Sexuality And The Life Cycle - Contraceptives PDF

SEXUALITY AND THE LIFE CYCLE 1 At the completion of this unit, students should be able to 1. Describe the historical and social issues surrounding contraception 2. Explain the different types of contraceptives and the advantage and disadvantages associated with each 2 CONTRACEPTION HISTORIC...

SEXUALITY AND THE LIFE CYCLE 1 At the completion of this unit, students should be able to 1. Describe the historical and social issues surrounding contraception 2. Explain the different types of contraceptives and the advantage and disadvantages associated with each 2 CONTRACEPTION HISTORICAL AND SOCIAL PERSPECTIVES 4  CONTRACEPTIVES IN THE USA 1870’s- Comstock Laws - national laws that prohibited the dissemination of contraceptive information through the U.S on the grounds that such information was obscene; named after Anthony Comstock (then secretary of the New York Society for the Suppression of Vice) Margaret Sanger was most instrumental in promoting changes in birth control legislation and availability in the USA. 1915- she opened an illegal clinic where women could obtain and learn to use the diaphragms she had shipped from Europe. She published birth control information in her newspaper, The Woman Rebel. As a result, she was arraigned for violating the Comstock Laws and fled to Europe to avoid prosecution but later returned to promote research on birth control hormones, financed by her wealthy friend Katherine McCormack. 5  CONTRACEPTIVES IN THE USA 1960-the first birth control pills came on the U.S. market, after limited testing and research in Puerto Rico. Fertility control through contraception rather than abstinence was a profound shift that implied an acceptance of female sexual expression and broadened the roles that women might choose (D’Emilio & Freedman, 1988; Rubin, 2010). Prior to 1965 (Griswold v. Connecticut ruling) the Supreme Court prohibited the use of contraceptives by married couples; this was overruled due to the court’s decision about married couple’s rights to privacy. 1972- Supreme Court case Eisenstadt v. Baird extended the right to privacy to unmarried individuals by decriminalizing the use of contraception by single people. A 9% overall drop in the birth rate of 15- to 20-year-old women occurred after access to the birth control pill became legal (Thomas, 2009). In the following years other laws governing contraceptive availability have continued to change albeit anti-contraception advocates continue to engage in political battles.  BENEFITS OF CONTRACEPTIVE USE 1. Heterosexual couples can enjoy sexual intimacy with minimal risk of unwanted pregnancies. 2. Children are more likely to be born to parents who are prepared for the responsibility of rearing them, and the ability to space children at least 18 months apart increases newborn health (Conde-Agudelo et al., 2006). 3. Far fewer women than ever before have to decide to have an abortion. 4. Allowed women in the United States to become equal partners with men in modern society; due to the increased earning power of women, men have had opportunities unknown to their own fathers to expand their involvement with their children. Although 98% of Catholic women in the US have used a contraceptive method, the official doctrine of the Church continues to maintain that all birth control methods other than abstinence and methods based on the menstrual cycle are immoral ( Jones & Dreweke, 7 2011).  GLOBAL USE OF CONTRACEPTION Disparity persists with its use- only 6% of married women in Nigeria more than 70% in the United States and China, use birth control. About 215 million women across the globe are not using effective contraception. In regions like sub-Saharan Africa, South Central Asia, and Southeast Asia, 49 million women experience unintended pregnancies each year and they also have high maternal mortality rates, with an average of 1 in 65 women dying from pregnancy, childbirth, or abortion complications. Sierra Leone has the highest rate, with 1 in 8 mothers dying in childbirth, while in the U.S., the risk is significantly lower at 1 in 4,800. Increased accessibility enhances quality of life and alleviates overpopulation Impoverished families with many children struggle to provide adequate food, health care, and education. Overpopulation, combined with resource overconsumption in developed countries, threatens the environment. Expanding women's access to education and economic opportunities is key to controlling population growth, as educated women tend to have fewer children and are more likely to use contraception. 8  SHARING RESPONSIBILITY Shared responsibility of contraception enhances a relationship and is a good way to initiate discussing personal and sexual topics. Women often do not consistently or correctly use birth control, negatively impacting both partners' sexual experiences and well-being. Discuss birth control before the first sexual encounter. Women can become more effective in obtaining contraceptives and men can be more assertive about using them. Openness to condoms or noncoital activities is another way to share contraceptive responsibility. 