Health Education 100

M. Collins, MPH

Managing Your Fertility

•History of Contraception

•18th century used condoms

•Crocodile dung was inserted in the uterus in ancient Egypt

•Stones in the uterus of camels in Arab states

•Opium molded into a cup and inserted in uterus Ancient Sumatra

•Metal Portiol caps used in 1800’s in Germany

Methods that don’t work

•Douching

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Health Education 100

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•Jumping up and down after intercourse

•Having intercourse while standing

•Having intercourse during her period

•Willing not to get pregnant

•Praying you don’t get pregnant

•It being your first time

•Saran wrap instead of a condom

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Health Education 100

M. Collins, MPH

Risk and Responsibility

  • In the United States, half of all pregnancies are unintended, Of unintended pregnancies, 1.5 million resulted in a live birth 1.6 million ended in abortion
  • Preventing sexually transmitted diseases (STD)
  • Mental Health

Chances of Getting Pregnant

•Intercourse the day before ovulation 30%

•Intercourse on the day of ovulation 15%

•Over a period of 1 year without contraception 90%

•64% of women in the US who could become pregnant use some method of contraception

Women, men, and birth control: who is responsible?

Ways men can help share responsibility:

•Explore different ways of making love without intercourse

•Help pay for Dr. Bills and share cost of contraception

•Keep track of supplies and partners cycle.

•Talk to your partner about birth control options

•If no more children are wanted--have a vasectomy

Definitions

  • Birth control - any means of preventing a birth from taking place; includes contraception and abortion
  • Contraception - the prevention of conception
  • Population Control-Policies implement to establish and optimum population size.
  • Family Planning – help couples have the number of children they want

Choosing a Method

  • Best method is the one you will use consistently
  • Theoretical effectiveness—in a lab
  • User effectiveness—in the population

Sexual Abstinence & Outercourse

  • Abstinence-refraining from sexual intercourse (vaginal, oral, & anal)
  • Celibacy-not engaging in any kind of sexual activity
  • Outercourse-a method of birth control using all avenues of sexual intimacy except penile-vaginal intercourse.

Hormonal Methods

•Works by preventing ovulation

•Possible side affects: nausea, vomiting, weight gain or loss, depression, increased or decreased sexual desire, mood changes, change in appetite, and headaches.

•Associated with blood clots, CVA, and liver tumors, especially in women who smoke; increased risk of breast cancer, decreased risk of ovarian cancer

The Pill/ Oral Contraceptives

•Don’t protect against STI’s

•Synthetic estrogens, progestin or both

•Discontinue use 3 months prior to pregnancy to prevent miscarriage

•1% failure if taken daily

Pill Failure

•Severe diarrhea

•Vomiting

•Missing pill by 12 hours

•Starting packet late

•Antibiotics

Hormonal Methods

Implants – Implanon®: Long-term contraceptive, Progestin Based

Injectable contraceptives -

  • Depo-provera (DMPA) works for 3 months
  • Lunelle – 1 month

Nuva Ring

•You put it in and you take it out yourself. NuvaRing® stays in place comfortably for 3 full weeks. Then you take it out for 1 week. You will be protected from pregnancy for the entire month. Then you insert a new NuvaRing®.

•NuvaRing® is a slender, flexible, transparent vaginal ring, about as big around as a silver dollar. It is completely odorless.

•NuvaRing® delivers steady low-dose contraceptive hormones around the clock.

Ortho Evra Patch

•Contains Estrogen/ progesterone

•Wear for 3 weeks, off 1 week

•No need to remember pill daily

•Some people have problems with adhesive

•Lower dose as doesn’t go through stomach

Barrier Methods

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Health Education 100

M. Collins, MPH

  • Male Condom
  • Female condom
  • Diaphragm
  • Cervical cap
  • Contraceptive sponge
  • FemCap

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Health Education 100

M. Collins, MPH

Female Condom—provides protection, form STI’s as well, non prescription

Cervical Cap and Diaphragm

  • May provide some protection against certain STI’s (chlamydia gonorrhea).
  • Not recommended for women who have poor vaginal muscle tone (Diaphragm), history of toxic shock syndrome (TSS), and recurrent urinary tract infections.
  • Must be put in before intercourse, reapplication of spermacide required for each time sex is repeated or every two hours and must be left in after intercourse. Should be removed after 8 hours to reduce risk of TSS.
  • Can not be used when there is vaginal bleeding.
  • Must be fitted by MD.

