避孕与流产英文ppt精解 117页Contraception and Abortion

1、Contraception and AbortionAgendaDiscuss History and Considerations Associated with MethodsDiscuss Contraception MethodsDiscuss AbortionClass Exercise: Contraception Values ClarificationComplete the handout entitled “Contraception Values Clarification.After you have completed the handout, discuss you

2、r response in small groups.IntroductionMajority of U.S. pregnancies are not planned and most are a result of not using contraceptionFactors increasing motivation to use contraception: vgood communication with partner, vlower cost, veffectiveness rates, vfrequency of intercourse, vmotivation to avoid

3、 pregnancy, vside effects, vopenness about sexualityContraception: HistoryContraception in Ancient TimesContraception in the U.S.: 1800s and Early 1900sContraception Outside the U.S.Contraception in Ancient TimesAncient Greeks: magic, superstition, herbsEgyptians: fumigating female genitalia, tampon

4、 soaked in herbal liquid & honey, inserting a mixture of crocodile feces, sour milk, & honeySouth Africa: insert vegetable seed podsAfrica: insert a grassy cervical plugPersia: insert alcohol soaked spongesGreece: insert empty pomegranate halvesContraception in the U.S.: 1800s and Early 1900

5、sConcern in early 1800s was to curb poverty by controlling fertility1873 Comstock laws prohibited dispersing information about contraceptives, including by doctorsContraception use is affected by Social issues e.g. desired family sizeEconomic issuesKnowledge & misinformationReligionGender roles

6、& power in some areas, men make the contraceptive decisions; for some it is the responsibility of bothChoosing a Method of ContraceptionFDA Approval ProcessLifestyle IssuesFDA Approval ProcessThe U.S. Food and Drug Administration (FDA) must formally approve the method10-14 year process to develo

7、p a new contraceptive drugDrug company submits a new drug application demonstrating safety in animal tests & a desire to conduct human trialsFDA Approval Process3 phasesvPhase 1: 20-80 volunteers to test effectivenessvPhase 2: several hundred to test effectiveness, side effects, risks vPhase 3:

8、hundreds to thousands are tested for generalizationAnimal trials are conducted throughout the processClass Discussion: Lifestyle Issues Associated with ContraceptiveThe following factors seem to be associated with choosing a contraceptive method:vOwn health & risksvNumber of sexual partnersvFreq

9、uency of intercoursevRisk of acquiring a STIvResponsibility levelvMethod costvAdvantages & disadvantages of the methodDiscuss influence of each.Contraception MethodsBarrier Methods: Condoms and CapsPrevent sperm from entering the uterusBarrier Methods:vCondomsvThe DiaphragmvThe Contraceptive Spo

10、ngevThe Cervical BarriersCondoms1850 latex condoms available in the U.S.$10-$15/dozenNon-expired condom is rolled onto an erect penis (foreskin pulled back), -inch empty space at the tipWater-based lubricants for latex condomsCondom grasped at base when withdrawingLatex condoms have lower rates of s

11、lippage & breakage, and offer better STI protectionCondomsIn 1994, female polyurethane/nonlatex condoms were available $2 each7 inches long with 2 flexible ringsInner ring squeezed and inserted close to the cervixOuter ring lies outside the vaginaAdequate lubrication is necessaryCondomsEffective

12、ness ratesvLatex condoms: 85-98% vFemale condoms: 79-95%Latex & polyurethane protect against STI transmissionLambskin condoms block sperm, but contain holes large enough for viruses to pass throughHeat can damage condomsCondomsAdvantages: vSTI protectionvEncourages male participationvInexpensive

13、vNo prescription necessaryvCan reduce premature ejaculationvCan reduce postcoital dripvNo medical side effectsCondomsDisadvantages:vReduces spontaneityvCan reduce sensationvFemale condoms can be difficult to use, uncomfortable, noisyFemale & male condoms should never be used togetherPopular in s

14、ome countries, not used in othersThe DiaphragmNot widely used, almost 0% in 2002Made of latex or siliconeMany sizes and shapes; a fitting by a health care provider is necessary$20-$35 diaphragm, $13 spermicidal jelly/cream, office visit chargeThey can last for many yearsDiaphragms come in a variety

15、of different shapes and sizes and must be fitted by a health-care provider.The DiaphragmDiaphragm rim is covered in spermicidal jelly & a tablespoon of jelly is placed in the dome; it is folded in half and inserted into the vagina with the front rim tucked under the pubic boneIt should not be fe

