© 2012 McGraw-Hill Companies. All Rights Reserved. Chapter 6

© 2012 McGraw-Hill Companies. All Rights Reserved.  Definitions:  Birth control: managing fertility and preventing unwanted pregnancy  Conception: the fusion of an ovum and sperm that creates a fertilized egg (zygote)  Contraception: preventing conception by blocking the female’s egg from uniting with the male’s sperm, thereby preventing pregnancy  Modern contraception is much more predictable and effective than in the past  Many contraceptives play a role in the prevention against sexually transmitted diseases 2

© 2012 McGraw-Hill Companies. All Rights Reserved.  Types of contraception  Barrier  Hormonal  Natural methods  Surgical methods  Factors affecting choice  Advantages  Disadvantages  Effectiveness  Contraceptive failure rate  Continuation rate 3

© 2012 McGraw-Hill Companies. All Rights Reserved.  Reversible contraception  Estrogen and progesterone taken orally  Mimics the hormonal activity of the corpus luteum  Corpus luteum secretes high levels of progesterone and estrogen to suppress ovulation  Combination pill  Most common  1-month packet containing estrogen and progestins  Extended-cycle pill  Seasonale, Seasonique, Lybrel  Minipill  Advantages  Disadvantages  Side effects  Effectiveness 4

© 2012 McGraw-Hill Companies. All Rights Reserved.  Thin, 1- 3/4 inch square patch  Releases estrogen and progestin slowly into the bloodstream  Prevention the same way as OCs  Worn for 1 week, replaced on the same day for 3 consecutive weeks; no patch fourth week  Advantages  Disadvantages  Effectiveness 5

© 2012 McGraw-Hill Companies. All Rights Reserved.  The NuvaRing  Resembles the rim of a diaphragm and is molded with progestin and estrogen  2 inch ring slowly releases the hormones  Prevents pregnancy the same way as OCs  During fourth week, remove the ring, and use a new ring after the fourth week  Advantages  Disadvantages  Effectiveness 6

© 2012 McGraw-Hill Companies. All Rights Reserved. 7 Table 6.2 Risks of Contraception, Pregnancy, and Abortion

© 2012 McGraw-Hill Companies. All Rights Reserved.  Implanon (approved for use in the U.S. in 2006)  Hormonal method  Single implant  Effective for 3 years  Inhibits ovulation and affects the development of the uterine lining  Advantages  Disadvantages  Side effects  Effectiveness – the most effective method! 8

© 2012 McGraw-Hill Companies. All Rights Reserved.  Depo-Provera  Hormonal treatment  Injectable progestin usually given every 12 weeks  Advantages  Disadvantages o Can cause a reduction in bone density  Side effects It may take 12 months before cycle returns  Effectiveness 9

© 2012 McGraw-Hill Companies. All Rights Reserved.  T-380A (ParaGard) up to 10 years of protection  Copper  Levonorgestral (Mirena) up to 5 years of protection  Release small amounts of progestin  Not exactly sure how it prevents pregnancy  Advantages  Disadvantages  Effectiveness 10

© 2012 McGraw-Hill Companies. All Rights Reserved. 11

© 2012 McGraw-Hill Companies. All Rights Reserved.  Thin sheaths, almost all latex in the U.S.  Protection against STDs  Advantages  Disadvantages  Effectiveness  Use with spermicide 12

© 2012 McGraw-Hill Companies. All Rights Reserved. 13

© 2012 McGraw-Hill Companies. All Rights Reserved.  Called the “FC2”  Synthetic, non-latex rubber sheath with two flexible rings  Can be inserted up to 8 hours before intercourse  Advantages  Disadvantages  Effectiveness 14

© 2012 McGraw-Hill Companies. All Rights Reserved. 15

© 2012 McGraw-Hill Companies. All Rights Reserved.  Dome-shaped cup of latex or silicone stretched over a collapsible metal ring  Custom fit by a doctor; available by prescription  Following intercourse, diaphragm must be left in place for at least 6 hours  Advantages  Disadvantages Toxic shock syndrome (TSS)  Effectiveness 16

