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					Choosing a contraception that’s right for




        www.sexualityandu.ca
                                                    sexualityandu.ca


Contents

   Female anatomy                    Male anatomy

   Female menstrual cycle            Birth control options for men
                                     Male condom
   Birth control options for women   Male sterilization
   Oral contraceptives
   Transdermal patch                 STI prevention
   Vaginal ring
   Injectable contraceptive          Side-effects (hormonal contraception)
   Intrauterine system
                                     Myths and misconceptions
   Intrauterine device
                                     What to ask during your visit
   Female sterilization

   Female condom
   Diaphragm and cervical cap
   Sponge and spermicides
                                                                      sexualityandu.ca


Unintended Pregnancies
      Unintended pregnancies with various contraceptive methods
         Numbers given are pregnancies for every 1000 women during first year of use




                                                                      Adapted from Trussell et al, 200
 F e m a l e r e p r o d u c t i v e s y s t esexualityandu.ca
                                              m


Fallopian tube
                             Ovaries




  Uterus




  Cervix



Vagina
 F e m a l e r e p r o d u c t i v e s y s t esexualityandu.ca
                                              m

   Fallopian tube

   Ovary

 Uterus


Bladder




 Clitoris
                                                   Cervix
   Urethra

     Vagina                                      Rectum
                                  sexualityandu.ca
F e m a l e menstrual c y c l e
Oralcontraceptives                                      sexualityandu.ca



What are they?
      • Prescription tablets taken once a day
      • There are two main types:
                1. Combination pill which contains two female hormones similar
to
                the body’s own estrogen and progesterone
                2. Progestin-only pill (or mini-pill) which does not contain
estrogen
      • Available under a variety of brand names with various strengths and

     formulations

How do they work?
     • Stop the release of a mature egg
     • Thicken the cervical mucus making it difficult for sperm to get to the
egg
     • Change the lining of the uterus making implantation difficult

Failure rate: 80 per 1000 women per year
Oralcontraceptives                                     sexualityandu.ca



What are the advantages?

      1. One of the most effective reversible birth control methods when
taken             consistently and reliably
      2. Simple and easy to use
      3. Regulates menstrual cycle and reduces cramps
      4. Does not interfere with intercourse
      5. Decreases acne
      6. Reduces the risks of endometrial and ovarian cancer
      7. May reduce perimenopausal symptoms
Oralcontraceptives                                     sexualityandu.ca



What are the disadvantages?

      1. Must be taken every day. The progestin-only pill must be taken at
the same
         time every day
      2. May cause irregular bleeding or spotting
      3. Effectiveness may be reduced by other medications
      4. Should not be used by women over the age of 35 who smoke
      5. May increase the risk of blood clots, particularly in women who have
certain            blood disorders or a family history of blood clots
      6. Does not protect against STIs
      7. May increase the number of headaches
      8. May not be suitable for breastfeeding women
Transdermalpatch                                        sexualityandu.ca



What is it?
      • A patch that releases hormones through the skin
      • Can be placed on the buttocks, upper outer arms, lower abdomen, or
upper
         torso excluding the breast
      • A new patch is applied once a week for three weeks followed by one
week
         without a patch

How does it work?
     • Prevents the ovary from releasing an egg
     • Thickens the cervical mucus making it difficult for sperm to get to the
egg
     • Changes the lining of the uterus making implantation difficult

Failure rate: 80 per 1000 women per year
Transdermalpatch                                      sexualityandu.ca



What are the advantages?

     1.   A reversible and highly effective birth control method
     2.   Once-a-week regimen; no daily contraceptive routine required
     3.   Simple and easy to use
     4.   Regulates menstrual cycle and reduces cramps
     5.   Does not interfere with intercourse
     6.   Expected to provide other benefits similar to oral contraceptives;
          research is needed
Transdermalpatch                                         sexualityandu.ca



What are the disadvantages?

     1.   May cause irregular bleeding or spotting
     2.   May cause breast sensitivity or headache
     3.   Does not protect against STIs
     4.   Patch may detach from skin (less than 2%)
     5.   Possible skin irritation at the application site
Vaginalring                                         sexualityandu.ca



What is it?
      • A flexible, nearly transparent ring that measures 54 mm (about 2
inches)            across
      • The ring releases a continuous dose of hormones for three weeks
while
         it is in the vagina

How does it work?
     • Prevents the ovary from releasing an egg
     • Thickens the cervical mucus making it difficult for sperm to reach
the egg
     • Changes the lining of the uterus making implantation difficult

Failure rate: 80 per 1000 women per year
Vaginalring                                           sexualityandu.ca



What are the advantages?

