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: $0-1000 (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)Internal Birth Control- IUD ’ s Paragard insertion (via YouTube, 0-0:53)Paragard insertion Mirena insertion (via YouTube, for healthcare providers)Mirena insertion Insertion of IUC (Medialvideos.us)IUC

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

11. Sterilization

12. 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/cauterizationTubal coagulation/cauterization –Tubes can be tied and cut (Pomeroy & Parkland techniques)Pomeroy &Parkland –Tubes can be clipped, clampedTubes can be clipped, clamped –These incision methods often performed after childbirth/abortion –Animation (SMART imagebase)Animation

17. Sterilization: Tubal Ligation Cost: $1000-3000 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: $450-700 (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)Open-ended (no scalpel) vasectomy Video (vasectomymedical.com)Video

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