Reproductive Health Health Article

Contraception

The purpose of contraceptives is to avoid pregnancy by preventing the likelihood of fertilization or implantation of a fertilized egg. Women can use devices that fit into either the vagina or uterus; these are known as barrier methods. There are advantages and disadvantages to each method. Sometimes they can cause such serious side effects as excessive mentrual bleeding. Barrier contraceptive devices, in addition to preventing pregnancy, also can help prevent sexually transmitted diseases (STDs) and the human immunodeficiency virus (HIV), the virus that causes the acquired immunodeficiency syndrome (AIDS). Male barrier methods include latex condoms.

Female barrier methods include the diaphragm, female condom, cervical cap, sponge, and intrauterine device (IUD). These devices can also be used with a chemical combination known as a spermicide, which helps to kill sperm during intercourse.

A diaphragm is a dome-shaped flexible barrier with a rim that fits into the vagina and prevents sperm from reaching the cervix. Health professionals recommend that diaphragms be used with spermicide to achieve an 82–94% effectiveness rate against pregnancy. Instruction is required on how to insert and remove the diaphragm. This device, which can be inserted up to six hours before intercourse, must remain in the vagina for six hours after intercourse. There are two disadvantages to the diaphragm. The diaphragm may be dislodged during sex. There is also an increased risk of bladder and urinary tract infections.

The female condom is designed to line the inside of the vagina. Made from polyurethane, unlike male condoms (which are made from latex), and used without a spermicide, the female condom can be inserted up to eight hours before intercourse.

The cervical cap is a small dome, but is not as flexible as the diaphragm. It is placed tightly on the cervix one-half hour to 48 hours prior to intercourse, and is used with spermicide. When used alone, the cervical cap provides an 82–94% effectiveness rate. With spermicide, the cervical cap provides an even greater degree of confidence against unwanted pregnancy. There are several reasons that cervical caps are not widely used. Some women have difficulty with their insertion, which must be done at least one-half hour before intercourse. There is some discomfort when they are being inserted. Cervical caps can also be difficult to remove, and repeated intercourse dictates reapplication of the unit. There is some risk of irritation and allergic reaction. Last, because of the risks of toxic shock syndrome (TSS), women should not wear the cervical cap more for more than 48 hours after intercourse.

The contraceptive sponge also acts as a barrier and is used with a spermicide. The sponge is available without a prescription, and the woman does not need training to insert and remove it. However, the spermicide used with the sponge may be irritating and cause allergic reactions. The sponge should not be used more than once, and should be left in the vagina for six hours after intercourse. If left in for more than six hours, the woman is at risk for toxic shock syndrome.

The IUD, inserted by a health professional, blocks the fallopian tubes so that sperm have fewer chances of passing through the tubes to fertilize the woman's egg. In the event that sperm do pass through the tubes and an egg is fertilized, the IUD can prevent the fertilized egg from becoming implanted in the uterus. An IUD, however, can cause cramping and bleeding in women, and can be spontaneously expelled. This device has also been known to increase a woman's risk of developing PID, may increase her menstrual flow, and cause cramping. The rate of effectiveness with the IUD is greater than 99%.

Birth control pills (also called "combined pills") are more than 99% effective against pregnancy. They do not offer any protection against sexually-transmitted diseases (STDs). While they have some other disadvantages for women, such as possible dizziness, nausea, menstruation changes, and weight and mood fluctuations, there are also advantages. These include continuous contraceptive protection, if taken as prescribed. They are reversible. When one stops taking them, the pills stop working, and another method of birth control must be used immediately. Birth control pills must be taken daily, and are contraindicated for smokers over 35 years of age. They also increase blood clot risk.

The minipill, which is progestin only, has a 95% estimated effectiveness rate. It can also cause irregular bleeding, breast tenderness, weight gain, and a slightly increased chance of ectopic pregnancy; it does provide some protection against PID. It is completely ineffective as a barrier to STDs.

With a greater than 99% rate effectiveness and continuos protection against pregnancy for up to five years, the woman who has had a subdermal implant does not need to be bothered remembering to take a pill. An in-office procedure is required, though, to surgically introduce the implant. The patient may suffer from side effects, which may include menstrual bleeding irregularities and weight change.

Another birth control method with a greater than 99% effectiveness rate is the contraceptive injection (depot medroxyprogesterone acetate). One has three months' of protection, with no need to remember to do anything related to birth control on a daily basis. The woman requires quarterly injections at the doctor's office by the doctor or nurse. As with the implant, there may be side effects, which also include changes in menstrual bleeding and weight.

Tubal ligation, performed surgically by a physician, is a procedure that is irreversible. After a woman has undergone this procedure, she has a greater than 99% guarantee against becoming pregnant.

Men have far fewer choices in barrier contraceptives, but condoms remain the most popular choice. They are easy to obtain and the best means of protection from STDs and HIV. Made from latex, condoms are placed over the penis before intercourse to prevent the ejaculation of sperm into the woman's vagina. They can be used with or without spermicides. Without a spermicide, condoms are 88–98% effective against pregnancy. With spermicide, condoms may provide even higher protection against pregnancy. The disadvantages of using a condom are possibly reduced feeling by the man. There may also be less sexual spontaneity—and, of course, condoms can break.

The man also has the option of having a vasectomy. A surgical procedure that is permanent, the vasectomy provides continuous contraceptive protection. It is over 99% effective, and has no side effects.

Spermicide may be used alone, but it must be inserted within one hour before intercourse; requires reapplication for repeated intercourse; must be left in place for six to eight hours afterward; and is often messy. It may give some protection against chlamydia and gonorrhea. Spermicide's effectiveness rate against pregnancy is 79–97% when properly used. It provides a greater measure of safety when used with a condom.

Lastly, there is periodic abstinence, which requires no equipment, foams, or gels. It does, however, necessitate extremely careful planning, motivation, and patience. When a couple is practicing abstinence, intercourse during half of the menstrual cycle is prohibited. If a woman has an irregular cycle, the couple cannot use this method, as fertile periods cannot be determined with any degree of confidence.