1、Contraception and AbortionAgendaDiscuss History and Considerations Associated with MethodsDiscuss Contraception MethodsDiscuss AbortionClass Exercise: Contraception Values ClarificationComplete the handout entitled “Contraception Values Clarification.After you have completed the handout, discuss you
2、r response in small groups.IntroductionMajority of U.S. pregnancies are not planned and most are a result of not using contraceptionFactors increasing motivation to use contraception: vgood communication with partner, vlower cost, veffectiveness rates, vfrequency of intercourse, vmotivation to avoid
3、 pregnancy, vside effects, vopenness about sexualityContraception: HistoryContraception in Ancient TimesContraception in the U.S.: 1800s and Early 1900sContraception Outside the U.S.Contraception in Ancient TimesAncient Greeks: magic, superstition, herbsEgyptians: fumigating female genitalia, tampon
4、 soaked in herbal liquid & honey, inserting a mixture of crocodile feces, sour milk, & honeySouth Africa: insert vegetable seed podsAfrica: insert a grassy cervical plugPersia: insert alcohol soaked spongesGreece: insert empty pomegranate halvesContraception in the U.S.: 1800s and Early 1900sConcern
5、 in early 1800s was to curb poverty by controlling fertility1873 Comstock laws prohibited dispersing information about contraceptives, including by doctorsContraception use is affected by Social issues e.g. desired family sizeEconomic issuesKnowledge & misinformationReligionGender roles & power in s
6、ome areas, men make the contraceptive decisions; for some it is the responsibility of bothChoosing a Method of ContraceptionFDA Approval ProcessLifestyle IssuesFDA Approval ProcessThe U.S. Food and Drug Administration (FDA) must formally approve the method10-14 year process to develop a new contrace
7、ptive drugDrug company submits a new drug application demonstrating safety in animal tests & a desire to conduct human trialsFDA Approval Process3 phasesvPhase 1: 20-80 volunteers to test effectivenessvPhase 2: several hundred to test effectiveness, side effects, risks vPhase 3: hundreds to thousand
8、s are tested for generalizationAnimal trials are conducted throughout the processClass Discussion: Lifestyle Issues Associated with ContraceptiveThe following factors seem to be associated with choosing a contraceptive method:vOwn health & risksvNumber of sexual partnersvFrequency of intercoursevRis
9、k of acquiring a STIvResponsibility levelvMethod costvAdvantages & disadvantages of the methodDiscuss influence of each.Contraception MethodsBarrier Methods: Condoms and CapsPrevent sperm from entering the uterusBarrier Methods:vCondomsvThe DiaphragmvThe Contraceptive SpongevThe Cervical BarriersCon
10、doms1850 latex condoms available in the U.S.$10-$15/dozenNon-expired condom is rolled onto an erect penis (foreskin pulled back), -inch empty space at the tipWater-based lubricants for latex condomsCondom grasped at base when withdrawingLatex condoms have lower rates of slippage & breakage, and offe
11、r better STI protectionCondomsIn 1994, female polyurethane/nonlatex condoms were available $2 each7 inches long with 2 flexible ringsInner ring squeezed and inserted close to the cervixOuter ring lies outside the vaginaAdequate lubrication is necessaryCondomsEffectiveness ratesvLatex condoms: 85-98%
12、 vFemale condoms: 79-95%Latex & polyurethane protect against STI transmissionLambskin condoms block sperm, but contain holes large enough for viruses to pass throughHeat can damage condomsCondomsAdvantages: vSTI protectionvEncourages male participationvInexpensivevNo prescription necessaryvCan reduc
13、e premature ejaculationvCan reduce postcoital dripvNo medical side effectsCondomsDisadvantages:vReduces spontaneityvCan reduce sensationvFemale condoms can be difficult to use, uncomfortable, noisyFemale & male condoms should never be used togetherPopular in some countries, not used in othersThe Dia
14、phragmNot widely used, almost 0% in 2002Made of latex or siliconeMany sizes and shapes; a fitting by a health care provider is necessary$20-$35 diaphragm, $13 spermicidal jelly/cream, office visit chargeThey can last for many yearsDiaphragms come in a variety of different shapes and sizes and must b
15、e fitted by a health-care provider.The DiaphragmDiaphragm rim is covered in spermicidal jelly & a tablespoon of jelly is placed in the dome; it is folded in half and inserted into the vagina with the front rim tucked under the pubic boneIt should not be felt & should cover the cervixIt can be insert
16、ed up to 6 hours prior to intercourseLeft in for at least 6-8 hours, no more than 24 After use it is washed with soap & water Instructions for proper insertion of a diaphragm.The Diaphragm84-94% effective, lower for those who have given birthAdvantages: vIncreases spontaneityvSome STI & PID protecti
17、onvReduces risk of cervical dysplasia & cancervDoes not affect hormonal levelsvRelatively inexpensiveThe DiaphragmDisadvantages:vPhysician fitting and prescriptionvInsertion & removal involves touching the genitalsvIncreased risk of toxic shock syndrome and urinary tract infectionvPostcoital dripLow
