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Contraception

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  • 1. HealthEducation-ContraceptionMiss Chantelle Chaudoin,MPH
  • 2. Types of Contraception/BirthControl: Abstinence Implanon Birth Control Pills Condoms Diaphram Female Condom Fertility Awareness-Based Methods (FAMs) IUD Emergency Contraception Female Sterilization Vasectomy Withdraw method
  • 3. Abstinence
  • 4. Abstinence What Is Abstinence? You may have heard people talk about abstinence in different ways. Some people think of abstinence as not having vaginal intercourse. They may enjoy other kinds of sex play that dont lead to pregnancy. This is better described as outercourse. Some people define abstinence as not having vaginal intercourse when a woman might get pregnant. This is better described as periodic abstinence, which is one of the fertility awareness-based methods of birth control. And some people define abstinence as not having any kind of sex play with a partner. This is the definition we use on these pages. Being continuously abstinent is the only way to be absolutely sure that you wont have an unintended pregnancy or get a sexually transmitted disease (STD).
  • 5. Abstinence How Does Abstinence Prevent Pregnancy? 
Abstinence prevents pregnancy by keeping sperm out of the vagina.

 How Effective Is Abstinence? 
Used continuously, abstinence is 100 percent effective in preventing pregnancy. It also prevents STDs.

 How Safe Is Abstinence? 
Abstinence is one of the safest ways to prevent pregnancy — there are no side effects.
  • 6. Abstinence What Are the Benefits of Abstinence?  has no medical or hormonal side effects  Is free  Women and men abstain from sex play for many reasons — even after theyve been sexually active. A couple may even choose to be abstinent after having had sex play with each other. The reasons people choose to be abstinent may change throughout life. People choose abstinence to  prevent pregnancy  prevent STDs  wait until theyre ready for a sexual relationship  wait to find the right partner  have fun with romantic partners without sexual involvement  focus on school, career, or extracurricular activities  support personal, moral, or religious beliefs and values  get over a breakup  heal from the death of a partner  follow medical advice during an illness or infection
  • 7. Abstinence What Are the Disadvantages of Abstinence?  There are few disadvantages to abstinence.  People may find it difficult to abstain for long periods of time and may end their period of abstinence without being prepared to protect themselves against pregnancy or infection.
  • 8. Abstinence How Do I Talk with My Partner About Being Abstinent?  Talking with your partner about your decision to abstain from sex play is important — whether or not youve had sex play before. Partners need to be honest with each other and make sexual decisions together. These are some of the best ways to keep a relationship happy. Even so, it may not be easy to do. You may feel awkward or embarrassed.  Its best to talk about your feelings before things get sexual. For many people its hard to be clear about what they want if they get aroused. It is helpful to think — ahead of time — about how you can say "no" to sex play. What behavior will be clear? What words will be best? You can practice saying the words out loud. Then think about how someone might respond to you.  Take the time to consider fully what being abstinent will mean for you. It is important to know what you are thinking and feeling and what you need. Then you can tell your partner about it.  Be straightforward about the limits you want to set.
  • 9. Implanon
  • 10. Implanon What Is Implanon? Implanon is a thin, flexible plastic implant about the size of a cardboard matchstick. It is inserted under the skin of the upper arm. It protects against pregnancy for up to three years
  • 11. Implanon How Does Implanon Work? Like several other methods of birth control, such as the birth control shot, Implanon releases a hormone — progestin. Hormones are chemicals made in our bodies. They control how different parts of our bodies work. The progestin in Implanon works by keeping a womans ovaries from releasing eggs — ovulation. Pregnancy cannot happen if there is no egg to join with sperm. The hormone in the implant also prevents pregnancy by thickening a womans cervical mucus. The mucus blocks sperm and keeps it from joining with an egg. The hormone also thins the lining of the uterus. In theory, this could prevent pregnancy by keeping a fertilized egg from attaching to the uterus.
  • 12. Implanon How Effective Is Implanon? Effectiveness is an important and common concern when choosing a birth control method. Implanon is very effective. Less than 1 out of 100 women a year will become pregnant using Implanon. It lasts up to three years. Certain medicines and supplements may make Implanon less effective. These include  the antibiotic rifampin — other antibiotics do not make Implanon less effective  certain medicines that are taken by mouth for yeast infections  certain HIV medicines  certain anti-seizure medicines  St. Johns wort Keep in mind Implanon doesnt protect against sexually transmitted diseases. Use a latex or female condom to reduce the risk of infection.
  • 13. Implanon How Safe Is Implanon? Most women can use Implanon safely. But all medications have some risks, so safety is a concern when choosing a birth control method. Talk with your health care provider about your health and whether Implanon is likely to be safe for you. You should not use Implanon if you are pregnant or have breast cancer. There are many other methods of birth control that may be safe for you if you cannot use Implanon. Read about other methods to find one that may be right for you.
  • 14. Implanon What Are the Benefits of Implanon?  Using Implanon is safe, simple, and convenient. Women like the implant because  The ability to become pregnant returns quickly when you stop using Implanon.  It can be used while breastfeeding.  It can be used by women who cannot take estrogen.  It gives continuous long-lasting birth control without sterilization.  There is no medicine to take every day.  Nothing needs to be put in place before vaginal intercourse.
  • 15. Implanon What Are the Disadvantages of Implanon?  Some women may have undesirable side effects while using Implanon. But many women adjust to it with few or no problems.  Irregular bleeding is the most common side effect, especially in the first 6–12 months of use.  For most women, periods become fewer and lighter. After one year, 1 out of 3 women who use Implanon will stop having periods completely.  Some women have longer, heavier periods.  Some women have increased spotting and light bleeding between periods. These side effects are completely normal. Some woman may worry that they are pregnant if they do not have a regular period. But when Implanon is used correctly, it is very effective. If you are concerned about a possible pregnancy, you can always take a pregnancy test.
  • 16. Implanon Less common side effects of Implanon include  change in sex drive  discoloring or scarring of the skin over the implant  Headache  Nausea  pain at the insertion site  sore breasts Serious Side Effects of Implanon  Many women have concerns about the possible risks of taking hormones in birth control. Serious problems do not occur often.  Serious problems usually have warning signs. Tell your health care provider immediately if  You have bleeding, pus, or increasing redness, or pain at insertion site.  You have a new lump in your breast.  You have no period after having a period every month.  You have unusually heavy or prolonged bleeding from your vagina.  The implant comes out or you have concerns about its location.
  • 17. Implanon How Is Implanon Inserted and Removed?  After taking your medical history and giving you a physical exam, your health care provider will numb a small area of your arm with a painkiller. Implanon is inserted under the skin. Insertion takes only a few minutes.  After insertion, be sure to tell any health care provider you may see that you are using Implanon.  The implant is effective for three years after it is inserted. After that, it should be removed. Even though it stops working, it may interfere with your period.  Implanon can be removed at any time. Your health care provider will numb the area with a painkiller and will usually make one small cut to remove the implant. Removal usually takes just a few minutes, but it generally takes longer than insertion. A new implant may be inserted at this time. Pregnancy can happen anytime after the implant is removed.
  • 18. Birth Control Pills
  • 19. Birth Control Pills What Are Birth Control Pills? Birth control pills are a kind of medication that women can take daily to prevent pregnancy. They are also sometimes called ―the pill‖ or oral contraception.
  • 20. Birth Control Pills How Do Birth Control Pills Work?  Its pretty common for people to be confused about how birth control pills work. Here’s what it boils down to: birth control pills are made of hormones. Hormones are chemicals made in our bodies. They control how different parts of our bodies work.  Some birth control pills contain two hormones — estrogen and progestin. These are called combination pills. Some are progestin- only pills. Most women on the pill take combination pills.

The hormones in the pill work by keeping a woman’s ovaries from releasing eggs — ovulation. Pregnancy cannot happen if there is no egg to join with sperm. The hormones in the pill also prevent pregnancy by thickening a woman’s cervical mucus. The mucus blocks sperm and keeps it from joining with an egg. 
  The hormones also thin the lining of the uterus. In theory, this could prevent pregnancy by keeping a fertilized egg from attaching to the uterus.
  • 21. Birth Control Pills How Effective Are Birth Control Pills?  Effectiveness is an important and common concern when choosing a birth control method. Birth control pills are very effective. Combination pills work best when taken every day. Progestin-only pills must be taken at the same time every day. That keeps the correct level of hormone in a woman’s body.  Less than 1 out of 100 women will get pregnant each year if they always take the pill each day as directed.  About 9 out of 100 women will get pregnant each year if they don’t always take the pill each day as directed.  The pill may be slightly less effective for women who are very overweight. Talk with your health care provider if you are concerned about how well the pill may work for you.  Certain medicines and supplements may make the pill less effective. These include  the antibiotic rifampin — other antibiotics do not make the pill less effective  certain medicines that are taken by mouth for yeast infections  certain HIV medicines  certain anti-seizure medicines  St. Johns wort  Vomiting and diarrhea may also keep the pill from working. Ask your health care provider for advice. Use a backup method of birth control — like a condom, female condom, diaphragm, sponge, or emergency contraception (morning after pill) — until you find out you don’t need to.

