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Nonhormonal Contraception

Nonhormonal contraception refers to mechanisms that prevent pregnancy without affecting the reproductive hormones in the user. Nonhormonal contraception includes physiologic methods, barrier methods, surgical methods, or the use of a copper intrauterine device (IUD). Efficacy levels vary significantly between methods. Most physiologic methods are associated with high failure rates, while, on the other hand, surgical methods are permanent and highly effective. The copper IUD is the most effective reversible method. Some barrier methods can prevent sexually transmitted infections (STIs) and, in addition, provide contraceptive coverage.

Last updated: 29 Apr, 2022

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Overview

Classification

Nonhormonal contraception can be classified into:

  • Physiologic methods:
  • Barrier methods:
    • Condom (male or female)
    • Spermicide
    • Contraceptive sponge
    • Diaphragm Diaphragm The diaphragm is a large, dome-shaped muscle that separates the thoracic cavity from the abdominal cavity. The diaphragm consists of muscle fibers and a large central tendon, which is divided into right and left parts. As the primary muscle of inspiration, the diaphragm contributes 75% of the total inspiratory muscle force. Diaphragm: Anatomy
    • Vaginal pH pH The quantitative measurement of the acidity or basicity of a solution. Acid-Base Balance regulator gel
  • Copper Copper A heavy metal trace element with the atomic symbol cu, atomic number 29, and atomic weight 63. 55. Trace Elements intrauterine device
  • Surgical methods:
    • Tubal occlusion or salpingectomy
    • Vasectomy

Choice of contraception

  • Reasons individuals may desire nonhormonal contraception:
    • Accessibility of some methods
    • Desire for a “backup” method to hormonal contraception
    • Low risk of systemic effects (e.g., venous thromboembolism Thromboembolism Obstruction of a blood vessel (embolism) by a blood clot (thrombus) in the blood stream. Systemic Lupus Erythematosus, hormonal effects)
    • Medical contraindications Contraindications A condition or factor associated with a recipient that makes the use of a drug, procedure, or physical agent improper or inadvisable. Contraindications may be absolute (life threatening) or relative (higher risk of complications in which benefits may outweigh risks). Noninvasive Ventilation to hormonal contraception
    • Additional benefit of preventing STI STI Sexually transmitted infections (STIs) are infections that spread either by vaginal intercourse, anal sex, or oral sex. Symptoms and signs may include vaginal discharge, penile discharge, dysuria, skin lesions (e.g., warts, ulcers) on or around the genitals, and pelvic pain. Some infections can lead to infertility and chronic debilitating disease. Sexually Transmitted Infections (STIs) transmission (barrier methods)
    • Desire a permanent solution (surgical methods)
  • Choice of the nonhormonal contraceptive may depend upon:
    • Ease of access and use
    • Affordability
    • Efficacy rate
    • Reversibility or permanence
    • Prevention of STIs STIs Sexually transmitted infections (STIs) or sexually transmitted diseases (STDs) are infections that spread either by vaginal intercourse, anal sex, or oral sex. Symptoms and signs may include vaginal discharge, penile discharge, dysuria, skin lesions (e.g., warts, ulcers) on or around the genitals, and pelvic pain. Some infections can lead to infertility and chronic debilitating disease. Sexually Transmitted Infections (STIs)
Comparison of the effectiveness of hormonal and non-hormonal contraceptives

Comparison of the effectiveness of hormonal and nonhormonal contraceptive methods
IUD IUD Inhalant use disorder is a substance use disorder defined by pathologic consumption of inhalant substances (such as glue, paint, or lighter fluid) in order to reach a euphoric feeling. Individuals administer inhalers through the mouth (commonly known as huffing) or sniff them through the nose. The effect lasts for only several minutes. Inhalant Use Disorder: intrauterine device

Image by Lecturio.

Physiologic Methods

Withdrawal/coitus interruptus

  • A traditional method that has been in use for centuries
  • The penis Penis The penis is the male organ of copulation and micturition. The organ is composed of a root, body, and glans. The root is attached to the pubic bone by the crura penis. The body consists of the 2 parallel corpora cavernosa and the corpus spongiosum. The glans is ensheathed by the prepuce or foreskin. Penis: Anatomy is completely withdrawn from the vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy prior to ejaculation.
  • Prevents fertilization Fertilization To undergo fertilization, the sperm enters the uterus, travels towards the ampulla of the fallopian tube, and encounters the oocyte. The zona pellucida (the outer layer of the oocyte) deteriorates along with the zygote, which travels towards the uterus and eventually forms a blastocyst, allowing for implantation to occur. Fertilization and First Week by preventing the sperm from reaching the egg
  • Very high failure rate because pre-ejaculate fluid contains viable sperm

