Barrier Methods

-for contraception and protection against STI, HPV, HSV, HIV Cervical Caps FR= Nulliparas-16% Mutiparous-32%
3sizes=one size fits all, varying(2)
Spermicides (F.R 20%-50%) Latex free rubber/silicone
Inserted high into the vagina to make contact with Soft Domes and brims
cervix. Blocking the cervix (jxn of cervix and vaginal
Nonoxynol-9 fornices)
● reducing sperm’s mobility toward cervical os, targeting not <6hrs no >48hrs removal
flagella and the body. requires less spermicide than diaphragm
●most common in U.S. can be inserted hours before coitus w/o additional spermicide
●surfactant that destroys sperm’s cell membrane Factors that interfere in wearing:
●>2x a day as lubricant in anal sex will increase risk for HIV angle of the uterus
transmission and can cause lesions vaginal muscle tone
●to be avoided by women who have high risk for HIV and cervical shape
other STI Bad candidates:
Intravaginal Spermicides Abnormal pap test result
●non Rx No appropriate size
Inserted 15mins before coitus and not 1hr before Difficulty of placing and removing the device
TSS Hx
Condoms (F.R. F♀= 21% M♂=15%) Vaginal/Cervical infection
-thin stretchable sheath that covers the penis before Allergies in spermicide and latex
coitus and removed after ejaculation
-Protection for GCT and HIV Contraceptive sponge;
-Non Rx/OTC Small, roud polyurethane sponge that contains
Male: nonoxynol-9 spermicide.
Single use Fits to the Cervix(concave) of ALL!
ECP- must be available to prevent breakage or slippage 3%- Polyester Loop- removal of the sponge
5% Moistened with h2o before insertion
Made with: latex rubber-break with oil-based lubricants 24hr-protection
(water-based and silicone is recommended) 6hr-left inside after coitus
Polyurethane-under reasearh 24-30hr=TSS
Natural membrane (animal tissue)- Cecum (lamb)
has small pores in which HepaB, HSV and HIV can enter. Hormonal Methods
Vaginal Stimulation-male condoms are contoured and rippled, Combined estrogen-progestin contraceptives
thin construction increases heat transmission and sensitivity
Female: ORAL CONRACEPTIVES (FR= almost 100%)
Single use COCs-Combined Oral Contraceptives
-lubricated vaginal sheath made with polyurethane and has
flexible ringsat both ends Inhibition of Ovulation= by suppressing the action oh the
-inserted in the vagina and anchored in the cervix hypothalamus and anterior pituitary gland, leading to
-Oil-based OK! And water based is used as silencer inappropriate secretion of FSH and LH
Caution! Don’t use m and f condoms @ the same time
=friction=breakage=pregnancy Alteration of Endometrium Maturation=less favorable site
for implantation
Diaphragms FR=16%
Made with silicone or latex COCs
Prevent migration of sperm blocking cervix Examined before undergoing pill-intake (yearly)
Washable, reusable inspected for holes and tears
Added with Spermicidal before insertion Should be taken at the same time each day.
Rx needed (1-4days of ingestion) endometrium sloughs and bleeds (2-
Fitting is required 3days) as a result of hormone withdrawal
Shallow, dome-shaped with flexible rim blocking the cervix Progestin-will make the cervical mucus remain thick
1. Coil Spring
2. Arcing Spring Cervical Mucus Thickening= under the influence of
3. Wide Seal Rim progesterone making an unsuitable environment for sperm
Largest fit without noticing it!!! penetration.
Yearly GyneExam-for refitting (20% weight gain/loss
abdominal/pelvic surg. Post-partum Monophasic Pills- provide fixed dosages of estrogen and
2years-must be replaced progestin
Disadvatage: reluctance of insertion and removal Multiphasic Pills - (bi/tripahsic oral contraceptives) – alters
6hours before-it must be worn the amount of progestin and sometimes the amount of estrogen
Messy!! within each cycle
Foreplay interruption Monophasic and Multiphasic Pills- reduce the total dosage of
Not good for women with poor vaginal muscle tone and hormones in a single cycle without sacrificing contraceptive
recurrent UTIs, pelvic relaxation (uterine prolapse), large efficacy.
cystocele,latex allergy
Proper placement-behind the pubic symphysis blocking the Advantages
cervix Acceptable-not diretly related to coitus
Worn in empty bladder User will be confident thus improvement in sexual
Side Effects: response
Tissue irritation Convinient- predictable menstrual period
TSS Decreased menstrual blood loss and decrease IDA
6-8hr after coitus removed! Regulation of Menorrhagia and irregular cycles
Menses-don’t use it!