Keep in mind the pill doesn’t protect against sexually transmitted infections. Use a latex or female condom to reduce the risk of infection.
  • 22. Birth Control Pills How Safe Are Birth Control Pills?  Most women can use birth control pills safely. But all medications have some risks, so safety is a concern when choosing a birth control method. Certain conditions increase the risk of serious side effects. Some of these conditions may even rule out using the pill. Talk with your health care provider to find out if the pill is likely to be safe for you. 

You should not take any kind of birth control pill if you have had breast cancer or think you might be pregnant. 

You should not take the progestin- only pill if you have blood clotting problems that are not being treated successfully.
 
You should not take the combination pill during prolonged bed rest or if you 

• get migraine headaches with aura 
• have certain inherited blood- clotting disorders 
• have or are being treated for blood clots or vein inflammation 
• have had a heart attack, stroke, angina, or other serious heart problems
• have had serious heart valve problems 
• have lupus with certain conditions 
• have serious liver disease or have had liver cancer 
• have very bad diabetes or have had diabetes for longer than 20 years
• have uncontrolled high blood pressure 
• smoke and are 35 or older 
• smoke and have high blood pressure 
• have had complications after organ transplant
• need to stay in bed for a long time
  • 23. Birth Control Pill What Are the Benefits of Birth Control Pills?  Taking the pill is simple, safe, and convenient. It does not interfere with having sex. Many women say it improves their sex lives because it helps them feel more spontaneous.  Women who do not need birth control often choose to take the pill for the other benefits it offers. Combination and progestin-only pills  reduce menstrual cramps  make periods lighter  offer some protection against pelvic inflammatory disease, which often leads to infertility when left untreated The combination pill offers many other benefits, including some protection against  Acne  bone thinning  breast growths that are not cancer  ectopic pregnancy  endometrial and ovarian cancers  serious infection in the ovaries, tubes, and uterus  iron deficiency anemia  cysts in the breasts and ovaries  premenstrual symptoms, including headaches and depression  bad cramps  heavy and/or irregular periods Combination pills can be used to control when and how often you have your period. Some pills are specially packaged for women to have only a few periods a year. Other pills can also be used continuously to prevent having periods. With these pills, women take an active pill every day to keep from getting their periods. It is normal for them to have spotting or bleeding the first 6 months. It may get less over time. Some stop having any bleeding at all. This is normal and will not harm your body. But it’s a good idea to get tested if you think you might be pregnant.
  • 24. Birth Control Pills What Are the Disadvantages of Birth Control Pills?  Some women may have undesirable side effects while taking birth control pills. But many women adjust to the pill with few or no problems.  Some of the most common side effects usually clear up after two or three months. They include  bleeding between periods (most often with progestin-only pills)  breast tenderness  nausea and vomiting  Nausea and vomiting may be helped by taking the pill in the evening or at bedtime. But do not stop taking the pill because you feel sick to your stomach — you will be at risk of pregnancy if you do.

The hormones in the pill may change a woman’s sexual desire. 

It’s important that you find a method that won’t make you feel sick or uncomfortable. If you continue to experience side effects after taking the pill for three months, talk with your health care provider about changing your prescription. 

After stopping the pill, it usually takes one or two months for a woman’s periods to return to the cycle she had before taking the pill. Once in a while, a woman may have irregular periods or no periods at all. This may go on for as long as six months after stopping. This is more likely if her periods were irregular before starting the pill.
  • 25. Birth Control Pill  Serious problems usually have warning signs. Report any of these signs to your health care provider as soon as possible:  a new lump in your breast  a sudden very bad headache  achy soreness in the leg  aura — seeing bright, flashing zigzag lines, usually before a very bad headache  bad pain in your abdomen or chest  headaches that are different, worse, or happen more often than usual  no period after having a period every month  trouble breathing  yellowing of the skin or eyes
  • 26. Condoms
  • 27. Condoms What Are Condoms? 
Condoms are worn on the penis during intercourse. They are made of thin latex or plastic that has been molded into the shape of a penis. Sometimes they are called rubbers, safes, or jimmies. They prevent pregnancy and reduce the risk of sexually transmitted diseases.
Condoms are available in different styles and colors, and are available dry, lubricated, and with spermicide.

 How Do Condoms Work? 
Condoms prevent pregnancy by collecting pre-cum and semen when a man ejaculates. This keeps sperm from entering the vagina. Pregnancy cannot happen if sperm cannot join with an egg.
By covering the penis and keeping semen out of the vagina, anus, or mouth, condoms also reduce the risk of sexually transmitted infections.
  • 28. Condoms How Effective Are Condoms?  Effectiveness is an important and common concern when choosing a birth control method.  Like all birth control methods, condoms are more effective when you use them correctly.  Each year, 2 out of 100 women whose partners use condoms will become pregnant if they always use condoms correctly.  Each year, 18 out of 100 women whose partners use condoms will become pregnant if they dont always use condoms correctly. You can make condoms more effective if you  use spermicide with them  pull out before ejaculation. Effectiveness is also a concern when it comes to safer sex. Condoms also protect both you and your partner from sexually transmitted infections. Condoms that are made of latex offer very good protection against HIV. Latex condoms also reduce the risk of other sexually transmitted infections, including  Chlamydia  Chancroid  Gonorrhea  Hepatitis  Herpes  HPV  pelvic inflammatory disease (PID)  Syphilis  trichomoniasis Condoms can also prevent urinary tract infections in men who wear them.
  • 29. Condoms How Safe Are Condoms? 
Almost everyone can use a condom safely. Some people are allergic to latex. If you are allergic to latex, you can try using a condom that is made from plastic.
 What Are the Benefits of Condoms? 
Using condoms is safe, simple, and convenient. Women and men like condoms because they  let men help prevent pregnancy and sexually transmitted infections  are inexpensive and easy to get  are lightweight and disposable  do not require a prescription  can help relieve premature ejaculation  may help a man stay erect longer  can be put on as part of sex play  can be used with all other birth control methods except the female condom to provide very effective pregnancy prevention and to reduce risk of sexually transmitted diseases  Many women and men say they have better sex when they use condoms. They are able to focus on their sexual pleasure without worrying about unintended pregnancy and sexually transmitted infection. Some couples put the condom on as part of their foreplay.
  • 30. Condoms What Are the Disadvantages of Condoms?  Most women and men can use condoms with no problem. Condoms have no side effects except for people who are allergic to latex. Up to 6 out of 100 people have such allergies. If you are allergic to latex, you can use condoms or female condoms made of plastic instead.  Some men and women feel that the condom dulls sensation. Others become frustrated and lose some of their sexual excitement when they stop to put on a condom. Some men are self-conscious about using condoms. Others feel pressured to ejaculate. And some men feel pressured about having to maintain an erection to keep the condom on. (If this is a concern, maintaining an erection is not necessary when using the female condom.)  Many men overcome these pressures and learn to enjoy using condoms by using them during sex play before intercourse. It may also help to try different styles and sizes to find the condom that is most comfortable for you and your partner.
  • 31. Condoms Putting on a Condom  Each package of condoms includes detailed instructions. Be sure to read and understand the instructions and check the expiration date before you use a condom.  Put the condom on before the penis touches the vulva. Men leak fluids from their penises before and after ejaculation. This fluid can carry enough germs to pass sexually transmitted infections and possibly cause pregnancy.  Use a condom only once. Use a fresh one for each erection ("hard-on"). Have a good supply on hand.  Condoms usually come rolled into a ring shape. They are individually sealed in aluminum foil or plastic. Be careful — dont tear the condom while unwrapping it. If it is torn, brittle, stiff, or sticky, throw it away and use another.  Put a drop or two of lubricant inside the condom.  Pull back the foreskin, unless circumcised, before rolling on the condom.  Place the rolled condom over the tip of the hard penis.  Leave a half-inch space at the tip to collect semen.  Pinch the air out of the tip with one hand while placing it on the penis.  Unroll the condom over the penis with the other hand.  Roll it all the way down to the base of the penis.  Smooth out any air bubbles. (Friction against air bubbles can cause condom breaks.)  Lubricate the outside of the condom
  • 32. Condoms How Do I Take Care of Condoms?  It is important to handle and store condoms properly. Long exposure to air, heat, and light makes them more likely to break.  Store them in a cool, dry place.  Don’t store them in a back pocket, wallet, or glove compartment for long periods of time.  Keep them in their individual foil or plastic pouch.  When you are ready to use the condom, don’t use it if the pouch is punctured or torn. Do not use your teeth or sharp objects, like scissors, to open the pouch.
 
