Contraception: Combination Birth Control Pills

Contraceptives: The Pill

• A combination pill includes estrogen and a synthetic version of progesterone called progestin.
• Higher doses than natural hormone levels are administered for 21 days.
• The following 7 days involve taking a placebo pill which contains no hormones.
• Ovulation is inhibited by combination pills.
• Progestin inhibits the production of luteinizing hormone (LH), preventing the signal to release the egg.
• High progestin levels also prevent follicle-stimulating hormone (FSH) from signaling ovulation.
• Cervical mucus is thickened, making it difficult for sperm to pass through.
• The endometrium, or uterine lining, is made inhospitable to implantation.
• The brain is tricked into thinking ovulation already occurred.
• Bleeding continues when off the pill but is lighter due to progestin inhibiting endometrium development.

Other Forms of Combination Pills

• Loestrin 24 requires 24 days on and 4 days off.
• Seasonale requires 84 days on and 7 days off, resulting in a period once every 3 months.
• Quickstart involves taking the pill as soon as possible, regardless of the cycle day.
• Some other drugs, like St. John's Wort and certain antibiotics, can reduce the pill's effectiveness.
• The pill does not cause cancer and can prevent ovarian and endometrial cancer.
• Taking the pill can reduce menstrual flow and cramps and clears up acne.
• Perfect user failure rate = 0.3%
• Typical user failure rate = 7%

Health Risks of Combination Pills

• Increased risk of thromboembolic disorders, especially for women over 35 who smoke or have a family history.
• Higher risk of sexually transmitted infections (STIs).
• There is a risk for people with blood clots.
• Combination Pills can worsen cancer and cause increased discharge.
• Not using a condom can make the vagina more vulnerable to infection.

Psychological Effects of Combination Pills

• Combination pills do not cause depression, though some women have reported experiencing it.
• Some women report increased or decreased desire, while others are not affected.

Other pills

• Women may want to switch to reduced estrogen pills to reduce blood clot risks.
• Or switch to reduced progestin to mitigate depression/vaginitis symptoms.

Types of Pills

• Seasonale consists of 84 days of pills, 7 days off, resulting in a period every three months.
• Loestrin 24 consists of 24 active pills and 4 inactive pills, resulting in a shorter period.

The Mini Pill

• It has a low dose of progestin as the only active ingredient.
• Estrogen-related side effects are avoided with the mini pill.
• Cervical mucus is changed, preventing the implantation of sperm.
• Safe to use while breastfeeding, but use is not advised during the first six weeks postpartum.

Other Types of Hormonal Contraception: The Patch

• The Ortho Evra patch delivers the same hormones as combination pills, but transdermally.
• One patch is applied per week for 3 weeks, followed by one week without a patch.
• The patch contains both estrogen and progestin.
• Weight may affect dosing, with reduced effectiveness for those weighing over 200 pounds.
• Condoms should be used during the first few days.

Other Types of Hormonal Contraception: The Ring

• The NuvaRing is inserted like a diaphragm and left in place for 3 weeks.
• It is removed for 1 week, and then a new ring is inserted.
• The ring contains both estrogen and progestin.
• Failure rates are similar to the pill.

Emergency Contraception

• Also known as "the morning after pill," and it contains a high dose of progestin.
• Most effective within 24 hours after intercourse, but it can be taken up to 150 hours (5 days) after.
• Ovulation is prevented so that the sperm cannot fertilize.
• An IUD can be inserted within 5 days.
• It is 62-85% effective.
• It becomes less effective as other forms of contraception.
• Side effects: Nausea

Long Acting Reversible Contraceptives (LARCs)

• Injection, implants, and IUDs (intra-uterine device)
• Low failure rates and do not depend on the user taking them
• Can be reversed in about 3 months

Depo-Provera Injection (The Shot)

• A progestin administered by injection so some may consider it a LARC .
• Requires repetition every 3 months for maximum effectiveness.
• Highly effective at a 4% typical-user rate.
• Minimal side effects.
• One must remember to get a shot every three months.
• It is Beneficial for those who cannot take the pill for health reasons

Side effects: Depo-Provera Injection (The Shot)

