The modern scientific forms of natural family planning include the following except: a. rhythm b. cervical mucous (Billings ) c. symptothermal d .standard days (SDM).

cervical secretions feel of cervix bbt .A. The woman learns how to tell when the fertile time of her cycle starts and ends.These are called fertility awareness methods.

Plan intercourse near mid-cycle (usually days 10 15) when conception is most likely.NFP: Mechanism of Action For contraception:  Avoid intercourse during the fertile phase of the menstrual cycle when conception is most likely. For conception:  .

NFP: Contraceptive Benefits Can be used to prevent or achieve pregnancy 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 .

BILLINGS METHOD A woman records what SHE FEELS AND SEES Peak day is last day of wetness Fertile days end 2 days after the peak .

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Woman is safe from day 3 onwards.This is the coverline. . Continue taking temp until there¶s a thermal shift .BASAL BODY TEMPERATURE Temp is taken daily and recorded. Draw a vertical line between says 2-3 of the shift.Draw a horizontal line across the highest temp from day 6-10. Discard the 1st 5 readings.

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this may be a sign that ovulation has not yet taken place.NFP: Client Instructions for BBT Method continued The infertile phase begins on the evening of the third consecutive day that temperature stays above the cover line (Thermal Shift Rule). . After infertile phase begins. wait until 3 consecutive temperatures are recorded above cover line before resuming intercourse. Abstain from sexual intercourse from beginning of menstrual period until beginning of infertile phase. To avoid pregnancy. If any of 3 temperatures falls on or below cover line during 3day count. you may stop taking temperature until next menstrual cycle begins and continue to have intercourse until first day of next menstrual period.

SYMPTOTHERMAL METHOD Combination of Billings and BBT Woman is safe from the 3rd day of the shift or the peak whichever comes later .

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NFP: Conditions Requiring Precautions Irregular menses Persistent vaginal discharge Breastfeeding .

NFP: Limitations Moderately effective (1 25 pregnancies per 100 women during the first year of use) Effectiveness depends on willingness to follow instructions Considerable training required to use correctly Requires trained provider (nonmedical) Requires abstinence during fertile phase to avoid conception .

g. HIV/AIDS) ..NFP: Limitations continued Requires daily record keeping Vaginal infections make cervical mucus difficult to interpret Basal thermometer needed for some methods Does not protect against STDs (e. HBV.

NFP: Who May Require Additional Counseling Women:      Whose age. immediately postabortion) With irregular menstrual cycles (calendar method only) Whose partner will not cooperate (abstain) during certain times in the cycle Who dislike touching their genitals . parity or health problems make pregnancy a high risk Without established menstrual cycles (breastfeeding.

STANDARD DAYS METHOD .

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1st day of menses b.The brown beads of the necklace used in SDM represent the : a. safe period . fertile period c.

The brown beads represent the safe period Red ±menses White ±fertile period .

FOR WOMEN WITH CYCLES RANGING FROM 26-32 DAYS MUST BE STRONGLY MOTIVATED .

LACTATION AMENORRHEA .

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LAM: Mechanisms of Action Frequent intense suckling disrupts secretion of gonadotrophin releasing hormone (GnRH) Irregular secretion of GnRH interferes with release of follicle stimulating hormone (FSH) and Decreased FSH and LH leutinizing disruptshormone (LH) follicular development in the ovary to suppress ovulation 31 .

What conditions must she fulfill ? .lactation amenorrhea A 25 year old G1P1breastfeeding mother wants to use LAM.

The baby gets at least 85 % of feedings from the breast .day and night No menses Baby is less than 6 months old .

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thickening the cervical mucous c . preventing ovulation b.disrupting existing pregnancy .COCs act by : a.

COCs: Mechanisms of Action Suppress ovulation Reduce sperm transport in upper genital tract (fallopian tubes) Change endometrium making implantation less likely Thicken cervical mucus (preventing sperm penetration) 36 .

. 10/11) Triphasic: 21 active pills contain 3 different E/P combinations (e..Types of COCs Monophasic: All 21 active pills contain same amount of Estrogen/Progestin (E/P) Biphasic: 21 active pills contain 2 different E/P combinations (e. 6/5/10) 37 .g.g.

any of the 1st 5 days of menses b.How to Start OCPs can be started on: a. any other time as long as she¶s not pregnant . within a wk after an abortion d.3-6 wks after childbirth if not breastfeeding c.

