HLTH201Chapter13

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  • Photo: Deborah Gilbert/Getty Images
  • CBS News Clip – Update on Supreme Court decision in exempting employers from providing contraception to employees for religious reasons.
    Figure: Distribution of women aged 15 to 44 years by contraceptive status in the United States, 2006-2008. Source: Jones, 2010.
  • Throughout the world, contraception has been affected by social and economic issues, knowledge levels, religion, and gender roles.
    Countries with predominately Catholic regions often promote natural methods of contraception, such as withdrawal or natural family planning, though not all residents of Catholic countries agree with the Church’s contraceptive views.
    Many women in other countries may not be involved in contraceptive decision making, and contraceptive use is thought to reduce a man’s masculinity, therefore making methods that do not harm sperm more acceptable.
    Scandinavian countries are regarded as some of the most progressive in regards to contraceptive use, as a variety of methods are easily available and free.
    Developed countries (Eastern Asia) have higher rates of contraceptive use than less developed countries (sub-Sahara Africa).
  • A pharmaceutical company must submit drug applications to the FDA showing the drug is safe in animal trials and that it is reasonably safe for human trials.
    There are three phases, each with increasing amounts of volunteers enrolled, to evaluate a new drug’s effectiveness and to determine adverse effects and risks; it usually taking between 10 to 14 years to develop a new contraceptive method.
    Medical devices, such as intrauterine devices (IUDs), are also subject to strict evaluation and regulation.
  • LO1: List four or five factors that should be taken into account when choosing a method of contraception.
    Choosing a contraceptive method is an important decision, and important factors to consider include your personal health, health risks, the number of sexual partners you have, frequency of vaginal intercourse, your risk for acquiring an STI, how responsible you are, the cost of the method, and the method’s advantages and disadvantages.
    Figure: Distribution of women aged 15 to 44 years by contraceptive status in the United States, 2006-2008. Source: Jones, 2010.
  • LO1: List four or five factors that should be taken into account when choosing a method of contraception.
    Choosing a contraceptive method is an important decision, and important factors to consider include your personal health, health risks, the number of sexual partners you have, frequency of vaginal intercourse, your risk for acquiring an STI, how responsible you are, the cost of the method, and the method’s advantages and disadvantages.
    Figure: Distribution of women aged 15 to 44 years by contraceptive status in the United States, 2006-2008. Source: Jones, 2010.
  • LO3: Explain how male condoms work and identify their effectiveness rates, advantages, and disadvantages.
    Effectiveness Rates:
    85-98% - when used correctly, the overall risk for condom breakage is very low.
    Advantages:
    Can be purchased without a prescription
    Are relatively inexpensive
    Have minimal adverse effects
    May reduce the risk of premature ejaculation
    Reduce post-coital drip
    Can be used in conjunction with other contraceptive methods
    Can be used during oral sex or anal sex to reduce the risk of STIs
    Disadvantages:
    Decreases spontaneity
    or be misplaced, leading to ineffectiveness
    Photo: A condom should be placed on an erect penis prior to any penetration. © Joel Gordon
  • Source: National Survey of Sexual Health and Behavior; Reece et al., 2010b.
  • LO4: Explain how female condoms work and identify their effectiveness rates, advantages, and disadvantages.
    Effectiveness Rates:
    79-95%.
    Advantages:
    Reduce post-coital drip
    Can be used by those with latex allergies
    Can be used with oil-based lubricants
    Have minimal side effects
    The external ring of the female condom may provide extra clitoral stimulation during vaginal intercourse
    Can be used in the anus during sexual activity
    Disadvantages:
    - - May decrease sensation
    - May slip during vaginal intercourse
    - May be difficult to insert
    - May provide discomfort during sexual activity
    - May result in excess lubrication with use
    May feel uncomfortable interrupting foreplay for insertion
    Photo: © Joel Gordon
  • Copyright © Cengage Learning 2013
  • LO5: Identify two types of cervical barriers, explain how they work, and identify their effectiveness rates, advantages, and disadvantages.
