Q 13. 1 How important is effective contraception for the world’s population?
A few years ago the world health organisation calculated that sexual intercourse takes place 42 billion times each year or 1,300 times per second. Whilst the exciting developments in the treatment of infertility attract media attention and acclaim, it is the need to control population growth that has become one of the major environmental problems to be resolved. It has been calculated that every minute there are 270 births and 90 deaths somewhere in the world resulting in a net world population growth of 180 people. The world population is approximately 6 billion and increasing at the staggering rate of an additional one million people every four days and one billion every ten years. In the year 1000A..D. there were only one hundred million, so there has been a sixty-fold increase in the last thousand years and a ten-fold increase over the last 200 years. Ninety percent of the population growth is happening in the poorer countries. There have been estimates that in such countries a couple will need to produce five children to have a reasonable expectation of one son reaching maturity. Studies have shown that women in the underdeveloped countries would avoid further pregnancies if adequate contraception were available. However, only 1% of aid to such countries is focused on family planning. In the developing world, modern contraception needs to be more readily available. Availability, however, is not the only answer. In the UK, where contraception is readily available and free of charge, one pregnancy in five is terminated for social reasons and one woman in four has had a pregnancy terminated by the age of 25.
References:
Trends in world population: How will the millenium compare with the past?. (1999 – 2849)
Q 13. 1 How important is effective contraception for the world’s population?
Q 13. 2 How long can my partner’s sperm survive in me?
Q 13. 3 How long are my eggs capable of fertilisation?
Q 13. 4 How long does my fertile phase last?
Q 13. 5 What is an ideal contraceptive?
Q 13. 6 How can the effectiveness of a contraceptive method be measured?
Q 13. 7 Can knowledge of the fertile phase be used for effective contraception?
Q 13. 8 I am breast-feeding my baby. Do I need contraception?
Q 13. 9 How effective is coitus interruptus?
Q 13. 10 How effective are condoms (sheaths)?
Q 13. 11 What are the advantages and disadvantages of condoms?
Q 13. 12 How long have vaginal methods of contraception been available?
Q 13. 13 How can I get a diaphragm (cap)?
Q 13. 14 How can the cap be checked?
Q 13. 15 How effective are diaphragms and caps?
Q 13. 16 What are the advantages and disadvantages of vaginal methods?
Q 13. 17 What is the contraceptive sponge?
Q 13. 18 How effective is the contraceptive sponge?
Q 13. 19 What is the female condom?
Q 13. 20 What are the advantages and disadvantages of female condoms?
Q 13. 21 How effective are spermicides?
Q 13. 22 What are the advantages and disadvantages of spermicides?
Q 13. 23 Which contraceptives are appropriate for an adolescent?
Q 13. 24 Which contraceptives are appropriate for a woman in her forties?
Q 13. 25 If I am taking the combined oral contraceptive pill or cyclical HRT, how can I tell when I have reached my menopause?
Q 13. 26 How effective is the Persona – Unipath Personal Contraceptive System?
Q 13. 27 Where can I obtain further information about contraception?
Q 13. 28 Could I have some Web sites?
Women’s Health – Home Page
Q 13. 2 How long can my partner’s sperm survive in me?
Soon after intercourse, the vaginal secretions return to their more typical acid state and sperm can only survive for six hours. The survival of sperm in cervical mucus, and the uterine and tubal fluid is the subject of debate. It probably varies between individuals. Originally it was thought that the maximum survival was four days but it is now believed that on occasion it may be up to 7 days.
Whereas a woman releases one egg each month, each adult testicle produces 1,000 sperm each second. Libido in women seems to peak around the time of ovulation (egg release). The secretion of the vagina is increased before intercourse when it becomes more alkaline than at other times. This more alkaline environment is more favourable to sperm survival. The ballooning of the upper vagina before intercourse reduces loss of seminal fluid after intercourse. There is evidence that during orgasm the uterus exerts a negative pressure, which tends to suck sperm in from the vagina.
Q 13. 1 How important is effective contraception for the world’s population?
Q 13. 2 How long can my partner’s sperm survive in me?
Q 13. 3 How long are my eggs capable of fertilisation?
Q 13. 4 How long does my fertile phase last?
