1. Copyright © 2006, Elsevier Inc. All rights reserved C HAPTER 14 Contraception

2. Copyright © 2006, Elsevier Inc. All rights reserved F IGURE 14-1 T HE MAIN MECHANISM OF ACTION OF MAJOR CONTRACEPTIVE METHODS IN MEN AND WOMEN.

3. Copyright © 2006, Elsevier Inc. All rights reserved B OX 1: W HERE I S THE M ALE B IRTH C ONTROL P ILL ?

4. Copyright © 2006, Elsevier Inc. All rights reserved F IGURE 14-2 I NSERTION, PROPER POSITION, AND REMOVAL OF A DIAPHRAGM. ( A ) T HE DIAPHRAGM IS INSERTED MANUALLY INTO THE VAGINA ( INSERTERS CAN ALSO BE USED WITH SOME KINDS OF DIAPHRAGMS ). ( B ) T HE DIAPHRAGM IS IN PROPER POSITION, FITTING SNUGLY BETWEEN THE POSTERIOR ASPECT OF THE PUBIC BONE AND THE POSTERIOR VAGINAL FORNIX, COMPLETELY COVERING THE CERVIX. ( C ) T HE DIAPHRAGM IS REMOVED BY HOOKING A FINGER UNDER THE FORWARD RIM ( THE EDGE BEHIND THE PUBIC BONE ).

5. Copyright © 2006, Elsevier Inc. All rights reserved F IGURE 14-3 A FEMALE CONDOM IN PLACE.

6. Copyright © 2006, Elsevier Inc. All rights reserved F IGURE 14-4 L APAROSCOPY OFFERS A SAFE AND SIMPLE WAY TO PERFORM TUBAL STERILIZATION. L IGHT FROM AN EXTERNAL SOURCE IS TRANSMITTED THROUGH GLASS FIBERS ( ENCLOSED IN THE TUBE IN THE UPPER PART OF THE ILLUSTRATION ). T HE SURGEON HAS A CLEAR VIEW OF THE ABDOMINAL ORGANS. T HE ABDOMEN IS DISTENDED WITH AN INERT GAS TO GIVE THE SURGEON ROOM TO MANEUVER THE INSTRUMENTS. I N THE SURGEON ’ S RIGHT HAND IS A SPECIALLY DESIGNED FORCEPS TO MANIPULATE THE TISSUE. A NOTHER TYPE OF LAPAROSCOPE CONTAINS AN OPTICAL VIEWER, FORCEPS, ANESTHETIZER, AND A CLIP OR BAND APPLICATOR, ALL IN ONE INSTRUMENT.

7. Copyright © 2006, Elsevier Inc. All rights reserved F IGURE 14-5 T UBAL STERILIZATION USING THE P OMEROY METHOD. E ACH OVIDUCT IS CUT AND TIED OFF

8. Copyright © 2006, Elsevier Inc. All rights reserved F IGURE 14-6 T HE PROCEDURE FOR PERFORMING A VASECTOMY.