Prevention of Pregnancy and STIs

Pathophysiology of Pregnancy

- 6 day window of opportunity

- 5 days before ovulation thru the day of

-greatest chance the day before ovulation

-egg viable for 24 hrs

-sperm for 5 days

-day 14 is ovulation: body temperature is at its lowest, sticky cloudy discharge helps sperm to swim

STI transmission

-tissue, membrane, fluids

-preventable

STI Vaccine Preventable

-HPV

-HepB

-HepC

Curable STIs

-Genital chlamydia [Chlamydia trachomatis]

-Gonorrhea [Neisseria gonorrhoeae]

-Nongonococcal urethritis (men) [Various, including Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma sp.]

-Syphilis [Treponema pallidum]

-Trichomoniasis [Trichomonas vaginalis]

Noncurable STIs

-AIDS (HIV)

-Genital Herpes (HSV-1 and HSV-2)

Chances of getting pregnant at 20...

-per cycle 25%

-per year 96%

-miscarriage 10%

-most fertile in 20s and least chance of miscarriage

Changes of getting pregnant at 40...

-per cycle 1-5%

-per year 40%

-miscarriage 34-53%

-females born with all eggs they will have

-loose one each period

Chances of getting Pregnant during a Cycle

-Period, Day 1-5: low to medium

-Ovulation, days 10-14: high chance, 5 days before and ovulation day

-Days 16-28: None, cervical mucus plug will prevent pregnancy until ovulation

Effectiveness of Contraceptive Methods

Least Effective: fertility awareness method, spermicide, male condom, female condom, withdrawal, sponge, injectable, pill, patch, ring, diaphragm, implant, IUD, vasectomy/hysterectomy: Most Effective

Contraceptive Method Stats

in general prescription produces are more effective than OTC

Selected Male Condoms

-synthetic, nonlatex condoms: most recommended

-natural membrane: not first recommendation, let HIV through

-Latex condom: allergy

Condom Advantages

-protection vs. STIs

-accessibility

-low cost

-male participation

-erection enhancement

-prevention of sperm allergy

-proof of protection

-portability

-minimal side effects

Condom Disadvantages

-sensitivity

-spontaneity

-problems with erection

-embarrassment

-coital depended

-lack of cooperation

-latex allergy

Lubricants that are Safe/Unsafe to use with latex condoms:

-Safe: water based, silicone based

-Unsafe: oil based, will break down and let STIs through

Vaginal Spermicides

-API: Nonoxynol-9

-breaks down sperm membrane, killing it

-use in combo with other products, alone is not enough

Norgestrel 0.075 mg (Opill)

-OTC Oral Contraceptive

-progestin only pill for adolescents and adults to prevent pregnancy

-taken at the same time every day within a 3 hr window if not, not reliable

-does not protect against STIs

-can be used post partum and breastfeeding

-91% effective with typical use

-Do not use if... are or may be pregnant, have undiagnosed uterine bleeding, have ever had breast cancer or any other cancer sensitve to progestin, have liver disease/tumor

Emergency Contraception Mechanism

-suppress ovulation

-interferes with fertilization

-inhibits transport of fertilized egg to uterus

-inhibits implantation of fertilized eff in the endometrium

Emergency Contraception Efficacy

-reduce risk by 52-100% depending on timing of intercourse and when initiated

OTC Emergency Contraception

Levonorgestrel 1.5 mg

Rx emergency contraception

-any levonorgestrel or D,L-norestrel pill

-ulipristal acetate 30 mg tablet

-copper IUD

Practical Knowledge for EC

-for anyone/everyone

-best used within 72 hrs of having unprotected sex

-1 dose

-if vomits within 2 hrs of taking, take repeat dose

-side effects of nausea and vomiting

-okay to use antiemetic

-contradictions if pregnate

-weight matters

EC and weight

-if > 155 lbs, efficacy decreases

-if BMI > 26 efficacy decreases

-if weight > 195 lbs, oral EC is likely not effective, need copper IUD

-efficacy: copper IUD> ulipristal> levonorgestrel

EC should be paired with...

-regular contraceptive

-predictable and patient centered contraception