Use only water- based lubricants, such as K-Y jelly or Astroglide, with latex condoms. Oil-based lubricants like petroleum jelly, cold cream, butter, or mineral and vegetable oils damage latex.
  • 33. Diaphragm
  • 34. Diaphragm What Is the Diaphragm? The diaphragm (DIE ah fram) is a shallow, dome- shaped cup with a flexible rim. It is made of silicone. You insert it into the vagina. When it is in place, it covers the cervix. How Does the Diaphragm Work? Diaphragms prevent pregnancy by keeping sperm from joining with an egg. In order to be as effective as possible, the diaphragm must be used with spermicide cream, gel, or jelly. Diaphragms work in two ways: The diaphragm blocks the opening to the uterus. The spermicide stops sperm from moving.
  • 35. Diaphragm How Effective Is the Diaphragm? Effectiveness is an important and common concern when choosing a birth control method. Like all birth control methods, the diaphragm is more effective when you use it correctly. If women always use the diaphragm as directed, 6 out of 100 will become pregnant each year. If women dont always use the diaphragm as directed, 12 out of 100 will become pregnant each year. You can make the diaphragm more effective if you Make sure it covers your cervix before each time you have intercourse. Make sure spermicide is used as recommended. Your partner can help you make the diaphragm more effective by using a latex condom or pulling out before ejaculation. Keep in mind that diaphragms do not protect you from sexually transmitted infections. Use a latex condom to reduce the risk of infection.
  • 36. Diaphragm How Safe Is the Diaphragm? Most women can use the diaphragm safely. But some conditions may make it difficult or impossible for some women to use a diaphragm. The diaphragm may not be right for you if you  are not comfortable touching your vagina and vulva  are sensitive to silicone or spermicide  gave birth in the last six weeks  have certain physical problems with your uterus or vagina  have difficulty inserting the diaphragm  have frequent urinary tract infections  have a history of toxic shock syndrome  have poor muscle tone in your vagina  recently had surgery on your cervix  recently had an abortion after the first trimester of pregnancy Your health care provider can help you decide if the diaphragm is likely to be safe for you. Only for You Your diaphragm should be used by you and only you. Do not share it with friends. And dont ever use anyone elses diaphragm.
  • 37. Diaphragm What Are the Benefits of the Diaphragm? 
Using a diaphragm is safe, simple, and convenient. Women like the diaphragm because  It can be carried in your pocket or purse.  It can be used during breastfeeding.  It generally cannot be felt by you or your partner.  It has no effect on a womans natural hormones.  It is immediately effective and reversible. There is no interruption of sex play — it can be inserted hours ahead of time. 
What Are the Disadvantages of the Diaphragm? 
The diaphragm  may be difficult for some women to insert  may be pushed out of place by some penis sizes, heavy thrusting, and certain sexual positions  must be in place every time a woman has vaginal intercourse  may need to be refitted
  • 38. Diaphragm Side Effects Most women can use the diaphragm with no problems. Serious problems are very rare. But some women may experience some side effects. Some women who use diaphragms may develop frequent urinary tract infections. To avoid infection, you can urinate before inserting the diaphragm and after intercourse. If you get frequent bladder infections, ask your health care provider to check to see if your diaphragm fits correctly. Some women who use diaphragms may develop vaginal irritation. This can be a sign of a sensitivity to silicone or to spermicide. If you have a mild reaction, try switching brands of spermicide to clear up the problem. If that doesnt work, stop using the diaphragm until you speak with your health care provider. Check with your health care provider if you  feel a burning sensation while urinating  are uncomfortable when the diaphragm is in place  have irregular spotting and bleeding  feel irritation or itching in the genital area  have redness or swelling of the vulva or vagina  have unusual discharge from the vagina These symptoms may be a sign of infection or other condition. Most conditions are easily treated.
  • 39. Diaphragm How Do I Take Care of My Diaphragm? If you take good care of your diaphragm, it may last about two years. Taking care of the diaphragm is simple. After you remove the diaphragm, wash it with mild soap and warm water. Allow it to air dry. Do not use any powders on the diaphragm — they can cause infections. Do not use oil-based lubricants — such as Vaseline or cold cream — with your diaphragm. They can damage silicone. Be sure to examine the diaphragm regularly. You can look for small holes or weak spots by holding it up to the light. If there is a hole or weak spot, light will shine through the diaphragm. You can also fill the cup of the diaphragm with water and look for leaks. Diaphragms can still be used if the silicone becomes discolored. But if the silicone develops cracks or holes it has become too thin. Stop using your diaphragm if you find that it has holes, weak spots, cracks, or wrinkles. Talk to your health care provider about getting a replacement. In the meanwhile, use another form of birth control, such as a condom, female condom, or sponge.
  • 40. Female Condom
  • 41. Female Condom What Are Female Condoms? 
The female condom is a plastic pouch that is used during intercourse to prevent pregnancy and reduce the risk of sexually transmitted diseases. It has flexible rings at each end. Just before vaginal intercourse, it is inserted deep into the vagina. The ring at the closed end holds the pouch in the vagina. The ring at the open end stays outside the vaginal opening during intercourse. And during anal intercourse, it is inserted into the anus. How Do Female Condoms Work? 
Female condoms work to prevent pregnancy by covering the inside of the vagina. They collect pre-cum and semen when a man ejaculates. This keeps sperm from entering the vagina. Pregnancy cannot happen if sperm cannot join with an egg.
By covering the inside of the vagina or anus and keeping semen and pre-cum out, condoms reduce the risk of sexually transmitted infections.
  • 42. Female Condom How Effective Are Female Condoms? Effectiveness is a common concern when choosing a birth control method. Like all birth control methods, the female condom is more effective when you use it correctly. If women always use the female condom correctly, 5 out of 100 will become pregnant each year. If women dont always use the female condom correctly, 21 out of 100 will become pregnant each year. You can make the female condom more effective if you usespermicide or if your partner pulls out before ejaculation.
  • 43. Female Condoms How Safe Are Female Condoms? 
Almost everyone can use female condoms safely. In fact, female condoms can be used by just about any woman who can use a tampon. They are also safe to use during anal sex. What Are the Benefits of Female Condoms? 
Using a female condom is safe, simple, and convenient. Women and men like female condoms because female condoms  allow women to share responsibility for preventing infection  are easy to get — can be purchased in drugstores and some supermarkets  can be inserted by a partner as part of sex play  can be used by people who are allergic to latex  can be used with oil-based as well as water-based lubricants  do not have an effect on a womans natural hormones  do not require a prescription  may enhance sex play — the external ring may stimulate the clitoris during vaginal intercourse  stay in place whether or not a man maintains his erection
  • 44. Female Condoms What Are the Disadvantages of Female Condoms? Most people can use female condoms with no problems for themselves or their partners. Some women and men may not like the female condom because it may cause irritation of the vagina, vulva, penis, or anus slip into the vagina during vaginal intercourse, or into the anus during anal intercourse reduce feeling during intercourse be noisy — adding extra lubricant can help if the female condom is noisy
  • 45. Female Condom How Do I Use Female Condoms? With a little practice, female condoms are very easy to use. To insert the female condom Put spermicide or lubricant on the outside of the closed end. Find a comfortable position. You can stand with one foot on a chair, sit on the edge of a chair, lie down, or squat. Squeeze together the sides of the inner ring at the closed end of the condom and insert it into the vagina like a tampon. Push the inner ring into the vagina as far as it can go — until it reaches the cervix. Pull out your finger and let the outer ring hang about an inch outside the vagina. If you want to use the female condom for anal intercourse, follow above instructions for inserting it into the anus. During vaginal intercourse, it is normal for the female condom to move side to side. Stop intercourse if the penis slips between the condom and the walls of the vagina or if the outer ring is pushed into the vagina. As long as your partner has not yet ejaculated, you can gently remove the condom from the vagina, add extra spermicide or lubricant, and insert it once again.
  • 46. Female Condom To remove the female condom Squeeze and twist the outer ring to keep semen inside the pouch. Gently pull it out of the vagina or anus. Throw it away. Do not flush it down the toilet. Do not reuse the female condom.
  • 47. Fertility Awareness BasedMethods
  • 48. Fertility Awareness BasedMethods What Are Fertility Awareness-Based Methods? 
Fertility awareness-based methods (FAMs) are ways to track ovulation — the release of an egg — in order to prevent pregnancy. Some people call FAMs "natural family planning."

