Mechanical Methods Of Contraception

Mechanical Methods of Contraception • Intrauterine Devices • Barrier Methods – Condoms – Spermicides – Diaphragm & Cervical Cap – Vaginal Sponge Intrauterine Devices(IUDs) Intrauterine Contraceptive Devices (IUCDs) Types of Medicated IUDs Copper-releasing:  Copper T 380A  Nova T  Multiload 375 Progestin-releasing:

IUDs: Limitations • Pelvic examination required and screening for sexually transmitted diseases (STDs) recommended before 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 during the first few months (copper-releasing only) • May be spontaneously expelled • Rarely (< 1/1000 cases), perforation of the uterus may occur during insertion • Do not prevent all ectopic pregnancies (especially Progestasert) • May increase risk of PID and subsequent infertility in women at risk for STDs (e.g., HBV, HIV/AIDS) Who Can Use IUDs Women of any reproductive age or parity who: – Want highly-effective, long-term contraception – 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 or should not use them – Are in need of emergency contraception IUDs: Who Should Not Use IUDs should not be used if woman: – Is pregnant (known or suspected) – Has unexplained vaginal bleeding until the cause is determined and any serious problems are treated – 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 be reasonably sure the client is not pregnant • Days 1 to 7 of the menstrual cycle • Postpartum – immediately following delivery, during the first 48 hours postpartum or – after 4 to 6 weeks; after 6 months if using LAM • Postabortion – immediately or within the first 7 days provided no evidence of pelvic infection IUDs: Infection Prevention Recommendations Pre-insertion: – Wash hands before examining client. – Wash genital area if hygiene poor. Insertion: – Put new or high-level disinfected gloves on both hands. – Load IUD in sterile package. – Clean cervical os (and vagina) thoroughly two 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


Progestasert LevoNova (LNG-20) Mirena

Copper IUDs: Mechanisms of Action

IUDs: Contraceptive Benefits • Highly effective • Effective immediately • Long-term method (up to 10 years protection with Copper T 380A) • Do not interfere with intercourse • Immediate return to fertility upon removal • Do not affect breastfeeding IUDs: Noncontraceptive Benefits • Decrease menstrual cramps (progestin-releasing only) • Decrease menstrual bleeding (progestin-releasing only)

Decrease ectopic pregnancy (except Progestasert7)

IUDs: Common Side Effects Copper-releasing: – Heavier menstrual bleeding – Irregular or heavy vaginal bleeding – Intermenstrual cramps – Increased menstrual cramping or pain – Vaginal discharge Progestin-releasing: – Amenorrhea or very light menstrual bleeding/spotting IUDs: Possible Other Problems • Missing strings • Slight increased risk of pelvic infection (up to 20 days after insertion) • Perforation of the uterus (rare) • Spontaneous expulsion • Ectopic pregnancy • Spontaneous abortion • Partner complains about feeling strings IUDs: General Information • Removal of the Copper T380A is necessary after 10 years 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 heavier with an IUD and bleeding/spotting may occur between periods, especially in first few months. • Evaluate for other cause(s) and treat if necessary. • If no other cause(s) found, treat with nonsteroidal anti-inflammatory agent (NSAID, such as ibuprofen) for 5-7 days. • Counsel on options and consider IUD removal if client requests. IUDs: Management of Cramping and Pain • Reassure client that cramping and menstrual pain (dysmenorrhea) may occur with an IUD, especially in first few months. • Evaluate for other cause(s) and treat if necessary. • If no other cause(s) found, consider treating with acetaminophen or ibuprofen daily with onset of menses. • Counsel on options and consider IUD removal if client requests. 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 Male Male Condoms: Definition • Thin sheaths of rubber, vinyl or natural products which may be treated with a spermicide for added protection. • 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 Action

