PHED 2022- Wellness Focus Lifestyle, Behavior & Disease

1. Chapter 9 – Contraception and Reproduction
9
Contraception and Reproduction
LectureOutline
I. Conception
A. Introduction
1. The processes that affect or permit conception are:
a. The creation of sperm, or spermatogenesis, starts in the male at
puberty, and the production of sperm is regulated by hormones.
b. Sperm cells form in the seminiferous tubules of the testes and are
passed into the epididymis, where they are stored until ejaculation.
c. A single male ejaculation may contain 500 million sperm.
d. To reach its goal, the sperm must move through the acidic secretions of
the vagina, enter the uterus, travel up the fallopian tube containing the
ovum, then fuse with the nucleus of the egg (fertilization).
e. Each woman is born with her lifetime supply of ova; between 300 and
500 eggs eventually mature and leave a woman’s ovaries during
ovulation.
f. Every month, one or the other of the woman’s ovaries releases an
ovum to the nearby fallopian tube. It travels through the fallopian tube
until it reaches the uterus.
g. An unfertilized egg lives for about 24 to 36 hours, disintegrates, and
during menstruation is expelled along with the uterine lining.
h. A mature ovum releases the chemical alluring, which attracts the
sperm. A sperm is able to penetrate the ovum’s outer membrane
because of a protein called fertilin.
i. The fertilized egg, called a zygote, travels down the fallopian tube.
When it reaches the uterus, about a week after fertilization, it burrows
into the endometrium, a process called implantation.
2. Conception can be prevented by contraception.
II. Abstinence or Nonpenetrative Sexual Activity
A. Abstinence is to abstain from vaginal intercourse and forms of nonpenetrative
sexual activity that could result in conception.

2. Chapter 9 – Contraception and Reproduction
B. People choose abstinence for various reasons, including: waiting until they
are ready for a sexual relationship; waiting until they find the “right” partner;
respecting religious or moral values; enjoying friendships without sexual
involvement; recovering from a breakup; or preventing pregnancy and
sexually transmitted infection.
C. Abstinence is the only form of birth control that is 100 percent effective and
risk-free.
D. Individuals who choose abstinence from vaginal intercourse often engage in
activities sometimes called outercourse, such as kissing, hugging, sensual
touching, and mutual masturbation.
E. Outercourse has no medical or hormonal side effects; it may prolong sex play
and enhance orgasm; it can be used when no other birth control methods are
available.
III. Contraception
A. Introduction
1. Some couples use withdrawal, or coitus interruptus (removal of the penis
from the vagina before ejaculation), to prevent pregnancy, even though
this is not a reliable form of birth control.
2. Good decisions are based on sound information.
3. You should consult a physician or family planning counselor if you have
questions or want to know how certain methods might affects existing of
familial medical conditions.
4. Failure rate refers to the number of pregnancies that occur per year for
every 100 women using a particular method of birth control.
B. The Benefits and Risks of Contraceptives
1. Using birth control is safer and healthier than not using it.
2. If you have any of the following you should talk with your doctor about
which types of contraceptives may increase your health risks:
a. High blood pressure
b. Episodes of depression
c. Seizure disorder
d. Ectopic pregnancy
e. Hepatitis
3. Various methods of birth control have side effects, although pregnancy
and childbirth account for much higher rates of medical complications
and deaths than any contraceptive.
C. Birth Control on Campus
1. 57.1 percent of students–53.9 percent of men and 58.9 percent of women–
reported using contraception the last time they had vaginal intercourse.

3. Chapter 9 – Contraception and Reproduction
2. Even students who know and understand the risks associated with
unprotected sex often do not take steps to prevent pregnancy or sexually
transmitted disease.
IV. Barrier Contraceptives
Barrier contraceptives block the meeting of egg and sperm by means of a physical
barrier.
A. Nonprescription Barriers
1. Condoms
a. Advantages of Condoms
i. Effective when used correctly
ii. Lowers a woman’s risk of pelvic inflammatory disease (PID) and
may protect against some urinary tract and genital infections
iii. No side effects
iv. No prescription required
v. Can be carried in a pocket or purse
vi. Inexpensive
vii. The female condom gives women more control in reducing their
risk of pregnancy and STIs and does not require a prescription or
medical appointment
viii. No effect on a woman’s natural hormones or fertility
ix. Female condom can be inserted up to eight hours before sex
b. Disadvantages of Condoms
i. Requires consistent and diligent use
ii. Not 100 percent effective in preventing pregnancy or STIs
iii. Risk of manufacturing defects, such as pinsize holes, and
breaking or slipping off during intercourse
iv. May inhibit sexual spontaneity
v. Users or partners may complain about odor, lubrication (too
much or too little), feel, taste, difficulty opening the packages, and
disposal
vi. Some men complain of reduced penile sensitivity or cannot
sustain an erection while putting on a condom
vii. Some women complain that the female condom is difficult to use,
squeaks, and looks odd
c. Male Condom
i. Covers the erect penis and catches the ejaculate, thus preventing
sperm from entering the woman’s reproductive tract
d. How the Male Condom Works
i. The polyurethane condom has proven to be not as effective as the
latex condom for pregnancy prevention.

