Birth Control Methods

SPERMICIDES &BARRIER METHODS

M NABIL EL TABBAKH
PROF.OBST.& GYNECOL.
AL AZHAR MEDICAL SCHOOL ,CAIRO,EGYPT neltabbakh@yahoo.com

FAMILY PLANNING

Family planning is a basic human right that benefits everyone

FAMILY PLANNING
The goal of family planning is to enable couples and individuals to freely Choose how many children to have and when to have them

FAMILY PLANNING
This can best be done by making a full range of safe and effective contraceptive methods available and by Giving men and women sufficient information to ensure they are able to make informed choices

Physician obligations are:

First do no harm.
(primum non nocere, Hippocrates )
400 B.C

Assessing the balance between risk and benefit

Temporary methods Permanent methods Emergency contraception

Temporary methods
Natural regulation of fertility

Barrier methods, Hormonal contraception

Intra uterine contraceptive devices

Emergency (Post coital ) contraception

Permanent methods
Sterilization
Female sterilization Vasectomy No-scalpel vasectomy (NSV)

Sterilization reversal Effectiveness

World Health Organization (WHO)

Eligibility criteria for the use of various contraceptive methods.

Category 1: A condition for which there is no restriction for the use of the contraceptive method

World Health Organization (WHO)

Eligibility criteria for the use of various contraceptive methods.

Category 2:
A condition where the advantages of using the method generally outweigh the theoretical or proven risks

World Health Organization (WHO)

Category 3: A condition where the theoretical or proven risks usually outweigh the advantages of using the method

World Health Organization (WHO)

Category 4: A condition which represents an unacceptable health risk if the contraceptive method is used

Are expressed in terms of how many women experience pregnancies during their first year of using the method.

reflects correct and consistent use, according to specified instructions, with every sex act

Typical use reflects the fact that most couples do not use their contraceptive methods correctly or consistently with every sex act; this rate, therefore, is considered more accurate than perfect use.

AVICENNA`S CANON HAD AN ENORMOUS INFLUENCE ON MEDICAL TEACHING FOR A CONSIDERABLE PERIOD
Roberto Margotta &Paul Lewis (1996)

Avicenna reported the use of contraceptive pessaries in humans

Spermicides
What are spermicides?
Spermicides are chemical compounds act to inactivate sperms in the vagina before it can move into the upper genital tract

About 1550 B.C. an Egyptian described how lint (fetet) inserted into the vagina could prevent conception (left). Is this the first description of a ?tampon

Spermicides , CHEMICAL NATURE

TWO BASIC COMPONENTS :
1-ACTIVE SPERMICIDAL AGENTS :
Surface acting (surfactants) Nonoxynol-9 Octoxynol-9 Menfegol Recently with antiviral activity : CHLORHEXIDINE,CHOLIC ACID & GRAMICIDINE.

2- THE BASE ( CARRIER ) AGENT foams, jellies, creams, foaming tablets, melting suppositories ,aerosols soluble films or vaginal suppositories.

Spermicides
Are they effective?
First year failure rate 11 31 %
Perfect use 3 %

Typical use 28 %

Spermicides
How do I use spermicides?
*Every time of sexual intercourse. *Insert the recommended dose deep into vagina to cover the cervix well just before sexual intercourse

*Insert tablets or suppositories or films 10 minutes ( 5-30 min) before sexual intercourse

Spermicides
*Use a second dose of spermicides If more than one hour passes before you have sexual intercourse *An additional application of the spermicides is needed for each additional act of intercourse *Douching shoul not allowed for at least 6 hours after coitus

Spermicides
Characteristics of spermicides?
Does not require a prescription May be discontinued at any time

Safe
May cause irritation in the vagina or on the penis Can cause an allergic reaction May interrupt sexual activity The definite faliure rate Not recommended for preventing STIs

