1. Contraception, sexual health & your responsibility to yourself
Hello and welcome.
Today we’re going to talk about contraception.
Contraception is the term given to different methods of birth control, but some types of contraception also help to prevent the transmission of sexually transmitted diseases.

2. About me Jodie Marlow Qualified practicing Midwife Mother of 3
First of all , a quick word about me, my name is Jodie, I’m a practising midwife of 2 years, and a proud mother of three children.

3. Today’s objectives
By the end of this presentation we will have discussed the following;
The importance of being ready and prepared to have sex safely
The many types of contraceptive available & choosing the right one for you
Emergency contraceptives
Whose responsibility is it to make sure I am having safe sex?
Where can I get contraceptive advice?
We will discuss today the many different types of contraception available, helping you to make an informed choice on what is right for you, and where can you obtain further advice. We will also discuss emergency contraception.

4. Let’s talk about Sex When do people start having sex?
16 is the legal age of consent for sex in the UK
The simple answer should be that people start having sex when they want to but in real life as a young person you may feel pressurised by your partner or peer-group to do this before you feel ready.
ALWAYS remember that you have a right to do this ONLY when you want to and not before.
It may feel like the most important thing in the world right now but as you grow older knowing you waited until the right time will bring fonder memories.
HETROSEXUAL SEX
From a study by Natsal (2000), the average age for heterosexuals to have sex is at 16.
As I have said: 16 is the legal age of consent for sex in the UK.
Nearly a third of men and a quarter of women, from 11,000 interviewed, aged 16 – 19 had heterosexual intercourse before they were 16, and around 80 per cent of young people aged said they did use a condom when they first had sex. Less than one in ten had used no contraception at all then they first had sex.
Men and women aged 16 – 24 have had an average of three heterosexual partners in their lifetime.
HOMOSEXUAL SEX
Homosexual sex is a sexual relationship between two people of the same sex.
A poll of 16,000 people aged 14 – 83 showed that the average age of intercourse for men was 17.5 years. Of those engaging in anal intercourse, 60 percent had used a condom. (Natsal 2000)

5. When is the right time? In a loving relationship
With someone you trust
In a comfortable setting
When you are sober!

6. Who uses contraception?
ANYONE WHO WANTS TO PROTECT THEMSELVES FROM AN STI OR UNWANTED PREGNANCY*
The office of national statistics (2008 – 2009) found over half (57%) of 16 – 19 year olds have used contraception. 65 per cent have used condoms, 54% have used the pill and some have used both methods. 86%are aware of the emergency contraceptive pill and 17% have used this method of contraception atleast once in the past 12 months.
7.9 % women aged under 16 accessed family planning clinics in England in 2009 – 2010, whilst 21.9% women aged 16 – 19 attended a family planning clinic during the same timespan.
These figures show that young people are accessing clinics to find out further information regarding their contraceptive choices, with women taking the lead due to the many choices available for them.
There are many choices for women as we will discover and it can take time to find the right method for you.
*No exceptions!

7. Why should I be careful? I won’t get pregnant or an STI
STI’s highest in young people below the age of 25
The UK has the highest rate of teenage pregnancies in Western Europe
• So we know that contraception prevents pregnancy but the humble condom can also protect again STI’s.
People below the age of 25 have the highest rate of sexually transmitted diseases, with the main age range being between 19 and 23.
• Chlamydia is the most common STI around and people don’t even know that they have it a lot of the time. It can go unnoticed for years and seriously affect your chances of having a baby when you are older, it’s not just HIV you need to protect yourself against.
The Uk also has the highest rate of teenage pregnancies in western Europe. I will inform you today about the best way to protect yourself again sexually transmitted diseases and also how prevent unplanned pregnancies.

8. So……. What’s out there? Barrier methods Hormone methods
Long acting reversible contraception
Permanent methods
Natural family planning
In the UK there are 15 methods of contraception currently available.
They fall into 5 categories, barrier methods, Hormone and long acting reversible methods are for women, intrauterine devices, Permanent methods, and natural family planning.

