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Mechanical Methods of Contraception

Mechanical Methods of Contraception

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Mechanical Methods Of ContraceptionMechanical Methods of Contraception
Intrauterine Devices
Barrier Methods
 – 
Condoms
 – 
Spermicides
 – 
Diaphragm & Cervical Cap
 – 
Vaginal SpongeIntrauterine Devices(IUDs)Intrauterine Contraceptive Devices (IUCDs) Types of Medicated IUDsCopper-releasing:
Copper T 380A
Nova T
Multiload 375Progestin-releasing:
Progestasert
 
LevoNova (LNG-20)
Mirena
 
Copper IUDs: Mechanisms of ActionIUDs: Contraceptive Benefits
Highly effective
Effective immediately
Long-term method (up to 10 years protection withCopper T 380A)
Do not interfere with intercourse
Immediate return to fertility upon removal
Do not affect breastfeedingIUDs: Noncontraceptive Benefits
Decrease menstrual cramps (progestin-releasingonly)
Decrease menstrual bleeding (progestin-releasingonly)
Decrease ectopic pregnancy (except Progestasert
7
)IUDs: Limitations
Pelvic examination required and screening forsexually transmitted diseases (STDs) recommendedbefore insertion
Require trained provider for insertion and removal
Need to check for strings after menstrual period if cramping, spotting or pain
Woman cannot stop use whenever she wants(provider-dependent)
Increase menstrual bleeding and cramping duringthe first few months (copper-releasing only)
May be spontaneously expelled
Rarely (< 1/1000 cases), perforation of the uterusmay occur during insertion
Do not prevent all ectopic pregnancies (especiallyProgestasert)
May increase risk of PID and subsequent infertility inwomen at risk for STDs (e.g., HBV, HIV/AIDS)Who Can Use IUDsWomen of any reproductive age or parity who:
 – 
Want highly-effective, long-termcontraception
 – 
Are breastfeeding
 – 
Are postpartum and not breastfeeding
 – 
Are postabortion
 – 
Are at low risk for STDs
 – 
Cannot remember to take a pill every day
 – 
Prefer not to use hormonal methods orshould not use them
 – 
Are in need of emergency contraceptionIUDs: Who Should Not UseIUDs should not be used if woman:
 – 
Is pregnant (known or suspected)
 – 
Has unexplained vaginal bleeding until thecause is determined and any serious problems aretreated
 – 
Has current, recent PID
 – 
Has acute purulent (pus-like) discharge
 – 
Has distorted uterine cavity
 – 
Has malignant trophoblast disease
 – 
Has known pelvic TB
 – 
Has genital tract cancer
 – 
Has an active genital tract infection (e.g.,vaginitis, cervicitis)When to Insert an IUD
Anytime during the menstrual cycle when you can bereasonably sure the client is not pregnant
Days 1 to 7 of the menstrual cycle
Postpartum
 – 
immediately following delivery, during thefirst 48 hours postpartum or
 – 
after 4 to 6 weeks; after 6 months if usingLAM
Postabortion
 – 
immediately or within the first 7 daysprovided no evidence of pelvic infectionIUDs: Infection Prevention RecommendationsPre-insertion:
 – 
Wash hands before examining client.
 – 
Wash genital area if hygiene poor.Insertion:
 – 
Put new or high-level disinfected gloves onboth hands.
 – 
Load IUD in sterile package.
 – 
Clean cervical os (and vagina) thoroughlytwo times with antiseptic.
 – 
Use “no touch” insertion technique.Postinsertion:
 – 
Decontaminate all dirty items.
 – 
Safely dispose of contaminated waste items.
 – 
Wash hands after removing gloves.IUD Insertion: Withdrawal Method
 
