Contraception

IUC’s, Sterilization

Intrauterine Contraceptives (IUC’s)

• IUC’s are made of flexible plastic, available only through prescription

• Three types– ParaGard (copper)– Mirena (hormone)– Skyla (hormone)

IUC’s: ParaGard• ParaGard contains copper• Copper prevents sperm

from fertilizing an ovum• Copper also makes

implantation of fertilized ovum difficult

• Amount of copper released is less than needed in daily diet

• Copper intolerance or insensitivity would preclude use of ParaGard

IUC’s: Paragard• Requires insertion into uterus by healthcare provider

– Takes only a few minutes– Insertion may cause cramping, dizziness

• Once inserted, may remain in place for ten years– Patient should not feel IUD

• Since no hormones present, monthly cycle should remain unchanged

• Effectiveness: 99%+ against pregnancy• Requires monthly checking for IUD slippage

IUC’s: ParaGard• Side effects: heavier and longer periods,

cramping, spotting in between periods– May lessen after a few months on ParaGard

• Complication risks: pelvic inflammatory disease shortly after insertion, perforation of uterus, expulsion

• Copper may provide protective benefit against endometrial cancer

• Cost: $0-1000 (Planned Parenthood)

IUC’s: Mirena• Progestin-only

intrauterine contraceptive

• Lasts for five years• Mirena:

– Prevents sperm from fertilizing ovum

– Prevents release of egg– Changes uterine lining

IUC’s: Mirena• Insertion: Similar to ParaGard• Effectiveness: 99%+ against pregnancy• Cost: $0-400 (Consumer Reports)• Side effects: Abdominal cramping (10% of users

during first few months), acne, breast tenderness, headache, mood changes, back pain– May lessen after a few months– As use continues, less menstrual bleeding

• Complication effects: ovarian cysts, pelvic inflammatory disease shortly after insertion, perforation of uterus, expulsion

IUC: Skyla• FDA approved in 2013• Hormone• Smaller than Mirena• Lasts three years instead of

five• Marketed to women who have

not had kids– Mirena marketed to women

with child (research done only on this group)

– IUC’s appropriate for all women

IUC’s

• Internal Birth Control- IUD’s (via Youtube)• Paragard insertion (via YouTube, 0-0:53)• Mirena insertion (via YouTube, for

healthcare providers)• Insertion of IUC (Medialvideos.us)

IUCs: Advantages & Disadvantages

• Effectiveness• Cost• Frequency of

application• Safety & side effects• Religion

• STI risk• Availability• Conspicuousness• Duration

Sterilization

Sterilization

• Sterilization = permanent contraception– Women undergo tubal ligation– Men undergo vasectomy

• The second most common contraceptive method used in the United States, behind the pill– No formalized data collection system exists– Data retrieved from surveys, questionnaires

Female reproductive anatomy

Male reproductive anatomy

Sterilization: Tubal Ligation

• Surgical technique• Close fallopian tubes,

preventing egg from traveling to uterus, preventing sperm from reaching egg

• Neither organs nor glands are removed

• Effectiveness: 99%+• Considered irreversible

Sterilization: Tubal Ligation• Tubal sterilization:

– Tubal coagulation/cauterization

– Tubes can be tied and cut (Pomeroy & Parkland techniques)

– Tubes can be clipped, clamped

– These incision methods often performed after childbirth/abortion

– Animation (SMART imagebase)

Sterilization: Tubal Ligation

• Cost: $1000-3000• Side effects: thought by many to be rare;

hormonal imbalance may lead to increased menstrual bleeding, cramping; adhesions

• Complications: infection, internal bleeding, ectopic pregnancy

Sterilization: Implants

• Non-incision method– No general anesthesia– Under an hour

• Coils inserted into fallopian tubes

• In following months, coils and tissue grow together, forming barrier to prevent sperm from reaching egg

Sterilization: Implants

• Side effects: expulsion of coil inserts, risk for ectopic pregnancy, cramping, menstrual changes, nausea/vomiting

• Demo

Sterilization: Vasectomy

• Vasectomy blocks sperm from traveling through vas deferentia, preventing sperm from mixing into semen

• No glands or organs are removed

• Effectiveness: 99%+• Considered irreversible

Sterilization: Vasectomy

• Vas deferens must be isolated

• Similar to tubal ligation, the vas deferens can be cut and tied, clamped, cauterized; “no scalpel” technique

• Another form of contraception must be used for a few months

Sterilization: Vasectomy• Cost: $450-700 (vasectomymedical.com)

• Side effects: bruising, sensitivity/pain, sperm leaking from tubes may lead to small lump (usually clears on its own), antibodies to sperm may develop, reducing chances of fertility in a reversal

• Complications: rare, usually associated with infection (fever, pus/blood from incision site, swelling, pain); ends of tubes may grow back together (very rare); decreased sexual desire (4 out of 1000 cases per Planned Parenthood) - no apparent physical cause

Sterilization: Vasectomy

• Open-ended (no scalpel) vasectomy (medicalvideos.us)

• Video (vasectomymedical.com)

Sterilization: Advantages & Disadvantages

• Effectiveness• Cost• Frequency of

application• Safety & side effects• Religion

• STI risk• Availability• Conspicuousness• Duration