Fertility awareness methods

  • Methods involving determination of a woman’s “fertile window” during the menstrual cycle Menstrual cycle The menstrual cycle is the cyclic pattern of hormonal and tissular activity that prepares a suitable uterine environment for the fertilization and implantation of an ovum. The menstrual cycle involves both an endometrial and ovarian cycle that are dependent on one another for proper functioning. There are 2 phases of the ovarian cycle and 3 phases of the endometrial cycle. Menstrual Cycle
  • Penis-in-vagina (PIV) intercourse is avoided (or other contraceptives are used) during the time. 
  • Since sperm can live for up to 5 days and the egg is viable for approximately 24 hours, the fertile window is approximately 6 days each cycle Cycle The type of signal that ends the inspiratory phase delivered by the ventilator Invasive Mechanical Ventilation.
  • The timing of ovulation Ovulation The discharge of an ovum from a rupturing follicle in the ovary. Menstrual Cycle can vary widely from cycle Cycle The type of signal that ends the inspiratory phase delivered by the ventilator Invasive Mechanical Ventilation to cycle Cycle The type of signal that ends the inspiratory phase delivered by the ventilator Invasive Mechanical Ventilation → predicting the fertile window in real time can be challenging and is highly prone to error Error Refers to any act of commission (doing something wrong) or omission (failing to do something right) that exposes patients to potentially hazardous situations. Disclosure of Information
  • The methods are frequently used to intentionally achieve pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care by engaging in intercourse during the fertile window.

Rhythm method (calendar method)

  • The fertile window is determined by looking at the woman’s recent menstrual history Menstrual History Child and Adolescent Care:
    • Calculated by an equation using the woman’s longest and shortest cycles over the last 6 or more months
    • Use the “standard days”: If a woman’s cycle Cycle The type of signal that ends the inspiratory phase delivered by the ventilator Invasive Mechanical Ventilation is reliably between 26 and 32 days, the standard fertile window is between cycle Cycle The type of signal that ends the inspiratory phase delivered by the ventilator Invasive Mechanical Ventilation days 8 and 19 (inclusive).
  • The cycle Cycle The type of signal that ends the inspiratory phase delivered by the ventilator Invasive Mechanical Ventilation has to be regular Regular Insulin.
  • Associated with a high failure rate due to variation in the timing of ovulation Ovulation The discharge of an ovum from a rupturing follicle in the ovary. Menstrual Cycle

Basal body temperature Body Temperature The measure of the level of heat of a human or animal. Heatstroke method

  • The woman tracks her basal body temperature Body Temperature The measure of the level of heat of a human or animal. Heatstroke (BBT) each morning.
  • Approximately 1‒2 days following ovulation Ovulation The discharge of an ovum from a rupturing follicle in the ovary. Menstrual Cycle, the increase in progesterone Progesterone The major progestational steroid that is secreted primarily by the corpus luteum and the placenta. Progesterone acts on the uterus, the mammary glands and the brain. It is required in embryo implantation; pregnancy maintenance, and the development of mammary tissue for milk production. Progesterone, converted from pregnenolone, also serves as an intermediate in the biosynthesis of gonadal steroid hormones and adrenal corticosteroids. Gonadal Hormones will cause an increase in BBT by about 0.5° F.
  • The egg is no longer viable by the time the sustained increase in temperature is noted.
  • The fertile window is over until the temperature drops again with menses Menses The periodic shedding of the endometrium and associated menstrual bleeding in the menstrual cycle of humans and primates. Menstruation is due to the decline in circulating progesterone, and occurs at the late luteal phase when luteolysis of the corpus luteum takes place. Menstrual Cycle.
  • Associated with a high failure rate (since many other factors can cause subtle increases in BBT)

Cervical mucus method

  • Based on cervical mucus changes observed before, during, and after ovulation Ovulation The discharge of an ovum from a rupturing follicle in the ovary. Menstrual Cycle due to hormonal changes throughout the cycle Cycle The type of signal that ends the inspiratory phase delivered by the ventilator Invasive Mechanical Ventilation
  • Leading up to ovulation Ovulation The discharge of an ovum from a rupturing follicle in the ovary. Menstrual Cycle, the mucus becomes progressively thinner, clearer, and stretchier.
  • The increase in progesterone Progesterone The major progestational steroid that is secreted primarily by the corpus luteum and the placenta. Progesterone acts on the uterus, the mammary glands and the brain. It is required in embryo implantation; pregnancy maintenance, and the development of mammary tissue for milk production. Progesterone, converted from pregnenolone, also serves as an intermediate in the biosynthesis of gonadal steroid hormones and adrenal corticosteroids. Gonadal Hormones that occurs following ovulation Ovulation The discharge of an ovum from a rupturing follicle in the ovary. Menstrual Cycle causes the mucus to “dry up” → indicates ovulation Ovulation The discharge of an ovum from a rupturing follicle in the ovary. Menstrual Cycle has already occurred and the egg is no longer viable
  • High failure rate due to misinterpretation of mucus consistency Consistency Dermatologic Examination

Lactational amenorrhea Amenorrhea Absence of menstruation. Congenital Malformations of the Female Reproductive System