9  Contraceptive effectiveness is best evaluated by looking at the failure rate- the number of women out of 100 who become pregnant by the end of the first year of using a particular method Table 10.2 shows the failure rate when contraceptive methods are used correctly and consistently; it also shows the rate of accidental pregnancies resulting from improper or 10 inconsistent use.  OUTERCOURSE Being sexually intimate without engaging in penile– vaginal intercourse. kissing, touching, mutual masturbation, and oral and anal sex Offers effective protection from pregnancy, once the male does not ejaculate near the vaginal opening. Can also used when it is advisable not to have intercourse for other reasons, e.g. following childbirth, abortion or during a herpes outbreak. It does not eliminate the chances of spreading sexually transmitted infections, especially if it involves oral or anal sex 12  HORMONE-BASED CONTRACEPTIVES Oral contraceptives are the most used, reversible method of contraception with more than 100 million women using them worldwide Does not interfere with subsequent ability to get pregnant. For most women, they improve overall health (Speroff & Fritz, 2005). Not advisable for about 16% of women- with a history of blood clots, liver disease, strokes, circulation problems, heart problems, jaundice, cancer of the breast or uterus, and undiagnosed genital bleeding. Women who smoke cigarettes or have migraine headaches, depression, high blood pressure, epilepsy, diabetes or prediabetes symptoms, asthma, or varicose veins should weigh the potential risks and use the pill only under close medical supervision. One pill is taken daily at the same time- Conventional packs usually contain 21 active pills and seven inactive (placebo) pills, or 24 active pills and four inactive pills. Bleeding occurs every month when you take the inactive pill. 13  4 BASIC TYPES OF THE PILL 1. The constant-dose combination pill (available since the early 1960s)is one of the most used oral contraceptives. It contains two hormones, synthetic estrogen and progestin (a progesterone-like substance); the dosage of these hormones remains constant throughout the menstrual cycle. 1. They are more than 32 different varieties of combination pills, and each variety contains various amounts and ratios of the two hormones. 2. The triphasic pill ( available since 1984) provides fluctuations of estrogen and progestin levels during the menstrual cycle; it is designed to reduce the total hormone dosage and any side effects while maintaining contraceptive effectiveness. 3. Extended-cycle contraceptive (a constant-dose pill) is taken continuously for 3 months without placebo pills. The only brand on the market, Seasonale, has a lower dose of estrogen and progestin than most other constant-dose or triphasic pills. It reduces the number of menstrual periods to 4 instead of 13 per year, which significantly benefits women who have uncomfortable menstrual symptoms during the placebo phase of using the combination pill. 4. The progestin-only pill, (available since 1973), contains only 0.35 milligrams of progestin—about one third the amount in an average-strength combination pill. It has a constant-dose formula and contains no estrogen; it is a good option for women who prefer or require a non-estrogen pill 14  HOW DO ORAL CONTRACEPTIVES WORK? Combination Pill The estrogen in the combination, triphasic, and extended-release pills prevents conception primarily by inhibiting ovulation. The progestin provides secondary contraceptive protection by thickening and chemically altering the cervical mucus so that the passage of sperm into the uterus is hampered, it also causes changes in the lining of the uterus, making it less receptive to implantation by a fertilized egg and it can inhibit ovulation. Progestin- only pill Most women who take this pill likely occasionally ovulate. The primary effect of the progestin is to alter the cervical mucus to a thick and tacky consistency that effectively blocks sperm from entering the uterus and providing alterations in the uterine lining that make it unreceptive to implantation Hormone-based methods cause changes in a woman’s body that inhibit ovulation and implantation 15  THE VAGINAL RING AND THE TRANSDERMAL PATCH NuvaRing and Ortho Evra are hormone-based contraceptives Work similarly to the pill -they release the hormones embedded in them through the vaginal lining or skin into the bloodstream Fewer side effects reported than oral contraceptive users. HOW TO USE The ring is inserted into the vagina between day 1 and day 5 of a menstrual period and is worn inside the vagina for 3 weeks, then removed for 1 week and replaced with a new ring. The ring can remain in place during intercourse, or it can be removed for up to 3 hours at a time without reducing its contraceptive effectiveness (Long, 2002). A woman chooses a specific day of the week after a menstrual period starts and identifies that day as “patch change day.” She replaces the old patch with a new patch on that same day each week for 3 weeks, followed by a patch-free 7-day interval. The patch can be placed on the buttock, abdomen, upper outer arm, or upper torso. 