    One type of cervical barrier method is a diaphragm, such as Lea’s Shield, and is designed to fit within the vagina to block access of sperm to the cervix.
    A second type of cervical barrier is a FemCap, or cervical cap, that is designed to fit more firmly onto the cervix.
    Blocks the entrance to the uterus and deactivates sperm via spermicidal cream or jelly
    Effectiveness Rates:
    84-94%, with higher effectiveness ratings for women who have given birth.
    Advantages:
    - Can be discreetly carried
    - May reduce the risk for cervical dysplasia
    Disadvantages:
    - - Require genital touching
    - Increase post-coital drip
    - May shift during vaginal intercourse
    - Cannot be used during menstruation
    - May develop a foul odor if left in place too long
    May lead to allergic reactions to the spermicidal cream or jelly
    Photos: All © Kenzie Henke
  • LO6: Explain how contraceptive sponges work and identify their effectiveness rates, advantages, and disadvantages.
    Creates a barrier by blocking the entrance to the uterus, absorbs sperm, and deactivates sperm through the use of spermicides
    Effectiveness Rates:
    84-91%, with women who have not born children experiencing greater effectiveness than do women who have given birth.
    Advantages:
    Does not affect hormone levels
    Allows couples to engage in vaginal intercourse multiple times during a 24-hour period
    Disadvantages:
    Increases post-coital drip
    Cannot be used during menstruation
    May cause a foul odor if left in too long
    May lead to allergic reactions to the spermicidal cream or jelly
    Figure: Insertion of a contraceptive sponge: (a) take it out of the packaging, (b) moisten with water, (c) wring out extra water, (d) fold in half, (e) insert the sponge into the vagina as far as it will go, (f) check to feel the cervix is covered by the sponge. © Cengage Learning 2013
  • LO7: Explain how birth control pills work and identify their effectiveness rates, advantages, and disadvantages.
    Prevents the pituitary gland from sending hormones to cause the ovaries to begin maturation of an ovum, inhibiting ovulation
    Effectiveness Rates:
    92-99.7% when used correctly, yet women significantly overweight may experience lowered effectiveness rates.
    Advantages:
    Increase menstrual regularity
    Reduce menstrual flow, menstrual cramps, premenstrual syndrome, and facial acne
    Protect against ovarian cysts, uterine and breast fibroids, certain cancers, and pelvic inflammatory disease
    Have rapid reversibility in that women often return to ovulation within two weeks of stopping use
    Disadvantages:
    Provide no protection from STIs
    Have side effects including nausea, increase in breast size, headaches, and decreased sexual desire
    Photo: © Kenzie Henke
  • LO8: Explain how hormonal rings work and identify their effectiveness rates, advantages, and disadvantages.
    Inhibits ovulation, increases cervical mucus, and changes the uterine lining to make it inhabitable to implantation.
    Effectiveness Rates:
    92-99.7%, yet the effectiveness may decrease when other medicines are taken, when exposed to high temperatures or direct sunlight, or when left in the vagina for more than 3 weeks.
    Advantages:
    Reduces the flow of menstruation, menstrual cramps, and premenstrual syndrome
    Provides lower levels of hormones than some other combined hormone methods
    May offer protection from pelvic inflammatory disease and other cancers
    Disadvantages:
    May cause adverse effects including bleeding, weight gain or loss, breast tenderness, nausea, mood changes, headaches, decreased sexual desire, increased vaginal irritation / discharge, and a risk for toxic shock syndrome
    May take 1-2 months for periods to resume with disuse, and may have irregularity in periods for up to 6 months with disuse
    Photo: The Nuva Ring. © Kenzie Henke
  • LO9: Explain how the hormonal patch works and identify its effectiveness rates, advantages, and disadvantages.
    Uses synthetic estrogen and progestin to inhibit ovulation, increase cervical mucus, and change the endometrial lining to make it inhabitable to implantation.
