Birth Control Planning


Published on

1 Comment
No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Birth Control Planning

  2. 2. Intro…pls. watch short video
  3. 3. Reproductive Life Planning <ul><li>Includes all the decisions an individual or couple make about having children. </li></ul><ul><li>As possible, pregnancies should be intended. </li></ul><ul><li>If unintended: mother less likely to breastfeed, less careful to protect fetus, greatest risk for low birth weight, dying in first year, being abused, undernourished . </li></ul>
  4. 4. THE FAMILY PLANNING PROGRAM <ul><li>In 2003 – 84 million pop. Expected to grow annually at 2.36%. So: pop. expected to double in 29 years. </li></ul><ul><li>Fertility rate: 3.5 children/woman= (2.5 desired) </li></ul><ul><li>Contraceptive prevalence rate: 15.4% (1996) to 48.9%(NDHS,2003) </li></ul><ul><li>Every year = 3 to 4 million women getting pregnant </li></ul>NDHS-National Demographic and Health Survey
  5. 5. According to NDHS: <ul><li>44% = got pregnant 1 st child at ages 20-24 yrs. 6.1% = ages 15-19 </li></ul><ul><li>High fertility rate coincides with low contraceptive prevalence rate </li></ul><ul><ul><li>= 47.3% among all Filipino women(15-49 yrs old) </li></ul></ul><ul><ul><li>= 70.6% among married women </li></ul></ul><ul><ul><li>= Highest % using contraceptives*: 35-39 age group </li></ul></ul><ul><ul><li>= Lowest % using contraceptives*: 15-19 age group </li></ul></ul>* Any method
  6. 11. Overall Goal of Family Planning Is to provide Universal access to family planning information & services wherever & whenever these are needed .
  7. 12. Family Planning aims to contribute to: <ul><li>Reduce infant deaths </li></ul><ul><li>Neonatal deaths </li></ul><ul><li>Under-five deaths </li></ul><ul><li>Maternal deaths </li></ul>
  8. 13. Laws Governing Population and Family Planning <ul><li>Presidential Decree No. 791 </li></ul><ul><li>– the revised Population Act defines the objectives, duties and functions of the POPCOM. Among others it empowers nurses and midwives to provide, dispense and administer acceptable methods of contraception after having training and authorization by the POPCOM in consultation with the appropriate licensing bodies </li></ul><ul><li>EO No. 2009. The Family Code of the Philippines. </li></ul>
  9. 14. Things to consider about contraceptive methods : <ul><li>Personal values </li></ul><ul><li>Ability to use a method correctly </li></ul><ul><li>How the method will affect sexual enjoyment </li></ul><ul><li>Financial factors </li></ul><ul><li>Status of a couple’s relationship </li></ul><ul><li>Prior experiences </li></ul><ul><li>Future plans </li></ul>
  10. 15. Ideal characteristics: <ul><li>Safe </li></ul><ul><li>100% effective </li></ul><ul><li>Free of side effects </li></ul><ul><li>Easily obtainable </li></ul><ul><li>Affordable </li></ul><ul><li>Easy to use and acceptable to both user and sexual partner </li></ul><ul><li>Free of effects on future pregnancies </li></ul>
  11. 16. I. Natural Family Planning methods <ul><li>No introduction of chemical of foreign material into the body. </li></ul><ul><li>Practice maybe due to religious belief, “natural” way is best for them. </li></ul><ul><li>Effectiveness varies greatly, depends on couples ability to refrain from having sex on fertile days. </li></ul><ul><li>Failure Rates: about 25% </li></ul><ul><li>Poses no risk to fetus </li></ul>
