This document discusses the history and methods of contraception. It begins with a brief overview of the historical and social perspectives of contraception from ancient times to modern issues. It then describes various hormonal methods like oral contraceptives, implants, injections, as well as barrier methods like condoms, diaphragms, and spermicides. Emergency contraception, natural family planning methods, sterilization, and less effective methods are also outlined. The document concludes with new directions in contraceptive research for both men and women.

1. Contraception
Dr. Rabinarayan Satapathy
Asst. Professor
Dept. of Obst.& Gynae
S.C.B. Medical College,Cuttack

2. Historical & Social Perspective
 Evidence of contraception since the
beginning of recorded history
 U.S. contraceptive efforts
– Comstock laws in 1800s restricted
contraceptive information through the mail
– 1915: Margaret Sanger’s illegal clinic &
contraceptive information

3. Historical & Social Perspective
 U.S. contraceptive efforts - cont’d
– 1965 U.S. Supreme Court ruling: states
could not prohibit use of contraception by
married couples: extended to single people
in 1972
– most states allow dispensing of
contraception to minors without parental
consent
– controversy re: TV ads for condoms,
government funded contraceptive services
for minors without parental notification

4. Historical & Social Perspective
 Contemporary issues
– growing emphasis on planning for
unwanted children
– population growth as a concern
– wide diversity of views among religious
leaders

5. Sharing responsibility
Benefits of shared
responsibility
 decreases “surprise
pregnancy”
 reduces stress &
increases trust
How to share
responsibility
 ask about BC before
intercourse
 read & discuss
options together
 attend a class or
clinic together
 share expenses
 help each other with
various methods

6. Choosing a birth control method
 Consider effectiveness
*failure rates reported for each method
*influenced by human error
*backup methods increase effectiveness
 consider cost; ease of use; side effects;
 consider noncoital methods of sexual
intimacy (“outercourse”)
*kissing, *mutual masturbation
*touching, petting * oral or anal sex

7. Hormone-based contraceptives
Oral contraceptives:
*combination pill:
contains estrogen &
progestin; inhibits
ovulation, thickens
cervical mucus, &
makes uterine lining
less receptive to
implantation
Advantages: spontaneity;
reversible;  effective;
may  dysmenorrhea,
PMS s/s, & some other
conditions; minipill has
no estrogen-related SE
Disadvantages:
*no STD protection
*estrogen-related side
effects
*spotting

8. Hormone-based contraceptives
Oral contraceptives:
*minipill: progestin
only; thickens
cervical mucus,
makes uterine lining
less receptive to
implantation, may
inhibit ovulation
Advantages:spontaneity;
reversible;  effective;
may  dysmenorrhea,
PMS s/s, & some other
conditions; minipill has
no estrogen-related SE
Disadvantages:
*no STD protection
*estrogen-related side
effects
*spotting

9. Hormone-based contraceptives
Norplant:
6 progestin filled
capsules implanted
under skin; time-
release over 5 years;
requires medical
insertion; works like
the minipill
Advantages:
*less hormone, but
constancy s
effectiveness
*no daily pill
Disadvantages:
*high initial cost
*may be hard to remove
*same as minipill

10. Hormone-based contraceptives
Depo-Provera:
injected progestin
every 12 weeks; works
like the minipill
Advantages:
*same as the minipill
Disadvantages:
*same as the minipill

11. Barrier methods
Condom:
a sheath that fits over
erect penis; forms
mechanical barrier to
keep sperm out of
vagina; lubricated
latex works best
Advantages:
*effective if used properly
*provides some STD
protection
*relatively cheap
Disadvantages:
*may disturb spontaneity
*may  some sensations
*possible allergy to latex

12. Barrier methods
Female condom:
a sheath that fits
inside vagina with
closed ring at the top,
open ring at vaginal
opening
Advantages:
*effective if used properly
*provides some STD
protection
*relatively cheap
Disadvantages:
*may disturb spontaneity
*may  some sensations
*possible allergy to latex

13. Barrier methods
Diaphragm:
latex or plastic dome with
flexible spring around the
rim; forms mechanical
barrier that keeps sperm
out of cervix/uterus; fitted
by Dr. who teacheshow
to insert & check proper
placement; place
spermicide around rim;
stays in for 6-8 hrs.
Advantages:
*no side effects
*s comfort & self-
knowledge
*spermicide may prevent
some STDs, infections
Disadvantages:
* failure rate than others
*messier
*poor fit s problems
*allergy to spermicide
*s spontaneity