39 .1 51 pregnancies per 100 women during the first year of use) Effective immediately if started by day 7 of menstrual cycle Pelvic examination not required to initiate use Do not interfere with intercourse Few side effects Convenient and easy to use Client can stop use Can be provided by trained nonmedical staff 1Hatcher et al 1998.COCs: Contraceptive Benefits Highly effective when taken daily (0.

shorter periods) Decrease menstrual cramps May improve anemia Protect against ovarian and endometrial cancer Decrease benign breast disease and ovarian cysts Prevent ectopic pregnancy Protect against some causes of PID 40 .COCs: Noncontraceptive Benefits Decrease menstrual flow (lighter.

ectopic pregnancy .Other advantages include: very effective if used correctly regulates menses can be used by any age group prevents iron deficiency anemia helps prevent ovarian cysts .

those with irregular period b.COCs can be used by the following except : a. Bp=140/90 . varicose veins c. Tb d.

If BP drops she can use COCs.prescribe another method.If BP remains elevated .If initial BP reading is 140/90 prescribe condom and ask her to come back. .

pill-take 1 as soon as you remember 2 pills in the 1st wk ±avoid sex .use backup method 2 pills in the 2nd wk-take a pill ASAP .take next pill at usual time. continue taking the rest as usual 3rd wk-go straight to the next pack .Missed PILLS ? 1.

Your patient has severe vomiting within 2 hours of intake of pills. just take anti-emetics b. a + b . What do you advise? a. proceed with the missed pell regimen c.

C the effect of vomiting is similar to those missing a pill .

Your patient is afraid to take OCPs because of a family history of breast Ca. What do you advise .

More studies are being conducted. . Some show that they are more common among pill users .OCPs are protective towards ovarian and endometrial Ca Results for breast and cervical Ca are equivocal.some do not.

Can a smoker take the pill ? .

Caution all smokers its dangerous to their health.Older women should choose another method. .as long as she¶s less than 35 years of age .Yes . If she cannot stop she can take the POP.

51 .COCs: Conditions Requiring Precautions (WHO Class 3) COCs are not recommended unless other methods are not available or acceptable if a woman:  Is < 3 weeks postpartum (even if not breastfeeding)  Has unexplained vaginal bleeding (only if serious problem suspected)  Has high blood pressure ( 160/100 and < 180/110)  Has a history of breast cancer  Has symptomatic gall bladder disease  Is taking drugs for epilepsy (phenytoin or barbiturates) or tuberculosis (rifampin) Source: WHO 1996.

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COCs: Who Should Not Use (WHO Class 4) COCs should not be used if a woman:      Is pregnant (known or suspected) Is breastfeeding (< 6 weeks postpartum) Is jaundiced (symptomatic viral hepatitis or cirrhosis) Has ischemic heart disease or stroke (current or history of) Has blood clotting disorders (deep vein thrombophlebitis or pulmonary embolus) 53 Source: WHO 1996. .

.COCs: Who Should Not Use (WHO Class 4) continued COCs should not be used if a woman:        Is a smoker and age 35 years or older Has diabetes (> 20 years duration) Has headaches (migraine) Has high blood pressure (> 180/110) Has breast cancer Has liver tumors Has to undergo major surgery with prolonged bed rest 54 Source: WHO 1996.

POPs: Mechanisms of Action Suppress ovulation Reduce sperm transport in upper genital tract (fallopian tubes) Change endometrium making implantation less likely Thicken cervical mucus (preventing sperm penetration) 55 .

What precautions will you tell her .A breast feeding mom who is a smoker on her 5th week postpartum wants to take the POP.

POPs can be used by smokers Must be started on the 6th week postpartum Must be taken at the same time everyday There is no rest period in between packs Higher risk for ectopic pregnancy (1 0f 10 ) Does not affect flow of breast milk .

if she's not breastfeeding.Does it matter what time of the day she takes her POP? Yes. . Since POP contains minimal hormone there¶s danger of ovulation if she takes it later than 3 hours.If this happens she take the missed pill as soon as she remembers and use a back-up method.

