Sexual Development/ Human Sexuality/ Contraception

1. Sexual Development/ Human Sexuality/ Contraception Prepared by:Teresa Fisher, PBT, RN, BSN Revised & Presented by: Judy Carlyle, MSN, RN

2. Family Planning • Goal: to assist clients with reproductive decision making, enabling the client to have control in preventing pregnancy, limiting the number of children, spacing the time between children, and voluntarily interrupting pregnancy as desired.

3. So Many options; which one to choose????? • Safe • Easily available • Economical • Available • Simple to use • Promptly reversible

4. Nurses Role in Contraception • Foster safe environment for consultation • Provide correct education • Distinguish myth from fact • Clarify misinformation • Fill in gaps of knowledge • Provide visual samples • Gain a complete history

5. History should include • Menstrual history • Contraceptive history • Contraceptive goal • Obstetric history • Medical history • Familial history

6. Methods of Contraception • Natural Methods 1) Abstinence 2) Coitus interruptus • Fertility awareness methods 1) Calendar method 2) Basal body temperature method 3) Cervical mucus method 4) Symptothermal method

7. Methods of Contraception • Spermicides & barrier methods * condoms * diaphragm * cervical cap * cervical sponge • Hormonal methods • Emergency contraception • Intrauterine devices • Sterilization

8. Abstinence • The practice of avoiding sexual intercourse

9. Advantages • Safe • Free • Available to all • 100% effective in preventing pregnancy & STIs • Can be initiated at any time • Encourages communication between partners

10. Disadvantages • Both participants must practice self-control

11. Nursing Education • Teach alternative methods of obtaining sexual pleasure • Provide positive feedback to clients who desire and maintain abstinence

12. Coitus Interruptus • AKA withdrawal • Male partner withdraws penis prior to ejaculation • Effectiveness depends on man’s ability to withdraw prior to ejaculation

13. Advantages • Can be practiced at any time during the menstrual cycle • Free

14. Disadvantages • One of the least reliable contraceptive methods • Only 80% effective • Does not protect from STIs • Some pre-ejaculatory fluid, which may contain sperm, may escape from the penis during the excitement phase prior to ejaculation • At the peak of sexual excitement, exercising self-control may be difficult

15. Nursing Education • Before engaging in sexual intercourse, the male should urinate and wipe off the tip of the penis to decrease the potential of introducing sperm into the vagina • Conception may occur if pre-ejaculatory fluid containing sperm enters the vagina • A spermicide or post-coital contraceptive may be needed if the female partner is exposed to sperm

16. Fertility Awareness Methods • Calendar based methods • Symptoms based method • Biologic marker methods

17. Advantages • Free • Safe • Acceptable to couples whose religious beliefs prohibit other methods, such as Roman Catholics • Increases awareness of the woman’s body • Encourages couple communication • Can be used to prevent or plan a pregnancy

18. Disadvantages • Requires extensive initial counseling and education • May interfere with sexual spontaneity • May be difficult or impossible for women with irregular menstrual cycles • Used alone, they offer no protection against sexually transmitted infection • Less effective in actual use

19. Calendar Rhythm Method • Based on assumption that ovulation occurs 14 days prior to the next menses, sperm are viable for 5 days, and the ovum is capable of being fertilized for 24 hours • 91% effective if used perfectly

20. Calendar rhythm method • Based on number of days in each cycle, counting from first day of menses • Beginning of fertile period is estimated by subtracting 18 days from length of shortest cycle in last 6 months • End of fertile period is determined by subtracting 11 days from length of longest cycle

21. Example of Calendar Rhythm Method • Shortest cycle 24 days 24-18 = 6th day • Longest cycle 30 days 30 -11 = 19th day • To avoid conception the couple would abstain during the fertile period days 6-19

22. Lets Try One • You are educating a client on the contraceptive calendar rhythm method. When you ask her how long her cycles have been for the last 6 months, she explains that her cycle is consistently 28 days. What days should you tell her to abstain from sexual intercourse???

23. Let’s Work This Together • Shortest cycle 28 days 28 -18 = 10th day • Longest cycle 28 days 28 – 11 = 17th day To avoid pregnancy the couple abstains from day 10-17.