16、lt & should cover the cervixIt can be inserted up to 6 hours prior to intercourseLeft in for at least 6-8 hours, no more than 24 After use it is washed with soap & water Instructions for proper insertion of a diaphragm.The Diaphragm84-94% effective, lower for those who have given birthAdvant

17、ages: vIncreases spontaneityvSome STI & PID protectionvReduces risk of cervical dysplasia & cancervDoes not affect hormonal levelsvRelatively inexpensiveThe DiaphragmDisadvantages:vPhysician fitting and prescriptionvInsertion & removal involves touching the genitalsvIncreased risk of tox

18、ic shock syndrome and urinary tract infectionvPostcoital dripLow usage outside the U.S.The Contraceptive SpongeThe Today contraceptive sponge was taken off the market for a decade due to issues with the manufacturing plant; reintroduced in 2005Available over the counter in one sizeThe sponge covers

19、the cervix & contains spermicide; it blocks, absorbs, & deactivates spermOne box of 3 sponges is $13The Today contraceptive sponge was back on the market in late 2005 in the United States.The DiaphragmSponge is moistened with water to activate the spermicide, folded in half, & inserted t

20、o cover the cervixCan be inserted up to 24 hours in advance, with intercourse occurring as many times as desirable in that time periodMust be left in at least 6 hours after intercourse75-89% effectiveness ratesInstructions for proper insertion of a contraceptive sponge.The DiaphragmAdvantages:vNo pr

21、escription necessaryvCan have intercourse several times within 24 hoursvIncrease sexual spontaneityvDo not affect hormonal levelsvDisposableThe DiaphragmDisadvantages:vIncreased risk of toxic shock syndrome & urinary tract infectionvCannot be used while menstruatingvRequires touching of the geni

22、talsvHigh expense if frequently usedvSome men can feel itLow usage rates in other culturesThe Cervical BarriersThimble-shaped, silicone barriers that fit over the cervixBlock entrance to the uterus & deactivate sperm with the spermicideFitting by a health care provider is necessaryTwo types:vFem

23、CapvLeas ShieldThe FemCap is a silicone cup shaped like a sailors hat that fits securely over the cervix. Leas Shield is a silicone cup with a one-way valve and a loop for easier removal.The Cervical Barriers$15-75 plus cost of spermicideLeft in place for 8 hours after intercourseAfter use, it is wa

24、shed with soap & waterNot to be used during menstruation86% effectiveness rate, lower for those who have had childrenThe Cervical BarriersAdvantages:vLeft in place for up to 48 hoursvDo not affect hormonal levelsvImmediately effectivevNot permanentvOne-way release valve in Leas Shield reduces ri

25、sk of toxic shock syndromeThe Cervical BarriersDisadvantages:vAbnormal Pap smearsvIncreased risk of urinary tract infectionsvIncreased vaginal odorsvCervical damagevIncreased postcoital dripvFitting is necessaryvSome male partners feel it & may dislodge itThe Cervical BarriersWidely used in Engl

26、andLeas Shield is available over the counter in Germany, Austria, Switzerland, & Canada Hormonal Methods for Women: The Pill, the Patch, and MoreChanging hormonal levels can deter production of ova, fertilization, and implantationHormonal Methods for Women: The Pill, the Patch, and MoreCombined-

27、Hormone MethodsvBirth Control PillsvHormonal RingvHormonal PatchProgestin-Only MethodsvSubdermal ImplantsvHormonal InjectiblesCombined-Hormone MethodsCombination of estrogen & progesteroneCan repress ovulation and thicken cervical mucusBirth Control PillsFederally approved in 1960Most popular co

28、ntraceptive in the U.S. and around the worldMost studied type of medication Combination birth control pills are $12-25 per monthDesigned to mimic a menstrual cycle, with 21 days of hormones and one off weekBleeding is medically inducedBirth Control PillsSome take 2 to 3 packs of active pills in a ro

29、w to reduce the number of menstrual periodsSeasonale 84-day active pill with 7-day placeboReducing periods can help those with heavy bleeding and cramping60% of women prefer to not have a periodBirth Control PillsIncrease in estrogen & progesterone prevent the pituitary from sending hormones to

30、ripen the ovariesCervical mucus thickens & endometrium buildup is minimalThe body is tricked into thinking it is pregnantMay experience other signs of pregnancy that usually disappear within a few monthsBirth Control PillsInitially prescribed a low-dose estrogen pill; increased if breakthrough b

