Contraceptives

  • Goal of Contraceptive Use

    • Primary objective: To prevent unintended pregnancy.

    • Secondary objective: To ensure use of the method produces minimum adverse effects.

  • Major Selection Criteria

    • Safety: Evaluating the health risks associated with a method.

    • Effectiveness: The success rate of the method in preventing pregnancy.

    • Accessibility: How easily a person can obtain the product.

    • Acceptability: The willingness and comfort of the user to employ the method consistently.

Male Condoms

  • Description and Materials

    • A sleeve that fits snugly over the erect penis.

    • Materials include:

      • Latex.

      • Polyurethane.

      • Lamb Cecum (Note: This material is only effective for the prevention of pregnancy, not for the prevention of STIs).     

  • Primary Functions

    • Prevention of pregnancy.

    • Prevention of Sexually Transmitted Infections (STIs) such as AIDS, hepatitis, and chlamydia.

  • Mode of Action

    • When worn before vaginal penetration, the condom acts as a physical barrier that prevents sperm from entering the vagina and fertilizing the egg.

  • Effectiveness

    • 85−95%85-95\% effective when used correctly.

  • Usage Guidelines

    • Selection and Storage:

      • Use only fresh condoms that have not been previously opened.

      • Ensure the product is within its expiration date.

      • Store in a dry, cool place. Avoid storing in a wallet or a car glove compartment due to heat and friction.

      • Check for signs of degradation: discolouration, brittleness, or stickiness.

    • Application:

      • Avoid tearing with long fingernails or jewellery.

      • Put the condom on the erect penis before any vaginal contact.

      • Leave 1/2"1/2" of space between the end of the condom and the tip of the penis to collect semen.

      • Pinch the top of the condom to remove air as it is unrolled to cover the entire length of the penis.

    • Post-Intercourse:

      • Withdraw the penis immediately after ejaculation while it is still erect.

      • Firmly hold onto the rim of the condom during withdrawal to prevent it from slipping off or spilling semen into the vagina.

    • Handling Breakage:

      • If a condom breaks, insert a vaginal spermicide product immediately.

    • Lubrication:

      • Use only water-based lubricants (Examples: K−YJellyK-Y Jelly, DuragelDuragel).

      • Warning: Oil-based lubricants weaken condoms and significantly increase the risk of breakage.

  • Adverse Effects

    • Decreased sensitivity of the glans penis and decreased sexual pleasure for the male.

    • Contact dermatitis due to latex allergy.

    • Symptoms include immediate localized itching and swelling or a delayed eczematous reaction.

    • Spermicide-treated condoms may enhance latex allergy reactions.

Femidoms (Female Condoms)

  • Description

    • A lubricated tube made of polyurethane (thin, soft, odourless plastic).

    • Length is approximately 6.56.5 inches.

    • Intended for one-time use only.

  • Structure

    • Consists of a sheath with a flexible ring at each end.

    • The outer ring fits over the vaginal mucosa.

    • The inner ring at the closed end is used for insertion and to hold the device in place inside the vagina.

  • Effectiveness

    • User-related failure rate: 25%25\% during the first year of use.

    • 95%95\% effectiveness if used properly.

  • Usage Guidelines

    • Can be inserted up to 88 hours before intercourse.

    • Ensure the product is fresh and within the expiration date.

    • Squeeze the inner "closed end" so it is long and narrow for insertion.

    • Insert as far as possible, leaving the outer ring outside the vagina.

    • Ensure the penis enters the vagina inside the pouch during intercourse.

    • Removal: Twist the outer ring and pull gently.

    • Contraindication: Do not use with a male condom; increased friction can cause displacement or breakage.

  • Advantages

    • Provides extensive barrier protection for the vagina, cervix, and external genital organs.

    • Can be inserted before intercourse; does not depend on male erection, protecting sexual spontaneity.

    • Does not need to be removed immediately after ejaculation.

    • Polyurethane material does not cause latex allergic reactions.

  • Adverse Effects

    • Vaginal irritation and decreased sensation for women.

    • Potential for increased noise ("squeaking") during sex.

    • Discomfort caused by the outer ring.

Diaphragm and Cervical Cap

  • Description

    • A flexible, cup-shaped rubber device placed in the vagina to cover the cervix.

  • Mode of Action

    • Mechanical barrier preventing sperm entry into the womb.

    • Absorbs semen.

    • Acts as a reservoir for spermicide.

  • Effectiveness

    • Cervical Cap: 86%86\% if the user has never given birth; 71%71\% if the user has given birth.

    • Diaphragm: 88−94%88-94\% effective.

  • Usage Guidelines

    • Check for tears, holes, or cracks along the rim before each use.

    • Apply a small amount of spermicide on both sides of the cup.

    • Compress the rim and slide it into the vagina upward to cover the cervix.

    • Can be inserted 2−32-3 hours before sex.

    • Requirement: Must remain in place for at least 66 hours after sex.

    • Maximum retention time: 2424 hours.

    • Professional fitting by a doctor or nurse is required to determine the correct size and shape.

  • Advantages and Disadvantages

    • Advantages: Not dependent on male erection; reusable and cost-effective; no need for immediate removal.

    • Disadvantages: Does not protect against STIs as well as condoms; risk of toxic shock syndrome (TSS); may be difficult to insert or could be pushed out of place; potential for allergic reactions.

Contraceptive Sponge

  • Description

    • A small, circular, disposable polyurethane sponge permeated with the spermicide Nonoxynol-9.

    • Dimensions: 2.5 cm2.5\,cm thick and 5.5 cm5.5\,cm in diameter.

