GYN: Contraception

Lab group E
Andrew Chittaphong, Hannah Copley, Micah Johnson, Sydney Mank, Angela Matthew,
Abbey Spivey, Himani Sullhan, Molly Turner, and Courtney Waisath
Condoms
➢ A thin
sheath-like
barrier
➢ Worn on the penis
(male)
➢ Or inserted
inside the vagina
(female) (Warner, 2018)
 ➢ Discrete

➢ Rare side effects

➢ STI prevention

Benefits ➢ Easily accessible and

inexpensive (male)
Male and Female
(Warner, 2018) ➢ Reversible

➢ Immediate return to
fertility
 ➢ 98% effective with

Male Condoms
perfect use
➢ 87% effective with
(Warner, 2018) normal use

➢ Possible reduced
sensitivity

➢ Fit issues

➢ Some men cannot maintain an

erection

➢ Interruption in foreplay
 ➢ 95% effective with

Female Condoms
(Hoke, 2018)
perfect use
➢ 79% effective with
normal use

➢ May be difficult to
insert and remove

➢ Availability issues

➢ Can make noise during

intercourse
 Spermicide
➢ Gel, foam, or cream inserted
into vagina, lubricant on
condoms
➢ Chemical paralyzes/kills sperm
cells before they can reach egg
➢ 72% effective with typical use
➢ 28% failure rate with typical
use
➢ Recommended use with another
method of birth control
(Bartz & Schreiber, 2018).
 Advantages Disadvantages
➢ Affordable ➢ No STI protection
➢ Convenient ➢ Messy
➢ Easy-to-use ➢ May be irritating
➢ Hormone-free ➢ Must use every
➢ Can be used with time you have sex
other forms of for effectiveness
birth control

(Bartz & Schreiber, 2018).

Diaphragm
➢ Reusable, dome-shaped
cup with a flexible
rim
➢ Single-size or
multi-size (fitted
to the woman)
➢ Place 2-6 hours
before intercourse
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8KHcPwBKIQjRx6BAgBEAU&url=https%3A%2F%2Fwww.drugs.com%2Fcg%2Fbarrier-methods-of-contraception.html&psig=
AOvVaw0dAcKfo7CBRMAv2Z7gCVNv&ust=1541555168950861
https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwieytX9077eAhWnj1QKHX40BrgQjRx6BAgBEAU&url=https%3A%2F%2Fwww.stay
athomemum.com.au%2Fmy-kids%2Fbirth-control-options%2Fusing-a-diaphragm-as-a-contraceptive%2F&psig=AOvVaw0dAcKfo7CBRMAv2Z7gCVNv&ust=1541555168950861
Efficacy of Diaphragm Use
➢ Use without spermicide has not been studied
in a well-designed trial
➢ Annual pregnancy rates per 100 women when
used with spermicide
○ 12% with typical use
○ 6% with perfect use
➢ Second-tier effectiveness category

(Bartz & Schreiber, 2018)

 Advantages Disadvantages
➢ Reusable, ➢ Dislodged during
cost-effective intercourse
➢ Does not affect ➢ Urinary tract
menstrual cycle infection
➢ Can be placed up ➢ Vaginal irritation
to 6 hours prior ➢ Risk for Toxic
to intercourse Shock Syndrome
➢ Easy insertion (TSS)
(Bartz & Schreiber, 2018)
Contraindications of Diaphragm
➢ Allergy to latex,
silicone, or
spermicide
➢ Frequent UTIs
➢ Difficulty with
insertion
➢ History of TSS

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwiC79Oq1L7eAhXp
(Bartz & Schreiber, 2018) s1QKHTW_DS4QjRx6BAgBEAU&url=https%3A%2F%2Ffamilydoctor.org%2Fbirth-control-how-to-use-your-diaphragm%2F&
psig=AOvVaw0dAcKfo7CBRMAv2Z7gCVNv&ust=1541555168950861
Depo-Provera
(Kaunitz & Schreiber, 2018)

