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Condom

Condom. The Advantages: Easily available Safe and inexpensive Easy to use No side effects Light, compact and disposable Provides protection against STDs & cervical cancer The Disadvantages: It may slip off or tear during coitus due to incorrect use,

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Condom

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  1. Condom The Advantages: • Easily available • Safe and inexpensive • Easy to use • No side effects • Light, compact and disposable • Provides protection against STDs & cervical cancer The Disadvantages: • It may slip off or tear during coitus due to incorrect use, • Interferes with sex sensation locally • Can cause irritation or allergic reaction.

  2. IUCDs • Non-medicated: • Lippes loop, spirals, coils, rings • Medicated: • Copper, silver core, Multiload Devices • Release of hormones • Progestasert • Levonorgestril

  3. Action of IUCDs • Foreign body, cellular and biochemical changes in endometrium - impair viability of gametes • Hormone releasing devices increase viscosity of the cervical mucus • High level of progesterone – unfavorable for implantation.

  4. Advantages of IUCDs • Most effective method • Simple, in a few minutes • Long acting, may be for 5-10 years • Inexpensive • Reversible • Lower incidence of side-effects, free of metabolic side effects

  5. Advantages of IUCDs • Highest continuation rate • No need for continued motivation • Easier to fit even in nulli parous women • Better tolerated by nulli para • Effective as post-coital contraceptive

  6. ABSOLUTE C/I OF IUCDs • Suspected pregnancy • Pelvic inflammatory diseases • Vaginal bleeding of undiagnosed aetiology • Cancer of the cervix, uterus or adnexia • Previous Ectopic pregnancy

  7. RELATIVE C/I OF IUCDs • Anaemia • Menorrhagia • H / O PID since last pregnancy • Purulent cervical discharge • Malformations, • Fibroids • Unmotivated client or person

  8. The ideal IUD candidate • Who has borne at least one child • Has no history of pelvic disease • Has normal menstrual periods • Is willing to check the IUD tail • Has access to follow-up and treatment of potential problems

  9. TIME OF INSERTION OF IUCD • Any time during reproductive age • During menstruation or within 10 days of the beginning of menstrual cycle • First week after delivery-immediate postpartum insertion • Better time is at 6-8 weeks after delivery-post puerperal insertion

  10. Side effects of IUCD • 1. Bleeding, greater loss, prolonged period • 2. Pain • 3. Pelvic infection • 4. Uterine perforation • 5. Pregnancy • 6. Ectopic pregnancy • 7. Expulsion • 8. Fertility after removal • 9. Cancer and teratogenesis • 10. Mortality

  11. HORMONAL CONTRACEPTIVES • Most effective spacing method • 100% effective • Synthetic estrogens • Ethinyl oestradiol • Mestranol • Synthetic progesterone • Pregnanes • Oestranes • Gonanes

  12. Classifications A. Oral Pills 1. Combined pill 2. Progestogen only pills (POP) 3. Post-coital pills 4. Once-a-month (long-acting) pill 5. Male pills B. Depot (slow release) formulations 1. Injectables 2. Subcutaneous implants 3. Vaginal rings

  13. Combined pills • Major spacing method • 30-35 microgram of synthetic estrogen • 0.5-1.0 microgram of progestogen. • Pill is given orally for 21 consec. Days, starting on 5th day of menstrual cycle • Pill is taken every day at a fixed time

  14. POP • Contains only progesterone • Small doses throughout the cycle • For those women- c/I combined pills

  15. Post coital contraception • Morning after • Within 48 hours of unprotected intercourse • IUCD • Hormonal: high doses of estrogen and progesterone • 2 pills immediately & 2 pills after 12 hours

  16. Once a month pill • Long acting estrogen • Short acting progesterone

  17. Mode of action of OCP • Prevents the release of ovum from ovary by locking pituitary secretion of gonadotropin. • Progesterone only pills renders the mucus thick, scanty that inhibits sperm penetration. • Progesterone also inhibits tubal motility • OCP are 100 % effective if taken regularly • Certain drugs affects the effect of OCP

  18. Beneficial effects • 100 % effective contraception • Protection against • Benign breast disorders • Ovarian cysts • Iron deficiency anaemia • PID • Ectopic pregnancy • Ovarian cancer

  19. Adverse effects of OCP • Cardiovascular effects • Carcinogens • Metabolic effects • Elevation of BP, decrease in high density lipoprot. • Blood clotting, increase sugar level • Increase in atherogenesis • Increase in myocardial infarction & stroke • Others: • liver disorder, lactation, fertility, ectopic preg. • Breast tenderness, weight gain, headache, • Bleeding disturbances , Foetal development

  20. Contraindications of OCP • Cancer of breast & genitals • Liver disease • Cardiac diseases, DVT • Congenital hyperlipideamia • Undiagnosed abnormal uterine bleeding • Age above 40 & smoker at age 35 • Hypertension, migraine, headache, epilepsy, diabetes, gall bladder disease • Nursing mother in first 6 months

  21. Checklist for Oral Contraceptives • above 40 years of age • above 35 years of age & heavy smoker • H / O Seizures • Severe pain in the calves or thighs • Symptomatic varicose veins in the legs • Severe chest pains, shortness of breath • Severe headache • Visual problems

  22. Lactating less than 6 months • Inter menstrual bleeding • Bleeding after sexual intercourse • Amenorrhoea • Abnormally yellow skin & eyes • High Blood pressure • Mass in the breast • Oedema - legs

  23. Depot formulations • Injectables: • DMPA 150 mg every 3 months • 99%, safe, effective, acceptable during lactation. • wt. gain, irregular menstrual bleeding • prolonged infertility • NET-EN 300 mg 2 months • Inj. During first 5 days of menstruation • Deep intramuscular into gluteus maximus. • Never message • ± 2 weeks

  24. Depot formulations • Sub dermal implants • Norplant • 6 silicone rubber capsules containing 35 mg of Levonorgestril • Implanted under the skin of left upper arm

  25. Terminal Methods • Permanent method • Females 90 – 95% • Males 5 – 10% • One time method, no sustained motivation • Risk of complications is rare

  26. Post-operative advice • He is not sterile immediately after the operation • At least 30 ejaculations may be necessary before the seminal examination is negative • To use contraceptives until aspermia has been established • To avoid taking bath for at least 24 hours after the operation. • To wear a T-bandage or scrotal support for 15 days and to keep the site clean and dry • To avoid cycling or lifting heavy weights for 15 days • Remove stitches on the 5th day after the operation.

  27. MCQ • Thread attached with IUCD is meant for • Anti inflammatory effect • Device can be pulled out when needed • Shape of loop • Assurance of loop’s presence • Blocking of sperm penetration

  28. MCQ • Multi load contains • Copper • Zinc • Silver • Gold • Progesterone

  29. MCQ • OCP is not c/I in • Pregnancy • Lactation • Fibroid • Overweight • A woman having 2-3 children

  30. MCQ • Most effective contraceptive method for spacing between pregnancies is • IUCD • Oral pills • Condom • Vasectomy • Abstinence from sexual intercourse

  31. MCQ • Estrogen content of OCP causes all except: • Myocardial infarction • Venous thrombo - embolism • Decreased quantity of breast milk • Increased blood sugar • Breast tenderness

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