CONTRACEPTION

1. Contraception
Dr. Rabinarayan Satapathy
Asst. Professor
Dept. of Obst.& Gynae
S.C.B. Medical College,Cuttack

2. Historical & Social Perspective
 Evidence of contraception since the
beginning of recorded history
 U.S. contraceptive efforts
– Comstock laws in 1800s restricted
contraceptive information through the mail
– 1915: Margaret Sanger’s illegal clinic &
contraceptive information

3. Historical & Social Perspective
 U.S. contraceptive efforts - cont’d
– 1965 U.S. Supreme Court ruling: states
could not prohibit use of contraception by
married couples: extended to single people
in 1972
– most states allow dispensing of
contraception to minors without parental
consent
– controversy re: TV ads for condoms,
government funded contraceptive services
for minors without parental notification

4. Historical & Social Perspective
 Contemporary issues
– growing emphasis on planning for
unwanted children
– population growth as a concern
– wide diversity of views among religious
leaders

5. Sharing responsibility
Benefits of shared
responsibility
 decreases “surprise
pregnancy”
 reduces stress &
increases trust
How to share
responsibility
 ask about BC before
intercourse
 read & discuss
options together
 attend a class or
clinic together
 share expenses
 help each other with
various methods

6. Choosing a birth control method
 Consider effectiveness
*failure rates reported for each method
*influenced by human error
*backup methods increase effectiveness
 consider cost; ease of use; side effects;
 consider noncoital methods of sexual
intimacy (“outercourse”)
*kissing, *mutual masturbation
*touching, petting * oral or anal sex

7. Hormone-based contraceptives
Oral contraceptives:
*combination pill:
contains estrogen &
progestin; inhibits
ovulation, thickens
cervical mucus, &
makes uterine lining
less receptive to
implantation
Advantages: spontaneity;
reversible;  effective;
may  dysmenorrhea,
PMS s/s, & some other
conditions; minipill has
no estrogen-related SE
Disadvantages:
*no STD protection
*estrogen-related side
effects
*spotting

8. Hormone-based contraceptives
Oral contraceptives:
*minipill: progestin
only; thickens
cervical mucus,
makes uterine lining
less receptive to
implantation, may
inhibit ovulation
Advantages:spontaneity;
reversible;  effective;
may  dysmenorrhea,
PMS s/s, & some other
conditions; minipill has
no estrogen-related SE
Disadvantages:
*no STD protection
*estrogen-related side
effects
*spotting

9. Hormone-based contraceptives
Norplant:
6 progestin filled
capsules implanted
under skin; time-
release over 5 years;
requires medical
insertion; works like
the minipill
Advantages:
*less hormone, but
constancy s
effectiveness
*no daily pill
Disadvantages:
*high initial cost
*may be hard to remove
*same as minipill

10. Hormone-based contraceptives
Depo-Provera:
injected progestin
every 12 weeks; works
like the minipill
Advantages:
*same as the minipill
Disadvantages:
*same as the minipill

11. Barrier methods
Condom:
a sheath that fits over
erect penis; forms
mechanical barrier to
keep sperm out of
vagina; lubricated
latex works best
Advantages:
*effective if used properly
*provides some STD
protection
*relatively cheap
Disadvantages:
*may disturb spontaneity
*may  some sensations
*possible allergy to latex

12. Barrier methods
Female condom:
a sheath that fits
inside vagina with
closed ring at the top,
open ring at vaginal
opening
Advantages:
*effective if used properly
*provides some STD
protection
*relatively cheap
Disadvantages:
*may disturb spontaneity
*may  some sensations
*possible allergy to latex

13. Barrier methods
Diaphragm:
latex or plastic dome with
flexible spring around the
rim; forms mechanical
barrier that keeps sperm
out of cervix/uterus; fitted
by Dr. who teacheshow
to insert & check proper
placement; place
spermicide around rim;
stays in for 6-8 hrs.
Advantages:
*no side effects
*s comfort & self-
knowledge
*spermicide may prevent
some STDs, infections
Disadvantages:
* failure rate than others
*messier
*poor fit s problems
*allergy to spermicide
*s spontaneity

14. Barrier methods
Cervical cap:
thimble-shaped latex
or plastic cup; works
like diaphragm; fitted
by Dr.; filled with
spermicide & pressed
onto cervix; stays in
for 6-24 hrs.
Advantages:
*alternative for  who
cannot wear diaphragm
*does not need repeated
doses of spermicide
Disadvantages:
* failure rate than others
*may damage cervix
*cannot fit up to 6% of 