    Effectiveness Rates:
    92-99.7%, yet may be less effective for significantly overweight women and when used with some other medications
    Advantages:
    Is highly effective
    Reduces menstrual flow, cramps, and premenstrual syndrome
    Disadvantages:
    - May expose women to higher levels of estrogen than typical birth control pills
    - Offers no protection from STIs
    - , including breakthrough bleeding, breast tenderness, nausea, mood changes, changes in sexual desire, skin reactions, or headaches
    May cause increased risk of blood clots
    Photo: The Ortho Evra contraceptive patch. Gusto/Photo Researchers, Inc.
  • LO10: Explain how progestin-only pills work and identify their effectiveness rates, advantages, and disadvantages.
    Inhibits ovulation, thickens cervical mucus, decreases Fallopian tube cilia movement to limit sperm mobility, and builds up the endometrial lining to make it inhabitable to implantation.
    Advantages:
    Can be safely used by almost all women including those who:
    are overweight
    are over 35
    smoke
    have high blood pressure
    have a history of blood clots
    and / or, are breastfeeding
    Disadvantages:
    May cause adverse effects, including menstrual cycle disturbances, headaches, nausea, weight gain / loss, breast tenderness, decreased sexual desire, and increased risk for ovarian cysts.
  • LO11: Explain how subdermal implants work and identify their effectiveness rates, advantages, and disadvantages.
    Suppresses ovulation, thickens cervical mucus, and changes the endometrial lining to make it inhabitable to implantation.
    Effectiveness:
    99%, yet may be lowered for women who are significantly overweight
    Advantages:
    ovulation returns within 6 weeks of disuse
    May decrease menstrual flow, cramping, and risk of endometrial cancer
    Can be used by women who are unable to take estrogen
    Disadvantages:
    May cause irregular or heavy bleeding, especially within the first 6-12 months of use
    May cause other adverse effects, including headaches, dizziness, weight gain, development of ovarian cysts, decreases in sexual desire, vaginal dryness, arm pain, and bleeding from the injection site
  • LO12: Explain how hormonal injectables work and identify their effectiveness rates, advantages, and disadvantages.
    Suppresses ovulation, thickens cervical mucus, and changes the endometrial lining to make it inhabitable for implantation.
    Effectiveness Rates:
    97-99.7%
    Advantages:
    Does not interfere with spontaneity
    Reduces menstrual flow, cramping, and premenstrual syndrome
    Does not contain estrogen
    Is reversible
    Disadvantages:
    May cause adverse effects, including irregular bleeding and spotting, fatigue, dizzy spells, weakness, headaches or migraines, weight gain, or decrease in bone density (the latter is reversible with disuse)
    May take 2-3 months to regain fertility with disuse
  • LO2: Explain how spermicides work and identify their effectiveness rates, advantages, and disadvantages.
    Effectiveness Rates:
    71% to 82% - overall, foam is more effective than jelly, cream, film or suppositories.
    Advantages:
    Do not interfere with a woman’s hormones
    Can be inserted during foreplay
    Provide lubrication during intercourse
    Have minimal adverse effects
    Can be used when a woman is breast-feeding
    Disadvantages:
    Must be used each time a couple engages in vaginal intercourse
    May become expensive over time
    May cause increases in post-coital drip
    May have an unpleasant taste
    May cause vaginal skin irritations or an increase in urinary tract infections
  • LO13: Explain how intrauterine methods work and identify their effectiveness rates, advantages, and disadvantages.
    The ParaGard IUD is placed in the uterus and causes an increase in copper ions and enzymes that impair sperm function and prevent fertilization.
    The Mirena IUD time-releases progestin, which thickens cervical mucus, inhibits sperm survival, and suppresses endometrial growth to make the uterus inhospitable to implantation.
    Skyla time-releases progestin, acting similar to other hormonal methods, and can be left in place for up to 3 years.
