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Choosing a contraception that’s right for u

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Unintended pregnancies with various contraceptive methodsNumbers given are pregnancies for every 1000 women during first year of use

Unintended Pregnancies

Adapted from Trussell et al, 2004.

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Fallopian tubeOvaries

Uterus

Cervix

Vagina

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Fallopian tube

Ovary

Uterus

Bladder

Clitoris

Urethra

Vagina

Cervix

Rectum

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How does it work?

• Causes changes in the lining of the uterus • Prevents the sperm from fertilizing the egg• Decreases the ability of the sperm to penetrate the cervical

mucus

Failure rate: 8 per 1000 women per year

I n t r a u t e r i n e d e v i c e ( I U D )

What is it?

• A T-shaped device with a copper wire around it • It is inserted into the uterus by a physician in the doctor’s office • Two threads may be felt in the vagina, so a woman can check for herself to ensure that the IUD is still in place

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What are the advantages?

1. Long-acting contraceptive; can be left in place for up to five years

2. No daily contraceptive routine required; device provides five years of

contraception 3. Does not contain estrogen4. Does not interfere with intercourse5. May reduce the risk of endometrial cancer 6. May be suitable for women who are breastfeeding

I n t r a u t e r i n e d e v i c e ( I U D )

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What are the disadvantages?

1. Possible side effects include irregular bleeding or spotting in the first months after insertion

2. Perforation of the uterus may occur at the time of insertion but this is rare

3. May increase menstrual bleeding or menstrual cramping4. May be expelled from the uterus. This happens in 2–10% of

IUD users5. Does not protect against STIs

I n t r a u t e r i n e d e v i c e ( I U D )

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Tubal occlusion “Having your tubes tied”

What is it?• A surgical procedure to close or block the fallopian tubes• Techniques include: • Laparoscopy – special instruments are inserted through two tiny incisions (less than 1 cm long) in the abdomen • Mini-laparotomy – also requires a small cut in the abdomen • Hysteroscopy – use of a thin telescope inserted into the uterus• Fallopian tubes may be blocked by using one of the following: • A clip or a ring • Cautery (an electric current) • Removing a small piece of each tube • Hysteroscopy for the insertion of tubal plugs (Essure)

How does it work?• The fallopian tube is blocked and therefore the sperm and egg cannot meet

Failure rate: 5 per 1000 women per year

Essure Cauterization

Clips

Ligation

Sites ofSterilization

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What are the advantages?

1. No daily contraceptive routine required; nothing to remember

2. Private3. Does not interfere with intercourse 4. No significant long term side effects

F e m a l e s t e r i l i z a t i o n

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What are the disadvantages?

1. Usually permanent and difficult to have reversed2. Possible post-sterilization regret 3. Possible short-term surgery-related complications:

abdominal discomfort; bruising, bleeding, or infection at the incision site; reaction to anesthesia

4. If pregnancy occurs, there is a higher chance that it will be an ectopic

pregnancy 5. Does not protect against STIs

F e m a l e s t e r i l i z a t i o n

s e x u a l i t y a n d u . c aF e m a l e c o n d o m

How does it work?• Placed in the vagina before intercourse • Lines the vagina completely, preventing direct contact between the penis

and the vagina and preventing the exchange of body fluids

• Sperm is trapped in the condom, which is thrown away after intercourse• A new condom should be used for each repeated act of intercourse

Failure rate: 210 per 1000 women per year

What is it? • Soft, disposable, polyurethane sheath • Available in drugstores without a prescription

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What are the advantages?

1. Available widely without a prescription2. No daily contraceptive routine or continued use required3. Woman remains in charge of placement and use 4. Protects against some STIs

F e m a l e c o n d o m

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What are the disadvantages?

1. Must be available at time of intercourse2. Requires proper insertion technique 3. Flexible inner ring may cause discomfort for some 4. More expensive than the male condom and not available in

all stores 5. Makes a noise during intercourse 6. May slip or break during intercourse 7. May be considered messy by some

F e m a l e c o n d o m

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How do they work?• A pelvic examination by a qualified health care professional is required for fitting diaphragms and cervical caps• Inserted into the vagina and fit over the cervix • When positioned properly, they block the entry to the uterus so sperm cannot enter and fertilize the egg• Spermicide should be reapplied for each repeated act of intercourse

Failure rate: 160-320 per 1000 women per year

What are they? • Intravaginal barrier methods that are used together with a spermicide • The diaphragm is a latex dome with a flexible steel ring around its edge (a non-latex diaphragm is also available) • The cervical cap is thimble-shaped silicone cap • Positioned into the vagina (diaphragm) or over the cervix (cervical cap) before intercourse • Must be left in the vagina for 6–8 hours after intercourse

Cervical Cap

Diaphragm

Diaphragm and Cervical Cap

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What are the advantages?

1. Does not contain hormones2. Can be used by women who are breastfeeding 3. Some protection against certain STIs

F e m a l e b a r r i e r m e t h o d s

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What are the disadvantages?