15. Barrier methods
Vaginal spermicides:
creams & jellies should
be used with
diaphragm or cervical
cap; not to be used
alone

16. Barrier methods
Vaginal spermicides:
foam, suppositories,
film; sperm are killed;
follow package
directions carefully
Advantages:
*no doctor
*no dangerous side effects
*provides extra lubrication
*prevents some STDs
Disadvantages:
*messy
*irritation of vaginal tissue
*may  yeast infections
*unpleasant taste, scent
* spontaneity

17. Intrauterine devices
Copper-T: affects sperm
motility & viability
Progestasert-T: works
like minipill; both
prevent fertilization,
irritate & inflame
uterine lining to prevent
implantation; alters
timing of the ovum’s
passage through
fallopian tube
Advantages:
*highly effective
*convenient
*s spontaneity
*ok for  who breastfeed
Disadvantages:
*initial cost
* PID risk
*discomfort
*risk of miscarriage
*2-20% expelled in 1st yr.
*rarely punctures womb

18. Emergency contraception
Hormonal:
birth control pills taken
within 72 hours of
unprotected
intercourse; works
like combination pill
Advantages:
*backup for rape or other
unplanned event
Disadvantages:
*nausea or vomiting
*unknown long-term
effects

19. Emergency contraception
Copper-T IUD:
inserted up to 7 days
after unprotected
intercourse; works
same as regular use
of IUD
Advantages:
*failure <1%
*backup for rape or other
unplanned event
Disadvantages:
*see IUD

20. Methods based on the menstrual cycle
abstinence based on:
Mucus method: cyclical
changes in cx mucus
Calendar method:
calendar estimate of
fertility
(BBT) Basal body-
temp. method: slight
changes in basal body
temp. @ ovulation
Advantages: no SE; free;
cost of a class or BBT
thermometer; s
comfort & self-
knowledge; s noncoital
activities; helps to plan
a wanted baby;
acceptable to most
religions
Disadvantages: s
spontaneity; requires
lots of motivation, lots
of record-keeping;
cycles can be disrupted
or irregular; most
unreliable method

21. Sterilization
Female
tubal ligation: blocks
sperm from traveling
down fallopian tube
to egg
Permanent: 70%
reversal success rate
Advantages:
*most effective of all
mehtods
*s spontaneity
*convenient
Disadvantages:
*pain during & after the
procedure
*rare surgical problems

22. Sterilization
Male
vasectomy: cutting &
closing of vas
deferens prevents
sperm from being
ejaclated with
semen
Permanent: 50%
pregnancy rate after
reversal
Advantages:
*cheaper & safer than
female surgery
Disadvantages:
*10-20 post operative
ejaculations
*prostate cancer?
*see Female

23. Less than effective methods
 Breastfeeding
– amenorrhea is common for a brief period
after birth while breastfeeding
– 80 % ovulate before first period
– unreliable
 Douching
– sperm reach uterus in 1-2 minutes
– douching may speed sperm along
– irritates vaginal tissue
– very ineffective

24. Less than effective methods
 Withdrawal before ejaculation
– difficult to judge when to withdraw
– anxiety may  pleasure
– preejaculatory secretions from Cowper’s
gland may carry sperm
– postejaculatory sperm on vulva may travel
into vagina/uterus
– unreliable

25. New directions in contraception
For men
– currently limited to condoms, vasectomy, &
withdrawal
– GRH inhibitor may  # & motility of sperm
*requires daily injections
*drop in testosterone
*possible erectile difficulty

26. New directions in contraception
 For men (cont’d)
– testosterone-derivative & progestin-related
drugs may  sperm count
*weekly injections; possible implant
– drugs that would inhibit ejaculation but not
orgasm
– NoFertil (Brazilian developed pill) destroys
male sperm without loss of erection
*potential 10-15% irreversible infertility

27. New directions in contraception
 For women
– implants, especially fewer than Norplant, or
biodegradable
– injectables
– progestin cream that is absorbed through
the skin
– vaginal rings that slowly release hormones
– one-sized & disposable diaphragms &
cervical caps

28. New directions in contraception
 For women (cont’d)
– IUDs with different shapes & hormones
– RU-486: an antiprogesterone substance
that prevents implantation & cause
menstruation
“Women who miscalculate are called
mothers.” Abigail Van Buren