Exam 2 Flashcards
The Pill general info
- combination est & progestin
- 21 days on, 7 off
- works by inhibiting ovulation, thickening cervical mucus, endometrium inhospitable for implantation
Quick Start
- with the pill… start pill as soon as prescribed, regardless of day in cycle
Health Risks of Pill
- no increased risks of cervical, uterine, or breast cancer
- protect against endometrial and ovarian cancer
- risk of thromboembolic disorders (blood clots)
- esp women over 35 who smoke - BP increase
- increased risk of STIs
Why increased risk of STIs with pill?
- more likely to not use a condom
- makes vagina more vulnerable to infection
Side effects of the pill
- increased vaginal discharge
- change in libido, up or down
- mood changes (20%)
- antibiotics can decrease effectiveness
- the pill can change dosage of antibiotic
Risk on pill 5+ years
- increased risk of benign hepatic tumors (liver)
The Patch
- Ortho evra
- 1 patch/week for 3 weeks
- estrogen & progestin
- lack of certainty about dosing, esp over 200lbs
- possibly higher or lower est levels
- slightly higher rates of blood clots
- more consistency with timing
Nuva Ring
- mainly works by stopping ovulation
- insert ring like diaphragm, leave in for 3 weeks
- failure rate comparable to pill
- est & progestin
Seasonale
- 84 days of pills, 7 off
- no additional side effects from normal
Other pills (2)
- Triphasic ( steady est levels, increasing progestin levels in phases)
- Progestin-only
Progestin-Only pills
- “mini pills”
- safest for breastfeeding mothers
- not to be used in first 6 weeks after birth
- not as effective)
Depo-Provera Injections
- Progestin only
- inhibits ovulation
- thickens cervical mucus
- inhibits growth of endometrium
- every 3 months
- works slightly better than pill (no memory needed)
- possible lag of 6-12 months of fertility
- most no problems after that
Emergency Contraception
- “morning after pill”
- 75-89% effective
- pregnancy rate .5-2%
- Plan-B one step
- Ella
- insertion of IUD within 5 days
- handful of BC pills
Plan B One-Step (next choice one dose)
- OTC
- effectiveness decreases longer you wait
- high dose of synthetic progesterone
- most effective within 24 hours after intercourse
- must be within 120 hours (5 days)
- mode of action depends on what time in cycle
- prevent ovulation, prevent fertilization, inhibit sperm function, inhibit endometrial growth - not abortion, egg not implanted
Ella
- non-hormonal (UPA) (Ulipristal acetate)
- by prescription only (antiprogestin)
LARC
- long acting reversible contraception
- preferred methods, dont rely on user, have very low failure rates
- implants, IUDs
- Implants
- Implanon/Nexplanon
- single rod, progestin-only
- lasts 3 years
- high cost
- effectiveness (99.95%)
- work like other progestin only birth controls
IUDs and side effects
- paraguard- copper
- mirena and skyla - progesterone
- changes uterine lining making it lethal to sperm and eggs
- side effects:
- increased menstrual cramping, flow
- usually not covered by insurance
- does not affect tampon use or intercourse
- can get pregnant immediately after
Copper T
- Paraguard
- changes enzymes in uterus so implantation unlikely
- up to 12 years
- more irregular bleeding
Progestin IUDs
- disrupts ovulation, reduces endometrium
- Mirena 5 years
- reduced flow
- Skyla 3 years
- smaller
Barrier Methods & Facts
- Diaphragm and Fem Cap
- metal rimmed, fits over cervix, place spermicide on rim and inner edge
- work by mechanical blockage of sperm, spermicide kills sperm
- may insert up to 6 hrs before intercourse
- needs to stay in 6 hours after, not more than 24
- one diaphragm can be used for ~2 yrs
- failure rate ~12%
- $75 + dr. visit + spermicide
Barrier Method: Sponge
- polyurethane and spermicide
- not very effective
External Condom
- Protection against STIs and pregnancy
- Latex - don’t use oil based lube
- lambskin - ineffective (STIs can get through)
- polyurethane- noisier
- leave 1/2 inch space at top
External Condom + Spermicide
- not more effective
- may increase risk for STIs b/c of irritation
Dental Dam
- type of external condom
- rectangle of latex
- placed over anus/vagina during oral sex
- some flavored (keep flavoring out of vagina, irritation)