4. Chapter 9 – Contraception and Reproduction
e. Effectiveness of the Male Condom
i. The theoretical effectiveness rate for condoms is 97 percent; the
actual rate is only 80 to 85 percent. The major reason that
condoms have such a low actual effectiveness is that couple
doesn’t use them each and every time they have sex.
f. Female Condom
i. The second-generation female condom, known as FC2, is a strong
thin, flexible nitrite sheath or pouch about 6.5 inches long. It
consists of flexible polyurethane ring at the closed ends of the
pouch.
g. How the Female Condom Works
i. When properly inserted, the outer ring should rest on the folds of
the skin around the vaginal opening, and inner ring (the closed
end) should fit against the cervix.
h. Effectiveness of the Female Condom
i. Properly used, they are believed to be as good as or better than
the male condom for preventing infections.
2. Contraceptive Sponge
a. How It Works
i. The contraceptive sponge acts as a barrier by blocking the
entrance to the uterus and absorbing and deactivating sperm.
b. Advantages of the Contraceptive Sponge
i. Does not require a prescription
ii. Easy to carry and use
iii. Can be inserted up to 24 hours before intercourse
iv. Effective immediately if used correctly
v. No effect on fertility
vi. Generally cannot be felt by a woman or her partner
vii. Can be used by women who are breast-feeding
c. Disadvantages of the Contraceptive Sponge
i. May be difficult to remove
ii. May be less effective in women who have had children
iii. No reliable protection against STIs
iv. Requires advance planning to place the sponge
v. Side effects include vaginal irritation and allergic reactions
vi. Should not be used during menstruation
vii. Slightly increased risk of toxic shock syndrome
3. Vaginal Spermicides
a. Include chemical foams, creams, jellies, vaginal suppositories, gels, and
film.

5. Chapter 9 – Contraception and Reproduction
b. Failure rates for vaginal suppositories are as high as 10 to 25 percent.
c. Vaginal contraceptive film, a thin two-inch-square film laced with
spermicide, is folded and inserted into the vagina, where it dissolves
into a stay-in –place gel.
d. How They Work
i. Spermicides consist of a chemical that kills sperm and potential
pathogens and an inert base, such as jelly, cream, foam, or film
that holds the spermicide close to the cervix.
e. Advantages of Vaginal Spermicides
i. Easy to use
ii. Effective if used with another form of contraception, such as
condoms
iii. Reduces the risk of some vaginal infections, PID, and STIs
iv. No effect on fertility
f. Disadvantages of Vaginal Spermicides
i. When used alone, does not protect against STIs
ii. Frequent use can increase risk of HIV from an infected partner
iii. Insertion interrupts sexual spontaneity
iv. May cause irritation
v. Some people cannot use them because of an allergic reaction
vi. Some users complain that spermicides are messy or interfere with
oral–genital contact
vii. Spermicidal suppositories that do not dissolve completely can feel
gritty
B. Prescription Barriers
1. Diaphragm
a. The diaphragm is a bowl-like rubber cup with a flexible rim that is
inserted into the vagina to cover the cervix and prevent the passage of
sperm into the uterus during sexual intercourse.
b. How It Works
i. Diaphragms are fitted and prescribed by a qualified health-care
professional in a range of diameter sizes.
ii. A diaphragm should remain in the vagina for at least six hours
after intercourse to ensure that all sperm are killed.
2. Cervical Cap
a. Like the diaphragm, the cervical cap combined with spermicide serves
as both a chemical and physical barrier to block the path of the sperm
to the uterus.

