This document summarizes a consultation with a 23-year-old unmarried Muslim woman requesting contraception as she is sexually active with her boyfriend. Her medical history and examination are unremarkable. The document discusses various contraceptive methods including their permissibility according to Islamic law and medical guidelines. Key factors discussed are the use of condoms to prevent sexually transmitted infections, as well as intrauterine devices and emergency contraception pills as temporary contraceptive options.

1. Dr Noor Azizah Tahir
18-19 Mei, 2013
Majlis Bersama Pelajar2 Malaysia
UNHAS, Makassar, Sulawesi, Indonesia

3. • Miss X, 23 year old, unmarried Muslim lady came in for
consultation on contraception.
• She is a student at a college with a hectic lifestyle
(busy with classes and internship)
• She is requesting for contraception as she is sexually
active with her boyfriend.
• She is open to any contraception method. She claims
that she is willing to commit to the strict regime of
contraception.
• She denies the natural method as she feels that it is
too risky
• However, she is very concerned on the weight gaining
effects of contraception.

4. • She has never been hospitalized before. She has
occasional headaches but has not been diagnosed
with migraine. Other systemic review was
unremarkable. No breast lump detected on breast
self examination. No previous history of dvt,
pulmonary embolism and chest pain.
• Menstrual history
• She attained menarche at 11 years of age. She
has regular 30 day cycle, for 7-10 days. She uses
around 3-4 pads a day. No intermenstrual
bleeding. No dysmenorrhea.

5. • No family history of heart disease, hypertension,
deep vein thrombosis, pulmonary embolism,
haematological disorder
• No previous use of ocp. No other drugs taken.
• This is her first boyfriend and claims that he is the
only person she has been with.
• She denies any promiscuity.
• She has never been pregnant before.
• She does not smoke, non alcoholic.

6. On examination, patient was sitting comfortably. Her vital
signs are as follows:
• Pulse: 84
• Blood pressure: 128/86
• Respiratory: 14
• Temperature: 37
• She has pink conjunctiva, no icteric sclera. Fair
hydration. No pedal edema. No leg swelling.
Cardiovascular examination
• S1 S2 heard, no murmurs.

7. Respiratory examination
• Equal air entry. No crepitations or ronchi.
Abdominal examination
• Abdomen was soft, non tender. No organomegaly.
Breast examination
• Symmetrical breasts. No skin changes, no nipple
changes. No breast lump felt. No nipple discharge.
No palpable axillary lymph nodes.

8.  Istihsan
 Istishab
 Maslahah Mursalah
 Sadd Al-Zarai’ ( (سد زرائع
 etc

9. • Zina ( Agama-Sosial-Etika)
• Contraception
• Sexual Transmitted Disease

10. • ''Dan janganlah kamu mendekati zina;sesungguhnya zina
itu adalah suatu perbuatan yg keji.Dan suatu jalan yg
buruk.(QS:17:32)

12.  Istihsan
 Istishab
 Maslahah Mursalah
 Sadd Al-Zarai’ ( (سد زرائع
 etc

13. • “Marry! Beget children; for I would be proud of your large
numbers amongst other people”
• ( Sunan Ibnu Majah, 1952, 1:599)

14. • Produce offspring

15. • 1) allowed to have fewer children?
• 2) allowed to have smaller families?
• 3) can pregnancies be terminated lawfully by induced
abortion in accordance with Islamic Fiqh?

16. • 1) allowed to have fewer children?
• 2) allowed to have smaller families?
• 3) can pregnancies be terminated lawfully by induced
abortion in accordance with Islamic Fiqh?

17. • “It is a great misery to have too many children without the
means to support them”
• (Al-Hakim)
• “Balance”

18. • 1) allowed to have fewer children?
• 2) allowed to have smaller families?
• 3) can pregnancies be terminated lawfully by induced
abortion in accordance with Islamic Fiqh?

