Contraception

Question 1

CONDOMS:
What are its advantages in Men and Women?

What are its disadvantages in Men and Women?

Answer 1

• • Men - Easily available, User control, Protection against STIs
  • Female - Can be put in advance and left inside, Not dependant on male erection to work, User control, Protection against STIs
• • Male - Last minute use, Needs to be taught, May cause allergies and psychosexual difficulties, High failure rate, Oil based lubricants degrade rubber
  • Female - Prominent, Expensive, Messy, Rustles during sex, Uncertain failure rate

Question 2

CAPS/DIAPHRAGMS:
What are the 2 types of caps available? What are they made of?

What has to be done when using them?

What are the advantages of each cap?

What are its disadvantages of each cap?

Answer 2

• • Diaphragm (Vaginal) Caps made of Latex
  • Suction (Cervical) Caps made of Plastic
• Both must be used with SPERMACIDE and left in at least 6 HOURS AFTER sex
• • Diaphragm - Can be put in advance, Offers protection against cervical dysplasia, Unawareness of it during sex, No hormones
  • Suction - Suitable for women with poor pelvic muscles, No problems with rubber allergies, Not prominent, No hormones
• • Diaphragm - Higher failure rate, Messy, Needs to be taught, Higher rate of UTI and Candidiasis
  • Suction - Needs an accessible and suitable cervix, Higher failure rate than Diaphragm, Needs to be taught

Question 3

FERTILITY AWARENESS:
What is it?

What are the key facts that need to be known for this to be effective?

What are the bodily changes that occur around Ovulation?

What are its main disadvantages?

Answer 3

• Avoiding sex in fertile period
• • Prediction of ovulation 14 days before period
  • Cervical mucous is receptive to sperm around time of ovulation
  • Sperm can survive 5 days in female tract
  • Oocyte can survive 24 hours
• • Raised Temperature during Luteal phase after Ovulation
  • Cervical position and mucous consistency
  • LH testing - detection of Ovulation
  • Lactational Amenorrhea - Prolactin during breastfeeding inhibits menstrual cycle
• USER DEPENDENT FAILURE RATE, Requires cooperation, and Limits sexual activity

Question 4

COMBINED ORAL CONTRACEPTIVE PILL (COCP):
What is the Protocol when taking it?

Benefits:
What are the main ones?

How does it link to cancer?

What does it help with?

Risks:
How does it affect the heart?

Which cancers does it increase the risk of?

What Psychological effects does it have?

What else does it increase the risk of?

Answer 4

• • 1st packet on 1st day of Menstrual period
  • Take 21 pills, Stop for a 7 day break (PILL FREE INTERVAL/PFI), then Restart on new packet
  • If missed pill within 1st 7 days, depend on other forms of contraception
  • If missed pill within last 7 days, skip the PFI

• Reliable, Safe, Unrelated to Sex, Rapidly reversible, User control
• Halves the risk of Ovarian and Endometrial cancer
• Endometriosis, Premenstrual syndrome, Dysmenorrhea, Menorrhagia

• HTN, VTE disorders
• Breast, Cervical, Liver cancer
• Mood swings, Depression, Libido
• GI, Hepatic, Dermatological disease

Question 5

PROGESTOGEN ONLY METHODS:
What methods are available?

Why are they more favourable to some than COCPs?

How does its window compare with COCPs?

Answer 5

• Pills (POP), Implants, Hormone releasing IUDs, Injections
• • As effective and predictable as COCP
  • Favourable side effects
  • NO OESTROGEN = Less contraindications
• 12 hour window vs 3 hour window for COCPs

Question 6

INTRAUTERINE DEVICES (IUD):
What are they?

How do they work?

What are its advantages?

What are its disadvantages?

What are the risks when using it?

What are the Absolute contraindications. with it?

Answer 6

• Copper bearing/Hormone bearing, inserted into Uterus and left in long term
• • Destroy sperm
  • Prevent implantation - mechanical interference, inflammatory reaction, and prostaglandin secretion
• • Non-user dependent, Immediately effective and reversible
  • Can be used long term, Reliable, Unrelated to Sex, Free from serious medical dangers, Works as emergency contraception

- • Has to be fitted by a trained medical practitioner
• Fitting may cause Pain and Discomfort
• Heavier and more painful periods
• Doesn’t protect against infection
• Threads may be felt by partner

• • Can be expelled
  • Can perforate Uterus (rare)
  • Miscarriage if left in during pregnancy
  • More likely to have an Ectopic pregnancy
• Current Pelvic inflammatory disease, Suspected/Known pregnancy, Unexplained vaginal bleeding, Abnormal uterine anatomy

Question 7

EMERGENCY CONTRACEPTION:
What is the Method of Choice?

Copper-bearing IUDs:
When should they be used?

Why is it the method of choice?

How does it work?

Post-Coital Pills:
When should they be taken?

What’s its failure rate?

How does it work?

Answer 7

• Copper-bearing IUDs
• Up to 120 hours after presumed ovulation or Up to 120 hours after unprotected sex
• Extremely low failure rate
• Kills sperm and prevents implantation in the Luteal phase

• Up to 72-120 hours after unprotected sex
• 1-1.7% (increases with time)
• Postpones ovulation by lengthening the Follicular phase