  12. 17. <ul><li>Natural family planning (NFP) </li></ul><ul><ul><li>term referring to the family planning methods approved by the Roman Catholic Church . </li></ul></ul><ul><ul><li>In accordance with the requirements for sexual behavior maintained by this church, NFP forbids the use of contraception , </li></ul></ul><ul><ul><li>as well as all orgasmic acts outside of those achieved through unprotected vaginal intercourse with the user's spouse. </li></ul></ul><ul><ul><ul><ul><ul><li>From Wikepedia. The free encyclopedia </li></ul></ul></ul></ul></ul>
  13. 18. NATURAL FAMILY PLANNING <ul><li>Rhythm (Calendar) method </li></ul><ul><li>Basal Body Temperature (BBT) </li></ul><ul><li>Ovulation or Cervical Mucus (Billings Method) </li></ul><ul><li>Symptothermal method </li></ul><ul><li>Ovulation Awareness </li></ul><ul><li>Lactation Amenorrhea Method </li></ul><ul><li>Coitus Interruptus </li></ul>
  14. 19. A. RHYTHM (Calendar) METHOD <ul><li>Abstaining from coitus on the days of menstrual cycle when a woman is most likely to conceive (3 or 4 days before until 3 or 4 days after ovulation). </li></ul><ul><li>Woman keeps a diary of 6 menstrual cycles </li></ul>
  15. 20. An illustration of the Standard Days Method. This method may be used by women whose menstrual cycles are always between 26 and 32 days in length Background B.C. typenatural birth control First use1999 (Standard Days) 1930 (Knaus-Ogino) Ancient ( ad hoc methods)
  16. 21. <ul><li>To calculate: </li></ul><ul><ul><li>-18 from shortest cycle documented. </li></ul></ul><ul><ul><li>-11 from longest cycle </li></ul></ul><ul><ul><li>ans. = represents her last fertile day. </li></ul></ul><ul><ul><li>Example: </li></ul></ul><ul><ul><li>If she has 6 menstrual cycles ranging from 25 to 29 days, fertile period would be from 7 th day (25-18) to the 18 th day (29-11). </li></ul></ul><ul><ul><li>To avoid pregnancy, avoid coitus/use contraceptive during those days. </li></ul></ul>
  17. 22. B. Basal Body Temperature (BBT) <ul><li>Identifying fertile and infertile period of a woman’s cycle by daily taking and recording of the rise in body temperature during and after ovulation. </li></ul><ul><li>Just before ovulation, a woman’s BBT falls about 0.5 ◦F. At time of ovulation, her BBT rises a full degree (influence of progesterone). </li></ul><ul><li>This higher level is maintained the rest of menstrual cycle. </li></ul>
  18. 23. <ul><li>How: Woman takes her temp each morning immediately after waking, before she undertake any activity. </li></ul><ul><li>She has ovulated, slight drip in temp followed by </li></ul><ul><li>Usually combined with calendar method </li></ul><ul><li>Ideal Failure rate: 9% </li></ul>
  19. 24. an example of a chart completed by a woman using BBT, cervical secretions, cervical position and feel, and other minor indicators.
  20. 25. C. Cervical Mucus/Billings/Ovulation <ul><li>Use changes in cervical mucus with ovulation </li></ul><ul><li>Woman: must be conscientious in assessing her vaginal secretions. </li></ul><ul><li>Ideal Failure rate: 3% </li></ul>Would your lifestyle be enhanced if you could: Manage your fertility naturally ? Achieve pregnancy naturally ? While breastfeeding, regulate fertility naturally ? Manage menopause naturally ? The Billings Ovulation Method can assist you with all these areas of your life.
