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Contraception

Contraception. Winter 2016 Potpourri. Contraception. Variety of methods Categorized by methodology Barriers Hormonal methods Fertility awareness methods Sterilization Contraceptive issues vary across countries Contraceptive methods in the U.S. ( Guttmacher Institute, 2010)

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Contraception

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  1. Contraception Winter 2016 Potpourri

  2. Contraception • Variety of methods • Categorized by methodology • Barriers • Hormonal methods • Fertility awareness methods • Sterilization • Contraceptive issues vary across countries • Contraceptive methods in the U.S.(Guttmacher Institute, 2010) • Contraceptive methods in the U.S., 1995 vs. 2006-10 (CDC) • Contraceptive prevalence (Excel, pdf map) across the world (United Nations, 2012) • Contraceptive prevalence by method (United Nations, 2011)

  3. Why Does Contraception Matter? • We (taxpayers) pay for many unexpected pregnancies • Rates of unintended pregnancy (Guttmacher Institute) • How much (Guttmacher Institute) • How much, #2 (Guttmacher Institute, published 2/2015)

  4. Sterilization

  5. Sterilization • Sterilization = permanent contraception • Women undergo tubal ligation or implant • Men undergo vasectomy • The second most common contraceptive method used in the United States (men’s and women’s methods combined) • No formalized data collection system exists • Data retrieved from surveys, questionnaires • Female sterilization: 700,000/year (emedicinehealth.com) • Vasectomies: 500,000/year (WebMD)

  6. Sterilization: Vasectomy • Vasectomy blocks sperm from traveling through the vas deferens, preventing sperm from mixing into semen • No glands or organs are removed • Effectiveness: 99%+ • Considered irreversible

  7. Sterilization: Vasectomy • Vas deferens must be isolated • The vas deferens can be cut and tied, clamped, cauterized, no scalpel technique • Another form of contraception must be used for a few months

  8. Sterilization: Vasectomy • Cost: $0-1000 (plannedparenthood.com) • Not currently covered via Affordable Care Act (arhp, 1/14) • Planned Parenthood may provide no- or low-cost vasectomies; state plans may offer benefit (Oregon, e.g.) • Side effects: bruising, sensitivity/pain, sperm leaking from tubes may lead to small lump (usually clears up on its own), antibodies to sperm may develop, reducing chances of fertility in a reversal • Complications: rare, usually associated with infection (fever, pus/blood from incision site, swelling, pain); ends of tubes may grow back together (very rare); decreased sexual desire (4 out of 1000 cases per Planned Parenthood) - no apparent physical cause

  9. Sterilization: Vasectomy • Animation (BUPA Health via YouTube, 2:36) • Video (vasectomymedical.com)

  10. Sterilization: Tubal Ligation • Surgical technique • Animation (1:35+) • Close fallopian tubes, preventing egg from traveling to uterus, preventing sperm from reaching egg • Neither organs nor glands are removed • Effectiveness: 99%+ • Considered irreversible

  11. Sterilization: Tubal Ligation • Tubal sterilization: • Tubes can be tied and cut (Pomeroy technique) • Tubes can be cauterized • Tubes can be clipped, clamped • These incision methods often performed after childbirth/abortion

  12. Sterilization: Tubal Ligation • Cost: $0-3000 • Side effects: thought by many to be rare; hormonal imbalance may lead to increased menstrual bleeding, cramping; adhesions • Complications: infection, internal bleeding, ectopic pregnancy • Before/after photos (private Flickr account)

  13. Sterilization: Implants • Non-incision method • No general anesthesia • Under an hour • Coils inserted into fallopian tubes • In following months, coils and tissue grow together, forming barrier to prevent sperm from reaching egg

  14. Sterilization: Implants • Side effects: expulsion of coil inserts, risk for ectopic pregnancy, cramping, menstrual changes, nausea/vomiting • Animation (YouTube) • Thousands of complaints regarding implant complications reported to FDA (NY Times, 2015)

  15. Intrauterine Contraceptives (IUC’s) • IUC’s are made of flexible plastic, available only through prescription • Three types (U.S.) • ParaGard (copper) • Mirena (hormone) • Skyla (hormone)

  16. IUC’s: ParaGard • ParaGard contains copper • Copper prevents sperm from fertilizing an ovum • Appears to be disagreement on whether ParaGard also causes inflammatory response in uterine cavity • Copper may also affect the ovum, reducing its ability to become fertilized (Medscape) • Amount of copper released is less than needed in daily diet • Copper intolerance or insensitivity would preclude use of ParaGard

  17. IUC’s: Paragard • Requires insertion into uterus by healthcare provider • Takes only a few minutes • Insertion may cause cramping, dizziness • Once inserted, may remain in place for ten years • Patient should not feel IUD • Since no hormones present, monthly cycle should remain unchanged • Insertion video • Effectiveness: 99%+ against pregnancy • Requires monthly checking for IUD slippage