  • Mode of Action

    • Mechanical barrier, absorbs semen, and provides spermicide.

  • Effectiveness

    • 88−90%88-90\% (nulliparous women); 76−80%76-80\% (women who have given birth previously).

  • Usage Guidelines

    • Moisten with 22 tablespoons of water before insertion.

    • Insert with the concave side covering the cervix.

    • Can be inserted up to 2424 hours before intercourse.

    • Must be left in place for 66 hours after coitus.

    • Maximum retention time: 2424 hours.

    • Contraindications: Do not use during menstruation or for 66 weeks postpartum.

    • Removal is facilitated by a polyester loop on the convex side; ensure the entire sponge is removed.

  • Adverse Effects

    • Relative risk of Toxic Shock Syndrome (TSS) and bacterial infection.

    • Potential for fragments to be left in the vagina.

    • Does not protect against STIs.

Spermicides

  • Active Ingredients & Dosage Forms

    • Examples: Nonoxynol−9Nonoxynol-9, Octoxynol−9Octoxynol-9, MenfegolMenfegol.

    • Forms: Vaginal gels, foams, creams, films, and suppositories.

  • Mode of Action

    • Immobilizes and kills sperm.

    • The vehicle (foam/gel) provides a physical barrier against sperm entering the cervix.

  • Effectiveness

    • Used alone: 70−80%70-80\% efficacy (≈25%\approx 25\% usage failure in first year).

    • Efficacy improves significantly when used with barrier methods.

  • Usage Guidelines

    • Must be placed into the vagina at least 10−1510-15 minutes before intercourse.

    • Effective for only 11 hour after application.

  • Adverse Effects

    • Frequent use or high concentrations may irritate or damage vaginal/cervical epithelium, leading to an increased risk of STIs.

    • No protection against STIs and possible allergic reactions.

Natural Contraceptive Methods: Calendar (Rhythm) Method

  • Underlying Assumptions

    • The ovum is fertilizable for approximately 2424 hours after ovulation (rare exceptions up to 7272 hours).

    • Spermatozoa can live for up to 55 days.

    • Ovulation occurs between 99 and 1616 days prior to the onset of menses.

  • Calculation of Fertile Period

    • Requires records of monthly menstrual cycle lengths.

    • Day 1 is the first day of menstrual bleeding.

    • Formula:

      1. First fertile day = (Shortest cycle length −18- 18 days)

      2. Last fertile day = (Longest cycle length −11- 11 days)

  • Usage

    • The couple must abstain from intercourse or use barrier methods during the calculated fertile period.

    • Only effective for women with regular menstrual cycles.

Natural Contraceptive Methods: Basal Body Temperature (BBT)

  • Measurement Procedure

    • Temperature must be taken before any physical activity (before getting out of bed).

    • Taken at the same time every day using a consistent method (oral or rectal).

    • Requires a mercury or electronic digital thermometer calibrated in increments of 0.01∘C0.01^\circ C.

  • Thermal Shift and Ovulation

    • BBT typically drops 12−2412-24 hours before ovulation.

    • After ovulation, high progesterone levels cause a sharp rise of at least 0.2∘C0.2^\circ C (0.4∘F0.4^\circ F) over 24−4824-48 hours.

    • The temperature remains elevated until a few days before the next menstruation.

  • Safe Periods

    • The safe (infertile) period begins 33 days after the temperature rise and lasts until the end of menstruation.

    • The pre-ovulatory period is difficult to determine via BBT and is not considered safe if using this method alone.

  • Influencing Factors

    • Stress, inadequate sleep, travel, fever, and lactation can affect BBT readings.

Natural Contraceptive Methods: Cervical Mucus Method

  • Observation and Hormonal Changes

    • Post-menstruation: Period of dryness.

    • Pre-ovulation (5−65-6 days prior): Rising estrogen increases mucus quantity and elasticity. It becomes clear (resembling raw egg white).

    • Ovulation: The last day of clear, stretchy mucus is typically within a day of ovulation.

    • Post-ovulation: Rising progesterone makes mucus thick, sticky, and cloudy, or it may be absent.

  • Defining Fertile Windows

    • A woman is considered fertile from the first day mucus is detected after menstruation until 44 days after the peak symptom (the last day of clear, stretchy mucus).

  • Considerations

    • Most women require 33 cycles of observation to learn the method.

    • Users must distinguish mucus from other secretions (infectious discharge, semen).

    • Vaginal products (gels, foams, douches) interfere with accuracy.

Questions & Discussion

  • True/False Review:

    • Statement: Femidoms are made of polyurethane. (TRUE)

    • Statement: Using a diaphragm can help prevent transmission of STDs. (FALSE - Condoms are significantly more effective).

    • Statement: Lamb Cecum condoms prevent STDs. (FALSE - They only prevent pregnancy).

    • Statement: The contraceptive sponge can be used for 4848 hours. (FALSE - Maximum retention is 2424 hours).

    • Statement: Estrogen results in increasing amounts of cervical mucus. (TRUE)

    • Statement: The fertile period starts when mucus is thick and cloudy. (FALSE - It starts when mucus is first detected; thin/clear is the most fertile).

  • Calculation Scenario:

    • Data: 30, 35, 29, 30, 31, 35 day cycles.

    • Shortest cycle: 2929 days. First fertile day: 29−18=Day 1129 - 18 = \text{Day 11}.

    • Longest cycle: 3535 days. Last fertile day: 35−11=Day 2435 - 11 = \text{Day 24}.

    • Fertile Period: Day 11 through Day 24.