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Chapter 6: Birth Control. For use with Human Sexuality Today (4 th Ed.) Bruce King Slides prepared by: Traci Craig. Chapter Overview. Teen Pregnancy in the US Worldwide need for contraception Myths and Ineffective Methods Fertility Awareness Methods Barrier Methods IUD Hormonal Methods

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Chapter 6 birth control l.jpg

Chapter 6: Birth Control

For use with Human Sexuality Today (4th Ed.)

Bruce King

Slides prepared by: Traci Craig


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Chapter Overview

  • Teen Pregnancy in the US

  • Worldwide need for contraception

  • Myths and Ineffective Methods

  • Fertility Awareness Methods

  • Barrier Methods

  • IUD

  • Hormonal Methods

  • Sterilization


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Teen Pregnancy

  • Rate peaked in 1991, but US rate is twice as high as England and Canada and 8 times as high as Japan.


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Fathers?

  • Half of the fathers are 20 years old or older, when mothers are 14 to 17.

  • Getting a woman pregnant a sign of masculinity.

  • No responsibility for ‘acquaintances’

  • ½ spend time with the child 1/5th contribute money

  • Do poorly in school, lack long-term goals, impoverished backgrounds, socially deviant behavior.


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Babies

  • High-risk babies with health problems—lack of prenatal care

  • Children of teen parents more likely to be victims of child abuse and neglect

  • Girls born to teen mothers are likely to experience economic dependence and an inability to escape poverty

  • Often become teen parents themselves.

  • Seek emotional closeness younger due to emotional deprivation from their own teen mother.


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Birth Control

  • Procreation only attitudes lack of contraception

  • Margaret Sanger watched a woman die from trying to self-induce abortion, founded Planned Parenthood.

  • 2/3rds of Americans in 1936 believed contraception should be made available to those who wanted it.

  • Last law prohibiting the sale of contraceptives to married couples was repealed in 1965, to unmarried couples in 1972.


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World Wide Contraception

  • Overpopulation: limited natural resources

  • World population: 6 billion 1999


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Overpopulation

  • UN estimates 9-10 billion people by 2050

  • Half of children born today are at poverty levels

  • To support this population, ALL cropland would have to produce 2.8 tons of grain per acre, per year.

  • Mass starvation: Ethiopia, Somalia, Asia, and in Brazil alone 2,000,000 children are abandoned

  • Indiainfanticide


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Overpopulation

  • China1982 forced birth control, no more than 1 child, pressure to abort second children

  • US Birth rates fell in the 60s. US population has stabilized.

  • In 20 developed countries, now below the replacement level.


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Birth Control Methods

  • 85-90% of couples would conceive within 1 year if they did not use any contraception

  • Perfect-use and Typical-use—1st year of use


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Contraceptive Myths—These aren’t true.

  • Males drinking Mountain Dew/Splurge before sex reduce sperm count to zero.

  • Females douching with coca-cola or ice water prevents pregnancy.

  • You can’t get pregnant the first time, or if you don’t kiss, or if the female is on top, or standing up.

  • If the woman doesn’t have an orgasm, she can’t get pregnant.


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Ineffective Methods

  • Coitus Interuptus (withdrawal)—the man withdraws the penis from the vagina just before ejaculation.

  • 13% of high school students rely on this method.

  • First year of use: 20% pregnancy rate

  • Also possible to get pregnant if the man ejaculates near a woman’s vagina—heavy petting.

  • Not very physically or emotionally satisfying, but perhaps better than nothing.


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Ineffective Methods

  • Douching after intercourse.

  • Sperm can make it to the cervix quickly and in fact the pressure caused by douching can force sperm further into the cervical opening.

  • Pregnancy rate: 40%

  • Increases risk of PID.


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Ineffective Methods

  • Breast feedingcauses the release of FSH and LH and prevents normal menstrual cycles.

  • In the first 6 months of breast feedingless than 2% pregnancy rate.

  • After 6 months the pregnancy rate rises.

  • Only works if the baby is fed on demand.

  • Less effective in America where women are not likely to be able to nurse the infant on demand.


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Abstinence

  • 100 percent effective and a recent decline in teens having sex.

  • Teaching abstinence

    • “Education Now Babies Later”: no effect on teen’s sexual decisions.

    • “Abstinence-plus”: also teaches contraception and is very effective in reducing teen pregnancy

  • Denmarkcomprehensive sex ed in it’s schools

  • Denmark teens just as sexually active as American teens, but the Denmark teen pregnancy rate is lowest in the world.


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Fertility Awareness: Abstaining during ovulation.

  • Rhythm Method/Natural Family Planning

  • Not opposed by the Catholic Church and EVANGLICAL Protestant denominations.

  • 3 variations of this method.

  • Pregnancy can only occur when an egg is present in the first 24 hours or so after ovulation.

  • Identification of ‘safe days’ and ‘unsafe periods’


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Fertility Awareness

  • Only works for women with regular cycles.

  • Sperm can live for 3-5 days.

