Download Contraception

Emergency Contraception
• Morning After Pills
• Must be 17 years of age or older to purchase without
a prescription
1. Preven ($10-$70.00)
2. Plan B ($45.00 or Sliding Scale
Costs)
3. Levonorgestrel ($50.00 -$100.00)
Medical Abortion
• RU-486
– Mifepristone (1st pill)
• Inhibits progesterone
– 3 Days later
– Misoprostol (2nd by mouth or vaginal
suppository)
• Promotes uterine contractions
* May be used up to seven weeks after
implantation (95% effective)
Surgical Abortions
• Early Vacuum Aspirations /Suction (D&C)
– 90% of all abortions
– Performed 4-6 weeks
• Dilation & Evacuation
– 7% of all abortions
– Performed 12-20 weeks
– Insertion of a medical drug, which dilates the
cervix
Surgical Abortion
• Induction Method
– Major Procedure
– Insertion of a saline solution, which starts
contractions
– 1% of all abortions
• Medical Extraction
– Rare procedure
Contraceptive History
History
Ancient Birth Control Methods
Beaver-Testicle Tea
Dances, Amulets, Rituals &
Myths
• Squatting or kneeling to provoke sneezing
• Jumping backwards seven times
• Leather pouch containing a cat’s liver on
the left foot
• Spitting in a frogs mouth three times
• Inserting a finger into the vagina and
“swishing it around” after intercourse
Dances, Amulets, Rituals &
Myths
• Soranus - Ancient Greek Doctor of
Gynecology
– Determined that women were fertile during
ovulation and promoted the rhythm method.
Unfortunately, he assumed that ovulation
occurred during menstruation.
Spermicides, IUDs, Pessaries, &
Douches
• Dried cow, elephant, & crocodile dung
mixed with honey
• Ground dates, acacia tree bark, & honey
blended into a paste
• Dried fish or cotton soaked with lemon
• Half lemons with the juice squeezed out
• Glass or metal diaphragms
Spermicides, IUDs, Pessaries, &
Douches
• IUDs invented by Arabs would placed pebbles in
the uteruses of their camels
• 1920 – German gynecologist Ernest Grafenberg
developed the first IUD for humans, which was
made from silkworm gut and coiled wire.
• Seaweed, leaves, wooden blocks, and apricot pits
were also used to block the cervix
• Vinegar injected into the vagina
Douche
French term for soak or wash
Douche Bag
Douche Can
Coitus Interruptus
• “Pull out” or withdrawal method
• When a man withdraws his penis from a
woman prior to ejaculation
• 80% Effective
• Couples in monogamous relationships who
do not have to worry about STIs or caring
for a child.
Breastfeeding
• Suppresses fertility
• Breastfeeding can provide up to 98%
effective contraception if three criteria are
met:
- The mother has not experienced the return
of her menstrual periods
- The mother is fully or nearly fully
breastfeeding
- The baby is less than six months old.
Evolution of the Condom
• Latin word "condus" which means "vessel”
• Oiled silk paper, linen sheaths, sheep
intestine, snake skin leather, or very thin
hollow horn
Condoms Today
• Condoms can be found in a variety of
shapes, sizes, colors, flavors and textures.
Many condoms also contain lubricants,
spermacides and a reservoir tip.
• Condoms that play music when they break
– “Dixie,” “The Anniversary Waltz,” “Happy
Birthday to You,” & the “1812 Overture”
Steps to Success
1. Sexual Arousal
2. Erection
3. Leave room at the tip & squeeze out any air
4. Roll on condom
5. Intercourse
6. Hold onto the base/rim of the condom
7. Withdrawal the penis
8. Orgasm
9. Loss of erection
10. Relaxation
Barrier Methods
Male Condom
• Made of latex or polyurethane
• Single use barrier method that blocks sperm
from entering the female
• Approximately 86%-97% effective
• Some protection against STIs
• Over the counter
• Inexpensive
• May leak, break, or interfere with spontaneity
Female condom
• Rubber sheath with a flexible ring that is
inserted in to the female
• Single use barrier method that blocks sperm
from entering the female
• 79%-95% effective
• Some protection against STIs
• Over the counter
• May leak, break, or interfere with spontaneity
• More difficult to use
What You Need to Know About
Nonoxynol-9
• N-9 is the active ingredient in all of the
over-the-counter (OTC) spermicidal
products available in the U.S. and has been
used for pregnancy prevention since the
1950s. An Advisory Review Panel of the
Food and Drug Administration (FDA) has
deemed N-9 a safe and effective
contraceptive.