14. Barrier methods
Cervical cap:
thimble-shaped latex
or plastic cup; works
like diaphragm; fitted
by Dr.; filled with
spermicide & pressed
onto cervix; stays in
for 6-24 hrs.
Advantages:
*alternative for  who
cannot wear diaphragm
*does not need repeated
doses of spermicide
Disadvantages:
* failure rate than others
*may damage cervix
*cannot fit up to 6% of 

15. Barrier methods
Vaginal spermicides:
creams & jellies should
be used with
diaphragm or cervical
cap; not to be used
alone

16. Barrier methods
Vaginal spermicides:
foam, suppositories,
film; sperm are killed;
follow package
directions carefully
Advantages:
*no doctor
*no dangerous side effects
*provides extra lubrication
*prevents some STDs
Disadvantages:
*messy
*irritation of vaginal tissue
*may  yeast infections
*unpleasant taste, scent
* spontaneity

17. Intrauterine devices
Copper-T: affects sperm
motility & viability
Progestasert-T: works
like minipill; both
prevent fertilization,
irritate & inflame
uterine lining to prevent
implantation; alters
timing of the ovum’s
passage through
fallopian tube
Advantages:
*highly effective
*convenient
*s spontaneity
*ok for  who breastfeed
Disadvantages:
*initial cost
* PID risk
*discomfort
*risk of miscarriage
*2-20% expelled in 1st yr.
*rarely punctures womb

18. Emergency contraception
Hormonal:
birth control pills taken
within 72 hours of
unprotected
intercourse; works
like combination pill
Advantages:
*backup for rape or other
unplanned event
Disadvantages:
*nausea or vomiting
*unknown long-term
effects

19. Emergency contraception
Copper-T IUD:
inserted up to 7 days
after unprotected
intercourse; works
same as regular use
of IUD
Advantages:
*failure <1%
*backup for rape or other
unplanned event
Disadvantages:
*see IUD

20. Methods based on the menstrual cycle
abstinence based on:
Mucus method: cyclical
changes in cx mucus
Calendar method:
calendar estimate of
fertility
(BBT) Basal body-
temp. method: slight
changes in basal body
temp. @ ovulation
Advantages: no SE; free;
cost of a class or BBT
thermometer; s
comfort & self-
knowledge; s noncoital
activities; helps to plan
a wanted baby;
acceptable to most
religions
Disadvantages: s
spontaneity; requires
lots of motivation, lots
of record-keeping;
cycles can be disrupted
or irregular; most
unreliable method

21. Sterilization
Female
tubal ligation: blocks
sperm from traveling
down fallopian tube
to egg
Permanent: 70%
reversal success rate
Advantages:
*most effective of all
mehtods
*s spontaneity
*convenient
Disadvantages:
*pain during & after the
procedure
*rare surgical problems

22. Sterilization
Male
vasectomy: cutting &
closing of vas
deferens prevents
sperm from being
ejaclated with
semen
Permanent: 50%
pregnancy rate after
reversal
Advantages:
*cheaper & safer than
female surgery
Disadvantages:
*10-20 post operative
ejaculations
*prostate cancer?
*see Female

23. Less than effective methods
 Breastfeeding
– amenorrhea is common for a brief period
after birth while breastfeeding
– 80 % ovulate before first period
– unreliable
 Douching
– sperm reach uterus in 1-2 minutes
– douching may speed sperm along
– irritates vaginal tissue
– very ineffective

24. Less than effective methods
 Withdrawal before ejaculation
– difficult to judge when to withdraw
– anxiety may  pleasure
– preejaculatory secretions from Cowper’s
gland may carry sperm
– postejaculatory sperm on vulva may travel
into vagina/uterus
– unreliable

25. New directions in contraception
For men
– currently limited to condoms, vasectomy, &
withdrawal
– GRH inhibitor may  # & motility of sperm
*requires daily injections
*drop in testosterone
*possible erectile difficulty

26. New directions in contraception
 For men (cont’d)
– testosterone-derivative & progestin-related
drugs may  sperm count
*weekly injections; possible implant
– drugs that would inhibit ejaculation but not
orgasm
– NoFertil (Brazilian developed pill) destroys
male sperm without loss of erection
*potential 10-15% irreversible infertility

27. New directions in contraception
 For women
– implants, especially fewer than Norplant, or
biodegradable
– injectables
– progestin cream that is absorbed through
the skin
– vaginal rings that slowly release hormones
– one-sized & disposable diaphragms &
cervical caps

28. New directions in contraception
 For women (cont’d)
– IUDs with different shapes & hormones
– RU-486: an antiprogesterone substance
that prevents implantation & cause
menstruation
“Women who miscalculate are called
mothers.” Abigail Van Buren