Q 13. 5 What is an ideal contraceptive?
Q 13. 6 How can the effectiveness of a contraceptive method be measured?
Q 13. 7 Can knowledge of the fertile phase be used for effective contraception?
Q 13. 8 I am breast-feeding my baby. Do I need contraception?
Q 13. 9 How effective is coitus interruptus?
Q 13. 10 How effective are condoms (sheaths)?
Q 13. 11 What are the advantages and disadvantages of condoms?
Q 13. 12 How long have vaginal methods of contraception been available?
Q 13. 13 How can I get a diaphragm (cap)?
Q 13. 14 How can the cap be checked?
Q 13. 15 How effective are diaphragms and caps?
Q 13. 16 What are the advantages and disadvantages of vaginal methods?
Q 13. 17 What is the contraceptive sponge?
Q 13. 18 How effective is the contraceptive sponge?
Q 13. 19 What is the female condom?
Q 13. 20 What are the advantages and disadvantages of female condoms?
Q 13. 21 How effective are spermicides?
Q 13. 22 What are the advantages and disadvantages of spermicides?
Q 13. 23 Which contraceptives are appropriate for an adolescent?
Q 13. 24 Which contraceptives are appropriate for a woman in her forties?
Q 13. 25 If I am taking the combined oral contraceptive pill or cyclical HRT, how can I tell when I have reached my menopause?
Q 13. 26 How effective is the Persona – Unipath Personal Contraceptive System?
Q 13. 27 Where can I obtain further information about contraception?
Q 13. 28 Could I have some Web sites?
Women’s Health – Home Page
Q 13. 3 How long are my eggs capable of fertilisation?
From knowledge gained from IVF, we know that ova (eggs) are most likely to be fertilised within the first 24 hours after ovulation. However, when the embryologist finds no evidence of fertilisation after 24 hours, re-insemination with fresh sperm may result in fertilisation. This would suggest that insemination, whether spontaneous or artificial is most likely to result in pregnancy if it occurs before or within twenty-four hours of ovulation.
Q 13. 4 How long does my fertile phase last?
Ovulation occurs 14 days before your next period is due. If your periods are occurring regularly every 28 days, your fertile phase will be from day 7 to day 15. If the cycle is irregular, you have to allow for your shortest and longest cycles. If, for example, a woman has a cycle varying from 21 to 35 days, then the potential fertile phase could be somewhere between day 1 and day 22; this is assuming that the current cycle could not be longer than 35 days although in reality one cannot be certain. Unlike the vast majority of other species, we humans do not have breeding seasons. An interesting observation once quoted by an expert at The Royal College of Obstetricians and Gynaecologists related to the monthly cycle. The best suggestion he could find was that in primitive ages, fertility would be enhanced if the woman released her monthly egg at a time when there was no moonlight for her man to go out hunting for food! Whereas in other species, such as the rabbit, coitus induces ovulation there is no evidence that this occurs in humans. The cervical mucus (the fluid in the neck of the womb) becomes more fluid and stretchy under the influence of the unopposed oestrogen before ovulation. It is only around the time of ovulation that the cervical mucus permits sperm through – at other times it is “hostile”.
Q 13. 1 How important is effective contraception for the world’s population?
Q 13. 2 How long can my partner’s sperm survive in me?
Q 13. 3 How long are my eggs capable of fertilisation?
Q 13. 4 How long does my fertile phase last?
Q 13. 5 What is an ideal contraceptive?
Q 13. 6 How can the effectiveness of a contraceptive method be measured?
Q 13. 7 Can knowledge of the fertile phase be used for effective contraception?
Q 13. 8 I am breast-feeding my baby. Do I need contraception?
Q 13. 9 How effective is coitus interruptus?
Q 13. 10 How effective are condoms (sheaths)?
Q 13. 11 What are the advantages and disadvantages of condoms?
Q 13. 12 How long have vaginal methods of contraception been available?
Q 13. 13 How can I get a diaphragm (cap)?
Q 13. 14 How can the cap be checked?
Q 13. 15 How effective are diaphragms and caps?
Q 13. 16 What are the advantages and disadvantages of vaginal methods?
Q 13. 17 What is the contraceptive sponge?
Q 13. 18 How effective is the contraceptive sponge?
