Week 12 Family Planning

panopto by celeste

Most common methods of contraception

• female sterilization 10.7 million

• oral contraceptive pills 10.4 million

• male condoms 7.9 million

• male sterilization 4.2 million

What accounts for the great difference between female and male sterilization?

Women take greater accountability/responsibility and unintended pregnancy impact them more

Oral contraceptives (OCs) are also called

Birth control pills (BCPs)

Barrier contraceptive methods include

condoms, diaphragms, the contraceptive sponge and cervical caps

Long acting hormonal contraceptive methods include

shots and implants (Depo)

Contraceptive methods available include

• intrauterine devices

• birth control pills

• condoms, diaphragms, contraceptive sponge, cervical caps

• shots and implants

Typical use / user effectiveness is

• the use of any given method by a typical couple

Typical use is less effective at preventing pregnancy because

• the typical user may not use the method with every act of intercourse or consistently / correctly use the product = less effective

Perfect use / theoretical effectiveness is

• a method used consistently and correctly according to a specified set of rules or guidelines with every act of intercourse

Statistics are based on the theory of

perfect use

Factors for patients to consider when choosing a contraceptive

• her comfort and her partner’s comfort

• effective

• cost effective

• easily hidden

• prevent STD transmission

• separates the act of intercourse from contraception if needed

• allows for immediate use if spontaneity is an issue

• may be easily reversible or permanent

Factors to take into consideration while counseling regarding contraceptive use

• medical history and risk factors

• effects an unwanted pregnancy would have at this point in the patient’s life

• potential for multiple partners in reproductive life span especially in the next few years

• patient’s comfort level touching her body and her lover’s body

• maturity level r/t responsibility to consistently use the method

• frequency of intercourse

• patient’s ability to understand instructions

• patient’s access to health care

• methods used to date

• patient’s weight

• patient’s ability to consistently use the method

What to advise the patient if there is a need to prevent pregnancy and STD transmission?

to combine two methods to enhance pregnancy prevention and STD transmission

ex: condoms and spermicidal foam / condoms and OCs

Cultural impact on contraceptive method

• mother’s expectations for her daughter in contrast to cultural norms

• patient’s belief and values regarding health and potential impact of chemicals introduced into the body

Over the counter methods

• condoms

• female condoms

• sponge

• contraceptive film

• spermicide

Major advantage of condom use is

the additional barrier to the transmission of STDs

Rates for conception with condom alone is

14% for typical use and 3% for perfect use

Most protection against pregnancy is possible if condoms are used with

spermicide foam, cream, jelly, suppository or film

Female condom works

• same way as male condom by acting as a barrier to sperm

• can be inserted 8 hours prior to sex but needs to be removed immediately after

Should female condom be used with a male condom?

no

How is the female condom used?

one ring sits up against the cervix and the second ring remains outside the body, covering part of the perineum and labia

How is the diaphragm used?

it is inserted into the vagina prior to sexual intercourse

What is special about diaphragm?

it needs to be fitted by a health care provider and will no longer fit properly if the patient gains/lose weight, becomes pregnant, or gives birth

How does the diaphragm work?

it creates a barrier between sperm and the uterus by covering the cervix, preventing sperm from entering the cervix during sexual intercourse

Diaphragm spermicide

is placed inside the dome and around the rim of the diaphragm→ kills any sperm that comes into contact with it

How long can diaphragms be inserted up to prior to intercourse?

6 hours

Does the patient need to add more spermicide when using diaphragm?

yes, every 2 hours or each each time she has sexual intercourse

What can happen if diaphragm is left in for more than 24 hours?

increase patient’s risk for Toxic Shock syndrome

Advantages of using the diaphragm

• easy to insert and remove

• inexpensive and reusable

• when inserted correctly, the diaphragm cannot be felt by either partner

• does not affect future fertility or patient’s menstrual cycle

Disadvantages of using the diaphragm

• can increase risk for Toxic Shock Syndrome (TSS)

• continual use of spermicide can irritate lining of vagina and increase risk of contracting STD

• increase likelihood of bladder infections

• does not protect against STDs so pt need to use a condom every time she has sex

How is the Cervical cap similar to diaphragm?

• it also consists of a dome that covers the cervix

• brim that holds the cap tightly in place, and a groove that holds spermicide jelly or cream

• prevent sperm from entering the uterus

How is the cervical cap different from diaphragm?

• cervical cap is much smaller and fits more tightly around the cervix when in place

• made of silicone rubber

• needs to be fitted by a health care provider

How is the cervical cap used?

• it is inserted prior to intercourse

• pt need to apply a small amount of spermicide to the bowl and brim of the cap, as well as to the cap

How long can the cervical cap be left in place?

48 hrs

Do you need to reapply spermicide when using cervical cap?

no but the cap needs to be left in place for at least 8 hrs after intercourse

Advantages of using cervical cap

• does not affect the patient’s fertility or menstrual cycle

• can be left in the vagina for up to 48 hrs

• usually unnoticeable for both partners

• requires less spermicide than the diaphragm, which increases pleasure of oral sex

Disadvantages of using cervical cap

• must be prescribed by a health care provider

• difficult to insert properly and may become dislodged during intercourse

• not effective against STDs

Contraceptive sponge is

small, disposable sponges made of polyurethane foam and infused with spermicide

How does contraceptive sponge work in preventing pregnancy?

block sperm from entering uterus, absorb and kill sperm

How is the contraceptive sponge used?

it needs to be moistened before use with water so that it becomes foamy and then inserted into vagina, positioning it so that it sits over the cervix

How is contraceptive sponge and diaphragm similar?

can be worn for 12-24 hours

How is contraceptive sponge different from diaphragm?

sponge offers continuous protection during that time, regardless of how often the patient have sex

How long do you need to wait after sex to remove contraceptive sponge?

wait 6 hours before removing sponge

Why can contraceptive sponge not be left in for more than 30 hours?

there is a risk for developing toxic shock syndrome

Failure rates for contraceptive sponge vary depending on

whether or not the parent has child and if the sponge was inserted properly

9-40%

What makes a woman more likely to have contraceptive sponge birth control fail?

women who have given birth vaginally

What risks are hormonal contraceptives associated with?

increased risks of myocardial infarction, stroke, venous thromboembolism, deep venous thrombosis, retinal vein thrombosis and pulmonary embolism

What does oral contraceptives do?

• suppress ovulation

• thin the uterine lining

• change the consistency of mucus in a woman’s cervix, making it har