NEW DEVELOPMENT IN SPERMICIDES

*RS 37367 25 50 TIMES POTENT > NONOXYNOL 9 *GOSSYPOL COTTON SEED DERIVATIVE
*SPERM ENZYME INHIBITORS *PROPRANOLOL B BLOCKER EFFECTIVE > 10 HOURS

barrier methods
SPONGES
*Polyurethane substance + 1 gm nonoxynol - 9 *Shaped like mushroom cap *Can be used for 24 hours *Should not removed before 6 hours *Disposable

barrier methods
SPONGES
*Allergic reaction *Toxic shock syndrome *Vaginal irritation *??Carcinogenic *Vaginal yeast infection

SPONGES
Contraceptive Sponge Average Failure: 26-40%
The sponge should be moistened with water (not saliva) just before inserting, then placed over the cervix
It provides protection for twenty-four hours

barrier methods

The Diaphragm
*A diaphragm is a shallow rubber dom with a firm flexible rim Different sizes ( 50 105 mm ) *contraceptive jelly or cream (spermicide)

The Diaphragm
TYPES
Coil Spring

Arching Spring

Flat Spring

The Diaphragm
The diaphragm is not an appropriate method if : *Allergy to rubber, latex, or spermicide (male & female ) *Frequent urinary tract or bladder infections
*Aanatomical abnormalities

The Diaphragm
TO SELECT TYPE SIZE

The Diaphragm

INSERTION - REMOVAL

The Diaphragm
POSITIONS FOR INSERTION

The Diaphragm
Immediately effective and reversible

Can be used during breastfeeding

Can be inserted up to 6 hours before intercourse
May reduce the risk of cervical cancer

The Diaphragm
May be difficult to insert and remove May cause irritation in the vagina

Associated with UTI in some women

barrier methods
Cervical Cap
A cervical cap is a soft, deep rubber cup (like a thimble) with a firm, round rim that fits snugly over the cervix.

Cervical Cap

Different sizes With Spermicide

TYPES

Cervical Cap
INSERTION
B

Cervical Cap
Is it effective?
Perfect use: 8 % Typical use: 20 % The cap provides effective contraception for 48 hours

Cervical Cap
New Types
Lea Shield: A silicone version of the cervical cap with a oneway valve, allowing it to be used during menstruation

NOT FDA APPROVED The Oves Cervical

Cap: A disposable cap, made of hypoallergenic silicone. Can be worn up to 72 hours

Cervical Cap
Side effects
*Toxic shock syndrome *Unpleasant odour *Discomfort and awareness of the cap during coitus *Accidental dislodgment

barrier methods
Male Condoms
A male condom is a thin sheath made of latex or other materials

Latex condoms protect against pregnancy & STDs

Male Condoms
The earliest known illustration of a man using a condom during sexual intercourse is painted on the wall of a cave in France. It is 12,000-15,000 years old Another ancient illustration of a condom was found in Egypt, and it is more than 3,000 years old
(Parisot, 1985 & 1987)
A Short History of the Condom. London: The Journeyman Press Ltd.

Male Condoms

1700

1800

1993

Male Condoms

Available in various shapes, colours, flavours, textures and sizes

Latex and polyurethane condoms also provide limited protection against

HPV that can cause genital warts HSV that can cause genital herpes Hepatitis-B virus

Male Condoms
How do they work?
The man puts the condom on his erect penis The condom holds the semen After sex, the man carefully takes off the condom so that it does not leak. Each condom can be used only once.

Male Condoms
Male condom instructions
Leave about one-half inch of empty space at the tip
After intercourse, hold onto the condom at the base of the penis as you withdraw from the vagina Lubricating the condom contraceptive cream or jelly For latex condom, do not use oil-based lubricants (such as petroleum jelly or vegetable oils) tear

Male Condoms
Benefits
No medical side-effects

inexpensive, easily accessed Protecting against STDs ( Latex )

Condoms can help men maintain an erection for a longer period
Lower risk for cervical dysplasia and cancer Condoms also prevent sperm allergy which some women suffer

Male Condoms
Can interrupt sexual activity Some individuals argue that condoms reduce sensitivity and pleasure during intercourse May sometimes tear or leak Can cause an allergic reaction

Male Condoms
Are they effective?

