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Contraception

General

Is there a "safe time" to have sexual intercourse?

There is no safe time to have unprotected sex if you wish to avoid pregnancy and sexually transmitted diseases. STDs can be transmitted whenever an infected person has sex with an uninfected person, and pregnancy is always a possibility, even during menstrual period. Although women are generally only fertile for a few days every month (usually around the middle of the menstrual cycle) most women have no definite way of knowing when this is. Sperms can also survive inside the body for several days, implying that a woman can potentially become pregnant over quite a long period of time. If she has irregular periods, "safe" days can be particularly difficult to predict.

What is safe period?

First, one should know the duration of the cycle. This duration varies from person to person and is usually between 26 to 31 days. Ovulation approximately occurs in the middle of the cycle, i.e. duration of the cycle minus 14 days (this also varies).

  • A week before and a week after the approximate day of ovulation is considered to be fertile period. The days apart from this is called the safe periods, where the fertilization does not take place. Calculation of fertile period: The shortest cycle minus 18 days=1st day of fertile period. The longest cycle minus 10 days= last day of fertile period.
  • Ex: if a women's menstrual cycle varies from 26days to 31days cycle, the shortest cycle [26days] minus18days=8th day and the longest cycle [31days] minus 10days=21st day. Thus, 8th to 21st day of each cycle counting from first day of menstrual period is considered as fertile period. Period other than this fertile period in a menstrual cycle is considered as safe period.

 

WWhat are the contraceptive choices available for males?

The contraceptive choices available for males include: condoms for temporary protection and vasectomy for permanent protection.

 

What are the contraceptive choices available for females?

The contraceptive choices available for females include:

  1. Female condom.
  2. Spermicides.
  3. Oral pills.
  4. Injectable contraceptives.
  5. Intra uterine device.
  6. Tubectomy.

 

What is the range of contraceptives available depending upon the need?

The range of contraceptives depending upon the need may be presented as follows:


SITUATION CONTRACEPTIVE CHOICE
Teens/ Young married couples- having no children Condom: Male/ Female Combined hormonal contraceptive pills Progestin only pills Centchroman (Saheli) Depo- Provera Norplant
Married Couples having children but willing for more; desirous of spacing pregnancy Condom: Male/ Female Combined hormonal contraceptive pills Progestin only pills IUD Depo- Provera Norplant
Married couples who have completed their family Condom: Male/ Female Progestin only pills Depo- Provera Norplant IUD Sterlization- male/female
Breastfeeding mothers Condom: Male/ Female Progestin only pills Depo- Provera Norplant IUD

Which contraception method is advised in breast feeding mothers?

The best contraceptive would be Cu T. If she is not willing for this she can go in for DMPA or mini-pills.

 

Male condom

What is a male condom?

A male condom is a sheath made to fit over a man‘s erect penis.

What material is a condom made of?

Most condoms are made of latex rubber.

What are the advantages in using a condom?

Using a condom may have the following advantages:

  • Condoms are one of the most reliable methods of birth control when used properly and consistently.
  • Condoms are user friendly. With a little practice, they can also add confidence to the enjoyment of sex.
  • Condoms are only needed when you are having sex unlike some other contraceptives which require you to take or have them all of the time.
  • Condoms are the only contraceptive that also helps prevent the spread of sexually transmitted diseases (STDs) including HIV when used properly and consistently.
  • Can be used by men of any age.
  • Usually easy to obtain and sold at most places.

What are the disadvantages of using a condom?

UThe disadvantages of using a condom are as follows

  • May cause itching for a few people who are allergic to latex.
  • There is a small possibility that the condom might slip off or break during sexual intercourse.
  • If used with oil based lubricants such as vaseline or oil, condoms can go weak and break.
  • A fresh piece of condom is required for each sexual act. It cannot be reused.

What is the effectiveness of a condom in protection against pregnancy?

If the partners of 100 women start using condoms, correctly and consistently, there are 3 pregnancies per 100 women in the first year of use. With irregular or inconsistent use, there is a likelihood of 14 of these women getting pregnant in the first year of use of condoms.

Why is condom not effective at times?

There are times when condom does not prevent pregnancy. The reasons include the following:

  • Not using condom regularly for each sexual act
  • Not using a fresh / new condom for each sexual act
  • Wearing a condom before erection
  • Not wearing condom upto shaft
  • Using oil based lubricants
  • Removing the condom after penis has lost erection and becomes soft.

What could be the possible reasons for incorrect or improper usage?

Reason of incorrect usage can be lack of proper knowledge about correct and consistent condom use.

 

What is the technique of correct usage of a condom?

The technique of correct usage of a condom is as follows:

  1. Make sure the package and condom appear to be in good condition, and check that if there is an expiry date that the date has not passed.
  2. Open the condom package at one corner being careful not to tear the condom with your fingernails, your teeth, or by being too rough.
  3. Place the rolled condom over the tip of the hard penis.
  4. Roll the condom all the way down to the base of the penis, and smooth out any air bubbles. (Air bubbles can cause a condom to break).
  5. Leave a space of at least half an inch at the tip of the condom for the semen to accumulate.
  6. If you want to use some extra lubrication, put it on the outside of the condom. But always use a water-based lubricant (such as KY Jelly - available at all leading chemist shops). Do not use an an oil-based lubricant such as vaseline /baby oil/coconut oil since will cause the latex to break.

 

What is to be done if the condom does not unroll??