 How Do Fertility Awareness-Based Methods Work? 
FAMs work by keeping sperm out of the vagina in the days near ovulation, when a woman is most fertile — most likely to become pregnant.
To prevent pregnancy, women can abstain from vaginal intercourse on their fertile days. Or they can use withdrawal, a condom, a sponge, a diaphragm, or a cap on those days. Or they may enjoy other kinds of sex play instead of vaginal intercourse on their fertile days.
  • 49. Fertility Awareness BasedMethods (FAMS) UNDERSTANDING YOUR FERTILITY PATTERN In order to know when you are most likely to get pregnant, you have to become familiar with your menstrual cycle. Before pregnancy can begin, a womans egg must join with a mans sperm. This is called fertilization. For a healthy woman, there are days when fertilization can happen. There are days when it cant. And there are some days when its unlikely — but still possible. To begin a pregnancy, a woman can have vaginal intercourse — without protection — during the days when its possible for the egg and sperm to join. We call those days your fertile days. A womans fertile days depend on the life span of the egg and the sperm. Her egg lives for about a day after ovulation. Sperm can live inside her body for about six days. A woman has a chance of her egg joining a sperm about seven days of every menstrual cycle. This includes the five days before ovulation. It includes the day of ovulation. It also includes the day or two after ovulation — even though its less likely to happen then. Knowing when your fertile days will happen can help you avoid a pregnancy. It can also help you plan one. The key is to figure out when you will ovulate. This will let you figure out the other fertile days that come before and after you ovulate. Then you can track your fertility pattern — the days of the month when you are fertile and the days of the month when you are not. You must do this carefully. Women dont all have the same fertility pattern. And some women have different patterns from one month to the next.
  • 50. Fertility Awareness BasedMethods (FAMS) What Are the Different Fertility Awareness-Based Methods? There are several methods you can use to predict when you will ovulate. Temperature Method — You will take your temperature in the morning every day before you get out of bed. Cervical Mucus Method — You will check the changes in your cervical mucus every day for the first part of your cycle until you are sure you have ovulated. Calendar Method — You will chart your cycles on a calendar. It is most effective to combine all three of these methods. Together, they are called the symptothermal method. Standard Days Method — You will track your cycle for several months to be sure that your cycle is always between 26 and 32 days long. Never longer or shorter. Then, you will not have unprotected vaginal intercourse on days 8–19.
  • 51. Fertility Awareness BasedMethods (FAMS) What is the Calendar Method? To prevent pregnancy, women can keep track of their menstrual cycles and abstain from unprotected vaginal intercourse when they are most likely to become pregnant. The methods you can use to do this are called fertility awareness-based methods (FAMs). One way that women track their fertility patterns is called the calendar method. The Calendar Method With the calendar method, you need to keep a record of the length of each menstrual cycle in order to determine when you are fertile. You can use an ordinary calendar. Circle day one of each cycle, which is the first day of your period. Count the total number of days in each cycle. Include the first day when you count. Do this for at least eight cycles (12 is better).
  • 52. Fertility Awareness BasedMethods (FAMS) Cycle Record First Day of Period Number of Days in Cycle Jan. 20 29 Feb. 18 29 Mar. 18 28 Apr. 16 29 May 12 26 June 9 28 July 9 30 Aug. 5 27 Dont use the calendar method if all your cycles are shorter than 27 days.
  • 53. Fertility Awareness Based Methods(FAMS)  Chart Your Calendar Pattern  To predict the first fertile day in your current cycle  Find the shortest cycle in your record.  Subtract 18 from the total number of days.  Count that number of days from day one of your current cycle, and mark that day with an X. Include day one when you count.  The day marked X is your first fertile day. To predict the last fertile day in your current cycle  Find the longest cycle in your record.  Subtract 11 days from the total number of days.  Count that number of days from day one of your current cycle, and mark that day with an X. Include day one when you count.  The day marked X is the last fertile day.
  • 54. Fertility Awareness BasedMethods (FAMS) Here is an example: Predicting your first fertile day. If your shortest cycle is 26 days long, subtract 18 from 26. That leaves 8. If day one was the fourth day of the month, the day you will mark X will be the 11th. Thats the first day youre likely to be fertile. So on that day, you should start abstaining from sex or start using a cervical cap, condom, diaphragm, or female condom. Predicting your last fertile day. If your longest cycle is 30 days, subtract 11 from 30. That leaves 19. If day one was the fourth day of the month, the day you will mark X will be the 22nd. Thats the last day youre likely to be fertile during your current cycle. So you may start to have unprotected vaginal intercourse after that day. In this example, the 11th through the 22nd are unsafe days. All the others are safe days.
  • 55. Fertility Awareness BasedMethods (FAMS) The Role of the Calendar Method The calendar method can only predict what are most likely to be safe days. It is especially risky if your cycles are not always the same length. Thats why it should always be used with other methods. Do not have unprotected intercourse on any day that the calendar method says is unsafe
  • 56. Fertility Awareness BasedMethods (FAMS) How Effective Are Fertility Awareness-Based Methods? Effectiveness is an important and common concern when choosing a birth control method. Like all birth control methods, fertility awareness- based methods are more effective when you use them correctly. Twenty-four out of every 100 couples who use fertility awareness- based methods each year will have a pregnancy if they dont always use the method correctly or consistently. Always practicing these methods correctly will make them more effective. How well fertility awareness-based methods work depends on both partners. Thats why it is important for both to learn about the methods and support each other in their use. These methods can work best for you if you have received careful instruction have only one sex partner and he is as committed to fertility awareness-based methods as you are have the discipline you need to check and chart your fertility signs dont mind abstaining or using withdrawal, a cervical cap or diaphragm, a sponge, spermicide, or latex or female condoms on your unsafe days
  • 57. Fertility Awareness BasedMethods (FAMS) How Safe Are Fertility Awareness-Based Methods? 
Fertility awareness-based methods are very safe — there are no side effects.

