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conception
CONTRACEPTIVES
method failure (varying %) user failure embarrassment inhibitions not spontaneous memory failure mood awkwardness dulled sensation alcohol, other drugs
Why?
CONTRACEPTIVES
Why? (Contd)
fear parents will find out fear to go to the doctor heat of the moment ashamed to buy expense takes the danger out of love embarrassed to ask male partners lots of guys hate condoms
CONTRACEPTIVES
Knowledge gradually disappeared due to religious restrictions. (Patriarchal societies) Most common contraceptive around the world:
CONTRACEPTIVES
Research
CONTRACEPTIVES
BARRIER
METHODS:
Male condom:
latex (best) or intestinal tissue of animals (mostly lambs), lubricated or un better: polyurethane, thinner, stronger, conduct heat but a bit looser relatively cheap depends on frequency of use! protects against STDs (latex only) no prescription or fittings easily available (in urban areas) now internet
CONTRACEPTIVES
BARRIER
METHODS (Contd):
CONTRACEPTIVES
Female condom:
polyurethane, lubricated, two rings, one over cervix, one over vulva polyurethane more resistant to tears and other damage female control expensive high failure rate (preliminary) spontaneity awkward
CONTRACEPTIVES
Diaphragm: no longer available in NL rubber with ring covers cervix loosely but stays in place if properly fitted used with contraceptive cream/jelly failure rate in US 18%, due to misuse, lower in Europe and Latin America can be inserted 6 hrs. before, must be left in 6 hrs. after can be left in place for repeated sex need Dr.s fitting and prescription does not protect against STDs
CONTRACEPTIVES
Diaphragm (Contd): must be with owner when needed failure due to arousal changes in vagina (ballooning), large changes in weight, birth, etc. need resizing cream or jelly can be irritating to women or partner not advisable during menstruation needs to be washed and dried thoroughly after each use no harmful side effects inexpensive
CONTRACEPTIVES
CONTRACEPTIVES
BARRIER
METHODS (Contd):
CONTRACEPTIVES
INTRAUTERINE
DEVICES
Different shapes, materials. Inserted inside uterine cavity by physician. Can work by preventing sperm from swimming up or by preventing implantation. Unknown. Very old method. Some brands caused PID (pelvic inflammatory disease) leading to permanent infertility, ectopic pregnancies and hemorrhaging.
CONTRACEPTIVES
INTRAUTERINE
DEVICES (Contd):
Can perforate uterine wall. If woman becomes pregnant, high risk of miscarriage. Periods heavier, cramping, bleeding between periods. No protection against STDs. Can be expelled by uterine contractions. Some women very happy with this method.
Spermicides:
Chemical substances that kill sperm.
Irritation or allergic reaction. Also added to other contraceptives. By itself high failure rate
Sponge:
Combination barrier and spermicide. 25% failure rate. No prescription needed, intercourse can be immediate or within 24 hrs. Increases rate of TSS and UTIs. Currently off market.
CONTRACEPTIVES
inhibiting production of LH thickening cervical mucus (sperm get stuck) changing the endometrium so implantation is unlikely
Different types of pill, see text. Mini pill: progestin only, less effective
CONTRACEPTIVES
HORMONAL
CONTRACEPTIVES:
CONTRACEPTIVES
Depo-Provera:
Injectable progesterone (medroxyprogesterone) prevents ovulation and changes mucus Breast cancer risk Osteoporosis Irregular menstruation Amenorrhea Weight gain Headaches Anxiety Stomach pain, cramps Dizziness Weakness, fatigue Loss of libido
CONTRACEPTIVES
HORMONAL
CONTRACEPTIVES
(Contd):
Quarterly shots of estrogen and progestin Lunelle, Cyclo-provera, Cyclofem 100% effective Same pros and cons Yasmin: ethinylestradiol + drospirenone (type of progesterone) synthetic recalled unsafe Patch: on fleshy body parts
CONTRACEPTIVES
Seasonale
taken continuously for 3 months low dose estrogen and progestin only 4 menstrual periods per year what long-term consequences???
