Artificial Family Planning Method

1. Oral contraceptives

Also known as the pill, oral contraceptives contain synthetic estrogen and progesterone.

Estrogen suppresses the FSH and LH to suppress ovulation, while progesterone
decreases the permeability of the cervical mucus to limit the sperm’s access to the ova.
To use the pill, it is recommended that the woman takes the first pill on the first Sunday
after the beginning of a menstrual flow, or the woman may choose to start the pill as
soon as it is prescribed.
Advise the woman that the first 7 days of taking the pill would still not have an effect, so
the couple must use another contraceptive method on the initial 7 days.
If the woman has skipped one day of taking the pill, she must take it the moment she
remembers it, than still follow the regular use of the contraceptive.
If the woman has missed taking the pill for more than one day, she and her partner
must consider an alternative contraception to avoid ovulation.
Side effects for OCs are nausea, weight gain, headache, breast tenderness,
breakthrough bleeding, vaginal infections, mild hypertension, and depression.
Contraindications to OCs are breastfeeding, age of 35 years and above, cardiovascular
diseases, hypertension, smoking, diabetes, and cirrhosis.

2. Transderm patch
The transdermal patch has a combination of both estrogen and progesterone in a form
of a patch.
For three weeks, the woman should apply one patch every week on the following areas:
upper outer arm, upper torso, abdomen, or buttocks.
At the fourth week, no patch is applied because the menstrual flow would then occur.
The area where the patch is applied should be clean, dry, free from any applications.
And without any redness or irritation.
Patches can be worn while bathing or swimming, but when the woman notices that the
patch is loose, she should immediately replace the patch.
If the patch has been loose for less than 24 hours, the woman need not use an
alternative form of contraceptive, but if she is not sure of how long the patch has been
loose, she should replace it and start with a new week cycle and also use an additional
contraceptive method.

3. Vaginal ring

The vaginal ring releases a combination of estrogen and progesterone and surrounds
the cervix.
This silicon ring is inserted vaginally and remains there for 3 weeks, then removed on
the fourth week as menstrual flow would occur.
The woman becomes fertile as soon as the ring is removed.
The vaginal ring has the same effectivity rate as the oral contraceptives.
4. Subdermal implant

The subdermal implants are two rod-like implants embedded under the skin of the
woman during her menses or on the 7th day of her menstruation to make sure that she
is not pregnant.
It contains etonogestrel, desogestrel, and progestin.
It is effective for 3 to 5 years.
Subdermal implants have a fail rate of 1%.

5. Hormonal injections

A hormonal injection consists of medroxyprogesterone, a progesterone, and given once

every 12 weeks intramuscularly.
The injection inhibits ovulation and causes changes in the endometrium and the cervical
mucus.
After administration the site should not be massaged so it could absorb slowly.
It has an effectiveness of almost 100%, making it one of the most popular choices for
birth control.
Advise the woman to ingest an adequate amount of calcium in her diet as there is a risk
for decreased of bone mineral density and to engage in weight-bearing exercises.

6. Intrauterine Device

An IUD is a small, T-shaped object that is inserted into the uterus via the vagina.
It prevents fertilization by creating a local sterile inflammatory condition to prevent
implantation.
The IUD is fitted only by the physician and inserted after the woman’s menstrual flow to
be sure that she is not pregnant.
The device contains progesterone and is effective for 5 to 7 years.
A woman with IUD is advised to check the flow of her menstruation every month and
the IUD string, and also to have a pelvic examination yearly.

7. Chemical Barriers
Chemical barriers such as spermicides, vaginal gels and creams, and glycerin films are
also used to cause the death of sperms before they can enter the cervix and also lower
the pH level of the vagina so it will not become conducive for the sperm.
These chemical barriers cannot prevent sexually transmitted infections; however, they
can be bought without any prescription.
The ideal fail rate of chemical barriers is 80%.

8. Diaphragm
A diaphragm works by inhibiting the entrance of the sperm into the vagina.
It is a circular, rubber disk that fits the cervix and should be placed before coitus.
If a spermicide is combined with the use of a diaphragm, there is a failure rate of 6%
ideally and 16% typically.
The diaphragm should be fitted only by the physician, and should remain in place for 6
hours after coitus.
It can be left in place for not more than 24 hours to avoid inflammation or irritation.