Q 13. 19 What is the female condom?
Q 13. 20 What are the advantages and disadvantages of female condoms?
Q 13. 21 How effective are spermicides?
Q 13. 22 What are the advantages and disadvantages of spermicides?
Q 13. 23 Which contraceptives are appropriate for an adolescent?
Q 13. 24 Which contraceptives are appropriate for a woman in her forties?
Q 13. 25 If I am taking the combined oral contraceptive pill or cyclical HRT, how can I tell when I have reached my menopause?
Q 13. 26 How effective is the Persona – Unipath Personal Contraceptive System?
Q 13. 27 Where can I obtain further information about contraception?
Q 13. 28 Could I have some Web sites?
Women’s Health – Home Page
Q 13. 5 What is an ideal contraceptive?
The perfect contraceptive would be:-
• guaranteed to protect against pregnancy.
• without danger of serious side-effects.
• without danger of nuisance side-effects.
• effective immediately.
• quickly reversible.
• acceptable from the user’s personal and cultural point of view.
We all look forward to the arrival of this perfect method but for the moment you need to look at the advantages and disadvantages of those methods that are currently available so that you can decide which method you would prefer. In general, the methods that carry the least risks are the least effective whereas the most effective methods also carry the greater risks of side-effects. Couples must be aware of the balance and decide on the method that seems best for them. For you, as an individual, effective contraception should provide you with control over some of the most important aspects of your life.
Q 13. 1 How important is effective contraception for the world’s population?
Q 13. 2 How long can my partner’s sperm survive in me?
Q 13. 3 How long are my eggs capable of fertilisation?
Q 13. 4 How long does my fertile phase last?
Q 13. 5 What is an ideal contraceptive?
Q 13. 6 How can the effectiveness of a contraceptive method be measured?
Q 13. 7 Can knowledge of the fertile phase be used for effective contraception?
Q 13. 8 I am breast-feeding my baby. Do I need contraception?
Q 13. 9 How effective is coitus interruptus?
Q 13. 10 How effective are condoms (sheaths)?
Q 13. 11 What are the advantages and disadvantages of condoms?
Q 13. 12 How long have vaginal methods of contraception been available?
Q 13. 13 How can I get a diaphragm (cap)?
Q 13. 14 How can the cap be checked?
Q 13. 15 How effective are diaphragms and caps?
Q 13. 16 What are the advantages and disadvantages of vaginal methods?
Q 13. 17 What is the contraceptive sponge?
Q 13. 18 How effective is the contraceptive sponge?
Q 13. 19 What is the female condom?
Q 13. 20 What are the advantages and disadvantages of female condoms?
Q 13. 21 How effective are spermicides?
Q 13. 22 What are the advantages and disadvantages of spermicides?
Q 13. 23 Which contraceptives are appropriate for an adolescent?
Q 13. 24 Which contraceptives are appropriate for a woman in her forties?
Q 13. 25 If I am taking the combined oral contraceptive pill or cyclical HRT, how can I tell when I have reached my menopause?
Q 13. 26 How effective is the Persona – Unipath Personal Contraceptive System?
Q 13. 27 Where can I obtain further information about contraception?
Q 13. 28 Could I have some Web sites?
Women’s Health – Home Page
Q 13. 6 How can the effectiveness of a contraceptive method be measured?
The Pearl pregnancy rate is the standard method for comparison of effectiveness (Table 13.1). This measures the number of pregnancies that occur for each contraceptive method if used by 100 women for one year. Long-term users of a method probably have lower pregnancy rates than indicated by the Pearl rate because those who have failures are likely to change method. Furthermore failures are more likely in younger women who may be more fertile and more sexually active. This explains why there is a range of quoted Pearl rates for each contraceptive method.
Table 13.1 Pearl Index – Pregnancy rates per 100 couples in first year of use.
