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Report on Surgical contraception. Barrier methods. Natural family planning. Pregnancy rate.
Counseling. Side effects

Natural family planning methods:

●coitus interruptus. Withdrawal of penis at point of ejaculation.(pearl index 20-30 )

●breast feeding(failure rate is high better to give additional contraception method-condom, IUCD )

●safe period (calendar method-pearl index –20-30) taken as ovum is fertilizable for 24hrs after it’s release and
sperm can fertilize for only 3days after it’s released. If regular cycle and regular ovulation (16-18days) the safe
period is before 13th day and after 19th day. If irregular cycles it’s shortest cycle-18days and longest cycle-11d.
Eg- if shortest cycle is 26days then (26-18=8days) and if longest cycle is 32days (32-11=21days). Fertile
period is between 8→21 days of the cycle
.
●Basal body temp chart- requires abstinence until the 3rd day of the rise of temp.

● Use of mucous rhythm – requires abstinence on all days of noticeable excessive mucoid vaginal discharge
and 3 days after.

Surgical contraception – 0.6% ♀ in Latvia .Irreversible and should be explained to the couple.

Indications ● if couple don’t want anymore children ● Medical reasons (IDDM, Chr. HD, ↑BP – as these
diseases may worsen if repeated pregnancy occurs) ●Genetical (Down’s) ●♀ > 35yrs and smoking > 20cigg/d.
● AIDS ●Inguinal hernia
When to perform – 24-48hrs after delivery ● 3months after delivery or abortion. In proliferative phase of
periods is the ideal time for operation ● following induced abortion.

Advantages ●very effective ●no need to think about pregnancy , side effects.

Disadvantage ●Irreversible ●risk due to surgery ● Psychological effect.

Methods – For Females : Salpingectomy , clipping – by conventional laprotomy , minilaprotomy, laproscopic,

posterior colpotomy (thru posterior fornix of vagina)
For Males : ● vasectomy – done with local anesthesia. Sterility is achieved only when two separate ejaculates
are free from sperm after 3-4 months. Complications – haematoma , sperm granuloma.

Barrier methods-these methods prevent sperm deposition in the vagina or prevent sperm penetration through
the cervical canal by mechanical, chemical or combined methods. ■Condoms-♀ and ♂.♀ Femidoms(a pouch
made of polyurethane which lines the vagina and also the external genitalia, at both ends rings which are
flexible,15cm in length), put between external os and introitus(pearl index 4-10).♂put when the penis is full
erected. Must be on for whole sexual act. In tip should be reservoir for sperms.

Advantages: ● cheap ● easy to carry, simple to use● no side effects or contraindications ● protection against
STD ● protection against cervical cell abnormalities ● useful when infrequent sex.

Disadvantages: ● accidental tearing during sex ● less sexual pleasure ●disposed after one act.

■Diaphragm-intravaginal device made of thin rubber with a flexible ring at the margin, diameter varies from 5-
10cm, requires medical experience ,when it is in position ,the diaphragm lies obliquely in vagina, with the
posterior part of the rim fitting closely in the posterior fornix, the anterior part behind the (below) symphysis
pubis and the diaphragm covering the cervix Before insertion spermicidal cream or jelly is smeared around the
rim and on the inner surface. Inserted 3hrs(up to) before intercourse and is kept for at least 6hrs after the last
coital act .
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Advantages :● entirely females responsibility(not like pills ● less side effects. ● protects from STD.

Disadvantages: ● ill fitting ● accidental displacement during sex.

■ Cervical cap-a small, firm shaped rubber cup , which fits over the cervix ,needs careful fitting, may dislodge
during coital act, can leave for 24hrs and be removed 6hrs after intercourse.

■ Vaginal sponges-usually used with spermicides (Nonoxynol-9 , acts as a spermicide),made of synthetic

polyurethane. It release spermicide during coitus, absorbs ejaculate and blocks the entrance to the cervical
canal. This Nonoxynol-9 also acts as a bacteriostatic .The sponge is for single use only over a 24hr period.
Should be Spermicides-Used as foam, jelly, creams , suppositories. Contain Nonoxynol-9.Usually with
combination of mechanical barriers. Has anti-infective properties and kills sperms. There may be local allergic
manifestations either in vagina or vulva).

Pregnancy rate;
Total no. of (accidental) pregnancies/100 ♀ years = Pearl Index
Months Used

●COCP :0.5 (<1)

●Minipills:1(½)-MMPA=0.25,implants=0.25.
●Emergency contraception=1/3
●IUD-Cu containing 1.5, IUS 0.15
● Condoms= 4-10
● Coitus interruptus =20-30.
Counseling
● what method she is using? If not why? what should be used? Facts to be considered.

Report on Surgical contraception. Barrier methods. Natural family planning. Pregnancy rate. Counseling. Side effects

Report prepared by
1. Dr. Adnan Akram, MD (EU), Department of Infectious Diseases. University Hospital Riga Latvia.

Contact: publications [at] infekcijas.eu