POPs: Drug Interactions Most interactions relate to increased liver metabolism of levonorgestrel:   Rifampin (tuberculosis) Anti-epilepsy (seizures): Barbiturates. phenytoin. carbamzepine (but not valproic acid)  Griseofulvin (long-term use only) 59 .

any amount) Surgery (with or without prolonged bed rest) Thromboembolic disorders Valvular heart disease (symptomatic or asymptomatic) 60 .POPs: Conditions for Which There Are No Restrictions Blood pressure (< 180/110) Diabetes (uncomplicated or < 20 years duration) Pre-eclampsia (history of) Smoking (any age.

POPs: Warning Signs Return to clinic if any of the following occur:     Delayed menstrual period after several months of regular cycles (may be sign of pregnancy) Severe lower abdominal pain Heavy or prolonged bleeding Migraine headaches 61 .

symptomatic) Source: WHO 1996.POPs: Conditions Requiring Precaution (WHO Class 3) POPs are not recommended unless other methods are not available or acceptable if woman:     Is breastfeeding (< 6 weeks postpartum) Has unexplained vaginal bleeding (only if serious problem suspected) Has breast cancer (current or history) Is jaundiced (active. 62 .

DMPA
T he breastfeeding mom mentioned earlier wanted to try DMPA instead. Upon further questioning you find out she has a BP of 170 /110 and a Hb of 9. Her FBS is 140 gm .What will you tell her?

PICs: Mechanisms of Action
Suppress ovulation
Reduce sperm transport in fallopian tubes

Change endometrium

Thicken cervical mucus (prevent sperm penetration)

Types of PICs
Depo-Provera (DMPA): 150 mg of depot-medroxyprogesterone acetate given every 3 months Noristerat (NET-EN): 200 mg of norethindrone enanthate given every 2 months

PICs: Use in Breastfeeding Women May increase quantity of breastmilk Have no effect on:     Initiation or duration of breastfeeding Quality of breastmilk Growth and development of infants Long-term growth and development of children through adolescence .

Note: This efficacy rate refers only to DMPA.PICs: Contraceptive Benefits Highly effective (0. .31 pregnancies per 100 women during first year of use) Rapidly effective (< 24 hours) if started by day 7 of menstrual cycle Intermediate-term method (2 or 3 months protection per injection) Pelvic examination not required to begin use Do not interfere with intercourse 1 Trussell et al 1998.

It can cause mild glucose intolerance but can be used by women without vascular disease .ok to use DMPA. .If systolic BP below 160 and diastolic below 100 .IF higher better to use another method.

A 16 year old wants to use DMPA because no one can tell she¶s using it. What will you tell her? At present there¶s concern that DMPA use in girls below 18 might affect bone development and cause osteoporosis. .

One study suggests that the baby may be born SGA. .Can a pregnant woman use DMPA? It is best avoided but it is not harmful to the mother nor to fetus.

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continue and use back up method .What to do if she¶s late for her injection and sexually active ? Check for pregnancy. If not pregnant .

Disadvantages of DMPA causes changes in menstrual bleeding delayed return to fertility Breast tenderness ,headaches ,moodiness ,nausea, hair loss ,less sex drive ,acne

PICs: Limitations
Changes in menstrual bleeding pattern  Irregular bleeding/spotting initially in most women Weight gain ( 2 kg) is common Although pregnancy is unlikely, if pregnancy occurs, it is more likely to be ectopic than in a nonuser Resupply must be available Must return for injections every 3 months (DMPA) or 2 months (NET-EN) Return to fertility may be delayed for 7 9 months (on average) after discontinuation

PICs: Management of Irregular Bleeding
Prolonged spotting (> 8 days) or moderate bleeding: Reassurance Check for gynecologic problem (e.g., cervicitis) Short-term treatment:
COCs (30-50 µg EE) for 1 cycle1, or  Ibuprofen (up to 800 mg 3 times daily x 5 days) Remind client to expect bleeding after completing COCs. 

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.PICs: Conditions Requiring Precautions (WHO Class 3) PICs are not recommended unless other methods are not available or acceptable if a woman:  Is breastfeeding (< 6 weeks postpartum)  Is jaundiced (symptomatic viral hepatitis or cirrhosis)  Has high blood pressure (u 180/110)  Has ischemic heart disease (current or history)  Has had stroke  Has liver tumors (adenoma or hepatoma)  Has diabetes (> 20 years duration) Source: WHO 1996.

PICs: Who Should Not Use (WHO Class 4) PICs should not be used if a woman:    Is pregnant (known or suspected) Has unexplained vaginal bleeding (if serious problem suspected) Has breast cancer Source: WHO 1996. .

