Chapter Thirteen: Managing Your Fertility Image source: The McGraw-Hill Companies, Inc./Kirstan Price, photographer

Birth Control vs. Contraception Birth control refers to all procedures and methods that can prevent the birth of a child Contraception refers to procedures used to prevent fertilization There are differences between the concept of birth control and contraception. Birth control is an umbrella term referring to all procedures you might use to prevent a birth of a child. Contraception refers to a more specific concept of preventing the fertilization of an ovum.

Reasons for Using Birth Control Provide financial support for children (proper timing) Prevent having children Reduce STD risks Religious doctrine Alternative lifestyle choices Financial and legal considerations for couples Availability of professional services

Theoretical Effectiveness vs. Use Effectiveness Theoretical effectiveness: Measure of a contraceptive method’s ability to prevent a pregnancy when the method is used precisely as directed during every act of intercourse Use effectiveness: Measure of a contraceptive method’s ability to prevent a pregnancy when used by the general public

Selecting Your Contraceptive Method Considerations when choosing contraception Safety Effectiveness Reliability Reversibility Affordability Ease of use Interference with sexual expression

Behavioral Contraceptive Methods Abstinence No sexual activity 100% effective Chance No method used 15% use effectiveness Withdrawal (“coitus interruptus”) Removal of penis from vagina before ejaculation 73% use effectiveness

Behavioral Contraceptive Methods (cont.) Periodic abstinence (rhythm method) Calendar (calculating the unsafe days of a women’s menstrual cycle) Basal body temperature (rise in body temperature correlates with timing of ovulation) Billings cervical mucus method (evaluate consistency of vaginal discharge to predict ovulation) Symptothermal (combines basal temperature and mucus methods) 75% use effectiveness

Periodic Abstinence Figure 16-1 Periodic abstinence

Over-the-Counter Contraceptive Methods Spermicides Foams Creams Jellies Films Suppositories Condoms Male Female Contraceptive sponge Image source: The McGraw-Hill Companies, Inc./Kirstan Price, photographer

Over-the-Counter Contraceptive Methods Vaginal spermicides OTC agents that are capable of killing sperm 71% use effectiveness Figure 16-2 Use of Spermicide

Over-the-Counter Contraceptive Methods (cont.) Male condom OTC latex shield designed to cover erect penis and retain semen upon ejaculation 85% use effectiveness Male condom with spermicide Latex condom in combination with spermicide 95% use effectiveness Female condom Polyurethane sheath inserted into the vagina 79% use effectiveness Contraceptive sponge Small, pillow-shaped contraceptive that contains spermicide; placed in the vagina to cover the cervical opening 84% use effectiveness

Use of a Male Condom Keep a supply on hand Handle condoms with care Put condom on before genital contact Lubricate the condom Take care the condom is not dislodged from penis Inspect condom for tears before discarding Figure: Maximizing the Effectiveness of Condoms

Prescription Contraceptive Methods Diaphragm Lea’s Shield FemCap Intrauterine device (IUD) Oral contraceptives Combined pills Minipills Injectable contraceptive Contraceptive implant Contraceptive ring Contraceptive patch Image source: The McGraw-Hill Companies, Inc./Kirstan Price, photographer

Prescription Birth Control Methods Diaphragm Soft rubber cup that covers the cervix Fitted by health care professional Used with spermicide 84% use effectiveness Lea’s Shield or FemCap Lea’s shield: Reusable oval silicone device that covers the cervix FemCap: Reusable hat-shaped silicone cap that covers the cervix Use similar to diaphragm 86% use effectiveness Intrauterine device (IUD) T-shaped device inserted into the uterus Medicated or unmedicated Somehow interferes with implantation of the ovum World’s most popular reversible contraceptive method 99%+ use effectiveness

Use of a Diaphragm Figure 16-3 Use of a Diaphragm

Prescription Birth Control Methods (cont.) Oral contraceptive pills Daily pills Estrogen works by reducing ovum development Progesterone reduces ovulation and thickens cervical mucus 92% use effectiveness Side effects Tenderness in breasts Nausea Headaches Spotting Weight gain Sex drive fluctuation Frequent vaginal infections Mild depression Potential risks Blood clots, stroke, hypertension, heart attack

Prescription Birth Control Methods (cont.) Minipills Daily pill Low-dose progesterone 92% use effectiveness Injectable contraceptive Each shot effective for a 3-month period Prevents ovulation and thickens the cervical mucus 97% use effectiveness Contraceptive ring (NuvaRing) Polymer device containing estrogen and progestin Placed deep in the vagina for a 3-week period 92%+ use effectiveness Contraceptive patch Skin patch containing estrogen and progestin Worn for 3 weeks, then 1 week off, then new patch

Prescription Birth Control Methods (cont.) Contraceptive implant Protection is good for 3 years Can be used while breastfeeding Physician must insert and remove May cause temporary irregular bleeding Possibility of cardiovascular problems Use effectiveness not yet known

Emergency Contraception Contraceptive measured used to prevent pregnancy within a few days of unprotected intercourse Hormonal or IUD insertion “Morning after” pill; not RU-486 (“abortion pill”) Plan B available behind the pharmacy counter Those under age 18 must have a prescription Will not cause abortion or affect established pregnancy

Sterilization Sterilization = Generally permanent birth control techniques that surgically disrupt the normal passage of ova or sperm Vasectomy: Removal of a section of the vas deferens Tubal ligation: Fallopian tubes are cut and the ends tied back

Male Sterilization: Vasectomy Figure 16-4A Vasectomy

Female Sterilization: Tubal Ligation Figure 16-4B Tubal Ligation

Abortion: Termination of a Pregnancy First Trimester Procedures Manual vacuum aspiration Procedure performed by dilating the cervix and removing uterine contents Dilation and suction curettage (D&C) Procedure in which the cervical canal is dilated to allow the uterine wall to be scraped Medication abortion RU-486 (mifepristone) blocks the action of progesterone and causes the lining of the uterus to break down

Abortion: Termination of a Pregnancy (cont.) Second Trimester Procedures Dilation and Evacuation (D&E) Performed between 13 and 16 weeks of pregnancy Cervix is dilated and contents are removed by suction Rarely used procedures Hypertonic saline procedure Prostaglandin procedure

Dilation and Evacuation Figure 16-5 Dilation and Evaluation. The cervix is dilated and the contents of the uterus are aspirated (removed by suction). This procedure is used to perform abortions during the second trimester.

Abortion: Termination of a Pregnancy (cont.) Partial-birth abortion Federal ban Third-trimester abortion procedures Hysterotomy Hysterectomy

Chapter Thirteen: Managing Your Fertility