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  1. s e x u a l i t y a n d u . c a Unintended Pregnancies Unintended pregnancies with various contraceptive methods Numbers given are pregnancies for every 1000 women during first year of use Adapted from Trussell et al, 2004.

  2. s e x u a l i t y a n d u . c a I n j e c t a b l e c o n t r a c e p t i v e What is it? • It contains a hormone called progesterone; it does not contain estrogen • The injection is given in the upper arm or buttocks every 12 to 13 weeks (four times a year) How does it work? • Prevents the ovary from releasing an egg • Thickens the cervical mucus making it difficult for sperm to get to the egg • Changes the lining of the uterus making implantation difficult Failure rate: 30 per 1000 women per year

  3. s e x u a l i t y a n d u . c a I n j e c t a b l e c o n t r a c e p t i v e What are the advantages? 1. One of the most effective reversible birth control methods available 2. Does not contain estrogen 3. No daily contraceptive routine required; 1 injection lasts for 3 months 4. Effectiveness is not reduced by other common medications 5. May be suitable for breastfeeding women or women who smoke 6. With continued use, menstrual cycles cease in over half of users after the first year, and two-thirds of users after two years of use 7. Improves symptoms of endometriosis 8. Reduces the risk of endometrial cancer 9. Effective immediately when given during the first 5 days of a normal menstrual period

  4. s e x u a l i t y a n d u . c a I n j e c t a b l e c o n t r a c e p t i v e What are the disadvantages? 1. Initially, irregular bleeding is the most common side effect 2. Decrease in bone mineral density which may be reversible when a woman stops taking the injection. Calcium supplementation is advised. 3. May be associated with weight gain in some women 4. Takes an average of nine months after the last injection for the ovaries to start releasing eggs again 5. Does not protect against STIs 6. The lack of a monthly period may be bothersome for some women

  5. s e x u a l i t y a n d u . c a Implants • Implants are placed in the body filled with hormone that prevents pregnancy • Physically inserted in simple 15 minute outpatient procedure • Plastic capsules the size of paper matchsticks inserted under the skin in the arm • 99.95% effectiveness rate NORPLANT CONSIDERATIONS: • Should be considered long term birth control • Requires no upkeep  • Extremely effective in pregnancy prevention > 99%

  6. Norplant Implant

  7. s e x u a l i t y a n d u . c a Implants NORPLANT I vs. NORPLANT II • 6 CAPSULES - 2 CAPSULES • 5 YEARS - 3 YEARS

  8. s e x u a l i t y a n d u . c a I n t r a u t e r i n e s y s t e m ( I U S ) What is it? • A T-shaped device that contains a hormone called levonorgestrel • The hormone is released slowly over time and acts on the lining of the uterus • It is inserted into the uterus by your physician in the doctor’s office • Two threads may be felt in the vagina, so a woman can check for herself to ensure that the IUS is still in place How does it work? • Thickens the cervical mucus making it difficult for sperm to reach the egg • Causes changes in the lining of the uterus that helps to prevent implantation • In some women, it may prevent the ovary from releasing an egg Failure rate: 1 per 1000 women per year

  9. s e x u a l i t y a n d u . c a I n t r a u t e r i n e s y s t e m ( I U S ) What are the advantages? 1. Long-acting contraceptive; can be left in place for up to five years 2. No daily contraceptive routine required; device provides five years of contraception 3. Does not contain estrogen 4. Does not interfere with intercourse 5. Regulates menstrual cycle and reduces cramps 6. May be suitable for women who are breastfeeding 7. May reduce pain due to endometriosis 8. May lower the risk of precancerous cells developing in the lining of the uterus 9. Some users will stop having menstrual cycles during insertion period

  10. s e x u a l i t y a n d u . c a I n t r a u t e r i n e s y s t e m ( I U S ) What are the disadvantages? 1. Possible side effects include irregular bleeding or spotting in the first months after insertion 2. Perforation of the uterus may occur at the time of insertion, but this is rare 3. May be expelled from the uterus, which happens with 6% of IUS users 4. Does not protect against STIs 5. Requires a physician for insertion and removal

  11. s e x u a l i t y a n d u . c a Side-Effects of Hormonal Contraception Sideeffects that may occur during the first few months on hormonal contraception include : • irregular bleeding, spotting • nausea • mood swings • bloating • breast tenderness • headaches

  12. s e x u a l i t y a n d u . c a Side-Effects of Hormonal Contraception Reason: • Your body is getting used to birth control • Fluctuating hormone levels when you start When will it stop? • Most symptoms are normal and will decrease or stop in the first 2-3 months. If they bother you or don’t get better: • Talk to your healthcare provider • There might be a method that’s better suited for you.

  13. s e x u a l i t y a n d u . c a Myths and Misconceptions about Hormonal Contraception Common myths and misconceptions • Causes weight gain • Causes acne • Causes infertility • Causes birth defects • Should take a break from time to time • Smokers should not be taking it • Women over age 35 should not take the Pill • No need for condoms if you’re on the Pill

  14. I n t r a u t e r i n e d e v i c e ( I U D ) s e x u a l i t y a n d u . c a What is it? • A T-shaped device with a copper wire around it • It is inserted into the uterus by a physician in the doctor’s office • Two threads may be felt in the vagina, so a woman can check for herself to ensure that the IUD is still in place How does it work? • Causes changes in the lining of the uterus • Prevents the sperm from fertilizing the egg • Decreases the ability of the sperm to penetrate the cervical mucus Failure rate: 8 per 1000 women per year

