Methods of Contraception / STIs Flashcards
Tier One Contraceptives
Long acting reversible methods are the most effective contraception in terms of typical use
* IUD and Implant
* Less than one pregnancy per 100 women in one year
Tier Two Contraceptives
The tier 2 methods are highly effective
* Contraceptive Injection * Contraceptive pill (both combined and progestin-only) * Contraceptive
hormonal patch * Contraceptive vaginal ring
* 6 to 12 pregnancies per 100 women in one year when used typically
Tier 3 and 4 Methods
Are moderately to least effective
* These methods of contraception require more effort by the user and have higher typical failure rates.
* 13-30 pregnancies per 100 women in one year when used typically Condoms (male and female), * Diaphragms, cervical cap, sponge * Fertility awareness-based methods
* Withdrawal * Spermicides
Natural Methods - Natural Family Planning
- Fertility awareness methods based on understanding of women’s ovulation cycle and timing of sexual intercourse
- All methods attempt to identify the period of female fertility and to avoid unprotected intercourse during that time period
Abstinence
Practive of avoiding sexual intercourse
Advantage
* Free, safe 100% effective preventing pregnancy and STD’s; encourages communication; Free
Disadvatage
* Both participants must practice self control
Withdrawl
Coitus interruptus male withdraws prior to ejaculation
How It Works
* Pull penis out of vagina before semen comes out.
* MUST be all the way out.
* Rather be early than late.
Advantage
* No side effects. Free, makes other BC more effective
Disadvantage
* Oldest but least reliable 80% effective w/typical use self control difficult
* Preejactulatory fluid may contain sperm
* No protection from STI’s
Calendar (Rhythm) Method
Based on assumption tha tovulation occurs 14 days prior to next menses
How It Works
* Women must record her menstrual cycles for 6-8 months to identify shortest and longest cycles. The fertile phase is calculated from 18 days before end of shortest cycle through 11 days from end of longest cycle. ie cycle 24-28 days fertile phase is day 6 through day 17
Pros
* Free safe and acceptable to many whose religious beliefs prohibit other methods provide an increased awarenss of the body, involve no artificial substances or devices encourage a couple to communicate useful in helping a couple to plan a pregnancy
Cons
* Least reliable of the fertility awareness methods 91% effective w/ perfect use 75% w/ typical
Basal Body Temp
Based on Thermal shift in menstrual cycle temp drop just prior to ovulation, rises and fluctuates at higher level until 2-4 days prior to next menses
How It Works
* Take temp every morning before arising record on graph shows 10th of degree to avoid couple abstains from intercourse on day of temp rise and 3 days after.
Because the temp rise does not occur until after ovulation a woman who had intercourse just before the rise is at risk of pregnancy (progesterone is thermogenic causing temp increase)
Cons
* Require extensive initial counseling to be used effectively. Interfere w/ sexual spontaneity extensive maintenance of records for several cycles before beginning to use them difficult or impossible for women with irregular cycles
Cervical Mucus Method
Billings Method
Involves assessment of cervical mucous changes that occur during the menstrual cycle. Due to influence of estrogen and progesterone
How It Works
* Clearer more stretchable - able to stretch between finger (spinn barkeit sign) more permeable to sperm ferning pattern
* Woman abstains from intercourse the time she
first notices mucus becoming clear and more elastic and slippery until 4 days after last wet mucus
Pros
* Can be used w/ women w/ irregulary cycles evaluates the effects of hormonal changes
Cons
* Mucus affected by douches and antihistamine drugs
Symptothermal Method
Incorporates the assessment of multiple indicators of ovulations BBT, cervical mucus, abdominal bloating, mittelschmerz (mid cycle pain) breast or pelvic tenderness, increased libido
Barrier Methods
Provid a physical or chemical barrier to block sperm from entering the cervix
Spermicides
Available as creams, jellies, foams, vaginal film and suppositories alone
Causes vaginal flora to be more acidic which is not favorable for sperm survival nonoxynol-9 and octoxynol09
How It Works
* Inserted into vagina before intercourse, they destroy sperm or neutralize vaginal secretions and therefore immobilize sperm. Only effective for 1 hr after insertion but should not be removed until 6 hr after intercourse
Pros
* Widely available and low toxicity
* no prescription
* safe for breast feeding women
Cons
* Minimally effective when used alone but their effectiveness increases in conjunction w/ a diaphragm or condom
* Allergic reaction is possible
* may interfere w/ spontaneity; messy
* Nonoxynol-9 is a common ingredient in spermicides. It can cause lesions and increase the risk of HIV and other sexually transmitted infections.