9. Barrier Methods Male condom
It protects against unplanned pregnancies AND STI’s
Condoms are the most widely known contraceptive. They are also known as Johnnies, rubbers, hats sheaths etc, and many more!
The condom is 98% effective when used correctly. It protects against unplanned pregnancies AND STI’s
It is made of very thin rubber or plastic which is put onto an erect penis BEFORE the penis comes into contact with the vagina.
The disadvantage of a condom can be that it may interrupt sex,or it may slip or split if not put on correctly.
It is important that the penis is removed from the vagina immediately following ejaculation as the penis starts to go soft and there is a risk that the sperm may ‘spill’ from the condom.
The advantage of using a condom though is that they are very easily available. The can be obtained from shops or from sexual health services and GUM clinics. (which will be available at the end)
Condoms can protect against a wide range of sexually transmitted diseases as well as unplanned pregnancies, when used correctly.
CONDOMS ARE GREAT!

10. Barrier Methods Female condom
It protects against unplanned pregnancies AND STI’s
The female equivalent of the male condom is the female condom!
Like the condom it is made from very thin plastic.
And is not affected by oil based lubricants like the male condom.
It is positioned inside the vagina prior to intercourse and has been shown to be 95% effective.
Again, like the male condom it can interrupt sex as the man has to ensure that his penis enters the female condom.
There is also a risk that it can be pushed into the vagina.
The female condom is not as widely available as the male condom, and a new condom has to be used every time, exactly like the male condom
They are available from some online shops but also GUM clinics and sexual health clinics.
The advantages are that the female condom can be put in at any time prior to sexual intercourse, and can protect both partners against sexually transmitted diseases.

11. Barrier Methods Diaphragm or ‘cap’ 92 – 96% effective
Used in conjunction with spermicide
Does NOT provide protection against STI’s
A diaphragm or cap is made from flexible latex or silicone and shaped like a rubbery dish. They are positioned into the vagina to cover the cervix after being covered with spermicide (AUDIENCE PARTICIPATION “WHAT DO YOU THINK SPERMICIDE IS?”)
As sperm need to enter the cervix to reach the womb and potentially fertilise an egg, by placing the cap over the cervix it will act as a barrier.
It can provide between 92 – 96% protection against unplanned pregnancies.
Placing the cap into position can interrupt sex but also the cap can be placed inside the vagina any time before sex. It poses no health risks, but some people can be allergic to the spermicide used.
Following intercourse the cap needs to be left in position for six hours, this is to ensure that no sperm enter the cervix.
Unlike condoms, the cap does not provide protection against STI’s.
The diaphragm needs to be the right size and therefore a doctor or family planning nurse will need to examine you prior to issuing the diaphragm.
Some women can experience cystitis from using the diaphragm and they can be tricky to use.

12. Hormone methods Key words to remember! Progesterone Estrogen
Progestogen
Before we start on hormone methods, its worth us quickly learning about three key words, progestrone, estrogen and progestogen as they will come up a lot when we talk about hormone contraceptive methods,
First of all progesterone, this is a hormone that helps to maintain a pregnancy following the fertilisation of an egg, it also regulates the monthly menstrual cycle
Estrogen is the hormone that stimulates the growth of the uterine lining which prepares the body to receive the fertilised egg and help it grow.
By using hormone contraceptive methods which contain progestogen, this will lower these levels and prevent pregnancy and prevent ovulation, which is the release of an egg prior to conception .

13. Hormone methods Contraceptive vaginal ring Not suitable for all
Small risk of side effects
Does NOT protect against STI’s
A vaginal ring is a flexible transparent ring that is positioned into the vagina where it produces estrogen and progestogen.. (AUDIENCE PARTICIPATION)
The hormones produced help to thin the lining of the womb and stops ovulation, it also thickens the cervical mucus providing 99 per cent protection against unplanned pregnancies.
it is not affected by sickness or diarrhea like some other hormone pills.
It is not suitable for all women. Some women who are overweight or are over 35 and smoke are advised that this may not be suitable.
The is a small risk of blood clots and breast and cervical cancer as well as some side effects such as nausea, increased discharge, breast tenderness and can effect mood.
The advantages are that after insertion it can stay in place for three weeks before needing to be removed for a 7 day break. A new ring is then inserted. It can also make periods lighter and less painful as well as reducing the risk of ovary uterus and colon cancer.
The contraceptive vaginal ring is available from sexual health clinics, nhs walk in centres and also the GP. Its does not protect against sti’s.