     1.   A reversible and highly effective birth control method
     2.   Once-a-month regimen; no daily contraceptive routine required
     3.   Regulates menstrual cycles
     4.   Does not interfere with intercourse
     5.   Does not require daily attention
     6.   Expected to provide other benefits similar to oral contraceptives;
           research is needed
Vaginalring                                       sexualityandu.ca



What are the disadvantages?

     1. Does not protect against STIs
     2. May cause irregular bleeding or spotting
     3. May cause side effects such as headache, nausea, or breast
         tenderness
     4. May cause vaginal discomfort
     5. The ring may be expelled from the vagina but this is uncommon
I n j e c t a b l e c o n t r a c e p t i v ee u a l i t y a n d u . c a
                                          s x



What is it?
     • It contains a hormone called progesterone; it does not contain
estrogen
     • The injection is given in the upper arm or buttocks every 12 to 13
weeks
       (four times a year)

How does it work?
     • Prevents the ovary from releasing an egg
     • Thickens the cervical mucus making it difficult for sperm to get to
the egg
     • Changes the lining of the uterus making implantation difficult

Failure rate: 30 per 1000 women per year
I n j e c t a b l e c o n t r a c e p t i v ee u a l i t y a n d u . c a
                                          s x



What are the advantages?

      1. One of the most effective reversible birth control methods
available
      2. Does not contain estrogen
      3. No daily contraceptive routine required; 1 injection lasts for 3
months
      4. Effectiveness is not reduced by other common medications
      5. May be suitable for breastfeeding women or women who smoke
      6. With continued use, menstrual cycles cease in over half of users
after
           the first year, and two-thirds of users after two years of use
      7. Improves symptoms of endometriosis
      8. Reduces the risk of endometrial cancer
      9. Effective immediately when given during the first 5 days of a
normal
           menstrual period
I n j e c t a b l e c o n t r a c e p t i v ee u a l i t y a n d u . c a
                                          s x



What are the disadvantages?

     1. Initially, irregular bleeding is the most common side effect
     2. Decrease in bone mineral density which may be reversible when
a
         woman stops taking the injection. Calcium supplementation is
advised.
     3. May be associated with weight gain in some women
     4. Takes an average of nine months after the last injection for the
ovaries
         to start releasing eggs again
     5. Does not protect against STIs
     6. The lack of a monthly period may be bothersome for some
women
I n t r a u t e r i n e s y s t e m ( I U sS x)u a l i t y a n d u . c a
                                            e



What is it?
      • A T-shaped device that contains a hormone called levonorgestrel
      • The hormone is released slowly over time and acts on the lining of
the
          uterus
      • It is inserted into the uterus by your physician in the doctor’s
office
      • Two threads may be felt in the vagina, so a woman can check for
herself
          to ensure that the IUS is still in place

How does it work?
     • Thickens the cervical mucus making it difficult for sperm to reach
the egg
     • Causes changes in the lining of the uterus that helps to prevent
         implantation
     • In some women, it may prevent the ovary from releasing an egg

Failure rate: 1 per 1000 women per year
I n t r a u t e r i n e s y s t e m ( I U sS x)u a l i t y a n d u . c a
                                            e



What are the advantages?

      1. Long-acting contraceptive; can be left in place for up to five
years
      2. No daily contraceptive routine required; device provides five
years of
      contraception
      3. Does not contain estrogen
      4. Does not interfere with intercourse
      5. Regulates menstrual cycle and reduces cramps
      6. May be suitable for women who are breastfeeding
      7. May reduce pain due to endometriosis
      8. May lower the risk of precancerous cells developing in the lining
of the
         uterus
      9. Some users will stop having menstrual cycles during insertion
period
I n t r a u t e r i n e s y s t e m ( I U sS x)u a l i t y a n d u . c a
                                            e



What are the disadvantages?

        1. Possible side effects include irregular bleeding or spotting in the
first
           months after insertion
       2. Perforation of the uterus may occur at the time of insertion, but
this is
           rare
       3. May be expelled from the uterus, which happens with 6% of IUS
users
       4. Does not protect against STIs
       5. Requires a physician for insertion and removal
                                                        sexualityandu.ca


Side-Effects of Hormonal Contraception

  Side effects that may occur during the first few months on hormonal
  contraception include :

      irregular bleeding, spotting
      nausea
      mood swings
      bloating
      breast tenderness
      headaches
                                                         sexualityandu.ca


Side-Effects of Hormonal Contraception

  Reason:
    Your body is getting used to birth control
    Fluctuating hormone levels when you start

  When will it stop?
    Most symptoms are normal and will decrease or stop in the first 2-3
     months.