N-9
• Mechanism of Action
• N-9 is the active ingredient in all OTC spermicidal
products in the U.S. N-9 is a chemical detergent
that damages sperm cell membranes, killing the
cells.
• N-9 is marketed and sold as a spermicidal
contraceptive product in several different
formulations, including:
• - Suppositories - Foam - Film - Gel - Cream
N-9 USE
• Diaphragms and cervical caps are FDA approved
for use in conjunction with spermicidal gels and
creams. Also, some condoms include a
spermicidal lubricant.
N-9 USE RECOMMENDATIONS FROM
WHO & CDC
• N-9 can be used as a contraceptive, alone or in
combination with a cervical barrier method, and
among women at low risk of HIV/STI infection
(Use the product no more than once daily.)
• N-9 should not be used for the purpose of
HIV/STI prevention.
• N-9 should not be used for contraception by
women at high risk of HIV infection.
N-9 USE RECOMMENDATIONS FROM
WHO & CDC
• Condoms with N-9 should not be promoted
for disease prevention. (However, it is
better to use N-9-lubricated condoms than
no condoms at all.)
• N-9 should not be used rectally.
Contraceptive foam, film,
suppositories
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Available over the counter
Must be inserted close to time of intercourse
Limited or no STI protection
74%-94% effective
Diaphragm
• Dome-shaped rubber disk that covers the cervix so
sperm cant reach the uterus
• Best if used with a spermicide
• 80%-94% effective
• Inserted before intercourse, left in for at least 6
hours
• Can be used multiple times
• Uncomfortable to use
• Has to be fitted
• Limited protection against STDs
Cervical Cap
• Soft rubber cup with a round rim which fits
around the cervix
• 80%-94% effective
• Hard to insert
• Can remain in place for up to 48 hours
without being removed
Hormonal Contraception
IUD (Intrauterine device)
• A T-shaped device inserted into the uterus
by a doctor
• Can last from 1 to 10 years
• About 2 in 100 pregnancies a year
• May result in ectopic pregnancies in the
fallopian tubes
Combination Pill
• Effectiveness
• Adult Users 99.7%
• Actual effectiveness: 92 %
– Forget to take a pill daily
– Eating disorders
Combination Pill
• Benefits – regular cycle every 28 days, reduces
cramps and flow, reduces risks of uterine and
ovarian cancer and other diseases
• Side Effects – nausea, headaches, weight gain,
fluid retention, bleeding between periods,
depression, mood changes, changes in vision,
dizziness, yeast infections, and smokers increase
chances of stroke and heart attack
• Who should not use it – heavy smokers, suffer
from severe depression, get migraines, have had
blood clots, cancer or blood diseases
• Cost – Depends on insurance coverage
Extended Cycle Pill
• Prevents ovulation, changes lining, difficult for fertilized
ovum to implant, thickens the cervical mucous
• Only four period per year
• 99% effective
• Advantage for women who suffer from severe cramping or
PMS
• Side Effects – irregular bleeding, fluid retention (hands and
feet), raise blood pressure, nausea, vomiting, headache,
vision, appetite, depression infections and allergic
reactions
• Who should not use it – same as mini and combo pill users
• Cost - $100 to $120 for three months
Nuva Ring
• It is a small, flexible ring that is inserted into
the vagina once a month
• It is left in place for three weeks and taken out
for the remaining week
• The Ring releases synthetic estrogen and
progestin to protect against pregnancy for
one month.