Internal Condom
- polyurethane (noisy)
- lube inside & outside
- STIs can be transmitted if it malfunctions/slips
- two rings, one at each end
- typical failure rate 21% (perfect 5%)
Spermicides
- foam, vaginal film etc
- Nonoxynd 9 (N-9)
- use along with diaphragm
- 28% failure rate
- must leave in 6 hours
- increased risk of STIs b/c of irritation
Douching/Withdrawal
- DONT DO THIS
- flushing out vagina can push sperm in
- pre-ejaculate contains sperm
- failure rate 22%
Rhythm
- Roman Catholic Church approved
- fertility awareness methods (abstain during ovulation)
- sperm can survive 5 days
- eggs can be fertilized 12-24 hours after ovulation
- Calendar, Standard Days, BBT, Cervical Mucus, Sympto-thermal
Calendar Method
- Rhythm method
- abstain 3 days before and 2 days after ovulation
- assume ovulation occurs on days 13-15
- need 6 months-1 year data to be effective
Standard days method
- Rhythm
- assume most menstrual cycles 26-32 days
- abstain days 8-19
- failure rate 12%
BBT Method
- Rhythm
- only tracks temp rise AFTER ovulation
- determine safe days after
Cervical mucus method
- Rhythm
- right after menstruation: relatively little mucus
- white & tacky: follicular phase
- thin: days shortly before ovulation
- determine safe days before
Sympto-Thermal Method
- mucus + BBT
- best rhythm method
Irreversible Methods
- Sterilization
Irreversible Method: Men
- Vasectomy: cut vas deferens
- no effect on hormone production
- 20 mins local anesthetic
- use contraception 3 months after
Reconnecting Vas deferens
- vasovasectomy
Irreversible Methods: Women
- tubal ligation (laparotomy): cut and tie fallopian tubes
- minilaparotomy: small incision usually immediately after giving birth
Failure Rate Definition
- “if 100 women use this method for 1 year, the % of whom become pregnant”
Effectiveness rate
- 1-failure rate
Perfect vs Typical user
- perfect: perfect
- typical: human error involved
Best method for spacing of births
- rhythm
- don’t care as much
Psychological Aspects of BC
- 750,000 teen pregnancies in US/yr
- 29% abortion
- 57% live births
- 14% miscarriage
- often as a result of not using contraception
Medical Abortion
- RU-486 (mifepristone): antiprogesterone + prostaglandin (misopristol)
- within 7-9 wks of conception
- anti-progesterone sloughs off uterus, prostaglandin makes uterine contractions
- 92% effective
- 17% all abortions
- commonly done in physician’s office
- shown little negative psychological effects of woman
Methotrexate
- used in medical abortions
- also used as cancer treatment and ectopic pregnancies
New contraceptive methods for men (3)
- new condoms
- pill or injection to suppress sperm production
- “switch” on vas
New contraceptive methods for women (3)
- better microbicides: kill sperm and viruses and bacteria (bufferGel)
- vaginal ring with antiviral to protect against HIV
- SPRMs: selective progesterone receptor modulators
SPRMs
- selective progesterone receptor modulators (ella)
- useful for emergency contraception
- depending on time in cycle when used either prevent LH surge or prevent implantation
Surgical Abortion
- vacuum aspiration (suction and curretage)
- 1st trimester up to 14 weeks
- outpatient
- dilation of cervix and suction of fetus
- most common method early abortion
- 88% abortions (& in first 12 weeks)
- dilation and evacuation (D&E) 2nd trimester abortions
Ekiti Yoruba
- S.W. Nigeria
- 200,000-500,000 pregnancies aborted/yr
- 10,000 women die/yr
- believe “real child” isn’t formed until 4th month
Turnaway study
- 3 groups: 1st trimester abortions, near limit abortions, & turnaways
- found good adjustment and mood of those who had abortion to those who didn’t
How many partners knew about abortion?
- 82% knew
- 80% of those were supportive
Masters & Johnson
- Masters: father of human sexual response
- Johnson: recruited by Masters, later married
“Glass Penis”
- insertable EMG sensor
- measured blood flow, muscle contractions, took pictures
Basic Phys Processes of sexual response
- Vasocongestion
- Myotonia
Stages of Sexual Response
- excitement
- orgasm
- resolution
Male Excitement Phase
- testes elevated, penis elevates
Male Late Excitement Phase
- testes fully elevated, color of penis deepens, secretion of cowper’s gland