METHOD
PEARL RATE
(Failures / 100 women years)
Question Number
None (young women)
80-90
None (age 40)
40-50
None (age 45)
10-20
None (age 50)
0 – 50
Contraceptive sponge
9 – 25
13.17
Rhythm methods
6 – 25
13.7
Spermicide only
4 – 25
13.22
Coitus interruptus
8 – 17
13.9
Persona
3 – 6
13.26
Male condom (sheath)
2 – 15
13.10
Female condom
5 – 15
13.19
Diaphragm
4 – 20
13.13
IUCD (“Coil”)
0.2 – 2
17.1
Levonorgestrel intrauterine system
Less than 0.5
14.26
Progestogen-only pill
0.3 – 4
14.4
Combined pill
0.1 – 3
15.3
Subcutaneous implants
0 – 0.1
14.25
Depo-Provera (injection)
0 – 1
14.19
Sterilisation – Female
0 – 0.5
18.2
Sterilisation – Male
0 – 0.05
18.10
Q 13. 1 How important is effective contraception for the world’s population?
Q 13. 2 How long can my partner’s sperm survive in me?
Q 13. 3 How long are my eggs capable of fertilisation?
Q 13. 4 How long does my fertile phase last?
Q 13. 5 What is an ideal contraceptive?
Q 13. 6 How can the effectiveness of a contraceptive method be measured?
Q 13. 7 Can knowledge of the fertile phase be used for effective contraception?
Q 13. 8 I am breast-feeding my baby. Do I need contraception?
Q 13. 9 How effective is coitus interruptus?
Q 13. 10 How effective are condoms (sheaths)?
Q 13. 11 What are the advantages and disadvantages of condoms?
Q 13. 12 How long have vaginal methods of contraception been available?
Q 13. 13 How can I get a diaphragm (cap)?
Q 13. 14 How can the cap be checked?
Q 13. 15 How effective are diaphragms and caps?
Q 13. 16 What are the advantages and disadvantages of vaginal methods?
Q 13. 17 What is the contraceptive sponge?
Q 13. 18 How effective is the contraceptive sponge?
Q 13. 19 What is the female condom?
Q 13. 20 What are the advantages and disadvantages of female condoms?
Q 13. 21 How effective are spermicides?
Q 13. 22 What are the advantages and disadvantages of spermicides?
Q 13. 23 Which contraceptives are appropriate for an adolescent?
Q 13. 24 Which contraceptives are appropriate for a woman in her forties?
Q 13. 25 If I am taking the combined oral contraceptive pill or cyclical HRT, how can I tell when I have reached my menopause?
Q 13. 26 How effective is the Persona – Unipath Personal Contraceptive System?
Q 13. 27 Where can I obtain further information about contraception?
Q 13. 28 Could I have some Web sites?
Women’s Health – Home Page
Q 13. 7 Can knowledge of ovulation and the fertile phase be used for effective contraception?
As sperm can survive for seven days, there are probably no “safe” days between cessation of the period and ovulation (Q13.4). Fertility awareness (e.g. rhythm methods) has one of the highest failure rates of contraceptive methods (Table 13.1) but there are no side-effects and the method is acceptable to some cultures more than others. If ovulation can be predicted accurately, intercourse from two days onwards would theoretically be unlikely to result in conception. Ovulation occurs 14 days before the next period. Calculation of the post ovulation “safe” period is easier for those women with a regular cycle. Ultrasound has shown that “ovulation pain” (Mittelschmerz) tends to begin 24 – 48 hours before ovulation. The basal temperature can be used as a guide to the timing of ovulation. Following ovulation, progesterone is produced (Fig 2. 3) and this results in the temperature rising by 0.5 degree centigrade. The temperature should be basal rather than after activity and is generally measured in the morning on waking. If you record your temperature for a couple of months and feel confident that your chart shows clear changes this method may have advantages if you are reluctant to use other methods. From the medical point of view this method is not regarded as being effective. Assessment of the cervical mucus provides an indication of ovulation but it is not reliable. Progesterone, which is released into the circulation after egg release and though the second half of your menstrual cycle, makes the mucus less profuse and more sticky. The rhythm or calendar method involves calculation of the shortest and longest cycles over the last twelve cycles. The fertile phase is calculated as 20 days subtracted from the shortest cycle and 11 days from the longest cycle. If the cycle is regularly 28 days the fertile phase would be from Day 8 (28-20) until Day 17 (28-11). If the cycle varies from 21 to 35 days, the fertile phase would be from Day 1 to Day 24. For those with irregular cycles there may be few safe days.
Q 13. 1 How important is effective contraception for the world’s population?
