Emergency Contraception

1. Emergency Contraception • Morning After Pills • Must be 17 years of age or older to purchase without a prescription 1. Preven ($10-$70.00) 2. Plan B ($45.00 or Sliding Scale Costs) 3. Levonorgestrel ($50.00 -$100.00)

2. Medical Abortion • RU-486 • Mifepristone (1st pill) • Inhibits progesterone • 3 Days later • Misoprostol (2nd by mouth or vaginal suppository) • Promotes uterine contractions * May be used up to seven weeks after implantation (95% effective)

3. Surgical Abortions • Early Vacuum Aspirations /Suction (D&C) • 90% of all abortions • Performed 4-6 weeks • Dilation & Evacuation • 7% of all abortions • Performed 12-20 weeks • Insertion of a medical drug, which dilates the cervix

4. Surgical Abortion • Induction Method • Major Procedure • Insertion of a saline solution, which starts contractions • 1% of all abortions • Medical Extraction • Rare procedure

5. Contraceptive History History

6. Ancient Birth Control MethodsBeaver-Testicle Tea

7. Dances, Amulets, Rituals & Myths • Squatting or kneeling to provoke sneezing • Jumping backwards seven times • Leather pouch containing a cat’s liver on the left foot • Spitting in a frogs mouth three times • Inserting a finger into the vagina and “swishing it around” after intercourse

8. Dances, Amulets, Rituals & Myths • Soranus - Ancient Greek Doctor of Gynecology • Determined that women were fertile during ovulation and promoted the rhythm method. Unfortunately, he assumed that ovulation occurred during menstruation.

9. Spermicides, IUDs, Pessaries, & Douches • Dried cow, elephant, & crocodile dung mixed with honey • Ground dates, acacia tree bark, & honey blended into a paste • Dried fish or cotton soaked with lemon • Half lemons with the juice squeezed out • Glass or metal diaphragms

10. Spermicides, IUDs, Pessaries, & Douches • IUDs invented by Arabs would placed pebbles in the uteruses of their camels • 1920 – German gynecologist Ernest Grafenberg developed the first IUD for humans, which was made from silkworm gut and coiled wire. • Seaweed, leaves, wooden blocks, and apricot pits were also used to block the cervix • Vinegar injected into the vagina

11. Douche French term for soak or wash Douche Bag Douche Can

12. Coitus Interruptus • “Pull out” or withdrawal method • When a man withdraws his penis from a woman prior to ejaculation • 80% Effective • Couples in monogamous relationships who do not have to worry about STIs or caring for a child.

13. Breastfeeding • Suppresses fertility • Breastfeeding can provide up to 98% effective contraception if three criteria are met: - The mother has not experienced the return of her menstrual periods - The mother is fully or nearly fully breastfeeding - The baby is less than six months old.

14. Evolution of the Condom • Latin word "condus" which means "vessel” • Oiled silk paper, linen sheaths, sheep intestine, snake skin leather, or very thin hollow horn

15. Condoms Today • Condoms can be found in a variety of shapes, sizes, colors, flavors and textures. Many condoms also contain lubricants, spermacides and a reservoir tip. • Condoms that play music when they break • “Dixie,”“The Anniversary Waltz,”“Happy Birthday to You,” & the “1812 Overture”

16. Steps to Success 1. Sexual Arousal 2. Erection 3. Leave room at the tip & squeeze out any air 4. Roll on condom 5. Intercourse 6. Hold onto the base/rim of the condom 7. Withdrawal the penis 8. Orgasm 9. Loss of erection 10. Relaxation

17. Barrier Methods

18. Male Condom • Made of latex or polyurethane • Single use barrier method that blocks sperm from entering the female • Approximately 86%-97% effective • Some protection against STIs • Over the counter • Inexpensive • May leak, break, or interfere with spontaneity

19. Female condom • Rubber sheath with a flexible ring that is inserted in to the female • Single use barrier method that blocks sperm from entering the female • 79%-95% effective • Some protection against STIs • Over the counter • May leak, break, or interfere with spontaneity • More difficult to use

20. What You Need to Know About Nonoxynol-9 • N-9 is the active ingredient in all of the over-the-counter (OTC) spermicidal products available in the U.S. and has been used for pregnancy prevention since the 1950s. An Advisory Review Panel of the Food and Drug Administration (FDA) has deemed N-9 a safe and effective contraceptive.