 What Are the Benefits of Fertility Awareness-Based Methods? 
 they cost very little. They are safe. They can be stopped easily to plan a pregnancy. Calendars, thermometers, and charts are easy to get. Medication is not needed.
  • 58. Fertility Awareness BasedMethods (FAMS) What Are the Disadvantages of Fertility Awareness-Based Methods? Fertility awareness-based methods may not work for you if you have more than one sex partner have a sex partner who isnt as committed to fertility awareness-based methods as you are dont want to keep close track of your safe days are not able to abstain or use another method for at least 10 unsafe days during each cycle take medicine that may affect reading the signs of these methods Do not depend on tracking your fertility if you have irregular periods have a partner who is not cooperative have a sexually transmitted infection or frequent abnormal vaginal discharges cannot keep careful records It may be more difficult to track your fertility if you are breastfeeding, are a teenager, or are getting close to menopause. The hormone shifts may make the signs unpredictable. Dont switch to a fertility awareness-based method after using a hormonal one, such as the pill. The hormones will affect your cycle. Use a method without hormones while youre learning to track your fertility.
  • 59. IUD What Is an IUD? The letters IUD stand for "intrauterine device." IUDs are small, "T-shaped" devices made of flexible plastic. A health care provider inserts an IUD into a womans uterus to prevent pregnancy. There are two brands of IUD available in the United States — ParaGard and Mirena.  The ParaGard IUD contains copper. It is effective for 12 years.  The Mirena IUD releases a small amount of progestin, a hormone. It is effective for five years.
  • 60. IUD How Does an IUD Work? Both the ParaGard and the Mirena IUDs affect the way sperm move, preventing them from joining with an egg. If sperm cannot join with an egg, pregnancy cannot happen. Both types also alter the lining of the uterus. Some people say that this keeps a fertilized egg from attaching to the lining of the uterus. But there is no proof that this actually happens. The progestin in the Mirena IUD helps prevent pregnancy. Progestin works by keeping a womans ovaries from releasing eggs — ovulation. Pregnancy cannot happen if there is no egg to join with sperm. Progestin also prevents pregnancy by thickening a womans cervical mucus. The mucus blocks sperm and keeps it from joining with an egg.
  • 61. IUD How Effective Is the IUD? Effectiveness is an important and common concern when choosing a birth control method. IUDs are one of the most effective forms of birth control available. Less than 1 out of 100 women will get pregnant each year if they use the ParaGard or the Mirena IUD. Keep in mind that the IUD doesnt protect against sexually transmitted infections. Use a latex or female condom along with the IUD to reduce the risk of infection.
  • 62. IUD How Safe Is the IUD? Most women can use either the ParaGard or the Mirena IUD safely. But all medications have some risks, so safety is a common concern when choosing a birth control method. Certain conditions increase the risk of side effects. Talk with your health care provider about your health and whether an IUD is likely to be safe for you. There are many other methods of birth control that may be safe for you if you cannot use an IUD. You should not use an IUD if you  have had a pelvic infection following either childbirth or an abortion in the past three months  have or may have a sexually transmitted infection or other pelvic infection  think you might be pregnant  have cervical cancer that hasnt been treated  have cancer of the uterus  have unexplained bleeding in your vagina  have pelvic tuberculosis  have a uterine perforation during IUD insertion A health care provider may find that the unique size, shape, or condition of a woman’s uterus does not allow correct placement of an IUD. This is not common. You should not use the ParaGard IUD if you  have, or may have, an allergy to copper or have Wilsons Disease — an inherited disease that blocks the body’s ability to get rid of copper You should not use the Mirena IUD if you  have severe liver disease  have, or may have, breast cancer
  • 63. IUD What Are the Benefits of an IUD? The ParaGard and the Mirena IUDs are two of the least expensive, longest lasting forms of birth control available to women today. There are many other benefits. IUDs may improve your sex life. There is nothing to put in place before intercourse to prevent pregnancy. Some women say that they feel free to be more spontaneous because they do not have to worry about becoming pregnant. 
 The ParaGard IUD does not change a womans hormone levels. 
 The Mirena IUD may reduce period cramps and make your period lighter. On average, menstrual flow is reduced by 90 percent. For some women, periods stop altogether. 
 IUDs can be used during breastfeeding.
 The ability to become pregnant returns quickly once the IUD is removed. Some women may worry that they are pregnant if they do not have a regular period. But the IUD is very effective. If you are concerned about a possible pregnancy, you can always take a pregnancy test. Overall, most women who get an IUD are satisfied with their choice. Ninety-nine percent of IUD users are pleased with them.
  • 64. IUD What Are the Disadvantages of an IUD? Its important to think about the possible side effects of using an IUD. You may have mild to moderate pain when the IUD is put in cramping or backache for a few days spotting between periods in the first 3–6 months irregular periods in the first 3–6 months — with Mirena heavier periods and worse menstrual cramps — with ParaGard Pain relievers can usually reduce bleeding, cramping, and other discomforts. If they are severe and do not seem to lessen, tell your health care provider.
  • 65. IUD Serious problems with the IUD are rare. There are three main things to watch out for when using an IUD: The IUD can sometimes slip out of the uterus. Sometimes it comes all the way out. Sometimes it only comes out a little. This is more likely to happen to women who are younger and who have never had a baby. If the IUD slips out of place, pregnancy can happen. If it comes out only part of the way, it has to be removed. In rare situations, a woman could develop an infection when using the IUD. This happens if bacteria get into the uterus when the IUD is inserted. Most infections develop within three weeks of having the IUD inserted. If the infection is not treated, it can affect a womans ability to become pregnant in the future. In very rare situations, when the IUD is inserted, it can push through the wall of the uterus. This might sound painful, but it usually isnt. Usually, when this happens, the health care provider will notice it and it can be fixed right away. But if not, the IUD can move around and harm other parts of the body. When this happens, surgery may be needed to remove the IUD. Most often, if complications happen, they are easy to treat with medicine or other treatments.
  • 66. IUD Its important to pay attention to any symptoms you might have after starting the IUD. Tell your health care provider immediately if you find the length of the string ends to be shorter or longer than they were at first, when you feel for them with your fingers are not able to feel the string ends when you check feel the hard plastic bottom of the "T" part of the IUD against the cervix, when you check think you might be pregnant have periods that are much heavier than normal or last much longer than normal have severe abdominal cramping, pain, or tenderness in the abdomen have pain or bleeding during sex have unexplained fever and/or chills have flu-like symptoms, such as muscle aches or tiredness have unusual vaginal discharge have a missed, late, or unusually light period have unexplained vaginal bleeding
  • 67. IUD How Soon After Getting an IUD Can I Have Sex? You can have sex as soon as you like after the IUD is inserted. The ParaGard IUD is effective immediately.
 The Mirena IUD is effective immediately if inserted within seven days after the start of your period. If you have Mirena inserted at any other time during your menstrual cycle, use another method of birth control like a condom, female condom, or spermicide if you have vaginal intercourse during the first week after insertion. Protection will begin after seven days.
  • 68. IUD What Happens When I Have an IUD Inserted? To get an IUD, you need to visit a health care provider. Your health care provider will ask you some questions about your medical history and the way you live your life. It is important to be open about your sex life because the IUD may not be right for you. But don’t worry. There are many other birth control methods to choose from if you cannot use the IUD. If an IUD seems to be a good choice for you, your health care provider will check your vagina and internal organs. You may be tested for sexually transmitted infections or for other infections to make sure it’s safe for you to get an IUD. If you have any kind of pelvic infection, you may need treatment before getting an IUD. An IUD can be inserted at any time of the month. But it is usually more comfortable if you have it inserted in the middle of your menstrual cycle. That is when the cervix — the opening to the uterus — is the most open.
  • 69. IUD What Should I Do After Getting an IUD? You should have a checkup after your first period. Dont wait longer than three months after you get your IUD to make sure it is still in place. Women using an IUD should have regular checkups to make sure everything is all right. This can be done at the same time as your periodic GYN exam. Remember when you have your IUD inserted. That way, if you see other health care providers, you can tell them when it needs to be replaced. The ParaGard IUD should be replaced after 12 years. The Mirena IUD should be replaced after five years.
  • 70. IUD How Do I Check My IUD? If an IUD is going to slip out of place, it will most likely happen in the first few months of use. But it may occur later. The IUD is most likely to slip out of place during your period. Check your pads, tampons, or cups to see if the IUD has fallen out. If it has, you must check with your health care provider. Until then, use another form of birth control such as latex or female condoms. Between your periods, you can check for the string ends. It is especially important to check every few days for the first few months. To check for the string ends ... Wash your hands. Then either sit or squat down.
 Put your index or middle finger up into your vagina until you touch the cervix. Your cervix will feel firm and somewhat rubbery, much like the tip of your nose. 
 Feel for the string ends that should be coming through. If you find them, it means that the IUD is in place and working. However, if the string ends feel longer or shorter than before, or if you feel the hard part of the IUD against your cervix, it may be that the IUD has moved and needs to be put back in place by your health care provider. You should not attempt to put the IUD back in place yourself. Be sure to use another form of birth control until it is put back in place.
 Do not pull on the string ends. Pulling might make the IUD move out of place or even come out.
  • 71. IUD How Is an IUD Removed? Having an IUD removed or replaced is usually simple. Your health care provider will do it for you. Women should never try to remove IUDs themselves or ask nonprofessionals to do it for them. Serious damage could result. In rare cases, IUDs cannot be easily pulled free. In these cases, the cervix may have to be dilated and a surgical tool may be used to free the IUD. In very rare cases, surgery becomes necessary
  • 72. Emergency Contraception
  • 73. Emergency Contraception What Is the Morning-After Pill (Emergency Contraception)? Emergency contraception is a safe and effective way to prevent pregnancy after unprotected intercourse. There are two kinds of emergency contraception: a pill, commonly called the morning-after pill. The brand names of the morning-after pill are ella, Next Choice, and Plan B One-Step. ParaGard IUD insertion Both kinds of emergency contraception can be used up to five days (120 hours) after unprotected intercourse. You may want to use it if The condom broke or slipped off, and he ejaculated in your vagina. You forgot to take your birth control pills, insert your ring, or apply your patch. Your diaphragm or cap slipped out of place, and he ejaculated inside your vagina. you miscalculated your "safe" days. He didnt pull out in time. You werent using any birth control. You were forced to have unprotected vaginal sex.
  • 74. Emergency Contraception How Does the Morning-After Pill (Emergency Contraception) Work? Two brands of the morning-after pill — Plan B One-Step and Next Choice — are made of one of the hormones found in birth control pills called progestin. Hormones are chemicals made in our bodies. They control how different parts of the body work. The other brand of the morning-after pill — ella — is made of a medication called ulipristal acetate. All brands of the morning-after pill work by keeping a womans ovaries from releasing eggs — ovulation. Pregnancy cannot happen if there is no egg to join with sperm. The hormone in the morning-after pill also prevents pregnancy by thickening a womans cervical mucus. The mucus blocks sperm and keeps it from joining with an egg. The morning-after pill can also thin the lining of the uterus. In theory, this could prevent pregnancy by keeping a fertilized egg from attaching to the uterus. You might have also heard that the morning-after pill causes an abortion. But thats not true. The morning-after pill is not the abortion pill. Emergency contraception is birth control, not abortion.
  • 75. Emergency Contraception How Effective Is the Morning-After Pill (Emergency Contraception)? Emergency contraception can be started up to 120 hours — five days — after unprotected intercourse. The sooner it is started, the better it works. Emergency contraception is also known as the morning-after pill, emergency birth control, backup birth control, and by the brand names Plan B One-Step, ella, and Next Choice. Plan B One-Step and Next Choice reduce the risk of pregnancy by 89 percent when started within 72 hours after unprotected intercourse. They continue to reduce the risk of pregnancy up to 120 hours after unprotected intercourse, but they are less effective as time passes. You need to use the morning-after pill to prevent pregnancy after each time you have unprotected intercourse. The morning-after pill will not prevent pregnancy for any unprotected intercourse you may have after taking the pills. If you do not have your period within three weeks after taking emergency contraception, you may want to consider taking a pregnancy test. The morning-after pill offers no protection against sexually transmitted diseases or infections. You may want to consider STD testing if there is a possibility that unprotected sex put you at risk.
  • 76. Emergency Contraception How Safe Is the Morning-After Pill (Emergency Contraception)? Emergency contraception is safe, and millions of women have used it. Various forms of emergency contraception have been used for more than 30 years. There have been no reports of serious complications. Even though Plan B One-Step and Next Choice are made of one of the same hormones used in the birth control pill, the morning-after pill does not have the same risks as taking the pill or other hormonal birth control methods continuously. Thats because the hormone in the morning-after pill is not in your body as long as it is with ongoing birth control.
  • 77. Emergency Contraception What Are the Disadvantages of the Morning-After Pill (Emergency Contraception)? You may have some undesirable side effects while using the morning- after pill. But many women use Plan B One-Step, ella, and Next Choice with few or no problems. Nausea and throwing up are the most common side effects. Less than 1 out of 4 women feel sick when they take them. You can use anti-nausea medicine one hour before taking emergency contraception if you are concerned about being nauseous. Many women also find it helpful to take the emergency contraception pills with a full stomach. Other side effects of the morning-after pill may include  breast tenderness  irregular bleeding  Dizziness  headaches If you use the morning-after pill frequently, it may cause your period to be irregular. Emergency contraception should not be used as a form of ongoing birth control because there are other forms of birth control that are a lot more effective.
  • 78. Emergency Contraception How Do I Use the Morning-After Pill (Emergency Contraception)? Take emergency contraception as soon as possible after unprotected intercourse. The sooner you start it, the better it will work. But it will reduce your risk of pregnancy if you start it up to 120 hours — five days — after unprotected intercourse. Next Choice can be taken in one dose or two doses. If you take it in two doses, take the second pill 12 hours after the first pill. Or simply take them both at the same time. Its your choice. You can use anti-nausea medicine one hour before taking emergency contraception if you are concerned about getting nauseated. Many women also find it helpful to take the emergency contraception pills with a full stomach. After you take emergency contraception, its normal for your next period to be different from usual. It may be earlier or later than usual. It may be heavier, lighter, more spotty, or the same as usual. Be sure to tell any health care provider that you may see before your next period that you have taken the morning-after pill. If you do not have your period within three weeks after taking emergency contraception, or if you have any symptoms of pregnancy, take a pregnancy test or schedule an appointment with your health care provider.
  • 79. Female Sterilization  What Is Sterilization?  Sterilization is a form of birth control. All sterilization procedures are meant to be permanent.  During a sterilization procedure, a health care provider closes or blocks a womans fallopian tubes. Closing the tubes can be done in several ways.  One way is by tying and cutting the tubes — this is called tubal ligation. The fallopian tubes also can be sealed using an instrument with an electrical current. They also can be closed with clips, clamps, or rings. Sometimes, a small piece of the tube is removed.  Sometimes, tiny inserts are put in the tubes. Tissue grows around them and blocks the tubes. The brand names for these types of sterilization are Adiana and Essure.
  • 80. Female Sterilization How Does Sterilization Work? 
Eggs are made in a womans ovaries. One egg is released each month. It passes through one of the fallopian tubes toward the uterus. Sterilization blocks each tube. Pregnancy cannot happen if sperm cannot reach the egg.