The condom should unroll smoothly and easily from the rim on the outside. If you have to struggle or if it takes more than a few seconds, it probably means that you are trying to put the condom on upside down. To take off the condom, don't try to roll it back up. Hold it near the rim and slide it off. Then start again with a new condom

 

When should the condom be removed?

Pull out before the penis softens, and hold the condom against the base of the penis while you pull out, so that the semen doesn't spill.

 

How should a condom be disposed?

Condom should be disposed properly for example wrapping it in a paper or tissue and throwing it away. It's not good to flush condoms down the toilet – as they are non-biodegradable and can block the sewer drain.

 

What should be done if the condom breaks during intercourse?

If a condom breaks during sexual intercourse, then pull out quickly and replace the condom. Whilst you are having sex, check the condom from time to time, to make sure it hasn't split or slipped off. If the condom has broken and you feel that semen has come out of the condom during sex, you should consider getting emergency contraception such as the morning after pill.

 

Are two condoms more effective than one?

Two condoms should not be used at once, as the latex rubbing against each other may cause the tear.

 

Please give some tips for caring for condoms.

Please give some tips for caring for condoms.

  1. Condoms should be stored in a cool dark place if possible.
  2. Avoid exposure of the condom to excessive heat, light and humidity.
  3. Handle condoms carefully. Fingernails and rings can damage condoms.
  4. Do not unroll condom befor use; this may weaken them. Also an unrolled condom is difficult to put on.

 

What is to be done if a condom or lubricant causes itching or rash on genitals?/span>

If condom or lubricant causes itching or rash on genitals, the following may be done: (i)Try using water as a lubricant. (ii)Consult a doctor to rule out itching or allergy.

 

What is to be done if a man cannot maintain an erection while putting on or using a condom?

In such a case, the following may be done:

  1. Try using a dry condom without spermicide.
  2. Female partner can be asked to try putting on the condom for the man, which would help to make its use more enjoyable.
  3. An extra amount of water or water based lubricant such as KY jelly may be used on the penis and extra lubricant on the outside.

 

Does use of condom affects man’s health or does he become weak?

No, the man does not become weak; on the contrary the fear of unwanted pregnancy is removed so he experiences sense of wellbeing.

 

Female condom

What is a female condom?

The female condom is a polyurethane sheath or pouch, about 17 cm (6.5 inches) in length. It is worn by a woman during sex. It entirely lines the vagina and it helps to prevent pregnancy and sexually transmitted diseases (STDs) including HIV.

What are the features of the female condom?

At each end of the condom there is a flexible ring. At the closed end of the sheath, the flexible ring is inserted into the vagina to hold the female condom in place. At the other open end of the sheath, the ring stays outside the vulva at the entrance to the vagina. This ring acts as a guide during penetration and it also stops the sheath bunching up inside the vagina. The condom is already smeared with a silicone based lubricant on its inner side.

What are the benefits of using a female condom?

The benefits of using a female condom are:

  • Opportunity for women to share the responsibility for the condoms with their partners
  • A woman can use the female condom if her partner refuses to use the male condom.
  • The polyurethane, the material the female condom is made of, is less likely to cause an allergic reaction than a male latex condom.
  • The female condom will protect against most STDs and pregnancy if used correctly.
  • It can be inserted up to 8 hours before intercourse so it does not interfere with the moment.
  • The polyurethane is thin and conducts heat well so sensation is preserved.
  • The female condom can be used with oil-based lubricants.
  • No special storage requirements are needed because polyurethane is not affected by changes in temperature and dampness. The expiry date for female condoms is 5 years from the date of manufacture.

What is the effectiveness of the female condom in preventing pregnancy?

When used correctly and consistently, effectiveness of the female condom is up to the extent of 98%. If not used correctly or consistently, the effectiveness rate drops.

What is the correct technique of using female condom?

The correct technique in using a female condom is as follows:

  1. Open the package carefully. Choose a position that is comfortable for insertion - squat, raise one leg, sit or lie down.
  2. Squeeze the inner ring with thumb and middle finger (so it becomes long and narrow), and then insert the inner ring and sheath into the vaginal opening.
  3. Place the index finger inside of the condom and push the inner ring as far as it will go.
  4. Make sure the condom is inserted straight, and is not twisted inside the vagina. The outer ring should remain on the outside of the vagina.
  5. The penis should be guided into the condom in order to ensure that the penis does not slip into the vagina outside the condom.

Is it easy to use a female condom?

Female condoms are not difficult to use, but you may want to practice to get used to them. Women should practice putting it in and removing it, prior to using it for the first time during sexual intercourse. It is recommended that female condom may need to be tried up to three times before users become confident and comfortable using it.

Can a lubricant be used with female condoms and, if so, what kind of lubricant can be used?

Female condoms come pre-lubricated with a silicone-based, non-spermicidal lubricant. This lubrication helps assist in the insertion of the device and allows easy movement during intercourse. The lubricant may make FC a little slippery at first. If the outer ring of FC gets pushed in or pulled out of the vagina, more lubricant may be needed. Also, if FC makes noise during sex, simply add more lubricant. Female condoms can be used with both water-based such as KY jelly and oil-based lubricants such as Vaseline and baby oil.

 

What is to be done if the condom slips/ gets torn during the intercourse?

If the condom slips during intercourse, or if it enters the vagina, then you should stop immediately and take the female condom out. Then insert a new one and add extra lubricant to the opening of the sheath or on the penis.

