Contraception

Question 1

Male condom

Answer 1

• What is it/How does it work? : - disposable sheath places over penis before sex prevents semen from entering the vagina
• Advantages: - cheap/ readily accessible, reliable when properly used, STD protection, no side effects of hormone-based contraception, fully/immediately reversible
• Disadvantages: - male must maintain erection for duration of condom use, may decrease erotic sensation
  perfect use failure rate: - 2%

Question 2

Female condom

Answer 2

• What is it/How does it work?: polyurethane plastic pouch inserted into the vagina, condom covers the entirety of the vagina & adjacent parts of the vulva
  -Advantages: - only female controlled contraceptive to offer STD protection, allows for spontaneity, doesn’t require male to maintain erection, easily & immediately reversible, can be used for anal sex
• Disadvantages:- may decrease erotic sensation/ may generate distracting noise, possibility of inserting penis unwillingly outside of condom, possibility of entire condom being drawn into vagina
  perfect use failure rate: 5%

Question 3

Diaphragms

Answer 3

• What is it/How does it work:- dome shaped latex or rubber barrier placed over the cervix, preventing sperm from entering the cervix
• Advantages:- more spontaneity than condoms(can be inserted beforehand), does not usually affect sensation, relatively cheap, long term use associated with a lower risk of cervical cancer
• Disadvantages:- inconvenient (needs to be fitted by professional), occasionally dislodged during sex, less STD protection that condoms, spermicide can cause irritation
  perfect use failure rate: 6%

Question 4

Cervical cap

Answer 4

• what is it/How does it work?:- small rubber or plastic cap that holds like a suction cup onto the cervix, spermicide is places on the inside of the cap prior to insertion
• Advantages:- similar to those of the diaphragm but with some differences:
  
  • cervical cap as an alternative to the diaphragm ( as some women have difficulty using a diaphragm)
• Disadvantages:- similar to those of the diaphragm but with some differences
  
  • failure rate is higher, especially in W who have had children , difficult to insert properly, can be dislodged during sex
    perfect use failure rate: 18%

Question 5

Spermicides (foams, creams, & suppositories)

Answer 5

• what is it/ how does it work? :- chemical that kills sperm, places into the vagina no more than 2 hours ahead of time for which it must remain for at least 6 hours afterwards
• Advantages:- available w/o a prescription, inexpensive, few side effects(allergic reactions/ irritation from frequent use)
• disadvantages:- failure rates are high when used as a solo method (25%), best used in combo with barrier methods, no significant STD protection
  perfect use failure rate: 9-18%

Question 6

Intrauterine Devices (ParaGard/Copper T & mirena)

Answer 6

• what is it/how does it work?: a T shaped device placed in uterus, causes low grade inflammation of the uterus that interferes with sperm transport
• advantages: as effective as female sterilization, few side effects/ no systematic hormonal side effects, convenient/ non-intrusive( only have to check thread once a month), reversible immediately on removal, significant protection against endometrial cancer
• Disadvantages: one time cost is fairly high ($200-$600), although a money saver in the long run, cramping/irregular bleeding may occur, no STD protection, increase likelihood of PID and ectopic pregnancy
  perfect use failure rate: 0.2-0.6%

Question 7

combination pill (constant dose/monophasic-all pills contain same drug dose) (triphasic-varies dose of estrongens & progestins)

Answer 7

• what is it/how does it work?: contains estrogen & progestin, prevents ovulation & causes cervix to secrete thick mucus to prevent sperm from entering uterus
• advantages: extremely reliable w/ perfect use, convenient & reversible, may have significant health benefits (decrease risk of ovarian/ endometrial cancer), lighter menstrual flows
• disadvantages: no STD/HIV protection, remember to take pill everyday, risk for W who are over 35 & smoke is particularly high, as well as for heavier W, nursing mother shouldn’t use
  perfect use failure rate: 0.3%

Question 8

progestin-only pills

Answer 8

• what is it/how does it work?: contains a low dose of progestin & no estrogen, alters cervical mucus (making it viscous/hostile to sperm transport), interferes w implantation in endometrium
• advantages: similar to combo pills, lack estrogenic side effects of combo pills, can be used by breastfeeding mothers
• disadvantages: similar to combo pills w/o the same side effects, disrupts menstrual cycles for W who were previously regular
  perfect use failure rate: 0.3%

Question 9

depo-provera

Answer 9

• what is it/ how does it work?: non oral hormone-based contraceptive, slow-release form of progestin
• advantages: requires an injection every 3 months, lack of estrogenic side effects, cessation of menstrual periods may appeal to W with menstrual problems
• disadvantages: repeated medical visits needed, no STD/HIV protection, irregular/prolonger bleeding, fully reversible but once injected cant be removed & may take 3 months for side effects to go away, loss of bone density
  perfect use failure rate: 0.3%

Question 10

Transdermal patches (ortho erva)

Answer 10

• what is it/how does it work?: patch containing hormones that diffuse slowly into the body through the skin, W uses one patch every week for 3 weeks, then one week without patch
• advantages: similar to that of combo pills with a few differences:
  
  • easier to use, compliance is better, increase in spontaneity
• disadvantages: local skin reactions, patch may work loose or fall off, not advised for smokers over 35, 2X more expensive than combo pills, increase risk of heart attack
  perfect use failure rate: 0.3%

Question 11

vaginal rings

Answer 11

• what is it/how does it work?: ring placed in vagina that releases a combo of estrogen & progestin, ring in place for 3 wks, then 1 week break
• advantages: similar to that of Ortho Evra, with a few differences
  
  • no skin reactions, lower estrogen exposure, nothing is visible, increase in spontaneity
• disadvantages: ring may slip out, may cause vaginal irritation/ discharge, reports of feeling the ring during sex, ring must be protected from heat
  perfect use failure rate: 0.3%