Non-hormonal contraception Flashcards
Contraception
general
Also known as birth control, anticonception, and fertility control
Method, procedure, device, behavior, or medication that allows for the prevention of pregnancy and for planning the timing of pregnancy
Can be used by one or both members in a relationship
Most commonly used methods in the United States:
Female permanent contraception (sterilization): 29%
Oral contraceptives (OCs): 19%
Male condoms: 13%
Intrauterine devices (IUDs): 12%
Male permanent contraception (sterilization): 9%
COntraception
effectiveness
Theoretical
Efficacy when consistent and reliable use occurs
Conditions of perfect use
Example: male condom
98% efficacy
Pregnancy rate at 1 year:
2% with perfect use
Actual
Efficacy when forgetfulness and improper use occurs
Conditions of typical use
Example: male condom
82% efficacy
Pregnancy rate at 1 year:
18% with typical use
Non-hormonal Contraception
general
Has no effect on the reproductive hormones
Each method has a different mechanism and extent of efficiency in preventingpregnancy
Includes:
Physiological methods - high failure rates
Barrier methods
Copper IUD
Surgical methods (permanent) - highly effective
Choice of Contraception
Non-hormonal contraceptive methods are often preferred due to:
Accessibility of some methods
Desire for a “backup” method to hormonal contraception
Low risk of systemic effects
Choice of the non-hormonal contraceptive may depend upon:
Ease of access and use
Affordability
Efficacy rate
Prevention of STIs
Physiologic Methods
Withdrawal/coitus interruptus
A traditional method that has been in use for centuries
Complete withdrawal of the penisfrom thevaginaprior to ejaculation
Preventsfertilizationby preventing the sperm from reaching the egg
Pre-ejaculate from the cowper gland may contains sperm
High failure rate
Physiologic Methods
Physiologic Methods
Lactation amenorrhea
Mechanism:
Infant’s suckling leads to increased prolactin production → increased milk production
Effects:
↓ Gonadotropin-releasing hormone
Delay in ovulation
Only viable for women who are/have:
Exclusivelybreastfeeding
Within the 1st 6 months postpartum
Not seen a return of their menstrual period (amenorrhea)
barrier methods
Condoms
Create a physical barrier between the male and female genitalia and secretions
Best to use with a water-based or silicone lubricant to prevent tearing and breaking
Effects:
Protects againstpregnancy
↓STIrisk (including HIV)
Protects againstHPVinfections → ↓ risk of cervical neoplasia
Types:
Male condoms
Female condoms
barrier method
Male condoms
advantage and disadvantage
Reversible male contraceptive method
Use:
A thin sheath with a reservoir at the tip and a base ring
Applied to an erect penis before penetration
Advantages:
Does not affect fertility
Protection from STIs
Easily accessible and inexpensive
Minimal side effects
Disadvantages:
Latex allergy is a contraindication
Potential ↓ in sensitivity
Slippage or breakage can occur
Pregnancy rate at 1 year:
2% with perfect use
18% with typical use
barrier method
female condom
Use:
A pouch with an inner and an outer ring
The inner ring holds the condom in place
The outer ring remains outside and covers the perineum
Should be used no more than 8 hours before intercourse
Advantages:
Does not affect fertility
Protection from STIs
Does not require medical evaluation or special fitting
Minimal side effects
Offers protection to women whose partners refuse to use a male condom
Disadvantages:
Allergy to nitrile is a contraindication
Not as readily available as male condoms
May be difficult to insert and remove properly
Possibility of:
Semen to spill when removing
Breakage
Pregnancy rate at 1 year:
5% with perfect use
21% with typical use
physiological methods
periodic absinence
Rhythm method (calendar method)
Based on the woman’smenstrual cycle
The cycle has to be regular
Interval of abstinence:
Subtract 18 from the shortest of the previous 12 cycles and 11 from the longest
Example: cycle varies from 26 to 29 days…abstinence is required from day 8 through 18 of each cycle
The greater the variance in cycle length, the longer the abstinence required
High failure rate
physiological methodsq
Symptothermal method
Periodic abstinence determined by signs and symptoms that correlate with different hormone levels as indicators for an approximate timeframe when ovulation is likely to occur
High failure rate
Basal body temperature (BBT)
Based on an ↑ in body temperature at rest (by 0.5–1.0 degrees) during and after ovulation
Cervical mucus
End of the follicular phase/ovulation - the mucus is increased, thinner, clearer, and elastic (Peak levels of FSH and LH; ↑ estrogen at the end of the follicular phase)
Luteal phase – mucus is thick and sticky (↓ FSH and LH; ↑ progesterone)
barrier methods
spermicides
Mechanism:
Provide a chemical barrier by killing or immobilizing sperm
Most spermicides contain nonoxynol-9
Use:
Can be used alone or with other barrier methods
Form: foams, creams, gels, films, and suppositories
Should be placed in thevaginaclose to the cervix at least 10‒15 minutes (no more than 1 hour) before sexual intercourse
Effective for 1 hour after insertion
Reinsertion is required for each act of intercourse
Advantages:
Does not affect fertility
Does not require a prescription
Easy to use
Disadvantages:
Should be used with other barrier methods due to limited efficacy
Does not protect against STIs
Can cause vaginal irritation or dryness → ↑ risk of HIV transmission
Pregnancy rate:
18% with perfect use
20% with typical use
barrier methods
Contraceptive Sponge
Mechanism:
Foam disk impregnated with nonoxynol-9
Acts as both a barrier device and spermicidal agent
Use:
Moisten with water before insertion into thevagina→ activates spermicide
Should cover the cervix
Can be inserted up to 24 hours before intercourse
Should be left in place for ≥ 6 hours after intercourse
Cannot be worn for longer than 30 hours
No need to be replaced for additional acts of intercourse
Advantages:
Available without a prescription or special fitting
Does not affect fertility
Disadvantages:
Less effective than other barrier methods
Can cause vaginal irritation or dryness → ↑ risk of HIV transmission
May be difficult to remove (can break apart during removal)
Associated with ↑ risk oftoxic shock syndrome(rare)
Pregnancy rate:
12% for nulliparous women
24% for multiparous women
barrier method
diaphram
Mechanism:
A reusable, dome-shaped rubber cup with a flexible rim that fits over the:
Cervix
Upper and lateral wall of thevagina
Provides a physical barrier to sperm
Use:
Usually with a spermicide (applied before insertion)
Ideally, placed < 1 hour before intercourse
Should remain in place for 6‒8 hours (no more than 24 hours after intercourse)
Advantages:
Does not affect fertility
Can be placed at a convenient time before intercourse
Durable and reusable (can last up to 2 years)
Disadvantages:
Can be difficult to use properly
Requires a prescription
Does not prevent STIs
Should be avoided during menses due to the risk of infection
Can cause discomfort and vaginal irritation
May become dislodged
Associated with:
Urinary tract infections
↑ Risk oftoxic shock syndrome(rare)
Pregnancy rate:
6% with perfect use
12% with typical use
barrier method
cervical cap
Mechanism:
Resembles a diaphragm but is smaller and more rigid
Provides a barrier against sperm entering the cervix
Use:
A spermicide should always be used
Must be inserted before intercourse
Should remain in place for ≥ 6 hours after intercourse (no more than 48 hours)
Advantages:
Does not affect fertility
Can be placed at a convenient time before intercourse
Durable and reusable (can last up to a year)
Disadvantages:
Can be difficult to use properly
Requires a medical visit and fitting
Refitting required after childbirth, weight gain, and weight loss
Does not prevent STIs
May cause vaginal irritation
Associated with urinary tract infections
Pregnancy rate:
12% for nulliparous women
24% for multiparous women
barrier method
Vaginal pH regulator gel
Mechanism:
Gel that lowers the vaginalpHto 3.5‒4.5 (even in the presence of alkaline semen) → immobilizes sperm
Use:
Used as an alternative to spermicide
Comes in single-dose, prefilled vaginal applicators
Should be applied within one hour of intercourse
Advantage:
Lower risk of vulvovaginal and penile irritation compared to spermicide
Disadvantages:
Requires a prescription
Typically used in conjunction with other products (condoms, diaphragms)
FDA approved, but newerproduct with less data regarding efficacy
barrier method
Copper Intrauterine Device
Mechanism:
T-shaped polyethylene device with a fine copper wire wound around the stem (and often the horizontal arms) and inserted into the endometrial cavity
Causes local, sterileinflammationand releases small amounts of copper → affects sperm mobility and egg implantation
Use:
Inserted by a clinician
STItesting is done just prior to insertion
Can remain in place for 10 years
Can be used foremergency contraceptionif placed within 5 days of unprotected intercourse
Advantages:
Highly effective
Provides long-term efficacy
Convenient
Does not affect fertility
Minimal systemic effects
Can be used as emergency contraception
May be removed at any time
Disadvantages:
Requires a medical visit for placement and removal
Does not protect against STIs
Side effects:
Heavy menstrual bleeding
Severe cramping
Copper Intrauterine Device
contraindications and complications
Contraindications:
Current STIs orpelvic inflammatory disease(PID)
Anatomic abnormalities that distort the uterine cavity
Unexplained vaginal bleeding
Knowncervical cancerorendometrial cancer
Pregnancy
Wilson disease or copper allergy
Complications:
Expulsion rates are < 5% within the 1st year after insertion
Uterine perforation
Ectopic pregnancy
↑ Risk of PID
Pregnancy rate:
0.5%‒0.8%
Higher failure rate in younger women
surgical methods
Tubal ligation
Mechanism:
Disrupts the patency of the fallopian tubes
Can be accomplished surgically by:
Cutting and excising a segment of the fallopian tubes
Fallopian tube closure via:
Ligation
Fulguration
Various mechanical devices (plastic bands or rings, spring-loaded clips)
Complete removal of the fallopian tubes (salpingectomy)
Indications and contraindications:
Indicated for women with a desire for permanent contraception (should be given extensive counseling)
No absolute contraindications
Risk factors for complications should be assessed:
Severeobesity
Prior abdominal surgery
Previous PID or abdominal infections
Comorbidities
Complications:
Death: 1–2 per 100,000 women
Hemorrhage or intestinal injuries: approximately 0.5% of women
Failure of tubal occlusion: up to 2-3% of women
Ectopic pregnancy: approximately 30% of pregnancies that occur after tubal occlusion
surgical methods
vasectomy
Mechanism:
Disrupts the patency of the vas deferens
Sterility requires about 20 ejaculations after the procedure and should be documented by 2 sperm-free ejaculations
Can be accomplished surgically by:
Transection of the vas deferens
Ligation or fulguration of the ends
Indications:
Indicated for men with a desire for permanent contraception (should be given extensive counseling)
Contraindications:
Scrotal hematoma
Infections
Complications:
Hematoma (≤ 5%)
Sperm granulomas (inflammatory response to sperm leakage)
Epididymitis
Post-vasectomypainsyndrome
Spontaneous re-anastomosis (usually occurs shortly after the procedure)