Q 13. 2 How long can my partner’s sperm survive in me?
Q 13. 3 How long are my eggs capable of fertilisation?
Q 13. 4 How long does my fertile phase last?
Q 13. 5 What is an ideal contraceptive?
Q 13. 6 How can the effectiveness of a contraceptive method be measured?
Q 13. 7 Can knowledge of the fertile phase be used for effective contraception?
Q 13. 8 I am breast-feeding my baby. Do I need contraception?
Q 13. 9 How effective is coitus interruptus?
Q 13. 10 How effective are condoms (sheaths)?
Q 13. 11 What are the advantages and disadvantages of condoms?
Q 13. 12 How long have vaginal methods of contraception been available?
Q 13. 13 How can I get a diaphragm (cap)?
Q 13. 14 How can the cap be checked?
Q 13. 15 How effective are diaphragms and caps?
Q 13. 16 What are the advantages and disadvantages of vaginal methods?
Q 13. 17 What is the contraceptive sponge?
Q 13. 18 How effective is the contraceptive sponge?
Q 13. 19 What is the female condom?
Q 13. 20 What are the advantages and disadvantages of female condoms?
Q 13. 21 How effective are spermicides?
Q 13. 22 What are the advantages and disadvantages of spermicides?
Q 13. 23 Which contraceptives are appropriate for an adolescent?
Q 13. 24 Which contraceptives are appropriate for a woman in her forties?
Q 13. 25 If I am taking the combined oral contraceptive pill or cyclical HRT, how can I tell when I have reached my menopause?
Q 13. 26 How effective is the Persona – Unipath Personal Contraceptive System?
Q 13. 27 Where can I obtain further information about contraception?
Q 13. 28 Could I have some Web sites?
Women’s Health – Home Page
Q 13. 8 I am breast-feeding my baby. Do I need contraception?
If your baby is less than six months old, you are fully breast feeding, and your periods have not recommenced, the chance of pregnancy is in the order of 2%. Beyond six months, the protective effect of breast-feeding diminishes.
Q 13. 9 How effective is coitus interruptus?
Withdrawal of the penis before ejaculation was historically the only method of contraception. There are no dangerous side-effects but reported failure rates of 10/100 women years indicate that it has only limited effectiveness (Table13.1). Furthermore, lack of satisfaction for some partners and anxiety that withdrawal may be too late are additional problems. In one study, 31 % of women discontinued the method because they found it unpleasant but this compared to 54% who found the sheath unpleasant. Although coitus interruptus is not promoted by family planning doctors, there are times when a couple have no other method available; it is certainly more effective than no method at all.
Q 13. 10 How effective are condoms (sheaths)?
Condoms made from animal skins, bladders or bowel have been in use for many centuries but probably more for the prevention of infection than pregnancy. Rubber condoms first became available in the middle of the nineteenth century. In the UK, about 20% of couples use condoms. In Japan, where the pill only became available in late 1999, 75% of couples use condoms. Recognition of the dangers of sexually transmitted diseases, and HIV in particular, have provided an additional benefit for condom use. With motivation and correct use, failure rates of just one pregnancy per 100 woman years have been reported although the average for “careful users” is about 4 pregnancies per 100 woman years. The addition of vaginal spermicides probably reduces the failure rate. The condom is likely to fail if not used correctly. If there is genital contact before the condom is applied there could be some sperm around the penis from previous intercourse. Withdrawal should occur before the penis becomes flaccid and care be taken to ensure that there is no spillage of semen. Sharp fingernails can damage the sheath during application. Several local treatments for vaginal infections, hormone preparations applied within the vagina, baby oil, sun tan preparations and vaseline can weaken the sheath. It is probably best not to rely on condoms if there has been any recent vaginal treatment. The lubricating KY jelly does not damage condoms.
Q 13. 11 What are the advantages and disadvantages of condoms?
The advantages and disadvantages of sheaths are summarised in Table 13.2.
Table 13. 2 Advantages and disadvantages of condoms (sheaths).
Advantages
Disadvantages
Easily obtained.
Interruption of foreplay.
Cheap (free on NHS).
Reduced sensitivity for male partner.
Very effective.
Great care required.
Protects against sexually transmitted disease.
