1. Contraception
Chapter 6

2. Definition: Contraceptives
Conception: the fusion of an ovum and sperm creating a fertilized egg (zygote)
Contraception: preventing conception by blocking the female’s egg from uniting with the male’s sperm

3. Principles of Contraception
Based on the physiology of reproduction
Types of contraception:
Barrier
Hormonal
Natural methods
Surgical
Factors affecting choice
Advantages and disadvantages

4. Principles of Contraception
Effectiveness
Contraceptive failure rate- % of women experiencing an unintended pregnancy in the 1st yr. of contraceptive use
Continuation rate- % of people who continue to use the method after a specified period of time

5. Oral Contraceptives: The Pill
Estrogen and progesterone taken orally
Mimics the corpus luteum
Secretes progesterone & estrogen to suppress ovulation
Combination pill
Most common
Advantages : Easy to use, effective, fertility returns after use
Disadvantages : exp. symptoms of pregnancy, no protection against STD’s; stroke, blood clots in older women who smoke

6. Contraceptive Skin Patch
Thin , tiny square patch
Releases estrogen and progestin slowly into the bloodstream
Prevents the same way as OCs
Worn for 1 week, replaced on the same day for 3 consecutive weeks. 4th wk. no patch
Advantages: as effective as OCs
Disadvantages: similar to OCs

7. Vaginal Contraceptive Ring
The NuvaRing
2 inch flexible vaginal ring molded w/ progestin and estrogen
Slowly releases hormones into bloodstream
Inserted during cycle, kept in for 3 wks., removed during 4th wk. (ring free) new ring inserted at next menstrual
Advantages : 1 month of protection, no daily/weekly action required
Disadvantages : similar to OCs and patch

8. Contraceptive Implants
Placed under skin of upper arm/leg
Delivers progesterone over a period
of years
May inhibit ovulation & affect development
of the uterine lining
Advantages: Highly effective, no further action required after insertion, contain no estrogen, so lower risk of estrogen related side effects
Disadvantages: no protection against STDs, menstrual irregularities, uncomfortable appearance

9. Injectable Contraceptives
Depo-Provera
Injectable progestin every 12 weeks
Provides protection like implants
Advantages Highly effective, requires little action on part of user ; No estrogen- related side effects, minor injection
Disadvantages: visit to health care facility every 3 months, side effects similar to Norplant, weight gain, infertility after stopping use

10. Emergency Contraception
“Morning-after Pill”, Plan B
Most common is the two dose regimen
May inhibit/delay ovulation or altering the transport of sperm/egg; do not affect a fertilized, implanted egg
Needs to be taken within 72 hours. Best used within 24 hours

11. The Intrauterine Device (IUD)
Small plastic device placed in the uterus
ParaGard (copper;protects 10 yrs.)
Mirena (protects 5 yrs.)
Releases small amounts of progestin
May work by preventing fertilization
Advantages: highly reliable, once inserted a simple check of string is all that’s needed; reduce risk of endometrial cancer; fertility restored after use
Disadvantages: limited to genital tract: heavy menstrual flow, uterine cramping, backache, spontaneous expulsion, may puncture uterine wall

12. Figure 6.1 An IUD properly positioned in the uterus
Figure 6-1: An IUD (Copper T-380A) properly positioned in the uterus.

13. Barrier methods

14. Male Condoms Thin latex, or polyurethane
Most widely used barrier method
Advantages: Protect against pregnancy and STD’s, easy to purchase, no prescription
Disadvantages: Most common complaints are reduced sensitivity and interfering with sexual intercourse

15. Female Condoms Polyurethane sheath with two flexible rings
Advantages: offers potentially more protection against genital warts and herpes b/c it covers base of penis as well
Disadvantage: more expensive, more difficult to use

16. Figure 6.3 The female condom properly positioned

17. Abstinence Abstinence
Without sexual intercourse for a chosen period of time
Benefits
More self respect and respect for others
Security that you are not being pursued for sexual reasons.
Less worry about STDs and Pregnancy.

18. The Fertility Awareness Method
Only one egg released each month
Lives for ~ 24 hrs. unless fertilized
Sperm can live in the body for 6-7 days
Only 8 days/month when conception can happen
FAM
Calendar method
A woman releases an egg days before her next period
Temperature method
A woman’s BT drops slightly before ovulation and rises slightly after
Withdrawal
Coitus interruptus

19. Male Sterilization: Vasectomy
Severing of the vas deferens
May return to work in 2 days
Reversal varies between 80% to 50%

20. Figure 6.7 Vasectomy
Figure 6-7 Vasectomy

21. Female Sterilization
Tubal sterilization (laparoscopy) is most commonly known as tubal ligation
Hysterectomy
Complication rate: 6-11%
Reversibility: Low

22. Figure 6.8 Tubal sterilization

23. Which Contraceptive Method is Right for You?
Key considerations include:
Health risks
Implications of unplanned pregnancy
STD risk
Convenience and comfort level
Type of relationship
Ease and cost of obtaining and maintaining each method
Religious or philosophical beliefs

24. Contraceptive Effectiveness
Most Effective (Perfect Use)
Pill, Patch, Ring, Injectiable = 0.3%
Implant =0.05%
ParaGard = 0.6%
Mirena = 0.1%
Male Condom =2.0%
Female Condom = 5.0%
Withdrawal = 4.0 %
Vasectomy = 0.1%
Tubal sterilization = 0.5%