 Reduced incidence of dysmenorrhea and
premenstrual syndrome (PMS) TRANSDERMAL CONTRACEPTIVE SYSTEM
Protection against endometrial/ovarian cancer (FR=2% in women weighing 198 lbs.)
Reduced the incidence of benign breast disease -Rx needed
Improve Acne -Each patch delivers continuous levels of
Protection agaist the development of fxnal ovarian norelgestromin(progesterone) and ethinyl estradiol
cyst and salpingitis -Intact skin @ upper outer arm, upper torso (front and
Decrease risk for ectopic pregnancy back excdg. the breast, lower abdomen, buttock
Perimenopausal women will experience regular - Once a week for 3weeks and 1 week without a
bleeding cycle, and regular hormonal pattern patch and withdrawal bleeding occurs.
Disadvantages: -action, efficacy, contraindications,skin reaction and
Conraindicated to women with: side-effects is the same as COCs.
Hx of thromboembolic disorders
Cerebrovascular and coronary artery disease VAGINAL CONTRACEPTIVE RING (FR= under 2%)
Breast cancer or other estrogen-dependent -Rx needed
tumors -flexible ring (made with ethylene vinyl acetate
Impaired liver fxn copolymer)
Liver Tumor -worn in the vagina for continuous levels of
Smoking habit 35y/o 10sticks/day etonorgestrel (progesterone)
Headache with focal neurologic disorder -3weeks worn in the vagina followed by 1 week
Surgery with prolonged immobilization without ring (withdrawal bleeding occurs)
(legs) - No fitting required
Hypertension (160/100) Some wearers will experience
DM with vascular disease Vaginitis
Side effects of High Dose of Estrogen and Progesterone Leucorrhea
Stroke Vaginal discomfort
MI Sex discomfort- the ring should not be removed for any longer
Thromboembolism than 3HOURS
Hypertension -SIMILAR TO COCs
Gallbladder disease
Liver tumors PROGESTIN-ONLY CONTRACEPTIVES
-inhibits ovulation, thickening and decreasing the
Estrogen Excess amount of cervical mucus, thinning the endometrium
Nausea and altering cilia in the uterine tubes.
Breast tenderness
Fluid retention ORAL PROGESTIN (MINI PILL) (FR=8%)
Chloasma Contain low dose of progestin
Estrogen Deficiency Irregular vaginal bleeding
Early spotting (days 1-14)
Hypomenorrhea INJECTABLE PROGESTINS (FR=3%)
Nervousness Depot medroxyprogesterone acetae (DMPA or Depo-
Athropic vaginitis =dyspareunia/painful coitus Provera 150mg IM @ deltoid G. Maximus G23 needle 2.5cm-
Progestin Excess 4cm long.
Increased appetite 5days-administration is initiated
Tiredness 11-13weeks-Administration
Depression Advantages: ssame contraceptive effect like COCs
Breast tenderness Long-lasting effect
Vaginal yeast infection 4x/year of injection
Oily skin and scalp Side-effects: increased mineral –density
Hirsutism Weight gain
Post pill amenorrhea Lipid changes
Progestin Deficiency Increased for venous thrombosis and
Late spotting and breakthrough bleeding (days 15-21) thromboembolism
Heavy flows with clots Irregular vaginal spotting
Decreased breast size Decreased Libido
BLEEDING IRREGULARITIES -most common side effect Breast Changes
of COCs Disadvantages: Low protection against STI, HIV
Don’t simultaneously take COCs with Delay in return to fertility 18months
Anticonvulsants= barbiturates, oxcarbazepine,
phenytion, phenobarbial, felbamate, IMPLANTABLE PROGESTINS
carbamazepine, primidone and topiramate Norplant system
*6 flexible, non bridgeable polymeric silicone (Silastic
Systemic anti-fungals: griseofulvin Capsules)
Antituberculosis drugs: Rifampicin and rifabutin SC=contains levonorgestrel 5-7 years of contraception
Anti-HIV protease inhibitors Wt. and age-factor that determines the span
Inner aspect of the non dominant upper arm
ORAL CONTRACETIVES 9-DAY REGIMEN (FR=<2%) Action: prevents (not all) ovulatory cycles and thickens
Levonorgestrel - ethinyl esradiol (Sesonale)- FDA2003 cervical mucus.
approved Advantage: long lasting effect, reversible
-contains estrogen and progestin taken in 3month IRREGULAR BLEEDING-most common side effect
cycles of 12 weeks of active pills followed by 1 Others= headache,nervousness nausea, skin changes and
week in active pills. vertigo
-13 week menstruation will occur Implanon-rod implant
-Rx needed, taken on daily schedule