  • Mechanism:
    • Prolactin Prolactin A lactogenic hormone secreted by the adenohypophysis. It is a polypeptide of approximately 23 kd. Besides its major action on lactation, in some species prolactin exerts effects on reproduction, maternal behavior, fat metabolism, immunomodulation and osmoregulation. Breasts: Anatomy is secreted to stimulate the production of breast milk.
    • Effects: 
      • Gonadotropin-releasing hormone Gonadotropin-releasing hormone A decapeptide that stimulates the synthesis and secretion of both pituitary gonadotropins, luteinizing hormone and follicle stimulating hormone. Gnrh is produced by neurons in the septum preoptic area of the hypothalamus and released into the pituitary portal blood, leading to stimulation of gonadotrophs in the anterior pituitary gland. Puberty → ↓ follicle-stimulating hormone ( FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle) and luteinizing hormone ( LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle)
      • Ovulation Ovulation The discharge of an ovum from a rupturing follicle in the ovary. Menstrual Cycle is suppressed.
  • Only viable for women:
    • Who are exclusively breastfeeding Breastfeeding Breastfeeding is often the primary source of nutrition for the newborn. During pregnancy, hormonal stimulation causes the number and size of mammary glands in the breast to significantly increase. After delivery, prolactin stimulates milk production, while oxytocin stimulates milk expulsion through the lactiferous ducts, where it is sucked out through the nipple by the infant. Breastfeeding (frequently day and night)
    • Within the 1st 6 months postpartum
    • Who have not seen a return of their menstrual period
  • It is important for a woman to look for signs of ovulation Ovulation The discharge of an ovum from a rupturing follicle in the ovary. Menstrual Cycle (e.g., changes in cervical mucus), which will occur prior to the return of her menstrual period.

Barrier Methods

Condoms

Mechanism:

  • Creates a physical barrier between the male and female genitalia and secretions
  • Effects:
    • Protects against pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care by preventing semen from entering the cervix Cervix The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina. Externally, the cervix is lined by stratified squamous cells; however, the cervical canal is lined by columnar epithelium. Uterus, Cervix, and Fallopian Tubes: Anatomy
    • STI STI Sexually transmitted infections (STIs) are infections that spread either by vaginal intercourse, anal sex, or oral sex. Symptoms and signs may include vaginal discharge, penile discharge, dysuria, skin lesions (e.g., warts, ulcers) on or around the genitals, and pelvic pain. Some infections can lead to infertility and chronic debilitating disease. Sexually Transmitted Infections (STIs) risk, including HIV HIV Anti-HIV Drugs
    • Some protection against HPV HPV Human papillomavirus (HPV) is a nonenveloped, circular, double-stranded DNA virus belonging to the Papillomaviridae family. Humans are the only reservoir, and transmission occurs through close skin-to-skin or sexual contact. Human papillomaviruses infect basal epithelial cells and can affect cell-regulatory proteins to result in cell proliferation. Papillomavirus (HPV) infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease → ↓ risk of cervical neoplasia

Male condom:

  • Only reversible male contraceptive method (except for withdrawal)
  • A thin (usually latex) tube with a reservoir Reservoir Animate or inanimate sources which normally harbor disease-causing organisms and thus serve as potential sources of disease outbreaks. Reservoirs are distinguished from vectors (disease vectors) and carriers, which are agents of disease transmission rather than continuing sources of potential disease outbreaks. Humans may serve both as disease reservoirs and carriers. Escherichia coli at the tip and a base ring
  • Applied to an erect penis Penis The penis is the male organ of copulation and micturition. The organ is composed of a root, body, and glans. The root is attached to the pubic bone by the crura penis. The body consists of the 2 parallel corpora cavernosa and the corpus spongiosum. The glans is ensheathed by the prepuce or foreskin. Penis: Anatomy before penetration Penetration X-rays
  • Pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care rate at 1 year:
    • 2% with perfect use
    • 18% with typical use (inconsistent use)

Female condom:

  • A pouch with an inner and an outer ring
  • The inner ring is inserted into the vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy. The outer ring remains outside and covers the perineum Perineum The body region lying between the genital area and the anus on the surface of the trunk, and to the shallow compartment lying deep to this area that is inferior to the pelvic diaphragm. The surface area is between the vulva and the anus in the female, and between the scrotum and the anus in the male. Vagina, Vulva, and Pelvic Floor: Anatomy.
  • Should be used no more than 8 hours before intercourse
  • Pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care rate at 1 year:
    • 5% with perfect use
    • 21% with typical use

Advantages:

  • Does not affect Affect The feeling-tone accompaniment of an idea or mental representation. It is the most direct psychic derivative of instinct and the psychic representative of the various bodily changes by means of which instincts manifest themselves. Psychiatric Assessment fertility
  • Protection from STIs STIs Sexually transmitted infections (STIs) or sexually transmitted diseases (STDs) are infections that spread either by vaginal intercourse, anal sex, or oral sex. Symptoms and signs may include vaginal discharge, penile discharge, dysuria, skin lesions (e.g., warts, ulcers) on or around the genitals, and pelvic pain. Some infections can lead to infertility and chronic debilitating disease. Sexually Transmitted Infections (STIs)
  • Easily accessible (condoms for men)
  • Inexpensive
  • Minimal side effects
  • Does not require medical evaluation or special fitting
  • Condoms for women offer protection if the partner refuses to use a condom

Disadvantages:

  • Potential allergies Allergies A medical specialty concerned with the hypersensitivity of the individual to foreign substances and protection from the resultant infection or disorder. Selective IgA Deficiency to the materials of the condom 
  • Potential ↓ in sensitivity Sensitivity Binary classification measures to assess test results. Sensitivity or recall rate is the proportion of true positives. Blotting Techniques
  • Some individuals may have difficulty finding a proper fit.
  • Slippage or breakage can occur.
  • Condoms for women may be difficult to find and/or insert/remove properly.
Unrolled male condom nonhormonal contraception

A partially unrolled male condom

Image: “An unrolled male condom” by Béa. License: Public Domain

Spermicides

  • Mechanism:
  • Use:
    • Can be in the form of foams, creams, and suppositories Suppositories Medicated dosage forms that are designed to be inserted into the rectal, vaginal, or urethral orifice of the body for absorption. Generally, the active ingredients are packaged in dosage forms containing fatty bases such as cocoa butter, hydrogenated oil, or glycerogelatin that are solid at room temperature but melt or dissolve at body temperature. Large Bowel Obstruction
    • Suppositories Suppositories Medicated dosage forms that are designed to be inserted into the rectal, vaginal, or urethral orifice of the body for absorption. Generally, the active ingredients are packaged in dosage forms containing fatty bases such as cocoa butter, hydrogenated oil, or glycerogelatin that are solid at room temperature but melt or dissolve at body temperature. Large Bowel Obstruction should be placed in the vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy at least 10‒30 minutes (no more than 1 hour) before sexual intercourse
    • Typically used in combination with condoms
    • Decreases the chance of pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care if used immediately following a condom break/slip/spill
  • Advantages:
    • Does not require a prescription
    • Easy to use
    • Does not affect Affect The feeling-tone accompaniment of an idea or mental representation. It is the most direct psychic derivative of instinct and the psychic representative of the various bodily changes by means of which instincts manifest themselves. Psychiatric Assessment fertility
  • Disadvantages:
    • Should be used with other barrier methods due to limited efficacy alone
    • Does not protect against STIs STIs Sexually transmitted infections (STIs) or sexually transmitted diseases (STDs) are infections that spread either by vaginal intercourse, anal sex, or oral sex. Symptoms and signs may include vaginal discharge, penile discharge, dysuria, skin lesions (e.g., warts, ulcers) on or around the genitals, and pelvic pain. Some infections can lead to infertility and chronic debilitating disease. Sexually Transmitted Infections (STIs)
    • May cause vaginal irritation → ↑ risk for HIV infection HIV infection Human immunodeficiency virus (HIV), a single-stranded RNA virus belonging to the Retroviridae family, is the etiologic agent of acquired immunodeficiency syndrome (AIDS). The human immunodeficiency virus is a sexually transmitted or blood-borne infection that attacks CD4+ T lymphocyte cells, macrophages, and dendritic cells, leading to eventual immunodeficiency. HIV Infection and AIDS
  • Pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care rate:
    • 18% with perfect use
    • 20% with typical use

Diaphragm Diaphragm The diaphragm is a large, dome-shaped muscle that separates the thoracic cavity from the abdominal cavity. The diaphragm consists of muscle fibers and a large central tendon, which is divided into right and left parts. As the primary muscle of inspiration, the diaphragm contributes 75% of the total inspiratory muscle force. Diaphragm: Anatomy

  • Mechanism:
    • A reusable, dome-shaped rubber cup with a flexible rim that fits over the:
      • Cervix Cervix The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina. Externally, the cervix is lined by stratified squamous cells; however, the cervical canal is lined by columnar epithelium. Uterus, Cervix, and Fallopian Tubes: Anatomy
      • Upper and lateral wall of the vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy
    • Provides a physical barrier to sperm
  • Types:
    • Conventional latex diaphragm Diaphragm The diaphragm is a large, dome-shaped muscle that separates the thoracic cavity from the abdominal cavity. The diaphragm consists of muscle fibers and a large central tendon, which is divided into right and left parts. As the primary muscle of inspiration, the diaphragm contributes 75% of the total inspiratory muscle force. Diaphragm: Anatomy:
      • Available in various sizes
      • Requires a medical visit and special fitting
      • Should be refitted after childbirth or weight changes
    • New single-size diaphragm Diaphragm The diaphragm is a large, dome-shaped muscle that separates the thoracic cavity from the abdominal cavity. The diaphragm consists of muscle fibers and a large central tendon, which is divided into right and left parts. As the primary muscle of inspiration, the diaphragm contributes 75% of the total inspiratory muscle force. Diaphragm: Anatomy:
      • Made of silicone
      • 1 size fits most.
      • Does not require a fitting
      • More durable
  • Use:
    • Usually with a spermicide (applied before insertion)
    • Ideally, placed < 1 hour before intercourse
    • Should remain in place for 6‒8 hours (but no more than 24 hours after intercourse)
  • Advantages:
    • Does not affect Affect The feeling-tone accompaniment of an idea or mental representation. It is the most direct psychic derivative of instinct and the psychic representative of the various bodily changes by means of which instincts manifest themselves. Psychiatric Assessment fertility
    • Can be placed at a convenient time before intercourse
    • Durable and reusable (can last up to 2 years)
    • More effective than the sponge
  • Disadvantages:
    • Individuals need instruction on proper use (may be difficult for some)
    • Requires a prescription
    • Does not prevent STIs STIs Sexually transmitted infections (STIs) or sexually transmitted diseases (STDs) are infections that spread either by vaginal intercourse, anal sex, or oral sex. Symptoms and signs may include vaginal discharge, penile discharge, dysuria, skin lesions (e.g., warts, ulcers) on or around the genitals, and pelvic pain. Some infections can lead to infertility and chronic debilitating disease. Sexually Transmitted Infections (STIs)
    • Should be avoided during menses Menses The periodic shedding of the endometrium and associated menstrual bleeding in the menstrual cycle of humans and primates. Menstruation is due to the decline in circulating progesterone, and occurs at the late luteal phase when luteolysis of the corpus luteum takes place. Menstrual Cycle
    • Can cause discomfort and vaginal irritation
    • May become dislodged
    • Associated with:
      • Urinary tract infections Urinary tract infections Urinary tract infections (UTIs) represent a wide spectrum of diseases, from self-limiting simple cystitis to severe pyelonephritis that can result in sepsis and death. Urinary tract infections are most commonly caused by Escherichia coli, but may also be caused by other bacteria and fungi. Urinary tract infections (UTIs)
      • ↑ Risk of toxic shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock syndrome (rare)
  • Pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care rate:
    • 6% with perfect use
    • 12% with typical use
Contraceptive_diaphragm

A contraceptive diaphragm Diaphragm The diaphragm is a large, dome-shaped muscle that separates the thoracic cavity from the abdominal cavity. The diaphragm consists of muscle fibers and a large central tendon, which is divided into right and left parts. As the primary muscle of inspiration, the diaphragm contributes 75% of the total inspiratory muscle force. Diaphragm: Anatomy

Image: “A contraceptive diaphragm Diaphragm The diaphragm is a large, dome-shaped muscle that separates the thoracic cavity from the abdominal cavity. The diaphragm consists of muscle fibers and a large central tendon, which is divided into right and left parts. As the primary muscle of inspiration, the diaphragm contributes 75% of the total inspiratory muscle force. Diaphragm: Anatomy” by Axefan2. License: Public Domain

Contraceptive sponge

  • Mechanism:
    • Foam disk impregnated with nonoxynol-9
    • Acts as both a barrier device and spermicidal agent
  • Use:
    • Moisten with water before insertion into the vagina Vagina The vagina is the female genital canal, extending from the vulva externally to the cervix uteri internally. The structures have sexual, reproductive, and urinary functions and a rich blood supply, mainly arising from the internal iliac artery. Vagina, Vulva, and Pelvic Floor: Anatomy → activates spermicide
    • Should cover the cervix Cervix The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The most inferior portion of the uterus is the cervix, which connects the uterine cavity to the vagina. Externally, the cervix is lined by stratified squamous cells; however, the cervical canal is lined by columnar epithelium. Uterus, Cervix, and Fallopian Tubes: Anatomy
    • Can be inserted up to 24 hours before intercourse
    • Should be left in place for ≥ 6 hours after intercourse
  • Advantages:
    • Available without a prescription or special fitting
    • Does not affect Affect The feeling-tone accompaniment of an idea or mental representation. It is the most direct psychic derivative of instinct and the psychic representative of the various bodily changes by means of which instincts manifest themselves. Psychiatric Assessment fertility
  • Disadvantages:
    • Less effective than other barrier methods
    • Can cause vaginal irritation or dryness → ↑ risk of HIV HIV Anti-HIV Drugs transmission
    • May be difficult to remove (can break apart during removal)
    • Associated with ↑ risk of toxic shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock syndrome (rare)
  • Pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care rate:

Vaginal pH pH The quantitative measurement of the acidity or basicity of a solution. Acid-Base Balance regulator gel

  • Mechanism: lowers the vaginal pH pH The quantitative measurement of the acidity or basicity of a solution. Acid-Base Balance to 3.5‒4.5 (even in the presence of alkaline semen) → immobilizes sperm
  • Use: 
    • Used as an alternative to spermicide
    • Comes in single-dose, prefilled vaginal applicators
    • Should be applied within one hour of intercourse
  • Primary advantage: has a lower risk of vulvovaginal and penile irritation compared to spermicide
  • Disadvantages:
    • Requires a prescription
    • Typically used in conjunction with other products (e.g., condoms, diaphragms)
    • FDA approved, but newer product Product A molecule created by the enzymatic reaction. Basics of Enzymes with less data regarding efficacy

Copper Intrauterine Device

The copper Copper A heavy metal trace element with the atomic symbol cu, atomic number 29, and atomic weight 63. 55. Trace Elements IUD IUD Inhalant use disorder is a substance use disorder defined by pathologic consumption of inhalant substances (such as glue, paint, or lighter fluid) in order to reach a euphoric feeling. Individuals administer inhalers through the mouth (commonly known as huffing) or sniff them through the nose. The effect lasts for only several minutes. Inhalant Use Disorder is the only nonhormonal long-acting, reversible contraceptive available. In the United States, the copper Copper A heavy metal trace element with the atomic symbol cu, atomic number 29, and atomic weight 63. 55. Trace Elements IUD IUD Inhalant use disorder is a substance use disorder defined by pathologic consumption of inhalant substances (such as glue, paint, or lighter fluid) in order to reach a euphoric feeling. Individuals administer inhalers through the mouth (commonly known as huffing) or sniff them through the nose. The effect lasts for only several minutes. Inhalant Use Disorder is sold under the brand name Paragard®.