• No period
• 6-12 months of infertility upon stopping

Implants

• Thin rod or tubes containing progestin
• Inserted under the skin in the arm that is effective for four years.
• In the United States, the implant is called Nexplanon.
• It works just like other progestin methods, but is more effective than the pill, with the same perfect user rate: 0.05.
• Advantages: No need to remember something often; progestin-only.
• Disadvantages: Undesired menstrual bleeding patterns in some people

IUDs: General Info

• It has a plastic, T-shaped frame, plus something that is copper.
• A medical professional inserts it through the cervix into the uterus.
• A painful procedure that they do not offer anesthetic is available.
• The two strings hang down from the cervix, going into the uterus.
• Hazardous environment for sperm and eggs is created.
• Implantation of eggs are prevented with the use of copper and causes increased cramps and flow.

Copper IUDs: Paragard

• Changes the enzymes in the uterus, making implantation unlikely.
• It Also makes it more difficult for the sperm to move, by creating a hazardous environment for sperm and eggs.
• Causes menstrual cramps, irregular bleeding and increased menstrual flow for about 10-20% of people.
• Failure rate is 0.8% for the first year, then lower and effective for 12 years.

Hormonal IUDs: Mirena, Kyleena, Liletta, Skyla

• It releases progestin directly into the uterus.
• Ovulation and the endometrium are disrupted.
• Effective for 3 to 6 years, depending on the brand.
• Side effects: Reduced menstrual flow and for about 20%, it stops bleeding altogether
• Typical user failure rate: about 0.8%
• Costly, but often covered by insurance, however Skyla is similar in effectiveness but much smaller.

Barrier Methods: Diaphragm

• A molded, silicone rubber device with a nylon spring around the edge
• One of the earliest effective methods of contraception.
• Works by blocking the entrance to the uterus and with spermicide to kill sperm upon entering.
• May insert up to 6 hrs before intercourse and Cream applied to diaphragm kills sperm in 6 hrs.
• Must leave in place 6 hrs after intercourse, but no more than 24 hours to prevent sperm from entering the uterus.
• Typical-user failure rate is ~17%

FemCap

• Made of silicone in 3 sizes and needs spermicide.
• A healthcare provider is needed, dome covers the cervix

The Sponge

• Made of polyurethane and looks like a pillow.
• A loop is present to for removal of the tampon-look alike
• Spermicide is contained.
• Effective for 24 hours but not effective.

Spermicides

• Tube or can made of nonoxynol
• Goes into the vagina like a tampon and pushes spermicide into cervix
• It must be left in 6-8 hours after intercourse
• It solely lasts for one round of intercourse and are not very effective.

Withdrawal

• The man pulls out before ejaculation may not happen in time as sperm can be in pre-cum.
• Not very effective.

Male Condom

• A thin sheath that comes rolled up in a packet, often made of latex or polyurethane for those allergic to latex
• Works by blocking sperm from entering the vagina and be put on before any intercourse or touching between genitals to maximize effectiveness.
• A new condom must be used at each intercourse while users should be careful to hold it on as the penis is withdrawn, to prevent leakage and slipping off.
• Condom's The perfect user failure rate is estimated at 2%. The typical-user failure rate is about 13%, usually due to inconsistent or incorrect use, but is a major advantage is protection against sexually transmitted infections (STIs).
• Spermicide condoms kill sperm but may causeallergic reactions while A rectangle of latex is used for STI protection during cunnilingus.

Female Condom

• Internal condom resembles a balloon and is made of polyurethane with two rings, one at each end
• One ring inserted into the vagina like a diaphragm, while the other is spread around the opening of the vagina.
• Typical user and perfect user failure rates are estimated at 21% and 5% respectively

Rhythm Methods

• Fertility awareness methods are used to determine ovulation and have intercourse around that time; Sperm can live up to 5 days, while Eggs can be fertilized 24 hours after ovulation
• The Calendar method is to Abstain 3 days before and 2 days after ovulation on the Assumption that ovulation occurs on day 14.
• The Standard days method of Assume most women have cycles 26-32 days and Abstain 8-19 with beads to help keep track.
• The Basal Body Temperature (BBT) method where body temperature remains low in cycle, and then drops when ovulation occurs, and on day after it rises sharply

Cervical Mucus Method

• Sympto-thermal method where Mucus stops vaginal day when clear
• Home ovulation tests may test for mucus+BBT.