Condoms
male and female ;
male condom made of latex, polyurethane (protect against
STI); or natural that do not protect against STI’s as they have small pores
Female- made of nitrile, non latex synthetic rubber with flexible rings and pre-lubricated with spermicide
Pros
* Protect against STIs, readily available
* No side effects
Cons
* Condoms can rupture or leak
Diaphragm
dome shape appliance made of rubber fits over cervix 94% perfect, 80% typical use w/ spermicide remove one in 24 hr, risk of toxic shock syndrome
How It Works
* Put spermicide in the cup
* Comfortable position, like you’re putting a tampon in
* Dome pointing down
* Can be inserted up to 6 hr before intercourse and must stay in place after for 6 hrs but no more than 24 hrs.
* Not recommended for those w/ hx of toxic shock syndrome
Difference between cap and dia→ caps are smaller and shaped like a sailors hat. Work in the same way.
Pros
* Safe for breast feeding, gives woman control. Do not interrupt sex. Don’t have hormones, last a long time
Cons
* Female condom more expensive than male
* Must be fitted properly replaced every 2 years, refitting w/ 20% wt gain/loss, and after every pregnancy
* risk of infection if kept in to long
* Replace every 2 yrs and refit after any gyn surgery, birth or major wt fluctuation
* Risk of TSS and does not protect against STI’s
Cervical Cap
small thimble shaped device made of soft rubber that fits over the cervix
91% perfect nulliparous, 80 typical, 74% perfect in parous 60% typical
How It Works
* Inserted up to 6 hrs prior and leave in after intercourse for 6 hrs but no more than 48 hrs
* Use spermicide
Pros
* Come in three sizes
* 86% effective
* Small—never been pregnant
* Medium –people who’ve had an abortion miscarriage or C/S
* Large – vaginal birth
Cons
* Less protective for women who have given birth 71%
* No protection against STD
* Need a prescription
* Can cause TSS
Contraceptive Sponge
small round polyurethane sponge containing nonoxynol-9 spermicide
How It Works
* Moisten with water prior to insertion in the vagina; should be left in place for 6 hrs after last act
* Worn 24 hours than discarded
* Can be inserted 24 hours prior.
* ONLY WORN FOR 24 HOURS
* Fits snugly against cervix, blocking entrance to uterus
* Contains spermicide
* Can be used by itself or with a condom
Pros
* 91% effective – realistically 88% effective
* 80% if given birth— realistically 76%
Cons
* Can increase risk of STD
* spermicide can be irritating which can make it easier for STD to enter body
* Risk of TSS
Hormonal Methods
Act by inhibiting the release of an ovum, creating an atrophic endometrium and by maintaining thick cervical mucus that slows sperm trspt and inhibits the process where the sperm penetrates the ovum
OCPs
Combined contain both estrogen and progestin
Progestin only ok to breast feed
How It Works
* Requires prescription;
* observe for and report complications as manifested by HA, vision changes, HTN, Chest pain and leg pain;
* if one pill missed take one asap if 2 or 3 pills missed follow manufacturer’s instructions and use alternative forms of contraception to prevent pregnancy.
* If Nausea occurs take at bedtime
* Prog Only: Fewer adverse effects when compared with combined oral contraceptive
Pros
* Use not directly related to act of sexual intercourse, menstrual periods more regular and predictable
Cons
* No protection against STD
* may decrease effectiveness of OC’s when taken
w/medications that affect liver enzymes (anticonvulsants,
antifungals, some antibiotics )
* not for women w/ history of thromboembolic or
cardiovascular disorders
* combined not for lactating women or those who smoke >20 cigs per day
* Prog Only: Less effective in suppressing ovulation than
combined oral contraceptives