Occasional allergy for either partner.
Possibly reduce risk of cervical cancer.
Vaginal treatments may damage sheaths (Q13.10)
Q 13. 1 How important is effective contraception for the world’s population?
Q 13. 2 How long can my partner’s sperm survive in me?
Q 13. 3 How long are my eggs capable of fertilisation?
Q 13. 4 How long does my fertile phase last?
Q 13. 5 What is an ideal contraceptive?
Q 13. 6 How can the effectiveness of a contraceptive method be measured?
Q 13. 7 Can knowledge of the fertile phase be used for effective contraception?
Q 13. 8 I am breast-feeding my baby. Do I need contraception?
Q 13. 9 How effective is coitus interruptus?
Q 13. 10 How effective are condoms (sheaths)?
Q 13. 11 What are the advantages and disadvantages of condoms?
Q 13. 12 How long have vaginal methods of contraception been available?
Q 13. 13 How can I get a diaphragm (cap)?
Q 13. 14 How can the cap be checked?
Q 13. 15 How effective are diaphragms and caps?
Q 13. 16 What are the advantages and disadvantages of vaginal methods?
Q 13. 17 What is the contraceptive sponge?
Q 13. 18 How effective is the contraceptive sponge?
Q 13. 19 What is the female condom?
Q 13. 20 What are the advantages and disadvantages of female condoms?
Q 13. 21 How effective are spermicides?
Q 13. 22 What are the advantages and disadvantages of spermicides?
Q 13. 23 Which contraceptives are appropriate for an adolescent?
Q 13. 24 Which contraceptives are appropriate for a woman in her forties?
Q 13. 25 If I am taking the combined oral contraceptive pill or cyclical HRT, how can I tell when I have reached my menopause?
Q 13. 26 How effective is the Persona – Unipath Personal Contraceptive System?
Q 13. 27 Where can I obtain further information about contraception?
Q 13. 28 Could I have some Web sites?
Women’s Health – Home Page
Q 13. 12 How long have vaginal methods of contraception been available?
There is reference to the use of vaginal contraception going back more than 3,000 years. Nowadays there are vaginal diaphragms that fit over the cervix and front of the vagina and cervical caps that fit over the cervix only. Until the development of the pill, the diaphragm was very popular with about 10% of couples relying on it.
Q 13. 13 How can I get a diaphragm (cap)?
These can be obtained either from your local general practitioner or a family planning clinic. The correct size of diaphragm is determined by a doctor trained in family planning. The caps are measured across the external diameter and there is a range from 50 to 100 mm in 5mm steps. The doctor will check at a follow up visit that you have learned to introduce the diaphragm correctly. During intercourse the vagina enlarges so that unlike male or female sheaths the diaphragm cannot provide a complete barrier to sperm. The objective of the diaphragm is to retain spermicide in the area of the cervix and prevent motile sperm from entering the cervical mucus. The cervical cap should stay attached to the cervix by suction and it is a more effective barrier method than the diaphragm. The diaphragm should remain in place for at least six hours after intercourse and it is then removed and washed in soapy water.
Q 13. 14 How can the cap be checked?
It is wise to check the diaphragm from time to time to ensure that there is no damage. It should be held up to the light to see that there are no holes and the outer ring should quickly return to its round shape after squeezing. A diaphragm will usually last for about two years. If it is lost, a replacement of the correct size can be purchased at a chemist.
Q 13. 15 How effective are diaphragms and caps?
Pregnancy rates vary between 2-15 per 100 women years (Table 13.1).
Q 13. 16 What are the advantages and disadvantages of vaginal methods?
The advantages and disadvantages of vaginal methods are summarised in Table 13.3.
Table 13. 3 Advantages and Disadvantages of Vaginal Methods
Advantages
Disadvantages
Vaginal methods are effective if used correctly.
You may not be happy with introducing and removing the diaphragm.
They are cheap
Requires a doctor to fit and check it.
Female partner takes responsibility.
Requires preparation and is not, therefore, totally spontaneous.
No interruption during intercourse.
Some male partners are aware of the cap and may not like it.
No loss of sensation for either partner.
No protection against viral conditions such as herpes simplex (Q31.3) or HIV(Q20.14).
