Contraception and Abortion Chapter 8 Contraception and Abortion Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-1

The Pill How it works - prevents ovulation; estrogen levels are artificially made high and this inhibits FSH production Effectiveness - typical-user failure rate is 5% Side effects - blood clots, increases amount of vaginal discharge and susceptibility to vaginitis, nausea Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-2

Advantages & Disadvantages of the Pill Advantages include: Close to 100% effective Reduces amount of menstrual flow, thus reduces cramps Clears up acne Protects against PID and ovarian and endometrial cancer Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-3

Advantages & Disadvantages of the Pill Disadvantages include: Cost Effort to take them correctly No protection against STD’s Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-4

Reversibility When a woman wants to become pregnant, she stops taking pills after the end of one cycle Some women experience a brief delay in becoming pregnant Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-5

Drug Interactions Antibiotics reduces the effectiveness of the pill The pill may increase the metabolism of some drugs, making them more potent Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-6

Other Kinds of Pills Combination pills 28-day pill Triphasic pill Progestin-only pills Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-7

Emergency Contraception Also called postcoital method Emergency contraception should be used only under supervision of a health care provider Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-8

Norplant Norplant is a progestin-only implant that lasts for five years Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-9

Norplant How it works - inhibits ovulation; thickens cervical mucus which makes it difficult for sperm to get through; creates puny endometrium so fertilized egg does not have much to implant in Effectiveness - most effective method now available; failure rate is only 0.05 percent Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-10

Norplant Side effects - menstrual cycle irregularities, difficulty with removal Advantage - does not require memory to use it properly Disadvantage - high initial cost Reversibility - physician removes capsules, progestin levels decrease, and woman can become pregnant Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-11

Depo-Provera Injections Progestin administered by injection Inhibits ovulation, thickens cervical mucus, inhibits growth of endometrium Failure rate of less than 1 percent Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-12

Intrauterine Device A plastic device sometimes containing metal or a hormone that is inserted into the uterus Prevents fertilization by producing changes in the uterus and fallopian tubes, sperm are immobilized and cannot move into the fallopian tube Extremely effective Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-13

Intrauterine Device Side effect - pelvic inflammatory disease Disadvantage - initial cost Advantage - high effectiveness rate, simple to use Reversibility - physician removes device and woman can become pregnant immediately Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-14

Diaphragm A cap-shaped rubber device that fits inside a woman’s vagina over the cervix How it works - blocks the entrance to the uterus so sperm cannot swim up into it Effectiveness - failure rate is about 20 percent Side effects - irritation of the vagina or penis, toxic shock syndrome Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-15

Diaphragm Advantages - not expensive, few side effects, very effective Disadvantages - changes spontaneity, must remember to use it, cream or jelly may leak out Reversibility - woman stops using the diaphragm Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-16

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Cervical Cap A rubber cap that fits snugly over the cervix Similar to diaphragm Effectiveness - failure rate of about 18 percent Offers some protection from STD’s Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-18

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Male Condom A contraceptive sheath that is placed over the penis How it works - catches semen and prevents it from entering the vagina Typical-user failure rate is about 14 percent Side effects - problem for those allergic to latex Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-20

Male Condom Advantages - cheap, convenient, easy to use, protects from STD’s Disadvantages - less spontaneity, reduces sensation Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-21

Female Condom Polyurethane sheath with two rings in it, one at either end Prevents sperm from entering vagina and blocks entrance to uterus Typical-user failure rate is 21 percent Side effects - vaginal irritation Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-22

Female Condom Advantage -less susceptible to tearing, method a woman can use herself to reduce risk of an STD Disadvantage - spontaneity, awkward, cost is about $2.00 per condom Reversibility - stop using the condom Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-23

Spermicides Include contraceptive foams, creams, jellies Chemicals in them kill sperm Blocks entrance to cervix Effectiveness - 25% failure rate Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-24

Douching Flushing out the inside of the vagina with a liquid Not an effective form of birth control Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-25

Withdrawal Man withdraws penis from vagina before he has an orgasm Coitus interruptus Ineffective method of birth control Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-26

Fertility Awareness Rhythm methods - involves abstaining from intercourse around the time the woman ovulates Calendar method is the simplest Basal body temperature method tells when woman ovulates; day of ovulation her temperature drops Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-27

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Fertility Awareness Cervical Mucus method - mucus changes consistency Sympto-Thermal method - combines cervical mucus method and basal body temperature method Home ovulation tests - tests hormone levels in urine Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-29

Sterilization Male sterilization - vasectomy Female sterilization - tubal ligation Procedures are 100 percent effective Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-30

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Psychological Aspects: Attitudes Toward Contraception Some people are ignorant about methods Others choose to not use them Erotophobes - don’t discuss sex, have sex lives influenced by guilt Attitudes and emotions, information, expectations and fantasies play important role in contraceptive use Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-34

Abortion Termination of a pregnancy Vacuum aspiration - vacuum suction or vacuum curettage Dilation and evacuation Induced labor Saline-induced abortion Prostaglandin method Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-35

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Abortion Hysterotomy - surgical method RU-486 - mifepristone; abortion pill Methotrexate - drug-induced early abortion Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-37

New Advances in Contraception Male Methods: Non-latex condoms Male hormonal methods Immunocontraceptives Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-38

New Advances in Contraception Female Methods: Lea’s shield Implants and injectables Vaginal rings IUDs Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 1-39