Perfect use: 3% Typical use: 14 %

Theoritical effectiveness : 98.5 % Use effectiveness : 8 15 / HWY

barrier methods

Strong, soft, transparent polyurethane sheath inserted in the vagina before sexual intercourse 15 cm long X 7 cm diameter

Has two flexible rings

The inner ring at the closed end of the condom eases insertion into the vagina, covering the cervix and holding the condom in place
The outer ring , The larger, open ring stays outside the vagina, covering part of the perineum and labia during intercourse.

There is silicone-based lubricant on the inside of the condom, but additional lubrication can be used.

The female condom has been available in Europe since 1992 approved in 1993 by FDA brand names, FC Female Condom, Reality, Femidom, Dominique, Femy, Myfemy, Protectiv' and Care.

Female condom instructions

*A new condom every time
*Make sure the condom is in place

*NO male condom with a female condom

*Inserted for up to 8 hours

*Wash your hands carefully with soap and water before inserting, or removing the female condom.

Female Condoms
How to insert the female condom ?

While holding the sheath at the closed end, grasp the flexible inner ring and squeeze it with the thumb and second or middle finger so it becomes long and narrow.

Female Condoms
How to insert the female condom ?

Choose a position that is comfortable for insertion squat, raise one leg, sit or lie down.

Gently insert the inner ring into the vagina. Feel the inner ring go up and move into place.

Female Condoms
How to insert the female condom ?

Place, the index finger on the inside of the condom, and push the inner ring up as far as it will go. Be sure the sheath is not twisted. The outer ring should remain on the outside of the vagina.

The female condom is now in place and ready for use

Female Condoms
How to remove the female condom?

Remove the female condom immediately after sexual intercourse before you stand up
New Studies / condoms might be used more than once

Female Condoms
How to remove the female condom?

To remove the condom, twist the outer ring and gently pull the condom out.

Wrap the condom in the package or in tissue, and throw it in the garbage. Do not put it into the toilet.

Characteristics of female condoms

Offer protection against STDs Available without a prescription Are stronger than latex male condoms
(40% stronger)

Can be used with oil-based lubricants

Characteristics of female condoms

Less likely to constrict the penis and decrease sensation for the man than latex male condoms
Do not interrupt sexual activity
(can be inserted up to 8 hours before intercourse)

Can make a noise during sexual intercourse May be expensive or limited in their availability May be difficult to insert

Couples might DISLIKE the FEMALE CONDOM because: The female condom can be hard to handle at first Some people don't like the outer ring that hangs outside the vagina

Female Condoms
Failure rate 21 %

barrier methods
Annual Accidental Pregnancy Rates for Consistent and Correct Use FC Female Male Latex Diaphragm Condom Condom Cervical Cap Spermicide

5%

3%

6%

11%

6%

barrier methods
ADAPTATION OF COITAL TECHNIQUE

COITUS INTERRUPTUS
( WITHDRAWAL )
Withdrawal is a method in which the man takes his penis out of the woman's vagina just before he ejaculates

COITUS INTERRUPTUS ( WITHDRAWAL )

There are two types of withdrawal
Coitus interruptus is the Latin name for withdrawal with ejaculation taking place afterwards Coitus reservatus is the Latin name for withdrawal without ejaculation Both have been used since ancient times for contraception and for other reasons
(Bullough & Bullough, 1990).

COITUS INTERRUPTUS ( WITHDRAWAL )

Effectiveness
Perfect use : 4% will become pregnant Typical use : 19% will become pregnant

Failure rate 5 20 / HWY

barrier methods
ADAPTATION OF COITAL TECHNIQUE

COITUS INTERFEMORA ( Outercourse )

THANK U