24. Disadvantage To Calendar Rhythm Method • Attempting to predict future events with past data

25. Standard Days Method • A modified form of calendar rhythm method • Has fixed number of days of fertility for each cycle • Day 8 – 19 • Cycle Beads (bracelet) • Is useful for women who have 26-32 day cycle • Unreliable for others • 12% failure rate

26. Cervical Mucus Method • Based on monitoring and recording of cervical secretions • Cervical mucus changes occur in response to levels of estrogen and progesterone • Spinnbarkeit – Watery thin, clear mucus becomes more abundant and thick. Feels similar to a lubricant and can be stretched 5+ cm between the thumb and forefinger

27. Spinnbarkeit Presence indicates period of maximal fertility Sperm deposited in this type of mucus can survive until ovulation occurs

28. Cervical Mucus in Relation to Conception • Cervical mucus that accompanies ovulation is necessary for viability & motility of sperm • Mucus alters pH by neutralizing acid

29. Barriers to Assessing Mucus • Contraceptive gels or foams • Vaginal infection • Douches • Vaginal deodorant • Medications (antihistamines dry up mucus) • Sexually aroused state thins mucus • Uncomfortable touching genitals

30. Education • Assess cervical mucus daily • Avoid intercourse when first notices cervical mucus becoming more clear, elastic, and slippery and then for 4 days • Instruct women on barriers to cervical mucus assessment

31. Basal Body Temperature Method • BBT is lowest body temperature of a healthy person taken immediately after waking and before getting out of bed • BBT varies from 36.2-36.3 during menses and 5 - 7 days after • At time of ovulation there is a slight decrease in temperature (fertile period) • After ovulation the BBT increases slightly and remains until 2-4 days prior to menstruation

32. Basal Body Temperature Method • Fertile period is day of first temp drop or first elevation through 3 days of elevated temp • Abstinence begins the first day of menstrual bleeding and lasts through 3 consecutive days of sustained temp rise

33. Basal Body Temperature Method Temps are recorded on graph 97% effective if performed correctly

34. Alterations in BBT Accuracy • Infection • Fatigue • Less than 3 hours sleep per night • Awakening late • Anxiety • New thermometer • Jet lag • Alcohol • Antipyretic medications • Heated waterbed • Electric blanket

35. Combination contraception • Calendar rhythm method • Two day method • BBT

36. Urine Ovulation Predictor Test • Detects the sudden surge of luteinizing hormone (LH) that occurs 12-24 hours before ovulation • Test is not affected by illness, emotional upset, or physical activity

37. Mechanical Methods of Contraception • Spermicide • Male condom • Female condom • Diaphragm • Cervical cap • Contraceptive sponge • Intrauterine device (IUD)

38. Spermicides • Serve as chemical barriers against the sperm • Nonoxynol-9 (N-9) work by reducing the sperm’s mobility • Attacks sperm flagella and body so they cannot reach the cervical os • Use of N-9 too often could increase transmission of HIV by disrupting vaginal mucosa

39. Intravaginal spermicides • Foams • Tablets • Suppositories • Creams • Films • Gels • Preloaded single-dose applicators • Inserted high in vagina to reach cervix • Inserted 15 min – 1 hr before sexual intercourse • When used alone 94% effective

40. Advantages • No prescription required • May be used alone or with a diaphragm or condom • May add additional lubrication and moisture • Penis can remain in vagina following ejaculation • Safe for breast-feeding women • Several choices

41. Disadvantages • The spermicide may be irritating to one or both clients • Some forms may be perceived as messy • May interfere with spontaneity

42. Nursing Education • Apply spermicide inside vagina & close to the cervix prior to inserting penis • Spermicides must be applied with each act of sexual intercourse • Onset of spermicidal action varies • When used alone effectiveness lasts no longer than 1 hour • Foams, creams, & gels are effective immediately • Vaginal contraceptive film & suppositories become effective 15 minutes after insertion into vagina

43. Male Condoms • Are made of latex, polyurethane, or animal tissue • Polyurethane is thinner and stronger than latex • Protects against pregnancy and some STIs • Latex condoms will break down with oil-based lubricants • Only water-based or silicone lubricants should be used

44. Advantages • Males are able to participate in contraception • Sexual intercourse may be prolonged • Condoms are available in a variety of sizes & styles at low cost or free • Partners can participate in placing the condom to enhance enjoyment • All condoms except those made of natural skins offer protection against pregnancy

45. Natural Skin Male Condoms • Natural skin condoms (lamb cecum) does not provide same protection against STIs & HIV • Contain small pores that could allow passage of viruses such as hepatitis B, HSV, & HIV

46. Disadvantages • Penis must be erect before placing the condom on • To prevent spillage of semen, the male must withdraw after ejaculating, while the penis is still erect • Condoms can rupture or leak • Oil-based lubricants can decrease effectiveness of condom

47. Use of the Male Condom • Make sure to educate on proper use and fit • Condom should be in place prior to any penile penetration

48. Client Education • Check expiration date on package • Avoid using oil-based lubricants • Put on condom by placing condom on the tip of the erect penis, leaving enough room at tip to collect sperm, then unroll condom from tip of erect penis to base • After intercourse erect penis should be withdrawn from vagina while holding rim of condom to prevent leakage • Inspect used condom for tears or holes • Discard used condom in disposable waste container • Do not flush in toilet

49. Female Condom • Thin, polyurethane sheath with flexible rings at each end, which covers cervix, lines vagina, and partially shields perineum • 95% effective with perfect use

50. Female Condom