  21. 26. Before ovulation: - thick and does not stretch With ovulation (peak day): - copious, thin, watery, transparent . Feels slippery and stretches at least 1 inch before the strand breaks = property known as “spinnbarkeit”. These are Fertile days
  22. 27. C. Symptothermal Method <ul><li>Combines the cervical mucus and BBT methods </li></ul><ul><li>Watches temp daily and analyzes cervical mucus daily. </li></ul><ul><li>Couple must abstain from intercourse until 3 days after rise in temp or 4 th day after peak of mucus change. </li></ul><ul><li>More effective than BBT or CM method alone </li></ul><ul><li>Ideal Failure rate: 2% </li></ul>
  23. 28. D. Ovulation Awareness <ul><li>Use an OTC ovulation detection kit. </li></ul><ul><li>These kits detect the midcycle surge of Luteinizing Hormone (LH) that can be detected in urine 12 to 24 hours before ovulation. </li></ul><ul><li>98% to 100% accurate in predicting ovulation </li></ul><ul><li>Expensive </li></ul>
  24. 29. BeSure ™ Ovulation  Prediction Test Kits Human LH Hormone Specific Lateral Flow Cassette Type Test All inclusive, 5 day ovulation prediction test kits. One-step, easy to perform, rapid developing, urine based test cassettes for identification of the increased levels of the human luteinizing hormone (LH) immediately proceeding the ovulatory period within the female reproductive cycle.
  25. 30. E. Lactation Amenorrhea Method <ul><li>Temporary introductory postpartum method of postponing pregnancy based on physiological infertility experienced by Breast Feeding women </li></ul><ul><li>Universally available to all postpartum breastfeeding women. </li></ul><ul><li>No other FP commodities required </li></ul><ul><li>Contributes to improve maternal and child health and nutrition </li></ul>
  26. 31. <ul><li>Only temporary, effective only up to 6 months postpartum </li></ul><ul><li>Effectiveness may decrease if mother and child are separated for extended periods of time (working mother). </li></ul><ul><li>Difficult to maintain (up to 6 mos.)due to variety of social circumstances </li></ul>
  27. 32. Efficacy and duration of LAM are enhanced with more intense breastfeeding patterns, especially during the earlier weeks and months
  28. 33. F. COITUS INTERRUPTUS <ul><li>One of oldest known methods of contraception </li></ul><ul><li>Couple proceeds with coitus until the moment of ejaculation. </li></ul><ul><li>Then the man withdraws & spermatozoa are emitted outside the vagina </li></ul><ul><li>Offers little protection </li></ul><ul><li>Adolescent boys may lack the control or experience to use the method effectively </li></ul>
  29. 34. II. BARRIER METHODS <ul><li>Placement of a chemical or other barrier between the cervix and advancing sperm so that sperm cannot enter the uterus or fallopian tubes & fertilize the ovum. </li></ul><ul><li>Major advantage: lack hormonal side effects associated with COCs </li></ul><ul><li>Failure rates: higher & sexual enjoyment may be lessened. </li></ul>
  30. 35. Examples: <ul><li>Condom or “rubber” – men </li></ul><ul><li>Vagina pouch – women </li></ul><ul><li>Diaphragm </li></ul><ul><li>Cervical cap </li></ul><ul><li>Vaginal sponge with spermicidal agent </li></ul>
  31. 36. A. Male Condom <ul><li>Condom – a latex rubber or synthetic sheath, placed over the erect penis before coitus begins. </li></ul><ul><li>Spermatozoa are deposited in the tip of condom </li></ul><ul><li>“ male-responsibility” birth control measures </li></ul><ul><li>Latex condoms: potential prevention against spread of STIs, major part of fight to prevent infection with Human immunodeficiency virus (HIV). </li></ul>
  32. 37. MALE CONDOM
  33. 38. B. FEMALE CONDOMS <ul><li>Latex sheaths made of polyurethane and prelubricated with a spermicide. </li></ul><ul><li>Inner ring (closed end)= covers cervix; Outer ring (open end)= rests against vaginal opening </li></ul><ul><li>May be inserted any time before sexual activity begins; then remove after ejaculation occurs. </li></ul>
  34. 39. <ul><li>Like male condoms, one time use only. Difficult to use </li></ul><ul><li>Offer protection against both conception and STI </li></ul><ul><li>OTC but more expensive than male condoms </li></ul>
  35. 40. The female condom, like the male condom, is a barrier contraceptive made of latex or polyurethane. The condom has a ring on each end. The ring that is placed inside the vagina fits over the cervix, while the other ring, which is open, rests outside of the vagina and covers the vulva. The female condom is sold over-the-counter.