IUDs: Common Side EffectsCopper-releasing:
 – 
Heavier menstrual bleeding
 – 
Irregular or heavy vaginal bleeding
 – 
Intermenstrual cramps
 – 
Increased menstrual cramping or pain
 – 
Vaginal dischargeProgestin-releasing:
 – 
Amenorrhea or very light menstrualbleeding/spottingIUDs: Possible Other Problems
Missing strings
Slight increased risk of pelvic infection (up to 20 daysafter insertion)
Perforation of the uterus (rare)
Spontaneous expulsion
Ectopic pregnancy
Spontaneous abortion
Partner complains about feeling stringsIUDs: General Information
Removal of the Copper T380A is necessary after 10years but may be done sooner if you wish.
Return to your provider if you:
 – 
cannot feel the strings,
 – 
feel the hard part of the IUD,
 – 
expel the IUD, or
 – 
miss a period.
Use condoms if at risk for STDs.IUDs: Management of Vaginal Bleeding Problems
Reassure client that menses generally are heavierwith an IUD and bleeding/spotting may occur betweenperiods, especially in first few months.
Evaluate for other cause(s) and treat if necessary.
If no other cause(s) found, treat with nonsteroidalanti-inflammatory agent (NSAID, such as ibuprofen) for5-7 days.
Counsel on options and consider IUD removal if clientrequests.IUDs: Management of Cramping and Pain
Reassure client that cramping and menstrual pain(dysmenorrhea) may occur with an IUD, especially infirst few months.
Evaluate for other cause(s) and treat if necessary.
If no other cause(s) found, consider treating withacetaminophen or ibuprofen daily with onset of menses.
Counsel on options and consider IUD removal if clientrequests.IUDs: Indications for Removal
If the client desires
At the end of effective life of the IUD
 – 
 TCu 380A = 10 years
If change in sexual practices (high risk behavior),consider adding barrier method (condoms) or removal.
If treated for STD or documented pelvic infection.
Menopause The Condoms Condoms for MaleMale Condoms: Definition
 Thin sheaths of rubber, vinyl or natural productswhich may be treated with a spermicide for addedprotection.
 They are placed on the penis once it is erect.
Condoms differ in such qualities as shape, color,lubrication, thickness, texture and addition of spermicide (usually nonoxynol-9). Types of Male Condoms
Latex (rubber)
Plastic (vinyl)
Natural (animal products)Male Condoms: Mechanisms of ActionMale Condoms: Contraceptive Benefits
Effective immediately
Do not affect breastfeeding
Can be used as backup to other methods
No method-related health risks
No systemic side effects
Widely available (pharmacies and community shops)
No prescription or medical assessment necessary
Inexpensive (short-term)Male Condoms: Noncontraceptive Benefits
Promote male involvement in family planning
Only family planning method that provides protectionagainst STDs (latex rubber and vinyl condoms only)
May prolong erection and time to ejaculation
May help prevent cervical cancerMale Condoms: Limitations
Disposal of used condoms may be a problem
Adequate storage must be available at client’s home
Supplies must be readily available before intercoursebegins
Resupply must be availableWho Can Use Male Condoms
Men who wish to participate actively in familyplanning
Couples who need contraception immediately
Couples who need a temporary method whileawaiting another method (e.g., implants, IUD orvoluntary sterilization)
Couples who need a backup method
Couples who have intercourse infrequently
Couples in which either partner has more than onesexual partner (at high risk for STDs, including HBV andHIV/AIDS), even if using another methodManagement of Common Side EffectsAllergic reactions, although uncommon, can be uncomfortableand possibly dangerous.
 – 
Allergic reaction to condom or local irritationto penis:
 
Ensure that condom is notmedicated.
If reaction persists, considernatural condoms (lambskin or gut) or anothermethod.
1
Help client choose another method.Allergic reactions, although uncommon, can be uncomfortableand possibly dangerous.
 – 
Allergic reaction to spermicide:
If symptoms persist afterintercourse and no evidence of STD, provideanother spermicide or a non-medicatedcondom or help client choose another method.Male Condoms: Management of Other Problems
Diminished sexual pleasure:
 – 
If decreased sensitivity is not acceptableeven with thinner condoms, help client chooseanother method.
Condom breaks or breakage suspected (beforeintercourse):
 – 
Check condom for a hole or demonstrableleak.
 – 
Discard and use new condom or usespermicide in conjunction with condom.
Condom breaks or slips off during intercourse:
 – 
Consider using a method of emergencycontraception.Male Condoms: Client Instructions
Use a new condom every time you have intercourse.
Use a spermicide with condom for maximumeffectiveness and protection.
Do not use teeth, knife, scissors or other sharputensils to open package.
 The condom should be unrolled onto erect penisbefore penis enters vagina, because pre-ejaculatorysemen contains active sperm.
If the condom does not have an enlarged end(reservoir tip), about 1-2 cm should be left at the tip forthe ejaculate.
While holding on to the base (ring) of the condom,withdraw penis before losing erection. This preventscondom from slipping off and spilling semen.
Each condom should only be used once.
Dispose of used condoms by placing in a wastecontainer, in latrine or burying.
Keep an extra supply of condoms available. Do notstore them in a warm place or they will deteriorate andmay leak during use.
Check date on condom package to ensure that it isnot out of date.
Do not use a condom if the package is broken or thecondom appears damaged or brittle.
Do not use mineral oil, cooking oils, baby oil orpetroleum jelly as lubricants for a condom. Theydamage condoms in seconds. If lubrication is required,use saliva or vaginal secretions.How to put on Male CondomHow to Put On a Male Condom
Carefully open the package so the condomdoes not tear. Do not unroll condom beforeputting it on. Put condom on when penis is hard.
 
If not circumcised, pull foreskin back. Pinch tipof condom and place it on end of penis.
Continue pinching tip while unrolling condomto base of penis.
 How to Remove a Male Condom
After ejaculation and while penis is still hard,hold base of condom and carefully withdrawpenis from vagina. Pull condom off penis gently,being careful semen does not spill out.
 Female CondomsFemale Condoms: Definition
 Thin sheath of polyurethane plastic withpolyurethane rings at either end. They are inserted intothe vagina before intercourse.Female Condoms: Mechanisms of ActionFemale Condoms: Contraceptive Benefits
Effective immediately
Do not affect breastfeeding

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