➢ Birth control shot that contains the

hormone progestin to prevent ovulation
➢ Makes cervical mucus thicker, making the
cervix impenetrable to sperm
➢ The injection is very effective with a
failure rate of less than 1% when
injections are given on time
 Advantages Disadvantages
➢ Highly effective
➢ Injection every 3
➢ Only have to think about
months
birth control 4 times a
➢ Effectiveness decreases
year
➢ Private if injections are not
➢ Lighter periods and received on time
amenorrhea ➢ May be difficult to get
➢ For those who have pregnant after
contraindications to discontinuing
estrogen-containing ➢ No STD/STI protection
contraceptives
➢ Temporary and reversible
(Kaunitz & Schreiber, 2018)
Side Effects and Contraindications (Kaunitz & Schreiber, 2018)

➢ Contraindications: breast cancer and pregnancy

➢ Many women don’t experience any side effects
➢ Side effects include:
○ Change in periods - irregular or prolonged bleeding
and spotting
○ Up to 50% of women completely stop having menstrual
periods after one year of use
○ Weight gain
○ Headaches
○ Mood changes
○ Reaction at injection site
Tubal Ligation
➢ Tubal ligation is a surgical
procedure done under
anesthesia that involves
cutting or tying the fallopian
tubes.

➢ Tubal ligation has an

effectiveness rate of 99.5%
(American Academy of Family Physicians, 2018)
 Advantages Disadvantages
➢ High rate of
➢ Bleeding or pain
effectiveness
at incision site
➢ Quick recovery
➢ Difficult to
time
reverse
➢ Studies have
➢ Does not protect
shown that it may
against STDs
reduce the risk
of ovarian cancer
(Durham & Chapman, 2014)
 Side Effects and Contraindications
➢ Contraindications:pregnancy
and previous abdominal or
intestinal surgery.
➢
➢ Side Effects: bleeding,
infection, ectopic
pregnancy,and incomplete
closing of fallopian tubes. (American Academy of Family
Physicians, 2018)
 Vasectomy
➢ The most successful method of permanent
male contraception
➢ Surgical procedure done under local
anesthesia where all or a segment of the
vas deferens is occluded/removed

This method has a 0.15-1% failure rate.

(Viera, 2017)
1
2

3
 Advantages Disadvantages
➢ Must use an
➢ Extremely high rate
of effectiveness alternative
➢ Discomfort for 2-3 contraceptive method
days until you receive two
➢ Difficult to reverse post-surgical sperm
➢ The cost is lower tests
than that of
➢ Discomfort for 2-3
long-term
contraception or days
female sterilization ➢ Difficult to reverse
(Viera, 2017)
Side Effects/Contraindications:
➢ Activities are limited, sexual activity is
avoided for a week
➢ Patients should be advised that vasectomy
does NOT prevent sexually transmitted
diseases.
➢ Contraindicated in patients with: abnormal
sexual development such as a nonpalpable
vas deferens, extensive genital surgery, or
a history of a solitary testicle (Viera, 2017)
 ➢ Pill with both
estrogen and progestin

Combined Oral
➢ Estrogen prevents
ovulation by
Combined Oral
Contraceptives suppressing LH and FSH

Contraceptives ➢ Progestin makes

endometrium
inhospitable, impairs
tubal motility, alters
cervical mucus
Martin & Barberi, 2018
Advantages and Disadvantages
Martin & Barberi, 2018

➢ .01% failure rate with ➢ Must be taken daily

perfect use ➢ Contraindicated in
➢ Useful in managing smokers, history of CV
menstrual cycle and disease or clotting
gynecologic disorders disorders
➢ Improved bone density ➢ Antibiotics,
➢ Can be used anticonvulsants
continuously until decrease efficacy
menopause ➢ Require prescription
 ➢ Missed pills
○ Single pill - take
ASAP
○ Pill not taken for 48
hrs - use backup