  18. IUC’s: ParaGard • Side effects: heavier and longer periods, cramping, spotting in between periods • May lessen after a few months on ParaGard • Complication risks: pelvic inflammatory disease shortly after insertion, perforation of uterus, expulsion • Copper may provide protective benefit against endometrial cancer • Cost: $0-1000 (Planned Parenthood)

  19. IUC’s: Mirena • Hormonal method (pregestogen) • Intrauterine device • Lasts for five years • Mirena: • Prevents sperm from fertilizing ovum • Prevents release of egg • Changes uterine lining

  20. IUC’s: Mirena • Insertion: Similar to ParaGard • Effectiveness: 99%+ against pregnancy • Cost: $0-1000 (Planned Parenthood, Bedsider.org) • Side effects: Abdominal cramping (10% of users during first few months), acne, breast tenderness, headache, mood changes, back pain • May lessen after a few months • As use continues, less menstrual bleeding • Complication effects: ovarian cysts, pelvic inflammatory disease shortly after insertion, perforation of uterus, expulsion

  21. IUC’s • Internal Birth Control- IUD’s (via Youtube) • Insertion of IUC (Medialvideos.us)

  22. Barrier Contraceptive Methods • Physical barriers • Prevent sperm from entering cervix • Block sperm from fertilizing ovum

  23. Barrier Contraceptive Methods • Historically, pessaries used • Objects or substances inserted into vagina • Pregnancy prevention effectiveness • Infection effectiveness • Current barrier methods: spermicide, male condom, female condom, diaphragm, cervical cap, sponge

  24. Barriers: Spermicide Nonoxynol-9 • Ingredient in spermicides, may be included in condom packaging • Originally thought nonoxynol-9 protected against HIV • In late 1990’s, early 2000’s, nonoxynol-9 was no longer thought to provide that protection • Among commercial sex workers in Africa, Thailand • Frequent use • Nonoxynol-9 may increase risk for disease transmission • Increases vaginal irritation, which can lead to lesions/sores • Lesions typically result in disease transmission vulnerability • 2007: FDA required manufacturers to provide warning • Effect of Coke on Sperm Motility • Mythbusters (1:04-4:00)

  25. Contraception: News, Interesting Info, Future, Past • Silk Parasol (path.org, Silk Parasol via product website) • Proposed panty condom in Uganda (monitor.co.ug, 2015) • Caya – new diaphragm, 2015 (0:30-2:35, product website) • RAPE-AXE female condom, reportedly not available (YouTube)

  26. Contraception in the Future • Nestorone • Estrogen and progestin • Gel or spray • Population Council Announcement, 2010 • Phase III trials (Antares Pharma) • Eventual availability? • New vaginal ring • 90 days • Progestin + microbicide • Microbicide = drug to reduce HIV, herpes, HPV • The Ring Study & ASPIRE • Press release – reduction of HIV by ~30% (2/2016)

  27. Contraception: The Future • Vasalgel (human trials in 2016-2017, per Parsemus Foundation) • Similar to India’s RISUG:Reversible Inhibition of Sperm Under Guidance • Contraceptive method for men, not available in U.S. • Injection into vas deferens of male (video, wired.com, :34) • Vasalgel disrupts membranes of sperm so they cannot fertilize • One injection to last 10 years • Marketing challenges

  28. Contraception: The Future • Male pills (5-10 years) • Gendarussa – plant-based, interferes with sperm’s ability to fertilize egg • Video (via YouTube, 8:00) • Anti-Eppin – interferes with sperm motility • “Clean sheets” pill - Inhibit ejaculation but allow orgasm • Short-term (<24 hours) method via pill, or longer-term via implant • If no ejaculate, STI risk may decrease

  29. Contraception: The Past • Male Contraceptive: Heat • Prolonged heat exposure can impair sperm production in testes • Ancient method • Effectiveness? • 116 degree bath • 45 minutes • Every day • Three weeks

  30. Contraception: Impact of Heat on Sperm

  31. Contraception: Impact of Heat on Sperm Dada, R, Gupta, NP, & K. Kucheria. Deterioration of Sperm Morphology in Men Exposed to High Temperature. Journal of the Anatomical Society of India. Vol. 50, No. 2 (2001-07-2001-12)

  32. Contraception: Impact of Heat on Sperm • Upper left: coiled tail • Upper right: bent tail • Lower left: double head • Lower right: triple head Dada, R, Gupta, NP, & K. Kucheria. Deterioration of Sperm Morphology in Men Exposed to High Temperature. Journal of the Anatomical Society of India. Vol. 50, No. 2 (2001-07-2001-12)

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