9. Cervical Cap

The cervical cap is another barrier method that is made of soft rubber and fitted on the
rim of the cervix.
It is shaped like a thimble with a thin rim, and could stay in place for not more than 48
hours. 

10. Male Condoms

The male condom is a latex or synthetic rubber sheath that is placed on the erect penis
before vaginal penetration to trap the sperm during ejaculation.
It can prevent STIs and can be bought over-the-counter without any fitting needed.
Male condoms have an ideal fail rate of 2% and a typical fail rate of 15% due to a break
in the sheath’s integrity or spilling.
After sexual intercourse, the condom is removed to be disposed.

11. Female Condoms

These are also latex rubber sheaths that are specially designed for females and
prelubricated with spermicide.
It has an inner ring that covers the cervix and an outer, open ring that is placed against
the vaginal opening.
These are disposable and require no prescription.
The fail rate of female condoms is 12% to 22%.

Surgical Methods
One of the most effective birth control methods is the surgical method. The two kinds of
surgical methods are used by either the male or the female, and would ensure that
conception is inhibited after the surgery for as long as the client lives.

1. Vasectomy

Males undergo vasectomy, which is executed through a small incision made on each
side of the scrotum.
The vas deferens is then tied, cauterized, cut, or plugged to block the passage of the
sperm.
This procedure is done with local anesthesia, so advise the patient that mild
local pain can be felt after the procedure.
Advise the patient to use a back-up contraceptive method until two negative sperm
count results are performed because the sperm could remain viable in the vas deferens
for 6 months.
There is a 99.5% accuracy rate for vasectomy and has a few complications.

2. Tubal Ligation

In women, tubal ligation is performed by occluding the fallopian tubes through cutting,
cauterizing, or blocking to inhibit the passage of the both the sperm and the ova.
After menstruation and before ovulation, the procedure is done through a small incision
under the woman’s umbilicus.
A laparoscope is used to visualize the surgery, and the patient is under local anesthesia.
The woman may return to her sexual activities after 2 to 3 days of the operation.
Educate that menstrual cycle would still occur, and make sure that coitus before ligation
is protected to avoid ectopic pregnancy.
The effectiveness of this method is at 99.5%.

What are Genetic Disorders

Genetic disorders are physical defects or illnesses that are caused by problems in your
body's genetic code. Everybody is made up of 46 chromosomes, and these
chromosomes carry your DNA. DNA is responsible for dictating how you will look, act,
and develop. When a baby is conceived, he receives 23 chromosomes from his mother
and 23 chromosomes from his father. These chromosomes come together to complete
an entire genetic code. Sometimes, however, defects can occur in some of the
chromosomes or individual genes. As a result, fetal development can change, and your
baby can be born with a genetic disorder.

What are the types of genetic disease?

1. chromosomal abnormalities
2. single gene defects
3. multifactorial problems
4. teratogenic problems

Parents who have a genetic disease

Several factors increase the likelihood that a person will inherit an alteration in a gene. If
you are concerned about your risk, you should talk to your health care provider or a
genetic counselor. The following factors may increase the chance of getting or passing
on a genetic disease:
Parents who have a genetic disease
A family history of a genetic disease
Parents who are closely related or part of a distinct ethnic or geographic community
Parents who do not show disease symptoms, but "carry" a disease gene in their genetic
makeup (this can be discovered through genetic testing).

Common tests for determining genetic abnormalities

Newborn screening
Newborn Screening is a simple procedure to find out if a baby has a congenital
metabolic disorder that may lead to mental disorder that may lead to mental
retardation and even death if left untreated

{Newborn screening program in the Philippines currently includes screening of six

disorders: congenital hypothyroidism (CH), congenital adrenal hyperplasia (CAH),
phenylketonuria (PKU), glucose-6- phosphate dehydrogenase (G6PD) deficiency,
galactosemia (GAL) and maple syrup urine disease (MSUD)}

Diagnostic testing
Diagnostic testing is used to identify or rule out a specific genetic or chromosomal
condition. In many cases, genetic testing is used to confirm a diagnosis when a particular
condition is suspected based on physical signs and symptoms. Diagnostic testing can be
performed before birth or at any time during a person's life, but is not available for all
genes or all genetic conditions. The results of a diagnostic test can influence a person's
choices about health care and the management of the disorder.