14. Hormone methods Contraceptive patch 99% effective Not for everyone
Some side effects
This is a small patch that is stuck onto the skin like a plaster, which releases two hormones estrogen and progestogen .
It is 99% effective and works in a very similar way to the previous seen contraceptive vaginal ring, by stopping ovulation, thickening cervical mucus and thinning the lining of the uterus.
It is easily applied and is left in place for 7 days, then replaced immediately, changing weekly for three weeks, After this the patch is removed for a7 day break when a new one is applied and the cycle continues.
Again this contraceptive is not affected by vomiting or diarrhea, periods may be light and less painful and may reduce the risk of ovary, uterine and colon cancer.
It is not appropriate for everyone, such as the over 35s who smoke, or are very overweight.
There are similar side effects to the vaginal ring, which include nausea, breast tenderness and also the possibility of a skin reaction.
This is available from sexual health clinics, young persons services, GP surgeries and gum clinics.

15. Hormone methods Combined contraceptive pill
Can provide 99% protection against unplanned pregnancies
Not suitable for some
The combined contraceptive pill is a small tablet that is taken every day at approximately the same time for 21 days. Then follows a 7 day break,
It releases those two hormones (which are????? *audience participation*estrogen and progestogen) which stop the ovaries releasing an egg, thickening the mucus in the cervix and thinning the lining of the womb, again to stop an egg implanting.
It can make periods lighter but is not suitable for overweight women or smokers over the age of 35. AUDIENCE PARTICIPATION
Missed pills, vomiting, certain medicines and diarrhea can make the pill less effective. Be aware.
If used correctly the pill can provide 99% protection against unplanned pregnancies.

16. Hormone methods Progestogen only pill Similar to the combined pill
Suitable for most women
This pill is similar to the combined pill, but it only has one hormone, progestogen. 99% effective
One pill is taking every day around the same time.
Progestogen works to thicken the cervical mucus to prevent sperm reaching an egg.
Progestogen also thins the lining of the uterus.
During some menstrual cycles the ovulation stops.
This pill can be used for women over the age of 35 who smoke, and also women who are breastfeeding as estrogen in the combined pill can affect milk production.

17. Long acting reversible contraception
Contraceptive injection
99% effective
Can be used when breastfeeding
The contraceptive injection is a one off injection that last BETWEEN weeks depending on which type is used.
It is a progestogen injection that stops ovulation, thickens the cervical mucus and thins the lining of the uterus, just like the contraceptive pills. It is 99% affective, and as it is progestogen only it can be used when breastfeeding.
Some disadvantages of this methods are that some women may have irregular periods, have no periods at all or may have some weight gain.
This method is not affected by diarrhea, vomiting or medicines but as it is an injection is cannot be removed.

18. Long acting reversible contraception
Implant
Can work for up to 3 years
Can be removed at any time
Some side effects
The implant is placed under the skin in the upper part of the arm, which is made numb by a local anaesthetic, which slowly releases progestogen. It stops ovulations, thickens mucus in the cervix and thins womb lining. 99% effective
This can work for up to three years, but can be removed at any time. Periods may be irregular, skin conditions such as acne can worsen. Some medicines can affect the implant, so care and advice should be sought.

19. Long acting reversible contraception
Intrauterine system (IUS)
It is 99% effective
Can work for up to 5 years
Can be removed at any time.
This is a small tshaped device that is inserted into the uterus through the cervix.
It works by releasing progestogen, again thickening the cervical mucus and thinning the lining of the womb.
It is 99% effective, and can work for up to 5 years. It can be removed at any time.
Periods can be lighter and short lasting although some women experience irregular bleeding in the first 6 months.
As this is a device inside the uterus there is a chance of infection, and insertion can cause discomfort.
Women are taught how to check the IUS is in place. This method of contraception is not effected by other medicines.

20. Long acting reversible contraception
Intrauterine device (IUD)
Inserted into the uterus and is 99% effective
Can remain in place for 5-10 years
Can also be taken out at any time, but insertion can be uncomfortable
The IUD is a small copper device that is inserted into the uterus and is 99% effective.
It can remain in place for 5-10 years but can also be taken out at any time, but insertion can be uncomfortable.
It is a T shaped device which works to prevent the sperm from reaching the egg that is released at the time of ovulation.
Periods may me heavy, longer or more painful and again as this is an intrauterine device there is also a chance of infection within the first 20 days. It is not affected by other medicines.