17  Depo-Provera and Lunelle- injectable hormone- based contraceptives. INJECTED CONTRACEPTIVES The active ingredient in Depo-Provera is progestin, which inhibits the secretion of gonadotropins and prevents follicular maturation and ovulation. This causes the endometrial lining of the uterus to thin, preventing implantation of a fertilized egg and progestin also alters the cervical mucus. Lunelle combines progestin and estrogen like combination pills. HOW TO USE A health-care provider gives the Depo-Provera shot once every 12 weeks, ideally within 5 days of the beginning of menstruation and it usually takes 10 months after stopping Depo-Provera for a woman to get pregnant. Lunelle requires a monthly injection, and fertility returns immediately after stopping injections. 18  Implanon is a matchstick-size slender rod 11/2 inches long that is inserted under the skin of the upper arm and releases contraceptive hormones. CONTRACEPTIVE IMPLANT It releases a slow, steady dose of progestin, and prevents pregnancy in the same ways as the progestin-only minipill. It may not be effective for women more than 30% heavier than their medically ideal weight. HOW TO USE A medical practitioner inserts the rod in a quick surgical procedure that requires only a local anesthetic. It is effective for up to 3 years, and fertility usually returns quickly after removal of the device In developing countries, long-acting methods play a critical role in providing effective contraception, however cost and accessibility remain issues. 19 BARRIER AND SPERMICIDE METHODS Other than the condom, Work by preventing barrier methods do not sperm from reaching an protect against STIs, ovum (egg cell). including AIDS and genital warts 20  CONDOMS Condom-a sheath that fits over the erect penis that serves as a mechanical barrier, effectively preventing any sperm from entering the vagina. Only temporary method of birth control available for men that also effectively reduces transmission of sexually transmitted infections, including AIDS. DO NOT store in hot places as heat causes deterioration, i.e. the glove compartment of a car or a back pocket. Lubricated condoms are less likely to break than nonlubricated ones. With proper use of a condom, both the ejaculate and the fluid from Cowper’s gland secretions ( “precum”) are contained in the tip. 21  Putting a condom on after vaginal penetration but before ejaculation increases the risk of pregnancy and STI transmission (Barclay, 2010). CONDOMS- MALE When using a plain-end condom (without the reservoir tip), the end needs to be twisted before unrolling the condom over the penis as this leaves some room at the end for the ejaculate and reduces the chances of the condom breaking. If the condom is nonlubricated, put saliva or water-based lubricant on the vulva and on the outside of the condom before inserting the penis into the vagina. Do not use oil-based lubricants, because they reduce the condom’s integrity and increase the chances of breakage. Because the penis begins to decrease in size and hardness soon after ejaculation, it is important to hold the condom at the base of the penis before withdrawing from the vagina otherwise the condom can slip off and spill semen inside the vagina. Best disposed of in the garbage rather than the toilet, because they can clog plumbing 22  CONDOMS- FEMALE Resembles a male condom but is worn internally by the woman. A flexible plastic ring at the closed end of the sheath fits loosely against the cervix, and another ring encircles the labial area. It fits the contours of the vagina, allowing the penis to move freely inside the sheath, which is coated with a silicone-based lubricant. Used correctly, female condoms can substantially reduce the risk of transmission of some STIs and are of particular benefit for women in countries with high HIV rates. 23  VAGINAL SPERMICIDES Foam, cream, jelly, suppositories, and film that contain a chemical that kills sperm. Foam is a white substance that resembles shaving cream and comes in a pressurized can and has a plastic applicator. Vaginal suppositories have an oval shape, and the sponge is a doughnut-shaped spermicide-containing device that absorbs and subsequently kills sperm. Vagina Contraceptive Film (VCF) is a paper- thin, 2-by-2-inch sheet that is laced with spermicide and packaged in a matchbook- like container holding 10 to 12 sheets. 