Considerations
contraception for 7

Considerations
(Martin & Barberi, 2018)
days
➢ Side effects
○ Breakthrough bleeding,
mood changes, weight
gain, breast changes
○ Thromboembolic risks
○ Depression??
 Contraceptive Ring - NuvaRing
➢ Flexible ring that is inserted
into the vagina
➢ Contains estrogen and progestin
➢ Wear it for 21 days; remove for
7 days. Repeat
➢ 91-99.7% effective

(U.S. Department of Human Health Services, 2018)

Nuva Ring (Continued)

➢ Don’t have to remember to take the pill everyday

➢ Usually cannot be felt by the person wearing it or
by the partner
➢ Disadvantages: have to remember to put a new ring
in on time every month, no protection from HIV and
STIs, might have discomfort at first
➢ Major side effects: blood clots, strokes,
hypertension, cancer, heart attacks

(U.S. Department of Human Health Services, 2018)

Contraceptive Patch - Xulane
➢ Hormonal patch containing estrogen and progestin
➢ Wear on the skin of the abdomen, upper arm, butt,
or back for 21 days, remove for 7 days. repeat.
➢ 91-99.7% effective

(U.S. Department of Human Health Services, 2018)

 Contraceptive Patch (Continued)

➢ Don’t have to take the pill everyday

➢ Doesn’t interrupt the act of intercourse
➢ Less effective in women weighing 198 pounds or
more
➢ No protection against STIs
➢ Major side effects: hypertension, blood clots,
stroke, heart attacks; risk is higher in
smokers and women older than 35
(U.S. Department of Human Health Services, 2018)
Long Acting Reversible Contraceptives: Intrauterine Device
Intrauterine Device
➢ Small plastic device that is inserted into the
uterus
○ Hormonal
○ Non-hormonal
➢ Local Sterile Inflammatory reaction
➢ Impairs implantation into the uterine wall
➢ Highly effective (>99%) and provides long-term
protection without the need to follow a daily
regimen
(Madden, 2018a)
 Advantages (IUD) Disadvantages (IUD)
➢ Easy to use ➢ Does not protect against
➢ Long-term protection STDs
➢ Hormonal IUDs decrease ➢ Pain associated with the
menstrual pain and insertion procedure of
heavy bleeding the IUD
➢ Copper IUD can be used ➢ Spotting and irregular
as emergency periods
contraceptive ➢ Risk of uterine
➢ Reduce the risk of perforation
cervical cancer ➢ Risk for pelvic
➢ Avoids the use of inflammatory disease
exogenous estrogen ➢ Risk of ectopic
pregnancy
(Madden, 2018a)
(Durham & Chapman, 2014)
Long Acting Reversible Contraceptives: Hormonal Implants
Hormonal Implants
➢ Small matchstick size flexible plastic rod
➢ Inserted in upper arm just beneath the skin surface
➢ Releases Progestin
➢ Causes changes in the cervical mucus and tubal
motility
➢ Approved for up to 3 years use
➢ OBGYN or other health care professional will insert
into upper arm
➢ Can be removed when pregnancy is desired
(Darney, 2018)
 Advantages Disadvantages
➢ Easy to use and no ➢ Can cause changes in
menstrual bleeding
need to do anything
➢ Can cause acne
once placed
flaring, headache,
➢ Long-term protection weight gain, and
➢ Can reduce pain irregular bleeding
during menstrual ➢ increased risk for
period ectopic pregnancy
➢ Can be inserted at ➢ Increased risk of
any time thromboembolic event
➢ Can be used while ➢ Has to be removed for
breastfeeding pregnancy
➢ Easily removed ➢ Does not protect
against STDs (Darney, 2018)
Contraindications for Long-Acting Reversible
Contraceptives
Intrauterine Device
➢ Extreme distortion of
uterine cavity
➢ Acute Pelvic Infection
➢ Known or suspected
pregnancy
➢ Copper Allergy/Wilson’s
Disease (Copper IUD)
➢ Unexplained abnormal
uterine bleeding
➢ Breast Cancer
(Madden, 2018b)
Hormonal Implant
➢ Known or suspected
pregnancy
➢ Current or past history of
thrombosis or
thromboembolic disorders
➢ Hepatic tumor or active
liver disease
➢ Known or suspected breast
cancer, history of breast
cancer
(Darney, 2018)
Emergency Contraception
Definition: Emergency contraceptives [EC]
are used after unprotected sex to prevent
an unwanted pregnancy

