Birth control can be
defined as any method used to prevent pregnancy. Devices, drugs, sexual
practices, agents, surgical procedures can be used to prevent conception or
pregnancy. Birth control methods are available for both men and women. Some
methods temporarily prevent pregnancy while others are permanent
(sterilization). Birth control methods can be categorized into: natural
methods, devices, injections, pharmaceutical types, and surgical types.
A. Natural Methods
1. Sexual Abstinence
Sexual
abstinence entails refraining from sexual intercourse. It is the most effective
form of birth control. The main difference between abstinence and other forms
of birth control that prevent pregnancy irrespective of the exchange of sexual
fluids is that abstinence prevents semen from coming in contact with the
vagina. Sexual abstinence is 100% effective in preventing pregnancy and
sexually transmitted diseases (STDs). Full sexual abstinence refers to not
engaging in sexual intercourse of any kind, including vaginal, anal and oral
sex. Sexual activity that cannot result in pregnancy is called outercourse.
Outercourse includes: kissing, massage, masturbation, dry humping, anal sex,
and oral sex. Generally, outercourse is 100% effective at preventing pregnancy.
Nonetheless, outercourse can result in pregnancy if sperm accidentally leaks
into the vagina during outercourse activities. Outercourse is not as safe
as abstinence as the transmission of STDs is still possible through non-vaginal
intercourse, such as through oral and anal sex. Periodic abstinence is not 100%
effective at preventing pregnancy. It entails abstaining from sexual
intercourse during the time of the month when a woman is most fertile.
The
advantages of abstinence as a method of contraception are: absence of hormonal
side effects, no financial cost, 100% effectiveness in the prevention of STDs
and unwanted pregnancies. Disadvantages of abstinence as a method of
birth control include the following:
- Avoiding sex can be hard for some people. If you plan on abstaining but end up having vaginal sex, it could result in pregnancy.
- Some types of outercourse like anal and oral sex can spread STDs.
- Many people find it hard refraining from vaginal sex once they engage in other sexual activities.
2. Withdrawal
Otherwise
known as coitus interruptus, the withdrawal method is the practice of
withdrawing the penis from the vagina and away from the lady's external
genitals before ejaculation to prevent pregnancy. The aim of withdrawal is to
prevent sperm from entering the vagina. This method requires a lot of
self-control. It is not a reliable form of birth control as pre-ejaculation
fluid may contain sperm. Also, the withdrawal may not be properly timed, and
does not offer protection from STDs. It is important that the man urinates and
cleans the tip of his penis if he is to have sex again (within a short space of
time). It is important that the woman takes emergency contraception if the
withdrawal wasn't properly timed and she is in her fertile window, in order to
avoid pregnancy.
B. Barrier methods/Devices
1. Male condoms
Condoms and
abstinence are the only methods of contraception that can both prevent
pregnancy and protect against STDs. Male condoms are worn on the penis, and are
98% effective at preventing pregnancy when used correctly during vaginal, anal
and oral sex. The man's penis should not touch the woman's vagina before he
puts on the condom as semen can come out of the penis prior to ejaculation.
Take note of the following facts about condoms:
- Condoms get expired and must not be used once expired.
- Condoms can split or tear if not used properly.
- Condoms should be stored in places that are neither too hot nor too cold, and should be kept away from sharp or rough surfaces that could tear them or wear them off.
- A condom must not be used more than once.
- A condom can slip off during sex. If this happens, emergency contraception and an STD check would be required.
- The man has to pull out right after ejaculation and before his penis loses the erection, so that the condom remains firm and semen doesn't leak.
- Oil-based lubricants can damage latex and polyisoprene condoms, but are safe to use with polyurethane condoms. Water-based lubricants on the other hand are safe to use with all condoms.
2. Female condom
Female
condoms are worn inside the vagina, and are 95% effective in preventing
pregnancy when used correctly. Female condoms prevent the transmission of STDs
as well. It prevents pregnancy by preventing semen from getting into the
uterus. The female condom is a soft, loose-fitting pouch with a ring on each
end. The female condom should be placed inside the vagina before there's any
contact with the penis. It can be inserted in the vagina up to eight hours
before sex. It should not be reused. Female condoms could be less effective if
damaged by sharp fingernails or jewelry. It could also be less effective if the
penis enters between the side of the vagina and the condom. Female condoms are
not as widely available as male condoms and are generally more expensive than
male condoms. Here's how a female condom should be used, according to
mayoclinic.org:
- Open the package carefully. Don't use your teeth or fingernails, which could tear the condom.