25  HOW DO VAGINAL SPERMICIDES WORK? Foam inserted with the applicator, rapidly covers the vaginal walls and the cervical os, or opening to the uterus. Vaginal suppositories take about 20 minutes (do not insert more than 30 mins prior to intercourse) to dissolve and cover the walls, some suppository brands effervesces and creates foam inside the vagina while other brands melt. Once VCF is inserted into the vagina, next to the cervix, it dissolves into a stay-in-place gel. Spermicides can irritate the inside of the vagina, which can make it more likely that STIs will be transmitted. They are the least effective contraceptive at preventing pregnancy so they should be used with condoms. A new application of spermicide is required before each act of intercourse The contraceptive sponge is effective for multiple acts of intercourse and can be inserted up to 24 hours in advance by pushing the sponge as far back into the vagina as possible, and placing it over the cervix, making sure the sponge covers the cervix. Can be left in 6-8 hours after intercourse. Read and follow instructions carefully for optimal results. 26  The diaphragm and FemCap cervical cap CERVICAL BARRIER DEVICES combine a physical barrier that covers the cervix with vaginal spermicide to protect the cervix from contact with viable sperm. These devices are dome shaped, with a rim around the open side. The diaphragm covers the upper vaginal wall from behind the cervix to underneath the pubic bone. The FemCap’s rim rests on the vaginal wall surrounding the cervix and has removal straps. 27  HOW TO USE CERVICAL BARRIER DEVICES The diaphragm is fitted by a medical professional. The Femcap does not have to be fitted but can be bought OTC in some countries and by prescription in others. These devices are used with spermicidal cream or jelly placed inside the dome of the cup and on the rim. Do not use oil-based lubricants with a diaphragm because it is made of latex and will deteriorate when used with oil-based lubricants. (The FemCap is made from silicone.) The diaphragm can last for several years, but the FemCap is usable for only one year. A pregnancy (including a miscarriage or an abortion) or a weight change of more than 10 pounds may require a different diaphragm. 28  INTRAUTERINE DEVICES An intrauterine device (IUD) is another long-acting reversible contraception (LARC). It is a small, plastic object that is inserted into the uterus. They can be hormonal or nonhormonal. the ParaGard (nonhormonal) is a plastic T with a copper wire wrapped around its stem and copper sleeves on the side arms. Can be in place for up to 12 years. Mirena, Skyla, Kyleena, and Liletta (hormonal) are a polyethylene T with a cylinder containing the hormone progestin. Can be in place for 3-6 years depending on hormone levels hormonal IUDs differ in size, level of hormones, and length of effectiveness All IUDs have fine plastic threads attached designed to hang slightly out of the cervix into the vagina. A medical professional inserts the IUD It does not interfere with sexual interaction and is highly effective Serious complications are rare 29 IUD’S 30  HOW DO IUD’S WORK Both the copper and the progestin in IUDs are effective in preventing fertilization. The ParaGard with copper seems to alter the tubal and uterine fluids, which affects the sperm and egg, so fertilization does not occur. Mirena, Skyla, Kyleena, and Liletta have effects like those of hormonal contraceptive methods and disrupt ovulatory patterns, thicken cervical mucus, alter endometrial lining, and impair tubal motility (Stewart, 1998). IUDs also affect women’s menstrual cycles with the ParaGard causing heavier periods, while hormonal IUDs may make periods lighter. 31  EMERGENCY CONTRACEPTION Hormone pills (“morning after pill”) or an IUD that can be used after unprotected intercourse to prevent pregnancy. Options for emergency contraception include: a hormone pill, packaged as Plan B or Next Choice; a nonhormonal pill, Ella; or insertion of a ParaGard IUD. The IUD is the most effective in preventing pregnancy and can be inserted up to 7 days after unprotected intercourse; if inserted up to 5 days after unprotected intercourse, it is more than 99% effective in preventing pregnancy. Plan B or Next Choice are the most used method and are most effective if taken within the first 24 hours after intercourse, typically 95% effective in preventing pregnancy. These hormone treatments work primarily by inhibiting ovulation and may also provide secondary protection by altering cervical mucus and the lining of the uterus. Ella, works up to 5 days after unprotected sex and is a nonhormonal pill that contains ulipristal, a drug that blocks the effects of key hormones necessary for conception. 32 WHY USE EMERGENCY CONTRACEPTION? Women may have Incorrect use of Most women use EC concerns about contraceptives (e.g a because they have possible contraceptive woman has missed had unprotected failure (e.g. if the her daily dose of the intercourse condom broke) pill) Woman has been a victim of sexual assault and does not have contraception coverage 33 35 FERTILITY AWARENESS METHODS 37  Natural family planning or fertility awareness methods are methods of birth control based on changes during the menstrual cycle. Based on the fact that a fertile woman’s body reveals subtle and overt signs of cyclic fertility that can be used to help prevent and to plan conception. Includes the calendar method, standard days method, mucus method, basal body temperature method, and symptothermal method. During the fertile period, couples using fertility awareness methods can abstain from intercourse and engage in other forms of sexual intimacy or can continue having intercourse and use other methods of birth control (Gribble et al., 2008). Benefits include low cost and lack of side effects. However, one must have extensive knowledgeable and training for good use. Mobile apps have aided in their use making it easier for women. 