Male 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 protection against STDs (latex rubber and vinyl condoms only) • May prolong erection and time to ejaculation • May help prevent cervical cancer Male 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 intercourse begins • Resupply must be available Who Can Use Male Condoms • Men who wish to participate actively in family planning • Couples who need contraception immediately • Couples who need a temporary method while awaiting another method (e.g., implants, IUD or voluntary sterilization) • Couples who need a backup method • Couples who have intercourse infrequently • Couples in which either partner has more than one sexual partner (at high risk for STDs, including HBV and HIV/AIDS), even if using another method Management of Common Side Effects Allergic reactions, although uncommon, can be uncomfortable and possibly dangerous. – Allergic reaction to condom or local irritation to penis:

• Ensure that condom is not medicated. If reaction persists, consider natural condoms (lambskin or gut) or another method.1 • Help client choose another method. Allergic reactions, although uncommon, can be uncomfortable and possibly dangerous. – Allergic reaction to spermicide: • If symptoms persist after intercourse and no evidence of STD, provide another spermicide or a non-medicated condom or help client choose another method. Male Condoms: Management of Other Problems • Diminished sexual pleasure: – If decreased sensitivity is not acceptable even with thinner condoms, help client choose another method. • Condom breaks or breakage suspected (before intercourse): – Check condom for a hole or demonstrable leak. – Discard and use new condom or use spermicide in conjunction with condom. • Condom breaks or slips off during intercourse: – Consider using a method of emergency contraception. Male Condoms: Client Instructions • Use a new condom every time you have intercourse. • Use a spermicide with condom for maximum effectiveness and protection. • Do not use teeth, knife, scissors or other sharp utensils to open package. • The condom should be unrolled onto erect penis before penis enters vagina, because pre-ejaculatory semen contains active sperm. • If the condom does not have an enlarged end (reservoir tip), about 1-2 cm should be left at the tip for the ejaculate. • While holding on to the base (ring) of the condom, withdraw penis before losing erection. This prevents condom from slipping off and spilling semen. • Each condom should only be used once. • Dispose of used condoms by placing in a waste container, in latrine or burying. • Keep an extra supply of condoms available. Do not store them in a warm place or they will deteriorate and may leak during use. • Check date on condom package to ensure that it is not out of date. • Do not use a condom if the package is broken or the condom appears damaged or brittle. • Do not use mineral oil, cooking oils, baby oil or petroleum jelly as lubricants for a condom. They damage condoms in seconds. If lubrication is required, use saliva or vaginal secretions. How to put on Male Condom

• If not circumcised, pull foreskin back. Pinch tip of condom and place it on end of penis.

Continue pinching tip while unrolling condom to base of penis.

How to Remove a Male Condom • After ejaculation and while penis is still hard, hold base of condom and carefully withdraw penis from vagina. Pull condom off penis gently, being careful semen does not spill out.

Female Condoms

Female Condoms: Definition • Thin sheath of polyurethane plastic with polyurethane rings at either end. They are inserted into the vagina before intercourse.

Female Condoms: Mechanisms of Action

How to Put On a Male Condom • Carefully open the package so the condom does not tear. Do not unroll condom before putting it on. Put condom on when penis is hard. Female Condoms: Contraceptive Benefits • Effective immediately • Do not affect breastfeeding

• Do not interfere with intercourse (may be inserted up to 8 hours before) • Can be used as backup to other methods • No method-related health risks • No systemic side effects • No prescription or medical assessment necessary • Controlled by the woman Female Condoms: Noncontraceptive Benefits • May provide protection against STDs • May help prevent cervical cancer Female Condoms: Limitations • Expensive (at this time)

• Push the ring up past the pubic bone. • Make sure the outer ring and part of the sheath are outside the vagina over the vulva. Female Condom