Vaginal Ring
• Small, flexible, plastic ring that is about 2 inches
wide
• Placed in the vagina each month and releases
hormones similar to those in birth control pills
• Prevents ovulation, removed after three weeks,
after having a menstrual period insert a new one
• Effectiveness – 98-99%
• Benefits – regular menstrual period, shorter and
lighter flow
• Side effects – bleeding between period, nausea,
headaches, weight gain or loss, mood changes
Vaginal Ring
• Who should not use it
– Smokers, High Blood Pressure, CVD, liver
disease, cancer
– Cost - $30-35 a month
Ortho Evra (patch)
• Patch worn on the lower abdomen or on the upper
body
• Releases progestin and estrogen into the
bloodstream
• Less effective for women weighing more than 198
pounds
• New patch applied once a week for 3 weeks, 4th
week no patch is worn so female can have her
menstrual period
Skin Patch
• Hormones are released to prevent ovulation from
occurring, mucus thickens, ovulation returns three months
after the patch is last used
• Effectiveness – 99% in women who weigh 198 pounds or
less
• Other benefits – menstrual cycle regular, shorter and
lighter flow
• Side effects – bleeding between periods, nausea,
headaches, weight gain or loss, mood changes
• Who should not use them – Same as others, include history
of blood clots
• Cost - $30-$35 a months
Norplant (Implant)
• 6 matchstick sized rubber rods implanted under
skin of the upper arm
• Steadily releases a contraceptive steroid
levonorgestrel
• Very effective. About 1 in 100 pregnancies
• Lasts for 5 years
• Reversible
• Expensive
• No STD protection
Depo-Provera (injection)
• Injectable progestin that prevents ovulation
• Prevents sperm from reaching egg and
keeps egg from implanting in the uterus
• Less than 1 out of 100 pregnancies
• 1 injection every 3 months
• Not safe against STDs
• Fertility may take a few months to get back
to normal
MISCELLANEOUS
WITHDRAWAL
• pregnancy is possible if sperm are
ejaculated on or into the vagina
• not effective against sexually
transmitted infections
WITHDRAWAL
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ADVANTAGES
can be used when no other method is available
POSSIBLE DISADVANTAGES
requires great self-control, experience, and trust
not for men who ejaculate prematurely
not for men who don’t know when to pull out
not recommended for teens
No Method
No Protection
• Free
• No protection against pregnancy
• No protection against STDs
ABSTINENCE
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100% EFFECTIVE
ADVANTAGES
No medical or hormonal side effects
Easy to use
Prevents sexually transmitted infections
100%FREE
POSSIBLE DISADVANTAGES
many people find it difficult to abstain from
sex
• many people fail to use protection when
abstinence ends
• A commitment required by both people
• Peer pressure
STERILIZATION
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ADVANTAGES
permanent protection against pregnancy
no lasting side effects
no effect on sexual pleasure
protects women whose health would be seriously
threatened by pregnancy
POSSIBLE DISADVANTAGES
risks of minor surgery if incision is made
some people later regret not being able to have
children
not usually reversible if you change your mind
rarely, tubes reopen, allowing pregnancy to occur
STERILIZATION
• Tubal sterilization — intended to permanently
block woman's tubes where sperm join egg
• Vasectomy — intended to permanently block
man's tubes that carry sperm
• 99.5-99.9% EFFECTIVE
Not effective against sexually transmitted
infections — use latex or female condoms to
reduce the risk.
STERILIZATION
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Tubal sterilization
bruising if incision is made
very rare injury to blood vessels or bowel
pregnancies that rarely occur are more likely to be
ectopic (in a fallopian tube)
Vasectomy
infection or blood clot in or near the testicles
temporary bruises, swelling, or tenderness of the
scrotum
sperm leakage may form temporary small lumps
near testicles
STERILIZATION
• COST
$2,000-$6,000/ tubal sterilization
240-$520/ vasectomy
(Vasectomy costs less because it is a
simpler procedure that can be done in the
clinician’s office.)
OUTERCOURSE
• NEARLY 100% EFFECTIVE
• pregnancy is possible if sperm are ejaculated
on or inside the vagina
• reduces the risk of many sexually transmitted
infections — unless body fluids are
exchanged through unprotected oral or anal
intercourse.
Outercourse
• ADVANTAGES
• no medical or hormonal side effects
• may prolong sex play and enhance
orgasm
• can be used when no other methods
are available
Outercourse
• POSSIBLE DISADVANTAGES
• many people find it difficult to abstain
from vaginal intercourse
• many people fail to use protection from
pregnancy or infections if intercourse
takes place
Fertility Awareness Methods
• Nothing to purchase
• Permitted by some religious groups that
don’t allow other methods
• Requires commitment to other person
• No intercourse during menstrual cycle
• 80%-99% effective if done correctly