  15. I n t r a u t e r i n e d e v i c e ( I U D ) s e x u a l i t y a n d u . c a

  16. I n t r a u t e r i n e d e v i c e ( I U D ) s e x u a l i t y a n d u . c a What are the advantages? 1. Long-acting contraceptive; can be left in place for up to five years 2. No daily contraceptive routine required; device provides five years of contraception 3. Does not contain estrogen 4. Does not interfere with intercourse 5. May reduce the risk of endometrial cancer 6. May be suitable for women who are breastfeeding

  17. I n t r a u t e r i n e d e v i c e ( I U D ) s e x u a l i t y a n d u . c a What are the disadvantages? 1. Possible side effects include irregular bleeding or spotting in the first months after insertion 2. Perforation of the uterus may occur at the time of insertion but this is rare 3. May increase menstrual bleeding or menstrual cramping 4. May be expelled from the uterus. This happens in 2–10% of IUD users 5. Does not protect against STIs

  18. METHODS BASED ON INFORMATION • Withdrawal • Natural Family Planning • Fertility Awareness Method • Abstinence

  19. WITHDRAWAL • Removal of penis from the vagina before ejaculation occurs • NOT a sufficient method of birth control by itself • Effectiveness rate is 80% (very unpredictable in teens, wide variation) • 1 of 5 women practicing withdrawal become pregnant • Very difficult for a male to ‘control’

  20. Natural Family Planning & Fertility Awareness Method • Women take a class on the menstrual cycle to calculate morefertile times • Requires special equipment and cannot be self-taught • NFP abstains from sex during the calculated fertile time • FAM uses barrier methods during fertile time • Perfect effectiveness rate = 91% • Typical effectiveness rate = 75% • No 100% safe day-irregular periods

  21. S T I p r e v e n t i o n s e x u a l i t y a n d u . c a Putting on a Male Condom • Male condoms usually come rolled up in a sealed packet, and most are pre-lubricated on the outside (the preferred choice). If the condom is brittle, stiff or sticky, discard it and use another. Begin the procedure when your penis is hard. • Put a drop or two of lubricant or saliva inside the tip of the condom (optional) • If you're not circumcised, pull back your foreskin • Place the rolled-up condom over the tip of your penis, leaving a half-inch space for semen collection • Pinch the air out of the tip of the condom • Unroll the condom all the way to the base of the penis • If you're not using a pre-lubricated condom, lubricate the outside of the condom with a water-based lubricant • When you've finished having sex (vaginal, anal or oral), hold the condom against the base of your penis while you pull out.

  22. S T I p r e v e n t i o n s e x u a l i t y a n d u . c a Dental dams and gloves A dental dam is a small piece of latex similar to the material used for latex condoms. • It can be used during oral sex. The dental dam is stretched across a woman’s vagina to prevent the exchange of bodily fluids. • It can also be used in other activities where a barrier is desired. • Latex surgical gloves can also be used in activities where a barrier is desired. General tips • When using latex dental dams, gloves, or condoms, apply only water- based lubricants. They are available at drugstores. • Use new dental dams, gloves, or condoms for each partner. • Do not re-use latex barriers or turn them over and use the other side.

  23. S T I p r e v e n t i o n s e x u a l i t y a n d u . c a 1 Cutting a condom to make a dental dam • When a dental dam is not available, a latex condom can be cut to create a latex barrier. 1. Unroll a new condom. 2. Using scissors, cut off both ends of the condom, removing the closed tip and the round loop at the base. 3. Cut the condom lengthwise so that it opens up into a rectangle. • If you are going to use the barrier for oral sex, you may wish to select a condom without spermicide or lubrication. A flavoured condom may be a good choice. 2 3

  24. S T I p r e v e n t i o n s e x u a l i t y a n d u . c a * Remember that no method of protection from STIs is perfect. Some STIs can be passed through skin-to-skin contact.

  25. s e x u a l i t y a n d u . c a What To Ask Your Healthcare Provider • Following are some questions you might want to ask regarding your sexual health. A good idea is to make a list before you visit. • Birth control related: • How do I know what birth control method is best for me? • How to take your method • How to deal with missed pills, patches, rings, or injections • What are the side-effects? Which are normal and how can I cope with them. • General women’s health • Should I get a mammogram? How do I know if I'm doing my breast self-exam correctly? • How often do I need a Pap smear or gynecological check-up? • How do I know if my period is normal? • Should I be tested for AIDS or other STIs?

  26. s e x u a l i t y a n d u . c a What Your Healthcare Provider May Ask You • Be prepared to answer questions about: • Medical history (surgeries, vaccines, menstrual cycle, etc) • Medications you are taking • Allergies • Family history (medical conditions like diabetes, heart problems) • Lifestyle • Sexual practices • Don't be embarrassed to tell the truth or ask a question. They are professionals and the information is required to give you the best care possible.

  27. Birth Control Costs • The Pill – $20 – $30 / month (requires prescription) • Birth Control Patch – $20 – $40 / month (requires prescription) • Cervical cap – $40 (need to be fitted by a doctor and then pick up at pharmacy) • Depo Provera - About $35.00 - $45.00 for each injection that lasts about 3 months (usually prescribed or from a walk-in clinic) • Diaphragm - About $40.00 - $70.00 cdn per diaphragm (requires fitting and prescription) • Female Condom - $3 each (drugstore) • Copper IUD - $70 (must be inserted by health care professional or family planning clinic) • Hormonal IUS - $300 - $400 • Vaginal Ring - $20 - $40 (requires prescription) • Male Condom - You can pick up a pack of condoms at the drug store for about .50¢ cdn. a condom • Lea’s Contraceptive - $50 (online) • Spermicide – About $10 - $25 depending on the product (drugstore) • Sponge - $10 - $15 (for a 4 pack in a drugstore) • Sterilization – Usually covered by medicare but reversal is not. (doctor)