 

What is to be done if the condom does not unroll??

The condom should unroll smoothly and easily from the rim on the outside. If you have to struggle or if it takes more than a few seconds, it probably means that you are trying to put the condom on upside down. To take off the condom, don't try to roll it back up. Hold it near the rim and slide it off. Then start again with a new condom

 

How should the condom be removed and disposed off?

To remove the condom, twist the outer ring gently and then pull the condom out keeping the sperm inside. Wrap the condom in the package or in tissue and throw it away. Do not put it into the toilet.

 

Can a female condom be re-used?

No, a female condom should not be re-used.

 

Can a female condom and a male condom be used at the same time?

You should not use two condoms at the same time. Using the condoms simultaneously may cause friction resulting in either or both condoms slipping or tearing, and/or the displacing of the outer ring of FC to the inside of the vagina.

 

What are the disadvantages in using a female condom?

The disadvantages encountered in using the female condom are as follows:

  1. The outer ring is visible outside the vagina, which can make some women feel self-conscious.
  2. The female condom can make noises during intercourse. Adding more lubricant can help this problem.

 

Spermicides

What is a spermicide?

Spermicides are chemical products inserted in a woman's vagina before sex that inactivate or kill sperm. They are available in a variety of preparations, including creams, film, foams, jellies, and suppositories which are liquids or solids that melt after they are inserted.

What is the effectiveness of spermicides?

The efficacy of spermicides ranges from 80% to 85%. Efficacy is improved if spermicides are used in conjunction with mechanical barrier methods like condom.

What is the mode of action of spermicides?

Spermicides destroy or immobilize the sperm.

Are spermicides protective against STIs and HIV/AIDS?

Spermicides are not protective against sexually transmitted infections. On the contrary, using the spermicide many times a day, by people at risk for HIV, or for anal sex, may irritate tissue and increase the risk of HIV and other sexually transmitted infections.

How is a spermicide used?

Detailed instructions for correct use are included in the packaging. Be sure to read and understand them before you use any of these products. Usually, a woman lies down or squats, then gently inserts the spermicide deep into her vagina. Contraceptive foams, creams, jellies, film, andsuppositoriesusually require waiting 10 minutes after insertion before intercourse can begin. These methods typically only remain effective for one hour after insertion. More spermicide must be inserted each time vaginal intercourse is repeated.

Progestin Only oral Contraceptives (Mini pill)

What are progestin only pills?

Progestogen Only Pills or Progestin Only Pills (POP) are contraceptive pills that only contain synthetic progestins and do not contain oestrogen. They are also known as mini pills.

How does progestogen only pills work?

This contraceptive does three things:

  1. First, like regular birth control pills, the progestin-only pill makes your body "think" that you are pregnant and stops your ovary from releasing an eg
  2. Second, the mini-pill causes changes in your uterus (where a baby grows) that makes your uterus less likely to let a pregnancy get started even if an egg is released.
  3. And third, the progestin-only pill thickens the mucus between your uterus and your vagina. (The vagina is the passageway from the uterus to the outside of the body.) Sperms have a hard time getting through the thick mucus to reach the egg.

For whom is the Progestin only Pill suitable?

The progestin-only pill is better than regular birth control pills:

  1. If you are breast-feeding because the mini-pill will not change your milk production.
  2. Women who are older than 35 years.
  3. Women who smoke.
  4. Those with history of high blood pressure
  5. Overweight.
  6. A history of blood clots.

Who shouldn't take the Progestin only Pill?

Doctors may refuse to prescribe the Progestin only Pill for you:

  1. If you have already had an abnormal pregnancy in which the foetus was lying outside the uterus (ectopic pregnancy).
  2. If you have severe artery disease, or an abnormally high cholesterolor other blood fats
  3. If you have breast cancer.
  4. If you have unexplained vaginal bleeding.

If I use the progestin-only pill, can I still get pregnant?

Two or three of every 100 women who use the progestin-only pill correctly and consistently could still get pregnant.

Does the progestin-only pill have any disadvantages?

Progestin only pill may have the following side effects lik

  1. Bleeding or spotting between the periods. This can be inconvenient, but it is not a health risk. If the bleeding seems heavy or if it bothers you, you can talk to your doctor about it.
  2. Weight gain.
  3. Breast tenderness

How is the mini pill taken?

Each pill package contains 28 pills. Every pill contains hormones. The mini pill can be started of the fifth day of bleeding. However, if you are sure that you are not pregnant, you can start progestin only pills at any time during your cycle.

What are the side effects which may arise immediately following start of the pill?

When you first start progestin only pills, as your body gets used to them, you could have minor side-effects like 'breakthrough' bleeding (bleeding between the periods) and headaches. They're not dangerous and usually go away in the first two months. If you have symptoms that persist longer, or seem severe consult a doctor.

What if pills are missed or taken late?

  1. If you are three or more hours late or you miss one POPs; take the missed pill as soon as you remember that you missed it; then go back to taking your POPs at your regular time. Be sure to use a backup method such as condom every time you have sex for the next 48 hours. If you miss two or more POP's in a row; restart your POP's right away and take two pills a day for two day. Immediately start using a back-up method.If your period does not begin in 4-6 weeks, consult a doctor. If you have unprotected sex, intercourse without a backup method, after missed or late POPs; ask your clinician about an emergency contraceptive If your period does not begin in 4-6 weeks after missing pills.
  2. If you miss two or more POP's in a row; restart your POP's right away and take two pills a day for two day. Immediately start using a back-up method.If your period does not begin in 4-6 weeks, consult a doctor
  3. If you have unprotected sex, intercourse without a backup method, after missed or late POPs; ask your clinician about an emergency contraceptive If your period does not begin in 4-6 weeks after missing pills.