 How Safe Is Sterilization? 
Most women can be sterilized safely. But like any medical procedure, there are risks.
One possible risk is that the tubes may reconnect by themselves — but this is rare. When women get pregnant after being sterilized, about 1 out of 3 has a pregnancy that develops in a fallopian tube. This is called ectopic pregnancy. Ectopic pregnancy is serious and may be life threatening.
  • 81. Female Sterilization What Are the Benefits of Sterilization? Sterilization is safe and, because it lasts for life, it is simple and convenient. It allows a woman to enjoy sex without worrying about pregnancy. Many women and men report that they have more sexual pleasure because they dont have to think about unwanted pregnancy anymore. Sterilization does not change your hormones. The hormones that affect hair, voice, sex drive, muscle tone, and breast size, are still made in the ovaries. Those hormones still flow through the body after sterilization. It will not cause symptoms of menopause or make menopause happen earlier. And most women who have been sterilized will still have normal periods. Sterilization may be right for you if  You dont want to have a child biologically in the future.  You have concerns about the side effects of other methods.  Other methods are unacceptable.  Your health would be threatened by a future pregnancy.  You dont want to pass on a hereditary illness or disability.  You and your partner agree that your family is complete, and no more children are wanted.  You and your partner have decided that sterilization is better for you than vasectomy is for him.
  • 82. Female Sterilization What Are the Disadvantages of Sterilization? There are several possible disadvantages of sterilization. Sterilization may not be a good choice for you if you  may want to have a child biologically in the future  are being pressured by a partner, friends, or family  are using it to solve problems that may be temporary — such as marriage or sexual problems, short-term mental or physical illnesses, financial worries, or being out of work You should consider any possible life changes, such as divorce, remarriage, or death of children. You dont need your partners permission to be sterilized, but it may be helpful to discuss it with your partner or anyone else who could be part of the decision-making process. There are risks with any medical procedure, including sterilization. Its important to understand the risks before being sterilized. Read below about the risks of each type of sterilization.
  • 83. Female Sterilzation What Are the Types of Sterilization? There are a few different types of sterilization. One type does not require an incision — a cut. It is called hysteroscopic sterilization. All the other methods require an incision.  NO-INCISION (HYSTEROSCOPIC) METHODS — ADIANA, ESSURE  INCISION METHODS — LAPAROSCOPY, MINI- LAPAROTOMY, LAPAROTOMY  HIGH-RISK METHOD — HYSTERECTOMY Your health care provider will help you decide which kind of sterilization might be right for you. Your medical history, including your weight and previous surgeries, may influence which kind will be best and safest for you.
  • 84. Female Sterilization How Effective Is Sterilization? Effectiveness is an important and common concern when choosing a birth control method. Sterilization is nearly 100 percent effective.  For every 1,000 women who have Essure, fewer than 3 will become pregnant.  For every 1,000 women who have traditional incision methods, about 5 will become pregnant.  For every 1,000 women who have Adiana, fewer than 20 will become pregnant. Most kinds of sterilization for women are effective right away. But it takes about three months before Adiana and Essure are effective. Keep in mind that sterilization provides no protection against sexually transmitted diseases. Latex or female condoms can reduce your risk of STDs.
  • 85. Female Sterilization What Happens During Sterilization with Adiana? To use Adiana, a health care provider puts a tiny insert into each of the fallopian tubes. Natural tissue grows around the inserts, blocking the tubes. During the procedure, the health care provider uses local anesthesia to numb the cervix. You may be offered other medication to help you relax and reduce your discomfort. A small, rigid, tube-like instrument called a hysteroscope is inserted into the vagina and through the cervix. A small amount of heat is applied to each fallopian tube. Two inserts — the size of a grain of rice — are placed in the spots where the heat was applied. 
 
While Adiana is being inserted — and for a short time after — you may have  pain or cramping, like strong menstrual cramps  mild nausea or vomiting (―sick to your stomach‖) You may have a vaginal discharge, like a light menstrual period, for a few days. Like Essure and vasectomy, Adiana is not effective right away. Three months after insertion, a special x-ray is performed to make sure the tubes are fully blocked. You must use another form of birth control until then, or you may get pregnant. Adiana offers some advantages over other methods of sterilization:  The procedure is safer than methods that require an incision.  General anesthesia is not needed.  A surgical setting is not needed.  Recovery is faster — some women return to normal activities the same day. With Adiana, no incisions are necessary. So you wont have any visible scars.
  • 86. Female Sterilization What Are the Risks with Adiana? Studies have shown that Adiana is safe, but there are still some possible risks:  One or both of the inserts may not be put in place correctly the first time. A second procedure may be needed.  The uterus may be injured during the insertion. This rare complication may require surgery.  The tubes may not be completely blocked after three months. It may be necessary to wait three more months to see if they become blocked. If they don’t, a second procedure may be needed. Other rare complications include too much fluid build up in your bloodstream, changes in the menstrual cycle, infection, and pelvic or back pain. Talk with your health care provider about the benefits and risks of Adiana to help you decide if it may be right for you.
  • 87. Female Sterilization What Happens During Sterilization with Essure? To use Essure, a health care provider puts a tiny insert called a microinsert into each of the fallopian tubes. Once in place, the inserts cause natural tissue to grow, blocking the tubes. During the procedure, the health care provider uses local anesthesia to numb the cervix. You may be offered other medication to help you relax and reduce your discomfort. Some women report mild to moderate pain while the inserts are being placed. A small, rigid, tube- like instrument called a hysteroscope is inserted into the vagina and through the cervix. The inserts are placed in the opening of the tubes. Like Adiana and vasectomy, Essure is not effective right away. Three months after insertion, a special x-ray is performed to make sure the tubes are fully blocked. You must use another form of birth control until then, or you may get pregnant.
 