  36. 41. C. DIAPHRAGMS <ul><li>Circular rubber disk placed over cervix before intercourse. Usually with spermicidal gel </li></ul><ul><li>Fitted initially by physician, nurse or midwife </li></ul>
  37. 42. <ul><li>Kept in place at least 6 hrs after coitus. </li></ul><ul><li>Should not stay for at least 24 hrs- may cause cervical inflammation (erosion) or urethral irritation </li></ul><ul><li>How to use: </li></ul><ul><ul><li>Inserted into the vagina (rim coated with spermicidal gel) by sliding it along the posterior wall & pressing it up against the cervix. </li></ul></ul>
  38. 43. <ul><ul><li>Check with a finger after insertion to be certain that its fitted well by palpating the cervical os through diaphragm. </li></ul></ul><ul><ul><li>Remove by inserting a finger through diaphragm and loosening by pressing against the anterior rim and then withdrawing it vaginally. </li></ul></ul><ul><li>After use, washes in mild soap & water, dries gently & stores in its protective case. May last for 2 to 3 years. </li></ul>
  39. 44. <ul><li>Side effects: </li></ul><ul><ul><li>History of recurrent UTIs </li></ul></ul><ul><ul><li>If uterus is prolapsed, retroflexed, or anteflexed </li></ul></ul><ul><ul><li>With acute cervicitis </li></ul></ul><ul><ul><li>Allergy to rubber or spermicides </li></ul></ul><ul><ul><li>History of Toxic Shock Syndrome </li></ul></ul><ul><ul><ul><li>a staphylococcal infection introduced through the vagina </li></ul></ul></ul>
  40. 45. How to prevent Toxic shock Syndrome <ul><li>Wash hands thoroughly with soap & water before insertion or removal of a diaphragm or cervical cap </li></ul><ul><li>Do not use diaphragm or a cervical cap during your menstrual period </li></ul><ul><li>Do not leave the diaphragm in place longer than 24 hours </li></ul>
  41. 46. <ul><li>Be aware of the symptoms of TSS, such as elevated temperature, diarrhea, vomiting, muscle aches and a sunburn-like rash. </li></ul><ul><li>If symptoms of TSS should occur, immediately remove the diaphragm & telephone your health care provider </li></ul>
  42. 47. D. CERVICAL CAPS <ul><li>Made of soft rubber, shaped like a thimble, and fit snugly over the uterine cervix </li></ul><ul><li>Failure rate as high as 32% </li></ul><ul><li>Readily dislodged </li></ul><ul><li>Contraindicated to: </li></ul><ul><ul><li>An abnormally short or long cervix </li></ul></ul><ul><ul><li>A previous abnormal Pap smear </li></ul></ul><ul><ul><li>A history of TSS </li></ul></ul>
  43. 48. <ul><li>An allergy to latex or spermicide </li></ul><ul><li>A history of PID, cervicitis, or papilloma virus infection </li></ul><ul><li>A history of cervical cancer </li></ul><ul><li>Undiagnosed vaginal bleeding </li></ul>
  44. 49. Cervical cap Oves brand cervical cap Position of cervical cap
  45. 50. E. Vaginally Inserted Spermicidal Products <ul><li>Cause death to spermatozoa before they enter the cervix </li></ul><ul><li>Also change the vaginal pH to a strong acid level (not conducive to sperm survival) </li></ul><ul><li>Purchased w/o prescription </li></ul><ul><li>Increase other methods effectiveness </li></ul>
  46. 51. <ul><li>Available in various preparations: gels, creams, sponges, films, foams & suppositories </li></ul><ul><li>How to use: </li></ul><ul><ul><li>Gels or creams are inserted into the vagina before coitus with an applicator. </li></ul></ul>
