Chapter 11: Contraception and Abortion Flashcards
condom
Sheath made of latex, polyurethane / polyisoprene or animal skin (lambskin) that covers the penis and serves as a barrier to sperm following ejaculation
-Failure rate of 12% associated with improper or inconsistent use
When all age groups were combined, __% used condoms and ___% used oral contraceptives
54.3
43.7
Making these two ways the most common
artificial contraception
Method of contraception that applies human-made device
oral contraceptive
commonly referred to as a birth-control pill, or simply “the pill.”
-Consists of sex hormones
Birth-control pills fall into two major categories:
combination pills and minipills
Combination pills
contain a combination of synthetic forms of the hormones estrogen and progesterone. (The synthetic form of progesterone is called progestin.)
-Inhibit releasing factors, interrupt FSH and LH
-Prevent ovulation
-Direct influence on ovarian follicle
-Estrogen and progestin impact mobility of egg
-Endometrium less developed
-Cervical mucus thickens and is more acidic
(TRUE CONTRACEPTION - no egg to be fertilized)
Minipill
contains only synthetic progesterone (progestin).
-No estrogen
Disadvantage: High level of bleeding irregularities
contains only synthetic progesterone (progestin).
(1) It prevents the ovary from releasing an egg;
(2) it thickens the cervical mucus, making it difficult for the sperm to reach the egg; and
(3) it changes the lining of the uterine wall, making it inhospitable for implantation.
The combination pill is taken for ___ days of the typical 28-day cycle, for seven days, the woman takes no pill, or she takes an inert placebo pill, to maintain the habit of taking a pill a day
21
Seasonale Pill
which is taken for 84 days
-Advantages can include decreased incidence of headaches, bloating, and breast tenderness; improved control of endometriosis symptoms and polycystic ovarian syndrome; and greater convenience because of fewer withdrawal bleeding periods per year
- Disadvantages may include possible delay in recognizing pregnancy, unscheduled bleeding and spotting, and higher costs (though costs are balanced by savings through fewer purchases of tampons, pads, or other sanitary supplies)
Minipills act in two ways
1) They thicken the cervical mucus, to impede the passage of sperm through the cervix
2) they render the inner lining of the uterus less receptive to a fertilized egg.
When it’s used consistently and correctly, the failure rate of the birth-control pill is very low—____% or less, depending on the type of pill
0.5
Under typical use, the failure rate increases to ___%
3
Failures can occur
when women forget to take the pill for two days or more, don’t use backup methods when they first go on the pill, or switch from one brand to another
A woman may temporarily experience reduced fertility after discontinuing oral contraceptives, but their use is not associated with _____
permanent infertility.
-Nearly all women begin ovulating regularly within three months of suspending use
Advantages of oral contraceptives
- nearly 100% effective when it’s used properly
- doesn’t interfere with sexual spontaneity or diminish sexual sensation.
- reduce the risk of pelvic inflammatory disease (PID), benign ovarian cysts, and fibrocystic (benign) breast growths
- regularizes menstrual cycles and reduces menstrual cramping and premenstrual discomfort
Disadvantages of oral contraceptives
- no protection against STIs
- reduce the effectiveness of antibiotics used to treat STIs
- woman must plan to begin using the pill at least several weeks before becoming sexually active or before discontinuing the use of other contraceptives.
- Hormone withdrawal when they dont take an active pill; These include headaches, pelvic pain, bloating, and breast tenderness.
Disadvantages of minipills
- produce vaginal dryness causes decreasing sexual sensation and making sex painful
- Irregular bleeding between menstrual periods, or so-called breakthrough bleeding
- psychological effects. Some users report depression and irritability
Breast cancer and the pill
No likely connection
Woman should avoid the pill if
they’ve had circulatory problems, blood clots, coronary disease, heart attacks, strokes, breast or uterine cancers, undiagnosed genital bleeding, liver tumours, or sickle-cell anemia (because of associated blood-clotting problems)
Emergency Contraception (EC) (AKA morning after, or Plan B)
is taken after unprotected sexual intercourse or when contraception fails, such as when a condom breaks.
- most effective when taken within 24 hours, although it is indicated for use up to 72 hours after unprotected sex
- nausea is a common side effect
Two types of Emergency Contraception
The most popular is two 0.75-milligram tablets of levonorgestrel (progestin only), known as Plan B.
The other, known as the Yuzpe regimen (combined estrogen and progestin), combines multiple birth-control pills.
Plan B
has fewer side effects and is more effective than the Yuzpe regimen.
- Plan B isn’t generally considered an abortion pill, because it can’t end an established pregnancy.