Hormonal: prevents the egg from fertilizing

with sperm after unprotected sex by
delaying/preventing ovulation (U.S. Department of Human
Health Services, 2018)

➢ Levonorgestrel (Plan B-One step) use

within 72 hours
➢ Ulipristal acetate (ella)use within 120
hours
Emergency Contraception CONTRAINDICATED IN
WOMEN WHO ARE ALREADY
PREGNANT

Effectiveness:
➢ Levonorgestrel: 87% effective

➢ Ulipristal acetate: 7 out of 100 women who would

have been pregnant will not become pregnant

EC can reduce the rate of unwanted pregnancies and

abortions in teens and young adult by 50% (Garrett,
Widman, Nesi & Noar, 2018, p. 264)
(U.S. Department of Human Health Services, 2018)
Emergency Contraception CONTRAINDICATED IN WOMEN
WHO: have uterine abnormalities,
uterine or cervical cancer, Wilson’s
disease or an allergy to the device

Non-Hormonal
➢ Copper T IUD (ParaGuard)
○ insert within 5 days of having
unprotected sex

➢ Effectiveness: 1 in 1000 women will

become pregnant (0.001% chance)

(U.S. Department of Human Health Services, 2018)

 Advantages Disadvantages
➢ Lack of knowledge- a lot of young
➢ Available without
women do not know it does not
prescription require a prescription
➢ No STI/STD protection
➢ Can be used within ➢ Not as effective as planned
72-120 hours after protection
unprotected sex ➢ Poor side effects such as nausea,
vomiting, stomach pain and
headaches,abnormal bleeding and
➢ Safe and private menstrual cycle
➢ EC hormonal pills are not to be
➢ Copper IUD can remain used as primary birth control
in place up to 10 years ➢ EC hormonal pills may not be as
effective in women with a BMI≥30
(U.S. Department of Human Health Services, 2018)
Exam Questions
1. What is the mechanism of action of spermicide?

a. It makes the cervical mucus thicker, making the

cervix impenetrable to sperm
b. It paralyzes and kills sperm cells before they
can reach an egg
c. It partially or fully occludes the vas deferens,
so sperm cannot enter the semen
d. It is a thin, sheath-like barrier that prevents
sperm from entering the uterus
Exam Questions
1. What is the mechanism of action of spermicide?

a. It makes the cervical mucus thicker, making the

cervix impenetrable to sperm
b. It paralyzes and kills sperm cells before they
can reach an egg
c. It partially or fully occludes the vas deferens,
so sperm cannot enter the semen
d. It is a thin, sheath-like barrier that prevents
sperm from entering the uterus
Exam Questions

2. What are the advantages of an IUD? (Select all

that apply)

a. Reduces one’s risk of cervical cancer

b. Protects against STIs
c. No pain associated with the insertion procedure
d. Avoids the use of exogenous estrogen
Exam Questions

2. What are the advantages of an IUD? (Select all

that apply)

a. Reduces one’s risk of cervical cancer

b. Protects against STIs
c. No pain associated with the insertion procedure
d. Avoids the use of exogenous estrogen
 References
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http://online.statref.com/Document.aspx?docAddress=ym-SzcqL3ARswzTL4LrntQ!!

Bartz, D. A. & Schreiber, C. A. (2018). Pericoital contraception: Diaphragm, cervical cap, spermicide, and sponge. In K. Eckler (Ed.),

UpToDate. Retrieved from

https://www-uptodate-com.ezproxy3.library.arizona.edu/contents/pericoital-contraception-diaphragm-cervical-cap-spermicide-and-spo

nge

Darney, P. D. (2018). Etonogestrel contraceptive implant.In K. Eckler (Ed.), UpToDate. Retrieved from

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