Module 2 - Topic 2.pdf

Module II Reproductive and Sexual Health Topic # Topic Title Time Duration 1 Human Sexuality 4...

Module II Reproductive and Sexual Health Topic # Topic Title Time Duration 1 Human Sexuality 4 hours 2 Responsible Parenthood 4 hours Module II discusses the dimensions and what influences human sexuality. It reviews anatomy and physiology of the reproductive system. It also outlines common methods available for reproductive life planning including physiologic actions and potential impacts on future pregnancies. The module examines the ovulation and the side effects of an ovulation suppressing agent. The Medical Eligibility Criteria for Contraceptive Use is introduced to help students understand the methods that are appropriate for a certain couple. TOPIC 2 Learning Objectives: After mastering the contents of this module, you should be able to: 1. Discuss Responsible Parenthood. 2. Determine appropriate family planning method for a specific couple. 3. Utilize the Medical Eligibility Criteria for Contraceptive Use in teaching clients on family planning methods. REPUBLIC ACT NO. 10354 – The Responsible Parenthood and Reproductive Health Act of 2012 or RPRH Act Responsible Parenthood - refers to the will and ability of a parent to respond to needs and aspirations of the family and children. It is likewise a shared responsibility between parents to determine and achieve the desired number of children, spacing and timing of their children according to their own family life, aspirations, taking into account psychological preparedness, health status, sociocultural and economic concerns consistent with their religious convictions. Menstrual cycle must be understood in order for a couple to decide as to what is the best family planning method to use. Reproductive life planning includes all the decisions an individual or couple make about whether and when to have children, how many children to have, and how they are spaced. Fertility is the capacity of the woman to conceive and bear a child and the capacity of a man to have a woman conceive. Male Fertility - Males, after they reach puberty, are always fertile and are able to make females pregnant at any time. Male fertility ends at death. Female Fertility - Unlike males, females are fertile only on certain days within a menstrual cycle, which is during ovulation. On other days, they are infertile. Fertilization occurs when there are sperm cells available to fertilize the ovum at the time of ovulation. Female fertility ends at menopause which occurs at 50 years of age (at an average). Joint or combined fertility involves the united and equal contribution of the male and female in the decision and ability to have a child. Family Planning Methods: A. FERTILITY AWARENESS BASE METHODS are family planning methods that focus on the awareness of the beginning and end of the fertile time of a woman’s menstrual cycle. These methods involve: – Determination of the fertile and infertile periods of a woman within the menstrual cycle. – Observation of the signs and symptoms of infertility and fertility during the menstrual cycle. Key Points on the FAB Methods:  Fertility awareness-based methods require cooperation of both partners.  A woman or couple using FAB methods must be aware of body changes or keep track of fertile and infertile days according to the rules of the specific FAB method being practiced.  To avoid pregnancy, the couple should abstain from sexual intercourse during the fertile phase. To achieve pregnancy, the couple can time sexual intercourse during the fertile phase.  FAB methods have no side effects or health risks.  SDM can be used by women with 26-32 days menstrual cycles. EFFECTIVENESS: All FAB Methods are above 95% effective. SIGNS OF FERTILITY There are two main naturally occurring fertility signs that a woman can observe to determine when she can or cannot become pregnant. These are: 1. Changes in the cervical mucus: Cervical mucus can be used to determine the beginning and end of the fertile days. 2. Changes in the basal body temperature: Basal body temperature can be used to determine when ovulation has passed and the fertile days have ended. 3. The first day of menstruation is the sign for keeping track of a woman’s menstrual cycle. THE FAB METHODS 1. CERVICAL MUCUS/BILLINGS OVULATION METHOD (CMM/BOM) is based on the daily observation of what a woman sees and feels at the vaginal area throughout the day. Cervical mucus changes indicate whether days are fertile or infertile and can be practiced by couples to avoid or achieve pregnancy. On the 4th day after the last day of wetness, all dry days are absolutely infertile days. On dry days following menstruation, couples can engage in sexual intercourse on alternate nights only. With perfect (correct) use, this method is 97% effective. However, with typical use, it is 80% effective. Alternatively, the Two Day Mucus-Based Method Rule states that two dry days (no secretions for two consecutive days) signify that intercourse will not result in pregnancy. 