contraception

© 2012 McGraw-Hill Companies. All Rights Reserved.

Chapter 6


Definitions: Birth control: managing fertility and preventing

unwanted pregnancy Conception: the fusion of an ovum and sperm

that creates a fertilized egg (zygote) Contraception: preventing conception by

blocking the female’s egg from uniting with the male’s sperm, thereby preventing pregnancy

Modern contraception is much more predictable and effective than in the past

Many contraceptives play a role in the prevention against sexually transmitted diseases

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Types of contraception BarrierHormonalNatural methodsSurgical methods

Factors affecting choiceAdvantagesDisadvantages

EffectivenessContraceptive failure rateContinuation rate

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Reversible contraception Estrogen and progesterone taken orally Mimics the hormonal activity of the corpus luteum

Corpus luteum secretes high levels of progesterone and estrogen to suppress ovulation

Combination pill Most common 1-month packet containing estrogen and progestins

Extended-cycle pill Seasonale, Seasonique, Lybrel

Minipill Advantages Disadvantages Side effects Effectiveness

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Thin, 1-3/4 inch square patch Releases estrogen and progestin slowly

into the bloodstream Prevention the same way as OCs Worn for 1 week, replaced on the same

day for 3 consecutive weeks; no patch fourth week

Advantages Disadvantages Effectiveness

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The NuvaRing Resembles the rim of a diaphragm and is

molded with progestin and estrogen 2 inch ring slowly releases the hormones Prevents pregnancy the same way as OCs During fourth week, remove the ring, and

use a new ring after the fourth week Advantages Disadvantages Effectiveness

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© 2012 McGraw-Hill Companies. All Rights Reserved. 7

Table 6.2 Risks of Contraception, Pregnancy, and Abortion


Implanon (approved for use in the U.S. in 2006)Hormonal methodSingle implantEffective for 3 years Inhibits ovulation and affects the

development of the uterine liningAdvantagesDisadvantagesSide effectsEffectiveness – the most effective method!

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Depo-ProveraHormonal treatment Injectable progestin usually given every 12

weeksAdvantages Disadvantageso Can cause a reduction in bone densitySide effects

It may take 12 months before cycle returnsEffectiveness

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T-380A (ParaGard) up to 10 years of protectionCopper

Levonorgestral (Mirena) up to 5 years of protectionRelease small amounts of progestin

Not exactly sure how it prevents pregnancy Advantages Disadvantages Effectiveness

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Thin sheaths, almost all latex in the U.S. Protection against STDs Advantages Disadvantages Effectiveness

Use with spermicide

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Called the “FC2” Synthetic, non-latex rubber sheath with two

flexible rings Can be inserted up to 8 hours before

intercourse Advantages Disadvantages Effectiveness

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Dome-shaped cup of latex or silicone stretched over a collapsible metal ring

Custom fit by a doctor; available by prescription

Following intercourse, diaphragm must be left in place for at least 6 hours

AdvantagesDisadvantages

Toxic shock syndrome (TSS)Effectiveness

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One-size-fits-all diaphragm-like device Available by prescription Can be used by women allergic to latex Advantages Disadvantages Effectiveness

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Small silicone cap that fits snugly over the cervix

Held in place by suction Must be fitted by a doctor Must place spermicide in the cup and on

brim Must replace FemCap annually Advantages Disadvantage Effectiveness

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Round, absorbent device about 2 inches in diameter that fits over the cervix

Presaturated with the same spermicide that is used in contraceptive creams and foams

Advantages Disadvantages

Toxic shock syndrome (TSS) Effectiveness

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Foams, creams, jelliesSpermicidal suppositoryVaginal Contraceptive Film (VCF)

Must be placed near the cervical entrance no more than 60 minutes before intercourse

Must wait 6 hours post if user wants to douche

Advantages Disadvantages Effectiveness

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Table 6.3 Contraceptive Methods And STD Protection


Abstinence The choice not to engage in sexual intercourse

Fertility awareness-based methods Abstain from intercourse during the fertile

phase of menstrual cycle Methods:• Calendar methods• Temperature methods• Mucus methods

Withdrawal Penis removed from vagina before ejaculation

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Used after unprotected sexual intercourse Plan B, Plan B One-Step, Next Choice (OTC)

Most effective if taken within 12 hours afterwards Can be taken up to 120 hours after intercourse OTC for over age 17 Possible side effects:• Nausea• Stomach pain• Headache• Dizziness• Breast tenderness

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Table 6.4 Contraceptives: From Most Effective to Least (Percent of Women Experiencing Unintended Pregnancy Within the First Year of Use)


Permanent contraception Vasectomy requires severing of the vas

deferens May return to work in 2 days Semen tested in about 12 weeks Costs $400 to $1,000 in the U.S. Effectiveness

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Tubal sterilization (tubal ligation) is most commonly performed by laparoscopy

Essure system (2002)Tiny, spring-like, metallic implants

causing scarring that blocks the fallopian tubes

Hysterectomy (removal of uterus) Complication rate 6-11% Reversibility

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When is it OK to begin having sexual relations?Society’s approachChanging of attitudes with the changing of

timeAnswering personal questions

Contraception and Gender Differences Sexuality and Contraception Education for

Teenagers

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Key considerations include:1. Health risks2. Implications of unplanned pregnancy3. STD risk4. Convenience and comfort level5. Type of relationship6. Ease and cost of obtaining and maintaining

each method7. Religious or philosophical beliefs8. Potential noncontraceptive benefits

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Chapter 6

contraception

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