1. Must be available at time of intercourse2. Requires proper insertion technique 3. Does not protect against certain STIs 4. Cannot be used by people who are allergic to spermicides 5. Diaphragm may increase the risk of persistent urinary tract

infection 6. Cervical cap should not be used during menstruation7. May become dislodged during intercourse8. Cervical cap may cause vaginal odour and discharge

F e m a l e b a r r i e r m e t h o d s

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Sponge and Spermicides

What are they?• The sponge is a soft, disposable, polyurethane foam device impregnated with a spermicide• Spermicides disable sperm and come in several forms, including creams, jellies, tablets, suppositories, foams, and film

How do they work? Sponge

• Fits over the cervix• Traps and absorbs sperm to augment effect of spermicide• Spermicide in the sponge disables the sperm • Effective for up to 12 hours

Spermicides• Contain an ingredient that disables sperm • Should be used together with another form of contraception

Failure rate: 160-320 per 1000 women per year

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What are the advantages?

1. Does not contain hormones 2. Can be used by women who are breastfeeding3. Can be used by women who smoke4. Spermicide may provide added lubrication

F e m a l e b a r r i e r m e t h o d s

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What are the disadvantages?

1. Must be available at time of intercourse2. Does not protect against certain STIs 3. Cannot be used by people who are allergic to spermicides4. Requires proper insertion technique 5. Sponge users may experience vaginal irritation or infection 6. Spermicide must be inserted into the vagina in advance (time depends on product)7. If left in the vagina in excess of the recommended time,

symptoms of toxic shock syndrome may appear

F e m a l e b a r r i e r m e t h o d s

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Seminal vesicles

Vas deferens

Prostate gland

Penis

Epididymis

Testicle

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How does it work? • Fits over the erect penis • Acts as a physical barrier preventing direct genital contact and the exchange of genital fluids, so the sperm does not enter the uterus and fertilize the egg • A new condom is used for each repeated act of intercourse

Failure rate: 150 per 1000 women per year

What is it?

• A soft disposable sheath • Available in various shapes, sizes, thicknesses,

colours and flavours • Most are latex, but non-latex condoms are also available in polyurethane, silicone, and lambskin

M a l e b a r r i e r m e t h o d s

Male Condom

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What are the advantages?

1. Available widely without a prescription2. Inexpensive3. Latex condoms protect against STIs4. Allows the male partner to assume some responsibility for

birth control5. Both partners can participate in their use6. May help the wearer avoid premature ejaculation

M a l e b a r r i e r m e t h o d s

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What are the disadvantages?

1. Must be available at time of intercourse2. May slip or break during intercourse3. Must be stored and handled properly4. People with latex allergies cannot use latex condoms, but

may be able to use non-latex condoms

5. May reduce sensitivity for either partner6. May interfere with the maintenance of an erection7. May reduce spontaneity 8. Lambskin condoms do not protect against STIs

M a l e b a r r i e r m e t h o d s

s e x u a l i t y a n d u . c aM a l e s t e r i l i z a t i o n

Vasectomy

What is it?• A surgical procedure to close or block the vas deferens (the tubes that carry sperm to the penis)

How does it work?• The vas deferens are closed so that no sperm is released to fertilize the egg• Common techniques include: • Conventional vasectomy – one or two incision are made in the scrotum to reach the vas deferens • No-scalpel vasectomy – a puncture opening is made in the scrotum• Vas deferens are closed by: • Electric current (cauterization) • A mechanical method, such as a clip • Removal of a small segment of each tube• Another form of contraception is required until a semen analysis shows no sperm

Failure rate: 1.5 per 1000 women per year

Urethra

Site ofVasectomy

Vasdeferens

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What are the advantages?

1. No contraceptive routine required; nothing to remember2. Private3. Does not interfere with intercourse4. No significant long-term side effects5. Simple procedure6. Less invasive and more cost-effective than tubal ligation for

women7. Allows the male partner to assume some responsibility for

birth control

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What are the disadvantages?

1. Difficult to have reversed2. Possible post-sterilization regret 3. Possible short-term surgery-related complications: pain and

swelling; vasovagal reaction; infection at the incision site4. Does not protect against STIs5. Not effective immediately. Must do a follow-up sperm

analysis that shows no sperm are present in the semen

M a l e s t e r i l i z a t i o n

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What To Ask Your Healthcare Provider

Following are some questions you might want to ask regarding your sexual health. A good idea is to make a list before you visit.

Birth control related: How do I know what birth control method is best for me? How to take your method How to deal with missed pills, patches, rings, or injections What are the side-effects? Which are normal and how can I cope

with them.

General women’s health Should I get a mammogram? How do I know if I'm doing my breast

self-exam correctly? How often do I need a Pap smear or gynecological check-up? How do I know if my period is normal? Should I be tested for AIDS or other STIs?

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What Your Healthcare Provider May Ask You

Be prepared to answer questions about:

Medical history (surgeries, vaccines, menstrual cycle, etc) Medications you are taking Allergies Family history (medical conditions like diabetes, heart problems) Lifestyle Sexual practices

Don't be embarrassed to tell the truth or ask a question. They are professionals and the information is required to give you the best care

possible.