogen and progestin) and is thought to be about as effective as the Pill.
The NuvaRing vaginal contraceptive ring With NuvaRing ®, estrogen and progestin release is activated once the ring comes into contact with the vagina. The hormones are then absorbed and distributed into the bloodstream. In a given 1-month period, NuvaRing ® must be inserted into the vagina, removed after 3 weeks, and a new ring must be inserted no more than 7 days later.
Combined Oral Contraceptives Come in different forms –Single hormone -- Progestin only –Combined hormone - progestin & estrogen –With Blanks or with lactose pills or ferrous sulfate so there are no blank days –Pill should be taken the same time each day –Extended-cycle COC- a 91 day regimen in which the woman takes a pill for 84 days followed by 7 days of menses.
Cautions in Use of Combined Oral Contraceptives Contraindicated in woman with history of –Thrombophlebitis and thromboembolic disorders –Cerebrovascular or cardiovascular diseases –Estrogen-dependent cancer or breast cancer –Benign or malignant liver tumors –Hypertension –Migraines with focal aura –Diabetes with vascular involvement
Cautions in Use of Combined Oral Contraceptives Contraindicated in woman with –Any of the above conditions –Impaired liver function –Suspected or known pregnancy –Undiagnosed vaginal bleeding –Heavy cigarette smoking –Major surgery requiring prolonged immobilization
Used after unprotected intercourse (condom breaks, rape, contraceptive not used correctly or did not use contraceptive).
Emergency Postcoital Contraception Ovral Ovral Therapy - Two tablets taken 72 hours after unprotected intercourse and 2 tables taken 12 hours later. Action: High levels of estrogen interfere with production of progesterone. Progesterone levels fall and therefore the endometrium will slough. Preven (kit) available by prescription - estrogen and progestin. Plan B – progestin-only method. Available OTC to women over 18 years old. May insert IUD within 5 days
Mechanical Barriers Intrauterine devices IUD › Prevents implantation › Most common is copper T-shape › Patient must check placement after menses and before intercourse › Side Effects: PID, increase in bleeding and spotting, cramping, uterine perforation. Report pelvic pain.
Intrauterine Device (IUD) The Mirena Intrauterine System, which releases levonorgestrel gradually, may be left in place for up to 5 years
Condom Male and Female Sheath to cover the penis in the male Sheath inserted into the vagina and anchored around the cervix Prevent the transport of sperm to the ovum Some should be used with a sperimicide Teach how to apply and how to remove to be effective.
The Contraceptive Sponge moisten well with water and insert into the vagina with the concave portion positioned over the cervix. Should be left in place for 6 hours and may be worn for 24 hours
Diaphragm Dome shaped rubber device with a flexible wire rim that covers the cervix. May be used with gel or foam
Patient Teaching Diaphragm Insertion a. Apply jelly to the rim and center of the diaphragm. b. insert the diaphragm, pushing the rim of the diaphragm under the symphysis pubis. c. Check placement of the diaphragm. Cervix should be felt through the diaphragm.
Diaphragm **Main Patient teaching is: Be sure to be re-evaluated for fit following delivery, pelvic surgery, or a weight gain or loss of 10 pounds.
Cervical Cap Similar to the diaphragm but smaller and may stay in for up to 48 hours.
Think About This ! Most women can use the same diaphragm for years if proper care is maintained. Which of the following situations would warrant re-measurement and refitting? a. weight gain or loss of 5 lbs. b. surgery involving general anesthesia c. pelvic infection d. pelvic surgery or delivery
Spermicides Jellies Foams Creams Gel Suppositories
Spermicides Patient Teaching 1. Place deeply in the vagina so it comes in contact with the cervix before each intercourse 2. Maximun effectiveness lasts about one hour. Must reapply. 3. Suppositories take 10-30 minutes to dissolve 4. Don’t douche for six hours following use
Test Yourself ! The most effective spermicidal contraceptive agent generally is: a. spermicidal cream b. spermicidal foam c. spermicidal jelly d. spermicidal vaginal suppository
Review How do each of these act as a contraceptive? IUD Condom Birth Control Pills Vasectomy Foams, jellies Transdermal patch Tubal ligation
Natural Family Planning Fertility Awareness / Periodic Abstinence Relies on the avoidance of intercourse during the presumed fertile days of the menstrual cycle.
Rhythm or Calendar Method Calculate the time at which ovulation is likely to occur based on the length of previous menstrual cycles. The woman must keep a diary of her menstrual cycles Abstain on the fertile days
Basal Body Temperature Keep a chart of rectal temperatures taken at the same time every day. Note: Illness, if slept on a heated water bed, heating blanket, fatigue, less than 3 hours of sleep.
Cervical Mucus Testing Used to assess for ovulation. Assess Cervical mucus throughout the menstrual cycle. Indications of ovulation, the cervical mucus will be: –copious –transparent –thin, watery –Stretchable / Spinnbarkheit This is the time to avoid intercourse
Fertility Awareness Assess Mittelschmerz -pain at ovulation Test-Tape - assess for the time that it is the darkest Predictor Tests for Ovulation - detects the sudden surge of LH that occurs approximately 12 to 24 hours before ovulation.
Least Reliable Methods of Contraception Abstinence Breastfeeding Coitus interruptus