- Plan B works by temporarily stopping the release of an egg from the ovary, preventing fertilization, and preventing a fertilized egg from attaching to the uterine wall.
The Contraceptive Patch
-The patch is thin and measures about 5 centimetres. It looks like a square bandage or a nicotine patch
The patch contains a week’s worth of hormones, which it gradually releases into the bloodstream. The patch is worn weekly for three weeks, then the fourth week is patch-free, to allow menstrual bleeding
The Vaginal Ring
The NuvaRing is a flexible vaginal ring that delivers hormones (a combination of estrogen and progestin) through the skin
- The ring is worn for three consecutive weeks, followed by a ring-free week, to allow menstruation. At the end of the ring-free week, the woman inserts another ring, beginning a new cycle.
- some studies have found an increase in sexual desire, fantasy, and satisfaction among users
- Not use if over 35 or smoke
Injectable Contraception
- Depo-Provera is an injectable hormone solution that’s available by prescription.
- Containing just progestin, it prevents ovulation and is 99.7% effective in preventing pregnancy.
- It’s administered by a needle in the muscle of the arm or buttocks every 12 weeks, preventing pregnancy for three months.
- Prolonged use—two years or more—has been associated with a decrease in bone-mineral density.
Lasts 10-13 weeks
Intrauterine Devices (IUDs) (aka intrauterine systems or IUS)
Small object inserted into the uterus and left in place to prevent conception
- considered the most effective reversible contraceptive methods and have the highest continuation rates
- available in canada: copper IUDs and levonorgestrel-releasing IUD systems
- excessive menstrual cramping, irregular bleeding (spotting) between periods, and heavier-than-usual menstrual bleeding
The Male Condom
- the most common barrier method of contraception
- Latex condoms are effective in preventing pregnancy and reducing the risk of STIs, especially HIV
- One disadvantage of the condom is that it may make sex less spontaneous.
The Female Condom
- The female condom consists of a polyurethane (plastic) sheath that’s used to line the vagina during intercourse
- brand name Reality
- During test trials, the pregnancy rate was estimated to range between 21% and 26%, though it’s estimated to be as low as 5% among cautious users
The Diaphragm
Shallow rubber cup or dome that is filled to the contours of a womens vagina. used with spermicide and it inserted before coitus
- left in place at least six hours after intercourse
- The major disadvantage of the diaphragm is the high pregnancy rate associated with typical use. Nearly one in five typical users (18%) of the diaphragm combined with spermicidal cream or jelly become pregnant during the first year of use
The Cervical Cap
- dome-shaped rubber cup. It comes in different sizes and must be fitted by a health care professional
- smaller than the diaphragm—about the size of a thimble—and is meant to fit snugly over the cervical opening
- spermicide applied inside it
- left in place for at least eight hours after intercourse
Disadvantages: Some women find the cap uncomfortable. Side effects include urinary tract infections and allergic reactions or sensitivities to the rubber or spermicide.
Spermicides
- coat the cervical opening, blocking the passage of sperm and killing sperm by chemical action
- Failure rates vary from 18% with perfect use to 28% with typical use.
- Spermicides should be left in place in the vagina (no douching) for several hours after intercourse
- Spermicides occasionally cause vaginal or penile irritation, and some partners find the taste unpleasant.
The Contraceptive Sponge
- soft, disposable device. Like the diaphragm, it provides a barrier that holds a spermicide, but the spermicide is built in. Unlike the diaphragm, the sponge doesn’t need to be fitted
- The failure rate is about 12% for women who have not had children, and about 24% among women who have.
Fertility-awareness methods, or rhythm methods
- rely on awareness of the fertile segments of a woman’s menstrual cycle. Terms such as “natural birth control” and “natural family planning” also refer to these methods
- rhythm methods seek to predict ovulation so the couple can abstain from intercourse when the woman is fertile.
- for religious or other reasons, prefer not to use artificial means
- No devices or chemicals are used, so there are no side effects.
The Calendar Method
assumes that ovulation occurs 14 days before menstruation. The couple abstains from intercourse during the period that begins three days before day 13 (because sperm are unlikely to survive for more than 72 hours in the female reproductive tract) and ends two days after day 15 (because an unfertilized ovum is unlikely to remain receptive to fertilization for longer than 48 hours). The period of abstention thus covers days 10 to 17 of the woman’s cycle
The Basal-Body-Temperature (BBT) Method
A fertility-awareness method of contraception that relies on predicting ovulation by tracking the women’s temperature during the course of menstrual cycle
-A woman’s basal body temperature sometimes dips slightly just before ovulation, then tends to rise between 0.2°C and 0.4°C just before, during, and after ovulation
The Cervical-Mucus (Ovulation) Method
A fertility-awareness method of contraception that relies on predicting ovulation by tracking the viscosity of cervical mucus
- One problem with the mucus method is that some women have difficulty detecting changes in the mucus discharge
- Such changes may also result from infections, certain medications, and contraceptive creams, jellies, and foams. Sexual arousal may also induce changes in viscosity.