{Diagnostic testing. If you have symptoms of a disease that may be caused by genetic
changes, sometimes called mutated genes, genetic testing can reveal if you have the
suspected disorder. For example, genetic testing may be used to confirm a diagnosis of
cystic fibrosis or Huntington's disease.}

Carrier testing
Carrier testing is used to identify people who carry one copy of a gene mutation that,
when present in two copies, causes a genetic disorder. This type of testing is offered to
individuals who have a family history of a genetic disorder and to people in certain
ethnic groups with an increased risk of specific genetic conditions. If both parents are
tested, the test can provide information about a couple's risk of having a child with a
genetic condition.

{Carrier testing. If you have a family history of a genetic disorder — such as sickle cell
anemia or cystic fibrosis — or you're in an ethnic group that has a high risk of a specific
genetic disorder, you may choose to have genetic testing before having children. An
expanded carrier screening test can detect genes associated with a wide variety of
genetic diseases and mutations and can identify if you and your partner are carriers for
the same conditions.}

Prenatal testing
Prenatal testing is used to detect changes in a fetus's genes or chromosomes before
birth. This type of testing is offered during pregnancy if there is an increased risk that
the baby will have a genetic or chromosomal disorder. In some cases, prenatal testing
can lessen a couple's uncertainty or help them make decisions about a pregnancy. It
cannot identify all possible inherited disorders and birth defects, however.

{Prenatal testing. If you're pregnant, tests can detect some types of abnormalities in
your baby's genes. Down syndrome and trisomy 18 syndrome are two genetic disorders
that are often screened for as part of prenatal genetic testing. Traditionally this is done
looking at markers in blood or by invasive testing such as amniocentesis. Newer testing
called cell-free DNA testing looks at a baby's DNA via a blood test done on the mother.}

Preimplantation testing
Preimplantation testing, also called preimplantation genetic diagnosis (PGD), is a
specialized technique that can reduce the risk of having a child with a particular genetic
or chromosomal disorder. It is used to detect genetic changes in embryos that were
created using assisted reproductive techniques such as in-vitro fertilization. In-vitro
fertilization involves removing egg cells from a woman’s ovaries and fertilizing them
with sperm cells outside the body. To perform preimplantation testing, a small number
of cells are taken from these embryos and tested for certain genetic changes. Only
embryos without these changes are implanted in the uterus to initiate a pregnancy.

{Preimplantation testing. Also called preimplantation genetic diagnosis, this test may be

used when you attempt to conceive a child through in vitro fertilization. The embryos
are screened for genetic abnormalities. Embryos without abnormalities are implanted in
the uterus in hopes of achieving pregnancy}

Predictive and presymptomatic testing

Predictive and presymptomatic types of testing are used to detect gene mutations
associated with disorders that appear after birth, often later in life. These tests can be
helpful to people who have a family member with a genetic disorder, but who have no
features of the disorder themselves at the time of testing. Predictive testing can identify
mutations that increase a person's risk of developing disorders with a genetic basis, such
as certain types of cancer. 

{Presymptomatic and predictive testing. If you have a family history of a genetic

condition, getting genetic testing before you have symptoms may show if you're at risk
of developing that condition. For example, this type of test may be useful for identifying
your risk of certain types of colorectal cancer.}

Forensic testing
Forensic testing uses DNA sequences to identify an individual for legal purposes. Unlike
the tests described above, forensic testing is not used to detect gene mutations
associated with disease. This type of testing can identify crime or catastrophe victims,
rule out or implicate a crime suspect, or establish biological relationships between
people (for example, paternity).

ANATOMY AND PHYSIOLOGY OF THE MALE AND FEMALE REPRODUCTIVE SYSTEM

FEMALE REPRODUCTIVE ANATOMY AND PHYSIOLOGY

THE EXTERNAL REPRODUCTIVE ORGANS

Mons pubis or mons veneris – pad of fat which lies over the symphysis pubis covered by
skin and at puberty by short hairs; protects the surrounding delicate tissues from
trauma.