18、 usage outside the U.S.The Contraceptive SpongeThe Today contraceptive sponge was taken off the market for a decade due to issues with the manufacturing plant; reintroduced in 2005Available over the counter in one sizeThe sponge covers the cervix & contains spermicide; it blocks, absorbs, & deactiva
19、tes spermOne box of 3 sponges is $13The Today contraceptive sponge was back on the market in late 2005 in the United States.The DiaphragmSponge is moistened with water to activate the spermicide, folded in half, & inserted to cover the cervixCan be inserted up to 24 hours in advance, with intercours
20、e occurring as many times as desirable in that time periodMust be left in at least 6 hours after intercourse75-89% effectiveness ratesInstructions for proper insertion of a contraceptive sponge.The DiaphragmAdvantages:vNo prescription necessaryvCan have intercourse several times within 24 hoursvIncr
21、ease sexual spontaneityvDo not affect hormonal levelsvDisposableThe DiaphragmDisadvantages:vIncreased risk of toxic shock syndrome & urinary tract infectionvCannot be used while menstruatingvRequires touching of the genitalsvHigh expense if frequently usedvSome men can feel itLow usage rates in othe
22、r culturesThe Cervical BarriersThimble-shaped, silicone barriers that fit over the cervixBlock entrance to the uterus & deactivate sperm with the spermicideFitting by a health care provider is necessaryTwo types:vFemCapvLeas ShieldThe FemCap is a silicone cup shaped like a sailors hat that fits secu
23、rely over the cervix. Leas Shield is a silicone cup with a one-way valve and a loop for easier removal.The Cervical Barriers$15-75 plus cost of spermicideLeft in place for 8 hours after intercourseAfter use, it is washed with soap & waterNot to be used during menstruation86% effectiveness rate, lowe
24、r for those who have had childrenThe Cervical BarriersAdvantages:vLeft in place for up to 48 hoursvDo not affect hormonal levelsvImmediately effectivevNot permanentvOne-way release valve in Leas Shield reduces risk of toxic shock syndromeThe Cervical BarriersDisadvantages:vAbnormal Pap smearsvIncrea
25、sed risk of urinary tract infectionsvIncreased vaginal odorsvCervical damagevIncreased postcoital dripvFitting is necessaryvSome male partners feel it & may dislodge itThe Cervical BarriersWidely used in EnglandLeas Shield is available over the counter in Germany, Austria, Switzerland, & Canada Horm
26、onal Methods for Women: The Pill, the Patch, and MoreChanging hormonal levels can deter production of ova, fertilization, and implantationHormonal Methods for Women: The Pill, the Patch, and MoreCombined-Hormone MethodsvBirth Control PillsvHormonal RingvHormonal PatchProgestin-Only MethodsvSubdermal
27、 ImplantsvHormonal InjectiblesCombined-Hormone MethodsCombination of estrogen & progesteroneCan repress ovulation and thicken cervical mucusBirth Control PillsFederally approved in 1960Most popular contraceptive in the U.S. and around the worldMost studied type of medication Combination birth contro
28、l pills are $12-25 per monthDesigned to mimic a menstrual cycle, with 21 days of hormones and one off weekBleeding is medically inducedBirth Control PillsSome take 2 to 3 packs of active pills in a row to reduce the number of menstrual periodsSeasonale 84-day active pill with 7-day placeboReducing p
29、eriods can help those with heavy bleeding and cramping60% of women prefer to not have a periodBirth Control PillsIncrease in estrogen & progesterone prevent the pituitary from sending hormones to ripen the ovariesCervical mucus thickens & endometrium buildup is minimalThe body is tricked into thinki
30、ng it is pregnantMay experience other signs of pregnancy that usually disappear within a few monthsBirth Control PillsInitially prescribed a low-dose estrogen pill; increased if breakthrough bleeding occursMonophasic pills contain the same dose of hormones in each pillMultiphasic pills vary in hormo
31、ne amountTriphasil pills have 3 sets, each week the hormonal dosage increases92-99.7% effectiveNeed to take it each day at the same timeBirth Control PillsAdvantages:vHigh effectiveness ratevDoesnt interfere with spontaneityvReduced menstrual flow, cramps, & PMSvIncreased menstrual regularityvReduce
32、d risk of ovarian cysts, uterine & breast fibroids, facial acne, ovarian & endometrial cancers, PID, benign breast diseaseBirth Control PillsDisadvantages:vNo STI protectionvFemales responsibility; taken dailyvCan be expensivevLower effectiveness if overweightvNot appropriate for smokersUsed through
33、out the world, although not popular everywhere; some places have it over the counterHormonal RingNuvaRing introduced in 2003Plastic ring inserted into the vagina once a month for 3 weeks, removed for 1 weekAffects the body as combination pills doBody heat & moisture activate a constant dose of estro
