-IBIS-1.5.0-
tx
reproductive system
contraception
diagnoses

definition and etiology

definition: prevention of conception.

review of methods:

sterilization: Tubal ligation in a woman and a vasectomy in a man. The man's procedure is much less complicated and less expensive, and has a lower rate of complications. In tubal ligation, the effectiveness rate is 98-99%. There is a very small number of deaths from the procedure (.02-.03%). The effectiveness rate is almost 100%. Reversibility rates vary from 25-50%, although that is not guaranteed.

rhythm method: Abstaining from sex during fertile period. The woman must be extremely regular to use this type of contraception, and even so it is quite risky. Ovulation can occur any time during the month and may change monthly, especially if the woman is under stress, sick, traveling, using alcohol or drugs, etc. Also, for some more sexually active couples, the abstinence may not be enjoyed.

withdrawal method: This entails removing the penis from the vagina just before ejaculation. It is effective 98-99% of the time, although pregnancies have been known to occur from the pre-ejaculatory discharge from the penis, which can contain some sperm. This type of contraception can only be used by men with excellent ejaculatory control and premature ejaculation is a contraindication for its use. It can also create a very anxious atmosphere during love-making, and may interfere with either the man's or woman's orgasm.

temperature method: This method uses the natural rise in body temperature that occurs with ovulation. Again, the woman must have very regular periods to use this method and unless this is practiced extremely carefully pregnancy will result. This method can also be affected by anovulatory cycles, fevers, travel, alcohol, and drugs.

birth control pill: These are hormonal drugs that suppress ovulation in women. In a small number of women, ovulation is never again established (or may take years) once they stop taking the BCP. The advantages are that intercourse may be spontaneous without having to stop to deal with a contraceptive device or control. Menstrual problems and endometriosis will all be controlled while on the pill. It has a 95-98% effectiveness rate. The woman must remember to take it daily.

cervical mucus check: This method depends on the woman checking her cervical mucus daily for its consistency. It has a questionable effectiveness rate when used alone (perhaps around 77%), and is contraindicated in women with irregular cycles, GC, or cystic fibrosis. It must be practiced very carefully, and sex must be abstained from during the time of ovulation, or another form of contraception must be employed.

foam (spermicide): This has a very low effectiveness rate (estimated at between 58-62%). It is easy to use, less messy than creams or jelly; however, it interrupts foreplay and is not very effective if used solely. It must be reapplied with each act of intercourse.

jelly or cream (spermicide): The effectiveness rate is less than 70%, and as with the foam, allergic reactions can occur.

sponge (spermicide and barrier): Basically the same as the above two: poor protection (estimated at 73%), and allergic reactions or irritation frequently occur.

condom (barrier): A condom alone has an effectiveness rate of only 60-80%; with spermicide, however, it increases to 95%. Condoms are easy to use, and buy, and offer protection against VD and AIDS (with the ones that contain nonoxynol-9). It can help the male afflicted with premature ejaculation, decreases vaginal leakage after intercourse, and is not associated with side-effects.

diaphragm (barrier): This should always be used with spermicide to gain the effectiveness rate of 85-95%.

cervical cap (barrier): The effectiveness rate is 85-98%. It can be inserted up to 12 hours before sex, though, which can help make lovemaking spontaneous without any interruptions, and does not need to be reinserted for each act of love-making.

signs and symptoms

• None

course and prognosis

review of complications:

sterilization:
In the woman, complications include problems with the general anesthesia; bowel or uterine perforations; increased menstrual complaints; risks involved with major surgery; chronic pelvic pain; and psychological problems from becoming infertile (the procedure in women is usually not reversible). In men, 1-10% will experience chronic scrotal pain (reversible with surgery). Because a vasectomy is an in-office procedure with just local anesthesia there are very low associations with complications (aside from the male feeling inadequate or having other issues arise from the operation). The effectiveness rate is almost 100%. Reversibility rates vary from 25-50%, although that is not guaranteed.

rhythm method:
Ovulation can occur any time during the month and may change monthly, especially if the woman is under stress, sick, traveling, using alcohol or drugs, etc.

withdrawal method:
This type of contraception can only be used by men with excellent ejaculatory control and premature ejaculation is a contraindication for its use. It can also create a very anxious atmosphere during love-making, and may interfere with either the man's or woman's orgasm.

temperature method:
The woman must have very regular periods to use this method and unless this is practiced extremely carefully pregnancy will result. This method can also be affected by anovulatory cycles, fevers, travel, alcohol, and drugs.

birth control pill:
This type of contraception is common and dangerous and is associated with: increased risk of blood clots (causing strokes and embolisms); increased risk of heart attacks; increased risk of developing high blood pressure; increased tendency to have abnormal blood sugars and become a diabetic (reversible by stopping the pill); increased risk of gallbladder disease; increased risk of liver disease; increased risk of endometrial and breast cancer; increased incidence of vaginitis; increased incidence of cervical dysplasia and eversion; increased development of asthma; increased depression and mood swings; vitamin deficiencies of B6 and folic acid; decreased immune system against viruses; increased eye pathology; and other symptoms such as nausea, fluid retention, chloasma, weight gain, etc. It is therefore contraindicated in women with poor circulation; uterine fibroids; tendency to depression; > 35 years old; any liver disease; abnormal genital bleeding; previous cancer or present cancer; lactation; cystic fibrosis; sickle cell anemia; and pregnancy. It is to be used with grave caution in migraines; abnormal blood sugars; epilepsy; asthma; mental retardation; and heart or kidney disease. Many physicians feel the BCP plays havoc with the body's own normal hormonal system and balance.

cervical mucus check:
It must be practiced very carefully, and sex must be abstained from during the time of ovulation, or another form of contraception must be employed.

foam (spermicide):
Allergic reactions are seen and may irritate either the vagina or the penis. It is easy to use, less messy than creams or jelly; however, it interrupts foreplay and is not very effective if used solely. It must be reapplied with each act of intercourse.

jelly or cream (spermicide):
Disadvantages include that it leaks from the vagina after intercourse as the woman sits or stands, some think it has a bad taste or smell, and it interrupts foreplay.

sponge (spermicide and barrier):
Allergic reactions or irritation frequently occur. The sponge may get stuck inside and be difficult to remove.

condom (barrier):
Allergic reactions are seen (due to the spermicide or rubber): but they are not associated with side-effects. However, they interrupt foreplay, decrease sensitivity for the male, can break, and can cause vaginal irritation if enough lubrication is not present.

diaphragm (barrier):
There may be a reaction to the spermicide, or vaginal or penile pain from its presence. 10% of women users experience chronic bladder infections that will cause them to have to give up the diaphragm. It must be fitted properly and rechecked after pregnancy, or noticeable weight loss or gain. It interrupts long-term foreplay (can only be in for about 1-2 hours before sex), must be reinserted with each act of love-making, and must stay in the woman from 6-12 hours after intercourse.

cervical cap (barrier):
There may be an allergic reaction to it, and there have been some reports of changes in the cervix resulting from the suction of the cap. It is quite difficult to insert correctly and remove and may be painfully felt by the man or woman during intercourse.

differential diagnosis

• None


footnotes