New Birth Control For Men

• Contraline is the first company to create contraceptive gel that blocks sperm flow from testes to vas deferens
• They implanted under anesthesia, it might be reversible, but the hormonal birth control reduced sex drive.

Male Sterilization

• Vasectomy is the Remove segment of vas deferens and ties ends

Female Sterilization

• A Laparotomy is used to tied and cut the Fallopian tubes apart with a Vacuum aspiration method performed up to 14 weeks.
• Quick with A tube, which sucks out any fetal matter with Dilation and evacuation in the Second trimester or Second Trimester
• Mifpristrone, also known to be a Drug that causes a Medical abortion. An Antiprogeston affect, which takes away the uterus lining and induces abortion up to 10 weeks.

Other Information: Abortion in Other Countries

• Nigeria is pressured to have many kids where women do not want to be seen using contraception and do abortions at home, causing about 10,000 deaths a year.
• Greece does not have Contraception is not widley used, but the doctor is available by private doctors.

Other Information About Birth and Abortion

• Annually in the US; 450,000 teen pregnancies, 29% of which culminate in abortions, 57% in live births, and 14% in miscarriages, and 45% of all pregnancies are unintended.
• The failure to use contraception, along with the fact that 10% of sexually active teen girls don't use contraception, and 49% seeking abortions used no method of contraception
• Medication abortions account for 42% of all abortions performed in first 8 weeks of US while 49% of abortions are surgical performed in the first trimester.

Psychological Considerations of Birth and Abortion

• Children in study groups are are more referred for counseling when their moms wanted an abortion
• While they had less difference in intelligence of students, the study group did worse in school.
• At age 16, boys in study group reported feeling neglected by mothers while in early 20s, the study group has lower job satisfaction and had increased conflict.
• Most women dont have severe negative responses to legal abortion with initially more mental health problems.
• Later on, there was more poorer physical health and minimalized mental health effects over time for women who denied abortion.

Common Cited Reasons for Abortion

• The reasons most frequently cited were due to the interference with a woman's education, work or ability to care for dependents, which was a reported by 74%
• A large 73% also reported that they could not afford a baby now and 48% did not want to be a single mother or were having relationship problems.
• While nearly four in 10 women said they had completed their childbearing, and almost one third were not ready to have a child.
• Fewer than 1% said their parents' or partners' desire for them to have an abortion was the most important reason while Younger women often reported that they were unprepared for the transition to motherhood, while older women regularly cited their responsibility to dependents

Economic Impact

• In California, 205,000 births were averted, which would have been $1.1 billion for the government.
• Contraceptive use saves $19 billion per year in medical costs and The Affordable Care Act ("Obama Care") covers contraceptives with no co-pay.

Physiology of Sexual Response

• William Masters began his research on the physiology of sexual response in 1954 in secret because it was considered taboo.
• He interviewed 215 prostitutes to gather information on how they facilitated sexual arousal and hired Virgina Johnson as his research assistant.
• Developed tools to measure arousal in a laboratory setting with 694 participants.
• There were men ranging from ages 21-89 and women from 18-78, showing women's and men's sexuality was physiologically very similar.
• The researchers Showed there was no real difference between orgasms due to stimulation of the clitoris versus the vagina.
• Masters and Johnson developed the human sexual response cycle stages with Excitement leading into Late excitement (plateau) into Orgasms into Resolution.

Definitions

• Vasocongestion refers to an accumulation of blood in the blood vessels of a region of the body, especially in the genitals.
• Myotonia refers to Muscle contraction.

Data Collection Techniques on Sexual Response

• Artificial coition was where Female participants stimulated themselves with an artificial penis constructed of clear plastic.
• Allowed changes in the vagina to be photographed for future observation.