- Consider using additional lubrication. You can apply additional water-based or oil-based lubricant to the condom to make it easier to insert and to minimize noise during sex.
- Insert the female condom. Squeeze the ring at the closed end of the pouch with your middle finger and thumb and insert it into your vagina like a tampon. Place your index finger inside the condom and push the ring up as far as it will go.
- Don't allow the condom to twist. Make sure the outer ring remains outside the vagina, extending about 1 inch (or about 2.5 centimeters) beyond the labia.
- Guide the penis into the female condom. Make sure the penis doesn't slip between the vagina and the outer surface of the female condom. During sex, make sure the outer ring of the condom doesn't get pushed into the vagina.
- After sex, remove the female condom carefully. Twist the outer ring so that the semen is contained in the condom and gently pull the device out of your vagina. Dispose of the female condom in the trash — not the toilet.
3. Contraceptive sponge
It is a soft,
round piece of plastic foam with a loop for removal. The contraceptive sponge
makes use of the barrier method and the spermicide nonoxynol-9. It is to be inserted deep into the vagina before sexual
intercourse to prevent pregnancy. It can be inserted up to 24 hours before sex,
and the user can have sex multiple times while using the same sponge. However,
the user must wait for at least six hours after sex before removing it. The
sponge blocks sperm from fertilizing an egg by covering the cervix. It also
releases spermicide to kill sperm that approach the cervix. It can trap sperm
as well. The following are the disadvantages of using the contraceptive sponge:
- It is unsafe to use while menstruating.
- It doesn't protect against STDs.
- The insertion and removal of the sponge can be messy and difficult.
- The sponge or spermicide it contains can irritate the vagina, which increases your risk of contracting an STD.
The failure rates for the contraceptive sponge, according to
healthline.com are:
- 9% for women who haven’t given birth and use the sponge correctly every time,
- 12% for women who haven’t given birth and don’t use the sponge correctly every time,
- 20% for women who have given birth and use the sponge correctly every time,
- 24% for women who have given birth and don’t use the sponge correctly every time.
4. The diaphragm
A diaphragm
is a latex-based or silicone-based reusable cap or dome-shaped cup that fits
over the cervix. Diaphragms are 94% effective in preventing pregnancy when used
correctly and used with spermicide. According to nhs.uk, a diaphragm is less
effective if:
- It is damaged - for example, it's torn or has holes,
- It is not the right size for you,
- You use it without spermicide,
- You don't use extra spermicide with your diaphragm or cap every time you have more sex
- You remove it too soon (less than six hours after the last time you had sex),
- You use oil-based products, such as baby lotion, bath oils, moisturizer or some vaginal medicines (for example, pessaries) with latex diaphragms - these can damage the latex.
- have recently had surgery to the cervix,
- have poor vaginal muscle tone,
- have a history of toxic shock syndrome,
- frequently have urinary tract infections,
- have given birth within the last six weeks,
- have recently undergone abortion after the first trimester,
- have latex, silicone or spermicide sensitivity.
5. Cervical cap
This is a
device that prevents sperm from entering the uterus. It is inserted into the
vagina and fits tightly over the cervix. A strap is attached to the cervical
cap to help with removal. The cervical cap must be used with spermicide to
effectively prevent pregnancy. It should not be used during any kind of vaginal
bleeding, including menstruation. Note that the cervical cap does not offer
protection from STDs. The cervical cap has a 16% failure rate when used by
women who have never been pregnant or given birth vaginally. It has a failure
rate of 32% when used by women who have given birth vaginally. The difference
owes to the fact that the vagina and cervix are stretched by giving birth
vaginally, so the cervical cap may not fit as well.
C.
Contraceptive injections
The
contraceptive shot/Depo-Provera shot is a manmade hormone called medroxyprogesterone (a hormone
similar to progesterone). It is injected in the arm or butt. It starts to work
immediately if you take it within the first five days of your period. If taken
on any other day of your cycle, you'll need to use supplementary contraception
for seven days. The Depo-Provera shot is 99% effective in preventing pregnancy, and
works for up to 12 or 14 weeks. The contraceptive steadily releases progestogen
into your bloodstream which prevents ovulation. What's more, it thickens
cervical mucus, which makes it difficult for sperm to swim to the cervix, and
thins the endometrium, making it difficult for implantation to take
place. Disadvantages of the contraceptive injection include:
Periods becoming heavier, more irregular, lighter,
shorter or stopping altogether
Side effects such as acne, hair loss, bloating,
nervousness, depression, loss of bone mineral density, decreased sex drive,
headaches and mood swings may be experienced. Disadvantages of the contraceptive injection include:
- It doesn't offer protection against STDs.