200mg 30% develop amenorrhea pregnancy rate=0.Another form of available injectable: NET EN (norethindrone enanthate ) given every 2 months 1ml preparation .4% (1/250) no effect on glucose tolerance .

There is a higher risk of blood clots and cardiovascular problems especially if the client is a smoker.PATCH What should you look out for with the patch? A woman using the patch is exposed to more estrogen than those taking the pill. .

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Male Condoms: Mechanisms of Action Prevent sperm from gaining access to female Prevent microorganisms reproductive tract (STDs) from passing from one partner to another (latex and vinyl condoms only) 83 .

Prevents premature ejaculation Not just for prostitutes Easy to use .CONDOMS How can a woman get her sex partner to use a condom? Condoms prevent pregnancy as well as STI .

Types of Male Condoms Latex (rubber) Plastic (vinyl) Natural (animal products) 85 .

86 1 . making maintenance of erection more difficult Trussell et al 1998.Male Condoms: Limitations Moderately effective (3 14 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) May reduce sensitivity of penis.

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 87 .

including HBV and HIV/AIDS)..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. even if using another method 88 .g. 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. implants.

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being careful semen does not spill out. hold base of condom and carefully withdraw penis from vagina. Source: WHO 1997. 90 .How to Remove a Male Condom After ejaculation and while penis is still hard. Pull condom off penis gently.

´ Source: AIDSTECH. sex is like that. 91 . ³By the time I put it on.´ You can say: ³I can help you put it on.´ ³Well. That should give you lots of extra sensations and help keep you in the mood. I won¶t be in the mood. But this way we¶ll be safe. AMREF and National AIDS Control Programme 1992.Male Condom Use: What to Say When He Says When he says: ³I¶ll lose my erection by the time I stop and put it on.´ ³It¶s so messy and it smells funny.

a total turnoff.Male Condom Use: What to Say When He Says When he says: ³Condoms are unnatural.´ Source: AIDSTECH. 92 . fake.´ ³This will help to prevent infection or reinfection.´ ³You never asked me to use a condom before. especially AIDS are a turnoff too.´ You can say: ³STDs. AMREF and National AIDS Control Programme 1992.

´ ³I don¶t have a condom with me.´ ³I do.Male Condom Use: What to Say When He Says When he says: ³Just this once.´ You can say: ³Once is all it takes. AMREF and National AIDS Control Programme 1992. 93 .´ Source: AIDSTECH.

´ (Open ³I know I¶m clean condom and feel how thin (disease-free).Male Condom Use: What to Say When He Says You can say: ³I know there is some reduced sensation. I¶m disease-free too.´ Source: AIDSTECH. AMREF and National AIDS Control Programme 1992. I haven¶t it is. but there is still plenty of sensation left. As months.´ .´ far as I know.) had sex with anyone in _ ³Thanks for telling me. It¶s like wearing a raincoat. 94 When he says: ³I can¶t feel anything. But I¶d still like to use a condom since either of us could have an infection and not know it.

 Allergic reaction to condom or local irritation to penis: Ensure that condom is not medicated. HIV/AIDS) and should not be used by those at risk.1 Help client choose another method. provide another spermicide or a nonmedicated condom or help client choose another method. If reaction persists.g.  Allergic reaction to spermicide: If symptoms persist after intercourse and no evidence of STD. although uncommon. can be uncomfortable and possibly dangerous.. 1 Natural condoms do not provide protection against STDs (e. 95 .Male Condoms: Management of Common Side Effects Allergic reactions. consider natural condoms (lambskin or gut) or another method. HBV.

.Male Condoms: Client Instructions Use a new condom every time you have intercourse. knife. because pre-ejaculatory semen contains 96 active sperm. scissors or other sharp utensils to open package. The condom should be unrolled onto erect penis before penis enters vagina. Do not use teeth. Use a spermicide with condom for maximum effectiveness and protection.

in latrine or burying. Dispose of used condoms by placing in a waste container. 97 . This prevents condom from slipping off and spilling semen. about 1 2 cm should be left at the tip for the ejaculate. withdraw penis before losing erection. Each condom should only be used once. While holding on to the base (ring) of the condom.Male Condoms: Client Instructions continued If the condom does not have an enlarged end (reservoir tip).