Reduced incidence of bacterial related sexually transmitted diseases (Q20.2),
Occasionally, there may be allergy to the rubber or spermicide.
Couples may feel less inhibited when the woman is menstruating.
Cannot be fitted before first intercourse (virgo intacta), if there is a vaginal septum (Q3.3) or utero-vaginal prolapse (Q 30. 1).
Cervical dysplasia (pre-malignancy Q 17.18) and cervical malignancy are reduced..
Q 13. 1 How important is effective contraception for the world’s population?
Q 13. 2 How long can my partner’s sperm survive in me?
Q 13. 3 How long are my eggs capable of fertilisation?
Q 13. 4 How long does my fertile phase last?
Q 13. 5 What is an ideal contraceptive?
Q 13. 6 How can the effectiveness of a contraceptive method be measured?
Q 13. 7 Can knowledge of the fertile phase be used for effective contraception?
Q 13. 8 I am breast-feeding my baby. Do I need contraception?
Q 13. 9 How effective is coitus interruptus?
Q 13. 10 How effective are condoms (sheaths)?
Q 13. 11 What are the advantages and disadvantages of condoms?
Q 13. 12 How long have vaginal methods of contraception been available?
Q 13. 13 How can I get a diaphragm (cap)?
Q 13. 14 How can the cap be checked?
Q 13. 15 How effective are diaphragms and caps?
Q 13. 16 What are the advantages and disadvantages of vaginal methods?
Q 13. 17 What is the contraceptive sponge?
Q 13. 18 How effective is the contraceptive sponge?
Q 13. 19 What is the female condom?
Q 13. 20 What are the advantages and disadvantages of female condoms?
Q 13. 21 How effective are spermicides?
Q 13. 22 What are the advantages and disadvantages of spermicides?
Q 13. 23 Which contraceptives are appropriate for an adolescent?
Q 13. 24 Which contraceptives are appropriate for a woman in her forties?
Q 13. 25 If I am taking the combined oral contraceptive pill or cyclical HRT, how can I tell when I have reached my menopause?
Q 13. 26 How effective is the Persona – Unipath Personal Contraceptive System?
Q 13. 27 Where can I obtain further information about contraception?
Q 13. 28 Could I have some Web sites?
Women’s Health – Home Page
Q 13. 17 What is the contraceptive sponge?
These are small polyurethane sponges, shaped to fit over the cervix. They are disposable, impregnated with spermicide and they have a tape allowing them to be removed easily. The sponge is moistened before insertion. A sponge is introduced up to 24 hours before intercourse.
Q 13. 18 How effective is the contraceptive sponge?
Pregnancy rates up to 25 per 100 women years have been quoted.
Q 13. 19 What is the female condom?
The latest female condom, Femidom, is made from polyurethane and has a lubricant. There is an inner ring measuring 60 mm diameter and an outer ring of 70mm. The rings are squeezed to allow insertion.
Q 13. 20 What are the advantages and disadvantages of female condoms?
They can be purchased without need for medical advice or prescription. The female partner takes responsibility and there is less loss of sensation for the male partner than with the male condom. It provides effective protection against sexually transmitted disease. This method of contraception became available in 1992. There are very few studies to determine its acceptability or effectiveness.
Q 13. 21 How effective are spermicides?
Spermicides (chemicals that kill sperm) have been available for many generations. The most popular spermicide currently available is nonoxynol-9. Spermicides are not as effective in real life as they appear to be in the laboratory.
Q 13. 22 What are the advantages and disadvantages of spermicides?
Pregnancy rates of up to 30 per 100 woman years have been reported (Table13.1). In view of these potentially high failure rates, family planning doctors generally recommend that you should use spermicides only in combination with other methods.
On balance it would seem that spermicides are likely to reduce your risk of pre-malignant and malignant conditions of the cervix.
Spermicides have been found to provide some protection against a variety of sexually transmitted diseases. From a medical point of view, additional precautions with a barrier are to be recommended.
Most chemicals introduced into the vagina are absorbed to some extent and this is true for spermicides.
There have been reports of possible harmful effects on the liver but these remain unproven.
There are probably no harmful effects on the fetus if you have been using spermicides in early pregnancy.
Q 13. 1 How important is effective contraception for the world’s population?