© 2012 McGraw-Hill Companies. All Rights Reserved. 17

© 2012 McGraw-Hill Companies. All Rights Reserved.  One-size-fits-all diaphragm-like device  Available by prescription  Can be used by women allergic to latex  Advantages  Disadvantages  Effectiveness 18

© 2012 McGraw-Hill Companies. All Rights Reserved.  Small silicone cap that fits snugly over the cervix  Held in place by suction  Must be fitted by a doctor  Must place spermicide in the cup and on brim  Must replace FemCap annually  Advantages  Disadvantage  Effectiveness 19

© 2012 McGraw-Hill Companies. All Rights Reserved.  Round, absorbent device about 2 inches in diameter that fits over the cervix  Presaturated with the same spermicide that is used in contraceptive creams and foams  Advantages  Disadvantages  Toxic shock syndrome (TSS)  Effectiveness 20

© 2012 McGraw-Hill Companies. All Rights Reserved.  Foams, creams, jellies  Spermicidal suppository  Vaginal Contraceptive Film (VCF)  Must be placed near the cervical entrance no more than 60 minutes before intercourse  Must wait 6 hours post if user wants to douche  Advantages  Disadvantages  Effectiveness 21

© 2012 McGraw-Hill Companies. All Rights Reserved. 22

© 2012 McGraw-Hill Companies. All Rights Reserved. 23 Table 6.3 Contraceptive Methods And STD Protection

© 2012 McGraw-Hill Companies. All Rights Reserved.  Abstinence  The choice not to engage in sexual intercourse  Fertility awareness-based methods  Abstain from intercourse during the fertile phase of menstrual cycle  Methods: Calendar methods Temperature methods Mucus methods  Withdrawal  Penis removed from vagina before ejaculation 24

© 2012 McGraw-Hill Companies. All Rights Reserved.  Used after unprotected sexual intercourse  Plan B, Plan B One-Step, Next Choice (OTC)  Most effective if taken within 12 hours afterwards  Can be taken up to 120 hours after intercourse  OTC for over age 17  Possible side effects: Nausea Stomach pain Headache Dizziness Breast tenderness 25

© 2012 McGraw-Hill Companies. All Rights Reserved. 26 Table 6.4 Contraceptives: From Most Effective to Least (Percent of Women Experiencing Unintended Pregnancy Within the First Year of Use)

© 2012 McGraw-Hill Companies. All Rights Reserved.  Permanent contraception  Vasectomy requires severing of the vas deferens  May return to work in 2 days  Semen tested in about 12 weeks  Costs $400 to $1,000 in the U.S.  Effectiveness 27

© 2012 McGraw-Hill Companies. All Rights Reserved. 28

© 2012 McGraw-Hill Companies. All Rights Reserved.  Tubal sterilization (tubal ligation) is most commonly performed by laparoscopy  Essure system (2002)  Tiny, spring-like, metallic implants causing scarring that blocks the fallopian tubes  Hysterectomy (removal of uterus)  Complication rate 6-11%  Reversibility 29

© 2012 McGraw-Hill Companies. All Rights Reserved. 30

© 2012 McGraw-Hill Companies. All Rights Reserved.  When is it OK to begin having sexual relations?  Society’s approach  Changing of attitudes with the changing of time  Answering personal questions  Contraception and Gender Differences  Sexuality and Contraception Education for Teenagers 31

© 2012 McGraw-Hill Companies. All Rights Reserved.  Key considerations include: 1. Health risks 2. Implications of unplanned pregnancy 3. STD risk 4. Convenience and comfort level 5. Type of relationship 6. Ease and cost of obtaining and maintaining each method 7. Religious or philosophical beliefs 8. Potential noncontraceptive benefits 32

© 2012 McGraw-Hill Companies. All Rights Reserved. Chapter 6