  47. 52. <ul><ul><li>To be effective: must be 1 hr before coitus, should not douche for 6 hrs after, to ensure that the agent has completed its spermicidal action. </li></ul></ul><ul><ul><li>Contraindicated: with acute cervicitis, and inconveniency </li></ul></ul><ul><ul><li>Adolescent usually uses: no parental permission or extensive expense </li></ul></ul>
  48. 53. ORAL CONTRACEPTION <ul><li>The Pill or COCs (combined oral contraceptives) </li></ul><ul><li>With varying amounts of synthetic estrogen combined with a small amount of synthetic progesterone (progestin) </li></ul><ul><li>Estrogen – acts on FSH and LH thus suppresses ovulation </li></ul>
  49. 54. <ul><li>Progesterone – cause a decrease in the permeability of cervical mucus thereby limiting sperm motility and access to ova. </li></ul><ul><ul><li>Also interferes with tubal transport and endometrial proliferation . </li></ul></ul>
  50. 56. The pill
  51. 57. <ul><li>3 types: </li></ul><ul><ul><li>Monophasic: </li></ul></ul><ul><ul><ul><li>fixed doses of both estrogen and progesterone throughout 21 day cycle </li></ul></ul></ul><ul><ul><li>Biphasic: </li></ul></ul><ul><ul><ul><li>constant amount of estrogen throughout cycle BUT increased amount of progestin during the last 11 days . </li></ul></ul></ul>
  52. 58. <ul><ul><li>Triphasic: </li></ul></ul><ul><ul><ul><li>Varies level of estrogen and progesterone. Closely mimic natural cycle, reducing breakthrough bleeding (bleeding outside the normal menstrual flow) </li></ul></ul></ul>
  53. 59. <ul><li>COCs must be prescribed by physician after pelvic examination and a Papanicolaou (Pap) smear. </li></ul><ul><li>Packed 21 or 28 pills to a container </li></ul><ul><ul><li>28 pills ( 21 active pills/7 placebo pills) </li></ul></ul><ul><li>Used correctly: 99.7% effective </li></ul><ul><li>Typical failure rate: 8% </li></ul>
  54. 60. Noncontraceptive benefits <ul><li>Decreases incidence of the ff conditions: </li></ul><ul><ul><li>Dysmenorrhea, due to lack o ovulation </li></ul></ul><ul><ul><li>Premenstrual dysphoric syndrome, because of increase progesterone levels </li></ul></ul><ul><ul><li>Iron deficiency anemia, due to reduced amount of menstrual flow </li></ul></ul><ul><ul><li>Colon cancer </li></ul></ul>
  55. 61. <ul><ul><li>Acute pelvic inflammatory disease (PID) and the resulting tubal scarring </li></ul></ul><ul><ul><li>Endometrial and ovarian cancer and ovarian cysts </li></ul></ul><ul><ul><li>Fibrocystic breast disease </li></ul></ul><ul><ul><li>Possibly osteoporosis and uterine myomata(fibroid uterine tumors) </li></ul></ul>
  56. 62. <ul><li>May have some metabolic effects: estrogen interferes with lipid metabolism, concentration of low-density lipoproteins (LDL) & HDL level </li></ul><ul><li>Main side effects: </li></ul><ul><ul><li>Nausea </li></ul></ul><ul><ul><li>Weight gain </li></ul></ul><ul><ul><li>Headache </li></ul></ul>
  57. 63. <ul><ul><li>Breast tenderness </li></ul></ul><ul><ul><li>Breakthrough bleeding (spotting outside the menstrual period) </li></ul></ul><ul><ul><li>Monilial Vaginal infections </li></ul></ul><ul><ul><li>Mild hypertension </li></ul></ul><ul><ul><li>Depression </li></ul></ul>
  58. 64. Contraindications to Oral Contraceptive Use <ul><li>Breast-feeding & less than 6 weeks postpartum </li></ul><ul><li>Age 35 years or older & smoking 15 or more cigarettes per day </li></ul><ul><li>Multiple risk factors for arterial cardiovascular disease, such as older age, smoking, diabetes, hypertension </li></ul>
  59. 65. <ul><li>Elevated blood pressure of 160 mm Hg systolic or above or 100 mm Hg diastolic or above </li></ul><ul><li>Current or history of deep vein thrombosis or pulmonary embolism </li></ul><ul><li>Major surgery that requires prolonged immobilization </li></ul><ul><li>Current or history of ischemic heart disease </li></ul>