2. BASAL BODY TEMPERATURE (BBT) is based on a woman’s resting body temperature (i.e., body temperature after three hours of continuous sleep) which is lower before ovulation until it rises to a higher level beginning around the time of ovulation. Her infertile days begin from the fourth day of the high temperature reading to the last day of the cycle. All days from the start of the menstrual cycle up to the third high temperature reading are considered fertile days. With perfect use, this method is 99% effective. With typical use, its effectiveness is 80%. 3. SYMPTO-THERMAL METHOD (STM) is based on the combined technology of the Basal Body Temperature (e.g. the resting body temperature) and the Cervical Mucus/Billings Ovulation Method (e.g. observations of mucus changes at the vaginal area throughout the day) together with other signs (i.e., breast engorgement, unilateral lower abdominal pain) which indicate that the woman is fertile or infertile. This method is 98% effective as correctly used. 4. STANDARD DAYS METHOD (SDM) is based on a calculated fertile and infertile period for menstrual cycle lengths that are 26 to 32 days. Women who are qualified (e.g. with 26 to 32 days menstrual cycles) to use this method are counseled to abstain from sexual intercourse on days 8-19 to avoid pregnancy. Couples on this method use a device, the color-coded “Cycle Beads”, to mark the fertile and infertile days of the menstrual cycle. SDM is 95.25% effective with correct use and 88% with typical use. How to use the Cycle Beads  Assess the length of the menstrual cycle if it falls within the range of 26–32 days by considering the following information:  The last menstrual period  The previous/past menstrual period  When she expects her next menses  If the cycle length is less than 26 days or more than 32 days, the client cannot use the method. – If the cycle meets the criteria, provide an SDM card and cycle beads, which can be used in marking the days of the cycle.  Show the woman the Cycle Beads and instruct her on how to use it:  – On the first day of the menstrual cycle (e.g. first day of menstrual bleeding), she puts the ring on the red bead and marks with an “x” the date on the calendar. – She moves the ring to a bead each day. It is recommended that she moves the ring every morning upon waking up so that she does not forget. The brown beads signify infertile days while the white beads signify fertile days. – When the ring is on a white bead, she abstains from sexual intercourse  Draw the client’s attention to the dark brown and black beads. Tell her that if she experiences menstrual bleeding before the dark brown bead, this means that her cycle is short and less than 26 days. If the ring has reached the black bead and she still does not experience menstrual bleeding, then her cycle is more than 32 days. If either happens twice in a year, she cannot reliably use the SDM as her FP method Advantages of FAB methods:  Effective when used correctly and consistently.  No physical side effects.  No prescription required.  Inexpensive; no medication involved.  No follow-up medical appointments required.  Better understanding of the couple about their sexual physiology and reproductive functions.  Shared responsibility for family planning.  Foster better communication between partners.  All FAB methods can be used for spacing, limiting, and achieving pregnancy. Disadvantages of FAB methods:  May inhibit sexual spontaneity.  Except for SDM, need extensive training - it takes about two to three cycles to accurately identify the fertile period and how to effectively use it.  Require consistent and accurate record keeping and close attention to body changes.  Require periods of abstinence from sexual intercourse, which may be difficult for some couples.  Require rigid adherence to daily routine of awaking at a fixed time, without any disturbance before taking the temperature (specific for BBT and STM).  Can be used only by women whose cycles are within 26-32 days (specific for SDM).  Offer no protection against STI, HIV/AIDS. B. LACTATION AMENORRHEA METHOD The Lactational Amenorrhea Method is a contraceptive method that relies on the condition of infertility that results from specific breastfeeding patterns. There are three criteria that must be met to be able to qualify for the use of LAM: 1. The woman exclusively breastfeeds infant. Exclusively breastfeeding may be interpreted as:  Exclusive means no supplements of any sort are given. Infant receives no other liquid or food, not even water in addition to breast milk.  Very small amount (one or two swallows) of water, vitamins or antibiotics as medically prescribed.  Simply put, the woman should use both breasts to breastfeed her baby on demand with no more than a four-hour interval between any two daytime feeds and no more than a six-hour interval between any two nighttime feeds. 2. Amenorrhea. Mother’s monthly bleeding has not returned. In the first weeks postpartum (e.g. in the first 56 days postpartum), there is often continued spotting. This is not considered to be a menstrual period if the woman is fully lactating. 