Reproductive Health 2

Question 1

what are natural methods?

Answer 1

• Natural methods works on the principle of avoiding chances of ovum and
  sperms meeting.
• As no medicines or devices are used in these methods, side effects are almost
  nil.
• Chances of failure, though, of this method are also high.

1. Rhythm or Periodic abstinence
2. Withdrawal or Coitus interruptus
3. Lactational amenorrhea

Question 2

explain the 3 natural methods

Answer 2

(I) Periodic abstinence is one such method in which
the couples avoid or abstain from coitus from day 10 to 17 of the menstrual cycle when ovulation could be expected. As chances of fertilisation are very high during this period, it is called the fertile period. Therefore, by abstaining from coitus during this period, conception could be prevented.

(II) Withdrawal or coitus interruptus is another method in which the male partner withdraws his penis from the vagina just before ejaculation so as to avoid insemination.

(III)Lactational amenorrhea (absence of
menstruation) method is based on the fact that ovulation
and therefore the cycle do not occur during the period of
intense lactation following parturition. Therefore, as long
as the mother breast-feeds the child fully, chances of
conception are almost nil. However, this method has been
reported to be effective only upto a maximum period of six
months following parturition.

High concentration of
prolactin may lead to inhibition of menstrual cycle

Question 3

what is barrier method

Answer 3

In barrier methods, ovum and sperms are prevented
from physically meeting with the help of barriers.

Such
methods are available for both males and females

Question 4

condom and its uses

Answer 4

Condoms (Figure 4.1 a, b) are barriers made of thin rubber/
latex sheath that are used to cover the penis in the male or
vagina and cervix in the female, just before coitus so that
the ejaculated semen would not enter into the female
reproductive tract. This can prevent conception. ‘Nirodh’ is
a popular brand of condom for the male. Use of condoms
has increased in recent years due to its additional benefit of
protecting the user from contracting STDs and AIDS. Both
the male and the female condoms(Femidome) are disposable, can be
self-inserted and thereby gives privacy to the user.

Question 5

diaphragms, vaults, cervical caps

Answer 5

Diaphragms, cervical caps and vaults are also barriers
made of rubber that are inserted into the female reproductive
tract to cover the cervix during coitus. They prevent
conception by blocking the entry of sperms through the
cervix. They are reusable. Spermicidal creams, jellies and
foams are usually used alongwith these barriers to increase
their contraceptive efficiency.

Question 6

describe chemical method

Answer 6

• These include the contraceptives which contain spermicides.
• Spermicides are chemicals with contact of which sperms are killed or
  destroyed.
  1. Intra uterine Device
  2. Pills
  3. Implants
  4. Injections

Question 7

Intra Uterine Devices (IUDs)

Answer 7

• These are inserted by doctors or expert nurses in the uterus through vagina.
• First IUD was used by Graffenberg, composed of silver wire, when it was put
  into the uterus, till it was there, the female wasn’t pregnant.
• IUD’s increases phagocytosis of sperm within the uterus.
• IUD’s are ideal contraceptives for the females who want to delay pregnancy or
  space children.
• It is one of most widely accepted methods of contraception in India.

Question 8

Non-medicated IUDs-

Answer 8

• These devices are made of plastic or stainless steel only.
• E.g.- Lippe’s loop made of plastic (Polyethylene) impregnated with barium
  sulphate is still used in many part of world.
• Mechanism- Promote the phagocytic cells of uterus to phagocytosis of sperms
  within the uterus.

Question 9

Copper releasing IUDs-

Answer 9

E.g.- CuT, Cu7, Multiload 375
* Mechanism- Copper releasing IUDs, released Cu ions that suppress sperm
motility and the fertilizing capacity of sperms.

Question 10

Hormone releasing IUDs

Answer 10

E.g.- Progestasert, LNG-20
* Mechanism- The hormone releasing IUDs, make the uterus unsuitable for
implantation and the cervix hostile to the sperms.

Question 11

Pills

Answer 11

Oral administration of small doses of either progestogens
or progestogen–estrogen combinations is another
contraceptive method used by the females.

They are used in the form of tablets and hence are popularly called the pills.

Pills have to be taken daily for a period of 21 days
starting preferably within the first five days of menstrual
cycle. After a gap of 7 days (during which menstruation
occurs) it has to be repeated in the same pattern till the
female desires to prevent conception. They inhibit ovulation
and implantation as well as alter the quality of cervical mucus to prevent/ retard entry of sperms.

Pills are very effective with lesser side effects and
are well accepted by the females.

1. Combination Pills- Contains a combination
   of progestogen and estrogen. E.g. Daily oral
   pills:- Mala-N, Mala-D

Question 12

PoPs

Answer 12

2. Mini Pills-
   * Progestin Only Pills (POPs).
   * These pills prevent ovulation and implantation as well as alter the quality
   of cervical mucus to prevent/retard entry of sperms to prevent fertilization.
   * These pills are very effective with lesser side effects and are well accepted by
   the females.

Question 13

Saheli

Answer 13

Saheli –the new oral contraceptive for
the females contains a non-steroidal preparation. It is a ‘once a week’ pill with very few side effects and high contraceptive value

was developed by scientists at Central Drug Research Institute (CDRI) in Lucknow, India

• Saheli is a chemical composition of centchroman or ormeloxifene (anti-
  estrogenic activity to prevent implantation activity and cause contraception).
• Suppress proliferative stage of Endometrium (blocks estrogen receptor in the
  uterus) and hence PREVENT IMPLANTATION.

Question 14

Oral Contraceptives for males

Answer 14

Gossypol-
* It is a pigment isolated from the seeds of cotton
plant (Gossypium sp.).
* It causes spermatogenesis arrest.
* The major concern with it is lack of reversibility (i.e.
it causes permanent infertility) in most of the cases.

Question 15

Emergency Contraceptives

Answer 15

Administration of progestogens or progestogen-estrogen
combinations or IUDs within 72 hours of coitus have been found to be
very effective as emergency contraceptives as they could be used to avoid
possible pregnancy due to rape or casual unprotected intercourse.

E.g. Unwanted-72, i-pill, ezy pill.

Question 16

Injectable and Implants

Answer 16

• Progestogens alone or in combination with estrogen can also be used by
  females as injections or implants under the skin.
• Their mode of action is similar to that of pills and their effective periods are
  much longer.

Implants-
* ‘Norplant’ is a brand of implants.
* It consists of six match stick sized tubes containing
the progestin levonorgestrel, which is released in
small amounts for up to 5 years.
* High level of progesterone inhibits the secretions
of gonadotrophin. So, ovulation is absent.

Injection-
* Progestogen only injections containing Depot Medroxy
Progesterone Acetate (DMPA).
* Sold under brand name Depo-Provera.
* These provide three months protection with a single
dose.

Question 17

surgical method or sterilisation

Answer 17

Surgical methods, also called sterilisation, are generally advised for
the male/female partner as a terminal method to prevent any more
pregnancies. Surgical intervention blocks gamete transport and thereby
prevent conception. Sterilisation procedure in the male is called ‘vasectomy and that in the female, ‘tubectomy’. In vasectomy, a small part of the vas
deferens is removed or tied up through a small incision on the scrotum
(Figure 4.4a) whereas in tubectomy, a small part of the fallopian tube is
removed (Figure 4.4b) or tied up through a small incision in the abdomen
or through vagina. These techniques are highly effective but their
reversibility is very poor.