21. N-9 • Mechanism of Action • N-9 is the active ingredient in all OTC spermicidal products in the U.S. N-9 is a chemical detergent that damages sperm cell membranes, killing the cells. • N-9 is marketed and sold as a spermicidal contraceptive product in several different formulations, including: • - Suppositories - Foam - Film - Gel - Cream

22. N-9 USE • Diaphragms and cervical caps are FDA approved for use in conjunction with spermicidal gels and creams. Also, some condoms include a spermicidal lubricant.

23. N-9 USE RECOMMENDATIONS FROM WHO & CDC • N-9 can be used as a contraceptive, alone or in combination with a cervical barrier method, and among women at low risk of HIV/STI infection (Use the product no more than once daily.) • N-9 should not be used for the purpose of HIV/STI prevention. • N-9 should not be used for contraception by women at high risk of HIV infection.

24. N-9 USE RECOMMENDATIONS FROM WHO & CDC • Condoms with N-9 should not be promoted for disease prevention. (However, it is better to use N-9-lubricated condoms than no condoms at all.) • N-9 should not be used rectally.

25. Contraceptive foam, film, suppositories • Available over the counter • Must be inserted close to time of intercourse • Limited or no STI protection • 74%-94% effective

26. Diaphragm • Dome-shaped rubber disk that covers the cervix so sperm cant reach the uterus • Best if used with a spermicide • 80%-94% effective • Inserted before intercourse, left in for at least 6 hours • Can be used multiple times • Uncomfortable to use • Has to be fitted • Limited protection against STDs

27. Cervical Cap • Soft rubber cup with a round rim which fits around the cervix • 80%-94% effective • Hard to insert • Can remain in place for up to 48 hours without being removed

28. Hormonal Contraception

29. IUD (Intrauterine device) • A T-shaped device inserted into the uterus by a doctor • Can last from 1 to 10 years • About 2 in 100 pregnancies a year • May result in ectopic pregnancies in the fallopian tubes

30. Combination Pill • Effectiveness • Adult Users 99.7% • Actual effectiveness: 92 % • Forget to take a pill daily • Eating disorders

31. Combination Pill • Benefits – regular cycle every 28 days, reduces cramps and flow, reduces risks of uterine and ovarian cancer and other diseases • Side Effects – nausea, headaches, weight gain, fluid retention, bleeding between periods, depression, mood changes, changes in vision, dizziness, yeast infections, and smokers increase chances of stroke and heart attack • Who should not use it – heavy smokers, suffer from severe depression, get migraines, have had blood clots, cancer or blood diseases • Cost – Depends on insurance coverage

32. Extended Cycle Pill • Prevents ovulation, changes lining, difficult for fertilized ovum to implant, thickens the cervical mucous • Only four period per year • 99% effective • Advantage for women who suffer from severe cramping or PMS • Side Effects – irregular bleeding, fluid retention (hands and feet), raise blood pressure, nausea, vomiting, headache, vision, appetite, depression infections and allergic reactions • Who should not use it – same as mini and combo pill users • Cost - $100 to $120 for three months

33. Nuva Ring • It is a small, flexible ring that is inserted into the vagina once a month • It is left in place for three weeks and taken out for the remaining week • The Ring releases synthetic estrogen and progestin to protect against pregnancy for one month.