3. Infant is less than six months old. If she is fully breastfeeding and her menses have not returned, the effectiveness of LAM diminishes over time. Ovulation resumes in 20% to 50% of women near the end of the six-month postpartum. If any of the criteria is not met, it is no longer LAM. MECHANISM OF ACTION Works primarily by preventing the release of eggs from the ovaries (ovulation). Frequent breastfeeding temporarily prevents the release of the natural hormones that cause ovulation. EFFECTIVENESS The effectiveness of LAM as consistently followed at 99.5%; if typically used, it is 98%. Mothers should initiate breastfeeding as soon as possible after birth, and avoid separation from the baby as much as possible. Breastfeed the infant on demand day and night, with no more than a four-hour interval between any two daytime feeds, and no more than a 6-hour interval between any two night time feeds. ADVANTAGES OF LAM 1. It can be started immediately after delivery. 2. It is economical and easily available. 3. It does not require a prescription. 4. No action is required at the time of intercourse. 5. There are no side effects or precautions to its use. 6. No commodities or supplies are required for clients or for the family planning program. 7. Fosters mother-child bonding. 8. It serves as a bridge to using other methods since LAM is used for a limited time only. 9. It is consistent with religious and cultural practices. DISADVANTAGES OF LAM 1. Full or nearly full breastfeeding pattern may be difficult for some women to maintain. 2. The duration of the method's effectiveness is limited to a brief six-month postpartum period. If a mother and child are separated for extended periods of time (because the mother works outside the home), the breastfeeding practice required for LAM cannot be followed. 3. There is no protection against sexually transmitted infections, including HIV. 4. In addition, it may be difficult to convince some providers who are unfamiliar with the method that LAM is a reliable contraceptive. C. HORMONAL CONTRACEPTIVE METHODS 1. Low-dose Combined Oral Contraceptives, otherwise known as pills or oral contraceptives, contain hormones similar to the woman’s natural hormones - estrogen and progesterone. They are taken daily to prevent conception.  Two types of pill packets are available in the Philippines. One type has 28 pills in a packet, with 21 "active" pills containing hormones and seven "inactive or reminder" pills of a different color. The reminder pills do not contain hormones. Another type of pills contain only the 21 "active/hormone containing” tablets. Mechanism of Action  Low-dose COCs prevent ovulation by suppressing follicle-stimulating hormone (FSH) and luteinizing hormone (LH). It also causes thickening of the cervical mucus, which makes it difficult for sperm to pass through.  Low-dose COCs do not disrupt an existing pregnancy. Effectiveness  Low-dose COCs are effective, if perfectly used, 99.7%, as typically used, 92%. Advantages of COCs  Safe as proven by extensive studies  Reversible, rapid return of fertility  Convenient, easy to use, no need to do anything at the time of sexual intercourse  Has significant non-contraceptive benefits  Monthly periods regular and predictable  Reduces symptoms of gynecologic conditions such as painful menses and endometriosis  Reduces the risk for ovarian and endometrial cancer  Decreases risk of iron-deficiency anemia  Can be used at any age from adolescence to menopause Disadvantages of COCs  Requires regular and dependable supply.  Client-dependent: effectiveness depends on the client’s compliance to the daily routine of taking the pills.  Often not used correctly and consistently, which lowers its effectiveness.  Strong motivation to take pills correctly is needed.  Offers no protection against STIs/HIV.  Not most appropriate choice for lactating women (unless there is no other method available and risk of pregnancy is high) as it can suppress lactation.  Effectiveness may be lowered when taken with certain drugs such as rifampicin and most anti-convulsants.  Increased risk to users over 35 years old who smoke and have other health problem  SIDE EFFECT(S) POSSIBLE CAUSE(S) MANAGEMENT Amenorrhea/  Possible pregnancy  Check for pregnancy scanty menses  Inadequate endometrial build-up  Reassurance Spotting/breakt  Missed pills  Encourage regular intake of pills hrough bleeding  More common with low dose COCs at the same time each day  Taking pills at different times of the  Avoid missing pills day  Take another pill from another  Vomiting and/or diarrhea within pack when diarrhea or vomiting two hours of intake occurs within two hours of intake  Drug interaction  Change method if taking rifampicin or anti-convulsants Nausea  Possible flu or infection  Check for flu, infection or  Possible pregnancy pregnancy  Taking pills on an empty stomach  Take pills at bedtime or with food Headaches  Estrogen effect  Take analgesics (paracetamol)  Refer if getting worse Breast  Effect of hormones in pills  Recommend use of supportive tenderness bra  Take pain relievers  Try hot or cold compress Warning Signs J - Jaundice A - Abdominal pain (severe) C - Chest pain H - Headaches (severe) E - Eye problems such as brief loss of vision, seeing flashes of light or zigzag lines S - Severe leg pains 2. Progestin-Only Injectables What Are Progestin-Only Injectables?  