Labia majora – two folds of skin with fat underneath; contain Bartholin’s glands which
are believed to secrete a yellowish mucus which acts as a lubricant during sexual
intercourse. The openings of the Bartholin’s glands are located posteriorly on either
side of the vaginal orifice.

Labia minora – two thin folds of delicate tissues; form an upper fold encircling the
clitoris )called the prepuce) and unite posteriorly (called the fourchette) which is highly
sensitive to manipulation and trauma that is why it is often torn during a woman’s
delivery.

Glans clitoris - small erectile structure at the anterior junction of the labia minora,
which is comparable to the penis in its being extremely sensitive

Vestibule – narrow space seen when the labia minora are separated.

Urethral meatus – external opening of the urethra: slightly behind and to the side are
the openings of the Skene’s glands (which are often involved in infections of the
external genitalia).

Vaginal orifice or Introitus – external opening of the vagina covered by a thin membrane
(called hymen) in virgins.
 Perinuem – area from the lower border of the vaginal orifice to the anus; contains the
muscles (e.g., pubococcoygeal and levator ani muscles) which support the pelvic organs,
the arteries that supply blood to the external genitalia and the pudendal nerves which
are important during delivery under anesthesia.

THE INTERNAL REPRODUCTIVE ORGANS

A. VAGINA
Vagina – a 3-4 inch long dilatable canal located between the bladder and the rectum;
contains rugae (which permit considerable stretching without tearing); organ of
copulation; passageway for menstrual discharges and fetus.

B. UTERUS
 Hollow pear-shaped fibromuscular organ 3 inches lone, 2 inches wide, 1 inch thick and
weighing 50-60 gms. In a non-pregnant woman
 Held in place by broad ligaments (from sides of uterus to pelvic walls; also hold Fallopian
tubes and ovaries in place) and round ligaments (from sides of the uterus to the mons
pubis)
 Abundant blood supply from uterine and ovarian arteries
 Organ of menstruation; site of implantation, retainment and nourishment of the
products of conception
 Composed of 3 muscle layers: perimetrium, myometrium and endometrium
 Consists of three parts
◦ Corpus (body)- upper portion with a triangular part called fundus
◦ Isthmus – area between corpus and cervix which forms part of the lower uterine
segment
◦ Cervix – lower cylindrical portion.

C. FALLOPIAN TUBES
4 inches long from each side of the fundus; widest part (called ampulla) spreads into
fingerlike projections (called fimbriae). Responsible for transport of mature ovum from
ovary to uterus; fertilization takes place in its outer third or outer half.

D. OVARIES
Almond-shaped, dull white sex glands near the fimbriae, kept in place by ligaments.
Produce, mature and expel ova and manufacture estrogen and progesterone.

III. THE PELVIS – although not a part of the female reproductive system but of the
skeletal system, it is a very important body part of pregnant women.

A. Structure
1. Two os coxae/innominate bones – made up of:
◦ Ilium – upper extended part; curved upper border is the iliac crest.
◦ Ischium – under part; when sitting, the body rests on the ischial tuberosities;
ischial spines are important landmarks.
◦ Pubis – front part; join to form an articulation of the pelvis called the symphysis
pubis.

2. Sacrum
wedge-shaped, forms the back part of the pelvis. Consists of 5 fused vertebrae, the first
having a prominent upper margin called the sacral promontory.

3. Coccyx
Lowest part of the spine; degree of movement between sacrum and coccyx made
possible by the third articulation of the pelvis called sacroccygeal joint which allows
room for delivery of the fetal head.

Types of female pelvis

1. Gynecoid – “normal” female pelvis. Inlet is well rounded forward and back. Most
ideal for childbirth.
2. Anthropoid – transverse diameter is narrow, AP diameter is lager than normal.
3. Platypelloid – inlet is oval, AP diameter is shallow
4. Android – “male” pelvis. Intel has a narrow, shallow posterior portion and pointed
anterior portion.