6. Chapter 9 – Contraception and Reproduction
b. How It Works
i. The cervical cap is fitted by a qualified health-care professional.
ii. The woman fills it one-third to two-thirds full with spermicide and
inserts it by holding its edges together and sliding it into the
vagina. The cup is then pressed into the cervix.
3. FemCap
a. The FemCap is a non-hormonal, latex-free barrier contraceptive that
works with a spermicide.
b. How It Works
i. A prescription is required to purchase the FemCap. To use the
FemCap, apply spermicide to the bowl of the FemCap (which goes
over the cervix) to the outer brim, to the groove that will face into
the vagina. Insert the squeezed, flattened cap into the vagina with
the bowl facing upward.
4. Advantages of Prescription Barriers
a. Can be inserted up to six hours before sex
b. Doesn’t interrupt sexual activity; can be inserted hours ahead of time
c. Usually not felt by either partner
d. Can easily be carried in pocket or purse
e. No effect on a woman’s natural hormones or fertility
f. Cervical caps are an alternative for women who cannot use
diaphragms or find them too messy
5. Disadvantages of Prescription Barriers
a. Less effective than hormonal contraceptives
b. Available by prescription only
c. Require advance planning or interruption of sexual activity to position
the device before intercourse
d. May slip out of place during intercourse
e. May be uncomfortable for some women and their partners
f. Spermicidal foams, creams, and jellies may be messy, cause irritation,
and detract from oral–genital sex
g. Some diaphragm users report bladder discomfort, urethral irritation,
or recurrent cystitis
h. Some cap users find it more difficult to insert and remove, and
uncomfortable to wear
i. Slightly increased risk of toxic shock syndrome

7. Chapter 9 – Contraception and Reproduction
V. Hormonal Contraceptives
A. Introduction
1. Hormonal Contraceptives can provide benefits beyond birth control,
including:
a. Regular menstrual cycles
b. Reduction of menstrual pain and excess bleeding
c. Treatment of premenstrual syndrome
d. Prevention of migraines
e. Decreased risk of endometrial cancer, ovarian cancer, and colorectal
cancer
f. Treatment of acne and excess facial hair
g. Improved bone mineral density
B. Oral Contraceptives
1. The pill—the popular term for oral contraceptives—is the method of birth
control preferred by unmarried women and by those under age 30.
2. Combination Oral Contraceptives (COCs)
a. These pills consist of two hormones, synthetic estrogen and progestin,
which play important roles in controlling ovulation and the menstrual
cycle.
b. Monophasic pills - release a constant dose of estrogen and progestin
throughout a woman’s menstrual cycle.
c. Multiphasic pills – mimic normal hormonal fluctuations of the natural
menstrual cycle by providing different levels of estrogen and
progesterone at different times of the month. Multiphasic pills reduce
total hormonal dose and side effects.
d. Both monophasic and multiphasic pills block the release of hormones
that would stimulate the process leading to ovulation. They also make
the cervical mucus more hostile to sperm and make implantation of a
fertilized egg in the uterine lining more difficult.
e. Yasmin contains a unique progestin that works like a mild diuretic and
prevents fluid retention. YAZ, a lower-dose 24-day version, can ease
emotional and physical premenstrual symptoms.
3. Progestin-Only Pills
a. Progestin-only “mini pills” contain only a small amount of progestin
and no estrogen.
b. The pills prevent pregnancy by thickening cervical mucus, making it
hard for sperm to penetrate, and by interfering with implantation of a
fertilized egg.
c. The risk of heart disease and stroke is lower with progestin-only pills
than with any combination pill.

8. Chapter 9 – Contraception and Reproduction
d. Users of progestin-only pills have to be conscientious about taking
these pills—not just every day, but at the same time every day.
4. Before Using Oral Contraceptives
a. Before starting the pill, a woman should undergo a physical
examination that includes a blood pressure test, a breast exam, blood
tests, and a urine sample.
5. How they Work
a. Oral contraceptives usually come in 28-day packets: 21 of the pills
contain hormones, and 7 are “blanks,” included so the women can take
a pill every day, even during her menstrual period.
6. A Special Caution
a. Common antibiotics, including many of the ones prescribed for dental
procedures or skin conditions, may lower the effectiveness of oral
contraceptives, particularly low-dose birth control pills.
7. Advantages of Oral Contraceptives
a. Extremely effective when taken consistently
b. Convenient
c. Moderately priced
d. Does not interrupt sexual activity
e. Reversible within three months of stopping the pill
f. Reduces the risk of benign breast lumps, ovarian cysts, iron-deficiency
anemia, pelvic inflammatory disease, endometrial cancer, and ovarian
cancer
g. May relieve painful menstruation
8. Disadvantages of Oral Contraceptives
a. In real life, rates of unintended pregnancies among pill users are as
high as 2.8 percent in the first year of use and 5.7 percent after three
years
b. Requires a prescription
c. Increases risk of cardiovascular problems, primarily for women over
age 35 who smoke and those with high blood pressure or other health
problems
d. Side effects vary with different brands but include spotting between
periods, weight gain or loss, nausea and vomiting, breast tenderness,
and decreased sex drive
e. Must be taken at the same time every day (especially critical with low-
dose estrogen and progestin-only pills)
f. No protection against STIs
g. Must use a secondary form of birth control for the initial seven days of
use