The injectable contraceptives depot medroxyprogesterone acetate (DMPA).  Do not contain estrogen, and so can be used throughout breastfeeding, starting 6 weeks after giving birth, and by women who cannot use methods with estrogen.  Given by injection into the muscle (intramuscular injection) or, with a new formulation of DMPA, just under the skin (subcutaneous injection). The hormone is then released slowly into the bloodstream.  DMPA, the most widely used progestin-only injectable, is also known in its intramuscular form as “the shot,” “the jab,” the injection, Depo, Depo-Provera, and Petogen. The subcutaneous version in the Uniject injection system is currently marketed under the name Sayana Press and in prefilled single-dose disposable hypodermic syringes as depo- subQ provera 104.  Work primarily by preventing the release of eggs from the ovaries (ovulation). How Effective?  Effectiveness depends on getting injections regularly: Risk of pregnancy is greatest when a woman misses an injection. - As commonly used, about 4 pregnancies per 100 women using progestin-only injectables over the first year. This means that 96 of every 100 women using injectables will not become pregnant. - When women have injections on time, less than 1 pregnancy per 100 women using progestin-only injectables over the first year (2 per 1,000 women).  Return of fertility after injections are stopped: An average of about 4 months longer for DMPA.  Protection against sexually transmitted infections (STIs): None Side Effects, Health Benefits, and Health Risks Side effects: Most users report some changes in monthly bleeding. † Typically, these include, with DMPA:  First 3 months:  Irregular bleeding  Prolonged bleeding At one year:  No monthly bleeding  Infrequent bleeding  Irregular bleeding Some users report the following:  Weight gain  Headaches  Dizziness  Abdominal bloating and discomfort  Mood changes  Less sex drive Other possible physical changes:  Loss of bone density Health Beenifits :DMPA - Helps protect against:  Risks of pregnancy  Cancer of the lining of the uterus (endometrial cancer)  Uterine fibroids  May help protect against: - Symptomatic pelvic inflammatory disease - Iron-deficiency anemia  Reduces: - Sickle cell crises among women with - sickle cell anemia  Symptoms of endometriosis - (pelvic pain, irregular bleeding) Why Some Women Say They Like Progestin-Only Injectables  Requires action only every 2 or 3 months. No daily pill-taking.  Do not interfere with sex  Are private: No one else can tell that a woman is using contraception  Stop monthly bleeding (for many women)  May help women to gain weight D. BARRIER METHOD - MALE CONDOMS  The condom is one of the barrier methods. Barrier methods mechanically or chemically prevent fertilization or the union of the egg and sperm cell. The male condom is the only FP method included in the Philippine FP Program that prevents both pregnancy and sexually-transmitted infections (STIs).  DESCRIPTION The condom is a sheath made of thin, latex rubber designed to fit over a man’s erect penis.  MECHANISM OF ACTION - Prevents entry of sperm into the vagina. - Sperm and disease- causing organisms including HIV do not pass through intact latex rubber or polyurethane condoms. - Some condoms have a spermicidal coating which adds to its effectiveness.  EFFECTIVENESS - Condoms, in order to be effective must be used correctly and consistently. If correctly and consistently used, it is 98% effective; if typically used, 85%. E. LONG ACTING AND PERMANENT METHODS There are four contraceptive methods that are categorized as long acting and/or permanent: IUDs, implants, female sterilization, and vasectomy. IUDs and implants are long-acting and temporary. When they are removed, return to fertility is prompt. Female sterilization and vasectomy are permanent methods. 1. The Intrauterine Device (IUD) is one of the family planning method provided by the Philippine Family Planning Program. Advantages of IUD:  Highly effective and very safe  Reversible and economical  May be safely used by lactating and immediate postpartum women  Good choice for women who cannot use other methods  Long duration of use (up to 12 years for TCu380A)  Once inserted, they are convenient and extremely easy to use, providing worry-free continuous protection Allows privacy and control over her fertility (client does not have to use anything at the time of sexual intercourse)  Does not interact with medications client may use  No systemic side effects as its effects are confined to the uterus Disadvantages of IUD  Requires a pelvic exam to insert the IUD  Requires a trained health service provider to insert/remove the IUD  Does not protect against STIs  Increases the risk of PID for women with STIs  Device may be expelled, possibly without the woman knowing it (especially for postpartum insertions) Warning Signs: The service provider should instruct the client to immediately seek consultation when:  She thinks that she may be pregnant. This is when she has missed a menstrual period and has signs of pregnancy.  