Emergency contraception

What is emergency contraception (or emergency birth control)?

Emergency contraception, or emergency birth control, is used to prevent a woman from getting pregnant after she has had unprotected sex (sex without using birth control).Some commonly available emergency contraceptive pills are i-pill, unwanted 72 (only one pill need to be taken) etc.

Which are the situations that warrant use of emergency contraception?

A woman who had an unprotected sex and wants to prevent pregnancy can use emergency contraception in the following circumstances:

  1. She did not expect to have sex and was not using any contraception
  2. Sex was forced upon her without her consent.
  3. A condom broke or slipped
  4. She ran out of contraceptives or missed two to three birth control pills in a row

How does emergency contraception work?

Emergency contraception can prevent you from becoming pregnant by:

  1. Keeping the egg from leaving the ovary.
  2. Keeping the sperm from meeting the egg.
  3. Keeping the fertilized egg from attaching to the uterus (womb).

What is there in the emergency contraceptive pills?

Emergency contraceptive pill or the morning after pillgenerally contains the higher doses of hoemone levonorgestrel (1.5 gm).

How long after sexual intercourse can emergency contraceptive pills be taken?

Emergency contraceptive measures can be taken within the first 72 hours after unprotected sexual intercourse. However it is advisable to take it as soon as possible after unprotected sex. The guidelines on the package should be carefully read before taking the drug.

What are the types of emergency contraception?

There are two types:

  1. Emergency contraceptive pills (ECPs).
  2. Intrauterine devices (IUDs)..

Are there any side effects when taking Emergency contraceptive pills?

The most common side effects experienced when taking EC pills are the following:

  1. Nausea and vomiting
  2. Irregular vaginal bleeding
  3. Fatigue.
  4. Fatigue.
  5. Headache
  6. Dizziness
  7. Breast tenderness

How is to one deal with nausea when taking the pill??

To reduce nausea:

  1. Try to eat something before taking the pills.
  2. Take an over-the-counter anti-nausea drug before the second set of pills.
  3. Take the pills with milk not water.

Is emergency contraception always effective?

Yes, emergency contraception is quite effective. If 100 women use emergency contraception then only one is likely to become pregnant.

What are the danger signs one should be alert with when taking emergency contraceptive pills?

Women who experience any of the following symptoms while taking EC should call the clinic immediately:

  1. Abdominal pains (severe).
  2. Unusually light bleeding in the subsequent period.
  3. If next period does not occur.

How does an IUD function as an emergency contraceptive?

The IUD is a T-shaped, plastic device placed into the uterus (womb) by a doctor within five days after having sex. The IUD works by:

  1. Keeping the sperm from meeting the egg.
  2. Keeping the egg from attaching to the uterus (womb). Your doctor can remove the IUD after your next period. Or, it can be left in place for up to 10 years to use as your regular birth control method..

Can emergency contraceptive be used as regular contraceptive?

Emergency contraceptive pill as the name signifies should be used in emergency situation only. If the couple does not want pregnancy and indulge in sexual intercourse regularly, they should use conventional contraceptive. The emergency contraceptive pills contain high dosage of hormones which disrupt the normal menstrual period. It may cause other medical problem in the woman if used regularly. Regular use of birth control of pills is always more effective than emergency contraceptio

Where are available contraceptives available?

The emergency contraceptive pills are available at the government dispensaries and hospitals. These are also available commercially in the market by various trade names.

Progestin only injectables contraceptives

What are Progestin only injectables?

Progestin only injectables contain a progesterone preparation. They are available in two varieties: DMPA-depot (Depo-Provera) which is injected every 3 months and NET-EN (Norethidrone enanthate) which is injected every 2 months.

How do Progestin only injectables work??

Progestin only injectables work by:

  1. Inhibiting ovulation
  2. Cause thickening of the cervical mucus to prevent upward passage to the sperm.

What are the advantages of using Depo-Provera?

The advantages are as follows:

  1. It is very effective..
  2. Provides long term pregnancy protection and is reversible.
  3. Convenient to use: avoids the hassles of daily intake of pills.
  4. Free from the side effects of estrogen such as danger of formation of blood clot in blood vessels.
  5. Helps prevent ectopicpregnancies (pregnancy outside the uterus) and ovarian cancer.

Are there any side effects of Depo - Provera?

Most women have some changes in their menstrual periods while using Depo-Provera, including:

  1. Irregular and unpredictable bleeding or spotting.
  2. An increase or decrease in menstrual bleeding, or no bleeding at all. Other possible side effects include weight gain, headaches, nervousness, abdominal discomfort, dizziness and weakness or fatigue.The absence of periods is not harmful, and periods usually return to normal after Depo-Provera is stopped. If unusually heavy or continuous bleeding occurs, you should see your doctor.

How effective is Depo-Provera ?

Depo-Provera is as effective as tubal ligation (having your tubes tied) and more effective at preventing pregnancy than several other methods, including birth control pills, condoms and diaphragms. It does not, however, protect against AIDS or any other sexually transmitted diseases.

Is the effect of Depo-Provera permanent?