9. Chapter 9 – Contraception and Reproduction
C. Extended-Use Pills
1. Prescribed to lessen the number or menstrual cycles for women with
asthma, rashes, or other conditions that flare up during their periods.
2. Seasonale and Seasonique are prescription forms of oral contraception that
prevent pregnancy as effectively as other birth control pills but produce
only four menstrual periods a year.
3. How They Work
a. Women take “active” pills continuously for three months. During this
time, Seasonale prevents the uterine lining from thickening enough to
produce a full menstrual period.
b. Every three months, a woman takes one week of inactive pills to
produce a “pill period,” which may be lighter than a regular period.
4. Advantages
a. Fewer periods
b. Tri-monthly periods are usually lighter, with less blood flow
5. Disadvantages
a. Similar to those of other oral contraceptives in terms of health risk,
costs, and side effects
b. No protection from STIs
c. More spotting and breakthrough bleeding than with a 28-day pill
d. Determining pregnancy is difficult without a monthly period
6. Lybrel, the “No-Period” Pill
a. Lybrel works the same way as other combination hormonal birth
control pills, but it is taken 365 days without interruption.
b. How It Works
i. Lybrel stops the body’s monthly preparation for pregnancy by
lowering the production of hormones that make pregnancy
possible.
c. Advantages
i. No menstrual periods, cramps, or other symptoms
ii. No need to stop taking pills or switch to dummy pills for a week
iii. Relief from menstruation-linked conditions such as endometriosis
and menstrual migraines
d. Disadvantages
i. Spotting
ii. Health risks similar to those of other combination pills
iii. Determining pregnancy is difficult without a monthly period
iv. Some women feel that eliminating periods is unnatural

10. Chapter 9 – Contraception and Reproduction
D. Contraceptive Patch
1. The Ortho Evra birth control patch, the first transdermal (through the
skin) contraceptive, works like a combination pill but looks like a Band-
Aid.
2. How it Works
a. A woman applies the patch to her back, upper arm, lower abdomen, or
buttocks and changes it every seven days for three weeks.
b. Advantages of the Patch
i. Good alternative for women who cannot remember, do not like,
or have problems swallowing daily pills
ii. Highly effective when used correctly
iii. Does not interrupt sexual activity
iv. Fewer side effects—such as nausea, breakthrough bleeding, and
mood swings—than pills
v. Fertility returns quickly after you stop using it
c. Disadvantages of the Patch
i. Must apply a new patch every week
ii. Requires a prescription
iii. No protection against STIs
iv. Increases risk of blood clots, heart attack, and stroke particularly
for women who smoke or have certain health conditions
v. Less effective in women who weigh more than 198 pounds
vi. Some women report breast tenderness, headaches, upper
respiratory infections, or self-consciousness wearing the patch
vii. Contact lens wearers may experience vision changes
viii. Five percent of women report that at least one patch slipped off;
two percent report skin irritation
ix. Must use another form of birth control for the initial seven days
of use
E. Contraceptive Vaginal Ring (CVR)
1. The silver-dollar-sized NuvaRing, a 2-inch ring made of flexible,
transparent plastic, slowly emits the same hormones as oral contraceptives
through the vaginal tissues.
2. How it Works
a. The flexible, plastic 2-inch ring compresses so a woman can easily
insert it. Each ring stays in place for three weeks, and then is removed
for the fourth week of the menstrual cycle.
b. Advantages of the NuvaRing
i. Under medical supervision, may be safer than birth control pills
for women with mild hypertension or diabetes

11. Chapter 9 – Contraception and Reproduction
ii. Less likelihood of pill-related side effects, such as nausea, mood
swings, spotting, and cramping
iii. No need to remember a daily pill or weekly patch
iv. Fertility returns quickly when ring is removed
v. Reduced pain during menstrual periods
vi. May improve acne and reduce excess body hair
vii. Can help prevent menstrual migraines
c. Disadvantages of the NuvaRing
i. Slight increased risk of blood clots, heart attack, and stroke in
women older than 35 who smoke 15 or more cigarettes a day or
who have other cardiovascular risk factors
ii. Some women do not feel comfortable placing and removing
something inside their vagina
iii. Possible side effects include vaginal discharge, irritation, and
infection
iv. Cannot use oil-based vaginal medications for yeast infections
while ring is in place
v. No protection against STIs
F. Intrauterine Contraceptives
1. An intrauterine device (IUD) is a small piece of molded plastic, with a
nylon string attached, which is inserted into the uterus through the cervix.
2. The ParaGuard IUD, which contains copper, protects against pregnancy
for 12 years.
3. The Mirena intrauterine system consists of a T-shaped device inserted in
the uterus by a physician that releases a continuous low dose of progestin
and provides five years of protection from pregnancy.
4. How They Work
a. A physician must insert the IUD into a woman’s uterus.
5. Advantages of IUDs
a. Highly effective at preventing pregnancy
b. No need to think about contraception for five years
c. Allows sexual spontaneity; neither partner can feel it
d. Starts working immediately
e. New mothers can breast-feed while using it
f. Periods become shorter and lighter or stop altogether
g. Low incidence of side effects
h. Can be removed at any time
6. Disadvantages of IUDs
a. Spotting or breakthrough bleeding in first three to six months
b. No protection against STIs

