Why don’t teenagers use contraception?

• Despite education, availability/access, and affordability, why don’t teenagers who are sexually active regularly use contraceptives?

Contraceptive Review for Test

Contraceptive Review

• Product Name

• Product Type: Barrier, Hormonal, Surgical, or miscellaneous

• Product Effectiveness

• Advantages

• Disadvantages

• Cost

Contraceptive Design Project

Contraceptive Design Project

• Design/create a new contraceptive method

• All products must be realistic, cost effective and prevent pregnancy (STIs)

• All products should be eco-friendly :-)

Contraceptive Design Steps

1. Decide on a new contraceptive method

2. Illustrate your new product – place all notes on the back of your illustration

3. Build the prototype

4. The Sales Pitch - Present your idea/product to the class

5. Class votes on the best product

Contraceptive Design Rubric

• Critical Thinking 20%

• Reality 20%

• Model/Prototype 20%

• Creativity 10%

• Presentation/Sales Pitch 20%

• Question & Answer Period 10%

Contraceptive Design (Day 2)

• Project approval

• Completion of illustration and all notes

• Prototype development

• Presentation style & order

What can this couple do? List all possible options.

Given the alternatives, what’s your group’s advice?

Emergency Contraception & Abortion

Emergency Contraception

• Morning After Pills

– Preven ($60.00)

– Plan B (Sliding Scale Costs)

Medical Abortion

• RU-486 – Mifepristone (1st pill)

• Inhibits progesterone– 3 Days later

– Misoprostol (2nd by mouth or vaginal suppository)

• Promotes uterine contractions

* May be used up to seven weeks after implantation (95% effective)

Surgical Abortions

• Early Vacuum Aspirations /Suction (D&C)– 90% of all abortions– Performed 4-6 weeks

• Dilation & Evacuation– 7% of all abortions – Performed 12-20 weeks– Insertion of a medical drug, which dilates the

cervix

Surgical Abortion

• Induction Method– Major Procedure– Insertion of a saline solution, which starts

contractions– 1% of all abortions

• Medical Extraction– Rare procedure

Contraceptive History

History

Ancient Birth Control MethodsBeaver-Testicle Tea

Dances, Amulets, Rituals & Myths

• Squatting or kneeling to provoke sneezing

• Jumping backwards seven times

• Leather pouch containing a cat’s liver on the left foot

• Spitting in a frogs mouth three times

• Inserting a finger into the vagina and “swishing it around” after intercourse

Dances, Amulets, Rituals & Myths

• Soranus - Ancient Greek Doctor of Gynecology– Determined that women were fertile during

ovulation and promoted the rhythm method. Unfortunately, he assumed that ovulation occurred during menstruation.

Spermicides, IUDs, Pessaries, & Douches

• Dried cow, elephant, & crocodile dung mixed with honey

• Ground dates, acacia tree bark, & honey blended into a paste

• Dried fish or cotton soaked with lemon

• Half lemons with the juice squeezed out

• Glass or metal diaphragms

Spermicides, IUDs, Pessaries, & Douches

• IUDs invented by Arabs would placed pebbles in the uteruses of their camels

• 1920 – German gynecologist Ernest Grafenberg developed the first IUD for humans, which was made from silkworm gut and coiled wire.

• Seaweed, leaves, wooden blocks, and apricot pits were also used to block the cervix

• Vinegar injected into the vagina

Douche French term for soak or wash

Douche Bag Douche Can

Coitus Interruptus

• “Pull out” or withdrawal method

• When a man withdraws his penis from a woman prior to ejaculation

• 80% Effective

• Couples in monogamous relationships who do not have to worry about STIs or caring for a child.

Breastfeeding

• Suppresses fertility

• Breastfeeding can provide up to 98% effective contraception if three criteria are met:

- The mother has not experienced the return of her menstrual periods

- The mother is fully or nearly fully breastfeeding

- The baby is less than six months old.