Moderately effective (5-21 pregnancies per 100 women during the first year1) • Effectiveness as contraceptives depends on willingness to follow instructions • User-dependent (require continued motivation and use with each act of intercourse) • Disposal of used condoms may be a problem • Adequate storage must be available at the client’s home • Supplies must be readily available before intercouse begins • Resupply must be available Female Condoms: Who Can Use Women: • Who prefer not to use hormonal methods or cannot use them (e.g., smokers over 35 years of age) • Who prefer not to use IUDs • Who are breastfeeding and need contraception • Who want protection from STDs and whose partners will not use condoms Couples: • Who need contraception immediately • Who need a temporary method while awaiting another method (e.g., implants, IUD or voluntary sterilization) • Who need a backup method • Who have intercourse infrequently • In which either partner has more than one sexual partner (at high risk for STDs, including HBV and HIV/AIDS), even if using another method Female Condoms: Management of Problems • Diminished sexual pleasure: – If decreased sensitivity is not acceptable, help client choose another method. • Condom breaks or breakage suspected (before intercourse): – Check condom for a hole or demonstrable leak. – Discard and use new condom. • Condom breaks or slips off during intercourse: – Consider using a method of emergency contraception. Female Condoms: Client Instructions • Use a new condom every time you have intercourse. • The female condom can be inserted up to 8 hours before intercourse. • Wash hands with soap and water.

Female Condom • Female condom in place

The Cervical Cap: Diaphragm The Cervical Cap & Spermicide

How cervical cap works? • The cervical cap is a thimble-shaped rubber (latex) cup that fits snugly over the cervix. • It is usually used with a small amount of special gel that contains a spermicide. • The woma inserts the cap and spermicide together into your vagina to cover the cervix Cervical Cap • The cervical cap comes in four sizes. • Each woman must be fitted for her cap by a trained doctor or health provider. • Act as a barrier that keeps sperm from entering the uterus. How to use the cervical cap: • Wash hands. • Fill the cap 1/3 full of spermicidal gel. • Squeeze the sides of the cap together and put it all the way into the vagina and onto the cervix to form a strong suction. • When you are fitted, your doctor or health provider will teach you how to do this correctly. • Must leave it in place for at least six hours after your last sexual intercourse. • No need to add extra spermicidal gel with each intercourse. • It is recommended to leave it in place no more than 48 hours.

Remove the condom from the package. Do not use teeth, knife, scissors or other sharp utensils to open package. • Hold the condom with the open end down. • Use the thumb and middle finger to squeeze the flexible ring at the closed end into a narrow oval. • With your other hand, spread the lips of your vagina. • Insert the ring and sheath into the vagina. • Use your index finger to push the ring as far as possible into the vagina. • Insert a finger into the condom until it touches the bottom of the ring.

• To remove the cap, push the rim away the cervix. Proper Use • Take good care of your cap by washing it gently in warm water and mild soap. • Rinse well, pat dry, dust with cornstarch and put the cap back into its case. • Check the cap for holes or weak spots before using it. • If you use extra lubricants during sex, be sure that they are water-based like KY liquid. – Oil based lubricants like Vaseline or lotions can weaken the rubber and make it crack or tear. Potential Risks • Wearing a cap for longer than 48 hours is not recommended because of possible risk of Toxic Shock Syndrome (TSS). • Some women who use the cap may be more likely to have abnormal cells on their Pap smears. Danger signs for TSS • Sudden high fever • Vomiting, diarrhea • Dizziness, faintness, weakness • Sore throat, aching muscles and joints • Rash (like a sunburn) The Cervical Cap & Diaphragm

1. Primarily, it works as a delivery system for spermicide. By continuously releasing spermicide throughout the vagina it will kill sperm on contact. 2. Additionally, the Today Sponge provides contraceptive protection by trapping and absorbing sperm, 3. It covers the cervix and thereby blocking the entry of sperm into the cervix. Who can use the Today Sponge? • Any woman comfortable using tampons or other vaginal contraceptives should be able to use the Today Sponge.