12. Chapter 9 – Contraception and Reproduction
c. Potential side effects include acne, headaches, nausea, breast
tenderness, and mood changes
d. Increased risk of benign ovarian cysts
e. May take up to a year for fertility to return after discontinuation
G. Contraception Injection
1. A progestin-only contraceptive is available in the form of a birth control
“shot” or injection.
2. Depo-Provera or its newer form, Depo-subQ Provera, must be given every
12 weeks.
3. Because of the risk of significant bone mineral loss, the FDA has
recommended that women not use Depo-Provera for longer than two
years.
4. How It Works
a. The long-acting hormonal contraceptive raises levels of progesterone,
thereby simulating pregnancy. The pituitary gland does not produce
FSH and LH, which normally cause egg ripening and release. The
endometrial lining of the uterus thins, preventing implantation of a
fertilized egg.
5. Advantages of Contraceptive Injections
a. Because it contains only progestin, it is safe for women who cannot
take combination birth control pills
b. No risk of user error
c. No worry about buying, storing, or using contraceptives
d. No need to think about contraception for three months at a time
e. Possible protection against endometrial and ovarian cancer
f. Can be used by women who are breast-feeding
g. May decrease menstrual migraines
6. Disadvantages of Contraceptive Injections
a. Must visit a doctor or clinic every three months for injection
b. Menstrual cycles become irregular or cease
c. Potential side effects include decreased sex drive, depression,
headaches, dizziness, frequent urination, allergic reactions, and hair
loss or increase in hair growth
d. Increased weight gain
e. No protection against STIs
f. May increase the risk of acquiring chlamydia and gonorrhea compared
to women not using a hormonal contraceptive. Scientists do not know
the reason for this increased risk
g. Delayed return of fertility
h. Long-term use may significantly reduce bone density

13. Chapter 9 – Contraception and Reproduction
H. Contraceptive Implants
1. Thin, flexible, plastic implant—about the size of a matchstick—is inserted
under the skin of the upper arm to provide birth control that is 99 percent
effective for up to three years.
2. Implanon is now available throughout the United States. Nexplanon is a
newer version designed for easier insertion and removal.
3. How They Work
a. Contraceptive implants work primarily by releasing progestin and
suppressing ovulation.
4. Advantages
a. Can be used while breast-feeding
b. Can be used by women who cannot take estrogen
c. Provides continuous long-lasting birth control without sterilization
d. No medicine to take every day
e. Does not interfere with sexual foreplay
f. Ability to become pregnant returns quickly once it is removed
5. Disadvantages
a. Irregular bleeding
b. Side effects such as dizziness, acne, hair loss, headache, nausea,
nervousness, and pain at insertion site
c. No protection against STIs
d. Change in appetite
e. Change in sex drive
f. Cysts on the ovaries
g. Depression, mood changes
h. Discoloring or scarring of the skin over the implant
VI. Fertility Awareness Methods
A. Overview
1. The different methods of birth control based on a woman’s menstrual
cycle are sometimes referred to as natural family planning or fertility
awareness methods.
2. How It Works
a. The Calendar Method
i. Often called the rhythm method; based on counting the woman’s
safe days based on her individual menstrual cycle
b. Basal-Body-Temperature Method
i. Determines the safe days based on the woman’s basal body
temperature, which rises after ovulation

14. Chapter 9 – Contraception and Reproduction
c. The Cervical Mucus Method
i. Also called the ovulation method; based on observation of
changes in the consistency of the woman’s vaginal mucus
throughout her menstrual cycle. The period of maximum fertility
occurs when the mucus is smooth and slippery
3. Advantages of Fertility Awareness
a. No expense
b. No side effects
c. No need for a prescription, medical visit, or fittings
d. Nothing to insert, swallow, or check
e. No effect on fertility
f. Complies with the teachings of the Roman Catholic Church
4. Disadvantages of Fertility Awareness
a. Less reliable than other forms of birth control
b. Couples must abstain from vaginal intercourse eight to eleven days a
month or use some form of contraception
c. Conscientious planning and scheduling are essential
d. May not work for women with irregular menstrual cycles
e. Some women find the mucus or temperature methods difficult to use
VII. Emergency Contraception
A. Introduction
1. Emergency contraception (EC) is the use of a method of contraception to
prevent unintended pregnancy after unprotected intercourse or the failure
of another form of contraception, such as a condom breaking or slipping
off.
2. The use of EC has more than doubled in recent years, particularly among
women in their early 20s.
3. Emergency contraception provides a second chance to prevent pregnancy
following unprotected sexual intercourse or contraceptive failure.
4. How It Works
a. ECPs stop pregnancy in the same way as other hormonal
contraceptives: They delay or inhibit ovulation, inhibit fertilization, or
block implantation of a fertilized egg, depending on a woman’s phase
of the menstrual cycle.
b. They have no effect once a pregnancy has been established.
c. The morning-after pill also may be safe for use as a regular birth
control method and may appeal to women who do not have sex
regularly and who could use it before or after sex. However, it is not as
effective as regular birth control pills, patches, or rings.