Viscosity
Stickiness, consistency
Peak days
The days during the menstrual cycle when a women is most likely to be fertile
Withdrawal (aka pull and pray)
-method is most commonly used among younger women
Permanent methods (aka Sterilization)
Surgical procedure that render people incapable of reproduction, without affecting sexual activity
-Sterilization is nearly 100% effective
Vasectomy
- permanent method of contraception used by men
- Each vas is cut, a small segment is removed, and the ends are tied off or cauterized (to prevent them from growing back together)
- sperm can no longer reach the urethra. Instead, they’re harmlessly reabsorbed by the body.
vasovasotomy
the ends of the vas deferens are sewn together, and in a few days they grow together. Estimates of success at reversal, as measured by subsequent pregnancies, range from 16% to 79%
Tubal Ligation (aka tubal sterilization)
Most common method of permanent contraception among women
-fallopian tubes are surgically blocked, to prevent the meeting of sperm and ova
The two main surgical procedures for tubal sterilization are
minilaparotomy and laparoscopy
minilaparotomy
Kind of tubal sterilization in which a small incision is made in the abdomen to provide access to the fallopian tubes
laparoscopy (aka belly-button surgery)
Medical procedure in which a long, narrow tube (laparoscope) is inserted through an incision in the navel, permitting visual inspection of organs in the pelvic cavity
colpotomy
the fallopian tubes are approached through an incision in the back wall of the vagina.
hysterectomy
-major operation that’s commonly performed because of cancer and other diseases of the reproductive tract
Surgical removal of the uterus
Douche
Application of a jet of liquid to the vagina as a rinse
-Regular douching can also alter the natural chemistry of the vagina, increasing the risk of vaginal infection
abortion (aka induced abortion)
Purposeful termination of a pregnancy before the embryo or fetus is capable of sustaining independent life
Historical and Legal Perspectives of Abortion
Attitudes toward abortion have varied across cultures and eras. Abortion was permitted in ancient Greece and Rome. The Bible doesn’t specifically prohibit abortion
Abortion was illegal in Canada until _____
1969
Abortion Attitudes in Canada
77% of Canadians said abortion should be permitted
Canadian Abortion Statistics
only a minority of hospitals perform abortions today, and these are typically in urban areas
-It is estimated that about 30% of Canadian women have at least one abortion in their lifetime
Methods of Abortion
Vacuum Aspiration
Dilation and Evacuation (D&E)
Vacuum Aspiration (suction curettage)
Removal of the uterine contents via a suction machine
-most common, safest, relatively painless and inexpensive
Dilation and Evacuation (D&E)
Removal of the uterine contents via a suction tube and forceps.
-The uterine wall may be scraped, to ensure that the lining has been fully removed
Abortion Drugs
RU-486, or mifepristone
-induces early abortion by blocking the effects of progesterone, the hormone that stimulates proliferation of the endometrium and allows implantation of the fertilized ovum
Psychological Consequences of Abortion
may experience a range of negative emotions, including fear, anger that she directs inward (“How could I let this happen?”), guilt (“What would my parents think, if they knew I was having an abortion?”), and ambivalence (“Will I regret it, if I have an abortion? Will I regret it more if I don’t?”).
