Physiologic Methods

 Abstinence: abstaining from penile–vaginal intercourse.

 Coitus interruptus (withdrawal): removal of penis from vagina
prior to ejaculation.
 Lactational amenorrhea method: breastfeeding.
 Fertility awareness–based methods: determine when woman
is most fertile; using either abstinence or barrier contraception.
 Basal body temperature method:
 Cervical mucus ovulation-detection method
Symptothermal method: combine the basal body temperature
with the cervical mucus.


 BC: Barrier Methods
 Male condom
 Should not be applied tightly
 Should extend one-half inch beyond tip of penis to collect
ejaculate
 Adverse effects: irritation, allergic reaction, unfavorable oral sex,
accidental splitting of condom
 Not best choice for under-25-group due to noncompliance and
inconsistent use
Female Condom
 Barrier Methods
 Diaphragms: woman-controlled method; provides
contraceptive protection; protection against some STIs.
 Cervical caps: cuplike devices; cover cervix. (Nullipara
 Vaginal sponge: single-use, soft, absorbent,
polyurethane device; contains spermicide. contains N-9
spermicide
 Left in place for 6 Hrs after intercourse.
 Toxic shock syndrome (signs of TSS: sunburn type of rash,
diarrhea, dizziness, faintness, weakness, sore throat, aching
muscles and joints, sudden high fever, and vomiting).
Tampons 4 h
Preparation of Diaphragm/
 BC: Barrier Methods (cont'd)
 Diaphragm
 Latex hemisphere with flexible rim that fits over the cervix
 Allows woman control, no systemic side effects
 A teaspoon of spermicide is placed in cup before insertion and
diaphragm must be left in for 6-8 hours after intercourse
 Instructed to urinate before inserting to avoid UTIs
 Non-hormonal Methods

 Sterilization: male and female.

 Copper intrauterine device (IUD).
 Sterilization
 Permanent procedure.
 Female sterilization: permanently blocking fallopian
tubes.
 Male sterilization (vasectomy): cuts or blocks both right
and left vas deferens; no effect on sex drive, male
hormone production, or sexual function. Use an
alternative methods 1 month or 3-4 ejaculation.
Male and Female
 BC: Sterilization
Male sterilization consists of vasectomy
Outpatient procedure with local anesthesia
Not considered sterile until two sperm-free ejaculations
Complications: hematoma, sperm granuloma, and spontaneous re-
anastomosis

Female sterilization is tubal ligation

General anesthesia by trans-peritoneal incision
Complications: hemorrhage, puncture, and cautery of the bowel (0.6%)
 Hormonal methods:
Oral contraceptives and side effects:
Abdominal pain, Chest Pain, Leg pain, Eyes
problems, and Headache.
Transdermal contraceptive system: deliver
continuous level of progesterone and ethynyl
estradiol. Could be applied weekly for 3
weeks and rest 1 week for menstrual period.
Vaginal ring: Deliver continuous level of
progesterone and ethynyl-estradiol. I ring can
be worn for 3 weeks, then rest for 1 week.
IUD. Mirena 5 years
Implants. 3 years
 Absolute Contraindications
Mnemonic: “My CUPLETS”
 (My) Migraines with focal neurologic aura
 (C) CAD or CVA
 (U) Undiagnosed genital bleeding
 (P) Pregnant or suspect pregnancy
 (L) Liver tumor or active liver disease
 (E) Estrogen-dependent tumor
 (T) Thrombus or emboli
 (S) Smoker age 35 or older
 Relative Contraindications
 Migraine headaches
 Migraine with or without aura is a relative
contraindication
 Smoker below age of 35 years
 Fracture or cast on lower extremities
 Severe depression
 Hyperlipidemia
 Cautions
Effectiveness decrease (when some
medications are taking simultaneously):
Anticonvulsants: Phenytoin,
oxycarbazepine, phenobarbital.
Antifungal: Griseofulvin.
Antituberculosis: Rifampicin.
Anti HIV: Nelfinavir and amprenavir.
Penicillin and derivate
Tetracycline
 BC: Pregnancy, Postpartum,
and OCs
 OCs should be started no earlier than 4 to 6 weeks after
delivery in non-nursing women
 Estrogen decreases the amount and quality of breast milk
 Progestins promote breast milk production so progestin-
only OCs should be used in women who are breastfeeding
 Progestin Hormonal Methods
 Progestin injection: depot medroxyprogesterone acetate
(DMPA) injection (Depo-Provera).
 Synthetic progestogen given every (12 weeks.
3 months)
 If given in early pregnancy, does not appear to stimulate
fetal anomalies or miscarriage.
 Bone mineral density (BMD) does decrease during
DMPA use; reverses after discontinuation.
 BC: Medroxyprogesterone Acetate Injections
 Depo-Provera: 150 mg deep IM injections given every 3
months/12 weeks
 After 5 years of use, bone density loss has been observed;
calcium supplements advised
 Difficult to conceive for up to 1 year after discontinuation
 May be used for patients who smoke
https://youtu.be/unMoohI0MEA
 Intrauterine Contraception

 IUDs: long-acting reversible contraceptive.

 Copper IUD: T-shaped device of polyethylene with copper
wire around stem and arms; may stay in place for 10
years.
 Reaction to having foreign body in reproductive tract;
sterile inflammatory response that is spermicidal.
 LNG-IUS (Mirena): T-shaped, but contains no copper; may
stay in place for 5 years. Levonorgestrel-releasing
intrauterine device.