Contraception

1. Contraception Human Sexuality Rhonda Martin, M.S., R.N.

2. Historical & Social Perspective • Evidence of contraception since the beginning of recorded history • U.S. contraceptive efforts • Comstock laws in 1800s restricted contraceptive information through the mail • 1915: Margaret Sanger’s illegal clinic & contraceptive information

3. Historical & Social Perspective • U.S. contraceptive efforts - cont’d • 1965 U.S. Supreme Court ruling: states could not prohibit use of contraception by married couples: extended to single people in 1972 • most states allow dispensing of contraception to minors without parental consent • controversy re: TV ads for condoms, government funded contraceptive services for minors without parental notification

4. Historical & Social Perspective • Contemporary issues • growing emphasis on planning for unwanted children • population growth as a concern • wide diversity of views among religious leaders

5. Benefits of shared responsibility decreases “surprise pregnancy” reduces stress & increases trust How to share responsibility ask about BC before intercourse read & discuss options together attend a class or clinic together share expenses help each other with various methods Sharing responsibility

6. Choosing a birth control method • Consider effectiveness *failure rates reported for each method *influenced by human error *backup methods increase effectiveness • consider cost; ease of use; side effects; • consider noncoital methods of sexual intimacy (“outercourse”) *kissing, *mutual masturbation *touching, petting * oral or anal sex

7. Hormone-based contraceptives Oral contraceptives: *combination pill: contains estrogen & progestin; inhibits ovulation, thickens cervical mucus, & makes uterine lining less receptive to implantation Advantages: spontaneity; reversible;  effective; may  dysmenorrhea, PMS s/s, & some other conditions; minipill has no estrogen-related SE Disadvantages: *no STD protection *estrogen-related side effects *spotting

8. Hormone-based contraceptives Oral contraceptives: *minipill: progestin only; thickens cervical mucus, makes uterine lining less receptive to implantation, may inhibit ovulation Advantages:spontaneity; reversible;  effective; may  dysmenorrhea, PMS s/s, & some other conditions; minipill has no estrogen-related SE Disadvantages: *no STD protection *estrogen-related side effects *spotting

9. Hormone-based contraceptives Norplant: 6 progestin filled capsules implanted under skin; time- release over 5 years; requires medical insertion; works like the minipill Advantages: *less hormone, but constancy s effectiveness *no daily pill Disadvantages: *high initial cost *may be hard to remove *same as minipill

10. Hormone-based contraceptives Depo-Provera: injected progestin every 12 weeks; works like the minipill Advantages: *same as the minipill Disadvantages: *same as the minipill

11. Barrier methods Condom: a sheath that fits over erect penis; forms mechanical barrier to keep sperm out of vagina; lubricated latex works best Advantages: *effective if used properly *provides some STD protection *relatively cheap Disadvantages: *may disturb spontaneity *may  some sensations *possible allergy to latex

12. Barrier methods Female condom: a sheath that fits inside vagina with closed ring at the top, open ring at vaginal opening Advantages: *effective if used properly *provides some STD protection *relatively cheap Disadvantages: *may disturb spontaneity *may  some sensations *possible allergy to latex

13. Barrier methods Diaphragm: latex or plastic dome with flexible spring around the rim; forms mechanical barrier that keeps sperm out of cervix/uterus; fitted by Dr. who teacheshow to insert & check proper placement; place spermicide around rim; stays in for 6-8 hrs. Advantages: *no side effects *s comfort & self-knowledge *spermicide may prevent some STDs, infections Disadvantages: * failure rate than others *messier *poor fit s problems *allergy to spermicide *s spontaneity

14. Barrier methods Cervical cap: thimble-shaped latex or plastic cup; works like diaphragm; fitted by Dr.; filled with spermicide & pressed onto cervix; stays in for 6-24 hrs. Advantages: *alternative for  who cannot wear diaphragm *does not need repeated doses of spermicide Disadvantages: * failure rate than others *may damage cervix *cannot fit up to 6% of 