-Women with greater support from their male partners or parents tend to show more positive emotional reactions following abortion
First attempts at birth control
1900-1100 BCE
-Concoction of crocodile dung in fermented mucilage with honey and sodium bicarbonate smeared on the vagina
Controversies over birth control
Parent / child relationship is emotional and can complicate this
Roman catholic church only approves _______
rhythm method (form of abstinence)
Birth control is appropriate to:
Prevent illness (mothers opinion)
Avoid deformities
Prevent unwanted pregnancy
Limit population growth
The law used to restrict prescription of birth control and abortion for those under ______ without parental approval
16
The pill regimen
Take at the start of menstruation
- withdrawal bleeding for 3-4 days after last active pill (21 active pills. 7 dummy pills = 28)
- Protection starts after 1 week of taking the pill
Withdrawal bleeding (Lecture)
You can control the timing of withdrawal bleeding
- bleeding begins 3-4 days after last active pill
- need to take at least 14 active pills to have withdrawal bleeding
- You can skip dummy pills altogether to avoid bleeding end of second package
- Take the pill around the same time every day
Missing one birth control pill
Double up as soon as you remember (you are still protected)
Missing two pills
Double up for the next 2 days and finish cycle
-and use another birth control method as you may not be protected
Vomiting within 4 hours of taking birth control pill
Drinking too much and throwing up
-take another pill
Severe diarrhea for 2 days or more
double up on the pills, finish cycle, and use another method
Factors that can diminish effectiveness of the pill
- Barbiturates (sleeping pills)
- Butazolidin (arthritis)
- Miltown and Equanil
- Dilantin
- Rifampin
- Antibiotics
- Alcohol metabolism slowed down so you stay drunk longer
Advantages to the pill
99.9% effective, but 6% user failure
Potent among young people and decreases with age
Advantages to the pill
Responsibility
Allows for dissociation of contraception from sex act
No need to decide beforehand or have items on hand
Advantages to the pill
Ease and convenience
Pill mentality: when in doubt, pop a pill
-But some do not like taking pills and drugs
Advantages to the pill
No break in the flow of sex
example: wait a sec, let me put on my condom or let me put in my diaphragm
Sense of spontaneity with the pill as it is already taken
Advantages to the pill
Physical advantages
- Regularize menstrual cycle
- Relief from dysmenorrhea, ance, PMS, decreased period flow
- Decrease facial hair
- Increase breast size
Advantages to the pill
Reduces the risk of some illnesses
67% lower risk of endometrial cancer after 8 years of pill use
- 54% lower risk of ovarian cancer (pill does not cause cancer)
- Reduces likelihood of fallopian tube infection and pelvic inflammatory disease
- Fewer benign ovarian cysts and breast disease
Disadvantages to the pill
Provides no protection against sexually transmitted infections (STI’s)
Prescription drug / cost: it costs money
-fear of parents being told if they are young (but this is old)
Selection of pill is important since the brand of choice can avoid disadvantages
Women with low blood estrogen can tolerate higher dosage of estrogen than those with higher levels
How to tell if someone has low levels of estrogen
Small breasts, scanty menses, a tall / thing frame, facial hair (blood acidity level can directly answer this)
Disadvantages to the pill etc
Thrombophlebitis (blood clot in veins)
-risk of dying 1.4-4 per 100k on the pill over 35 years of age
Risk of fatal heart attack for 40-44 years old varies by degree of smoking
Smoker + pill = 59-83 per 100,000 (>15 cigs a day)
Pill does not increase risk of cardiovascular disease in non smokers primarily because of low dose of estrogen
Can increase hypertension (blood pressure)
Avoid the pill is (especially for those over the age of 40 and a smoker)
- History of phlebitis
- Previous embolism
- Painful varicose veins
- Cardiac problems
- blood type A individuals are more susceptible whereas those with type O are more resistant to thromboembolism
Those with breast cancer should
NEVER TAKE THE PILL
40-50% of these cancers worsen under estrogen treatment
Women on pill are more likely to have sex
without a condom
and with more people
Lidegaard and colleagues (201)
Tracked over 1,000,000 danish women over 14 years
Ages 15-34
Women with depression prior to 15 were excluded
Positive link between use of hormonal birth control and subsequent depression diagnosis and use of anti-depressants
Depression
40% risk of increase in depression after taking pill for 6 months
Combination pill: 1.2 fold increase
Minipill: 1.3 fold increase
Findings do not imply that birth control alone causes depression
Pills death rate
22-45 per million users per year
Death rate for pregnancy and childbirth
Canada 110 per million, Usa 280, China 320
Condoms (lecture)
- Very popular due to lack of STI’s
- safer sex
- 50% of women aged 20-34 used condoms with last intercourse
Lambskin condoms
are not good for STI’s, especially HIV
Side-effects to condoms
Some have allergy to latex (polyurethane alternatives)
Advantages of condoms
- Prevent most STI’s except herpes or warts
- relatively inexpensive
- Easy to get and use (no prescription)
- One size fits all
- Easily reversible option
Disadvantages to condoms
Interrupts spontaneity
-forethought and motivation (have it with you and actually put it on)
-Sensation reduced (may interfere with erection)
Unpleasant taste - flavoured
-Water-based lubrications only, not oil-based
-Males responsibility (male must cooperate)
-Can expire
Female condom (lecture)
Some protection against STI (not as good as male condoms)
Can be inserted before intercourse
Wegner et al (2018)
Tactics young women use to resist condom use when a partner wants to use one
-women most likely to use risk-level reassurance (37.9%) and seduction (33.2%)
-Higher frequency and quantity of alcohol consumption, lower perceived risk of STI’s
Condom use ____ with level of relationship commitment, whereas ratings of pleasure ______
Decrease condoms
Increase pleasure