    Effectiveness Rates:
    99.2-99.9%
    Advantages:
    Can be used as emergency contraception
    Has fast reversibility with removal
    Can be used during breast-feeding
    Disadvantages:
    Offers no protection from STIs
    Carries a small risk for uterine perforation
    May be felt by a sexual partner
    Figure: Insertion of an intrauterine device. © Cengage Learning 2013
  • Source: © Joel Gordon
  • LO14: Explain how fertility awareness-based methods work and identify their effectiveness rates, advantages, and disadvantages.
    Involves monitoring BBT to detect body temperature rise that occurs immediately prior to ovulation and thus monitors for changes in the cervical mucus that allow for sperm transport
    Effectiveness Rates:
    88-97%, yet is limited with inaccuracy in monitoring for one’s fertility period and non-avoidance of intercourse during this time
    Advantages:
    May encourage couples’ communications and knowledge attainment regarding contraception and the menstrual cycle, thus involving the male partner
    Have no side effects
    May help with pregnancy as a result of ovulation familiarity
    Disadvantages:
    Takes time and commitment to learn and practice accurately
    Are often more suitable for “spacing out” pregnancies rather than limiting pregnancies
    Photo: CycleBeads can be used with fertility awareness-based methods to help determine fertile days. A ring is moved over a series of color-coded beads that represent low- and high-fertility days. © Kenzie Henke
  • LO15: Explain how withdrawal works and identify its effectiveness rates, advantages, and disadvantages.
    Involves withdrawal of the penis from the vagina before ejaculation
    Effectiveness Rates:
    73-96%
    Advantages:
    Is an acceptable method for those with religious concerns
    Is free
    Does not require devices or chemicals
    Is better than use of no method of birth control
    Disadvantages:
    Provides no protection from STIs
    May contribute to ejaculatory issues
    Can be difficult and stressful to “pull out”
    Requires trust from the female partner
  • LO16: Explain how sterilization methods work and identify their effectiveness rates, advantages, and disadvantages.
    Female sterilization closes or blocks the Fallopian tubes to block ovum / sperm connections.
    Male sterilization blocks the flow of sperm through the vas deferens prior to emergence from the male body.
    Effectiveness Rates:
    99-99.9%, with immediate effectiveness for tubal sterilizations and 12 week delays in effectiveness for vasectomies
    Advantages:
    Is a highly effective, permanent method of contraception
    Does not interfere with hormones
    Offers few long-term effects
    Once completed, does not interfere with spontaneity
    Disadvantages:
    Requires medical intervention and / or surgery
    Can be expensive
    Provides no protection from STIs
    Is considered irreversible
  • LO17: Describe the surgical and nonsurgical methods of female sterilization.
    Tubal sterilization involves surgical procedures that close or block the Fallopian tubes through cauterization, by which a ring, band, or clamp pinches each tube closed, or through ligation, by which the tubes are tied or bound. Both are conducted by inserting a laparoscope though a small incision under the naval or through the lower abdomen. Following the procedure, ovulation continues, yet ovum cannot travel to the uterus.
    Non-surgical procedures involve placing a spring (Essure) or silicone inserts (Adiana) into the Fallopian tubes, which stimulates the body’s growth of tissue around and within the materials, naturally filling the tubes and blocking ovum / sperm mobility.
    Figure: Insertion of Essure, a permanent contraceptive method. © Cengage Learning 2013
  • LO18: Describe the male sterilization procedure and explain the outcome of a vasectomy.
    Two small incisions about 0.25 to 0.5 inch long are made in the scrotum during outpatient surgery involving a local anesthetic, and the vas deferens are clipped, cut or cauterized.
    Following vasectomy, men will ejaculate yet no sperm will be present in the ejaculate. Testosterone production, erections and urination are non-affected.
    © Cengage Learning 2013
  • LO19: Discuss the primary reasons for the use of emergency contraception, and explain the outcome of taking an emergency contraceptive pill.
