Chapter 11 Contraception

Historical and Social Perspectives Evidence of contraception since the beginning of recorded history U.S. contraceptive efforts 1800s Comstock laws 1915: Margaret Sanger's U.S. Supreme Court rulings Griswold vs. Connecticut Eisenstadt vs. Baird

Historical and Social Perspectives (cont.) Contemporary issues planning for wanted children physical health of mother insurance coverage of contraceptives population growth cultural gender-role expectations wide diversity of views among cultures and religious leaders

Historical and Social Perspectives (cont.) Fig. 11.1 Average number of children, by mother’s education level and race/ethnicity in the United States.

Sharing Responsibility and Choosing a Birth Control Method How to share responsibility ask about BC before intercourse read & discuss options together attend a class or clinic together share expenses

Choosing a Birth Control Method Choosing a BC method consider effectiveness and cost consider ease of use and side effects characteristics of ineffective use guilt negative attitudes about sex self-view

Contraceptive Effectiveness Failure Rate consistent use failure rate typical use failure rate

Contraceptive Effectiveness Fig. 11.2 Factors to consider when choosing a birth control method.

Choosing a Birth Control Method (cont.) Hormone-Based Contraceptives combination pill Triphasic pill Constant-dose Progestin-only pill

Choosing a Birth Control Method (cont.) Table 11.3 Possible side effects with the birth control pill.

Choosing a Birth Control Method (cont.) Vaginal ring Transdermal patch Depo-Provera

Choosing a Birth Control Method (cont.) Barrier Methods Condom: sheath fits over erect penis

Choosing a Birth Control Method (cont.) Fig. 11.5b A condom with a reservoir tip does not need to be twisted at the top as it is put on the penis.

Choosing a Birth Control Method (cont.) Barrier Methods (cont.) Female condom: sheath fits in vagina

Choosing a Birth Control Method (cont.) Fig. 11.6b A female condom consists of two flexible polyurethane rings and a soft, loose-fitting polyurethane sheath

Choosing a Birth Control Method (cont.) Vaginal spermicides: foam sponge suppositories creams film

Choosing a Birth Control Method (cont.) Barrier Methods (cont.) Diaphragm: latex dome Cervical cap Fem Cap Lea’s Shield

Choosing a Birth Control Method (cont.) Barrier Methods (cont.) Diaphragm: latex dome

Choosing a Birth Control Method (cont.) Fig. 11.8e These figures illustrate the insertion and checking of a diaphragm.

Choosing a Birth Control Method (cont.) Intrauterine Devices affects sperm motility & viability thicken cervical mucous alter endometrial lining impair tubal motility

Choosing a Birth Control Method (cont.) Emergency contraception Hormonal: birth control pills taken within 72 hours of unprotected intercourse Copper-T IUD: inserted up to five days after unprotected intercourse Access issues

Choosing a Birth Control Method (cont.) Fertility Awareness Methods Standard days method Mucus method: based on cyclical changes Calendar method: self- knowledge of fertility Basal body-temperature

Choosing a Birth Control Method (cont.) How to compute basal body temperature Fig. 11.11 An example of a basal body temperature during a model menstrual cycle.

Choosing a Birth Control Method (cont.) Sterilization (female) tubal sterilization Minilaparotomy Laparoscopy Culpotomy Transcervical sterilization

Choosing a Birth Control Method (cont.) Sterilization (female) Fig. 11.2 Female sterilization by laparoscopic ligation. Front view shows tubes after ligation.

Choosing a Birth Control Method (cont.) Sterilization (cont.) Male vasectomy Fig. 11.14 Male sterilization by vasectomy.

Less than Effective Methods Nursing amenorrhea is common for a brief period after birth while breastfeeding 80% ovulate before first period unreliable

Less than Effective Methods (cont.) Withdrawal before ejaculation difficult to judge when to withdraw anxiety may lower pleasure Cowper's gland fluid may carry sperm any sperm on vulva may travel into vagina/uterus; unreliable

Less than Effective Methods (cont.) Douching sperm reach uterus in 1-2 minutes douching may speed sperm along irritates vaginal tissue very ineffective

New Directions in Contraception For men Testosterone & progestin may lower sperm count GRH inhibitor (LHRH agonist) may lower number & motility of sperm Medications used for other purposes

New Directions in Contraception (cont.) For women implants new IUDs new female condoms spermicides with microbicides immunocontraceptives

New Directions in Contraception (cont.) For women (cont.) one-sized & disposable diaphragms & cervical caps spermicides containing microbicides, developed to prevent STD’s IUDs with different shapes & hormones