21. Natural family planning
No adverse side effects
‘persona’
Can be 99% effective
Natural family planning works by predicting fertile and infertile times during the menstrual cycle.
There are no adverse side affects, as no chemicals or products are used.
There is a device called ‘persona’ which will test the hormone levels in the females urine.
If used correctly, it can provide up to 99% protection against pregnancy.
The disadvantages are you must keep daily records and it can take up to 6 menstrual cycles to learn effectively.

22. Permanent Methods Male and Female sterilisation
A male sterlisation is called a vasectomy and a female sterilisation is called tubal occlusion.
This method may be suitable for people who do not wish to have any more children.
It is permanent although around 1 in 2000 male sterilisations fail. With female sterilisation around 1 in 200.
For men the procedure in usually carried out under a local anaesthetic and can be performed as an outpatient in hospital, in local GP settings or at a clinic.
A very small incision is made into the scrotum to find the tubes that carry the sperm. They are then closed with heat.
For women the procedure is more involved and requires a hospital stay. Some methods are carried out under a local or general anaesthestic depending on the procedure chosen. Sometimes the fallopian tubes are clipped, cut, or tied with rings.
Counseling should be sought with this method as it is meant to be a permanent prevention of any future pregnancies, and once the procedure has been carried out, it is not easily reversible.

23. Where can I get advice?
Contraceptive Health Service clinics /Family planning clinics
GP practices
Integrated Sexual Health Service
Youth Advisory Clinic
There are many places in which you can get free confidential advice regarding contraception. On the handout there is a list of the local clinics. You can also receive confidential advice from your GP.

24. Eeek! Emergency! Emergency contraception pill
To be taken no later than 72 hours after failure or non-use of contraception
If the pill is taken within 24 hours it can help to prevent 95 out of 100 pregnancies
So we all have too much to drink and do something silly. And it IS silly but not the end of the world...
It’s always best to admit you’ve been silly and make sure you speak to someone rather than ignore the situation because you fear being told off or laughed at. You can go to any of the organisations detailed in the handout and get confidential emergency help. Did you know you can now buy the morning after pill from the chemist?
BUT IT WILL NOT PROTECT YOU FROM STI’S SO YOU SHOULD ALWAYS MAKE SURE YOU HAVE A SEXUAL HEALTH CHECKUP TOO.
The emergency pill is available of the method if contraception chosen has failed, or a pill has been missed, or if no contraception has been used.
It works by being given 1 pill no later than 72 hours after the failure of contraception or unprotected sex.
If the pill is taken within 24 hours it can help to prevent 95 out of 100 pregnancies, if it is taken 72 hours following sex then the success rate is 58 out of 100 pregnancies.
It is important to take the pill as soon as possible following sex and can be obtained from GP, family planning clinics, youth advisory centres, sexual health services, walk in centre gum clinics a+e and pharmacies.
It is not recommended as a regular source of contraception!

25. Responsibility
Whose responsibility is it to make sure I am having safe sex?
YOURS
Whose responsibility is it to make sure I am having safe sex?
YOURS
When you are sure you are ready to have sex and you have looked at all of the available contraceptive options you need to make sure you take responsibility for your own sexual health.

26. Responsibility
“Shouldn’t the boy take care of that? I don’t want to look like easy.”
“She should deal with that stuff, what do I care if she gets pregnant?”
And it takes two to make a baby…
And even if she doesn’t get pregnant you could both be spreading an STI you don’t even know about.
Whose responsibility is it to make sure I am having safe sex?
Shouldn’t the boy take care of that? I don’t want to look like a easy.
Making sure you protect yourself won’t make you look like a slag, you’ll just look like the mature prepared person that you are.
She should deal with that stuff, what do I care if she gets pregnant?
Respect and responsibility are the most important parts of a relationship.
And it takes two to make a baby...
And even if she doesn’t get pregnant you could both be spreading an STI you don’t even know

27. So what have we learnt? Barrier methods Hormone methods
Long lasting reversible contraception
Permanent methods
Emergency contraception
So what have we learnt?
Barrier methods
Hormone methods
Long acting reversible contraception
Permanent methods
Emergency contraception
Responsibility
Lets go over the objectives again and discuss the answers together; AUDIENCE INTERACTION
How important is it to be ready and prepared to have sex safely?
What types of contraceptives are out there? What’s right for me?
Where can I get contraceptive advice?
Where can I get emergency contraceptives
Whose responsibility is it to make sure I am having safe sex?

28. Over to you…
Any questions?

29. THANKYOU!
Please take a handout