19. • LAM

20. • 233 of chapter البقرة . 2 in the Holy Quran?
وَٰالوٰ لِ د تُ يُرضِعنَ أَوٰ لدَهُنّ حَولَينِ كامِلَيۖ نِ لِمَن أَرادَ أَن يُتِمّ الرّضاعَۚ ةَ وَعَلَى ۞ •
المَولودِ لَهُ رِزقُهُنّ وَكِسوَتُهُنّ بِالمَعرو فِ ل تُكَلّفُ نَفسٌ إِلّ وُسعَهۚ ا ل تُضارّٰ ولِدَةٌ
بِوَلَدِها وَل مَولودٌ لَهُ بِوَلَدِۚ هِ وَعَلَى الوارِثِ مِثلُٰ ذلِ كَ فَإِن أَرادا فِصالً عَن تَراضٍ
مِنهُما وَتَشاوُرٍ فَل جُناحَ عَلَيهِمۗ ا وَإِن أَرَدتُم أَن تَستَرضِعوا أَوٰ ل دَكُم فَل جُناحَ عَلَيكُم
إِذا سَلّمتُم ما ءاتَيتُم بِالمَعرو فِ وَاتّقُوا الَّ وَاعلَموا أَنّ الَّ بِما تَعمَلونَ بَصيرٌ
• Malay translation
______________________________

21. • Para ibu hendaklah menyusukan anak-anaknya selama dua tahun
penuh, yaitu bagi yang ingin menyempurnakan penyusuan. Dan
kewajiban ayah memberi makan dan pakaian kepada para ibu
dengan cara yang makruf. Seseorang tidak dibebani melainkan
menurut kadar kesanggupannya. Janganlah seorang ibu menderita
kesengsaraan karena anaknya dan juga seorang ayah karena
anaknya, dan waris pun berkewajiban demikian. Apabila keduanya
ingin menyapih (sebelum dua tahun) dengan kerelaan keduanya dan
permusyawaratan, maka tidak ada dosa atas keduanya. Dan jika
kamu ingin anakmu disusukan oleh orang lain, maka tidak ada dosa
bagimu apabila kamu memberikan pembayaran menurut yang patut.
Bertakwalah kepada Allah dan ketahuilah bahwa Allah Maha Melihat
apa yang kamu kerjakan.

22. • “Jabir, a companion of Prophet Muhd SAW syas that
coitus interruptus was practised with the knowledge of
the Prophet SAW and he did not object it”

23. • Persidangan Jawatankuasa Fatwa Majlis Kebangsaan
Bagi Hal Ehwal Ugama Islam Malaysia Kali Ke-12 yang
bersidang pada 20 Februari 1977 telah membincangkan
Rancangan Keluarga.

24. • Persidangan telah memutuskan bahawa Rancangan
Keluarga mengandungi tiga bahagian, iaitu:

25. • Mencegahkan beranak atau menghadkan bilangan anak
hukumnya adalah haram melainkan dengan sebab-sebab
yang diharuskan oleh syarak bagi orang-orang
perseorangan.

26. • Menyusun keluarga dari segi kesihatan, pelajaran dan
kebahagiaan keluarga dengan cara yang lain daripada
(a) dan (b) di atas adalah harus.

27. • Memandulkan lelaki atau perempuan hukumnya adalah
haram.

28. • > 35 years ago
• Multigravida
• Medical Condition

29. • Haram .

30. • Intrauterine Device
•Emergency Contraceptive Pill

31. Learning objectives:
Evolution of IUD
Advantages
Disadvantages
Contraindication

32. 2nd generation
•Cu T 200,
• Cu T 220
• Cu T 380A
• ML Cu 375
• Nova T
3rd generation

35. •Perforation of uterus
• Abnormal bleeding per vagina
• Infection/ PID
• Not feeling well (fever, chill, etc)
• String missing
•Mild cramping

36. Contraindications: IUD
‘SHOULD NOT’ be inserted in women with:
Known or suspected pregnancy
Cervical or endometrial cancer or
unexplained vaginal bleeding
Malignant trophoblastic disease or
known pelvic tuberculosis
Uterine distortion that impedes correct
IUD placement
Infection following childbirth or following
incomplete abortion
Source: WHO, 2004

37. • Postcoital contraception
• Any method used to prevent pregnancy after unprotected
intercourse but before implantation
• Treatment can be given any time between 2-7 days of
unprotected intercourse