Mechanism

  • A T-shaped polyethylene device with a fine copper Copper A heavy metal trace element with the atomic symbol cu, atomic number 29, and atomic weight 63. 55. Trace Elements wire wound around the stem (and often the horizontal arms) is inserted into the endometrial cavity.
  • The copper Copper A heavy metal trace element with the atomic symbol cu, atomic number 29, and atomic weight 63. 55. Trace Elements causes local, sterile Sterile Basic Procedures inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body’s defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation and releases small amounts of copper Copper A heavy metal trace element with the atomic symbol cu, atomic number 29, and atomic weight 63. 55. Trace Elements → affects sperm mobility Mobility Examination of the Breast and implantation Implantation Endometrial implantation of embryo, mammalian at the blastocyst stage. Fertilization and First Week
Example of an iud

Image of a copper Copper A heavy metal trace element with the atomic symbol cu, atomic number 29, and atomic weight 63. 55. Trace Elements IUD IUD Inhalant use disorder is a substance use disorder defined by pathologic consumption of inhalant substances (such as glue, paint, or lighter fluid) in order to reach a euphoric feeling. Individuals administer inhalers through the mouth (commonly known as huffing) or sniff them through the nose. The effect lasts for only several minutes. Inhalant Use Disorder

Image: “Example of IUD IUD Inhalant use disorder is a substance use disorder defined by pathologic consumption of inhalant substances (such as glue, paint, or lighter fluid) in order to reach a euphoric feeling. Individuals administer inhalers through the mouth (commonly known as huffing) or sniff them through the nose. The effect lasts for only several minutes. Inhalant Use Disorder” by Robin Marty. License: CC BY 2.0

Use

  • Inserted by a clinician Clinician A physician, nurse practitioner, physician assistant, or another health professional who is directly involved in patient care and has a professional relationship with patients. Clinician–Patient Relationship in the office
  • Can remain in place for 10 years (evidence suggests the device is safe and effective for at least 12 years)
  • Can be used for emergency contraception Emergency contraception Means of postcoital intervention to avoid pregnancy, such as the administration of postcoital contraceptives to prevent fertilization of an egg or implantation of a fertilized egg. Hormonal Contraceptives if placed within 5 days of unprotected intercourse

Advantages

  • Highly effective
  • Provides long-term efficacy
  • Convenient
  • Does not affect Affect The feeling-tone accompaniment of an idea or mental representation. It is the most direct psychic derivative of instinct and the psychic representative of the various bodily changes by means of which instincts manifest themselves. Psychiatric Assessment fertility
  • Minimal systemic effects
  • Can be used as emergency contraception Emergency contraception Means of postcoital intervention to avoid pregnancy, such as the administration of postcoital contraceptives to prevent fertilization of an egg or implantation of a fertilized egg. Hormonal Contraceptives
  • May be removed at any time (by a clinician Clinician A physician, nurse practitioner, physician assistant, or another health professional who is directly involved in patient care and has a professional relationship with patients. Clinician–Patient Relationship)

Disadvantages

  • Requires a medical visit for placement and removal
  • Does not protect against STIs STIs Sexually transmitted infections (STIs) or sexually transmitted diseases (STDs) are infections that spread either by vaginal intercourse, anal sex, or oral sex. Symptoms and signs may include vaginal discharge, penile discharge, dysuria, skin lesions (e.g., warts, ulcers) on or around the genitals, and pelvic pain. Some infections can lead to infertility and chronic debilitating disease. Sexually Transmitted Infections (STIs)
  • Side effects:
    • Heavier menstrual bleeding (primarily during the 1st year)
    • Severe cramping

Contraindications Contraindications A condition or factor associated with a recipient that makes the use of a drug, procedure, or physical agent improper or inadvisable. Contraindications may be absolute (life threatening) or relative (higher risk of complications in which benefits may outweigh risks). Noninvasive Ventilation

  • Current STIs STIs Sexually transmitted infections (STIs) or sexually transmitted diseases (STDs) are infections that spread either by vaginal intercourse, anal sex, or oral sex. Symptoms and signs may include vaginal discharge, penile discharge, dysuria, skin lesions (e.g., warts, ulcers) on or around the genitals, and pelvic pain. Some infections can lead to infertility and chronic debilitating disease. Sexually Transmitted Infections (STIs) or pelvic inflammatory disease Pelvic inflammatory disease Pelvic inflammatory disease (PID) is defined as a polymicrobial infection of the upper female reproductive system. The disease can affect the uterus, fallopian tubes, ovaries, and adjacent structures. Pelvic inflammatory disease is closely linked with sexually transmitted diseases, most commonly caused by Chlamydia trachomatis, Neisseria gonorrhoeae, and Gardnerella vaginalis. Pelvic Inflammatory Disease ( PID PID Pelvic inflammatory disease (PID) is defined as a polymicrobial infection of the upper female reproductive system. The disease can affect the uterus, fallopian tubes, ovaries, and adjacent structures. Pelvic inflammatory disease is closely linked with sexually transmitted diseases, most commonly caused by Chlamydia trachomatis, Neisseria gonorrhoeae, and gardnerella vaginalis. Pelvic Inflammatory Disease)
  • Anatomic abnormalities that distort the uterine cavity
  • Unexplained vaginal bleeding
  • Known cervical cancer Cervical cancer Cervical cancer, or invasive cervical carcinoma (ICC), is the 3rd most common cancer in women in the world, with > 50% of the cases being fatal. In the United States, ICC is the 13th most common cancer and the cause of < 3% of all cancer deaths due to the slow progression of precursor lesions and, more importantly, effective cancer screening. Cervical Cancer or endometrial cancer Endometrial Cancer Endometrial carcinoma (EC) is the most common gynecologic malignancy in the developed world, and it has several histologic types. Endometrioid carcinoma (known as type 1 EC) typically develops from atypical endometrial hyperplasia, is hormonally responsive, and carries a favorable prognosis. Endometrial Hyperplasia and Endometrial Cancer
  • Pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care
  • Wilson disease or copper Copper A heavy metal trace element with the atomic symbol cu, atomic number 29, and atomic weight 63. 55. Trace Elements allergy Allergy An abnormal adaptive immune response that may or may not involve antigen-specific IgE Type I Hypersensitivity Reaction