Vaginal contraceptives, such as the Today Sponge, are indicated for women for whom the pill may be unacceptable. Who should NOT use the Today Sponge? • A woman who is menstruating • A woman or her partner if one or both of them have a sensitivity to: 1) sulfa drugs, 2) the spermicide, Nonoxynol-9 3) polyurethane • A woman with a vaginal abnormality • A woman who currently has a vaginal infection. • Any woman who has ever had toxic shock syndrome

A woman who has recently had a vaginal delivery (within 8 weeks), miscarriage, or other termination of pregnancy and has not been examined by her physician, • A woman who cannot risk any chance of pregnancy whatsoever. Spermicidal Jelly & Cream

The diaphragm

Vaginal Contraceptive Film

Vaginal Sponge

Voluntary Surgical Contraception for Women Tubal Occlusion Types of Tubal Occlusion • Postpartum – Minilaparotomy (Infraumbilical) • Interval – Minilaparotomy – Laparoscopy Tubal Occlusion: Mechanism of Action

How does Sponge stay in place? • The Sponge is held in place by the vaginal muscles. • In addition, the indentation (the dimple) helps position the Today Sponge properly and keeps it in place directly over the cervix. How long can you leave it? • The maximum recommended wear time for the Today Sponge is 30 hours. • This includes multiple acts of intercourse. • If intercourse takes place on or near the 24th hour, the Today Sponge should only be left in place for 6 hours afterwards, completing the 30-hour maximum. Mechanism of Action • The Today Sponge works in three ways to protect you against pregnancy:

Tubal Sterilization Laparoscopy

• Postabortion: immediately or within 7 days, provided no evidence of pelvic infection Tubal Occlusion: Client Instructions • Keep operative site dry for 2 days. Resume normal activities gradually. • Avoid sexual intercourse for 1 week or until comfortable. • Avoid heavy lifting and hard work for 1 week. • For pain take 1 or 2 analgesic tablets every 4 to 6 hours.


Tubal Occlusion: Noncontraceptive Benefits • Does not interfere with breastfeeding • Decreased risk of ovarian cancer Tubal Occlusion: Limitations • Must be considered permanent (success of reversal cannot be guaranteed) • Client may regret later (age < 35) • Small risk of complications • Short-term discomfort and pain following procedure • Requires trained physician (gynecologist or surgeon for laparoscopy) • Slightly decreased long-term effectiveness • Increased risk of ectopic pregnancy • Does not protect against STDs (e.g., HBV, HIV/AIDS) Who Can Use Tubal Occlusion Women: • Who are age > 22 and < 45 • Who want highly effective, permanent protection against pregnancy • For whom pregnancy would pose a serious health risk • Who are postpartum • Who are postabortion • Who are breastfeeding (within 48 hours or after 6 weeks) • Who are certain they have achieved their desired family size • Who understand and voluntarily consent to procedure Tubal Occlusion: Intra-operative Complications Minilaparotomy and Laparoscopy: – Uterine perforation – Bleeding from mesoslpinx – Convulsion and toxic reactions to local anesthesia – Injury to urinary bladder – Respiratory depression or arrest – Injury to intra-abdominal viscera Laparoscopy (primarily): – Gas or air embolism – Vasovagal attack Tubal Occlusion: Immediate Postoperative Complications • Pain at infection site • Superficial bleeding (skin edges or subcutaneously) • Postoperative fever • Wound infection • Gas embolism with laparoscopy (very rare) • Hematoma (subcutaneous) When to Perform Tubal Occlusion Procedure • Anytime during the menstrual cycle you can be reasonably sure the client is not pregnant • Days 6–13 of menstrual cycle (proliferative phase preferred) • Postpartum: Within 2 days or after 6 weeks If delivered at home and immunized (tetanus toxoid), can be performed under antibiotic cover (if no sepsis).