No. Depo-Provera only works for about 3 months. The shot must be repeated every 3 months to prevent pregnancy. After a woman stops using Depo-Provera, her normal ovarian function returns after a short time. However, it takes an average of 9 to 10 months to get pregnant after getting the last injection.

How is Depo Provera administered?

Depo-Provera is given as 1 injection in the buttock or upper arm every three months.

How is to one deal with nausea when taking the pill??

To reduce nausea:

  1. Try to eat something before taking the pills.
  2. Take an over-the-counter anti-nausea drug before the second set of pills.
  3. Take the pills with milk not water.

When should Depo-Provera be started?

Situation When to start
Having regular menstrual cycles Any time, preferable during the first 7 days after menstruation.
After child birth (normal vaginal or caesarean) , if breastfeeding As early as six weeks after child birth
After child birth (normal vaginal or caesarean), if not breastfeeding Immediately or at any time in the first 6 weeks after child birth
After miscarriage or abortion Within first 7 days after first or second trimester miscarriage or abortion.

What are the danger signs one should be alert with when taking emergency contraceptive pills?

Women who experience any of the following symptoms while taking EC should call the clinic immediately:

  1. Abdominal pains (severe).
  2. Unusually light bleeding in the subsequent period.
  3. If next period does not occur.

Who are eligible to use Depo Provera?

Depo Provera can be used safely by women who:

  1. Are breastfeeding
  2. Smoke cigarettes.
  3. Have no children.
  4. Any age group- from adolescents to those over 40 years of age.
  5. Have benign breast disease.
  6. Havemild to moderate blood pressure

Who should not use Depo-Provera?

Women who have any of the following should not use Depo-Provera:a history of jaundice, blood clots, vaginal bleeding without a known reason, cancer of the breast or reproductive organs, known or suspected pregnancy, or allergy to the medication in Depo-Provera.

What is the ideal time or what should be the gap period to get injected with DMPA after caesarean delivery, will this affect the feeding of the child or not?

If the woman is breastfeeding the DMPA can be started as early as six weeks after child birth. If she is not breastfeeding DMPA can be started immediately or at any time in the first 6 weeks after child bi

How Noristerat injection does prevent pregnancy?

It stops release of eggs from the ovaries and also causes thickening of cervical secretions/fluids at the entrance of womb making it difficult for the sperm to pass through.

Who can use this method?

It can be used by women of any age or parity who want to space births. It provides effective and safe contraception after delivery and abortion. It is suitable for nursing mothers since it does not have effect on quality and quantity of milk. It is also suitable for women who may have side effects related to use of oestrogen containing contraceptive eg. Combined oral pills. Women with certain medical diseases, who cannot use other contraceptives e.g. combination oral pills, can use injectable contraceptive.

When is the first injection given?

The first injection can be given anytime provided you are not pregnant, preferably during first 7 days of your normal menses. It can also be given:

  1. Immediately after an abortion.
  2. 6 weeks after delivery if you are breast feeding.

What are the benefits of using this injection?

It is very effective (99.6%) and reversible. It is a convenient method and will ensure/maintain privacy. Once you take this injection, you will be carefree about contraception for 2 months. You will not need to take every day like for the pills. In some women it may reduce painful periods.

Intra uterine devices

What is an intrauterine device?

An intrauterine device, called an IUD for short, is a small, plastic, T-shaped device with a string attached to the end. The IUD is placed inside the uterus to prevent pregnancy. This placement can be done during an OPD visit. Once in place, the IUD stays in your uterus until someone doctor removes it.

How does it work?

The IUD prevents sperm from joining with an egg. It does this by making the sperm unable to go into the egg and by changing the lining of the uterus

What are the types of IUDs?

The different types of IUDs are:

  1. Copper bearing IUDs- These contain a copper wire inserted inside a plastic tube.
  2. Hormone releasing IUDs (newer form of IUDs): These are made of plastic and contain small amounts of hormone progesterone.

What are the advantages of an IUD?

The IUD has many advantages:

  1. It's very effective in preventing pregnancy.
  2. Convenient –no hassle of taking the pill is involved.
  3. It's inexpensive.
  4. An IUD can be removed by your doctor at any timeConvenient –no hassle of taking the pill is involved.
  5. It starts working right away.
  6. There's a low risk of side effects.
  7. Mothers who use an IUD can breast-feed safely.

What are the disadvantages?

Though IUDs are very much safe in preventing pregnancy, it has some few minor side effects. The disadvantages are as follows:

  1. You may have cramps and backache for the first few hours after an IUD is put in your uterus.
  2. Some women have bleeding for a couple of weeks after the IUD is inserted, and heavy periods after that.
  3. Rarely, the uterus can be injured when the IUD is put inside.
  4. The IUD doesn't protect you from AIDS or any other sexually transmitted diseases. In fact, these infections can be more serious in women who have an IUD. In addition, the more people you have sex with, the greater your chance of getting an infection if you have an IUD.

What are the disadvantages of a hormonal IUD over Copper IUD?

Hormonal IUDs are:

  1. Costlier as compared to Copper IUD.
  2. Can cause irregular bleeding or spotting in the first six months of use.

How effective is an IUD in preventing pregnancy?

The IUD is one of the most effective methods of contraception. The IUD has been found to be as much as 99% effective when inserted properly.

How long is an IUD effective?

It depends on the kind your doctor prescribed to you. The copper IUD can remain in your body as long as 10 years. The hormonal IUD needs to be replaced every 5 years. Your doctor can remove either of these at any time if you decide to get pregnant or if you no longer want to use it.