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Female Condoms: Mechanisms of Action Prevent sperm from gaining access to female Prevent microorganisms reproductive tract (STDs) from passing from one partner to another 99 .

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 100 .

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IUD Types: Copper bearing Hormone releasing (Mirena ) Inert (Lippes loop) .

Types of Medicated IUDs Copper-releasing:    Progestin-releasing:   Copper T 380A Nova T Multiload 375  Progestasert LevoNova (LNG20) Mirena 103 .

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Copper IUDs: Mechanisms of Action Interfere with reproductive process before ova reach uterine cavity Change endometrial lining Interfere with ability of sperm to pass through uterine cavity Thicken cervical mucus 105 .

6 0.IUDs: Contraceptive Benefits Highly effective (0. not affect breastfeeding Do 106 1 .81 pregnancies per 100 women during the first year of use for Copper T 380A) 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 Trussell et al 1998.

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 107 .Who Can Use IUDs Women of any reproductive age or parity who:         Want highly-effective.

Will you insert one ? . She¶s on her 14 day of the cycle .A 19 year old G0 came to you asking for an IUD.

There is no minimum or maximum age for its use. . You may insert one even if the woman is not menstruating as long as your sure that there is no pregnancy.A woman who never a pregnancy may use an IUD altho¶ it¶s not the best method for her.

Can a patient get an IUD just after pregnancy or abortion? .

You must be sure there is no infection before insertion. Same is true post abortion. Incidence of expulsion is higher.it can be inserted after a vaginal delivery or placed inside the uterus during a CS.Yes . The person who does this MUST BE PROPERLY TRAINED in this method. .

A patient complaining of heavy vaginal menses came to your clinic.How will you manage her? .She has an IUD for the past year.

1. 2.Give iron supplements 4. .Help her choose another method.Rule out any gyne problem 3.Reassure her that heavier menses is more common among IUD users especially during the 1st 6 months.remove or ifanemia is severs remove.If patient desires .

Sex partner was recently diagnosed with urethritis. .Oral temp is 38.A woman with an IUD comes to you complaining of a lower abdominal pain. Give the diagnosis and management .5 C .with cervical motion tenderness .

The IUD can stay in place if she improves BUT if symptoms persist or she develops an abscess remove. Schedule ff-up . Treat immediately considering the range of pathogens.Consider PID. Treat sexual partner.

There¶s an increased risk of abortion or infection. remove to avoid risk of infection and pre mature birth .Patient must be told removal can cause abortion. observe closely.What to do if patient gets pregnant? If strings are visible and pregnancy is less than 13 weeks. . If strings not visible or pregnancy is more than 13 wks.

Explain that he can really feel them cut them shorter Remove the IUD and provide another method .The partner complains of the strings.

NO TOUCH TECHNIQUE Load the inserter while still in the sterile package Clean the cervix with antiseptic before insertion Don¶t touch the vaginal wall with the sound or inserter Pass the sound or inserter through the cervix only once .

REMOVING theIUD Reasons for removal: patient¶s request side effects medical reasons : pregnancy PID perforation partial expulsion abnormal bleeding menopause IUD has reached expiration date .

Checking the IUD once a week during the 1st month after manses if patient notices symptoms missed period exposure to STI longer strings /something hsrd in the vagina increasing pain .

121 .IUDs: Conditions Requiring Precautions (WHO Class 3) IUDs are not recommended unless other methods are not available or acceptable if a woman has:    Benign trophoblast disease More than one sexual partner A partner who has more than one sexual partner Source: WHO 1996.

BTL Should BTL / Vasectomy be offered only to couples of a certain age / with a certain number of children ? Is the partner¶s consent necessary ? .

.The client must not be limited to temporary methods because of age or parity.The person has the right to make his/ her own decision .No. The partner¶s consent is not needed .

Types of Tubal Ligation Postpartum  Minilaparotomy (Infraumbilical) Laparoscopy Interval  124 .

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Tubal LIGATION: Anesthesia Local anesthesia of choice Spinal±only in select cases     obese associated (documented) pelvic pathology allergy to local anesthesia medical problems 126 .

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 127 .Who Can Use Tubal LIGATION Women: Who are age > 22 and < 45 Who want highly effective.

can be performed under antibiotic cover (if no sepsis). Postabortion: immediately or within 7 days.When to Perform Tubal Ligation 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). provided no evidence of pelvic infection 128 .