Schedule a routine followup visit between 7–14 days. • Return after 1 week if nonabsorbable stitches used. Warning Signs for Tubal Occlusion Clients Return to clinic if following problems occur: • Fever (greater than 38°C or 100.4°F) • Dizziness with fainting • Persistent or increased abdominal pain • Bleeding or fluid coming from the incision • Signs or symptoms of pregnancy Tubal Occlusion: Contraceptive Benefits • Highly effective • Effective immediately • Permanent • Does not interfere with intercourse • Good for client if pregnancy would pose a serious health risk • Simple surgery, usually done under local anesthesia • No long-term side effects • No change in sexual function (no effect on hormone production by ovaries) Voluntary Surgical Contraception for Men Vasectomy Vasectomy in the US • Third most popular contraceptive method • Used by 13% of married couples of reproductive age • Use growing three times faster than oral contraceptive pill use Types of Vasectomy • No-scalpel technique (preferred) • Incisional Incisional Vasectomy • 1 or 2 incisions in the scrotum • 99% of operations occur under local anesthesia • Different methods of occlusion can be used o Ligation o Cautery o Combination No-Scalpel Vasectomy • Developed in China, introduced in US in 1988 • Improved anesthesia • Clinician holds tubes in place under skin • One puncture • No stitches needed Advantages of NSV over Incisional Vasectomy

Vasectomy: Mechanism of Action

By blocking the vas deferens (ejaculatory duct), sperm are not present in the ejaculate. Vasectomy: Contraceptive Benefits • Highly effective • Permanent • Does not interfere with intercourse • Good for couples if pregnancy or tubal occlusion would pose a serious health risk to the woman • Simple surgery done under local anesthesia • No long-term side effects • No change in sexual function (no effect on hormone production by testes) No-Scalpel Vasectomy Failure rate: – 0.2-0.4% Complications – Hematoma – Infection – Epididymitis Overall < 2% Mortality < 0.001% Vasectomy: Long-Term Reproductive Health Effects • Prostate cancer: slight increased risk reported, but newer studies fail to support this information • Testicular cancer: no association based on several studies • Cardiovascular disease: no association based on studies • HIV transmission: no data to support decreased rate of transmission Who Can Use Vasectomy Men: • Of any reproductive age (usually #50) • Who want a highly effective, permanent contraceptive method • Whose wives have age, parity or health problems that might pose a serious health risk if they become pregnant • Who understand and voluntarily consent to the procedure • Who are certain they have achieved their desired family size Vasectomy: Postoperative Problems • Wound infection • Hematoma • Granuloma • Excessive swelling • Pain at incision site Vasectomy: Client Instructions • Keep bandage on for 3 days. • Do not pull or scratch wound while healing. • You may bathe after 24 hours but do not let the wound get wet. After 3 days you may wash the wound with soap and water. • Wear a scrotal support, keep the operative site dry and rest for 2 days. • For pain take 1 or 2 analgesic tablets every 4 to 6 hours and apply ice packs. • Avoid heavy lifting and hard work for 3 days. • Avoid sexual intercourse for 2 or 3 days or until comfortable. – Use condoms or another family planning method for 3 months or 20 ejaculations. • Return after 1 week if nonabsorbable stitches used. • Return for a semen test 3 months after the operation. Natural Family Planning (NFP) NFP: Mechanism of Action For contraception:

 Avoid intercourse during the fertile phase of the menstrual cycle when conception is most likely. For conception:  Plan intercourse near mid-cycle (usually days 10B15) when conception is most likely. NFP: Contraceptive Benefits  Can be used to prevent or achieve pregnancy Methods of NFP  Calendar Method  Basal Body Temperature (BBT)  Cervical Mucus Method (Billings)  Symptothermal (BBT + cervical mucus)  No method-related health risks  No systemic side effects  Inexpensive NFP: Noncontraceptive Benefits  Improved knowledge of reproductive system  Possible closer relationship between couple  Increased male involvement in family planning NFP: Calendar Method  Monitor length of at least 6 menstrual cycles while abstaining or using another contraceptive method. Then calculate when fertile days occur following the instructions below. o From number of days in longest cycle, subtract 11. This identifies the last fertile day of cycle. o From number of days in shortest cycle, subtract 18. This identifies the first fertile day of your cycle.  Your fertile period is calculated to be days 8 - 19 of cycle (12 days of abstinence needed to avoid pregnancy). NFP: Basal Body Temperature Chart