    Emergency contraception is primarily used in cases of unprotected vaginal intercourse, when no contraception was used or contraception was used improperly, when male or female condoms slip or break during intercourse, when an IUD was expelled, or when sexual assault occurred.
    The method inhibits ovulation, thickens cervical mucus, and reduces endometrial buildup in order to prevent pregnancy by limiting implantation (does not terminate pregnancy).
    Ella, a single pill that can prevent pregnancy up to 5 days after unprotected intercourse, was approved in 2010
    Photo: Emergency contraception, such as Next Choice, must be taken within 72 hours to prevent pregnancy. © Janell Carroll
  • LO20: Identify common demographic statistics associated with abortion, such as age and ethnicity.
    Higher abortion rates are directly related to rates of unintended pregnancy, which are typically related to lack of access to high-quality contraception and inconsistency in contraceptive use.
    This is reflected in the demographics of women who typically have abortions in the US who are:
    Most likely to be in their 20s (not teens), be poor or have lower income, be unmarried, and / or be of ethnic or racial minorities
    Most are unmarried yet in a relationship
    In 2008, rates by ethnicity included:
    36% were non-Hispanic White women
    30% were non-Hispanic Black women
    25% were Hispanic women
    9% were non-Hispanic women of other races
    Figure: Since abortion was legalized in 1973, the number of deaths from abortion has declined dramatically. Source: Alan Guttmacher Institute (2008b); Strauss et al. (2006).
  • LO21: Discuss the arguments offered by both sides of the abortion debate.
    Pro-life supporters express:
    Belief that human life starts at conception; thus, an embryo, at any stage of development, is a person
    Mixed views regarding abortion, in that some express that it is always murder and should thus be illegal, whereas others believe abortion should be available for specific cases (e.g., rape, maternal danger)
    Pro-choice supporters express:
    Belief that a woman should have control over her own fertility
    Belief that abortion is a woman’s choice and that the government should not interfere by legally restricting or banning abortions
    Video: Will abortion ever become illegal?
  • LO22: Compare the practice of abortion in the United States pre- and post- Roe v. Wade.
    Many women died or were severely injured by illegal surgical abortions performed by semi-skilled practioners prior to Roe vs. Wade or during self-induced abortions.
    Although abortion was illegal and banned by all 50 states by 1965 with some exceptions (to protect maternal life, in cases of rape, incest or fetal deformity), its practice was quite common.
    Following Roe v. Wade, a woman’s right to have an abortion is constitutionally protected yet not absolute as state law can regulate fetal viability standards differentially. Despite the difficulties in sometimes getting abortions as a result of these state-related regulations, the numbers of women who seek abortion have not decreased over time and legalization has led to fewer women being hospitalized for abortion-related complications and significantly fewer abortion-related deaths have occurred.
    Video: Abortion before Roe vs Wade
  • LO23: Compare the timing, process, and outcomes of surgical and medication abortion procedures.
    A first-trimester vacuum aspiration is performed up to 16 weeks, is generally simpler and safer than later-term abortions, and can be accomplished in a private clinic, physician’s office, or hospital, takes between 4-6 minutes, and involves numbing and dilation of the cervix and the insertion of a vacuum aspirator, which empties the uterine contents.
    Second-trimester surgical abortions (dilation and evacuation) involves dilation of the cervix up to 12-24 hours prior to the abortive procedure to both slowly dilate the cervix and absorb fluid and then the uterus is emptied with suction and various instruments during a 15-20 minute procedure.
    Outcomes of both include bleeding and cramping which can be minimized with over-the-counter analgesics and possible spotting for up to six weeks. Additionally, possible risks include medicinal allergies, excessive bleeding, infection, injury to the cervix, uterine perforation, and / or incomplete abortions.
    A medicated abortion through the use of an “abortive pill” containing mifepristone, which blocks progesterone and inhibits endometrial buildup, involves a physical examination, blood work and an ultrasound to determine the length of pregnancy, taking of the pill, bleeding within 4-5 hours, and subsequent taking of misoprostol (a prostaglandin), which causes uterine contraction and expulsion of contents within 3 days of taking the first abortive pill.
