Sexuality: Contraceptive Methods

1. Sexuality: Contraceptive Methods Ricci pp. 127-149

2. Methods (Box 4.5) • Behavioral—abstinence, rhythm, withdrawal, lactation • Barrier—condom, diaphragm, cap, sponge • Hormonal—estrogen/progestin combos • Permanent—tubal, vasectomy • Summary of pros and cons in Table 4.4

3. Sterilization • Tubal ligation, Essure (micro-coil tubal obstr), vasectomy • Considered permanent altho is only 99.5% effective; reversal more likely with vasectomy • Tubals are done by laparoscopy and require outpatient surgery with general anesthesia • Essure done in doctor’s office by hysteroscopic placement in tubes; requires contrast • Vasectomies are done in doctor’s office with local anesthesia and small incision

4. Hormone Therapy • Oral (BCP) • Transdermal (patch) • Injection (Depo) • Implant (Implanon) • Vaginal ring (NuvaRing) • Orals, patches, and rings require 3 wk on, 1 week off therapy. Depo is q12wk, Implanon q3 yr, and IUCs q5-10 years.

5. Hormone Therapy cont’d • Most are some combination of estrogen and progestin. A few types are extended-release. • The emergency type is a higher dosage and only 1-2 doses. IUCs within 7d is also considered emergency contraception. • All prevent ovulation if working properly. • Advantages are convenience, effectiveness, spontaneity in sex, changes in menstrual cycle.

6. Hormone Therapy cont’d • Disadvantages are having to remember pills qd, weight gain, changes in menstrual cycle, no STI protection, no smoking, need Rx, serious SEs, and interaction with anticonvulsants and antimicrobials. • Acronym ACHES is helpful for some women for reporting serious side effects. (Box 4.6) • Acronym PAINS used for reporting problems with IUCs. (Box 4.7)

7. Barrier Methods • Types include condoms, diaphragm, cervical cap, sponge, spermicides. • Advantages include protection against most STIs (not HPV and natural condoms do not protect against HIV), virtually no side effects except for allergic reactions, some need no Rx, and when used with spermicides, can be more effective.

8. Disadvantages • Have to plan for sex • Need to use spermicide • Messy • Decreased sensation • Allergy to latex or deodorants • Diaphragms have to be fitted by trained clinician and inserted 4h before left in for 6h after sex • Caps have to be fitted, inserted 12h and left in for 48h • Sponges can cause toxic shock syndrome.

9. Coitus Interruptus • A.K.A. “pulling out”. Man withdraws penis just before ejaculation. • Advantages—hmmm…this is a hard one….no Rx needed, no prep beforehand, better than no method, cheap (unless you get pregnant!) • Disadvantages—difficult for man, messy, large room for error

10. Abstinence • Avoids pregnancy and STIs • Adherence to values and convictions • Intercourse vs. “outercourse” • Outercourse alternatives: • Masturbation (single or mutual) • Sex toys • Oral • Fantasy

11. Rhythm Method • Assessing time of ovulation using basal body temperature readings and using those results to avoid times to have intercourse. • Advantages: no drugs, no artificial barriers, nothing invasive, more natural, religious beliefs • Disadvantages—requires a lot of discipline, room for error without dedication, a least 7-10 days of abstinence each month. Eggs live 24h, sperm 5d.