She thinks that the IUD might be out of place. For example, when the strings are missing or the hard plastic of the IUD is felt.  She has symptoms of infection like increasing or severe pain in the lower abdomen, pain during sexual intercourse, unusual vaginal discharge, fever, chills, nausea and/or vomiting. The signs of complication can be easily remembered through PAINS:  Period late  Abdominal pain  Infection  Not feeling well  Strings missing or longer Addressing Common Misconceptions About the IUD The IUD does not Studies suggest that the IUD prevents pregnancy primarily by preventing act as an fertilization rather than inhibiting implantation of the fertilized egg (Rivera abortifacient et al., 1999). This is particularly true of the copper-bearing IUDs. The IUD does not The IUD reduces the risk of ectopic pregnancy by preventing pregnancy. increase a Because IUDs are so effective at preventing pregnancy, they also offer client's risk of excellent protection against ectopic pregnancy. Women who use copper- ectopic bearing IUDs are 91% less likely than women using no contraception to pregnancy. have an ectopic pregnancy (Sivin, 1991). The absolute The following points should be considered: number of  Less than 1% of IUD users become pregnant, which reduces a woman’s ectopic risk for ectopic pregnancy. pregnancies  IUD users are 50% less likely to have an ectopic pregnancy than are among IUD users women using no contraception. is much lower  However, in the unlikely event that an IUD user becomes pregnant, than that among she has equal chances of having an ectopic pregnancy as non-users. the general Since ectopic pregnancy is a serious condition that requires emergency population. care, this condition must be considered.  Among IUDs, the TCu380A and Multiload Cu375 are lowest in rates of ectopic pregnancy (WHO, 1987). A long-term study of women using the TCu380A found the rate to be less than one (0.09%) per 100 women a year, and less than one (0.89%) per 100 women at 10 years (Ganacharya, Bhattoa, and Batar, 2003).  Women with a history of ectopic pregnancy can use the IUD with no restrictions. The IUD does not Strict randomized controlled trials and literature reviews reveal that PID cause PID, nor among IUD users is rare (ARHP, 2004; Grimes, 2000). Early studies that does the IUD reported a link between PID and IUD use were flawed and poorly need to be designed. Inappropriate groups were used for comparison, infection in removed to treat IUD users was over-diagnosed, and there was a lack of control for PID confounding factors (Buchan et al., 1990). Here are some important points about PID and the IUD based on recent research:  During the first three to four weeks after IUD insertion, there is a slight increase in the risk of PID among IUD users compared to non-IUD users, but it is still rare (less than seven per 1000 cases). After that, an IUD user appears to be no more likely to develop PID than a non-IUD user (Farley et al., 1992).  PID in IUD users is caused by the STIs, gonorrhea and chlamydia, not the IUD itself (Darney, 2001; Grimes, 2000). However, the risk is still very low, with an estimated three cases per 1000 insertions in settings with a high prevalence (10%) of these STls (Shelton, 2001).  If PID occurs, the infection can be treated while the IUD is kept in place, if the client so desires. Studies have shown that removing the IUD does  not have an impact on the clinical course of the infection. If the infection responds to treatment within 72 hours, the IUD does not need to be removed (WHO, 2004b).  Randomized controlled trials and cohort studies reveal that the monofilament string does not increase the risk of PID (Grimes, 2000).  Women who have a history of PID can generally use the IUD (the advantages generally outweigh the risks), provided their current risk for STls is low. The IUD is Nulliparous women can generally use the IUD (the advantages generally suitable for use outweigh the risks). In theory, the smaller size of a nulligravid uterus may in nulliparous increase the risk of expulsion, whereas uterine enlargement, even if due women. to an abortion, may promote successful IUD use (Hatcher et al., 2004). Expulsion rates tend to be slightly higher in nulliparous women compared to parous women (Grimes, 2004). The IUD can be HIV-infected women who are clinically well can generally use the IUD (the safely used by advantages generally outweigh the risks). A large study in Nairobi showed HIV-infected that HIV-infected women had no significant increase in the risk of