    Outcomes include 4-5 hours of heavy bleeding, cramping, nausea, diarrhea, abdominal pain, dizziness, and / or minor fever and chills as the abortion is completed and up to 4 additional weeks of bleeding. A follow-up medical visit is also necessary, and a surgical abortion may be required for incomplete abortions.
    Figure: The majority of abortions are done within the first 12 weeks of pregnancy. © Cengage Learning 2013
  • LO24: Identify common physiological and psychological reactions to abortion.
    Research suggests that legal abortions are medically safe and have few long-term physiological, psychological, or fertility-related problems.
    Following a first-trimester vacuum aspiration, common physiological symptoms include cramping, heavy bleeding with possible clots, and nausea for several days.
    Following second-trimester abortive procedures, possible physiological complications include hemorrhaging, cervical laceration, uterine perforation, and infection.
    The most common psychological / emotional reaction to abortion is relief, although some women also express socially-based emotions such as shame, guilt and fear of disapproval and / or internally-based emotions of regret, anxiety, depression, doubt, anger, self-reproach, increased sadness, and / or a sense of loss.
    LO25: Identify common psychological reactions to abortion in men and discuss the impact of abortion on relationships.
    Some men may experience sadness, a sense of loss, fear for their partner’s well-being, and they may refrain from gaining social support by talking about these feelings. Other men may attempt to control women’s choices by becoming abusive.
  • Teenagers may be more vulnerable to postabortion anxiety, depression, sleep problems, and substance use/abuse, mostly because of developmental limitations and a lack of emotional support.
    Many states have passed laws that control and limit teenagers’ access to abortion such as parental notification laws, though some states offer a medical emergency exception or judicial bypass options, where a minor can obtain consent from a judge.
  • HLTH201Chapter13

    1. 1. 13 ContraceptionContraception and Abortionand Abortion Chapter 13
    2. 2. 13 Contraception Methods > How do you decide what birth control method to use? > Should the government dictate your method of birth control? CBS NEWS CLIP
    3. 3. 13 Global Contraceptive Use Figure 13.3 In 2011, worldwide 63% of women of reproductive age who were married or in a relationship were using a contraceptive method, although contraceptive use varied widely across major areas. Contraceptive usage was lowest in Africa and highest in Europe, Latin America, and the Caribbean and North America.
    4. 4. 13 Contraception in the U.S. Today > Several methods currently available > The U.S. Food and Drug Administration (FDA) must formally approve the method > FDA approval process > Three phases > Phase 1: 20-80 volunteers to test effectiveness > Phase 2: several hundred to test effectiveness, side effects, risks > Phase 3: hundreds to thousands are tested for generalization
    5. 5. 13 Contraception Methods > When choosing a contraceptive method, one must keep their lifestyle in mind, including these important issues: > Personal health and health risks. > Advantages and disadvantages of methods. > The number of sexual partners. > Frequency of sexual intercourse. > Risk of acquiring an STI. > Personal responsibility. > Cost of methods.
    6. 6. 13 Contraception Methods > It is important for sexually active individuals to be knowledgeable about various contraceptive methods, including: > How they work > Effectiveness rates (including typical use and perfect use) > Cost > Advantages and disadvantages
    7. 7. 13
    8. 8. 13 Males Condoms > Creates a barrier between the penis and the vagina, limiting pregnancy and providing protection against some STIs and HIV Advantages •Help prevent pregnancy •Can be discreetly carried in a pocket or purse •Offer some protections against many STIs Disadvantages •May pose size and erection issues •May reduce male sensation •May break during use
    9. 9. 13 Condom Usage Figure 13.6 Condom use by age and gender.
