Reproductive Choices

Learning objectives What is meant by the ‘failure rate’ of contraceptives? Distinguish between ‘perfect use failure rate’ and ‘actual use failure rate’. What is meant by each? Understand how each method of birth control discussed in class works. Understand how each method of birth control may fail and why. What are the fertile and infertile periods of a menstrual cycle? What are permanent methods of sterilization. Why might you choose to use them or avoid them?

Failure rates ‘Perfect use’ ‘Typical use’

Abstinence Avoidance of copulation • • The only birth control method that is 100% effective!

Barrier Contraceptives • Block the meeting of egg and sperm by means of a physical or chemical barrier

Condoms • Male condom - Pre-lubricated, spermicide best - Check expiration dates treated are - If lubrication is used, it MUST BE water- based

• Female condom - External ring, internal ring with polyurethane sheath in between - May be more effective than male condom at preventing pregnancies & infections

Male / Female Condoms • 15-20% failure rate (5% when used spermicide) No side effects (except latex allergies) with • • Do protect against STIs

Contraceptive Sponge • Polyurethane laced with spermicide foam • Covers entrance to cervix Can be inserted up to 24 hours before sex •

Vaginal Spermicide Designed to kill • sperm and potential pathogens Foams, creams, jellies, suppositories Some meant to be used with other methods, some used alone • •

Contraceptive Film (VCF) Vaginal Contraceptive Film (VCF) • Thin, 2”-square film laced with spermicide Folded and inserted, dissolves into gel •

Spermicides • NEARLY 100% effective when paired with a condom • 20-50% failure alone Prevent some infections rate •

Prescription Barrier Methods Diaphragm – rubber “bowl” that covers cervix and holds spermicide Cervical cap – smaller & thicker than diaphragm FemCap – Non-latex Methods • • •

Prescription Barrier Methods • Can be inserted several hours before sex Must be left in for 6 hours after No hormones or side effects 6-16% failure rate • • •

Hormonal Contraceptives • Mimic hormones produced during pregnancy which can: - Block hormones that stimulate ovulation - Make cervix hostile to sperm - Prevent implantation of egg **DO NOT protect against STIs** •

Oral Contraceptives • “The pill” 28-day packs are most common (21 hormones, 7 Combination with without) (estrogen • + progestin) or minipills (progestin only) Must be taken at same time each day •

Oral Contraceptives • Up to 99% effective Reduced risk of some cancers Side effects: nausea, weight gain, decreased sex drive Risks for smokers, those with high BP, diabetes, seizure disorders • •

Ortho Evra Patch • Transdermal (through the skin) Continuous low dose of estrogen and progestin Looks like a band- aid, but waterproof Increased risk of heart attack and stroke • • •

NuvaRing • Ring made of flexible plastic that is inserted into vagina Slowly releases estrogen and progestin • • Stays in place for 3 weeks, removed for 1

Contraceptive Injection • Ex: Depo-Provera Progestin only – prevents implantation Shot given every 3 months Cannot use for more than 2 years – bone mineral loss Increased risk of chlamydia and gonorrhea • • •

Emergency Contraception • Reactive (rather than proactive) hormonal contraception Ex: Plan B (“morning after pill”) Prevents ovulation or implantation Non-prescription if over 18 • • •

Intrauterine Device (IUD) Molded plastic or copper that is inserted into uterus Interferes with implantation (hormones) or kills sperm (copper) Old model associated with serious complications Last 1-10 years 99.2-99.9% effective

Mirena Intrauterine System • IUD + continuous low-dose of progestin (so it’s partly a hormonal method) Effective for 5 years 99% effective •

Fertility Awareness Method • “Rhythm method” Woman tracks her cycle for at least months 20% failure rate Complies with Roman Catholic Church 8 •

Male Sterilization (Vasectomy) Severing of vas deferens Short, in-office procedure to block flow of sperm Reversal is about 50% effective • • •

Female Sterilization (Tubal ligation or Tubal occlusion) • Cutting, tying, or blocking fallopian tubes Outpatient surgery using laproscopy Can sometimes be reversed • •