避孕与流产英文精解--Contr课件.ppt

1、Contraception and AbortionAgendaDiscuss History and Considerations Associated with MethodsDiscuss Contraception MethodsDiscuss AbortionClass Exercise:Contraception Values ClarificationComplete the handout entitled“Contraception Values Clarification.After you have completed the handout,discuss your r

2、esponse in small groups.IntroductionMajority of U.S.pregnancies are not planned and most are a result of not using contraceptionFactors increasing motivation to use contraception:vgood communication with partner,vlower cost,veffectiveness rates,vfrequency of intercourse,vmotivation to avoid pregnanc

3、y,vside effects,vopenness about sexualityContraception:HistoryContraception in Ancient TimesContraception in the U.S.:1800s and Early 1900sContraception Outside the U.S.Contraception in Ancient TimesAncient Greeks:magic,superstition,herbsEgyptians:fumigating female genitalia,tampon soaked in herbal

4、liquid&honey,inserting a mixture of crocodile feces,sour milk,&honeySouth Africa:insert vegetable seed podsAfrica:insert a grassy cervical plugPersia:insert alcohol soaked spongesGreece:insert empty pomegranate halvesContraception in the U.S.:1800s and Early 1900sConcern in early 1800s was to curb p

5、overty by controlling fertility1873 Comstock laws prohibited dispersing information about contraceptives,including by doctorsContraception use is affected by Social issues e.g.desired family sizeEconomic issuesKnowledge&misinformationReligionGender roles&power in some areas,men make the contraceptiv

6、e decisions;for some it is the responsibility of bothChoosing a Method of ContraceptionFDA Approval ProcessLifestyle IssuesFDA Approval ProcessThe U.S.Food and Drug Administration(FDA)must formally approve the method10-14 year process to develop a new contraceptive drugDrug company submits a new dru

7、g application demonstrating safety in animal tests&a desire to conduct human trialsFDA Approval Process3 phasesvPhase 1:20-80 volunteers to test effectivenessvPhase 2:several hundred to test effectiveness,side effects,risks vPhase 3:hundreds to thousands are tested for generalizationAnimal trials ar

8、e conducted throughout the processClass Discussion:Lifestyle Issues Associated with ContraceptiveThe following factors seem to be associated with choosing a contraceptive method:vOwn health&risksvNumber of sexual partnersvFrequency of intercoursevRisk of acquiring a STIvResponsibility levelvMethod c

9、ostvAdvantages&disadvantages of the methodDiscuss influence of each.Contraception MethodsBarrier Methods:Condoms and CapsPrevent sperm from entering the uterusBarrier Methods:vCondomsvThe DiaphragmvThe Contraceptive SpongevThe Cervical BarriersCondoms1850 latex condoms available in the U.S.$10-$15/d

10、ozenNon-expired condom is rolled onto an erect penis(foreskin pulled back),-inch empty space at the tipWater-based lubricants for latex condomsCondom grasped at base when withdrawingLatex condoms have lower rates of slippage&breakage,and offer better STI protectionCondomsIn 1994,female polyurethane/

11、nonlatex condoms were available$2 each7 inches long with 2 flexible ringsInner ring squeezed and inserted close to the cervixOuter ring lies outside the vaginaAdequate lubrication is necessaryCondomsEffectiveness ratesvLatex condoms:85-98%vFemale condoms:79-95%Latex&polyurethane protect against STI

12、transmissionLambskin condoms block sperm,but contain holes large enough for viruses to pass throughHeat can damage condomsCondomsAdvantages:vSTI protectionvEncourages male participationvInexpensivevNo prescription necessaryvCan reduce premature ejaculationvCan reduce postcoital dripvNo medical side

13、effectsCondomsDisadvantages:vReduces spontaneityvCan reduce sensationvFemale condoms can be difficult to use,uncomfortable,noisyFemale&male condoms should never be used togetherPopular in some countries,not used in othersThe DiaphragmNot widely used,almost 0%in 2002Made of latex or siliconeMany size

14、s and shapes;a fitting by a health care provider is necessary$20-$35 diaphragm,$13 spermicidal jelly/cream,office visit chargeThey can last for many yearsDiaphragms come in a variety of different shapes and sizes and must be fitted by a health-care provider.The DiaphragmDiaphragm rim is covered in s

15、permicidal jelly&a tablespoon of jelly is placed in the dome;it is folded in half and inserted into the vagina with the front rim tucked under the pubic boneIt should not be felt&should cover the cervixIt can be inserted up to 6 hours prior to intercourseLeft in for at least 6-8 hours,no more than 2

16、4 After use it is washed with soap&water Instructions for proper insertion of a diaphragm.The Diaphragm84-94%effective,lower for those who have given birthAdvantages:vIncreases spontaneityvSome STI&PID protectionvReduces risk of cervical dysplasia&cancervDoes not affect hormonal levelsvRelatively in

17、expensiveThe DiaphragmDisadvantages:vPhysician fitting and prescriptionvInsertion&removal involves touching the genitalsvIncreased risk of toxic shock syndrome and urinary tract infectionvPostcoital dripLow usage outside the U.S.The Contraceptive SpongeThe Today contraceptive sponge was taken off th

18、e market for a decade due to issues with the manufacturing plant;reintroduced in 2005Available over the counter in one sizeThe sponge covers the cervix&contains spermicide;it blocks,absorbs,&deactivates spermOne box of 3 sponges is$13The Today contraceptive sponge was back on the market in late 2005

19、 in the United States.The DiaphragmSponge is moistened with water to activate the spermicide,folded in half,&inserted to cover the cervixCan be inserted up to 24 hours in advance,with intercourse occurring as many times as desirable in that time periodMust be left in at least 6 hours after intercour

20、se75-89%effectiveness ratesInstructions for proper insertion of a contraceptive sponge.The DiaphragmAdvantages:vNo prescription necessaryvCan have intercourse several times within 24 hoursvIncrease sexual spontaneityvDo not affect hormonal levelsvDisposableThe DiaphragmDisadvantages:vIncreased risk

21、of toxic shock syndrome&urinary tract infectionvCannot be used while menstruatingvRequires touching of the genitalsvHigh expense if frequently usedvSome men can feel itLow usage rates in other culturesThe Cervical BarriersThimble-shaped,silicone barriers that fit over the cervixBlock entrance to the

22、 uterus&deactivate sperm with the spermicideFitting by a health care provider is necessaryTwo types:vFemCapvLeas ShieldThe FemCap is a silicone cup shaped like a sailors hat that fits securely over the cervix.Leas Shield is a silicone cup with a one-way valve and a loop for easier removal.The Cervic

23、al Barriers$15-75 plus cost of spermicideLeft in place for 8 hours after intercourseAfter use,it is washed with soap&waterNot to be used during menstruation86%effectiveness rate,lower for those who have had childrenThe Cervical BarriersAdvantages:vLeft in place for up to 48 hoursvDo not affect hormo

24、nal levelsvImmediately effectivevNot permanentvOne-way release valve in Leas Shield reduces risk of toxic shock syndromeThe Cervical BarriersDisadvantages:vAbnormal Pap smearsvIncreased risk of urinary tract infectionsvIncreased vaginal odorsvCervical damagevIncreased postcoital dripvFitting is nece

25、ssaryvSome male partners feel it&may dislodge itThe Cervical BarriersWidely used in EnglandLeas Shield is available over the counter in Germany,Austria,Switzerland,&Canada Hormonal Methods for Women:The Pill,the Patch,and MoreChanging hormonal levels can deter production of ova,fertilization,and imp

26、lantationHormonal Methods for Women:The Pill,the Patch,and MoreCombined-Hormone MethodsvBirth Control PillsvHormonal RingvHormonal PatchProgestin-Only MethodsvSubdermal ImplantsvHormonal InjectiblesCombined-Hormone MethodsCombination of estrogen&progesteroneCan repress ovulation and thicken cervical

27、 mucusBirth Control PillsFederally approved in 1960Most popular contraceptive in the U.S.and around the worldMost studied type of medication Combination birth control pills are$12-25 per monthDesigned to mimic a menstrual cycle,with 21 days of hormones and one off weekBleeding is medically inducedBi

28、rth Control PillsSome take 2 to 3 packs of active pills in a row to reduce the number of menstrual periodsSeasonale 84-day active pill with 7-day placeboReducing periods can help those with heavy bleeding and cramping60%of women prefer to not have a periodBirth Control PillsIncrease in estrogen&prog

29、esterone prevent the pituitary from sending hormones to ripen the ovariesCervical mucus thickens&endometrium buildup is minimalThe body is tricked into thinking it is pregnantMay experience other signs of pregnancy that usually disappear within a few monthsBirth Control PillsInitially prescribed a l

30、ow-dose estrogen pill;increased if breakthrough bleeding occursMonophasic pills contain the same dose of hormones in each pillMultiphasic pills vary in hormone amountTriphasil pills have 3 sets,each week the hormonal dosage increases92-99.7%effectiveNeed to take it each day at the same timeBirth Con

31、trol PillsAdvantages:vHigh effectiveness ratevDoesnt interfere with spontaneityvReduced menstrual flow,cramps,&PMSvIncreased menstrual regularityvReduced risk of ovarian cysts,uterine&breast fibroids,facial acne,ovarian&endometrial cancers,PID,benign breast diseaseBirth Control PillsDisadvantages:vN

32、o STI protectionvFemales responsibility;taken dailyvCan be expensivevLower effectiveness if overweightvNot appropriate for smokersUsed throughout the world,although not popular everywhere;some places have it over the counterHormonal RingNuvaRing introduced in 2003Plastic ring inserted into the vagin

33、a once a month for 3 weeks,removed for 1 weekAffects the body as combination pills doBody heat&moisture activate a constant dose of estrogen&progesterone;lower dose than pills$30-35 per month99.7%effectiveThe NuvaRing is inserted deep into the vagina;moisture and heat cause it to time-release hormon

34、es that inhibit ovulation.Hormonal RingAdvantages:vHigh effectivenessvDoesnt interfere with spontaneityvReduces menstrual flow,cramps,PMSvIncreases menstrual regularityvProtection from ovarian&endometrial cancer and ovarian cystsvFertility restored upon removalHormonal RingDisadvantages:vComfortable

35、 touching genitalsvNo STI protectionvSide effects that typically disappear with regular use:breakthrough bleeding,weight change,breast tenderness,nausea,mood changes,changes in sexual desire,increased vaginal irritation&dischargeNo data on cross-cultural useHormonal PatchOrtho Evra patch is a thin,p

36、each colored sticker attached to the skin with time-released hormonesPlaced on buttock,stomach,or upper torso for 3 weeks,no patch for the 4th weekAffects the body as combination pills do$30-35 per month99.7%effective,lower if weigh more than 198 poundsThe Ortho Evra patch is worn on the buttock,abd

37、omen,or upper torso for three weeks each month.Hormonal PatchAdvantages:vHigh effectivenessvDoesnt interfere with spontaneityvReduces menstrual flow,cramps,PMSvIncreases menstrual regularityvProtection from ovarian&endometrial cancer and ovarian cystsHormonal PatchDisadvantages:vNo STI protectionvSi

38、de effects similar to hormonal ringvSkin irritation vChange in vision,discomfort to contact wearersvCollects lintvNearly impossible to conceal from partnerNo data on cross-cultural useProgestin-Only MethodsDo not contain estrogen and can be used by women that cannot take estrogen,such as those who a

39、re breastfeeding&smokersOver time,may eliminate periodsMay cause slight weight gain,bloatedness,&breast tendernessProgestin-Only MethodsMinipill/POPs(progestin-only pills)vInhibit ovulation and thicken mucusvFewer side effects than combination pillsv92-99.7%effectivevMore expensive than combination

40、pillsvCan cause irregular bleedingvHigher rate of ectopic pregnancies if get pregnant while taking the minipillSubdermal ImplantsConstant dose of progestin is time released for up to 5 yearsNorplant is no longer availableJadelle is FDA approved but not marketed in the U.S.v2 silicone cylinders impla

41、nted in the forearm in a 10 minute procedure;$500+Implanon is a single-rod approved in 2004Fertility restored upon removalSubdermal ImplantsSuppresses ovulation,thickens cervical mucus,unreceptive endometrium99.95%effective,decreases after the 3rd yearLower effectiveness rates if over 154 poundsAdva

42、ntages:vEffective,long-lasting,reversiblevSimple implantation procedurevNo estrogen side effectsvDecreased menstrual flow,crampingSubdermal ImplantsDisadvantages:vExpensive implantation fees,arm pain,painful removal,possible scarringvIrregular bleeding,crampingvHeadaches,nausea,dizziness,weight chan

43、ge,rash,acne,hair growth or lossvVision problemsPopular in South AfricaHormonal InjectiblesDepo-medroxyprogesterone acetate(Depo-Provera)synthetic progesteroneMost popular non-oral contraceptive Injected into the arm or buttock muscle every 3 months$30-125 per injectionWorks within 24 hoursFertility

44、 resumes 10 months after last injectionHormonal Injectibles97-99.7%effectiveAdvantages:vLong lasting injectionvModerately expensivevNo estrogenvDecreased menstrual flow&crampingvDecreased risk of endometrial&ovarian cancersvAllows for spontaneityHormonal InjectiblesDisadvantages:vOffice visits every

45、 3 monthsvIrregular bleedingvFatigue,dizziness,weakness,headachesvAppetite increasesvDecrease in bone densityvRisk of liver,cervical,and breast cancersvLong return to fertilityLow usage rates in many countriesChemical Methods for Women:SpermicidesSpermicides come as foams,gels,suppositories,creams,f

46、oaming tablets,films,and capsulesInserted into vagina with applicator or finger 10-30 minutes prior to intercourse$5-10 over the counterCan also help reduce STIsLikely to see microbicides introduced that will protect from HIV&other STIsChemical Methods for Women:Spermicides71-82%effectiveEffectivene

47、ss is reduced if tampons or douches are used within 6-8 hoursFoam is more effective than other varietiesAdvantages:vOver the countervProvide lubricationvSome protection from STIsvNo serious side effectsChemical Methods for Women:SpermicidesDisadvantages:vUsed each timevIncreased postcoital dripvMay

48、produce allergic reactions,skin irritationsvIncreased risk of urinary tract infectionsvUnpleasant tasteWidely used in some countries,and not used much in other countriesIntrauterine Methods for Women:IUDs and IUSsIntrauterine Device(IUD)vParaGard Copper T can be left in for 12 yearsIntrauterine Syst

49、em(IUS)vMirena IUD that contains time-released progestin;can be left in for 5 yearsMost IUD&IUS users are 35 or older$150-300 plus office visitIntrauterine Methods for Women:IUDs and IUSsIUDs&IUSs create a slight infection in the uterus that obstructs sperm mobilityProgesterone from the IUS also aff

50、ects the endometrium,hampering implantationHealth care providers insert the IUD Each month the woman must check for the string to assure it is still in place99.2-99.9%effective,lower if never pregnantInsertion of an IUD.Intrauterine Methods for Women:IUDs and IUSsAdvantages:vLeast expensive method o