women who are complications, including infection in early months, than HIV negative clinically well. women (Sinei et al., 2001). In another study of HIV-infected and HIV- negative IUD users with a low risk of STI, no differences were found in overall or infection related complications between the two groups (Sinei et al., 1998). The IUD does not There is no current evidence that use of the IUD in HIV infected women increase the risk leads to increased risk of HIV transmission. Studies have shown that of HIV among HIV infected women using the IUD, there is no increase in viral transmission. shedding and no statistically significant increase in HIV transmission to male partners (ARHP, 2004; Richardson et al., 1999). The IUD does not Women who have AIDS, are on ARV therapy, and are clinically well can interfere with generally use the IUD (advantages generally outweigh the risks). Because ARV therapy. it is a non-hormonal family planning method, the IUD is not affected by liver enzymes and will not interfere with or be affected by ARV therapy (ARHP, 2004; Hatcher et al., 2004). Bilateral tubal ligation (BTL) is known as female sterilization as it provides permanent contraception for women who do not want any more children. It is a safe and simple surgical procedure to tie and cut the two fallopian tubes located on both sides of the uterus. MECHANISM OF ACTION  The service provider makes a small incision in the woman’s abdomen and ties and cuts the two fallopian tubes on each side of the uterus. These tubes carry eggs from the ovaries to the uterus. EFFECTIVENESS  BTL is very effective with an effectiveness rate of 99.5%. ADVANTAGES  Very effective.  Permanent. A single decision leads to lifelong, safe prevention of pregnancy.  Nothing to remember, no supplies needed, and no repeated clinic visits required.  No interference with sex. Does not affect the woman’s ability to have sex.  Increased sexual enjoyment because no need to worry about pregnancy.  Has no hormonal side effects.  No effect on breastmilk.  No known long-term side effects or health risks.  Can be performed just after a woman gives birth (immediately/within seven days after childbirth).  For interval cases, can be done six weeks after delivery.  Can be performed at any day of the menstrual cycle provided the service provider is reasonably sure that the woman is not pregnant. DISADVANTAGES  Requires minor surgery.  Compared with vasectomy, BTL is:  Slightly more risky  Often more expensive  Considered to be permanent as reversal surgery is difficult, expensive and success cannot be guaranteed.  If pregnancy happens (very rare), there is a greater risk for ectopic pregnancy compared to women who have not undergone the procedure.  Does not protect against STIs including HIV/AIDS. POSSIBLE SIDE EFFECTS There are no long-term side effects of BTL. Common side effect: pain over the operative site which diminishes in a day or two. Complications of surgery, which include the following, are uncommon:  Infection or bleeding at the incision  Internal infection or bleeding  Injury to internal organs Anesthesia risk: - With local anesthesia alone or with sedation, rare risk of allergic reaction or overdose. With general anesthesia, occasional delayed recovery and side effects. Complications are more severe than with local anesthesia. WARNING SIGNS Problems affect women’s satisfaction with BTL. It is, therefore, important that the service provider attends to clients complaining of the following warning signs of complications and refer her to a facility or health service provider who can assess and manage her complaint. These warning signs are:  Bleeding, pain, pus, heat, swelling or redness of the wound that becomes worse or is persistent. These are signs of infection on the incision site.  High grade fever is a sign of more severe infection.  Fainting, persistent light-headedness, or extreme dizziness.  Missed period, which signifies pregnancy. VASECTOMY - known as male sterilization as it provides permanent contraception for men who decide they will not want any more children.  It is a safe, simple, and quick surgical procedure. The procedure can be done in a clinic or office with proper infection prevention practices.  The procedure involves tying and cutting a segment of the two vas, which carries sperm.  No scalpel vasectomy is a small puncture on the scrotum (not using a scalpel) to get the vas. This is the DOH-approved procedure for vasectomy. MECHANISM OF ACTION  The service provider makes a puncture in the man’s scrotum and ties and cuts the two vas. The vas carries sperm from the testicles.  Semen is still produced and found in the tubes after the blocked vas.  With the two vas blocked, there will be no sperm in the semen. The man continues to have erections and ejaculates semen. EFFECTIVENESS:  Vasectomy is very effective at 99.9% for correct use, but slightly lower with typical use at 99.8%.  