1. Contraception
IUC’s, Sterilization

2. Intrauterine Contraceptives (IUC’s)
IUC’s are made of flexible plastic, available only through prescription
Three types
ParaGard (copper)
Mirena (hormone)
Skyla (hormone)

3. IUC’s: ParaGard ParaGard contains copper
Copper prevents sperm from fertilizing an ovum
Copper also makes implantation of fertilized ovum difficult
Amount of copper released is less than needed in daily diet
Copper intolerance or insensitivity would preclude use of ParaGard

4. IUC’s: Paragard Requires insertion into uterus by healthcare provider
Takes only a few minutes
Insertion may cause cramping, dizziness
Once inserted, may remain in place for ten years
Patient should not feel IUD
Since no hormones present, monthly cycle should remain unchanged
Effectiveness: 99%+ against pregnancy
Requires monthly checking for IUD slippage

5. IUC’s: ParaGard
Side effects: heavier and longer periods, cramping, spotting in between periods
May lessen after a few months on ParaGard
Complication risks: pelvic inflammatory disease shortly after insertion, perforation of uterus, expulsion
Copper may provide protective benefit against endometrial cancer
Cost: $ (Planned Parenthood)

6. IUC’s: Mirena Progestin-only intrauterine contraceptive
Lasts for five years
Mirena:
Prevents sperm from fertilizing ovum
Prevents release of egg
Changes uterine lining

7. IUC’s: Mirena Insertion: Similar to ParaGard
Effectiveness: 99%+ against pregnancy
Cost: $0-400 (Consumer Reports)
Side effects: Abdominal cramping (10% of users during first few months), acne, breast tenderness, headache, mood changes, back pain
May lessen after a few months
As use continues, less menstrual bleeding
Complication effects: ovarian cysts, pelvic inflammatory disease shortly after insertion, perforation of uterus, expulsion

8. IUC: Skyla FDA approved in 2013 Hormone Smaller than Mirena
Lasts three years instead of five
Marketed to women who have not had kids
Mirena marketed to women with child (research done only on this group)
IUC’s appropriate for all women

9. IUC’s Internal Birth Control- IUD’s (via Youtube)
Paragard insertion (via YouTube, 0-0:53)
Mirena insertion (via YouTube, for healthcare providers)
Insertion of IUC (Medialvideos.us)

10. IUCs: Advantages & Disadvantages
Effectiveness
Cost
Frequency of application
Safety & side effects
Religion
STI risk
Availability
Conspicuousness
Duration

11. Sterilization

12. Sterilization Sterilization = permanent contraception
Women undergo tubal ligation
Men undergo vasectomy
The second most common contraceptive method used in the United States, behind the pill
No formalized data collection system exists
Data retrieved from surveys, questionnaires

13. Female reproductive anatomy

14. Male reproductive anatomy

15. Sterilization: Tubal Ligation
Surgical technique
Close fallopian tubes, preventing egg from traveling to uterus, preventing sperm from reaching egg
Neither organs nor glands are removed
Effectiveness: 99%+
Considered irreversible

16. Sterilization: Tubal Ligation
Tubal sterilization:
Tubal coagulation/cauterization
Tubes can be tied and cut (Pomeroy & Parkland techniques)
Tubes can be clipped, clamped
These incision methods often performed after childbirth/abortion
Animation (SMART imagebase)

17. Sterilization: Tubal Ligation
Cost: $
Side effects: thought by many to be rare; hormonal imbalance may lead to increased menstrual bleeding, cramping; adhesions
Complications: infection, internal bleeding, ectopic pregnancy

18. Sterilization: Implants
Non-incision method
No general anesthesia
Under an hour
Coils inserted into fallopian tubes
In following months, coils and tissue grow together, forming barrier to prevent sperm from reaching egg

19. Sterilization: Implants
Side effects: expulsion of coil inserts, risk for ectopic pregnancy, cramping, menstrual changes, nausea/vomiting
Demo

20. Sterilization: Vasectomy
Vasectomy blocks sperm from traveling through vas deferentia, preventing sperm from mixing into semen
No glands or organs are removed
Effectiveness: 99%+
Considered irreversible

21. Sterilization: Vasectomy
Vas deferens must be isolated
Similar to tubal ligation, the vas deferens can be cut and tied, clamped, cauterized; “no scalpel” technique
Another form of contraception must be used for a few months

22. Sterilization: Vasectomy
Cost: $ (vasectomymedical.com)
Side effects: bruising, sensitivity/pain, sperm leaking from tubes may lead to small lump (usually clears on its own), antibodies to sperm may develop, reducing chances of fertility in a reversal
Complications: rare, usually associated with infection (fever, pus/blood from incision site, swelling, pain); ends of tubes may grow back together (very rare); decreased sexual desire (4 out of 1000 cases per Planned Parenthood) - no apparent physical cause

23. Sterilization: Vasectomy
Open-ended (no scalpel) vasectomy (medicalvideos.us)
Video (vasectomymedical.com)

24. Sterilization: Advantages & Disadvantages
Effectiveness
Cost
Frequency of application
Safety & side effects
Religion
STI risk
Availability
Conspicuousness
Duration