Contraception - Birth Control Contraception Historical Perspective Ancient EgyptCrocodile Dung Ancient Greece(6th Century)Eating the uterus testis or

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Unformatted text preview: Birth Control & Contraception Historical Perspective Ancient Egypt—Crocodile Dung Ancient Greece (6th Century)—Eating the uterus, testis, or hoof paring of a mule 18th Century Italy—Casanova developed animalmembrane condoms tied with ribbon at the base of the penis. 17th Century Western Europe—withdrawal and vaginal sponges soaked in a variety of solutions B.C. & Contraception in the U.S. Comstock laws (1870s) Margaret Sanger 1915: opened first clinic where women could obtain and learn about diaphragms. The Woman Rebel—newspaper publishing birth control information Sanger & Katherine Dexter McCormack paid for limited testing and research. Griswold v. Connecticut (1965) Eisenstadt v. Baird (1972) Contraception—A basic necessity A woman who wants only 2 children must use contraception for roughly three decades of her life 93% of (hetero)sexually active women in the U.S. use contraception 7 in 10 U.S. women aged 15–44 (approx. 42 million) are at risk of unintended pregnancy. Individuals have many reason for preventing pregnancy. Contraception and Gender How does restricting access to contraception affect women? How does it affect men? Contraceptive use has medical benefits Use of any method helps prevent high-risk pregnancies All methods help women space births Some methods have non-contraceptive benefits: Condom use reduces the risk of sexually transmitted infections (STIs) Some hormonal methods reduce the risk of ovarian and endometrial cancer, ovarian cysts, painful menstrual cramps and acne Sharing Responsibility & Choosing a Method Sharing the responsibility of contraception: Can enhance a relationship Can help develop communication skills Can prevent resentment Can provide physical and emotional support Choosing a method is a personal choice Good to know all of your options Critical to undergo medical examinations, tests, consultation, and continuing care. Contraceptive Methods A Note on Efficacy Human error is one of the main reasons for contraceptive failure. Use of Backup Methods is often critical People who are guilty about sex are more likely to use contraception ineffectively. Women who are uncomfortable with their sexuality often take a more passive role in contraceptive behavior. Low income women and younger women also experience greater failure rates. A Note on Efficacy--Definitions Failure Rates—The number of women out of 100 who become pregnant by the end of the first year of using a method. "Typical use" takes into account the fact that sometimes people won't use a contraceptive correctly or consistently (i.e., forgetting to take a Pill each day, not putting on a condom correctly, etc.) "Perfect use" assumes that a method is used correctly each time and with every act of intercourse. Kinds of Contraception “Outercourse” or Noncoital activity or Abstinence Barrier & Spermicide Methods Hormonal Methods Fertility Awareness Sterilization Abstinence & “Outercourse” & Noncoital Activity Abstinence can take the form of no sexual activity – which is of course the safest form of protection. But abstinence can take other forms as well: Avoiding just penile-vaginal/anal intercourse entirely or during specific times of the month. Can also be beneficial for other medically necessary reasons. Important caveats: If the man ejaculates near the vaginal opening, still a risk for pregnancy. The anus is near the vaginal opening. Barrier Contraceptives How they work: Provide a barrier so that sperm cannot pass through the cervix or even enter a partner’s body. Barrier Methods: Disadvantages Not as effective as hormonal methods Most require concomitant spermicide Efficacy is highly dependent on consistent and correct use Some require partner cooperation Vaginal insertion and removal may be unacceptable Increased risk of urinary tract infection when used with a spermicide Some require fitting by a clinician Most are less effective in parous women Barrier Methods: Advantages No hormonal side effects Some methods available without prescription Some reduce sexually transmitted infections Female Condom Efficacy: Perfect use – 5/100 Typical use – 21/100 Advantages: Provides some protection against . sexually transmitted infections Does not require a prescription Can be inserted well before intercourse Made of latex-free material (polyurethane) Female Condom Disadvantages: May not be as effective against pregnancy as the male condom . Must be inserted and removed by woman Available in only one size Labeled for single use May be noisy Outer ring may be visually unappealing and uncomfortable Male Condom Efficacy: Perfect use – 3/100 Two Types: Latex Polyurethane Typical use – 14/100 Advantages: Provides greater protection against sexually transmitted infections than any other method of contraception Provides substantial protection against pregnancy, especially when used with a spermicide Does not require a prescription Can be used with other methods Inexpensive and widely available Male Condom Two Types: Latex Polyurethane Disadvantages: Can be used for only one act of intercourse Can tear or slip during use, but this is less frequent with lubricated condoms May decrease sexual pleasure May interfere with spontaneity Requires cooperation of male partner Mistakes people make with Condoms What might people do that makes condoms ineffective? Summary A number of prescription-only and over-thecounter barrier methods are available Some methods provide protection against sexually-transmitted infections Barrier methods are less effective than