Alfred Trojan

• 1921 – Alfred Trojan, a factory worker in Akron, Ohio, accidentally dunked his erect penis into a vat of vulcanized rubber

Evolution of the Condom

• Latin word "condus" which means "vessel”

• Oiled silk paper, linen sheaths, sheep intestine, snake skin leather, or very thin hollow horn

Condoms Today

• Condoms can be found in a variety of shapes, sizes, colors, flavors and textures. Many condoms also contain lubricants, spermacides and a reservoir tip.

• Condoms that play music when they break– “Dixie,” “The Anniversary Waltz,” “Happy

Birthday to You,” & the “1812 Overture”

Contraceptive Museum

• History of Contraception Museum at Case Western Reserve University in Cleveland

• Phone: 216-368-364811000 Euclid Ave.Cleveland, OH 44106-1714

Male Condom

• Made of latex or polyurethane• Single use barrier method that blocks sperm

from entering the female• Approximately 86%-97% effective• Some protection against STIs • Over the counter

• Inexpensive• May leak, break, or interfere with spontaneity

Female condom

• Rubber sheath with a flexible ring that is inserted in to the female

• Single use barrier method that blocks sperm from entering the female

• 79%-95% effective• Some protection against STIs • Over the counter

• May leak, break, or interfere with spontaneity• More difficult to use

Nonoxynol-9 Information

What You Need to Know About Nonoxynol-9

• N-9 is the active ingredient in all of the over-the-counter (OTC) spermicidal products available in the U.S. and has been used for pregnancy prevention since the 1950s. An Advisory Review Panel of the Food and Drug Administration (FDA) has deemed N-9 a safe and effective contraceptive.

WHAT IS N-9?• N-9 is the active ingredient in all OTC spermicidal

products in the U.S. N-9 is a chemical detergent that damages sperm cell membranes, killing the cells.

• N-9 is marketed and sold as a spermicidal contraceptive product in several different formulations, including:

• Suppositories - Foam – Film (VCF) - Gel - Cream

N-9

• Diaphragms and cervical caps are FDA approved for use in conjunction with spermicidal gels and creams. Also, some condoms include a spermicidal lubricant.

N-9 USE RECOMMENDATIONS FROM WHO & CDC

• N-9 can be used as a contraceptive, alone or in combination with a cervical barrier method, and among women at low risk of HIV/STI infection (Use the product no more than once daily.)

• N-9 should not be used for the purpose of HIV/STI prevention.

• N-9 should not be used for contraception by women at high risk of HIV infection.

N-9 USE RECOMMENDATIONS FROM WHO & CDC

• Condoms with N-9 should not be promoted for disease prevention. (However, it is better to use N-9-lubricated condoms than no condoms at all.)

• N-9 should not be used rectally.

Contraceptives Methods

Spermicide

• A foam, cream, jelly, film, suppository or a tablet that contains Nonoxynol-9

• 20-50 out of 100 pregnancies

• No protection against STDs

Contraceptive foam, film, suppositories

• Available over the counter

• Must be inserted close to time of intercourse

• Limited STD protection

• 74%-94% effective

IUD (Intrauterine device)

• A T-shaped device inserted into the uterus by a doctor

• Can last from 1 to 10 years

• About 2 in 100 pregnancies a year

• Pregnancies usually end up in fallopian tubes

Diaphragm • Dome-shaped rubber disk that covers the cervix so

sperm cant reach the uterus• Best if used with a spermicide• 80%-94% effective • Inserted before intercourse, left in for at least 6 hours • Can be used multiple times• Uncomfortable to use• Has to be fitted• Limited protection against STDs

Cervical Cap

• Soft rubber cup with a round rim which fits around the cervix

• 80%-94% effective

• Hard to insert

• Can remain in place for up to 48 hours without being removed

Combination Pill

• Effectiveness

• Adult Users 99.7%

• Actual effectiveness: 92 %– Forget a pill or two– Not following directions– Certain antibiotics– Vomiting or diarrhea

Combination Pill

• Benefits – regular cycle every 28 days, reduces cramps and flow, reduces risks of uterine and ovarian cancer and other diseases

• Side Effects – nausea, headaches, weight gain, fluid retention, bleeding between periods, depression, mood changes, changes in vision, dizziness, yeast infections, and smokers increase chances of stroke and heart attack