Essure offers some advantages over other methods of sterilization:  The procedure is safer than methods that require an incision.  General anesthesia is not needed.  A surgical setting is not needed.  Recovery is faster — some women return to normal activities the same day. With Essure, no incisions are necessary. So you wont have any visible scars.
  • 88. Female Sterilization What Are the Risks with Essure? Studies have shown that Essure is safe, but there are still some possible risks:  One or both of the inserts may not be put in place correctly the first time. A second procedure may be needed.  The inserts may move out of place.  The tubes may not be completely blocked after three months. It may be necessary to wait three more months to see if they become blocked. If they dont, a second procedure may be needed.  The uterus may be injured during the insertion. This rare complication may require surgery.  The inserts may be damaged during other medical procedures. Other rare complications include too much fluid build up in your bloodstream, changes in the menstrual cycle, infection, and pelvic or back pain.

Talk with your health care provider about the benefits and risks of Essure to help you decide if it may be right for you.
  • 89. Female Sterilization What Happens During Sterilizations that Require an Incision? Laparoscopy Laparoscopy is one of the two most common types of sterilization. First you will get either general, regional, or local anesthesia. Then, your abdomen is inflated with an injection of harmless gas (carbon dioxide). This allows your health care provider to see your organs clearly. Then the provider makes a small cut near your navel and inserts a laparoscope (a rod-like instrument with a light and a viewing lens) to locate the fallopian tubes. The health care provider also may insert an instrument for closing the tubes, usually through a second small opening. Sometimes only one incision and one instrument are used. The procedure can be performed in outpatient surgical clinics. It usually takes 20–30 minutes. Very little scarring occurs. Women often go home the same day. Mini-Laparotomy Mini-laparotomy is another common type of sterilization. It is often performed after childbirth. No gas or laparoscope is used. Usually, local anesthesia is used. A small cut is made in the lower abdomen, just above the pubic hair or just below the navel. The health care provider locates the tubes, then ties, clips, or uses a probe with an electrical current to block them off. Women usually recover in a few days. Laparotomy Laparotomy is major surgery. It is less commonly used than the other incision methods. The health care provider makes a two-to-five-inch cut in the abdomen. The provider locates and closes off the tubes. The operation requires general or regional anesthesia. You may need to be hospitalized for 2–4 days. It may take several weeks at home to completely recover. If the procedure is done after delivery, your hospital stay may be extended by 1–2 days.
  • 90. Female Sterilization What Are the Risks of Sterilizations that Require an Incision? Complications can occur with any kind of surgery. These incision methods are considered low-risk surgeries. The complications that can occur during or after these them include  Bleeding  Infection  reaction to the anesthetic Infection is rare. It is treated with antibiotics. Very rarely, the bowel, bladder, uterus, or blood vessels are injured. You may need additional surgery to repair this. Complications may develop in 1–4 out of every 100 sterilizations that are performed through the abdomen. Death resulting from sterilization is extremely rare and is usually caused by a reaction to general anesthesia.
  • 91. Female Sterilization What Happens During Hysterectomy? 
Hysterectomy is the removal of the uterus. It is major surgery and is not usually used for sterilization. It is used to correct serious medical conditions.
If you have a hysterectomy, you will no longer have your period. Usually, it will not affect your fallopian tubes. However, some medical conditions also call for the removal of a tube and/or ovary, on one side or both. 
Hysterectomy is performed through the abdomen and/or vagina. Women need to spend several days in the hospital. They usually spend several weeks at home recovering. They should abstain from sexual intercourse for 4–6 weeks, until the health care provider says it is safe to have sex.

 What Are the Risks with Hysterectomy? 
Complications after hysterectomy, such as infection or blood loss, occur in 10–20 out of every 100 cases. Because hysterectomy is usually performed as a result of a serious medical problem, the risk of death is much greater than it is for more common sterilization methods.
  • 92. Female Sterilization Does Sterilization Hurt? 
Your health care provider will give you medicine to make sterilization as comfortable as possible. Numbing medication and/or sedatives will be used. The choice depends on your health and the method of sterilization being used. Conscious sedation allows you to be awake but deeply relaxed. Local and regional anesthesia block the feeling of pain in certain areas of your body. These are much safer than general anesthesia.
General anesthesia is entirely painless. It allows you to sleep through the procedure.
When you get local or regional anesthesia, you may feel brief discomfort. The pain is relieved with medications and, sometimes, sedatives. Most likely, you will feel little or no discomfort during the procedure.

 How Will I Feel After Sterilization? 
The discomfort you feel after the procedure depends on your general health, the type of procedure, and how well you deal with pain. You may feel tired and have slight pain in your abdomen. You may occasionally feel dizzy, nauseous, bloated, or gassy, or have shoulder pain or abdominal cramping. Women who use Adiana or Essure may have vaginal discharge, like a light menstrual period. Most symptoms will last 1–3 days.
Contact your health care provider immediately if you  bleed from an incision  develop a rash or fever  have difficulty breathing  have fainting spells  have severe, continuous abdominal pain  have unusual discharge or odor from your vagina
  • 93. Female Sterilization How Long Does It Take to Recover from Sterilization? It depends on your general health, lifestyle, and the method of sterilization that you use. With mini- laparotomy and laparoscopy, recovery is usually complete in a day or two. You may want to take it easy for the next week or so. In any case, you should avoid heavy lifting for about one week. Recovery from sterilization with Adiana or Essure is faster — some women return to normal activities the same day as the procedure. Others take a day or two. Talk with your health care provider about when its safe to start having sex again. Remember, if youve had Adiana or Essure, you need to use another birth control method until your health care provider confirms that your tubes are blocked.
  • 94. Vasectomy What Is Vasectomy? 
Vasectomy is a form of birth control for men that is meant to be permanent.
During vasectomy, a health care provider closes or blocks the tubes that carry sperm. When the tubes are closed, sperm cannot leave a mans body and cause pregnancy.

 How Does Vasectomy Work? 
Sperm are made in the testicles. They pass through two tubes called the vasa deferentia to other glands and mix with seminal fluids to form semen. Vasectomy blocks each vas deferens and keeps sperm out of the seminal fluid. The sperm are absorbed by the body instead of being ejaculated. Without sperm, your "cum" (ejaculate) cannot cause pregnancy.
  • 95. Vasectomy How Effective Is Vasectomy? Effectiveness is an important and common concern when choosing a birth control method. Vasectomy is the most effective birth control for men. It is nearly 100 percent effective. However, vasectomy is not immediately effective. Sperm remains beyond the blocked tubes. You must use other birth control until the sperm are used up. It usually takes about three months. A simple test — semen analysis — shows when there are no more sperm in your ejaculate.
  • 96. Vasectomy What Are the Types of Vasectomy? There are different ways for men to be sterilized. One type does not require an incision — a cut. The other types of vasectomy require an incision. Incision methods take about 20 minutes. The no-incision method takes less time. INCISION METHODS Usually, a local anesthetic is injected into the pelvic area. Then, the doctor makes an incision on each side of the scrotum to reach each vas deferens — the tubes that carry sperm. Sometimes a single incision is made in the center. Each tube is blocked. In most procedures, a small section of each tube is removed. Tubes may be tied off or blocked with surgical clips. Or, they may be closed using an instrument with an electrical current. NO-INCISION METHOD With the no-incision ("no-scalpel") method, the skin of the scrotum is not cut. One tiny puncture is made to reach both tubes. The tubes are then tied off, cauterized, or blocked. The tiny puncture heals quickly. No stitches are needed, and no scarring takes place. The no-scalpel method reduces bleeding and decreases the possibility of infection, bruising, and other complications.
  • 97. Vasectomy How Safe Is Vasectomy? 
Most men can have a vasectomy safely. But like any medical procedure, there are risks. Talk with your health care provider about whether vasectomy is likely to be safe for you.