  If they bother you or don’t get better:
      Talk to your healthcare provider
      There might be a method that’s better suited for you.
                                                   sexualityandu.ca


Myths and Misconceptions about Hormonal Contraception

  Common myths and misconceptions

      Causes weight gain
      Causes acne
      Causes infertility
      Causes birth defects
      Should take a break from time to
       time
      Smokers should not be taking it
      Women over age 35 should not
       take the Pill
      No need for condoms if you’re on the Pill
                                             )
I n t r a u t e r i n e d e v i c e ( I U De x u a l i t y a n d u . c a
                                          s




                   What is it?
                      • A T-shaped device with a copper wire around it
                      • It is inserted into the uterus by a physician in the
                  doctor’s
                        office
                      • Two threads may be felt in the vagina, so a woman
How does it work? can
                         check for herself to ensure that the IUD is still in
     • Causes changes in the lining of the uterus
                  place
     • Prevents the sperm from fertilizing the egg
     • Decreases the ability of the sperm to penetrate the cervical mucus

Failure rate: 8 per 1000 women per year
                                             )
I n t r a u t e r i n e d e v i c e ( I U De x u a l i t y a n d u . c a
                                          s



What are the advantages?

     1. Long-acting contraceptive; can be left in place for up to five
years
     2. No daily contraceptive routine required; device provides five
years of
         contraception
     3. Does not contain estrogen
     4. Does not interfere with intercourse
     5. May reduce the risk of endometrial cancer
     6. May be suitable for women who are breastfeeding
                                             )
I n t r a u t e r i n e d e v i c e ( I U De x u a l i t y a n d u . c a
                                          s



What are the disadvantages?

        1. Possible side effects include irregular bleeding or spotting in the
first
           months after insertion
       2. Perforation of the uterus may occur at the time of insertion but
this is
           rare
       3. May increase menstrual bleeding or menstrual cramping
       4. May be expelled from the uterus. This happens in 2–10% of IUD
users
       5. Does not protect against STIs
Femalesterilization                                          sexualityandu.ca

                                                                             Sites of
Tubal occlusion “Having your tubes tied”                                   Sterilization


What is it?
      • A surgical procedure to close or block the fallopian tubes
      • Techniques include:
          • Laparoscopy – special instruments are inserted through two tiny
            incisions (less than 1 cm long) in the abdomen                  Ligation

          • Mini-laparotomy – also requires a small cut in the abdomen
          • Hysteroscopy – use of a thin telescope inserted into the uterus
      • Fallopian tubes may be blocked by using one of the following:
          • A clip or a ring
          • Cautery (an electric current)                                    Clips
          • Removing a small piece of each tube
          • Hysteroscopy for the insertion of tubal plugs (Essure)

How does it work?
     • The fallopian tube is blocked and therefore the
       sperm and egg cannot meet                              Essure      Cauterization


Failure rate: 5 per 1000 women per year
Femalesterilization                                  sexualityandu.ca



What are the advantages?

     1.   No daily contraceptive routine required; nothing to remember
     2.   Private
     3.   Does not interfere with intercourse
     4.   No significant long term side effects
Femalesterilization                                     sexualityandu.ca



What are the disadvantages?

      1. Usually permanent and difficult to have reversed
      2. Possible post-sterilization regret
      3. Possible short-term surgery-related complications: abdominal
          discomfort; bruising, bleeding, or infection at the incision site;
reaction to
          anesthesia
      4. If pregnancy occurs, there is a higher chance that it will be an
ectopic
           pregnancy
      5. Does not protect against STIs
Femalecondom                                               sexualityandu.ca




                               What is it?
                                  • Soft, disposable, polyurethane sheath
                                  • Available in drugstores without a prescription



How does it work?
      • Placed in the vagina before intercourse
      • Lines the vagina completely, preventing direct contact between the penis
and the
         vagina and preventing the exchange of body fluids
      • Sperm is trapped in the condom, which is thrown away
        after intercourse
      • A new condom should be used for each repeated
        act of intercourse

Failure rate: 210 per 1000 women per year
Femalecondom                                         sexualityandu.ca



What are the advantages?

     1.   Available widely without a prescription
     2.   No daily contraceptive routine or continued use required
     3.   Woman remains in charge of placement and use
     4.   Protects against some STIs
Femalecondom                                         sexualityandu.ca



What are the disadvantages?

     1.   Must be available at time of intercourse
     2.   Requires proper insertion technique
     3.   Flexible inner ring may cause discomfort for some
     4.   More expensive than the male condom and not available in all
stores
     5.   Makes a noise during intercourse
     6.   May slip or break during intercourse
     7.   May be considered messy by some
     Femalebarriermethods                                         sexualityandu.ca


Diaphragm and Cervical Cap          What are they?
                                        • Intravaginal barrier methods that are used together
                                            with a spermicide
                                         • The diaphragm is a latex dome with a flexible steel
                                            ring around its edge (a non-latex diaphragm is
                                     also
                        Cervical Cap
                                            available)
                                         • The cervical cap is thimble-shaped silicone cap
             Diaphragm                   • Positioned into the vagina (diaphragm) or over the
                                           cervix (cervical cap) before intercourse
      How do they work?                  • Must be left in the vagina for 6–8 hours after
           • A pelvic examination by a qualified health care
                                     intercourse
             professional is required for fitting diaphragms and
             cervical caps
           • Inserted into the vagina and fit over the cervix
           • When positioned properly, they block the entry to
             the uterus so sperm cannot enter and
             fertilize the egg
           • Spermicide should be reapplied for
             each repeated act of intercourse

      Failure rate: 160-320 per
      1000 women per year
Femalebarriermethods                            sexualityandu.ca



What are the advantages?

     1. Does not contain hormones
     2. Can be used by women who are breastfeeding
     3. Some protection against certain STIs
Femalebarriermethods                                sexualityandu.ca



What are the disadvantages?

      1. Must be available at time of intercourse
      2. Requires proper insertion technique
      3. Does not protect against certain STIs
      4. Cannot be used by people who are allergic to spermicides
      5. Diaphragm may increase the risk of persistent urinary tract
infection
      6. Cervical cap should not be used during menstruation
      7. May become dislodged during intercourse
      8. Cervical cap may cause vaginal odour and discharge
     Femalebarriermethods                                         sexualityandu.ca


Sponge and Spermicides

      What are they?
               • The sponge is a soft, disposable, polyurethane foam device impregnated
      with a
                spermicide
              • Spermicides disable sperm and come in several forms, including creams,
      jellies,
                tablets, suppositories, foams, and film

      How do they work?
        Sponge
           • Fits over the cervix
           • Traps and absorbs sperm to augment effect of
             spermicide
           • Spermicide in the sponge disables the sperm
           • Effective for up to 12 hours
         Spermicides
           • Contain an ingredient that disables sperm
           • Should be used together with another form
             of contraception

      Failure rate: 160-320 per 1000 women per year
Femalebarriermethods                              sexualityandu.ca



What are the advantages?

     1.   Does not contain hormones
     2.   Can be used by women who are breastfeeding
     3.   Can be used by women who smoke
     4.   Spermicide may provide added lubrication
Femalebarriermethods                               sexualityandu.ca



What are the disadvantages?

     1.Must be available at time of intercourse
     2.Does not protect against certain STIs
     3.Cannot be used by people who are allergic to spermicides
     4.Requires proper insertion technique
     5.Sponge users may experience vaginal irritation or infection
     6.Spermicide must be inserted into the vagina in advance
       (time depends on product)
    7. If left in the vagina in excess of the recommended time,
symptoms of
         toxic shock syndrome may appear
                             sexualityandu.ca
    Malereproductivesystem


Seminal vesicles


Vas deferens


Prostate gland



  Penis


Epididymis


 Testicle
     Malebarriermethods                                   sexualityandu.ca


Male Condom

                         What is it?
                           • A soft disposable sheath
                           • Available in various shapes, sizes, thicknesses,
                             colours and flavours
                           • Most are latex, but non-latex condoms are also
                              available in polyurethane, silicone, and lambskin

     How does it work?
       • Fits over the erect penis
       • Acts as a physical barrier preventing direct genital
         contact and the exchange of genital fluids, so the
         sperm does not enter the uterus and fertilize
         the egg
       • A new condom is used for each repeated act
         of intercourse

     Failure rate: 150 per 1000 women per year
Malebarriermethods                                   sexualityandu.ca



What are the advantages?

     1.   Available widely without a prescription
     2.   Inexpensive
     3.   Latex condoms protect against STIs
     4.   Allows the male partner to assume some responsibility for birth
control
     5.   Both partners can participate in their use
     6.   May help the wearer avoid premature ejaculation
Malebarriermethods                                     sexualityandu.ca



What are the disadvantages?

       1.   Must be available at time of intercourse
       2.   May slip or break during intercourse
       3.   Must be stored and handled properly
       4.   People with latex allergies cannot use latex condoms, but may be
able
             to use non-latex condoms
       5.   May reduce sensitivity for either partner
       6.   May interfere with the maintenance of an erection
       7.   May reduce spontaneity
       8.   Lambskin condoms do not protect against STIs
     Malesterilization                                          sexualityandu.ca


Vasectomy

     What is it?
           • A surgical procedure to close or block the vas deferens (the tubes that
     carry sperm
              to the penis)

     How does it work?
          • The vas deferens are closed so that no sperm is released to fertilize the
     egg
          • Common techniques include:
              • Conventional vasectomy – one or two incision are made in the scrotum
                 to reach the vas deferens
              • No-scalpel vasectomy – a puncture opening                        Vas
                is made in the scrotum                    Urethra               deferens
          • Vas deferens are closed by:
              • Electric current (cauterization)
              • A mechanical method, such as a clip
              • Removal of a small segment of each tube
          • Another form of contraception is required
                                                          Site of
            until a semen analysis shows no sperm         Vasectomy

     Failure rate: 1.5 per 1000 women per year
Malesterilization                                     sexualityandu.ca



What are the advantages?

     1.   No contraceptive routine required; nothing to remember
     2.   Private
     3.   Does not interfere with intercourse
     4.   No significant long-term side effects
     5.   Simple procedure
     6.   Less invasive and more cost-effective than tubal ligation for
women
     7.   Allows the male partner to assume some responsibility for birth
control
Malesterilization                                  sexualityandu.ca



What are the disadvantages?

      1. Difficult to have reversed
      2. Possible post-sterilization regret
      3. Possible short-term surgery-related complications: pain and
swelling;
         vasovagal reaction; infection at the incision site
      4. Does not protect against STIs
      5. Not effective immediately. Must do a follow-up sperm analysis
that
          shows          no sperm are present in the semen
   STIprevention                                                   sexualityandu.ca



Dental dams and gloves
    A dental dam is a small piece of latex similar to the material used
   for latex condoms.
   • It can be used during oral sex. The dental dam is stretched across
   a
     woman’s vagina to prevent the exchange of bodily fluids.
   • It can also be used in other activities where a barrier is desired.
   • Latex surgical gloves can also be used in activities where a
   barrier is
     desired.

General tips
   • When using latex dental dams, gloves, or condoms, apply only
   water-
     based lubricants. They are available at drugstores.
   • Use new dental dams, gloves, or condoms for each partner.
   • Do not re-use latex barriers or turn them over and use the other
   side.
  STIprevention                                                    sexualityandu.ca




Cutting a condom to make a dental dam
                                                                         1

  • When a dental dam is not available, a latex condom can be cut to
  create
    a latex barrier.
          1. Unroll a new condom.
          2. Using scissors, cut off both ends of the condom, removing
  the
              closed tip and the round loop at the base.                 2
          3. Cut the condom lengthwise so that it opens up into a
  rectangle.

   • If you are going to use the barrier for oral sex, you may wish to
  select a
     condom without spermicide or lubrication. A flavoured condom
  may be                                                                 3
     a good choice.
STIprevention                                                sexualityandu.ca




Method                                           STI protection
Oral contraceptives                                    no
Transdermal patch                                      no
Vaginal Ring                                           no
Injectable contraceptive                               no
Intrauterine system (IUS)                              no
Intrauterine device (IUD)                              no
Female sterilization                                   no
Female condom                                         yes*
Diaphragm and cervical cap                           limited
Sponge and spermicides                               limited
Male condom                                yes with latex condoms*
Male sterilization                                     no

* Remember that no method of protection from STIs is perfect. Some STIs
can be passed through skin-to-skin contact.
                                                       sexualityandu.ca


What To Ask Your Healthcare Provider

   Following are some questions you might want to ask regarding your
   sexual health. A good idea is to make a list before you visit.

Birth control related:
      How do I know what birth control method is best for me?
      How to take your method
      How to deal with missed pills, patches, rings, or injections
      What are the side-effects? Which are normal and how can I cope with
       them.

General women’s health
     Should I get a mammogram? How do I know if I'm doing my breast
      self-exam correctly?
     How often do I need a Pap smear or gynecological check-up?
     How do I know if my period is normal?
     Should I be tested for AIDS or other STIs?
                                                            sexualityandu.ca


What Your Healthcare Provider May Ask You

  Be prepared to answer questions about:

       Medical history (surgeries, vaccines, menstrual cycle, etc)
       Medications you are taking
       Allergies
       Family history (medical conditions like diabetes, heart problems)
       Lifestyle
       Sexual practices

         Don't be embarrassed to tell the truth or ask a question. They are
       professionals and the information is required to give you the best care
                                      possible.

				
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