  60. 66. <ul><li>Stroke </li></ul><ul><li>Complicated valvular heart disease </li></ul><ul><li>Migraine with focal neurologic symptoms </li></ul><ul><li>Migraine w/o focal neurologic symptoms and age 35 years or older </li></ul>
  61. 67. <ul><li>Current breast cancer </li></ul><ul><li>Diabetes with nephropathy, retinopathy, neuropathy, vascular disease, or diabetes of more than 20 years duration </li></ul><ul><li>Severe cirrhosis </li></ul><ul><li>Liver tumors </li></ul>
  62. 68. Mini-pills <ul><li>Oral contraceptives containing only progesterone. </li></ul><ul><li>Ovulation may occur but progestin halts endometrium to fully develop: implantation will not occur </li></ul><ul><li>Taken everyday, even through menstrual flow </li></ul><ul><li>May be taken during breast feeding </li></ul>
  63. 69. Estrogen/Progesterone Patch <ul><li>Transdermal patches that continuously release a combination of estrogen & progesterone </li></ul><ul><li>Approved in US FDA in 2001 </li></ul><ul><li>Applied once a week for 3 weeks, a week when patch free a menstrual flow will occur </li></ul>
  64. 70. <ul><li>Effeciency equals COC, maybe less on women who weigh more than 90 kg </li></ul><ul><li>Advantages: increase adherence, easy concealment </li></ul><ul><li>Disadvantage: Mild breast discomfort & irritation at application site may occur </li></ul>
  65. 71. Vaginal Rings <ul><li>A silicone ring that surrounds the cervix & continuously release a combination of estrogen & progesterone </li></ul><ul><li>Hormones are absorbed directly by the mucous membrane of vagina, avoiding a “first-pass” through liver (as happens with COCs) </li></ul><ul><li>Also approved in 2001 by USA FDA </li></ul>
  66. 72. <ul><li>Ring is inserted by the woman and left in place for 3 weeks, then remove for 1 week. Menstrual bleeding occurs during ring-free week. </li></ul><ul><li>Efficiency is 99.7% </li></ul>
  67. 73. Emergency PostCoital Contraception <ul><li>“ morning-after pills” </li></ul><ul><li>With high level of estrogen interfering with progesterone production, prohibiting good implantation </li></ul><ul><li>Eg. Yuzpe Regimen (Preven) – specially designed particularly after a sexual assault has occurred </li></ul><ul><li>Effectiveness: between 75% & 85% </li></ul>
  68. 75. Subcutaneous Implants <ul><li>Norplant is a contraceptive method 6 non-biodegradable Silastic Implants </li></ul><ul><li>Plastic, flexible rods are implanted under the skin of a woman's upper arm. Rods contain a synthetic progesterone hormone, released in small doses continuously over a 5 year period. </li></ul>
  69. 76. <ul><li>Prevents pregnancy by: inhibiting ovulation, cervical mucus becomes thicker & harder to be penetrated by sperm, & making the lining of the uterus unreceptive to a fertilized egg. </li></ul><ul><li>Disadvantage: Expensive (ave. $500-$750) </li></ul>
  70. 77. <ul><li>Advantage: long-term, reversible, effective & reliable alternative to COCs & their estrogen-related side effects </li></ul><ul><ul><li>Sexual enjoyment not inhibited as with condoms, spermicides, diaphragms & natural family planning methods </li></ul></ul><ul><ul><li>Can be used during breast-feeding </li></ul></ul><ul><ul><li>Can be safely used in adolescents </li></ul></ul><ul><li>Rare complication: infection at insertion site </li></ul>
