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