38. Types of Emergency
Contraception
Mechanism of Action Efficacy
Emergency Contraception
Pill
• Levonorgestrel-only pill
•Yuzpe regime (Ethinyl
estradiol and
Levonorgestrel)
• When given before
ovulation, it suppresses
and delays ovulation
• Recent study shows that
levonorgestrel-only
regimen only prevents
pregnancy when taken
before fertilization of the
ovum occurs
• Has been shown to
reduce the risk of
pregnancy by 75% to 89%
•WHO reports a pregnancy
rate of 1.1% with
levonorgestrel-only
regimen compared with
3.2% for Yuzpe regimen
Copper IUCD
• effective when used
within 5 days of
unprotected intercourse
• A meta-analysis of 20
published papers showed
that copper IUCDs inserted
within 5 days of
unprotected intercourse
has an efficacy of 98.7%

40. • Chlamydia
• The most common curable STI (Chlam y d ia tra cho m a tis ) which infect
the cervix and the penile urethra
• Usually present with dyspareunia and discharge from penis and
vagina
• The most effective method would be using a condom
• Gonorrhea
• One of the most common STI (Ne is s e ria g o no rrho e a e )
• most of the time is asymptomatic however if left untreated may cause
pelvic inflammatory disease in woman and epididymitis in men which
in long run will cause infertility
• Most of the time it is treated with fluoroquinolones but in 2007, many
of cases have shown that there is resistant toward the antibiotic
• Condom would still be the best method in prevention

41. • Syphilis
• It is one of the most notorious STI (Tre p o ne m a p a llidum )
• Spread by direct contact with a syphilis sore usually during
intercourse
• On an early stage it may present with painless ulcer but left untreated
it may lead to neurosyphilis.
• Treated with penicillin G
• Trichomoniasis
• The most common STI in a sexually active women which usually
present with frothy, foul smelling discharge, dysparerunia and
irritation around the vaginal area
• It may infect the male partner but they tend no to have any symptom
• The best prevention method would still be the barrier method which
are condom

42. • Crabs/pubic lice
• Its not only microorganism that is consider an STI but lice is also one
of the most common STI (Pe d ic ulo s is p ubis )
• usually spread by sexual contact, although they also can be
transmitted by infested linens and clothing however they don’t last
long on the body
• Present with itching of the genital area as well as visible lice eggs
• HIV/AIDS
• Is a viral type of STI which is nowaday common in younger
generation of people
• It usually spread by an exchange of bodily fluids such as blood,
semens, breast milk and vaginal secretions.
• Again, barrier method though not 100%, is still the best method in
prevention of STI

43. Contraceptive Method Bacterial Infections Viral Infections
Condoms Usually protective Protective, but not for HPV
OCP/ Hormonal Methods Increases risk of chlamydia
and gonorrhea
Increases risk of HIV
Withdrawal Slightly protective Slightly protective
IUD Increases risk of pelvic
inflammatory disease (PID)
Not Protective
Fertility Awareness Not Protective Not Protective
Cervical Cap Potentially protective
against chlamydia and
gonorrhea. Research
currently underway.
Potentially protective
against HIV. Research
currently underway.
Spermicides Not Protective Increases risk of HIV
Diaphragm Protective against cervical
infection
Can facilitate vaginal
bacterial overgrowth
Protective against
cervical tumors

44. • Condoms made of latex or polyurethane can help
reduce the likelihood of most STD's, but even
these sometimes allow the transmission of
disease; 2-6% of condoms break or fall off during
intercourse, and a condom can break even if you
use it perfectly. A condom is not protective
against HPV.
• Hormonal methods can actually increase your
chances of getting an STD from your partner if he
is infected. It will supress the immune system, and
hormonal methods can make the reproductive tract
more vulnerable to infections like HIV and
chlamydia.

45. • Spermicides (lube or in condoms) containing
nonoxynol-9 were once thought to help
prevent HIV infection, but newer studies show
an increased risk because the chemical can
irritate the vagina, facilitating infection.
Consequently, spermicides are no longer
being recommended for HIV prevention.
• Withdrawal does not offer complete protection
from STDs. Lubricating fluids escape long
before ejaculation; usually they contain no
sperm but can transmit diseases like the AIDS
virus.

46. • UN recommends the use of hormonal contraception and
condoms to prevent STDs and pregnancy
• Iman and taqwa to prevent STDs and plan our
pregnancies to balance life roles and responsibilities

48. • Ahmad Abdel Aziz Yacoub. 2001. The Fiqh Of Medicine.
London: Taha
• e-fatwa.gov.my‘
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