Pharma Tips

Terminal Methods For Contraceptive

By: Pharma Tips | Views: 6639 | Date: 03-Jun-2011

Voluntary sterilization is a well-estabished contraceptive procedure for capsules desiring no more children.it is a one time method, it does not require sustained motivation of the user for its effectiveness, provides the most effective protection against pregnancy.

Voluntary sterilization is a well-estabished contraceptive procedure for capsules desiring no more children.it is a one time method, it does not require sustained motivation of the user for its effectiveness, provides the most effective protection against pregnancy.

Male sterilization
Male sterilization or vasectomy being a comparatively simple operationcan be performed even in primary health centres by trained doctors under local anaesthesia. When carried out under strict aseptic conditions, it should have no risk of mortality.In vasectomy, it is customary to remove a piece of vas at least 1 cm after clamping. The ends are ligated and then folded back on themselves and sutured into portion so that the cut ends face away from each other.This will reduce the risk of recanalisation at a later date.It is important to stress that the acceptor is not immediately sterile after the operation, usually until approximately 30 ejaculations have taken place. During this intermediate period another method of contraception must be used.If properly performed, vasectomies are almost 100 percent effective. [35]
Female sterilization [36]
It can be done as an interval procedure, postpartum or at the time of abortion. Two procedures have become most common,they are

Laparoscopy:

This is a technique of female sterilization through abdominal approach with a specialized instrument called “laparoscope”. The abdomen is inflated with gas(carbon dioxide, nitrous oxide or air) and the instrument is introduced into the abdominal cavity to visualize the tubes. Once the tubes are accessible, the Falope rings are applied to occlude the tubes. This operation should be undertaken only in those centres where spwcialist obstetrician-gynaecologists are available. The short operating time, shorter stay in hospital and a small scar are some of the attractive features of this operation.

Minilap operation
Minilaparotomy is a modification of abdominal tubectomy. It is a much simpler procedure requiring a smaller abdominal incision of only 2.5 to 3 cm conducted under local aneaesthesia. The minilap technique is considered a revolutionary procedure for female sterilization. It is also found to be a suitable procedure at the primary health centre level and in mass campaigns. It has the advantage over other methods with regard to safety, efficiency and ease in dealing with complications. Minilap operation is suitable for postpartum tubal sterilization.
The Norplant system vas approved by the US Food and Drug Administration on December 10, 1990. This system has been approved for use in 14 countries and is currently in clinical trials in 35 other countries. The Norplant is a long-term reversible Contraceptive, lists for 5 years, and any time during those 5 years it can be discontinued. The Norplant consists of 6 soft flexible Silastic capsules that are placed in a fanlike pattern under the 1kin ob the upper arm, done under oral anesthesia in an Office or clinic. The procedure takes about 10-15 minutes. It works by continuously releasing a synthetic hormone, Levonorgestrol (progestin), that inhibits ovulation, cause3 eggs found to be released regularly, and thickens cervical mucus. Thickening of the cervical mucus makes it more difficult for sperm to reach the egg
 There is an estrogen used with this system. The Norplant system compares with oral contraceptives for effectiveness with this system .6 pregnancies occurrad/1000 women by the end of 1 year; over 5 years the total rate was 1.5 pregnancaes/100 users. If placed within 7 days after the onset of menstrual bleeding or immediately following an abortion, Norplant is effective within 24 hours. A backup method is necessary for the remainder of the cycle if it is 0laced during other times. After removal the contraceptive effect ends quickly and previous level of fertility is obtained. The capsules are not noticeable unless the woman is very thin or muscular. However, the outline of the Capsules can be felt and once placed they will break or move around. There will be a very small scar left, which is not noticeable in most women. Discoloration may occur over the site, but once the Norplant is removed it disappears. Some common side effects of the Norplant system are: menstrual changes, such as midcycle bleeding or spotting, irregularity, more frequent periods, heavier or lighter flow, or amenorrhea. Other side effects reported have bean headaches, weight gain, nausea and dizziness, change in appetite, enlargement of ovaries and fallopian tubes, mastalgia (breast tenderness), altered hair growth, and decreased libido. Even with these side effects a continuation rate of about 80% has been reported among women after the 1st year. This system works well for women who are considering sterilization but are not quite ready to make a final decision. Also, for women who want a long-term reversible contraceptive, who want to avoid daily contraceptive methods, and who cannot use or wish to avoid using estrogen-containing contraceptives. Women who have a history of acute liver diseases, unexplained vaginal bleeding, breast cancer, or blood clots in the legs, lungs, or eyes should consult their doctor prior to using this method. Also, women who are or think they are pregnant should not have the capsules placed. Postpartum women can safely have the capsules placed, but breast feeding mothers should wait at least 6 weeks prior to having the procedure done. [37]

Seasonale

 Seasonale, is a newer birth control pill that is similar to others in that it is 99% effective when taken as directed, uses the same type of hormones, is a once-daily pill, and has similar side effects. What makes Seasonale different from other birth control pills is that it has 3 months of active pills, instead of 3 weeks. This extends the time between your scheduled periods and lets you have only 4 periods per year. If you are taking Seasonale, you are likely do experience breakthrough bleeding ob spotting. Seasonale is available by prescription at University Health Services.