Plan B
the longer the interval, the lower the effectiveness Plan B is now available prescription-free in most provinces alternative: two or more pills of any contraceptive pill
acetaminophen: pill lessens pain relief alcohol: pill enhances alcohol effects anticoagulants: pill decreases their effect antidepressants: pill enhances their effect barbiturates: interfere with pill effectiveness penicillin: decrease pill effectiveness tetracycline: ditto
More
blood clots, can lead to heart attack and stroke can lodge in lungs (respiratory difficulties) carcinogens:
mixed data need more long term studies increased breast cancer, ovarian & endometrial decreased cervical cancer different studies yield different data
increased infertility after long term (over 10 years) but could be due to age
CONTRACEPTIVES
liver tumors, can lead to death Difficulty: so many different formulations, ever changing controversial, contradictory results who funded the research?
of most done by pharmaceutical companies (biased) many based on self-report. Long term vs. short term
increased monilia and trichomona vaginal infections more susceptible to STDs (vaginal pH altered) nausea migraines or severe headaches drug interactions: either increase or decrease effectiveness
CONTRACEPTIVES
depression lower interest in sex bloating and/or weight gain interfere with milk production cost forgetting infrequent sex smokers break-through bleeding no STD protection
Environmental effects: the urine of users of hormonal contraceptives gets into the water systems affecting animals and possibly humans.
Remember ACHES for the Pill: Symptoms of Possible Serious Problems With the Birth Control Pill
Initial A C H Symptoms Abdominal pain (severe) Chest pain (severe) or shortness of breath Headaches (severe) Possible Problem Gallbladder disease, liver tumour, or blood clot Blood clot in lungs or heart attack Stroke, high blood pressure, or migraine headache Stroke, high blood pressure, or temporary vascular problems at many possible sites Blood clots in legs
CONTRACEPTIVES
NEW DEVELOPMENTS
The vaginal ring (which may also have estrogen) is a flexible polymer ring, inserted into the vagina for three weeks at a time. Removal at the start of fourth week brings on period Skin patch:
emits estrogen and progestin same as pill applied anywhere, once a week four week cycle (three on, one off) Not effective in heavy women (thick fat pad under skin prevents good absorption)
Methotrexate (kills embryo) + misoprostol (a prostaglandin) causes uterine contractions. In Dr.s office. Its an abortifacient.
CONTRACEPTIVES NEW
DEVELOPMENTS (Contd):
Essure coil:
inserted into Fallopian tubes through the vagina and uterus tissue grows around coil in 3 months, results in total blockage sterility ($1,000, not covered) not 100% effective
CONTRACEPTIVES
NEW
Testosterone enanthate:
inhibits sperm production (injection)
CONTRACEPTIVES
Natural
breastfeeding: only under certain conditions rhythm or calendar: Vatican roulette withdrawal (coitus interruptus) avoid ejaculation (coitus reservatus) sympto-thermal method: basal body temperature + vaginal mucus abstinence
SYMPTOTHERMAL METHOD
CONTRACEPTIVES
Tubal ligation:
Fallopian tubes cut, several methods, some failures. Usual surgical risks. Some evidence of increased incidence of hysterectomy for various problems.
Vasectomy:
Much simpler surgery: vas deferens cut or blocked. Can be done for reversibility (50-70% success). Two months wait for sperm already there to die. Very small % of men experience post-surgery discomfort for a few months, most OK in 48 hrs.
ABORTION:
Widely used for centuries. Even early Christianity did not condemn it. Until 20th century:
quickening
ABORTION
(Contd):
First trimester:
Very early (2-3 weeks):
RU-486 methotrexate + misoprostol D & C (dilatation and curettage) D & E (dilatation and extraction)
ABORTION
(Contd):
Prostaglandin injection:
D & E:
Under general anesthetic. Fetal skull may need to be crushed for passage
Like a Cesarean section Removal of uterus and contents
Hysterotomy:
Hysterectomy: