COMMON METHODS OF CONTRACEPTION METHODS WITH NO USER FAILURE METHOD

CONTRACEPTIVE INJECTION

EFFECTIVENESS
OVER 99% EFFECTIVE

HOW IT WORKS
Releases progesterone which prevents ovulation, thickens the cervical mucosa and thins the lining of the uterus to prevent implantation Small flexible rod inserted under the skin of the upper arm. Releases progesterone which produces same effects as injection Inserted using a local anesthetic

ADVANTAGES
Lasts 8-12 weeks depending on type of injection Can be used when breast feeding Effective for three years, but can be removed sooner Dont hve to think about contraception as long as implant is in place Fertility returns once removed Effective for 5 years but can be taken out sooner Periods usually lighter, shorter, and sometimes less painful Fertility returns once removed

DISADVANTAGES
Periods may stop, be irregular, or longer Periods and fertility may take some time to return Potential weight gain Periods may stop, be irregular, or longer Acne may occur or worsen Requires a procedure which may be offputting

IMPLANT

OVER 99% EFFECTIVE

INTRAUTERINE SYSTEM (IUS) OVER 99% EFFECTIVE A small device inserted into the uterus which slowly releases the hormone progesterone

INTRAUTERINE DEVICE

Over 99% effective

Small plastic and copper device placed into uterus. Stops sperm reaching the egg and may also prevent implantation

Effective immediately and for 5-10 years depending on type Fertility returns once removed Not affected by medications

FEMALE STERILIZATION (TUBAL OCCLUSION)

FAILURE RATE IS 1 IN 200. THIS IS A PERMANENT METHOD

Fallopian tubes are cut, sealed, or blocked. Stops meeting of the sperm and egg

Does not interrupt sex Cannot easily be reversed Periods unaffected No need for contraception

Irregular bleeding common in first 6 months Periods ,ay stop altogether Small chance of infection 20 days after insertion Ovarian cysts Insertion can be uncomfortable May not be suitable for women at risk of STI Periods may be heavier, longer and painful Insertion can be uncomfortable Small risk of infection upon insertion Operation risk Small increased risk of ectopic pregnancy if sterilization fails General or local anesthetic

MALE STERILIZATION

FAILURE RATE OF 1 IN 2,000 PERMANENT METHOD

Vas deferens cut, sealed, and tied

Does not interrupt sex Cannot be reversed No need for contraception Performed under a local anesthetic

Contraception must be used until semen test shows no sperm are remaining. Can take up to 8 weeks Some men experience ongoing testicle pain

METHODS WITH USER FAILURE METHOD EFFECTIVENESS

HOW IT WORKS
Small flexible plastic ring inserted into vagina releases estrogen and progesterone. Stops ovulation, thickens cervical mucosa and thins lining of the uterus to prevent implantation

ADVANTAGES
Not affected by illness such as sickness and diarrhea Can make bleeds regular, lighter, and less painful May reduce risk of ovarian and uterine cancers

DISADVANTAGES
Not suitable for overweight women or smokers over 35 Low risk of serious sideeffects such as blood los, breast and cervical cancer Temporary side-effects such as vaginal discharge, headaches, nausea, breast tenderness and mood changes Some medicines can make it less effective Not suitable for overweight women, or smokers over the age of 35 Low risk of side-effects Temporary side-effects e.g. headaches Possible skin reaction Not suitable for overweight and smokers Low risk of serious sideeffects Temporary side effects such as headache Missing pills make it less effective Periods may stop, be irregular, light or more frequent Temporary side-effects such as acne, breast tenderness, weight change Risk of ovarian cysts Needs to be taken at same time each day Some medicines reduce effectiveness Putting it on can interrupt sex May slip off or split if not used correctly, or is wrong size or shape Man needs to withdraw immediately after ejaculation and before the penis softens Oil based products damage latex condoms Putting it on can interrupt sex Need to make sure the penis enters the condom and not the space between the condom and vagina May get pushed into vagina Not as widely available

CONTRACEPTIVE PATCH OVER 99% EFFECTIVE LESS THAN 1 WOMAN IN 100/ YEAR Small patch placed onto skin releases estrogen and progesterone. Prevents ovulation, thickens cervical mucus and thins lining of the uterus to prevent implantation Contains estrogen and progesterone. Not affected by sickness Periods usually more regular, lighter and less painful May reduce risk of cancers Periods usually more regular, lighter and less painful Reduces risk of cancers Suitable for healthy non-smokers up to menopause Fertility returns once stopped Can be used bt women who cannot use estrogen Can be used by women who smoke and are over 35 Can be used when breast feeding

COMBINED PILL

OVER 99% EFFECTIVE IF TAKEN CORRECTLY <1 WOMAN IN 100 / YEAR

PROGESTERONE-ONLY PILL

OVER 99% EFFECTIVE IF TAKEN CORRECTLY <1 WOMAN IN 100 / YEAR

Contains progesterone, in some cycles stops ovulation

MALE CONDOM

98% EFFECTIVE (although suggested 15% failure rate)

Made of latex or polyurethane. Placed over erect penis to prevent entry of sperm

Free from contraception and sexual health clinics and sold widely Protects from STIs No serious side-effects Spermicide s not needed

FEMALE CONDOM 95% EFFECTIVE IF USED ACCORDING TO INSTRUCTION 5 women in 100/ year Soft, thin polyurethane sheath loosely lines the vagina and covers the area just outside and stops entry of sperm Can be put in any time before sex Protects both partners from STIs Oil-based products can be used with female condoms Spermicide not needed

DIAPHRAGM/ CAP WITH SPERMICIDE

92-96% EFFECTIVE WHEN USED WITH SPERMICIDE 4-8 WOMEN PREGENANT PER YEAR

Flexible latex or silicone device, used with spermicide, put into vagina to cover cervix. Stops sperm entering the uterus

Can be put in anytime before sex Only have to use it when you have sex Can be used during menstruation

Putting it on can interrupt sex Some people sensitive to spermicide Can take time to learn how to use correctly Needs to be left in for 6 hours after sex Need to avoid having sex, or use a condom during fertile times Takes 3-6 menstrual cycles to learn effectively Must keep daily records

NATURAL FAMILY PLANNING

UP TO 99% EFFECTIVE

Fertile and infertile times of the menstrual cycle are identified by noting different fertility indicators This shows when you can have sex without risking pregnancy

No physical side-effects No chemicals or products needed Gives woman a greater awareness of her body Can be used to plan pregnancy

EMERGENCY CONTRACEPTION Designed for use after unprotected intercourse: IUD o Reliable o Kills sperm HORMONES (morning after pill) E.g. LEVONELLE synthetic version of the natural hormone progesterone o High dose of combined contraceptive given in two doses o 12 hours apart o Within 72 hours of unprotected sex o Makes endometrium less stable and delays ovulation o Side effects include: Nausea Menstrual disturbances Abdominal cramps Mood swings Breast tenderness

COMPONENTS OF THE SEXUAL HEALTH SCREEN 1. 2. GUM (genitourinary medicine) clinics and STI clinics hold drop-in sessions and scheduled appointments The clinic is open to the wide public, and even under 16s can attend without risking confidentiality if the circumstance is fit 3. Confidentiality of under 16s will be breached only if harm to any party is suspected. The attendee must first be informed of this 4. GPs are not told of patient visits without permission 5. Fake names are common place 6. TESTS MAY INCLUDE: a. Urine sampling b. Blood samples c. Vaginal and urethral swabs d. A genital examination 7. Results can be reveived on the same day as testing, depeidng on the type of test 8. Testing positive for an STI will necessitate the need to return to the clinic and discuss treatment options 9. Many STIs can be cured with antibiotics 10. Clinics also offer safe sex advice including the use of condoms OTHER SERVICES OFFERED INCLUDE: Specialist advice Screening for sexually transmitted infections Chlamydia screening Contraception Emergency contraception Pregnancy testing Free condoms Young mens drop-in Advice and referral to termination services Psychosexual clinics - GP/consultant or family planning doctor referral only

LEGALITY, CONFIDENTIALITY, AND CONSENT WITH REGARDS TO ADOLESCENTS ISSUES SURROUNDING PRESCRIPTION OF CONTRACEPTIVES TO TEENAGERS o Is it legal for doctors to prescribe to them? (Consent and Competence) o Will the doctor tell the parents? (Confidentiality) CONSENT o Age of Legal Capacity (Scotland) Act 1991 16 o Gilick Competency Contraception can only be given without parental consent IF child is deemed competent Parents rights were not absolute but exist only in the benefits of the child DOCTORS NOT LEGALLY OBLIGED TO TELL PARENTS IF FOLLOWING 5 CONDITIONS ARE MET: THE ADVICE GIVEN IS UNDERSTOOD THE GIRL CANNOT BE PERSUADED TO TELL HER PARENTS SHE IS LIKELY TO HAVE SEXUAL INTERCOURSE WITH OR WITHOUT CONTRACEPTION IF NOT GIVEN THE ADVICE SHE SEEKS, HER MENTAL HEALTH WILL SUFFER IT IS IN HER BEST INTERESTS FOR HER TO RECEIVE THE ADVICE

Factors influencing Teenage Use of Contraception Main determinants o Adequate sexual and contraceptive education o High preventive motivation o Self-confidence and communication skills o Easy access to acceptable services Contraceptives have been free since 1975 Sex Education Forum was set up by National Childrens Bureau in 1987 o Provides support and guidance to sex educators o Education to foster Self Esteem Self-Awareness Sense of moral responsibility Skills to resist unwanted sexual experience Teenage knowledge of contraceptives is usually poor Doctors play a large role in provision o Teenagers are unwilling to approach as they are worried of being found out by their parents. Legality, confidentiality, and consent with regards to adolescents. Issues surrounding prescription of contraceptives to teenagers o Is it legal for doctors to prescribe to them? (Consent and Competence) o Will the doctor tell the parents? (Confidentiality) Consent o Age of Legal Capacity (Scotland) Act 1991 16 o Gilick Competency Contraception can only be given without parental consent IF child is deemed compentent Parents rights were not absolute but exist only in the benefits of the child Doctors not legally obliged to tell parents if following 5 conditions are met The advice given is understood The girl cannot be persuaded to tell her parents She is likely to have sexual intercourse with or without contraception If not given the advice she seeks, her mental health will suffer It is in her best interests for her to receive the advice