NFP: Client Instructions for Billings Method  Mark last day of clear, slippery, stretchy mucus with an X. This is the peak day, the most fertile time.  After the peak day, avoid intercourse for next 3 dry days and nights. These days are not safe.  Beginning on the morning of the fourth dry day, it is safe to have intercourse until your menstrual period begins again. NFP: Client Instructions for Symptothermal Method  Combination of Billings & BBT. Lactational Amenorrhea Method (LAM) LAM: Mechanisms of Action

LAM: Contraceptive Benefits  Effective  Effective immediately  Does not interfere with sexual intercourse  No systemic side effects  No medical supervision necessary  No supplies required  No cost involved LAM: Noncontraceptive Benefits  For child: o Passive immunization and protection from other infectious diseases o Best source of nutrition o Decreased exposure to contaminants in water, other milk or formulas, or on utensils  For mother: o Decreased postpartum bleeding Who Can Use LAM Women who:  Are fully or nearly fully breastfeeding  Have not had return of menses

 Inexpensive (short-term), easy to obtain, and easy to keep on hand in case sex occurs unepectedly.  Increased sexual enjoyment because there’s no need to worry about pregnancy or STD’s  Can be stopped anytime  Can be used by man of any age  Can be used without seeing a health provider first Male Condoms: Noncontraceptive Benefits  Promote male involvement in family planning  Only family planning method that provides protection against STDs (latex rubber and vinyl condoms only)  May prolong erection and time to ejaculation  May help prevent cervical cancer Male 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 intercourse begins  Resupply must be available Who Can Use Male Condoms  Men who wish to participate actively in family planning  Couples who need contraception immediately  Couples who need a temporary method while awaiting another method (e.g., implants, IUD or voluntary sterilization)  Couples who need a backup method  Couples who have intercourse infrequently  Couples in which either partner has more than one sexual partner (at high risk for STDs, including HBV and HIV/AIDS), even if using another method Male Condoms: Management of Common Side Effects Allergic reactions, although uncommon, can be uncomfortable and possibly dangerous.  Allergic reaction to condom or local irritation to penis: o Ensure that condom is not medicated. o If reaction persists, consider natural condoms (lambskin or gut) or another method.1 o Help client choose another method.  Allergic reaction to spermicide: o If symptoms persist after intercourse and no evidence of STD, provide another spermicide or a nonmedicated condom or help client choose another method. Male Condoms: Management of Other Problems  Diminished sexual pleasure: o If decreased sensitivity is not acceptable even with thinner condoms, help client choose another method.  Condom breaks or breakage suspected (before intercourse): o Check condom for a hole or demonstrable leak. o Discard and use new condom or use spermicide in conjunction with condom.  Condom breaks or slips off during intercourse: o Consider using a method of emergency contraception.  Condoms can weaken if stored too long or in too much heat, sunlight, or humidity, or if used with oilbased lubricants – and may break during use.  Poor- reputation. Many connect condoms with immoral sex, sex outside marriage, or sex with prostitutes.  May embarrass some people to buy, ask partner to use, put on, take off, or throw away condoms.

 Are less than 6 months postpartum

1

LAM: Client Instructions for Contraception  Always keep a backup method of contraception, such as condoms, readily available. Use it if: o your menses returns o you begin supplementing your baby’s diet o your baby reaches 6 months of age  Consult your healthcare provider or clinic before starting another contraceptive method  If you or your partner is at high risk for STDs, including the AIDS virus, you should use condoms as well as LAM. Condoms for Male Male Condoms: Definition  Thin sheaths of rubber, vinyl or natural products which may be treated with a spermicide for added protection. 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 Action

Male Condoms: Contraceptive Benefits  Effective immediately  Do not affect breastfeeding  No effect on breast milk (unlike COC)  Can be used as backup to other methods  No method-related health risks  No systemic (hormonal) side effects  Widely available (pharmacies and community shops)  No prescription or medical assessment necessary

Male Condoms: Client Instructions  Use a new condom every time you have intercourse.  Use a spermicide with condom for maximum effectiveness and protection.  Do not use teeth, knife, scissors or other sharp utensils to open package.  The condom should be unrolled onto erect penis before penis enters vagina, because pre-ejaculatory semen contains active sperm.