 What Are the Benefits of Vasectomy? 
Vasectomy is safe and, because it lasts for life, it is simple and convenient. It allows women and men to enjoy sex without worrying about pregnancy.
Vasectomy does not change your hormones or masculinity. And it will not affect your ability to get and stay erect. It also will not affect your sex organs, sexuality, and sexual pleasure. No glands or organs are removed or altered. Your hormones and sperm continue being produced. Your ejaculate will look just like it always did. And there will be about the same amount as before.
Vasectomy may be right for you if  You want to enjoy having sex without causing pregnancy.  You dont want to have a child biologically in the future.  Other methods are unacceptable.  You dont want to pass on a hereditary illness or disability.  Your partners health would be threatened by a future pregnancy.  You and your partner have concerns about the side effects of other methods.  You and your partner agree that your family is complete, and no more children are wanted.  You want to spare your partner the surgery and expense of tubal sterilization — sterilization for women is more complicated and costly.
  • 98. Vasectomy WhatAre the Disadvantages of Vasectomy? Vasectomy may not be a good choice for you if you  may want to have a child biologically in the future  are being pressured by a partner, friends, or family  want to use it to solve problems that may be temporary — such as marriage or sexual problems, short-term mental or physical illnesses, financial worries, or being out of work
  • 99. Vasectomy Possible Risks of Vasectomy There are risks with any medical procedure, including vasectomy. Major complications with vasectomy are rare and are usually caused by infection. Complication rates for vasectomy are generally lower for the no-incision method than for methods that include cutting the skin. After youve had a vasectomy, look for signs of infection:  a fever over 100° F  blood or pus oozing from the site of the incision  excessive pain or swelling See a health care provider if you have signs of infection. You may need an antibiotic. Other potential problems include  bruising, which usually clears up on its own  hematomas — swellings that contain blood. They usually clear up by themselves, or with bed rest or ice packs. In rare cases, they need to be drained by a health care provider.  hydroceles — swellings that contain fluid and tenderness near the testicles. They usually clear up in about a week. Applying heat and wearing an athletic supporter can help. In rare cases, they need to be drained with by a health care provider.  granuloma — sperm that leaks from the tubes and causes a small lump under the skin near the site of the surgery. This usually clears up by itself. Surgical treatment is sometimes required.  pain or discomfort in the testicles. This is usually temporary, but in about 2 out of 100 cases the pain may be chronic and severe. Most of the time, pain is relieved by taking anti-inflammatory drugs or other medications. Very rarely, an injection called a spermatic cord block can be used to deaden the pain temporarily. Vasectomy reversal is very rarely needed to relieve pain permanently.  Very rarely, the cut ends of a tube grow back together. This most often happens within four months of the operation and may allow pregnancy to happen.  Decreased sexual desire or an inability to have an erection occurs in 4 out of 1,000 cases. The most likely cause is emotional — there is no physical cause for sexual dysfunction associated with vasectomy.
  • 100. Vasectomy What Are the Risks of Vasectomy? Major complications with vasectomy are rare and are usually caused by infection. Complication rates for vasectomy are generally lower for the no-incision method than for methods that include cutting the skin. After youve had a vasectomy, look for signs of infection:  a fever over 100° F  blood or pus oozing from the site of the incision  excessive pain or swelling See a health care provider if you have signs of infection. You may need an antibiotic. Other potential problems include  bruising, which usually clears up on its own  hematomas — swellings that contain blood. They usually clear up by themselves, or with bed rest or ice packs. In rare cases, they need to be drained by a health care provider.  hydroceles — swellings that contain fluid and tenderness near the testicles. They usually clear up in about a week. Applying heat and wearing an athletic supporter can help. In rare cases, they need to be drained with by a health care provider.  granuloma — sperm that leaks from the tubes and causes a small lump under the skin near the site of the surgery. This usually clears up by itself. Surgical treatment is sometimes required.  pain or discomfort in the testicles. This is usually temporary, but in about 2 out of 100 cases the pain may be chronic and severe. Most of the time, pain is relieved by taking anti-inflammatory drugs or other medications. Very rarely, an injection called a spermatic cord block can be used to deaden the pain temporarily. Vasectomy reversal is very rarely needed to relieve pain permanently.  Very rarely, the cut ends of a tube grow back together. This most often happens within four months of the operation and may allow pregnancy to happen.  Decreased sexual desire or an inability to have an erection occurs in 4 out of 1,000 cases. The most likely cause is emotional — there is no physical cause for sexual dysfunction associated with vasectomy.
  • 101. Vasectomy Does Vasectomy Hurt? 
Your health care provider will give you medicine to make it as comfortable as possible. Numbing medication and/or sedatives will be used. The choice depends on your health and the method of sterilization being used. Conscious sedation allows you to be awake but deeply relaxed. Local anesthesia blocks the feeling of pain in a certain area of your body. It is much safer than general anesthesia.
General anesthesia is entirely painless. It allows you to sleep through the procedure.
When you get local anesthesia, you may feel brief discomfort. You may also feel some pain when the tubes are brought out through the incision.

 How Will I Feel After Vasectomy? 
As with any surgery, theres some discomfort after the operation. It will be different for each man. However, most men say the pain is "slight" or "moderate" and not "excessive." An athletic supporter, ice bag, and non-aspirin pain reliever may help ease the pain. Avoid strenuous physical work or exercise for about a week. There seems to be less pain associated with no-incision procedures.
  • 102. Vasectomy How Long Does Recovery Take After Vasectomy? That depends on your general health and lifestyle. Most men lose little or no time from work. A few need a day or two to rest. You will have to avoid strenuous work or exercise for about a week. Rare complications may require more days at home. However, prompt medical attention usually clears up any problems. For most men, sexual activity can begin again within a week. Others have sex sooner. Some wait longer. But remember, after the procedure, it takes about three months to clear sperm out of your system. Use another form of birth control for vaginal intercourse until a semen analysis shows there are no longer any sperm in your seminal fluid.
  • 103. Withdrawal What Is Withdrawal? 
A man who uses withdrawal will pull his penis out of the vagina before ejaculation — the moment when semen spurts out of his penis. Withdrawal is also known as coitus interruptus and the pull out method.
Withdrawal may be the worlds oldest way to practice birth control. About 35 million couples worldwide rely on withdrawal.

 How Does Withdrawal Work? 
Withdrawal prevents pregnancy by keeping sperm out of the vagina. Pregnancy cannot happen if there is no sperm present.
  • 104. Withdrawal How Effective Is Withdrawal? Effectiveness is an important and common concern when choosing a birth control method. Like all birth control methods, the pull out method is much more effective when you do it correctly.  Of every 100 women whose partners use withdrawal, 4 will become pregnant each year if they always do it correctly.  Of every 100 women whose partners use withdrawal, 27 will become pregnant each year if they dont always do it correctly. Couples who have great self-control, experience, and trust may use the pull out method more effectively. Men who use the pull out method must be able to know when they are reaching the point in sexual excitement when ejaculation can no longer be stopped or postponed. If you cannot predict this moment accurately, withdrawal will not be as effective. Even if a man pulls out in time, pregnancy can still happen. Some experts believe that pre-ejaculate, or pre-cum, can pick up enough sperm left in the urethra from a previous ejaculation to cause pregnancy. If a man urinates between ejaculations before having sex again, it will help clear the urethra of sperm and may increase the effectiveness of withdrawal. Pregnancy is also possible if semen or pre-ejaculate is spilled on the vulva. Keep in mind that the withdrawal method does not protect you from sexually transmitted diseases. Use a latex condom or female condom to reduce the risk of infection.
  • 105. Withdrawal How Safe Is Withdrawal? 
Anyone can use withdrawal safely — there are no side effects. 

 What Are the Benefits of Withdrawal? 
The pull out method is safe, simple, and convenient. Women and men like it because  It can be used to prevent pregnancy when no other method is available.  There are no medical or hormonal side effects.  No prescription is necessary.  It is free.  The pull out method can also make other forms of birth control, such as the cap, condom, diaphragm, or female condom, more effective.
  • 106. Withdrawal What Are the Disadvantages of Withdrawal? There are a few risks to using withdrawal as your only form of birth control. The biggest disadvantage is the risk of using withdrawal incorrectly. Withdrawal  requires great self-control, experience, and trust  is not for men who ejaculate prematurely  is not for men who dont know when to pull out  is not recommended for teens and sexually inexperienced men because it takes lots of experience before a man can be sure to know when hes going to ejaculate
  • 107. Withdrawal How Do I Practice Withdrawal? During sex, the man withdraws his penis from the vagina when he feels he is about to ejaculate, or before he reaches that point. He ejaculates, or comes, outside the vagina, being careful that semen does not spill onto his partners vulva. Men who want to use the pull out method need to understand their own sexual response. They need to know when they reach the point in sexual excitement when ejaculation can no longer be stopped or postponed. There are many other methods available if withdrawal is not right for you. If you need help choosing a method, were here to help. The staff at your local Planned Parenthood health center can talk with you and help you get the birth control method thats best for you.
  • 108. Additional Information Plannedparenthood.org

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