31、leeding occursMonophasic pills contain the same dose of hormones in each pillMultiphasic pills vary in hormone amountTriphasil pills have 3 sets, each week the hormonal dosage increases92-99.7% effectiveNeed to take it each day at the same timeBirth Control PillsAdvantages:vHigh effectiveness ratevD

32、oesnt interfere with spontaneityvReduced menstrual flow, cramps, & PMSvIncreased menstrual regularityvReduced risk of ovarian cysts, uterine & breast fibroids, facial acne, ovarian & endometrial cancers, PID, benign breast diseaseBirth Control PillsDisadvantages:vNo STI protectionvFemale

33、s responsibility; taken dailyvCan be expensivevLower effectiveness if overweightvNot appropriate for smokersUsed throughout the world, although not popular everywhere; some places have it over the counterHormonal RingNuvaRing introduced in 2003Plastic ring inserted into the vagina once a month for 3

34、 weeks, removed for 1 weekAffects the body as combination pills doBody heat & moisture activate a constant dose of estrogen & progesterone; lower dose than pills$30-35 per month99.7% effectiveThe NuvaRing is inserted deep into the vagina; moisture and heat cause it to time-release hormones t

35、hat inhibit ovulation.Hormonal RingAdvantages: vHigh effectivenessvDoesnt interfere with spontaneityvReduces menstrual flow, cramps, PMSvIncreases menstrual regularityvProtection from ovarian & endometrial cancer and ovarian cystsvFertility restored upon removalHormonal RingDisadvantages:vComfor

36、table touching genitalsvNo STI protectionvSide effects that typically disappear with regular use: breakthrough bleeding, weight change, breast tenderness, nausea, mood changes, changes in sexual desire, increased vaginal irritation & dischargeNo data on cross-cultural useHormonal PatchOrtho Evra

37、 patch is a thin, peach colored sticker attached to the skin with time-released hormonesPlaced on buttock, stomach, or upper torso for 3 weeks, no patch for the 4th weekAffects the body as combination pills do$30-35 per month99.7% effective, lower if weigh more than 198 poundsThe Ortho Evra patch is

38、 worn on the buttock, abdomen, or upper torso for three weeks each month.Hormonal PatchAdvantages:vHigh effectivenessvDoesnt interfere with spontaneityvReduces menstrual flow, cramps, PMSvIncreases menstrual regularityvProtection from ovarian & endometrial cancer and ovarian cystsHormonal PatchD

39、isadvantages:vNo STI protectionvSide effects similar to hormonal ringvSkin irritation vChange in vision, discomfort to contact wearersvCollects lintvNearly impossible to conceal from partnerNo data on cross-cultural useProgestin-Only MethodsDo not contain estrogen and can be used by women that canno

40、t take estrogen, such as those who are breastfeeding & smokersOver time, may eliminate periodsMay cause slight weight gain, bloatedness, & breast tendernessProgestin-Only MethodsMinipill/POPs (progestin-only pills)vInhibit ovulation and thicken mucusvFewer side effects than combination pills

41、v92-99.7% effectivevMore expensive than combination pillsvCan cause irregular bleedingvHigher rate of ectopic pregnancies if get pregnant while taking the minipillSubdermal ImplantsConstant dose of progestin is time released for up to 5 yearsNorplant is no longer availableJadelle is FDA approved but

42、 not marketed in the U.S.v2 silicone cylinders implanted in the forearm in a 10 minute procedure; $500+Implanon is a single-rod approved in 2004Fertility restored upon removalSubdermal ImplantsSuppresses ovulation, thickens cervical mucus, unreceptive endometrium99.95% effective, decreases after the

43、 3rd yearLower effectiveness rates if over 154 poundsAdvantages:vEffective, long-lasting, reversiblevSimple implantation procedurevNo estrogen side effectsvDecreased menstrual flow, crampingSubdermal ImplantsDisadvantages:vExpensive implantation fees, arm pain, painful removal, possible scarringvIrr

44、egular bleeding, crampingvHeadaches, nausea, dizziness, weight change, rash, acne, hair growth or lossvVision problemsPopular in South AfricaHormonal InjectiblesDepo-medroxyprogesterone acetate (Depo-Provera) synthetic progesteroneMost popular non-oral contraceptive Injected into the arm or buttock

45、muscle every 3 months$30-125 per injectionWorks within 24 hoursFertility resumes 10 months after last injectionHormonal Injectibles97-99.7% effectiveAdvantages:vLong lasting injectionvModerately expensivevNo estrogenvDecreased menstrual flow & crampingvDecreased risk of endometrial & ovarian