• Thin sheath of polyurethane plastic with polyurethane rings at either end. They are inserted into the vagina before intercourse.

Female Condoms: Mechanisms of Action

 If the condom does not have an enlarged end

(reservoir tip), about 1-2 cm should be left at the tip for the ejaculate.  While holding on to the base (ring) of the condom, withdraw penis before losing erection. This prevents condom from slipping off and spilling semen.  Each condom should only be used once.  Dispose of used condoms by placing in a waste container, in latrine or burying.  Keep an extra supply of condoms available. Do not store them in a warm place or they will deteriorate and may leak during use.  Check date on condom package to ensure that it is not out of date.  Do not use a condom if the package is broken or the condom appears damaged or brittle.  Do not use mineral oil, cooking oils, baby oil or petroleum jelly as lubricants for a condom. They damage condoms in seconds. If lubrication is required, use saliva or vaginal secretions. How to Put On a Male Condom • Carefully open the package so the condom does not tear. Do not unroll condom before putting it on. Put condom on when penis is hard.

Female Condoms: Contraceptive Benefits  Effective immediately  Do not affect breastfeeding  Do not interfere with intercourse (may be inserted up to 8 hours before)  Can be used as backup to other methods  No method-related health risks  No systemic side effects  No prescription or medical assessment necessary  Controlled by the woman Female Condoms: Noncontraceptive Benefits  May provide protection against STDs  May help prevent cervical cancer Female Condoms: Limitations  Expensive (at this time)

 Moderately effective (5-21 pregnancies per 100
women during the first year1)  Effectiveness as contraceptives depends on willingness to follow instructions  User-dependent (require continued motivation and use with each act of intercourse)  Disposal of used condoms may be a problem  Adequate storage must be available at the client’s home  Supplies must be readily available before intercouse begins  Resupply must be available Female Condoms: Who Can Use Women:  Who prefer not to use hormonal methods or cannot use them (e.g., smokers over 35 years of age)  Who prefer not to use IUDs  Who are breastfeeding and need contraception  Who want protection from STDs and whose partners will not use condoms Couples:  Who need contraception immediately  Who need a temporary method while awaiting another method (e.g., implants, IUD or voluntary sterilization)  Who need a backup method  Who have intercourse infrequently  In which either partner has more than one sexual partner (at high risk for STDs, including HBV and HIV/AIDS), even if using another method Female Condoms: Management of Problems  Diminished sexual pleasure: o If decreased sensitivity is not acceptable, help client choose another method.  Condom breaks or breakage suspected (before intercourse):

• If not circumcised, pull foreskin back. Pinch tip of condom and place it on end of penis.

Continue pinching tip while unrolling condom to base of penis.

How to Remove a Male Condom • After ejaculation and while penis is still hard, hold base of condom and carefully withdraw penis from vagina. Pull condom off penis gently, being careful semen does not spill out.

Female Condoms

o Check condom for a hole or demonstrable leak. o Discard and use new condom.  Condom breaks or slips off during intercourse: o Consider using a method of emergency contraception. Female Condoms: Client Instructions  Use a new condom every time you have intercourse.  The female condom can be inserted up to 8 hours before intercourse.  Wash hands with soap and water.

 Remove the condom from the package. Do not use
teeth, knife, scissors or other sharp utensils to open package.  Hold the condom with the open end down.  Use the thumb and middle finger to squeeze the flexible ring at the closed end into a narrow oval.  With your other hand, spread the lips of your vagina.  Insert the ring and sheath into the vagina.  Use your index finger to push the ring as far as possible into the vagina.  Insert a finger into the condom until it touches the bottom of the ring.  Push the ring up past the pubic bone.  Make sure the outer ring and part of the sheath are outside the vagina over the vulva.

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