Tubal ligation: Contraceptive Benefits Highly effective (0. 129 .51 pregnancies per 100 women during first year of use) 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) 1 Trussell et al 1998.

Tubal Ligation: Noncontraceptive Benefits Does not interfere with breastfeeding Decreased risk of ovarian cancer 130 .

cold.g. gastroenteritis. Cancer of the genital tract Deep venous thrombosis Source: WHO 1996.Tubal LIGATION: Conditions Requiring Precautions (WHO Class 3) Unexplained vaginal bleeding (until evaluated) Acute pelvic infection Acute systemic infection (e. viral hepatitis) Anemia (Hb < 7 g/dl) Abdominal skin infection Appropriate precautions include delay of procedure until condition improves or resolves.. 131 . flu.

4°F) Dizziness with fainting Persistent or increased abdominal pain Bleeding or fluid coming from the incision Signs or symptoms of pregnancy 132 .Warning Signs for Tubal Ligation Clients Return to clinic if following problems occur: Fever (greater than 38°C or 100.

Spousal consent is not required. The client has the right to change her mind anytime prior to the procedure. No incentives should be given to clients to accept VS. A standard consent form must be signed by the client before the VS procedure. 133 . The client should understand that voluntary sterilization (VS) is a permanent (not easily reversible) method.Tubal Ligation: Client Issues The client should make the decision for sterilization voluntarily.

g.. HIV/AIDS) 134 .Tubal Ligation: 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. HBV.

and weak.A 35 year G2P2 wants to have a BTL but is concerned that she will get fat. She is afraid that she might lose her libido.How can you reassure her? .

She can have sex as before.She will be as strong as ever. .After BTL the woman will look and feel the same.In fact it will be better because the fear of pregnancy is no longer there.

When pregnancy occurs .However reversal is difficult. and expensive .the risk of ectopic pregnsncy is increased. it is considered a permanent method . .Because of these reasons .Can BTL be reversed? It is possible for some women .those with enough tube left .

VASECTOMY Is it better for a man to undergo vasectomy or for a woman to undergo BTL? .

It is less expensive and slightly more effective . .Both are very effective .and permanent.safe .Each couple must decide on the method they want. Vasectomy tho¶ is simpler and safer to perform .

informed consent 140 .Tubal Ligation: Who May Require Additional Counseling Women: Who cannot withstand surgery Who are uncertain of their desire for future fertility Who do not give voluntary.

20 ejaculations or when no sperm are seen in a microscopically examined semen specimen. If either partner is at risk.Vasectomy: General Information Vasectomy does not provide protection from pregnancy until after 3 months. including AIDS. 141 . Vasectomy does not provide protection against STDs. the couple should use condoms even after vasectomy. Vasectomy will not affect sexual performance because the testes still function normally.

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 142 . permanent contraceptive method Whose wives have age.Who Can Use Vasectomy Men: Of any reproductive age (usually 50) Who want a highly effective.

Vasectomy: Contraceptive Benefits
Highly effective (0.1 0.15 pregnancies per 100 women during the first year of use) 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)

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No-Scalpel Vasectomy
Failure rate: 

0.2 0.4% Hematoma Infection Epididymitis

Complications 
 

Overall < 2% Mortality < 0.001%
Source: Carignan 1995.
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146 . A standard consent form must be signed by the client before the procedure. The client should understand that voluntary sterilization (VS) is a permanent (not easily reversible) method. Spousal consent is not required.Vasectomy: Client Issues The client should make the decision for sterilization voluntarily. No incentives should be given to clients to accept VS. The client has the right to change his mind anytime prior to the procedure.

.g. HBV.Vasectomy: Limitations Must be considered permanent (not reversible) Client may regret later Delayed effectiveness (requires up to 3 months or 20 ejaculations) Risks and side effects of minor surgery. especially if general anesthesia is used Short-term discomfort/pain following procedure Requires trained physician Does not protect against STDs (e. HIV/AIDS) 147 .

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Vasectomy: Postoperative Problems Wound infection Hematoma Granuloma Excessive swelling Pain at incision site 149 .

What advise to give post ±op rest for 2 days avoid heavy work /lifting for a few days pain relievers may be used to ease any pain wear snug underwear for 2-3 days to support the scrotum put cold compress .

What if he complains of pain and swelling? check the site for infection clean the wound give antibiotics .