hormonal methods Devices must be placed before coitus, reducing spontaneity May require cooperation of partner Hormonal Contraception Daily Use Oral Contraceptive Pill Nondaily Use Injectable contraceptive Contraceptive patch – Combination pill Vaginal ring – Progestin-only pill Hormone-releasing intrauterine system – Extended-cycle pill Hormonal Methods How they work: Prevent conception primarily by inhibiting ovulation. Estrogen affects the hypothalamus, inhibiting the release of LH and FSH. Progestin thickens and chemically alters cervical mucus so that the passage of sperm into the uterus is hampered. Progestin also changes the lining of the uterus, making it less receptive to a fertilized egg. Why they fail: Forgetting to take pills—50% of women say they miss at least one pill each cycle. Hormonal Methods Advantages Most effective, long-term reversible contraception available Most methods offer complete privacy Require no planning before intercourse Disadvantages Require a visit to a healthcare professional May cause common hormonal side effects Products containing estrogen may be associated with rare, but serious health risks Not effective against sexually transmitted disease Birth Control Pills Most take combination pills with both estrogen/progestin to inhibit ovulation and thicken cervical mucous Perfect use 1/100 Typical use 9/100 Common mistakes in use? Hormonal Contraception Injectable Methods Depo-Provera Progestin injections Lasts for 12 weeks (3 months) Less than 1 in 100 women will get pregnant with perfect use 3 in 100 women will get pregnant with imperfect use. Hormonal Contraception Implant Methods Implanon/Nexplanon—thin, plastic implant Releases progestin Lasts up to 3 years 1 in 100 women will become pregnant Implanon/Nexplanon: Pros & Cons Advantages Ability to become pregnant quickly returns Can be used while breastfeeding Can be used by women who cannot tolerate estrogen Ease of use—no daily or before sex action required Disadvantages Irregular bleeding Interactions with several medications Hormonal/Copper IUD Paraguard (copper) and Mirena (hormonal) Both affect movement of sperm by blocking access to eggs Hormonal IUD’s also release progestin Mirena lasts 5 years, Paraguard lasts 12 Paraguard can also be used in a similar way to “Plan B” if inserted ASAP after unprotected sex Nuvaring A small ring inserted into the vaginal canal once a month Same hormones as birth control pills Perfect rate 1/100 typical rate 9/100 Inserted and left in for 3 weeks, removed for 1 week every month Need a prescription 15-85$ monthly Fertility Awareness Methods Require knowledge, training, and quite a bit of work and care! Room for error & need for backup or abstinence. Acceptable for Catholic Church No side effects Several methods and combinations of methods: Calendar or rhythm method—Cycle Beads Basal Body Temperature Method Ovulation Method Symptothermal Method Sterilization For For men: Vasectomies Cutting or clamping the vas deferens, so that sperm cannot travel to the penis. Vasovasostomy: reversal of the vasectomy women: Tubal Ligations Cutting the fallopian tubes so that sperm cannot reach the egg and the egg cannot travel to the uterus. Essure Copper coils in the fallopian tubes cause scar tissue, with same effects as tubal ligation. Sterilization For men: Vasectomies Cutting or clamping the vas deferens, so that sperm cannot travel to the penis. Vasovasostomy: reversal of the vasectomy Sterilization—Pros & Cons Advantages Disadvantages Permanent Permanent Minimal side effects Surgical Non-hormonal No impact on sexual enjoyment procedure (except for Essure) Still risks for STIs and HIV Birth Control Methods Emergency Contraception Abortion Medical Surgical Emergency Contraception A large dose of the same hormones in oral contraceptives (see Table on p. 360). Needs to be taken ASAP (and within 120 hours of unprotected intercourse) —sooner, the better. Will not terminate an established pregnancy. EC inhibits ovulation, fertilization, or implantation. Taken within 72 hours, 95% effective. 2006—FDA allows OTC purchase for women 18+ Paraguard IUDs are also an option for those that have strong side effects to hormonal contraceptives Medical Abortions (RU-486) Became available in the U.S. In 2000 (available in Europe for nearly 20 years). Two-drug regimen (mifepristone & misoprostol) Prevents the cells of the uterine lining from getting the progesterone needed to support a fertilized egg. Most effective during the first 9 weeks. Backup method should be available. Similar cost as a surgical abortion. Some side effects can be serious. Surgical Abortions Vacuum Aspiration (1st trimester): Local anesthesia. Vagina is rinsed, cervix is dilated, and uterus is gently vacuumed. Most commonly used method. Dilation & Evacuation (2nd trimester): Local or general anesthesia Cervix is dilated and fetus is removed through curretage or other procedures. Sometimes called a D&C (Dilation & Curretage) Partial Birth Abortions Many societal myths about the procedure itself and statistics around it. Always trust empirical evidence over feelings (we call that science) Thailand 2010 Making abortion illegal doesn’t stop the practice. So society needs to discuss other ways of preventing pregnancy beyond just legality Less Than Effective Methods Nursing Withdrawal Douching Contraceptive Explorations For women: Microbicides Vaccines Hormone sprays Rape prevention? For men: Testosterone-based injections Vaccines Condoms: new materials, shapes and sizes Custom-fit condoms ...
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  • Spring '16
  • Combined oral contraceptive pill, Hormonal contraception, hormonal methods

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