Complications

  • Expulsion (rates are < 5% within the 1st year after insertion)
  • Uterine perforation Perforation A pathological hole in an organ, blood vessel or other soft part of the body, occurring in the absence of external force. Esophagitis
  • Ectopic pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care (lower overall risk; however, risk of ectopic pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care is high if pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care occurs)

Pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care rate

  • 0.5%‒0.8%
  • Higher failure rate in younger women

Surgical Methods

Female sterilization Sterilization Procedures to block or remove all or part of the genital tract for the purpose of rendering individuals sterile, incapable of reproduction. Surgical sterilization procedures are the most commonly used. There are also sterilization procedures involving chemical or physical means. Reproductive Ethical Issues

Mechanism:

  • Removes the ability of the egg and sperm to come into contact with one another in the fallopian tubes Fallopian tubes The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The fallopian tubes receive an ovum after ovulation and help move it and/or a fertilized embryo toward the uterus via ciliated cells lining the tubes and peristaltic movements of its smooth muscle. Uterus, Cervix, and Fallopian Tubes: Anatomy
  • Accomplished surgically
  • Methods:
    • Salpingectomy: 
      • Complete removal of the fallopian tubes Fallopian tubes The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The fallopian tubes receive an ovum after ovulation and help move it and/or a fertilized embryo toward the uterus via ciliated cells lining the tubes and peristaltic movements of its smooth muscle. Uterus, Cervix, and Fallopian Tubes: Anatomy
      • Reduces the risk of ovarian, fallopian tube Fallopian Tube A pair of highly specialized canals extending from the uterus to its corresponding ovary. They provide the means for ovum transport from the ovaries and they are the site of the ovum’s final maturation and fertilization. The fallopian tube consists of an interstitium, an isthmus, an ampulla, an infundibulum, and fimbriae. Its wall consists of three layers: serous, muscular, and an internal mucosal layer lined with both ciliated and secretory cells. Uterus, Cervix, and Fallopian Tubes: Anatomy, and primary peritoneal cancer → reason why salpingectomy is becoming standard
    • Partial salpingectomy: cutting and excising a segment of the fallopian tubes Fallopian tubes The uterus, cervix, and fallopian tubes are part of the internal female reproductive system. The fallopian tubes receive an ovum after ovulation and help move it and/or a fertilized embryo toward the uterus via ciliated cells lining the tubes and peristaltic movements of its smooth muscle. Uterus, Cervix, and Fallopian Tubes: Anatomy
    • Tubal ligation Ligation Application of a ligature to tie a vessel or strangulate a part. Esophageal Atresia and Tracheoesophageal Fistula or occlusion: 

Indications and contraindications Contraindications A condition or factor associated with a recipient that makes the use of a drug, procedure, or physical agent improper or inadvisable. Contraindications may be absolute (life threatening) or relative (higher risk of complications in which benefits may outweigh risks). Noninvasive Ventilation:

  • Indicated for women with a desire for permanent contraception (requires extensive counseling)
  • No absolute medical contraindications Contraindications A condition or factor associated with a recipient that makes the use of a drug, procedure, or physical agent improper or inadvisable. Contraindications may be absolute (life threatening) or relative (higher risk of complications in which benefits may outweigh risks). Noninvasive Ventilation
  • In the United States, legal restrictions prevent federal funding Funding Conflict of Interest for permanent contraception in women under 21 years of age (18 years in some states)
  • Risk for complications should be assessed and weighed against the risk of pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care and risks associated with alternative contraceptive methods.
  • Risk factors for complications include:
    • Severe obesity Obesity Obesity is a condition associated with excess body weight, specifically with the deposition of excessive adipose tissue. Obesity is considered a global epidemic. Major influences come from the western diet and sedentary lifestyles, but the exact mechanisms likely include a mixture of genetic and environmental factors. Obesity
    • Prior abdominal surgery
    • Previous PID PID Pelvic inflammatory disease (PID) is defined as a polymicrobial infection of the upper female reproductive system. The disease can affect the uterus, fallopian tubes, ovaries, and adjacent structures. Pelvic inflammatory disease is closely linked with sexually transmitted diseases, most commonly caused by Chlamydia trachomatis, Neisseria gonorrhoeae, and gardnerella vaginalis. Pelvic Inflammatory Disease or abdominal infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease
    • Comorbidities Comorbidities The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. St. Louis Encephalitis Virus

Complications:

  • Risk of regret:
    • Biggest risk with female sterilization Sterilization Procedures to block or remove all or part of the genital tract for the purpose of rendering individuals sterile, incapable of reproduction. Surgical sterilization procedures are the most commonly used. There are also sterilization procedures involving chemical or physical means. Reproductive Ethical Issues
    • Highest in young women (up to 20%)
    • Parity Parity The number of offspring a female has borne. It is contrasted with gravidity, which refers to the number of pregnancies, regardless of outcome. Pregnancy: Diagnosis, Physiology, and Care (including nulliparity) is not a significant risk factor for regret.
  • Death: 1–2 per 100,000 women
  • Hemorrhage or intestinal injuries: approximately 0.5% of women
  • 10-year failure rates (depends on surgical technique):
    • Partial salpingectomy: 2%
    • Tubal occlusion with clips or bands: 2%‒3.5%
    • Complete salpingectomy: thought to be significantly lower (less data)
  • Ectopic pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care: Approximately 30% of pregnancies that occur after tubal occlusion are ectopic.

Vasectomy

Mechanism:

  • Disrupts the patency of the vas deferens Vas Deferens The excretory duct of the testes that carries spermatozoa. It rises from the scrotum and joins the seminal vesicles to form the ejaculatory duct. Testicles: Anatomy
  • Can be accomplished surgically by:

Indications and contraindications Contraindications A condition or factor associated with a recipient that makes the use of a drug, procedure, or physical agent improper or inadvisable. Contraindications may be absolute (life threatening) or relative (higher risk of complications in which benefits may outweigh risks). Noninvasive Ventilation:

  • Indicated for men with a desire for permanent contraception (should be given extensive counseling)
  • Contraindications Contraindications A condition or factor associated with a recipient that makes the use of a drug, procedure, or physical agent improper or inadvisable. Contraindications may be absolute (life threatening) or relative (higher risk of complications in which benefits may outweigh risks). Noninvasive Ventilation:
    • Scrotal hematoma Hematoma A collection of blood outside the blood vessels. Hematoma can be localized in an organ, space, or tissue. Intussusception
    • Infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease
  • Statistically safer (and easier to perform) than female-sterilization procedures

Complications:

  • Hematoma Hematoma A collection of blood outside the blood vessels. Hematoma can be localized in an organ, space, or tissue. Intussusception (≤ 5%)
  • Sperm granulomas Granulomas A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. Sarcoidosis (inflammatory response to sperm leakage)
  • Epididymitis Epididymitis Epididymitis and orchitis are characterized by acute inflammation of the epididymis and the testicle, respectively, due to viral or bacterial infections. Patients typically present with gradually worsening testicular pain and scrotal swelling along with systemic symptoms such as fever, depending on severity. Epididymitis and Orchitis
  • Post-vasectomy pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways syndrome
  • Spontaneous reanastomosis:
    • Usually occurs shortly after the procedure
    • A follow-up semen analysis Semen analysis The quality of semen, an indicator of male fertility, can be determined by semen volume, ph, sperm concentration (sperm count), total sperm number, sperm viability, sperm vigor (sperm motility), normal sperm morphology, acrosome integrity, and the concentration of white blood cells. Infertility is usually required approximately 3 months following the procedure to ensure efficacy.

References

  1. Casey, F.E. (2020). Barrier contraceptives. MSD Manual Professional Version. Retrieved August 3, 2021, from https://www.msdmanuals.com/professional/gynecology-and-obstetrics/family-planning/barrier-contraceptives
  2. Casey, F.E. (2020). Intrauterine devices (IUDs; IUD). MSD Manual Professional Version. Retrieved August 3, 2021, from https://www.msdmanuals.com/professional/gynecology-and-obstetrics/family-planning/intrauterine-device-iuds-iud
  3. Casey, F.E. (2020). Permanent contraception. MSD Manual Professional Version. Retrieved August 3, 2021, from https://www.msdmanuals.com/professional/gynecology-and-obstetrics/family-planning/permanent-contraception
  4. Casey, F.E. (2020). Fertility awareness-based methods of contraception. MSD Manual Professional Version. Retrieved August 21, 2021, from https://www.msdmanuals.com/professional/gynecology-and-obstetrics/family-planning/fertility-awareness%E2%80%92based-methods-of-contraception
  5. Bartz, D.A. (2020). Pericoital contraception: diaphragm, cervical cap, spermicides, and sponge. UpToDate. Retrieved August 3, 2021, from https://www.uptodate.com/contents/pericoital-contraception-diaphragm-cervical-cap-spermicides-and-sponge
  6. Warner, L., et al. (2021). External (formerly male) condoms. UpToDate. Retrieved August 3, 2021, from https://www.uptodate.com/contents/external-formerly-male-condoms
  7. Hoke, T., et al. (2020). Female condoms. UpToDate. Retrieved August 3, 2021, from https://www.uptodate.com/contents/female-condoms
  8. Madden, T. (2021). Intrauterine contraception: Background and device types. UpToDate. Retrieved August 21, 2021, from https://www.uptodate.com/contents/intrauterine-contraception-background-and-device-types
  9. Braaten, K.P., and Dutton, C. (2021). Overview of female permanent contraception. UpToDate. Retrieved August 21, 2021, from https://www.uptodate.com/contents/overview-of-female-permanent-contraception
  10. Viera, A.J. (2021). Vasectomy. UpToDate. Retrieved August 21, 2021, from https://www.uptodate.com/contents/vasectomy

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