Who are eligible to use an IUD for contraception?

Who are eligible to use an IUD for contraception? IUD can be used by women who:

  1. Are breastfeeding
  2. Smoke.
  3. Have any of the medical conditions like high blood pressure, heart disease, liver or gall bladder disease, diabetes, epilepsy
  4. Woman who has delivered at least one child.

What is the ideal time for insertion of an IUD?

The ideal time for insertion of an IUD is as follows

  1. Having menstrual cycles: Any time during menstrual cycle within first 12 days after the start of menstrual bleeding.
  2. After child birth / abortion: Any time within 24 hours after childbirth or abortion.
  3. Have no children.

How is the IUD inserted?

This is usually done towards the end of a period or shortly after. However, it can be fitted at any time provided that you are certain you are not pregnant. You will need to have a vaginal examination. The doctor or nurse will pass a small instrument into your uterus to check its size and position. An IUD is then fitted. You will be taught how to feel the threads of the IUD so you can check it is in place. It is best to check the threads regularly, for example, once a month just after a period.

For how long does a patient need to stay at the hospital for inserting Cu-T?

Normally one does not have to stay in the hospital after IUCD insertion unless there has been some difficulty in its insertion.

Can Cu- T be inserted in an unmarried girl?

No, it is not desirable that unmarried girl gets Cu-T. There are other methods like oral pills for these girls.

When can IUCD be fitted in a woman and what is the cost of it?

No expense is involved if done from government hospital. Cu-T is best suited in a patient who has had at least one child, has no problem in her periods, and does not have any genital tract infection. Once inserted it can be removed easily when one wants a child or after 10 yrs.

After Cu-T insertion when can intercourse be done?

She can have sexual relation after 24-48 hrs, unless it is inserted with abortion in which case one should wait for next menstrual cycle.

When is a woman advised to check that her IUD is in place?

A woman is advised to check her IUD:

  1. Once a week during the first month after insertio.
  2. After noticing any unusual symptoms
  3. After a menstrual period.

What precautions are to be taken by a woman to check that her IUD is in place?

To check her IUD, a woman should:

  1. Wash her hands.
  2. Sit in a squatting position
  3. Insert 1 to 2 fingers in her vagina as far as she can until she feels the strings
  4. Wash her hands again.

When is a woman who has had her IUD inserted advised to consult a doctor?

A woman is advised to consult a doctor if:

  1. Her sex partner feels the IUD strings during sex and this bothers him. (ii) Heavy or prolonged bleeding that bothers the client.
  2. Increasing or severe pain in the lower abdomen, especially if associated with fever.
  3. Missed a menstrual period.
  4. Vaginal discharge with an unpleasant odour.
  5. Wants to opt for some other family planning method or would like to have the IUD removed.

Does Cu- T cause obesity?

No it has no effect on body fat composition.

Is Cu-t better than oral pills?

Both are good methods but oral pills have to be taken everyday, whereas CuT once inserted does not require removal till you desire it or for 10yrs.

Who should not use inta-uterine devices?

These ladies should not use intra-uterine device as a means of contraception:

  1. Nulliparous (woman who has never delivered a baby).
  2. Uterine anomaly.
  3. History of PID
  4. Postpartum infection of the uterus
  5. Septic abortion in the past 3 months
  6. Untreated infection of the uterus or vagina.

What are the reasons for sliding-up of the Cu-T in the body?

This is a very rare occurrence. However, it may occur at time of insertion. This occurs if done by an inexperienced person

What are the reasons for sliding-up of the Cu-T in the body?

This is a very rare occurrence. However, it may occur at time of insertion. This occurs if done by an inexperienced person

Centchroman

What is Centchroman?

Centchroman is a once-a-week oral contraceptive unrelated to hormonal oral contraceptives.

What are the advantages of using Centchroman?

Centchroman is safe and free from typical hormonal side effects such as nausea, weight gain, fluid retention, high blood pressure etc.

When must Centchromannot to be used?

Administration of Centchroman is not recommended in the following conditions:

  1. Recent history of clinical evidence of jaundice or liver diseases.
  2. Ovarian disease.
  3. Tuberculosis.
  4. Kidney disease.
  5. Allergic conditions..
  6. Cervical hyperplasia
  7. APCOS
  8. Chronic cervicitis.
  9. Chronic cervicitis.

How should centchroman pills be taken?

Regimen should be started with 1 tablet of 30 mg twice a week for 3 months followed by one tablet once a week as long as contraception is desired. The first tablet has to be taken on the first day of the menstrual cycle. Tablet should be taken on fixed days and at fixed times. Dosage should be followed irrespective of subsequent menstrual periods

What are the side effects of centchroman pills?

Some of its side effects are:

  1. Prolongation of menstrual cycles.
  2. Delayed menstruation. In case of delay exceeding 15 days, a doctor should be consulted to rule out pregnancy.

What is the efficacy of Centchroman?

Failure rate of Centchroman is 1.63%

Female sterlization - tubal ligation

What is tubal ligation?

Tubal ligation is a surgical sterilization technique for women. This procedure closes the fallopian tubes, and stops the egg from travelling to the uterus from the ovary. It also prevents sperm from reaching the fallopian tube to fertilize an egg.

How reliable is female sterilization?

