Chapter 11 Contraception

1. Chapter 11Contraception

2. Historical and Social Perspectives • Evidence of contraception since the beginning of recorded history • U.S. contraceptive efforts • 1800s Comstock laws • 1915: Margaret Sanger's • U.S. Supreme Court rulings • Griswold vs. Connecticut • Eisenstadt vs. Baird

3. Historical and Social Perspectives (cont.) • Contemporary issues • planning for wanted children • physical health of mother • insurance coverage of contraceptives • population growth • cultural gender-role expectations • wide diversity of views among cultures and religious leaders

4. Historical and Social Perspectives (cont.) Fig. 11.1 Average number of children, by mother’s education level and race/ethnicity in the United States.

5. Sharing Responsibility and Choosing a Birth Control Method • How to share responsibility • ask about BC before intercourse • read & discuss options together • attend a class or clinic together • share expenses

6. Choosing a Birth Control Method • Choosing a BC method • consider effectiveness and cost • consider ease of use and side effects • characteristics of ineffective use • guilt • negative attitudes about sex • self-view

7. Contraceptive Effectiveness • Failure Rate • consistent use failure rate • typical use failure rate

8. Contraceptive Effectiveness Fig. 11.2 Factors to consider when choosing a birth control method.

9. Choosing a Birth Control Method (cont.) • Hormone-Based Contraceptives • combination pill • Triphasic pill • Constant-dose • Progestin-only pill

10. Choosing a Birth Control Method (cont.) Table 11.3 Possible side effects with the birth control pill.

11. Choosing a Birth Control Method (cont.) • Vaginal ring • Transdermal patch • Depo-Provera

12. Choosing a Birth Control Method (cont.) • Barrier Methods • Condom: sheath fits over erect penis

13. Choosing a Birth Control Method (cont.) Fig. 11.5b A condom with a reservoir tip does not need to be twisted at the top as it is put on the penis.

14. Choosing a Birth Control Method (cont.) • Barrier Methods (cont.) • Female condom: sheath fits in vagina

15. Choosing a Birth Control Method (cont.) Fig. 11.6b A female condom consists of two flexible polyurethane rings and a soft, loose-fitting polyurethane sheath

16. Choosing a Birth Control Method (cont.) • Vaginal spermicides: • foam • sponge • suppositories • creams • film

17. Choosing a Birth Control Method (cont.) • Barrier Methods (cont.) • Diaphragm: latex dome • Cervical cap • Fem Cap • Lea’s Shield

18. Choosing a Birth Control Method (cont.) • Barrier Methods (cont.) • Diaphragm: latex dome

19. Choosing a Birth Control Method (cont.) Fig. 11.8e These figures illustrate the insertion and checking of a diaphragm.

20. Choosing a Birth Control Method (cont.) • Intrauterine Devices • affects sperm motility & viability • thicken cervical mucous • alter endometrial lining • impair tubal motility

21. Choosing a Birth Control Method (cont.) • Emergency contraception • Hormonal: birth control pills taken within 72 hours of unprotected intercourse • Copper-T IUD: inserted up to five days after unprotected intercourse • Access issues

22. Choosing a Birth Control Method (cont.) • Fertility Awareness Methods • Standard days method • Mucus method: based on cyclical changes • Calendar method: self- knowledge of fertility • Basal body-temperature

23. Choosing a Birth Control Method (cont.) • How to compute basal body temperature Fig. 11.11 An example of a basal body temperature during a model menstrual cycle.

24. Choosing a Birth Control Method (cont.) • Sterilization (female) • tubal sterilization • Minilaparotomy • Laparoscopy • Culpotomy • Transcervical sterilization

25. Choosing a Birth Control Method (cont.) • Sterilization (female) Fig. 11.2 Female sterilization by laparoscopic ligation. Front view shows tubes after ligation.

26. Choosing a Birth Control Method (cont.) • Sterilization (cont.) • Male vasectomy Fig. 11.14 Male sterilization by vasectomy.

27. Less than Effective Methods • Nursing • amenorrhea is common for a brief period after birth while breastfeeding • 80% ovulate before first period • unreliable

28. Less than Effective Methods (cont.) • Withdrawal before ejaculation • difficult to judge when to withdraw • anxiety may lower pleasure • Cowper's gland fluid may carry sperm • any sperm on vulva may travel into vagina/uterus; unreliable

29. Less than Effective Methods (cont.) • Douching • sperm reach uterus in 1-2 minutes • douching may speed sperm along • irritates vaginal tissue • very ineffective

30. New Directions in Contraception • For men • Testosterone & progestin may lower sperm count • GRH inhibitor (LHRH agonist) may lower number & motility of sperm • Medications used for other purposes

31. New Directions in Contraception (cont.) • For women • implants • new IUDs • new female condoms • spermicides with microbicides • immunocontraceptives

32. New Directions in Contraception (cont.) • For women (cont.) • one-sized & disposable diaphragms & cervical caps • spermicides containing microbicides, developed to prevent STD’s • IUDs with different shapes & hormones