15. Chapter 9 – Contraception and Reproduction
VIII. Sterilization
A. Introduction
1. This is the most popular method of birth control among married couples
in the U.S.
2. Sterilization is surgery to end a person’s reproductive capability.
B. Male Sterilization
1. The cutting of the vas deferens, the tube that carries sperm from one of the
testes into the urethra for ejaculation, is called a vasectomy.
2. During the 15- or 20-minute office procedure, done under a local
anesthetic, the doctor makes small incisions in the scrotum, lifts up each
vas deferens, cuts it, and ties off the ends to block the flow of sperm.
C. Female Sterilization
1. The two terms used to describe female sterilization are tubal ligation (the
cutting or tying of the fallopian tubes) and tubal occlusion (the blocking of
the tubes).
2. One of the common methods of tubal ligation or occlusion uses
laparoscopy, commonly called belly-button or band-aid surgery.
3. Essure
a. This involves the placement of small, flexible microcoils into the
fallopian tubes via the vagina by a physician.
D. Advantages of Sterilization
1. Offers permanent protection against unwanted pregnancy.
2. No effect on sex drive in men or women. Many couples report greater
sexual activity and pleasure because they no longer have to worry about
pregnancy or deal with contraceptives.
3. Vasectomy and tubal ligation are performed as outpatient procedures,
with a quick recovery time.
4. Use of Essure requires no incision, so there is less discomfort and very
rapid recovery. Essure may be an option for women with chronic health
conditions, such as obesity, diabetes, or heart disease.
E. Disadvantages of Sterilization
1. All procedures should be considered permanent and used only if both
partners are certain they want no more children
2. No protection against STIs
3. Must use another form of birth control for first three months
4. Many long-term risks remain unknown, but there is no evidence of any
link between vasectomy and prostate cancer

16. Chapter 9 – Contraception and Reproduction
IX. Childfree by Choice
A. More women and men are deliberately choosing to remain “childfree.”
B. Single childfree women tend to be better educated, more cosmopolitan, less
religious, and more professional than those in the general population.
C. Childfree couples are predominantly urban, well-educated, and upper
middle class, with egalitarian and long-running marriages.
D. Reasons for not having children are diverse, including:
1. A desire to maintain their freedom and have more time with their partners
2. Career ambitions
3. Concern about overpopulation and the fate of Earth
4. Concern about a hostile work environment for mothers and the
inadequacy of day care
5. Disillusionment with the have-it-all hopes of baby boomers and a belief in
a have-most-of-it philosophy
X. Unwanted Pregnancy
A. A woman faced with an unwanted pregnancy—often alone, unwed, and
desperate—can find it extremely difficult to decide what to do.
B. Giving up her child for adoption is an option for women who do not feel
abortion is right for them.
XI. Abortion
A. Introduction
1. After rising steadily through the 1970s, the number of elective abortions
leveled off in the 1980s and has declined since then to approximately
785,000 per year.
2. Although women of all backgrounds have abortions, abortion in the
United States is most likely to occur among single women, racial or ethnic
minorities, low-income women, and women who have had at least one
child.
B. Medical Abortion
1. The term medical abortion describes the use of drugs, also called
abortifacients, to terminate a pregnancy.
C. Other Abortion Methods
1. About two-thirds of all abortions (64 percent) are performed within the
first 8 weeks of pregnancy. Only about 1 percent of abortions occur after
20 weeks.