• Who should not use it – heavy smokers, suffer from severe depression, get migraines, have had blood clots, CVS, cancer or blood diseases

• Cost - $10 to $35 a month

ABSTINENCE • 100% EFFECTIVE• ADVANTAGES • No medical or hormonal side effects • Easy to use • Prevents sexually transmitted infections• 100%FREE• POSSIBLE DISADVANTAGES• many people find it difficult to abstain from sex • many people fail to use protection when abstinence ends • A commitment required by both people• Peer pressure

Extended Cycle Pill

• Prevents ovulation, changes lining, difficult for fertilized ovum to implant, thickens the cervical mucous

• Only four period per year• 99% effective• Advantage for women who suffer from severe cramping or

PMS• Side Effects – irregular bleeding, fluid retention (hands and

feet), raise blood pressure, nausea, vomiting, headache, vision, appetite, depression infections and allergic reactions

• Who should not use it – smokers, CVS, cancer• Cost - $100 to $120 for three months

Facts To Know

• Other Benefits from correct use: benefits from the birth control method that are in addition to its use to prevent pregnancy

• Side Effects: unwanted changes, including health risks, that might occur when the birth control method is used

• Who should not use: a list of cautions that identify users who should not use the birth control method because it might cause health risks or might be inappropriate

• Cost: an estimate of how much money the birth control method will cost

Facts to Know About Birth Control Methods

• How it works: the way the birth control methods works to prevent pregnancy

• Instructions for correct use: directions for using the birth control method the right way

• Effectiveness: – Theoretical Effectiveness: % that tells how well birth control

works if adult users use it the correct way every time and have no preexisting conditions that reduce how well it works

– Actual user Effectiveness: % that tells how well birth control works if adult users do not use it in the correct way and have no conditions that reduce how well it works

Kinds of Birth Control methods

• Abstinence from Sex• Oral Contraceptives - Combination Pill, Progestin Only

Pill, Extended-Cycle Pill• Vaginal Ring• Injectable Contraceptives – injectable Progestin• Skin Patch• Barrier Methods – Spermicides, Diaphragm, Cervical cap,

Male and Female Condom• Fertility Awareness Methods – basal Body Temperature

Method, The Calendar Method, The Mucous Method• Sterilization – Tubal Ligation (Female), Vasectomy (Male)• Unreliable Methods – The Douche and Withdrawal

Preven

• 1-888-PREVEN2 or www.PREVEN.com• 90%-99% effective• Estrogen and Progestin pills• Pills can be taken up to 72 hours after intercourse• Must remember to take daily• Some side effects (ex. nausea, gain weight)• Only works if implantation hasn’t taken place• 2nd pill must be taken 12 hours after the first pill• Cost $60.00• Reversible• Continuous protection against pregnancy

Plan B

• 1-888-not-2-late or 1-800-230-plan

• Progestin pill only

• Cost- unknown, price differs

• Lowers risk of pregnancy by 75%

Norplant (Implant)

• 6 matchstick sized rubber rods implanted under skin of the upper arm

• Steadily releases a contraceptive steroid levonorgestrel

• Very effective. About 1 in 100 pregnancies• Lasts for 5 years until person needs to replace them• Reversible• Very expensive• No STD protection

Depo-Provera (injection)

• Injectable progestin that prevents ovulation• Prevents sperm from reaching egg and

keeps egg from implanting in the uterus• Less than 1 out of 100 pregnancies• 1 injection every 3 months• Not safe against STDs• Fertility may take a few months to get back

to normal

Lunelle (injection)

• Injectable form of Progestin and Estrogen

• Less than 1 out of 100 pregnancies

• Could change menstrual cycle, cause to gain weight

• Given 1 time a month

• Prescription given from doctor

• No STD protection

WITHDRAWAL

• Effectiveness varies: Increases if male doesn’t predict when to pull out

• pregnancy is possible if sperm are spilled on the vagina

• not effective against sexually transmitted infections — use latex or female condoms to reduce the risk