    10. 10. 13 Female Condoms > Creates a barrier between the penis and the vagina, limiting pregnancy and providing protection against some STIs Advantages •Can be purchased without a prescription •Can be discreetly carried •Do not require erection to stay in place •Can be discreetly carried in a pocket / purse Disadvantages •Can be difficult to insert •Can be uncomfortable •May be expensive over time
    11. 11. 13 Using a Female Condom Figure 13.8 Female condoms are inserted into the vagina like a tampon. The inner ring is pushed up inside the vagina until it reaches the cervix, while the outer ring hangs about an inch outside of the vagina.
    12. 12. 13 Cervical Barriers Diaphragms come in a variety of different shapes and sizes and must be fitted by a health care professional. The FemCap is a silicone cup that fits securely over the cervix. Lea’s Shield is a silicone cup with a one-way valve and a loop for easier removal. Advantages •Are immediately effective •Do not affect spontaneity •Do not affect hormone levels •Allow couples to engage in intercourse multiple times Disadvantages •Require a prescription •Do not offer protection against STIs •May be difficult to insert and / or remove •May cause allergies or adverse reactions
    13. 13. 13 Contraceptive Sponges > Sponges work in three ways: > as a barrier blocking the entrance to the uterus > absorbing sperm > deactivating sperm Advantages •Can be purchased without a prescription •Can be discreetly carried •Is immediately effective •Does not affect spontaneity Disadvantages •Increases risks of toxic shock syndrome and urinary tract infections •May be difficult to insert and remove •Does not offer protection against STIs
    14. 14. 13 Birth Control Pills > Prevents the pituitary gland from releasing hormones that cause the ovaries to begin maturation of an ovum so a woman does not ovulate Advantages •Offer one of the highest effectiveness rates •Do not interfere with spontaneity •Protects against certain disease •Reduces fear of pregnancy Disadvantages •Require a prescription •Require daily doses •Can be expensive
    15. 15. 13 Hormonal Ring Advantages •Is highly effective and easy to use •Does not interfere with spontaneity •Increases menstrual regularity Disadvantages •Requires a prescription •Offers no protection against STIs •Requires genital touching •Takes longer to resume periods > NuvaRing is a one-size-fits-all plastic ring that it inserted into the vagina once a month, releasing a constant does of estrogen and progesterone
    16. 16. 13 Hormonal Patch > The Ortho Evra patch is a thin patch that sticks to the skin and time-releases hormones into the bloodstream Advantages •Has more than a 90% perfect dosing level because it is adhered to the skin •Does not interfere with spontaneity •Increases menstrual regularity Disadvantages •Requires a prescription •Offers no protection against STIs •May cause adverse effects
    17. 17. 13 Progestin-Only Hormones > Progestin-only pills (minipills) are similar to combination birth control pills, except they contain a progestin hormone and no estrogen. Advantages •Reduce menstrual cramps •May eliminate periods •Contains a lower hormone level Disadvantages •Require regularity in administration •Offers no protection from STIs
    18. 18. 13 Progestin-Only Hormones > Subdermal contraceptive implants involve surgically inserting under the skin a match-stick rod that time-releases progestin. Advantages •Is highly effective •Is long-lasting (up to 3 years) •Is easily reversible Disadvantages •Requires a prescription and medical visit which may be expensive •Removal may be difficult and takes longer than insertion
    19. 19. 13 Hormonal Injectables > It is a progestin injected into the muscle of a woman’s buttock or arm and works by preventing ovulation, thickening cervical mucus, and changing the uterine lining. Advantages •Is highly effective •Lasts for 3 months and requires only 4 shots / year •Is only moderately expensive Disadvantages •Require regularity in administration •Requires every 3 month medical visits •May cause adverse effects
    20. 20. 13 Spermicides > Two components to a spermicide: > An inert base that holds spermicides close to the cervix > And the second component which destroys the sperm Advantages •Do not require a prescription •Can be discreetly carried in a pocket / purse Disadvantages •Must be used each time •May cause allergies or adverse reactions •Requires planning
    21. 21. 13 Intrauterine Methods > An IUD is a small device made of flexible plastic that is placed in the uterus to prevent pregnancy Advantages •Are the least expensive contraception method over time •Do not interfere with spontaneity •Have long-lasting effects •Reduces or eliminates menstrual flow and cramping Disadvantages •Requires moderately painful insertion and removal procedures •May cause irregular bleeding patterns and spotting, particularly the ParaGard
    22. 22. 13 IUDs: The Copper T and the Mirena ((a) The ParaGard is a T-shaped intrauterine device (IUD) made of flexible plastic; it contains copper and can be left in place for up to 12 years. (b) The Mirena is a T-shaped IUD made of flexible plastic; it continuously releases a small amount of progestin and can be left in place for up to 5 years.