46、 cancersvAllows for spontaneityHormonal InjectiblesDisadvantages:vOffice visits every 3 monthsvIrregular bleedingvFatigue, dizziness, weakness, headachesvAppetite increasesvDecrease in bone densityvRisk of liver, cervical, and breast cancersvLong return to fertilityLow usage rates in many countriesC

47、hemical Methods for Women: SpermicidesSpermicides come as foams, gels, suppositories, creams, foaming tablets, films, and capsulesInserted into vagina with applicator or finger 10-30 minutes prior to intercourse$5-10 over the counterCan also help reduce STIsLikely to see microbicides introduced that

48、 will protect from HIV & other STIsChemical Methods for Women: Spermicides71-82% effectiveEffectiveness is reduced if tampons or douches are used within 6-8 hoursFoam is more effective than other varietiesAdvantages:vOver the countervProvide lubricationvSome protection from STIsvNo serious side

49、effectsChemical Methods for Women: SpermicidesDisadvantages:vUsed each timevIncreased postcoital dripvMay produce allergic reactions, skin irritationsvIncreased risk of urinary tract infectionsvUnpleasant tasteWidely used in some countries, and not used much in other countriesIntrauterine Methods fo

50、r Women: IUDs and IUSsIntrauterine Device (IUD) vParaGard Copper T can be left in for 12 yearsIntrauterine System (IUS)vMirena IUD that contains time-released progestin; can be left in for 5 yearsMost IUD & IUS users are 35 or older$150-300 plus office visitIntrauterine Methods for Women: IUDs a

51、nd IUSsIUDs & IUSs create a slight infection in the uterus that obstructs sperm mobilityProgesterone from the IUS also affects the endometrium, hampering implantationHealth care providers insert the IUD Each month the woman must check for the string to assure it is still in place99.2-99.9% effec

52、tive, lower if never pregnantInsertion of an IUD.Intrauterine Methods for Women: IUDs and IUSsAdvantages:vLeast expensive method over timevAllows for spontaneityvDecreases menstrual flow (Mirena)vLong lasting effectsIntrauterine Methods for Women: IUDs and IUSsDisadvantages:vNo STI protectionvRisk o

53、f uterine perforation and PIDvIrregular bleedingvPainful insertion & removalvIncreased menstrual flow and crampingvMay be expelled from uterusvMay cause discomfort to the partnerWidely used through most of the worldNatural Methods for Women and MenNatural Family Planning and Fertility AwarenessW

54、ithdrawalAbstinenceNatural Family Planning and Fertility AwarenessInvolves a woman charting her menstrual periods and determining ovulation by daily monitoring of basal body temperature and checking cervical mucusBody temperature rises 0.4-0.8F before ovulation & remains elevated until menstruat

55、ionCervical mucus is thin, stretchy during ovulationNatural Family Planning and Fertility AwarenessAbstinence is practiced during ovulationOr a form of birth control is used during ovulation (fertility awareness)Mostly used by women spacing pregnancies that are not as concerned about preventionOvula

56、tion kits can also be used75-99% effectiveNatural Family Planning and Fertility AwarenessAdvantages:vUseful if other methods are not acceptable for religious reasonsvInexpensivevEducates about the menstrual cyclevEncourages partner communicationvNo side effectsNatural Family Planning and Fertility A

57、warenessDisadvantages:vNo STI protectionvRestricts spontaneityvLow effectivenessvTakes time & commitmentvSeveral cycles need to be recorded before it is reliableWidely used in many countries, particularly Catholic countriesWithdrawalAlso called coitus interruptusJust before ejaculation, the male

58、 withdraws his penis and ejaculates outside of the woman73-96% effectiveSperm may remain in urethra from previous ejaculations & impregnate without the male ejaculating inside of the womanWithdrawalAdvantages:vUseful if other methods are not acceptable for religious reasonsvNo costsvGood if coup

59、les arent concerned about preventionWithdrawalDisadvantages:vNo STI protectionvLow effectivenessvMay lead to premature ejaculationvMay be stressful vRequires trust & restraintWidely used in many countriesAbstinenceRefraining from sexual intercourse100% effectiveProtects against STIsPermanent (Su

60、rgical) MethodsA woman may be fertile until 50-51 yearsA man may be fertile most of his lifeSterilization in one of the safest & most effective contraceptive methodsSurgery that is typically irreversibleTwo types:vFemale SterilizationvMale SterilizationFemale SterilizationAlso called tubal sterilization or getting “tubes tied”A small incision is made under the navel or lower in the abdomenBoth Fallopian tubes are blocked through cauterization, rings, bands, clips, plug