Extra-low-Dose Birth Control Pills
The newest pill, Yasmin, is the latest low-dose birth control pill. Similar to Alesse, Loeqtrin, and Cyclessa, this pill is 99% effective when taken correctly and helps decrease the amount of PMS water retention. As with all hormonal methods, you increase your risk of heart attacks and blood clots.
The Contraceptive Sponge
 The Today Sponge  has returned to the market after receiving approval from the fda. the sponge cab be inserted hours before a woman has intercourse and remain in her body for up to 24 hours. it also contains spermicides that may offer some protection against itis and is 72% to 84% effective at preventing pregnancy, depending on whether you have had children or jot. the sponge can be purchased at health services pharmacy.

Vaginal Ring
 Nuvaring is a new hormonal method that is similar to a diaphragm in that it is a flexible plastic ring, but instead of having to insert it before each act of intercourse and remove it 6 Hours later, it is left in place for 3 weeks. The ring emits progestin and estrogen and as about 99% effective at preventing pregnancy. Inserting nuvaring correctly will be a key factor in insuring its effectiveness. Because it is a hormonal method, it has similar risks that are associated with birth control pills. It costs about $35 a month. It is available at Health Services, talk to your medical provider if you are interested in trying this method.

Hormonal IUDs

Mirena is a new hormonal iud, similar to the progastasert iud. the advantage is that mirena also emits the hormone progestin as an extra level of contraceptive protection. Iuds offer a high level of protection (approxima4ely 99%) but this method is not advised for women who haven't had children yet. It costs about $350 to $400 plus the cost of insertion, and although it is not available at ealph services, a medical provider may give you a referral to a site where it is available.

Single Rod Implant

  Implanon, is a single rod (Hormonal implant method) that is placed. Norplant, a multiple rod implant which is no longer available in the US. Amplafon is a thin, flexible plastic implant about the size of matchstick, which contains the synthetic hormone progestin, Inserted under your upper arm, it can be left in place for up to 3 years. A woman won't be able to see the rod, unless she is very thin, but she can feel it with her fingers. Researches estimate that Implanon will be upto 99.9% effective for up to 3 years. Irregular bleeding is the most common side effect. Periods become fewer and lighter for most women and, in times, may stop altogether. Some women will have longer and heavier periods and some may have increased irregular or breakthrough bleeding. Implanon costs about $600, plus the cost of insertion. Implanon is not currently available at Health Services, but a medical provider may give you a referral to a site where it is available.

Male contraceptives
The development of cont2aceptive methods for men poses a different challenge because men are continuously producing sperm and therefore are continuously fertile, unlike women who have a limited number of fertile days each month. The current research is focused on developing contraceptive injections, implants, or vaccines that will reduce a male’s sperm count low enough to levels unlikely do cause pregnancy, but without damaging lifetime sperm production. Tests are currently being conducted overseas and the information if this field will continue to be expanded.

What is the female condom?
The female condom, the first condom-like device designed for women, was approved by the FDA in May 1993 for sale in the US [42]
It is a loose-fitting, pre-lubricated, 7-inch polyurethane pouch that fits into the vagina. It is a barrier method of birth control, which if used correctly, can prevent semen from being deposited in the vagina. It can also protect women against several sexually transmitted infections (STIs), including HIV, by preventing the exchange of fluids (semen, vaginal secretions, blood).
In the US it is sold under the name "Reality." This same product is sold under different names in other countries. It is available without a prescription in most major drug stores, although it may be somewhat difficult to find.. It is sold in packs of 3 or 6 and costs $2 to $3 dollars per condom. Reality female condoms are available at Health Education, which is on the 3rd floor of Health Services.

How is it used?

There is a flexible ring at the closed end of the thin, soft pouch. A slightly larger ring is at the open end. The ring at the closed end holds the condom in place in the vagina. The ring at the open end rests outside the vagina. If the condom is correctly placed in the vagina, it should form a "lining" against the walls of the vagina. The female condom can be put in up to 8 hours before sex. Follow these instructions for inserting it:

Find a comfortable position. Three possible options are standing with one foot on a chair, squatting with your knees apart or lying down with your legs bent and knees apart.

