00:01
So, now, let's get into some of our choices.
00:04
So, we're going to break these into categories
so that it's a little bit easier to sort of keep it altogether.
00:09
Well, first going to talk about non-hormonal methods
and then we're going to talk about hormonal methods.
00:15
That will make it simple.
So, let's talk about the barrier methods first.
00:19
Barrier methods can include spermicides,
the male condom, the female condom,
or diaphragm, or cervical cap.
Let's look at condoms first.
00:30
So, condoms basically work by keeping the
sperm away from the vagina, pretty simple.
00:36
So, there are several types of condoms though
and we want to make sure
that our clients understand so they can
make a choice about which one.
00:43
So, latex is the most common.
00:46
So, this prevents pregnancy and it also
prevents HIV and other STD infection.
00:53
There are also synthetic condoms
that are not made up of latex
for clients that might have an allergy to latex.
00:59
This also will prevent pregnancy
and HIV and other STDs.
01:04
The final condom we'll talk about,
however, is a natural or lamb-skin condoms.
01:09
This is made up of a different sort of membranous
material that's not latex and it's not synthetic.
01:14
So, it still prevents pregnancy
but not as consistent at preventing HIV
and some other STDs and
that's because it is poorest.
01:23
So, sperm are actually pretty large
in comparison to viruses
so it can keep the sperm from getting through
but it's a little dicey on the others.
01:32
So, I wouldn't recommend this except
for a client who feels fairly comfortable
they're in a safe relationship in terms
of transmission of HIV or other STDs.
01:41
Okay. The typical failure rate, remember
we're talking about humans, is around 13%.
01:47
Now, along with the condom,
we want to think about lubricants.
01:52
So first let's talk about some lubricants
that might not be a good idea.
01:57
So, massage oils, baby oils,
lotion, petroleum jelly.
02:02
They're lubricants, yes, however, they weaken
the condom and they may cause it to tear or break.
02:09
So, when you talk to your clients about
using a lubrication with their condoms,
you want to make sure you tell them
what not to use, not just what to use,
and tell them why because the why
sometimes helps you remember.
02:23
Now, let's talk about spermicides.
Spermicides are often used also with condoms.
02:30
What do spermicides do? They kill sperm.
Get it -cide, kill sperm, spermicide altogether.
02:38
It comes in a form of jelly or a foam
like a mousse or it can come in a film
that looks like one of those Listerine
breath mints, or a suppository.
02:49
So, it can look sort of like a little capsule.
So those are all the ways that a spermicide might look.
02:55
And again, it's used typically
with some other methods,
so any of these other barrier methods
the one we talked about, the condom,
and a few we're getting ready to talk
about also can be used along
with the spermicide to get that failure
rate down just a little bit.
03:10
Speaking of female condom,
this is what it looks like.
03:13
So, I hope you can appreciate this
on the graphic, but a female condom
is much larger than a male condom
because it actually is inserted into the vagina.
03:22
So there is an applicator often that goes
with it and the ring is squeezed
and then pushed up into the vagina
and it sits right up underneath the cervix.
03:32
It helps to keep the sperm from getting into the uterus, just
like the condom does but a little bit closer to the cervix.
03:40
It can be inserted up to 8 hours before sexual intercourse,
which might be a benefit if you think about it.
03:46
This could be placed before a night out
rather than during the actual event.
03:51
The failure rate during typical use
for a female condom is around 21%.
03:57
Now, let's talk about the diaphragm.
03:59
So the diaphragm is a round, latex dome
that actually goes inside of the vagina.
04:06
It has a metal ring around the perimeter
to help it keep its shape
and then it's filled with spermicide
and that spermicide is usually a jelly or cream
or a foam and that has to be used with
a diaphragm to achieve its full effectiveness.
04:21
And the diaphragm is placed in the vagina
all the way next to the cervix,
so it creates a seal with the spermicide
so that the sperm not only are unable
to get through because
the diaphragm is in the way,
but it can even get around the edges
because the spermicide creates that seal,
kind of like if you've ever seen dentures
and they have that cream in the middle
to keep the dentures in your mouth,
it does the same thing.
04:46
That's a weird visual
but go with me on that.
04:49
Now, the diaphragm can be inserted
up to 4 hours before intercourse,
again which is nice if you're planning
on an evening or morning or afternoon
it doesn't have to be right before
the intercourse actually happens.
05:00
But here's the most important part.
So what that means is that it doesn't matter
how many times someone
actually has intercourse,
each time they would just put
more spermicide into the vagina.
05:12
They have to leave it in place so that that spermicide
will actually kill all the sperm that are hanging out.
05:19
Because those sperm, they really want to get
inside the vagina and into the uterus
and up to the eggs that might be there,
so they're willing to wait.
05:28
So, we have to get rid of every single one of them
or the diaphragm won't be particularly effective.
05:34
So, failure rate, if we use the diaphragm
perfectly it would be around 6%,
but again we're human so the typical use
rate in terms of failure is more like 12%.
05:48
Now, let's look at the cervical cap.
05:49
So the cervical cap has a little bit more
structure than the diaphragm.
05:53
So, it's not as pliable. It's pretty hard
when you compare the two.
05:58
Now, instead of just going into the vagina,
the cervical cap actually seals itself to the cervix.
06:05
So, it's a cap, like a hat.
Now you also see the spermicide,
so again we have to use spermicide along with the
cervical cap in order to achieve full effectiveness.
06:16
The cervical cap, as you
can see in this diagram,
fits really snugly right on top
of the cervix like a kiss. Right?
Just reaches all the way around it.
So it creates a suction there with the cap.
06:28
Both of these methods, the diaphragm
and the cervical cap have to be fitted by a provider.
06:34
You can't just borrow someone's.
06:36
You have your own cervical cap
and your own diaphragm that fit your body.
06:41
So, the great thing is the cervical cap can be
left in the body for up to 48 hours, which is great.
06:48
Now, it must stay in 6 hours after the last
active sexual intercourse, maybe not so great.
06:55
So, when we think about the typical
failure rate for a nulliparous client,
never had a baby, it's around 14%.
07:03
A client who has had a baby, however,
that failure rate goes up to around 27%.
07:09
Now, the sponge is also a device that
meets the criteria of a barrier method
because it keeps the sperm
from getting to the egg.
07:18
Unlike the diaphragm and the cervical cap,
however, this does not have to be fitted by a provider.
07:25
So, the sponge is actually a sponge
and their spermicide already in it.
07:31
So, once the spermicide is activated when it's placed
into the vagina, then the spermicide is already there.
07:37
So, it fits over the cervix. Now because it's
not fitted, it's going to be a little bit looser
in terms of how it fits inside of the vagina.
Again, it works for up to 24 hours.
07:50
Yay, that's great, but it still must be left
in the vagina for at least 6 hours
after the last active intercourse
so that the spermicide
that's contained within the
sponge can kill all the sperm.
08:04
Typical use for someone who's never
had a baby is around 14%.
08:08
Remember that's what nulliparous means.
08:11
For a client who's had a baby,
then it goes down to around 27%.
08:16
So, you may ask yourself, why are they different
depending on whether you've had a baby or not?
Because if you've never had a baby,
remember your cervix is a nice tight os
that makes a circle and once
you've had a baby before,
the tone in the uterus and the changes in the
cervix make it a little bit less likely it's going to work.