Human Sexual Response Cycle Stages

• The Excitement phase includes Beginning of erotic arousal into Erection, vaginal, lubrication.
• The Plateau stage includes Sexual tensions which intensify and reaches an extreme level; Duration is largely dependent on stimulation and individual drive to keep going
• The Orgasm is characterized by an intense sensation that occurs at the peak of sexual arousal and is followed by the release of sexual tensions.
• The Resolution includes Body physiologically returning to an unaroused state and a Reversal of the process that built up during the excitement stage

Male Sexual Response Stages

• Excitement phase includes partial elevation of Testes with full erection.
• The Plateau phase includes Enlarged prostate, Secretion of Cowper's gland, fully elevated Testes, thickened Scrotum, increased size of Testes, and a deepened Color of tip color.
• Orgasm includes Seminal vesicles contractions and the Rectal sphincter's to contract prostate; Contractions force the seminal fluid through the urethra as well as Penile contractions.
• Two stages of orgasm is the contraction of Vas, seminal vesicles, and prostate and the Penile contractions.
• Resolution detumescence is the Loss of erection in the penis and a Refractory period where cannot be re-aroused follows orgasm.

Female Sexual Response Stages

• During the excitement phase, Vaginal lubrication appears, Labia and Clitorous swell.
• The plateau consists of orgasmic platform tightening where a tightening of the entrance to the vagina is caused by the contraction of the bulbospongiosus muscle.
• Additionally, a labia's color changes, the Clitoriss retracts, and the Vagina expands

Female Orgasm

• Contractions occur in uterus and Rectal sphincter.
• This results in Rhythmic contractions in orgasmic platform
• Orgasm is Myths is where That most females orgasm from peenatration alone and that Vaginal orgasms are better or means the sex is better are false to Truth.
• The truth is, that most female orgasms involve stimulation of the clitoris in some way, but, both orgasms result from stimulation of the same anatomyical structure and experiences are highly individualized and subjective.
• The Grafenberg spot which shows 40% of women reported having experienced ejaculation at the time of orgasm at least once, and 66% reported having n especially sensitive area on the front wall of the vagina.

Breast Response to Sexual Stimulation

• During the Excitement stage, Size Increases, Nipples become erect, and Superficial veins become more visible.
• The Plateau and Orgasm stage includes Size growing, Areolar engorgement hiding nipple, Sex flush appearance, and Superficial veins that become more visible.
• During Resolution stage, their Breats return to unaroused size in five to ten minutes, with Rapid Disappearance of sex flush and Rapid Loss of tumescnece in niples and areolae

Criticisms of The Sexual Response Cycle

• Subject selection bias: Required participants to have sexual experience and history of orgasm, excluding if not
• The sample used consisted of those of higher socioeconomic classes/education levels, mostly white, and willing to come in and have sex in a lab with an Experimenter bias.
• Participants also practiced before participation and communicated their expectations which may have led to some biased results.
• These cycle has been implemented by clinicians ot come up with sexual disorders and risks pathologizing natural variations in sexual experience, with Emphasis on orgasm.

Kaplans Triphasic Model of Sexual Response

• Sexual desire component is psychological with Vasocongestion and Muscular contractions/orgasm
• Component also comes Spontaneously and is called Responsive Desires

Sexual Excitation-Inhibition Model (Dual Control Model)

• Basic Processes underlie sexual response and the Authors argue that all research has focused on excitation.
• Propensities towards sexual excitation and inhibition vary widely from one person to the next, with most people fall in moderate range on both and function well.
• People high on excitation and low on inhibition often engage in high risk sexual behaviors while those People high on inhibition may have erectile dysfunction

Bassons Sexual Response Model For Women

• Argues that there difficulties with masters and johnsons model and kaplans desire phase
• Women may relate to traditional human sexual response model but it changes over time with new stresses
• The sexual desire becomes responsive

Emotion and Arousal

• A study showed that Positive emotions increased sexual behaviors, as well as Strong negative emotions which related to more thoughts about arousal.
• The study linked shame to arousal and relates to depression/anxiety.
• A Better mood followed one day after sex.