  71. 78. <ul><li>Potential side effects: </li></ul><ul><ul><li>Weight gain </li></ul></ul><ul><ul><li>Irregular menstrual cycle (e.g., spotting, breakthrough bleeding, amenorrhea, prolonged periods) </li></ul></ul><ul><ul><li>Hair loss </li></ul></ul><ul><ul><li>Depression </li></ul></ul><ul><ul><li>Scarring at insertion site </li></ul></ul><ul><ul><li>Need for removal </li></ul></ul>
  72. 79. Norplant
  73. 80. Intramuscular Injections <ul><li>Single injection of medroxyprogesterone acetate (Depo-Provera) – every 12 weeks </li></ul><ul><li>Lunelle (a synthetic estrogen & progesterone) – every 30 days </li></ul><ul><li>They inhibit ovulation, alter the endometrium, & change cervical mucus </li></ul><ul><li>100% effective, can be used during breast feeding </li></ul>
  74. 81. <ul><li>Long-term reliability w/o many side effects, no visible sign that birth control measure is being used </li></ul><ul><li>Possible side effects: irregular menstrual cycle, headache, weight gain, depression </li></ul><ul><li>Risk for osteoporosis: so, include adequate amount of Ca in diet (up to 1200 mg/day), engage in weight bearing exercise daily </li></ul>
  75. 82. INTRAUTERINE DEVICES <ul><li>A small plastic object inserted into the uterus through the vagina </li></ul><ul><li>1980’s very popular in US but decrease due to lawsuits with increase incidence of PID (infection of the pelvic organ) </li></ul><ul><li>IUD prevent fertilization by creating a local sterile inflammatory condition that prevents implantation </li></ul>
  76. 83. <ul><li>Fitted by a physician, nurse, midwife (ambulatory setting) </li></ul><ul><li>Inserted after menstrual flow or after childbirth </li></ul><ul><li>3 common types of IUD (US) </li></ul><ul><ul><li>Copper T380(ParaGard) </li></ul></ul><ul><ul><li>T-shaped plastic device wound with copper </li></ul></ul><ul><ul><li>Progestasert & Mirena </li></ul></ul>
  77. 84. <ul><li>Advantages: only one insertion, does not require daily attention, does not interfere with sexual enjoyment </li></ul><ul><li>Check: IUD string is in place & yearly pelvic exam </li></ul><ul><li>Contraindications: </li></ul><ul><ul><li>Has or history of PID </li></ul></ul><ul><ul><li>Risk for Toxic Shock Syndrome (TSS; a staphylococcal infection from the use of tampons) </li></ul></ul>
  78. 85. <ul><ul><li>Multiple sexual partners: risk for STIs </li></ul></ul><ul><ul><li>Never been pregnant </li></ul></ul><ul><ul><li>Uterus distorted in shape </li></ul></ul><ul><ul><li>Severe dysmenorrhea, menorrhagia, history of ectopic pregnancy </li></ul></ul><ul><ul><li>Valvular heart disease </li></ul></ul><ul><ul><li>Anemia </li></ul></ul>
  79. 86. SURGICAL METHODS <ul><li>Includes sterilization: </li></ul><ul><ul><li>Tubal sterilization – women </li></ul></ul><ul><ul><li>Vasectomy – men </li></ul></ul><ul><li>Preferred method: most effective, no effect on sexuality </li></ul><ul><li>Chosen with great thought and care and should be considered permanent </li></ul>
  80. 87. <ul><li>Not recommended: fertility is important to self-esteem </li></ul><ul><li>***Play video*** </li></ul>
  81. 88. MALE & FEMALE
  82. 89. VASECTOMY <ul><li>Small incision made on each side of the scrotum. Vas deferens is then cut & tied, cauterized, or plugged, blocking the passage of spermatozoa </li></ul><ul><li>Ambulatory, under local anesthesia </li></ul><ul><li>99.5% effective </li></ul>
  83. 90. procedure