34、gen & progesterone; lower dose than pills$30-35 per month99.7% effectiveThe NuvaRing is inserted deep into the vagina; moisture and heat cause it to time-release hormones that inhibit ovulation.Hormonal RingAdvantages: vHigh effectivenessvDoesnt interfere with spontaneityvReduces menstrual flow, cra
35、mps, PMSvIncreases menstrual regularityvProtection from ovarian & endometrial cancer and ovarian cystsvFertility restored upon removalHormonal RingDisadvantages:vComfortable touching genitalsvNo STI protectionvSide effects that typically disappear with regular use: breakthrough bleeding, weight chan
36、ge, breast tenderness, nausea, mood changes, changes in sexual desire, increased vaginal irritation & dischargeNo data on cross-cultural useHormonal PatchOrtho Evra patch is a thin, peach colored sticker attached to the skin with time-released hormonesPlaced on buttock, stomach, or upper torso for 3
37、 weeks, no patch for the 4th weekAffects the body as combination pills do$30-35 per month99.7% effective, lower if weigh more than 198 poundsThe Ortho Evra patch is worn on the buttock, abdomen, or upper torso for three weeks each month.Hormonal PatchAdvantages:vHigh effectivenessvDoesnt interfere w
38、ith spontaneityvReduces menstrual flow, cramps, PMSvIncreases menstrual regularityvProtection from ovarian & endometrial cancer and ovarian cystsHormonal PatchDisadvantages:vNo STI protectionvSide effects similar to hormonal ringvSkin irritation vChange in vision, discomfort to contact wearersvColle
39、cts lintvNearly impossible to conceal from partnerNo data on cross-cultural useProgestin-Only MethodsDo not contain estrogen and can be used by women that cannot take estrogen, such as those who are breastfeeding & smokersOver time, may eliminate periodsMay cause slight weight gain, bloatedness, & b
40、reast tendernessProgestin-Only MethodsMinipill/POPs (progestin-only pills)vInhibit ovulation and thicken mucusvFewer side effects than combination pillsv92-99.7% effectivevMore expensive than combination pillsvCan cause irregular bleedingvHigher rate of ectopic pregnancies if get pregnant while taki
41、ng the minipillSubdermal ImplantsConstant dose of progestin is time released for up to 5 yearsNorplant is no longer availableJadelle is FDA approved but not marketed in the U.S.v2 silicone cylinders implanted in the forearm in a 10 minute procedure; $500+Implanon is a single-rod approved in 2004Fert
42、ility restored upon removalSubdermal ImplantsSuppresses ovulation, thickens cervical mucus, unreceptive endometrium99.95% effective, decreases after the 3rd yearLower effectiveness rates if over 154 poundsAdvantages:vEffective, long-lasting, reversiblevSimple implantation procedurevNo estrogen side
43、effectsvDecreased menstrual flow, crampingSubdermal ImplantsDisadvantages:vExpensive implantation fees, arm pain, painful removal, possible scarringvIrregular bleeding, crampingvHeadaches, nausea, dizziness, weight change, rash, acne, hair growth or lossvVision problemsPopular in South AfricaHormona
44、l InjectiblesDepo-medroxyprogesterone acetate (Depo-Provera) synthetic progesteroneMost popular non-oral contraceptive Injected into the arm or buttock muscle every 3 months$30-125 per injectionWorks within 24 hoursFertility resumes 10 months after last injectionHormonal Injectibles97-99.7% effectiv
45、eAdvantages:vLong lasting injectionvModerately expensivevNo estrogenvDecreased menstrual flow & crampingvDecreased risk of endometrial & ovarian cancersvAllows for spontaneityHormonal InjectiblesDisadvantages:vOffice visits every 3 monthsvIrregular bleedingvFatigue, dizziness, weakness, headachesvAp
46、petite increasesvDecrease in bone densityvRisk of liver, cervical, and breast cancersvLong return to fertilityLow usage rates in many countriesChemical Methods for Women: SpermicidesSpermicides come as foams, gels, suppositories, creams, foaming tablets, films, and capsulesInserted into vagina with
47、applicator or finger 10-30 minutes prior to intercourse$5-10 over the counterCan also help reduce STIsLikely to see microbicides introduced that will protect from HIV & other STIsChemical Methods for Women: Spermicides71-82% effectiveEffectiveness is reduced if tampons or douches are used within 6-8
48、 hoursFoam is more effective than other varietiesAdvantages:vOver the countervProvide lubricationvSome protection from STIsvNo serious side effectsChemical Methods for Women: SpermicidesDisadvantages:vUsed each timevIncreased postcoital dripvMay produce allergic reactions, skin irritationsvIncreased
49、 risk of urinary tract infectionsvUnpleasant tasteWidely used in some countries, and not used much in other countriesIntrauterine Methods for Women: IUDs and IUSsIntrauterine Device (IUD) vParaGard Copper T can be left in for 12 yearsIntrauterine System (IUS)vMirena IUD that contains time-released p
50、rogestin; can be left in for 5 yearsMost IUD & IUS users are 35 or older$150-300 plus office visitIntrauterine Methods for Women: IUDs and IUSsIUDs & IUSs create a slight infection in the uterus that obstructs sperm mobilityProgesterone from the IUS also affects the endometrium, hampering implantati
