| ID | 328 |
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| Name | CONTRACEPTION8 |
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| Introduction | Contraception is the prevention of conception by methods other than abstinence from coitus; its use to limit the size and age structure of family is birth control or Family Planning. Indications: 1. Limitation of the family as well as population. 2. Ill-health of mother: hypertension, heartdisease, nephritis, psychosis, blood disease etc. 3. Socio-economic condition of the family. 4. Spacing of birth. 5. Maternal diseases transmissible to the foetus- e.g Syphilis, Hemolytic disease, Epilepsy, He-mophilia etc. 6. Sensitized mother due to Rh-incompatibility. Different contraceptive methods: A. Temporary methods: 1. Natural methods: a. Safe period- rhythm method, b. Incomplete coitus i. coitus interfemora. ii. coitus reservatus. iii. coitus interruptus. c. Cervical mucus method e. Douching (after coitus) 2. Barrier methods: a. Physical- - for male- condom - for Female- cervical occlussive cap, vaginal sponge (soaked in sper-micidal fluid), vaginal diaphragm, b. Chemical- i. spermicidal pessaries ii. foam tablets iii. creams or jellies. 3. Mechanical methods: intrauterine contraceptive devices (IUCD)- a. Non medicated- lippes loop ‘ b. Medicated- copper-T, progestesent. 4. Hormonal- a. Oral pills- i. minipill ii. combined pill iii. sequential pill iv. morning after pill (post coital pill) v. once a month pill b. Injectable- i. inj. depot-preparation ii. subecutaneous implant- norplant 5. Post conceptional method- menstrual regulation (M.R) B. Permanent methods: 1. Vasectomy (male). 2. Tubectomy (female). Criteria for an ideal contraceptive method: 1. It should be effective. 2. It should be safe. 3. It should be inexpensive. 4. It should be reversible. 5. It should be simple to administer. 6. It should be acceptable to the users. 7. It should be long lasting enough to avoid frequent administration. 8. It should require little or no medical supervision. Safe period: Rhythm method Coitus may be restricted to those times in the menstrual cycle when there is a chance that an ovum will be available for fertilization. When the cycle is 28+2 days, the safe period comprises the 4 days of menstrual flow, 3 days postmenstrually and 9 days premenstrually. Disadvantages: 1. It is non applicable to those, having irregular cycle. Incomplete coitus 1. Coitus interfemora- the male organ is gripped between the thighs of the female. 2. Coitus reservatus - this allowes full penetration but restricts bodily movement and stimulation so that orgasm and ejaculation do not occurs. 3. Coitus interruptus- the penis is withdrawn immediately before ejaculation. Advantages: 1. They cost nothing. 2. They require no special appliance. Disadvantages: 1. The control of ejaculation is always uncertain. 2. Active spermatozoa can be present in pre-ejaculatory secretion. 3. Spermatozoa deposited on the vulva can ascend the vagina. 4. Unsafe in multiparous woman. 5. It deprives the woman and sometimes the man of orgasm. 6. They may give rise to nervous and emotional reactions. Male sheath (Condom) Fine rubber sheath to cover the erect penis and to contain the semen. They are used only once. Advantages: 1. The technique is simple. 2. It avoids the transfer of venereal and other infections. 3. It is relatively efficient. Disadvantages: 1. It is expensive. 2. It makes the act less pleasurable for both part-ners. 3. It can make vaginal entry more difficult. 4. It is not applicable for aged or undersexed men. 5. The man may omit to use it,when under the influence of alcohol. Douching Douching after coitus aims to wash away or to destroy the spermatozoa before they enter the cervix. Fluids commonly used for this purpose are water, a weak solution of soap, 5% acetic acid, lemon juice in water and antiseptic solution of all kinds. The method is reasonably effective only if applied immediately after coitus. Indications: 1. In emergency when another method fails. 2. When a condom tears. Chemical & physico-chemical contraceptives Spermicidal Pessaries,Tablets, Creams or Jellies can be inserted or injected into the vagina before coitus. They are introduced deep into the vagina. They are used immediately before coitus. Advantages: 1. They are easy to apply. 2. They do not interfere with the coital act. 3. They facilitate coitus by lubrication. Disadvantages: They are un reliable when used alone, so their main use is as adjunct to mechanical appliances. Vaginal occlusive pessary Dutch cap; Vaginal diaphragm The ‘Dutch cap’ consists of a saucer-shaped rubber diaphragm with a metal coil spring in its rim which fits snugly across the upper vagina. The cap should be inserted every night before the woman retires to bed and is removed on raising the following morning. Advantages: 1. It is as safe a mechanical method as any for the intelligent women. 2. It is easy to apply. 3. It is cheap. 4. It does not interfere with natural coitus or with the orgasm. Disadvantages: 1. It is not applicable with uterine prolapse or retroversion. 2. Sensitive women find the method objectionable or embrrassing. Intra-uterine contraceptive devices (IUCD) IVpes: 1. Mirena (an IUD which releases levonorgestrel). 2. Copper-T (TCu 380A- a copper-bearing IUD). Insertion: lUDs are introduced inside the uterus by special applicator. The mirena is effective for 5 years. Copper-T is effective for about 10 years. Indications: 1. When other methods have failed or are inapplicable. 2. When oral contraceptives are contraindicated. Contra-indications: 1. In the early puerperium following labour or abortion. 2. When the woman has irregular and heavy periods, uterine fibroids or other pelvic disease. 3. When there is evidence of present or past pelvic infection. 4. If the uterus is bicornuate. 5. If the woman is nulliparous. 6. A history of previous cesarean section. Disadvantages & complications: 1. Fainting or collapse of the patient. 2. Intermenstrual spotting & menorrhagia. 3. Dysmenorrhoea and intermenstrual pain. 4. Acute and chronic salpingo-oophoritis. 5. Endometritis,carcinoma of uterus. 6. Cervical injury. 7. Perforation of the uterus. 8. Fracture of the device. 9. Spontaneous extrusion of the IUCD. 10. Ectopic pregnancy may occur. Advantages: 1. If they stay in place and cause no serious side-effects, they offer a cheap and practical means of considerably lowering fertility. 2. If adverse reactions occur, they disappear imme-diately the device is removed. 3. The method does not require privacy and toilet facilities 4. It does not lower fertility 5. If a woman decides she would like to have more children after removal of the device. |
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