Female sterilization provides permanent contraception for women who do not want more children.It is more than 99% effective. About 1 in 200 women will become pregnant after sterilization. This is because the tubes can, rarely, come back together again after being cut or blocked.

How is it done?

There are 2 methods of tubal ligation done under local or spinal anesthesia:

  1. Aminilaparotomy involves making a small incision in the abdomen, locating the tubes, and cutting and closing them of
  2. A laparoscopic tubal ligation involves inflating the abdomen with carbon dioxide or nitrous oxide gas, making a small incision in the abdominal wall, and inserting a fiberoptic light and an instrument that coagulates the tubes with an electric current or puts a clip or plastic band around the end of each tube.

What are the advantages of female sterilizations?

It is permanent and you don't have to think of contraception again.

What are the disadvantages of female sterilization?

As it is permanent some people may regret having the operation in future years, particularly if their circumstances change. It is also not as easy to reverse as compared to male sterilization.

Is ligation planning operation in ladies done on both sides?

There are two fallopian tubes in a woman‘s body. Both the tubes need to be ligated.

How soon is it effective?

You must continue to use other forms of contraception until your next period occurs after the operation

Will sterilization change a woman’s monthly periods or make her menstrual bleeding stop?

No, sterilization has no such impact on a woman‘s monthly period.

Will it reduce my sex drive?

No. Sex may be more enjoyable as the worry or inconvenience of other forms of contraception is removed.

Can cesarean section and tubectomy done at the same time ?

Yes, Family planning operation can be done along with caesarean delivery operation. However if you decide to do family planning after caesarean is already done you can wait for 6weeks and get laparoscopic ligation done.

Why menstruation does not stop after family planning operation?

In the family planning operation, the tubes which carry ova are tied so that ova cannot meet the sperms ejaculated by a man. The menstruation occurs as a result of hormones produ

What are the reasons of women becoming pregnant even after family planning operation?

Rarely, the two ends of the tube which are cut can reunite or a new opening can form and which allows egg to meet the sperms resulting in failure of operation.

What are the complications of the family planning operation in females?

The family planning operation is safe operation if case is correctly chosen. The complications of laparoscopy or laparotomy like injury to surrounding abdominal viscera or vessels if performed by an inexperienced person. In the long term 1 in 200 women can have failure of ligation

Does family planning operation affect the health of the person?

No. It is safe operation and has no ill effect on health

How many days after tubectomy, can a female resume household chores?

If it is laparoscopic operation, in a week time.If by minilapatomy, in 2-3 weeks time

When should one plan for the family planning operation, before or after menstruation?

Preferably after menstruation. But if one is very sure of not being pregnant, she can plan the procedure anytime.

When can a couple resume intercourse after tubectomy operation?

The couple may resume intercourse after 3-4 weeks. After delivery or abortion they can resume the intercourse after six weeks.

Why some women complain of pain in abdomen after sterilization operation?

It is unlikely to be due to sterilization operation. It is likely to be co-incidental, but still the doctor should be consulted

How much money will I get if I get tubectomy done at a government facility?

The compensation package for the person undergoing permanent sterilization varies from Rs.250-1100 for different cases

What are the high foucus states?

Bihar, Uttar Pradesh, Madhya Pradesh, Rajasthan, Jharkhand, Chattisgarh, Uttarakhand, Orissa, Jammu and Kashmir, Himachal Pradesh, Assam, Arunachal Pradesh, Manipur, Mizoram, Meghalaya, Nagaland, Tripura, Sikkim.

What are the NON-high foucus states?

Karnataka, Kerala, Tamil Nadu, Andhra Pradesh, Maharashtra, Goa, Gujarat, Punjab, Haryana, West Bengal, Delhi, Chandigarh, Pondicherry, Andaman and Nicobar Islands, Lakshadweep and Minicoy Islands, Dadra and Nagar Haveli, Daman and Diu

Male sterlization- Vasectomy

What is a vasectomy?

Vasectomy is a simple surgery that provides permanent birth control for men. A vasectomy prevents by pregnancy cutting and sealing the tubes that carry sperm into semen. The surgery is straightforward and has a low risk of problems. For most men, a vasectomy doesn't cause any noticeable side effects. Before getting a vasectomy, one needs to be sure that he does not want to father a child in the future. Surgery to reverse a vasectomy is complicated and doesn't always restore fertility

How is a vasectomy done?

A vasectomy is usually done as an outpatient procedure. The operation takes about half an hour. You'll be awake during the procedure. Your doctor will give you a local anesthetic to numb your scrotum. After this, your doctor will cut a small opening on one side of your scrotum and pull out part of the vas deferens on that side. You may feel some tugging and pulling. A small section of the vas deferens is removed. The ends of the vas deferens will be sealed by stitching them shut, by searing them shut with heat, or by using another method. Your doctor will then do the same thing on the other side. Your doctor will close the 2 openings in your scrotum with stitches.

What is no-scalpel vasectomy?

The no-scalpel vasectomy involves making a very small puncture (a hole) in the scrotum instead of an incision. The puncture is so small that it heals without stitches.

How effective is vasectomy in preventing pregnancy?

Vasectomy may be the safest, most effective kind of birth control. Only about 15 out of 10,000 couples get pregnant in the first year after a vasectomy.

Are there any reasons why one shouldn't have a vasectomy?

You should not go for vasectomy unless you're sure you don't want to have children in the future. Also you may have delay in getting a vasectomy done if you have an infection on or around your genitals, or you have a bleeding disorder.

Can vasectomy be reversed?