More effective when used correctly. This means using condoms or his woman partner using another effective family planning method (e.g. pills, injectable) consistently for at least three months after the procedure and after a semen check showing no sperm has been performed. ADVANTAGES:  Very effective.  Permanent. A single decision leads to lifelong, safe, and effective contraception.  Nothing to remember except to use condoms or another effective method for at least three months after the procedure.  No interference with sex. Does not affect the man’s ability to have sex.  Increased sexual enjoyment because no need to worry about pregnancy.  No supplies to get, and no repeated clinic visits required.  No known long-term side effects or health risks.  Compared to BTL, vasectomy is:  More effective  Safer Easier to perform  Less expensive Able to be tested for effectiveness at any time If pregnancy occurs in the man’s partner, less likely to be ectopic DISADVANTAGES:  Requires minor surgery by a specially trained health care provider.  Not immediately effective. The couple should use another effective family planning method for at least three months after the procedure.  Must be considered as permanent. Reversal surgery is more difficult, expensive, may not be available in some areas, and success is not guaranteed. Men who may want to have more children in the future should choose a different method.  Does not protect against STIs including HIV/AIDS. POSSIBLE SIDE EFFECTS: Common side effects of vasectomy are:  Discomfort for two to three days  Pain in the scrotum, swelling and bruising which decreases for about two to three days Warning Signs:  Severe bleeding or blood clots after the procedure  Redness, heat, swelling, pain at the incision site  Pus at the incision site  Pain lasting for month SUMMARY CHART OF U.S. MEDICAL ELIGIBILITY CRITERIA FOR CONTRACEPTIVE USE ABBREBIATION: ARV – antiretroviral C – continuation of Contraceptive method CHC - combined hormonal contraception (pill, patch, and, ring) COC=combined oral contraceptive CuIUD=copper-containing intrauterine device DMPA = depot medroxyprogesterone acetate I=initiation of contraceptive method; LNG-IUD=levonorgestrel-releasing intrauterine device NA=not applicable; POP=progestin-only pill; P/R=patch/ring; SSRI=selective serotonin reuptake inhibitor; ‡ Condi on that exposes a woman to increased risk as a result of pregnancy. HOW TO USE THE MEC: 1. Know MEC Categories: No restriction for the use of the contraceptive method for a woman with that 1 condition. Advantages of using the method generally outweigh the theoretical or proven 2 risks  Theoretical or proven risks of the method usually outweigh the advantages – not 3 usually recommended unless more appropriate methods are not available or acceptable Unacceptable health risk if the contraceptive method is used by a woman with 4 that condition 2. Look up to the table the condition of the patient. 3. Interpret and explain to client the possible contraceptive methods they can use. The example shows that a client who is smoking and is above35 years old smoking more than 15 cigarettes per day cannot use combined hormonal contraceptive (CHC) because it belongs to category 4. Category 4 states: Unacceptable health risk if the contraceptive method is used by a woman with that condition however she may use IUD, implants, DMPA and POP since those methods belong to category 1. 4. Master your MEC Chart. It can help in the reproductive planning counselling.  Fertility Awareness Base Methods are family planning methods that focus on the awareness of the beginning and end of the fertile time of a woman’s menstrual cycle.  Hormonal Contraceptive Methods includes combined oral contraceptives and progestin only injectables.  The condom is one of the barrier methods.  There are four contraceptive methods that are categorized as long acting and/or permanent: IUDs, implants, female sterilization, and vasectomy. IUDs and implants are long-acting and temporary. When they are removed, return to fertility is prompt. Female sterilization and vasectomy are permanent methods.  The use of MEC Chart contains recommendations that are meant to serve as a source of clinical guidance, health care providers should always consider the individual clinical circumstances of each person seeking family planning services. This report is not intended to be a substitute for professional medical advice for individual patients. Persons should seek advice from their health care providers when considering family planning options. References: Silbert-Flagg, JoAnne, Pillitteri, Adelle. (2018). Maternal and Child Health Nursing. Philadelphia: Wolters Kluwer Peate, Ian, Nair, Muralitharan. (2017). Fundamentals of Anatomy and Physiology For Nursing and Health Care Students. West Sussex, UK. John Wiley & Sons, Ltd. Department of Health. Family Planning Competency Based Training (FPCBT) Modules World Health Organization Department of Reproductive Health and Research. (2011) Family Planning: A Global Handbook for Provider https://www.cdc.gov/reproductivehealth/contraception/unintendedpregnancy/pdf/MEC_Slide Set_2016.pdf