FemCap

•Use with spermicide

•Inserted before sexual arousal

•Covers the cervix

•Removed at least 6 hours after intercourse

•Not Latex

•Requires prescription, Cost $64.85

Today Sponge- Barrier ,Spermicide, available through internet only

Lea’s Shield

  • One-size fits all diaphragm device available by prescription.
  • Silicone rubber allowing flow of air/fluids from cervix, must be used with spermicide and left in place for 8 hours after intercourse.
  • User/failure rates are similar to diaphragm user rate effectiveness is unknown as this time.

Spermicides

Spermicide - substance toxic to sperm, Example: Nonoxyol 9

Types: Bioadhesive gel, Contraceptive foam, Contraceptive film, Creams, jellies,

Vaginal suppositories

Intrauterine Device (IUD)

  • Tiny T-shape plastic or copper device inserted into uterus
  • Interferes with the movement of sperm and egg
  • Insertion can be painful, heavy cramping and menstrual flow
  • Most popular form of reversible birth control in the world
  • Best for those with 1 partner, low risk of STI’s and Pelvic infections.

Fertility Awareness Methods

Calendar (rhythm) method

-Calculating the “safe” days

- “unsafe days” are considered to be during ovulation(10th-17th days)

-Better for women who have regular cycles

-Best to chart menstrual cycles prior to use to determine longest and shortest cycles

Basal body temperature (BBT) method

Fertility Awareness Methods

Cervical mucus method

  • Determine the menstrual cycle stage by examining the mucous secretions
  • Noticeable change prior and after ovulation
  • Clear, slippery mucous appears immediately after ovulation
  • During “unsafe days”, women need to use alternative contraception

Symptothermal method -When the Basal body Temperature (BBT) and Cervical mucous method are used together

Sterilization

Women:Tubal Sterilization - closing the tubes by cutting and electro cauterization, ties or clips

–Hysterectomy - surgical removal of the uterus

–Essure – Coils implanted in fallopian tubes

–there are no incisions or punctures to the body.

–takes about 35 minutes, does not require general anesthesia,

Men:

Vasectomy - cut or tie off the Vas deferns, More common in US than tubal sterilization

Vasaclip

•2.5% failure rate, higher than regular vasectomy

•Cost $400, not covered by most insurance yet

•Long standing use of titanium clips in vasectomies have been used.

Emergency Contraception

Emergency contraceptive pill (ECP)

  • Planned Parenthood provides info on converting pills
  • These emergency contraceptives are intended for use within 72 hours of unprotected sex

Copper IUD

  • Inserted 7 days after unprotected sex
  • This method should only be used if one plans to continue to use the IUD device

Failure Rates of Contraception

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Health Education 100

M. Collins, MPH

•Chance 85%

•Withdrawal 27%

•Morning-after pill 25%

•Female condom 21%

•Family planning 25%

•Spermicides only 20%

•Sponge 20%

•Diaphragm 18%

•Cervical Cap 16% if no kids

•Fem Cap 15-3%

•Male condom only 12%

•Male condom & spermacide 5%

•Pill 3-8%

•Nuva ring 2%

•IUD 0.1-2.0%

•Implants (Implanon) 1.9%

•The Patch 1-8%

•Depo-Provera 0.3%

•Female Sterilization 0.5%

•Male sterilization 0.15%

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Abortion Methods

Mifepristone (RU-486) -prevents the cells of the uterine lining from getting the progesterone they need to support a fertilized ovum. A surgical backup arrangement may be needed if treatment fails

Surgical methods:

  • Vacuum aspiration - uterus is gently vacuumed to remove the fertilized ovum
  • Dilation and evacuation- (13th & 26th week)-fetus is removed by curettage (scraping with a curette, a small spoon-shaped instrument) and a intravenous solution to encourage contractions
  • Hysterotomy- fetus removed by an incision in the woman’s abdomen (cesarean section)

Abortion World Wide

  • Legal in US Since 1973
  • China – requires for birth defects
  • Main form of birth control in Romania and Russia due to lack of birth control info
  • Greece: ratio 1.8 abortions to 1.3 live births
  • Outlawed in many countries with religious based political systems: Chile, Brazil, Thailand, and South Africa, may still be frequently practiced even if illegal

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