Hold the female condom with the open end hanging down. Squeeze the inner ring (at the closed end) with your thumb and middle finger and insert it into the vagina just past the pubic bone, much like a diaphragm or cervical cap. This inner ring lies at the closed end of the sheath and serves as an insertion mechanism and internal anchor. Make sure the condom is inserted straight and not twisted into the vagina.
The outer ring forms the external edge of the sheath and remains outside the vagina after it is inserted. Once in place, the device should cover the woman's labia and the base of the penis during intercourse.

During sex, it may be helpful to use your hand to guide the penis into the vagina inside the female condom. It is important that the penis is not inserted to the side of the outer ring. If the condom seems to be sticking to and moving with the penis rather than resting in the vagina, stop and add lubricant (K-Y jelly, Surgilube, Astroglide) to the inside of the condom (near the outer ring) or to the penis.
Female condoms should not be used simultaneously with male condoms because the friction between the two condoms may cause the condoms to break.

To remove the female condom after intercourse:
* Squeeze and twist the outer ring to keep the semen inside the pouch.
* Remove it gently before you stand up. Wrap it in a tissue and throw it away in the garbage. Do not flush it down the toilet.
Do not reuse female condoms. Use a new one every time you have intercourse. Be careful not to tear the condom with fingernails or sharp objects.

How effective is the female condom in preventing pregnancy and STIs?
Studies of the Reality condom show that it provides similar protection against pregnancy as other barrier methods, such as the diaphragm. If used perfectly, 5% of women will experience a pregnancy within the first year of use. In typical use (which includes imperfect insertion and inconsistent use), 21% of couples will experience a pregnancy within the first year. The rate of breaks or tears in the female condom is less than 1%, compared to 4% with the male condom.
Like the male condom, the female condom does not provide complete protection against all STIs. Infections such as herpes or HPV (genital warts) may still be transmitted by organisms on areas of the skin that are not covered by the condom.

What are the benefits?
The female condom provides an opportunity for women to share responsibility for the use of condoms with their partners.
* A woman can use the female condom if her partner refuses to use condoms.
* The polyurethane is less likely to cause an allergic reaction than a male latex condom. It also tears less often.
The female condom is available over the counter without a prescription. Unlike a diaphragm, it does not need to be fitted by a medical provider (one size fits all).
* The female condom will protect against most STIs if it is used correctly. It also covers much of the vulva for additional protection in that area.
* The outer ring of the female condom stimulates the clitoris during intercourse.
* The female condom can be used for protection against STIs during oral sex. Its design allows tongue insertion and fingering of the vagina or anus. If using the female condom in the anus, remove the inner ring before insertion.
* It can be inserted up to 8 hours before sex so it does not interfere with "the moment."
* The polyurethane is thin and conducts heat well so sensation is preserved.

What are the disadvantages?

* The outer ring is visible outside the vagina, which makes some women self-conscious in front of their partners.
* It makes crackling and popping noises during intercourse. Extra lubricant may help this problem.
* It has a higher failure rate than non-barrier methods such as oral contraceptive pills.
* It is somewhat cumbersome to insert.
* Each female condom can be used just once and is relatively expensive.

What are cervical caps and shields? The cervical cap is a rigid, thimble-shaped cup made of latex rubber that fits over the cervix and is held in place by suction. The cervical cap is slowly being phased out and replaced with the Fem Cap. The Fem Cap is a silicone cup shaped like a sailor's hat that fits securely in the vagina to cover the cervix. Lea's Shield is also a silicone cup with an air valve that fits snugly over the cervix and has a loop to help remove it. As with a diaphragm, it is necessary to use a small amount of spermicidal cream or gel with each method.

How do they work?

Each method acts as a physical and a chemical barrier, similar to the diaphragm, to prevent sperm from entering the uterus and fertilizing an egg. They must be used with spermicidal cream or jelly which helps inactivate sperm.

How effective are they in preventing pregnancy and STIs?

For cervical caps, [43] the typical pregnancy rate (which includes imperfect insertion and inconsistent use) for users who have never given birth is 16% per year; the perfect use rate is 9% per year. Pregnancy rates for women who have given birth are 32% for typical use and 26% perfect use. The difference in rates is because the cervix is bigger after childbirth and the cap may not fit as well.
For Fem Caps, the pregnancy rate for perfect use is not available, but for typical use the rate is 14%.
For Lea's Shields, the pregnancy rate for perfect use is not available, but for typical use the rate is 15%.
It is important to consider that none of these methods offer any protection against sexually transmitted infections (STHs).
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