17. Chapter 9 – Contraception and Reproduction
2. Suction curettage
a. Usually done from 7 to 13 weeks after the last menstrual period,
involves the gradual dilation (opening) of the cervix, often by inserting
into the cervix one or more sticks of laminaria (a sterilized seaweed
that absorbs moisture and expands, thus gradually stretching the
cervix).
b. The laminaria is removed and the physician inserts a suction tip into
the cervix, and the uterine contents are drawn out via a vacuum
system.
c. A curette is used for scrapping and to check for complete removal of
contents of the uterus.
XII. The Psychological Impact of Abortion
A. Introduction
1. The primary emotion of women who have just had an abortion is relief.
Although many women also express feelings of guilt or sadness.
2. The best predictor of psychological well-being after abortion is a woman’s
emotional well-being prior to pregnancy.
B. Politics of Abortion
1. Abortions were legal in the United States until the 1860s.
2. In 1973, the U.S. Supreme Court, following a 1970 ruling on the case of
Roe v. Wade by the New York Supreme Court, said that an abortion in the
first trimester of pregnancy was a decision between a woman and her
physician and was protected by privacy laws.
3. The Supreme Court upheld a federal law banning partial birth abortions,
which are performed in the later stages of pregnancy and involves
collapsing the skull to allow a fetus to slip easily from the birth canal.
XIII. Pregnancy
A. Overview
1. Pregnancy and birthrates in the United States have declined to the lowest
rate ever recorded.
2. Pregnancy rates have fallen for women in their teens and 20s, while they
have increased for women in their late 30s and early 40s.
B. Preconception Care
1. Preconception care—the enhancement of a woman’s health and well-
being prior to conception in order to ensure a healthy pregnancy and
baby—includes risk assessment, health promotion, and interventions to
reduce risk.

18. Chapter 9 – Contraception and Reproduction
C. Home Pregnancy Tests
1. Home pregnancy tests detect the presence of human chorionic
gonadotropin (hCG), which is secreted as the fertilized egg implants in the
uterus.
D. Prenatal Care
1. A Healthy Diet
a. Doctors have long recommended a well-balanced diet that provides a
complete variety of key nutrients.
b. In addition, pregnant women should:
i. Make sure they are getting an adequate level of folic acid in order
to prevent neural tube defects.
ii. Avoid soft unpasteurized cheeses to prevent Listeria infections,
which can be harmful to a fetus.
iii. Eat a diet rich in fruit and vegetables, which provides an
additional benefit: a lower risk of premature birth.
iv. Increase their caloric intake to ensure adequate nutrition for the
fetus but not put on so much weight that it increases the risks to
their own health and their baby’s.
v. Not avoid any specific foods unless they are allergic to them.
Recent research suggests that eating nuts during pregnancy
lowers a child’s risk of having a nut allergy—as long as the
mother is not allergic herself
2. Exercise
a. The proven benefits of light to moderate exercise during pregnancy
include a greater sense of well-being, enhanced mood, shorter labor,
and fewer obstetric complications.
3. Avoid Smoking and Smoke
a. Smoking and exposure to secondhand smoke during pregnancy puts a
woman and her unborn child in jeopardy.
4. Don’t Use Alcohol or Drugs
a. Alcohol and illegal drugs are clear threats to an unborn child.
However, even some common prescription drugs, such as
acetaminophen and antidepressants, can pose short- and long-term
risks.
E. How a Woman’s Body Changes During Pregnancy
1. The woman’s uterus becomes slightly larger, and the cervix becomes
softer and bluish due to increased blood flow.
2. Progesterone and estrogen trigger changes in the milk glands and ducts in
the breasts, increasing size and tenderness.
3. More frequent need to urinate.

19. Chapter 9 – Contraception and Reproduction
4. As the pregnancy progresses, the woman’s skin stretches as her body
shape changes, her center of gravity changes as her abdomen protrudes,
and her internal organs shift as the baby grows.
F. How a Baby Grows
1. When a zygote reaches the uterus, it’s still smaller than the head of a pin.
2. Once nestled into the spongy uterine lining, it becomes an embryo.
3. The embryo takes on an elongated shape, rounded at one end. A sac called
the amnion envelops it.
4. As water and other small molecules cross the amniotic membrane, the
embryo floats freely in the absorbed fluid, cushioned from shocks and
bumps.
5. At nine weeks, the embryo is called a fetus.
6. A special organ, the placenta, forms. Attached to the embryo by the
umbilical cord, the placenta supplies the growing baby with fluid and
nutrients from the maternal bloodstream and carries waste back to the
mother’s body for disposal.
G. Complications of Pregnancy
1. Perinatology, or maternal-fetal medicine, focuses on the special needs of
high-risk mothers and their unborn babies.
2. Ectopic Pregnancy
a. In this type of pregnancy, the fertilized egg remains in the fallopian
tube instead of traveling to the uterus.
3. Miscarriage
a. Also called spontaneous abortion.
b. About 10 to 20 percent of pregnancies end in miscarriage, or
spontaneous abortion, before the 20th week of gestation.
4. Infections
a. Rubella is the infectious disease most clearly linked to birth defects.
b. Cytomegalovirus is the most common prenatal infection today.
i. This infection produces mild flu-like symptoms in adults but can
cause brain damage, retardation, liver disease, cerebral palsy,
hearing problems, and other malformations in unborn babies.
5. Genetic Disorders
a. Every individual has an estimated four to six defective genes, but the
chances of passing them on to a child are slim.
b. The child of a parent with an abnormal dominant gene has a 50 percent
likelihood of inheriting it.
c. A mother’s age has long been associated with increased risk of
chromosomal disorders such as Down syndrome. More recently,