  • Day of ovulation pregnancy rate is 12%

  • Calendar method

    • Subtract 18 from the length of the shortest cycle

    • Subtract 11 from the length of the longest cycle

    • The results are the days you should abstain

  • Tests Human Willpower & 40-45% failure rate


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Basal Body Temperature

  • A woman’s resting temperature rises by a few tenths of one degree 24 to 72 hours after ovulation.

  • Abstain from end of menstruation until 4 days after rise in temperature.

  • Temperature should be taken first thing in the morning before doing ANYTHING.

  • Some women have irregular basal body temp

  • Test of willpower and 25% pregnancy rate.


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Billings Method

  • Changes in the cervical mucus: changes from white to clear a day or two before ovulation.

  • Douching makes this ineffective

  • Abstain from end of menstruation until 4 days post change in consistency (wait until discharge is white again)

  • 16-20% pregnancy rate for typical use

  • 17 days per month of abstinence could be trying

  • Combining Billings and Basal Body Temp is called sympto-thermal method and is better than either method alone.


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Spermicides

  • Nonoxynol-9 or octoxinol-9: foams, jellies, creams, and film (VCF)

  • Put into the vagina shortly before intercourse.

  • Typical use rate is 26%, as low as 6% with proper use.

  • Reduce gonorrhea, chlamydia and cervical cancer.

  • Increase risk of HIV, and urinary tract infection.

  • 1 in 20 people experience that spermicides burn or irritate the vagina or penis.


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Barrier Methods: Male Condoms

  • Latex, lamb intestine, polyurethane or synthetic elastomers condoms prevent sperm from meeting egg.

  • Highly effective against STDs

  • American men are often reluctant to use them.

  • Condoms come rolled up, dry or lubricated, and in different sizes.


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Barrier Methods: Male Condoms

  • Put the condom on prior to intercourse.

  • Unroll over penis (pull back foreskin if uncircumcised).

  • Hold on to base of condom at withdrawal.

  • Use only once, do not store in warm places, check expiration date.

  • Do not use with oils, lotions or petroleum jelly.


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Barrier Methods: Male Condoms

  • With spermicide the theoretical failure rate is less than 1%.

  • Breakage rate is 1-3% with human vaginal intercourse, higher for anal intercourse.

  • Two condoms reduces breakage rate to 0.

  • Breakage more likely in men who do not use condoms regularly.


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Male Condoms and Reluctance

  • Men believe it reduces sensitivity (only slightly and a pro)

  • Polyurethane condoms are only half as thick as rubber and transmit heat better.

  • Allergy—1-3% of people are allergic to rubber.

  • Loss of spontaneity

  • Minor annoyance compared to diaphragm, cervical cap, etc.

  • Women buy 40-50% of condoms


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Barrier Methods: Female Condoms

  • Intravaginal, 7” long polyurethane bag held in place by two flexible rings. Insert the close ended ring against the cervix, outside ring partially covers the labia.


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Barrier Methods: Female Condoms

  • Thinner than male condoms

  • No health concerns or adverse effects

  • Women can protect themselves even when partner refuses to use male condoms.

  • Pregnancy rate in first year is 5% or less.


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Barrier Methods: Diaphragm

  • Dome shaped rubber cup with a flexible rim that fits over the cervix.

  • Only about 1.7% of American women use this method.

  • Fitted by a health care worker, prescription given for a diaphragm that fits her.

  • Requires instructions and coaching on proper use.


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Barrier Methods: Diaphragm

  • Use with spermicidal jelly on inside of diaphragm and rim.

  • Insert no more than 2 hours prior to sex.

  • Leave in for 6-8 hours to ensure there are no more live sperm. Do not leave in more than 12 hours.


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Barrier Methods: Diaphragm

  • Pregnancy rate is 6%, typical use is 15%.

  • Not for women with a history of urinary tract infection. Should not use during menstruation or if there is abnormal vaginal discharge.

  • Detract from oral-genital relations.


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Barrier Methods: Cervical Cap

  • Made of latex rubber or plastic and smaller and more compact than a diaphragm.

  • Used with a small amount of spermicide.

  • Fits over cervix via suction.

  • Insertion and removal more difficult than for diaphragm.

  • After intercourse, make sure it is in place and hasn’t been dislodged.


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Barrier Methods: Cervical Cap

  • 1st year failure rate is 18%.

  • May have adverse effects on cervical tissue.

  • More effective for women who have not given birth.


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Barrier Methods: Contraceptive Sponge

  • Most popular over the counter method prior to the production stop in 1995.

  • New sponge by new company.

  • Polyurethane contraceptive sponge, 2” in diameter and 1” thick, containing spermicide. Blocks cervical opening and kills sperm.


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Contraceptive Sponge

  • Does not require pelvic exam.

  • Easy to insert

  • Moisten with tap water and insert deep into the vagina.

  • Can be left in 24 hours—no need to add more spermicide

  • Small loop enables removal for disposal.

  • Some women report mild irritation (6%)

  • Actual use rate is 17-20%.

  • More effective in women who have not given birth.


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IUD

  • Intrauterine Device

  • Numerous health problems with early IUDs and taken off the market.