Neural and Hormonal Bases of Arousal

• Sensory neurons in the Spinal Reflexes neurons that detect stimuli and transit the message to spinal cord.
• Transmitters centers in the spinal cord that receive the message, interpet, and send our message to produce response of neurons or muscles that respond to stimulation.
• Erection is Produced by a spinal reflex and a Neural message that send to a Parasympathetic.
• This message leads to muscle relaxation and blood flow.
• However, even someone who suffers from spinal cord injuries may not feel erection, but it may occur
• Ejaculation centers are higher in spinal cord and involve both Parasympathetic and sympathetic nervous system systems.
• In this system, A Message goes out to the ejaculation center in lumbar portion of spinal cord when sperm and internal organs are released into bladder.
• Reflexes in women can lead to the clitorous stimulating to the reflex center in the sacral portion of the spinal cord through both sympathetic and parasympathetic nerve fibers.
• Female ejaculation is associated with the G spot (skenes glands).
• Even with paralysis in the body women can still get reaction of vagina and have orgasms, conceiving a baby is still normal.

Brain Control of Sexual Response

• Hetereosexual men creat neural activity in the sexual interest netwrok, nucleus accumbes by hypothalynys, amydala, anterior cingulate cortex, and hypothalumus (parts of limbic system)
• Erection is not in these areas; PET and fMRI scans show regions of brain.
• With erection, brain activity in insula and claustrium, striatum (hypothalumus).
• During arousal, dopamine, melanocortins (stimulate attention to sexual stimuli and desire in limbic system), ocytocin, and norepinephrine
• Sexual Arousal can be an Inhibitory Process and are influenced by hormones who had effects on genital anatomy and cause permanent change in organization of structures

Hormones and Sex

• Organizing effects: permanent changes in organziation of structures are present during prenatal development and causes permanent change in organziation of structures
• After reaching adulthood, it's unlikely that men who are casteratd will engage in in sex unless given testosterone (activating effects)
• Androgens are related to sexual desire in women and affect pheremones.

Pheromones

• They are biochemicals secreted outside of the body, through smell
• Studies found that males show more testosterone when in presence of urine in ovulating female
• They also fond menstrual synchrony through phermones: menstrual synchrony over the convergence over several months of the dates of onset of menstrual periods amng women who were in close contact with each other.

Sexual Techniques

• Erogenous zones are parts of the body that are sexually sensitive and can be performed by either 1 or 2 people through:
• Autoeroticism (Masterbation/Fantasy) is where masturbation from glans and corona are hypersensitive is commonly performed.
• Concious or mental imagry or daydream involving seucal activity is fantasy.
• There is also exercised induced orgasm from cycling, running, yoga, Women from liftin weights, climbing rope and sex toys available such as Dildos with body oils
• Two person sex initiates sex by kissing and through other senses to generate various fetishes to lead to Oral and anal sex

Cybersex

• Food, drug, perfume- that excited sexual desire

Sex Research

• The cremaster muscle that surrounds the testes contracts or relaces to move the testes closer to or further from the body to reguluate temperature.
• The testes tensing has something to do with temperature control,
• Regular sexual activity leads to shorter refractory periods, varying between participants.
• You should care about research methods because of What research to believe and not to believe; critical thinking skills; evaluating the book is crucial in this class

Type of Measures

• Self reports, Behavior, Direct observation of behavior, Eye tracking, and Implict measures
• Biological measures are not assessments that attempt to measure implicit associations that participants may not be aware of
• Instead, biological measures use genital measures of arousal/lubrication
• It requires defining: population,sample,Random/Probability Sampling,Convenience Sampling, and Randomness
• Volunteers are more sexually permissive
• The reserach is limited by Purposeful Memory, memory, and estimates, and

Ethics

• Informed consent: right to know
• Protection from harm: Minimize stress and Anonymity
• No harmed people- equality
• Research should be Cost-benefit analysis

The Kinsey Report

• Studied sexual behavior in 1938 by gaining structured questionnaire data and the University began a marriage course leading to the lack awareness in human behavior.
• Collected data from 5300 men and 6000 women and published in 1948 and 1953
• Resulted in its being very famous

The NNSHB (2009): National Survey of Sexual Health and Behavior

• Indiana and Kinsey were used and did Random digit dialing+ residential addresses The test's ages range from ages 14-94, had a 53% response from adults and was answered on website, with 69% white, 14% Hispanic, 11% black, 7% other Web surveys allowed larger samples
• The interviews weren't private and honest.

Media Content Analysis

• It analyzes the effect of media on sexuality.
• There is a set of procedures to make text more valid.
• You can copy the various content, and define the actions
• Determine what you analyze.