20. Chapter 9 – Contraception and Reproduction
research has linked a father’s age of 45 or older to several neuro-
psychiatric disorders.
6. Premature Labor
a. Approximately 8 percent of all babies are born too soon (before the
37th week of pregnancy).
b. The warning signs of premature labor include a dull, low backache; a
feeling of tightness or pressure on the lower abdomen; and intestinal
cramps, sometimes with diarrhea.
XIV. Childbirth
A. Preparing for Childbirth
1. Women who attend prenatal classes are less likely to undergo caesarean
deliveries and more likely to breast-feed.
2. An epidural block involves injecting an anesthetic into the membrane
around the spinal cord, numbing the lower body.
3. A spinal block involves the injection going directly into the spinal canal
and numbs the lower body.
B. Labor and Delivery
1. There are three stages of labor.
a. The First Stage
i. This stage (early or latent phase) starts with effacement (thinning)
and dilation (opening up) of the cervix.
ii. During this time the amniotic sac of fluids usually breaks a sign
that the woman should call her doctor.
iii. Contractions go from being not uncomfortable to the most
difficult during this stage.
iv. This stage ends when the cervix is dilated to about 8 centimeters.
b. The Second Stage
i. During this stage of labor, the cervix is completely dilated, during
which the baby moves into the vagina, or birth canal, and out of
the mother’s body.
ii. This stage can take up to an hour or more.
iii. Strong contractions may last 60 to 09 second and occur every two
to three minutes.
iv. An episiotomy—an incision from the lower end of the vagina
toward the anus to enlarge the vaginal opening as the baby’s
head appears, or crowns—may be performed by a doctor.
v. The baby can be in a more difficult position, facing up rather than
down, or with the feet or buttocks first (a breech birth), and a
cesarean birth may then be necessary.

21. Chapter 9 – Contraception and Reproduction
c. The Third Stage
i. During this stage of labor, the uterus contracts firmly after the
birth of the baby and, usually within five minutes, the placenta
separates from the uterine wall.
C. Caesarean Birth
1. In a caesarean delivery (also referred to as a caesarean section, or C-
section), the doctor lifts the baby out of the woman’s body through an
incision made in the lower abdomen and uterus.
2. The most common reason for caesarean birth is failure to progress, a
vague term indicating that labor has gone on too long and may put the
baby or mother at risk.
XV. Infertility
A. Introduction
1. The World Health Organization defines infertility as the failure to
conceive after one year of unprotected intercourse.
2. Affects one in six couples in the United States.
3. In women, the most common causes of sub-fertility or infertility are age,
abnormal menstrual patterns, suppression of ovulation, and blocked
fallopian tubes.
4. Male sub-fertility or infertility is usually linked to either the quantity or
the quality of sperm, which may be inactive, misshapen, or insufficient.
5. Infertility can have an enormous emotional impact.
B. Options for Infertile Couples
1. The odds of successful pregnancy range from 30 to 70 percent, depending
on the specific cause of infertility.
2. One result of successful infertility treatments has been a boom in multiple
births.
3. Artificial Insemination
a. The introduction of viable sperm into the vagina by artificial means.
4. Assisted Reproductive Technology (ART)
a. The most common ART procedure is in vitro fertilization (IVF), which
involves removing the ova from a woman’s ovary and placing the
woman’s egg and her mate’s sperm in a laboratory dish for
fertilization. After several days, if the egg shows signs of development,
it is returned to the woman’s uterus.

22. Chapter 9 – Contraception and Reproduction
XVI. Adoption
A. Adoption matches would-be parents yearning for youngsters to love with
infants or children who need loving.
B. Census records indicate that there are currently 1.6 million adopted children
in the United States.
Key Terms
adoption
amnion
artificial insemination
barrier contraceptives
blastocyst
caesarean delivery
cervical cap
coitus interruptus
conception
condom
contraception
diaphragm
ectopic pregnancy
embryo
emergency contraception (EC)
failure rate
fertilization
fetus
implantation
infertility
intrauterine device (IUD)
labor
laparoscopy
medical abortion
minipill, progestin-only pill
miscarriage
monophasic pill
multiphasic pill
oral contraceptives
placenta
preconception care
premature labor
rhythm method
rubella
spermatogenesis
sterilization
suction curettage
tubal ligation
tubal occlusion
vaginal contraceptive film (VCF)
vaginal spermicide
vasectomy
zygote