WITHDRAWAL

• ADVANTAGES• can be used when no other method is available • POSSIBLE DISADVANTAGES• requires great self-control, experience, and trust • not for men who ejaculate prematurely • not for men who don’t know when to pull out • not recommended for teens

Fertility Awareness Methods

• Nothing to purchase

• Permitted by some religious groups that don’t allow other methods

• Requires commitment to other person

• No intercourse during menstrual cycle

• 80%-99% effective if done correctly

No Method No Protection

• Only 15% effective

• Free

• No protection against pregnancy

• No protection against STDs

STERILIZATION• ADVANTAGES• permanent protection against pregnancy • no lasting side effects • no effect on sexual pleasure • protects women whose health would be seriously

threatened by pregnancy • POSSIBLE DISADVANTAGES• risks of minor surgery if incision is made • some people later regret not being able to have

children • not usually reversible if you change your mind • rarely, tubes reopen, allowing pregnancy to occur

STERILIZATION

• Tubal sterilization — intended to permanently block woman's tubes where sperm join egg

• Vasectomy — intended to permanently block man's tubes that carry sperm

• 99.5-99.9% EFFECTIVENot effective against sexually transmitted infections — use latex or female condoms to reduce the risk.

STERILIZATION• Tubal sterilization o bruising if incision is made o very rare injury to blood vessels or bowel o pregnancies that rarely occur are more likely to be

ectopic (in a fallopian tube) • Vasectomy o infection or blood clot in or near the testicles o temporary bruises, swelling, or tenderness of the scrotum • sperm leakage may form temporary small lumps near

testicles

STERILIZATION

• COST$2,000-$6,000/ tubal sterilization240-$520/ vasectomy(Vasectomy costs less because it is a simpler procedure that can be done in the clinician’s office.)

Skin Patch

• Hormones are released to prevent ovulation from occurring, mucus thickens, ovulation returns three months after the patch is last used

• Effectiveness – 99% in women who weigh 198 pounds or less

• Other benefits – menstrual cycle regular, shorter and lighter flow

• Side effects – bleeding between periods, nausea, headaches, weight gain or loss, mood changes

• Who should not use them – Same as others, include history of blood clots

• Cost - $30-$35 a months

Ortho Evra (patch)

• Patch worn on the lower abdomen or on the upper body

• Releases progestin and estrogen into the bloodstream

• Less effective for women weighing more than 198 pounds

• New patch applied once a week for 3 weeks, 4th week no patch is worn so female can have her menstrual period

Vaginal Ring

• Small, flexible, plastic ring that is about 2 inches wide• Placed in the vagina each month and releases

hormones similar to those in birth control pills• Prevents ovulation, removed after three weeks, after

having a menstrual period insert a new one• Effectiveness – 98-99%• Benefits – regular menstrual period, shorter and

lighter flow• Side effects – bleeding between period, nausea,

headaches, weight gain or loss, mood changes

Vaginal Ring

• Who should not use it– Smokers, High Blood Pressure, CVD, liver

disease, cancer

– Cost - $30-35 a month

Nuva Ring

• It is a small, flexible ring that is inserted into the vagina once a month

• It is left in place for three weeks and taken out for the remaining week

• The Ring releases synthetic estrogen and progestin to protect against pregnancy for one month.

• Two woman out of every 100 who use the ring become pregnant

Cost of the Nuva Ring

• The cost of the first visit and/or examination, if needed, ranges from about $35-$125

• At some family planning clinics, the cost may depend on your income.

• The Ring costs between $30 and $35 a month.

• The cost is usually lower at a clinic and is covered by Medicaid.

OUTERCOURSE

• NEARLY 100% EFFECTIVE• pregnancy is possible if sperm are spilled on

the vagina• reduces the risk of many sexually transmitted

infections — unless body fluids are exchanged through unprotected oral or anal intercourse.

• Latex or female condoms can reduce risk of infection.

Outercourse

• ADVANTAGES

• no medical or hormonal side effects

• may prolong sex play and enhance orgasm

• can be used when no other methods are available

Outercourse

• POSSIBLE DISADVANTAGES

• many people find it difficult to abstain from vaginal intercourse

• many people fail to use protection from pregnancy or infections if intercourse takes place