Various Analysis

• Two researchers must come to a consensus.
• There has to be consistency in Qualatative data of attributes,surveys,experiments.
• There have to be various in-depth, rich descriptions that you can come from studies.
• Quantitative literature: to analyze if there's differences in sex.
• It is the Gold Standard to make experiments work.

Correlation & Experiments

• Research with 1 variable and controlled is called experiment and can be manipulated.
• Correlational studies indicate that variables cause and correlate with each other.
• This requires determining that variables cause and correlate with each other and the population needs to be determined with: average, median, and the most frequent action.
• Believes in group differences were originated that way.
• Should make structural disparities in group

Diversity Science

• Diversity science is how people create, interpret, and maintain various differences
• Should analyze and research the diverse with various methods with valid tests

Sex Research Summary

• Researches based on measures
• You can analyze reports- can be ethical issues.
• The report includes population descriptions
• And web-base surveys require valid experiments to analyze the data and use methods for accurate description.

Lifespan Development (Adolescence) chapter 9

• A study of sexuality throughput the course of our lives

Difficulties in Studying Sexuality in Childhood

• It is difficult to study Infants and their sexual lives
• The U.S. limits what studies can show.
• 1950+60s: It limits what kids could see.
• Modern: Kids don't have the relationships
• The kids may have fewer problems and better development.
• Parents report in surveys of their kids
• Studies are very limited that describe sexual practices

Preschool Years (0-4 Years)

• Birth indicates that genitals, touching, increases sex.
• Masturbation comes from parent reaction, and infants that are male get erection while females can lubricated.

Adolescence and School

Sex:

• Sex is learned early on through perceptions and genders
• They often express various dissatisfaction of their desire with the world

Attachment

This process:

• Forms in infancy with Self-stimluation: discover genitals quickly.

Encounters

• Involve a sense of touching one another as they age more when understand love and marriage.
• Knowledge about gender is learned as the gender identity is developed.

Childhood (5-11 Years)

• Freud's thepry wrong about latency
• The adrenal hormone increases for males and females and both begin masturbation
• Limited Hetero
• Kids mostly engage with peers of same gender
• If the sexual play comes from partners- they are likely

Knowledge

The ideas that kids learn are:

• Hetero vs essential gender, and the feelings with them
• Kids learn in Australia, Britain, and America

Are American Children being Too Sexualized?

Today:

• The people have a value that focuses too much on sex
• Too much sex ads on children

Counterfeiting The Issue of Sexualization

Try promoting:

• Athletics, educate them on sex better, allow parent navigatin
• Teen interest in sex follows
• Adolescents get an understanding of their bodies
• Hormones are increased.

Adolescense (12-18)

• More than 50% are in a relationship in US.
• Changes in the body lead to secondary changes, and the puberty triggers changes such as voice
• In the US, earlier times for the teens to get puberty has increased with changes being: diet, industrial
• It takes a perfect model

Teen and Sex

Early:

• Takes interaction. Masterbation happens less with girls
• Most college kids are adolescents and study to find themeselves.

Patterns

• Most are engaging; if no=they are not getting action
• College Kids have sex

College & Hook Ups

• Are too much with no relationships as result or hooking up with people
• Alcohol and more is involved

LGBTQ Students

View hookups negatively

• The adolescent brain differs with the rate in which it changes in young and adults
• The amygdala comes first, then the other factors The rate they have can vary, if too early= it's a problem They are more likely to get pregnant if doing the act way later more, but can get worse.

Adolecents that do Same Gender Sex

Often occur in highschool students vs those who have a higher sex count

Patterns in Life

• Never Married people tend to have some sort of intention to still marry as 43% of the age group.
• Older people find new ways to meet: the people tend to have the same social needs, dating apps, dating websites, and are long term singles may have certain preferences and difficulty They like to see couples in a romantic or social view that allows the single-term

Cohabilitating

• 42% tend to live at lease with one person as the marriage percent with them is about half/60%
• Cohabitarion only effects divorce rates.

Marrying

• Gets pushed back as their lives are more sexual.
• More or less has made people marry someone who understands and they fully understand.
• It is good for those two to stay together and sexually staisfy one another.