contraception
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Contraception

Reproductive Medicine

Contraception is a measure or method used to prevent pregnancy. These methods can be temporary or permanent, aimed at helping individuals choose whether and when to conceive while engaging in sexual activity.

Barrier Methods

  • Male Condom: Male condom usage is one of the most common contraceptive methods. Besides being convenient and inexpensive, it effectively prevents the transmission of HIV/AIDS and sexually transmitted infections (STIs).A drawback is that condoms are disposable and cannot be reused, so they must be correctly worn for each sexual encounter. Water-based lubricants, rather than oil-based ones, should be used to reduce the risk of condom breakage. The failure rate of this method is 13%. 
     
  • Female Condom: The contraceptive principle of female condoms is similar to that of male condoms, creating a barrier within the vagina to prevent sperm from reaching the egg. It also helps prevent HIV/AIDS and STIs. Female condoms are also disposable, but unlike male condoms made of latex, they are often made of plastic, which is less common. The failure rate of this method is 21%.
     
  • Diaphragm: A diaphragm is a cup-shaped silicone product placed in front of the cervix before sexual intercourse to prevent sperm from reaching the egg. It must be used with spermicide to achieve effective contraception. The failure rate of this method is 17%.

Reversible Methods

Intrauterine Device (IUD): A small, often T-shaped contraceptive device inserted into the uterus by a doctor. Its copper component alters the uterine environment, reducing the sperm's mobility and significantly lowering the chances of successful fertilization. It can remain in place for up to 10 years, with a contraceptive failure rate of 0.8%.

Hormonal Methods

  • Subdermal Implant: A doctor inserts a rod-shaped contraceptive device under the skin of a woman's arm. The implant contains progestin, which has contraceptive effects, with a failure rate of 0.01%.
  • Oral Contraceptives: Oral contraceptives for women contain a combination of estrogen and progestin and must be prescribed by a doctor. The failure rate is 7%.
  • Contraceptive Patch: The contraceptive patch is a prescription medication that works similarly to oral contraceptives. It contains estrogen and progestin. When a woman applies the patch to her abdomen, buttocks, or lower body, the estrogen and progestin are absorbed into the bloodstream, providing contraceptive effects. The failure rate is 7%.
  • Vaginal Contraceptive Ring: Women can place the vaginal contraceptive ring themselves at the top of the vagina. The ring slowly releases estrogen and progestin and can be worn for three weeks. It is removed during the fourth week when menstruation occurs. The failure rate is 7%.

Natural Contraception

  • Natural contraception, also known as fertility awareness-based methods or non-hormonal contraception, relies on identifying a woman's fertile window (the period around ovulation when a woman is most likely to conceive) to prevent pregnancy. These methods include the basal body temperature, calendar rhythm, and cervical mucus observation methods, among others. While natural contraception methods can be appealing to some couples because they do not involve drugs or physical contraceptive devices, their effectiveness can be influenced by several factors, including the couple's correct use and consistent adherence.
  • In practice, due to errors in use, calculation mistakes, or natural variations in the menstrual cycle, their actual effectiveness often falls below theoretical values, with effectiveness rates possibly dropping to between 75% and 88%.

Emergency Contraception

  • Emergency contraception, also known as the morning-after pill or post-coital pill, is a method of contraception used after unprotected sexual intercourse to prevent unintended pregnancy. This form of contraception should be used as an emergency measure rather than a regular method of contraception. Emergency contraception pills typically contain high doses of female hormones such as levonorgestrel or estrogen. These hormones can intervene in multiple stages of the fertilization process, including delaying or preventing ovulation, preventing the binding of sperm and egg, or altering the uterine lining to prevent the implantation of a fertilized egg.
     
  • The effectiveness of emergency contraception depends on the timing of ingestion and the duration of time after sexual intercourse. Generally, the earlier it is taken, the more effective it is, with the optimal time being within 72 hours (3 days) after intercourse. Although emergency contraception pills are quite effective in preventing pregnancy, they do not prevent sexually transmitted diseases (STDs) and should not be used as a regular method of contraception.

Sterilization

Sterilization is a permanent contraceptive surgery designed to block the pathway of sperm or eggs to the uterus, thereby preventing pregnancy. This method is suitable for men and women who have decided not to have children in the future. Men can undergo a vasectomy, and women can opt for tubal ligation or tubal occlusion (Tubectomy) for permanent contraception, with failure rates of 0.15% for men and 0.5% for women.

  • For men (Vasectomy):
    A vasectomy is a minor surgery that prevents sperm from entering the ejaculate by cutting or sealing the vas deferens (the tubes that carry sperm from the testicles to the urethra). This surgery is usually performed under local anaesthesia and is a relatively simple and safe method of contraception.
     
  • For women (Tubectomy):
    Tubectomy involves cutting, sealing, or blocking the fallopian tubes (the pathway through which eggs travel from the ovaries to the uterus) to prevent the meeting of sperm and egg. This surgery may require general anaesthesia and is often performed using laparoscopic surgery, a minimally invasive surgical technique.

Sterilization is considered a very effective method of contraception. However, it is permanent, and although reversal is possible in some cases, reversal surgery is expensive and not consistently successful. Therefore, careful consideration and discussions with healthcare professionals should be undertaken before deciding to undergo sterilization surgery.

Contraceptive failure rates are based on statistics from the Centres for Disease Control and Prevention (CDC) in 2018.

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