15. Barrier methods Vaginal spermicides: creams & jellies should be used with diaphragm or cervical cap; not to be used alone

16. Barrier methods Vaginal spermicides: foam, suppositories, film; sperm are killed; follow package directions carefully Advantages: *no doctor *no dangerous side effects *provides extra lubrication *prevents some STDs Disadvantages: *messy *irritation of vaginal tissue *may  yeast infections *unpleasant taste, scent * spontaneity

17. Intrauterine devices Copper-T: affects sperm motility & viability Progestasert-T: works like minipill; both prevent fertilization, irritate & inflame uterine lining to prevent implantation; alters timing of the ovum’s passage through fallopian tube Advantages: *highly effective *convenient *s spontaneity *ok for  who breastfeed Disadvantages: *initial cost * PID risk *discomfort *risk of miscarriage *2-20% expelled in 1st yr. *rarely punctures womb

18. Emergency contraception Hormonal: birth control pills taken within 72 hours of unprotected intercourse; works like combination pill Advantages: *backup for rape or other unplanned event Disadvantages: *nausea or vomiting *unknown long-term effects

19. Emergency contraception Copper-T IUD: inserted up to 7 days after unprotected intercourse; works same as regular use of IUD Advantages: *failure <1% *backup for rape or other unplanned event Disadvantages: *see IUD

20. Methods based on the menstrual cycle abstinence based on: Mucus method: cyclical changes in cx mucus Calendar method: calendar estimate of fertility (BBT) Basal body-temp. method: slight changes in basal body temp. @ ovulation Advantages: no SE; free; cost of a class or BBT thermometer; s comfort & self-knowledge; s noncoital activities; helps to plan a wanted baby; acceptable to most religions Disadvantages: s spontaneity; requires lots of motivation, lots of record-keeping; cycles can be disrupted or irregular; most unreliable method

21. Sterilization Female tubal ligation: blocks sperm from traveling down fallopian tube to egg Permanent: 70% reversal success rate Advantages: *most effective of all mehtods *s spontaneity *convenient Disadvantages: *pain during & after the procedure *rare surgical problems

22. Sterilization Male vasectomy: cutting & closing of vas deferens prevents sperm from being ejaclated with semen Permanent: 50% pregnancy rate after reversal Advantages: *cheaper & safer than female surgery Disadvantages: *10-20 post operative ejaculations *prostate cancer? *see Female

23. Less than effective methods • Breastfeeding • amenorrhea is common for a brief period after birth while breastfeeding • 80 % ovulate before first period • unreliable • Douching • sperm reach uterus in 1-2 minutes • douching may speed sperm along • irritates vaginal tissue • very ineffective

24. Less than effective methods • Withdrawal before ejaculation • difficult to judge when to withdraw • anxiety may  pleasure • preejaculatory secretions from Cowper’s gland may carry sperm • postejaculatory sperm on vulva may travel into vagina/uterus • unreliable

25. New directions in contraception For men • currently limited to condoms, vasectomy, & withdrawal • GRH inhibitor may  # & motility of sperm *requires daily injections *drop in testosterone *possible erectile difficulty

26. New directions in contraception • For men (cont’d) • testosterone-derivative & progestin-related drugs may  sperm count *weekly injections; possible implant • drugs that would inhibit ejaculation but not orgasm • NoFertil (Brazilian developed pill) destroys male sperm without loss of erection *potential 10-15% irreversible infertility

27. New directions in contraception • For women • implants, especially fewer than Norplant, or biodegradable • injectables • progestin cream that is absorbed through the skin • vaginal rings that slowly release hormones • one-sized & disposable diaphragms & cervical caps

28. New directions in contraception • For women (cont’d) • IUDs with different shapes & hormones • RU-486: an antiprogesterone substance that prevents implantation & cause menstruation “Women who miscalculate are called mothers.” Abigail Van Buren

29. Resources www.plannedparenthood.org/ or www.ippf.org/index.html successful contraception: www.arhp.org/success/index.html Margaret Sanger: www.nyu.edu/projects/sanger/index.html