- Weight gain is possible.
- It is not suitable if you intend to have a baby in the near future, given that it can take up to a year for fertility to return to normal after the shot.
D. Pharmaceutical types
1. The intrauterine device (IUD)
The IUD is
used by 10% of people on birth control. There are two types of IUDs - hormonal
IUDs and nonhormonal or copper IUDs. Hormonal IUDs release a synthetic version
of the hormone progesterone - progestin - which thickens cervical mucus and
makes it almost impossible for sperm to reach the egg. It also prevents
implantation by thinning the lining of the uterus. Hormonal IUDs can prevent
pregnancy for three to six years, depending on the brand.
Nonhormonal
or copper IUDs prevent pregnancy by damaging sperm. They also create an immune
response that stops the development of healthy eggs and destroy
health eggs that do develop. The copper IUD can prevent pregnancy for 10
years and more. Non-hormonal IUDs are not suitable for women who have an
allergy to copper, have painful periods, endometriosis or suffer from Wilson's
disease. Copper IUDs can cause heavier periods.
2. Contraceptive pill
Otherwise
called oral contraception, contraception pills are to be taken daily, at the
same time every day. Contraceptive pills work by releasing hormones that
prevent the ovaries from releasing eggs. The hormones in question also thicken
cervical mucus, preventing sperm from swimming to the egg. There are two types
of contraception pills - combination pills and progestin-only pills.
Combination pills contain synthetic forms of estrogen and progestin. There are
three types of combination pills - monophasic pills, multiphasic pills and
extended-cycle pills. With extended-cycle pills, you have your period only
three to four times a year. Progestin-only pills also called the minipill
contain progestin only.
- St. John's wort
- rifampin (an antibiotic)
- some HIV medications like Iopinavir and Saquinavir
- some antiseizure medications such as Carbamazepine and Topiramate.
- Vomiting or diarrhea also reduces the pill's efficacy.
Side effects
of contraceptive pills include: nausea, breast tenderness, decreased sex drive,
and bleeding between periods.
The
advantages of combination pills include protection against: severe menstrual
cramps, heavy periods, endometrial and ovarian cancer, non-cancerous breast
tumors, osteoporosis, acne, ectopic pregnancies, and anemia.
3. Contraceptive patch
The
transdermal contraceptive patch is a small, skin-on patch that is worn on the
skin of the belly, upper arm, butt or back. It is changed every three weeks as
the patch is used on a four-week cycle (three weeks on and one week off).
During the fourth week, you have your period. The patch releases hormones that
prevent pregnancy. This method has a 91% efficacy rate.
4. Vaginal ring/birth control ring
This is one
of the most effective birth control methods, with over 99% efficacy rate. The
vaginal ring is a small, soft plastic ring that is placed in the vagina. It
releases estrogen and progestogen into the bloodstream, preventing ovulation
each month. Each ring is used for 21 days, then removed for a seven-day
ring-free break. You cannot get pregnant during the ring-free break. A new ring
is then worn for another 21 days.
5. The implant
The birth control
implant is inserted under the skin of your upper arm. The implant slowly
releases a progestin hormone called etonogestrel into the body which prevents
the release of eggs from the ovaries and thickens cervical mucus, thereby
inhibiting pregnancy. The implant can stay in place for up to but no longer
than three years. Fertility returns as soon as the implant is removed. Its side
effects include: headache, breast pain, nausea, weight gain, ovarian cysts and
an infection at the insertion site. Like most contraceptives, the implant does
not offer protection against STDs. It has a very high efficacy rate - over 99%.
6. Emergency "morning after" pill
This is not
and should not be used as regular contraception. The emergency contraception
pill contains levonorgestrel which can prevent pregnancy after unprotected sex.
It either prevents or delays ovulation or interferes with the fertilization of
an egg, or prevents implantation of a fertilized egg. Note that emergency
contraception does not stop the development of a fetus once the fertilized egg
is implanted in the uterus. If taken within 72 hours after unprotected
sex, levonorgestrel
can reduce the risk of pregnancy by up to 89%.
E. Surgical methods
Surgical birth
control/sterilization methods are considered to be permanent forms of
contraception and is intended for men and women who do not intend to have
children in the future. In some cases, sterilization can be reversed but success
is not guaranteed. Permanent methods of contraception include tubal ligation
(tubes tied), use of tubal implants (hysteroscopic
sterilization),
hysterectomy and vasectomy.
Classification of hysterectomy
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