  84. 91. <ul><li>Does not interfere with production of sperm, does not pass beyond severed vas deferens and absorbed at that point. (seminal fluid continues but w/o sperm) </li></ul><ul><li>Advantages: </li></ul><ul><ul><li>Very effective 3 months after the procedure </li></ul></ul><ul><ul><li>Permanent, safe, simple & easy to perform </li></ul></ul><ul><ul><li>Can be performed in a clinic, office or at a primary care center </li></ul></ul>
  85. 92. <ul><ul><li>No resupplies or repeated clinic visits </li></ul></ul><ul><ul><li>No apparent long term risks </li></ul></ul><ul><ul><li>An option for couples whose female partner could not undergo permanent contraception </li></ul></ul><ul><ul><li>A man who had vasectomy will not lose his sexual ability and ejaculation </li></ul></ul><ul><ul><li>Does not affect male hormonal function </li></ul></ul>
  86. 93. <ul><li>Disadvantages: </li></ul><ul><ul><li>Slightly uncomfortable due to slight pain & swelling 2-3 days after procedure </li></ul></ul><ul><ul><li>Reversibility is difficult and expensive </li></ul></ul><ul><ul><li>Bleeding may result in hematoma in the scrotum </li></ul></ul><ul><ul><li>May be associated with urolithiasis development </li></ul></ul><ul><ul><li>A few men develop chronic pain after vasectomy (postvasectomy pain syndrome) </li></ul></ul>
  87. 94. TUBAL LIGATION <ul><li>Fallopian tubes are occluded by cautery, crushing, clamping, or blocking & thereby preventing passage of both sperm and ova </li></ul><ul><li>99.5% effective </li></ul><ul><li>Operation performed: </li></ul><ul><ul><li>Laparoscopy – using a lighted laparoscope </li></ul></ul><ul><ul><li>Culdoscopy - a tube inserted through the posterior fornix of the vagina </li></ul></ul><ul><ul><li>Colpotomy – incision through the vagina </li></ul></ul>
  89. 96. <ul><li>Laparoscopy </li></ul><ul><ul><li>A small as 1 cm is made just under the woman’s umbilicus (under general or local anesthesia) </li></ul></ul><ul><ul><li>A lighted laparoscope in inserted through the incision. </li></ul></ul><ul><ul><li>Carbon dioxide is then pumped into the incision to lift the abdominal wall upward and out of the line of vision. </li></ul></ul>
  90. 97. <ul><ul><li>The fallopian tube is located through laparoscope & an electrical current to coagulate tissue is then passed through the instrument for 3 to 5 seconds. </li></ul></ul><ul><ul><li>Or the tubes are clamped & cut, or filled with a silicone gel to seal them </li></ul></ul><ul><ul><li>Can be done as soon as 4 to 6 hours after the birth of a baby or after an abortion </li></ul></ul>
  91. 98. <ul><li>* Woman may return to having coitus 2 to 3 days after procedure </li></ul><ul><li>Does not affect menstrual flow (unlike hysterectomy: removal of the uterus or ovaries) </li></ul><ul><li>Complications: bowel perforation, hemorrhage, & the risk of general anesthesia after the procedure </li></ul>
  92. 99. <ul><li>Associated with decrease incidence of ovarian cancer: unknown why </li></ul><ul><li>****Play video**** </li></ul>
  93. 100. FUTURE TRENDS IN CONTRACEPTION <ul><li>Lower-dose of estrogen pills </li></ul><ul><li>Progesterone-implanted diaphragm and biodegradable implants that do not have to be removed </li></ul>
  94. 101. <ul><li>Permanently implanted progesterone-filled vaginal ring </li></ul><ul><li>Birth Control Vaccine </li></ul><ul><ul><li>consist of antibodies against Human Chorionic Gonadotropin Hormone & injections of testosterone for males (halts sperm production, just as estrogen halts ova production in female)Birth Control Vaccine </li></ul></ul>
  95. 102. FEMCAP
  96. 103. pls. watch short videos
  97. 104. THANK YOU ALL…. grace, jerry, reg, pepz, alice, ruby, lor, xer, kd, norie, choy, sheila