Q 13. 2 How long can my partner’s sperm survive in me?
Q 13. 3 How long are my eggs capable of fertilisation?
Q 13. 3 How long are my eggs capable of fertilisation?
Q 13. 4 How long does my fertile phase last?
Q 13. 5 What is an ideal contraceptive?
Q 13. 6 How can the effectiveness of a contraceptive method be measured?
Q 13. 7 Can knowledge of the fertile phase be used for effective contraception?
Q 13. 8 I am breast-feeding my baby. Do I need contraception?
Q 13. 9 How effective is coitus interruptus?
Q 13. 10 How effective are condoms (sheaths)?
Q 13. 11 What are the advantages and disadvantages of condoms?
Q 13. 12 How long have vaginal methods of contraception been available?
Q 13. 13 How can I get a diaphragm (cap)?
Q 13. 14 How can the cap be checked?
Q 13. 15 How effective are diaphragms and caps?
Q 13. 16 What are the advantages and disadvantages of vaginal methods?
Q 13. 17 What is the contraceptive sponge?
Q 13. 18 How effective is the contraceptive sponge?
Q 13. 19 What is the female condom?
Q 13. 20 What are the advantages and disadvantages of female condoms?
Q 13. 21 How effective are spermicides?
Q 13. 22 What are the advantages and disadvantages of spermicides?
Q 13. 23 Which contraceptives are appropriate for an adolescent?
Q 13. 24 Which contraceptives are appropriate for a woman in her forties?
Q 13. 25 If I am taking the combined oral contraceptive pill or cyclical HRT, how can I tell when I have reached my menopause?
Q 13. 26 How effective is the Persona – Unipath Personal Contraceptive System?
Q 13. 27 Where can I obtain further information about contraception?
Q 13. 28 Could I have some Web sites?
Women’s Health – Home Page
Q 13. 23 Which contraceptives are appropriate for an adolescent?
Contraception for adolescents has been discussed in Q5.18
Q 13. 24 Which contraceptives are appropriate for a woman in her forties?
From the age of 40 years, fertility decreases quickly (Table 13.1). It is wise for contraception to continue for two years after your last spontaneous period if you are more than 45 and for one year if you are more than fifty. For women who seem to have an earlier menopause, there is a tiny risk of ovulation and they should use contraception if they wish to be certain. For a non-smoker, who is not obese and who has a normal blood pressure, the combined oral contraceptive pill can be continued until the menopause. If the combined pill is contraindicated a progestogen only pill provides a good alternative.
The IUCD, barrier methods and sterilisation have a place. If periods are heavy the LNG-IUS (Q14.26) may improve the loss and provides excellent contraception.
Q 13. 25 If I am taking the combined oral contraceptive pill or cyclical HRT, how can I tell when I have reached my menopause?
A blood test, taken on the last day of the pill free interval, for FSH and oestradiol levels provides a valuable indication on whether you have reached your menopause (Q26.14). If you are taking cyclical HRT, you should complete your current pack and then withhold the HRT for at least 7 days before having the blood test. Some would suggest that the tests should be repeated two months later.
Q 13. 26 How effective is the Persona – Unipath Personal Contraceptive System?
The Persona is a small computerised monitor that assesses your early morning urine samples for levels of two hormones – LH and an oestrogen. Sixteen daily tests are usually required in the first cycle and eight after that. A red indicator indicates fertile days. First year failure rates are in the order of 6 per hundred women-years (Table13.1). One authority suggests that if sheaths are used from Day 1 until the first ‘red’ day, abstention through the red days and unprotected intercourse from the second ‘green’ day, failure rates of less than 3% could be expected.
Q 13. 27 Where can I obtain further information about contraception?
Brook Advisory Centre
421 Highgate Studios
53-79 Highgate Road
London NW5 1TL
Family Planning Association
2-12 Pentonville Road
London N1 9FP
Margaret Pyke Centre
73 Charlotte Street
London W1P 1LB
Q 13. 28 Could I have some Web sites?
Evaluation of the quality of Web sites is discussed in Q4.27. You may find that several general women’s health sites may help you (Q4.28). The following are more specialised Web sites on topics found in this chapter.
Women’s Health – Home Page