    23. 23. 13 Fertility-Awareness Methods > Natural methods of contraception do not alter physiological function, and include natural family planning and fertility awareness, withdrawal, and abstinence. Advantages •Are acceptable methods for those with religious concerns •Are inexpensive •May encourage communication Disadvantages •Restricts spontaneity •Provide no protection from STIs •Take time and commitment •Offers no protection against STIs
    24. 24. 13 Withdrawal Method > Withdrawal, or coitus interruptus, involves withdrawing the penis from the vagina before ejaculation > it can be used alone or in conjunction with other methods. > It’s free, but does not protect against STI’s
    25. 25. 13 Sterilization > Female sterilization, or tubal sterilization, is the most widely used method of birth control in the world. > Male sterilization, or vasectomy, is simpler and less expensive than female sterilization, and works by blocking the flow of sperm through the vas deferens so that a man ejaculates semen that contains no sperm
    26. 26. 13 Female Sterilization
    27. 27. 13 Male Vasectomy
    28. 28. 13 Emergency Contraception > Emergency contraception (EC) is designed to avoid pregnancy after unprotected vaginal intercourse, in case of unanticipated sexual intercourse, contraceptive failure, or sexual assault > It can be used up to 5 days after unprotected intercourse. > Plan B was approved by the FDA in 1999, Plan B One Step approved in 2013 > Next Choice, as with others, is the generic equivalent to Plan B, and are available without a prescription to men and women older than 17 years old
    29. 29. 13 Abortion and Demographics > Of the 208 million pregnancies that occurred in 2008 worldwide, 20% ended in abortion. > In the U.S., 40% of unintended pregnancies end in abortion.
    30. 30. 13 The Abortion Debate > Pro-life supporters believe that human life begins at conception, and thus an embryo is a person; most believe abortion should be illegal or strictly regulated by the government. > Pro-choice supporters believe that the abortion decision should be left up to the woman and not regulated by the government.
    31. 31. 13 Roe v. Wade > In 1965, all 50 states banned abortion, though there were exceptions that varied by state. > Those would could not obtain legal abortions had the baby or underwent illegal abortions, also called back-alley abortions, that often resulted in multiple complications and even death. > In 1973, the Supreme Court ruled in Roe v. Wade that women have a constitutionally protected right to have an abortion in the early stages of pregnancy.
    32. 32. 13 Abortion Procedures > First-trimester surgical abortions (also called vacuum aspiration) are performed up to 16 weeks after a woman’s last period and are simpler and safer than abortions performed after this time. > Second-trimester surgical abortions are those performed later than 16 weeks after a woman’s last period > Medication Abortion > Mifepristone, also known as the “abortion pill” or RU-486, was first approved in France in 1988, but was not approved in the U.S. until 2000.
    33. 33. 13 Physical and Psychological Reactions > Research has found few long-term physiological, psychological, or fertility-related problems later in life after an abortion. > Although women experience a range of emotions after abortion, the most prominent response is relief > Women whose partners support them and help them through the abortion show more positive responses after an abortion.
    34. 34. 13 Teens and Abortion > 18% of U.S. women who have abortions are teenagers > Some states require parental notification or consent > In lieu of that, they may request a judicial bypass option

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