  • Prevent implantation of a fertilized egg

  • However, studies show primarily prevents fertilization by their effect on sperm transit.

  • Copper or progesterone coating which impair sperm passage.


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IUD

  • Body tries to expel the device from the uterus.

  • Added thread so women could check to for dislodging transmission of bacteria and viruses

  • Heavier and longer menstrual flow.


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The IUD Today

  • Progestasert T and Copper T have a single filament polyethylene stringdo not increase PID risk.

  • Less than .8 percent of contraceptive users chose the IUD in 1995.


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Hormonal Methods

  • One of the most popular reversible method of contraception. Failure rate is 3%.

  • Not immediately effective—it takes one full cycle to be effective.

  • Various types:

    • Combination pills

    • Minipill


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Hormonal Methods

  • Contain synthetic progesterone and estrogen.

  • Prevents ovulation by stopping release of FSH and LH from pituitary

  • Keeps uterine lining thin and cervical mucus thick.


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Hormonal Methods

  • Minipill contains only progestins.

    • Inhibits development of endometrium

    • Keeps cervical mucus thick

    • Women who are breastfeeding or cannot tolerate other side effects.

  • Today’s combination pills have 50 micrograms of estrogen (compared to 150 micrograms in 70s and 80s).


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Hormonal Methods

  • Side Effects: nausea, constipation, breast tenderness, bloating, emotional depression

  • Most diminish within a few months.

  • Increased susceptibility to yeast infection.

  • Smoking and taking the pill increase risk for cardiovascular problems.

  • For nonsmokers, the risks associated with the pill are less than those associated with pregnancy and childbirth.


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Hormonal Methods

  • Lowers risk for ovarian cancer

  • Decrease in number of benign breast tumors.

  • Reduces ratse of ovarian cysts, rheumatoid arthritis, and PID.

  • Reduces PMS, pain and bleeding and improves acne.


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Depo-Provera

  • Progestin shot lasts for 3 months and prevents ovulation by blocking FSH and LH from being released.

  • Pregnancy rate of less than 1%

  • Side effects: menstrual irregularity, weight gain (15 lb), tiredness, weakness, nervousness, dizziness, headache.

  • Lunelle—new shot with estrogen & progesterone.


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Norplant

  • Hormonal method of protection for 5 year period.

  • Six flexible silicon tubes are inserted under the skin of the upper arm in a fan like pattern.

  • Tubes release synthetic progesterone inhibits LH surge and ovulation.

  • 15-30 minute procedure


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Norplant

  • Failure rate is 2 in 1000.

  • In the first year, side effects include irregular bleeding, spotting, weight gain, headache, nervousness, dizziness, nausea, breast tenderness, and acne.

  • Should not be used by women with liver disease or tumors, breast cancer, or a history of blood clots.


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Emergency Contraception

  • 3 methods

  • Yuzpe method: synthetic estrogen and then levonorgestrel within 72 hours and again 12 hours later—75% effective. Not abortion.

  • Progestin only pill as well—90% effective.

  • Implantation of IUD—hard to find doctor willing to take the time to do this.


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Voluntary Sterilization

  • More Americans rely on sterilization than any other method (28% female, 11% male).

  • Married couples use this method after last planned child.

  • Unmarried women who are also not planning on future children.


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Vasectomy

  • Men—Vasectomy

    • Small incision in the scrotum under local anesthetic. Tying off and cutting the vas deferens. Takes 20 minutes.

    • China—no scalpel method, skin of scrotum is pierced with a sharp instrument. 10 minutes. Less bleeding and infection.


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Vasectomy

  • Does not interfere with production of hormones or sperm.

  • Sperm that are already past the vas deferens must be eliminated before vasectomy is effective (12-16 ejaculations).

  • Men who have been sterilized still ejaculated, the semen does not contain sperm.


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Tubal Ligation

  • Tying off and/or cutting the fallopian tubes. Prevent passage of egg and sperm. Eggs absorbed by woman’s body.

  • All require general anesthesia, but no need for prolonged hospital stay.


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Tubal Ligation

  • Minilaparotomy: 1 inch incision in abdomen fallopian tubes tied up and cut.

  • Laparoscopy is done via video transmitted via inserting a tube-like camera and surgical instruments into the belly button to cut the fallopian tubes.

  • Culpotomy: cutting of fallopian tubes is done through small incisions in the vagina.


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Sterilization Reversal

  • Not a guarantee

  • Microsurgery required to tie the vas deferens or fallopian tubes back together

  • Success rates are better for reversing vasectomy.

  • Studies show male sterilization is a better option for a couple in terms of expense, complication rates, and regret.


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Unwanted Pregnancy:Final Options

  • Keeping and raising a baby—higher than normal levels of frustration for women who may stop education to raise the child.

  • Adoption—long-lasting adjustment problems for the biological mother/father.

  • Abortion—lots of controversy regarding the issue.


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Future Technology

  • More female condom options

  • Unisex condom garment

  • Lea’s shield

  • Disposable cervical cap

  • Male pill

  • Vaccination

  • US is behind other countries in developing contraceptives.