34. Vaginal Ring • Small, flexible, plastic ring that is about 2 inches wide • Placed in the vagina each month and releases hormones similar to those in birth control pills • Prevents ovulation, removed after three weeks, after having a menstrual period insert a new one • Effectiveness – 98-99% • Benefits – regular menstrual period, shorter and lighter flow • Side effects – bleeding between period, nausea, headaches, weight gain or loss, mood changes

35. Vaginal Ring • Who should not use it • Smokers, High Blood Pressure, CVD, liver disease, cancer • Cost - $30-35 a month

36. Ortho Evra (patch) • Patch worn on the lower abdomen or on the upper body • Releases progestin and estrogen into the bloodstream • Less effective for women weighing more than 198 pounds • New patch applied once a week for 3 weeks, 4th week no patch is worn so female can have her menstrual period

37. Skin Patch • Hormones are released to prevent ovulation from occurring, mucus thickens, ovulation returns three months after the patch is last used • Effectiveness – 99% in women who weigh 198 pounds or less • Other benefits – menstrual cycle regular, shorter and lighter flow • Side effects – bleeding between periods, nausea, headaches, weight gain or loss, mood changes • Who should not use them – Same as others, include history of blood clots • Cost - $30-$35 a months

38. Norplant (Implant) • 6 matchstick sized rubber rods implanted under skin of the upper arm • Steadily releases a contraceptive steroid levonorgestrel • Very effective. About 1 in 100 pregnancies • Lasts for 5 years • Reversible • Expensive • No STD protection

39. Depo-Provera (injection) • Injectable progestin that prevents ovulation • Prevents sperm from reaching egg and keeps egg from implanting in the uterus • Less than 1 out of 100 pregnancies • 1 injection every 3 months • Not safe against STDs • Fertility may take a few months to get back to normal

40. MISCELLANEOUS

41. WITHDRAWAL • pregnancy is possible if sperm are ejaculated on or into the vagina • not effective against sexually transmitted infections

42. WITHDRAWAL • ADVANTAGES • can be used when no other method is available • POSSIBLE DISADVANTAGES • requires great self-control, experience, and trust • not for men who ejaculate prematurely • not for men who don’t know when to pull out • not recommended for teens

43. No MethodNo Protection • Free • No protection against pregnancy • No protection against STDs

44. ABSTINENCE • 100% EFFECTIVE • ADVANTAGES • No medical or hormonal side effects • Easy to use • Prevents sexually transmitted infections • 100%FREE • POSSIBLE DISADVANTAGES • many people find it difficult to abstain from sex • many people fail to use protection when abstinence ends • A commitment required by both people • Peer pressure

45. STERILIZATION • ADVANTAGES • permanent protection against pregnancy • no lasting side effects • no effect on sexual pleasure • protects women whose health would be seriously threatened by pregnancy • POSSIBLE DISADVANTAGES • risks of minor surgery if incision is made • some people later regret not being able to have children • not usually reversible if you change your mind • rarely, tubes reopen, allowing pregnancy to occur

46. STERILIZATION • Tubal sterilization — intended to permanently block woman's tubes where sperm join egg • Vasectomy — intended to permanently block man's tubes that carry sperm • 99.5-99.9% EFFECTIVENot effective against sexually transmitted infections — use latex or female condoms to reduce the risk.

47. STERILIZATION • Tubal sterilization • bruising if incision is made • very rare injury to blood vessels or bowel • pregnancies that rarely occur are more likely to be ectopic (in a fallopian tube) • Vasectomy • infection or blood clot in or near the testicles • temporary bruises, swelling, or tenderness of the scrotum • sperm leakage may form temporary small lumps near testicles

48. STERILIZATION • COST$2,000-$6,000/ tubal sterilization240-$520/ vasectomy(Vasectomy costs less because it is a simpler procedure that can be done in the clinician’s office.)

49. OUTERCOURSE • NEARLY 100% EFFECTIVE • pregnancy is possible if sperm are ejaculated on or inside the vagina • reduces the risk of many sexually transmitted infections — unless body fluids are exchanged through unprotected oral or anal intercourse.

50. Outercourse • ADVANTAGES • no medical or hormonal side effects • may prolong sex play and enhance orgasm • can be used when no other methods are available