38  CALENDAR METHOD/RHYTHM METHOD A birth control method based on abstinence from intercourse during calendar-estimated fertile days. About 75% effective, with perfect use it can be between 91%-99% effective. To use this method, a woman keeps a chart, preferably for 1 year, of the length of her cycles (cannot be on oral contraceptives). 1. Count the first day of menstruation as day 1, and the last day as the day before your next period begins. 2. To find high-risk days, subtract 18 from your shortest cycle length. For example, if your shortest cycle is 26 days, day 8 is the first high-risk day. 3. To know when unprotected sex can resume, subtract 10 from your longest cycle. If your longest cycle is 32 days, intercourse can resume on day 22. 39  STANDARD DAYS METHOD A birth control method that requires couples to avoid unprotected intercourse for a 12-day period in the middle of the menstrual cycle. For women with regular menstrual cycles between 26 and 32 days. Couples avoid unprotected sex from days 8 to 19, the "fertile window," which accounts for ovulation variations. About 82% effective with typical use and up to 95% with perfect use. Women can track their cycle using a calendar. 40  The mucus method, also called the ovulation method, is based on the cyclical changes of cervical mucus that reveal periods of fertility in a woman’s cycle. MUCUS METHOD A woman learns to “read” the amounts and textures of vaginal secretions and to maintain a daily chart of the changes. A woman reads her mucus by putting her fingers inside her vagina daily and noting the consistency of the secretions. Can be up to 99% effective if performed perfectly and is 78%–90% effective with typical use. The Two Day Method is a simplified mucus-based fertility tracking method in which a woman checks for cervical mucus on the current and previous day. If mucus is present on either day, she is considered fertile and should abstain from intercourse or use contraception. It is 96% effective with perfect use and 86% effective with typical use. 41  BASAL BODY TEMPERATURE METHOD The basal body temperature method tracks fertility by measuring body temperature upon waking. Just before ovulation, the temperature slightly drops, then rises (by about 0.2°F) after ovulation due to increased progesterone. Accurate thermometers are needed to detect these small changes. Natural Cycles app helps track basal temperature and uses an algorithm to predict fertility. With a typical-use effectiveness of 93% and perfect-use effectiveness of around 99%. 42 SYMPOTHERMAL METHOD A birth control method that involves recording of multiple signs of fertility, including basal body temperature, cervical mucus, and cervical position. This method involves recording observations about various fertility symptoms in a chart or mobile app. By using multiple data sources, it may be more effective than other fertility awareness methods, with 99% effectiveness under perfect use. However, this requires consistent and careful adherence to the rules for accurate fertility tracking. 43 NEW DIRECTIONS IN CONTRACEPTION 44  MALES Recent research focuses on methods to inhibit sperm production, motility, or function without significant side effects or affecting sexual interest. The most promising approach is using testosterone or a testosterone-progestin combination, effective in 95% of men. Most men are open to using a male contraceptive, and most women would trust their partners to do so. The male pill is likely to be administered via injection, implant, patch, or cream. Researchers are also exploring nonhormonal male contraception using medications that cause infertility. 45  FEMALES New female contraceptive options focus on different hormone delivery methods. A spray-on or gel contraceptive and a year-long vaginal ring are being developed. A progesterone vaginal ring for breastfeeding women is used in some developing countries, but not yet in the U.S. Research also explores nonhormonal birth control, like a contraceptive vaccine, a vaginal ring, and spermicides that block sperm motility. New IUD designs include a reversible plug in the oviduct, effective in preventing pregnancy in animals. Efforts are also focused on STI and HIV protection, with spermicides containing microbicides being tested for both effectiveness and sexual pleasure. Although contraceptive options have expanded, the ideal 100% effective, side- effect-free methods are still out of reach. 46 THANK YOU