Some vasectomies can be undone, or "reversed," but the surgery is expensive and hard to access. Even though most men can ejaculate sperm after the reversal surgery, the sperm are often not able to fertilize an egg.

How successful is the vasectomy reversal surgery?

Success rates of reversal of vasectomy vary with, the technique used, the years between the vasectomy and the reversal attempt and the experience and skill of the surgeon. Some of the best success rates are patency rate of 99% with a pregnancy rate of 64%.n

How should I prepare for the operation?

On the day of the operation, bring snug underwear with you and make sure your genital area is clean. Your doctor will probably give you instructions on how to clean the area before you come in. Your doctor may suggest you bring someone to drive you home after surgery.

WWhat can I expect after the operation?/span>

Right after the operation, your doctor will have you lie down for a couple of hours with an ice pack placed on your scrotum. You may have some bruising in the area of the surgery. The bruises should slowly lighten and be gone in about 2 weeks. You should feel back to normal within a couple of weeks.

When can I go back to work?

Rest is to be taken for 2 days. Heavy work or vigorous exercise should be avoided for a few days

What are the precautions to be taken after Vasectomy?

Following a vasectomy, a person will have some bruising, swelling and pain. It usually gets better within a few days. One should follow the advice given by the surgeon including the following:

  1. Supporting the scrotum with a bandage and tight fitting underwear for at least 48 hours after vasectomy.
  2. Periodically using an ice pack to help with swelling and pain for one to three days after surgery.
  3. Resting for 24 hours after surgery. One may be able to do light activity after two or three days, but one needs to avoid sports, lifting and heavy work for a week or so.
  4. Not taking any aspirin or ibuprofen for three to seven days after surgery. These medications increase risk of bleeding.
  5. Avoiding sexual activity for a week. One may notice blood in your semen for three or four days after surgery.
  6. Contacting doctor immediately if there are signs of infection, such as pus or blood oozing from the surgery site, fever, or worsening pain or swelling

Will the vasectomy work right away?

No. You'll need to ejaculate as many as 15 to 20 times before the sperm will be cleared from both the vas deferens. For that reason, it is important to use condoms or any other family planning method for 3 months after the procedure.

What are the side effects of a vasectomy?

Problems that might occur after your vasectomy include

  1. Bleeding.
  2. Pain.
  3. infection.

When can one have sex after a vasectomy?

Avoid sexual activity for at least a week. If you do ejaculate, you may notice blood in your semen for three or four days after surgery.

Apart from the usual follow up, which are the conditions for which a man who has undergone vasectomy must consult a doctor?

Call your doctor if:

  1. You have a fever.
  2. You have swelling that won't go down or keeps getting worse.
  3. You have trouble urinating.
  4. You can feel a lump forming in your scrotum
  5. You have bleeding from an incision that doesn't stop even after you've pinched the site between 2 gauze pads for 10 minutes

Will a vasectomy affect one’s sex life?

After you have healed from the vasectomy, your sex life shouldn't change at all. You'll still ejaculate almost the same amount of semen as you did before, and you won't notice a change in your sex drive.

When can one have unprotected sex after vasectomy?

A vasectomy doesn't provide immediate protection against pregnancy. One needs to ejaculate as many as 15 to 20 times before the sperm will be cleared from both the vas deferens. For this reason, it is important to use condoms or any other family planning method for at least 3 months after the procedure till the semen analysis shows complete absence of sperms. Semen analysis is advised in all men 3-4 months after vasectomy to ensure absence of sperm.

What happens to the sperm after vasectomy?

Once sperm can't get through the vas deferens, your testicles will begin making fewer sperm. Your body will absorb the sperm that are made

Is it better for a man to have a vasectomy or for a woman to be sterilized?

Each couple must decide for themselves which method is best for them. Both are very effective, safe and permanent. However, vasectomy is simpler and safer to perform that female sterilization. Also it is less expensive and slightly more effective

Does vasectomy increase the risk of prostate cancer?

No, vasectomy does not increase the risk of prostate cancer.

Can an HIV infected person undergo vasectomy?

Yes, an HIV infected person can undergo vasectomy.

Natural family planning methods

What are natural family planning methods?

The natural family planning methods are based on abstaining from sex during the fertile time of woman‘s menstrual cycle. They do not use any modern method of contraception. These are less effective than the modern methods.

When is fertile period in women?

A woman is fertile when she is ovulating and for a few days before and after ovulation. Ovulation usually occurs mid cycle. More precisely, ovulation usually occurs 14 days before the onset of bleeding. However, it is very difficult to determine the fertile period if cycles are irregular.

What are some of the common natural family planning methods?

The common natural family planning methods include: Rhythm Method, cervical mucus method, Basal Body temperature (BBT) Method, Standard Days Method (SDM).

What is Rhythm Method?

The rhythm method is based on the idea that women ovulate 14 days before menstruation begins. Based on this assumption, the rhythm method requires a woman to count back 14 days from the first day of her period. This will presumably be the day on which she ovulated and will ovulate the following month. In order to avoid pregnancy, she will need to abstain from sex or use another form of birth control, like condoms around this time.

What are the drawbacks of the rhythm method?

The rhythm method has a high failure rate of 13 to 20%. It is not recommended for women who have irregular cycles.

What is cervical mucus method?

The cervical mucus method is based on the fact that at the time of ovulation, cervical mucus becomes thinner and stickier. It will be clear, slippery and very stretchy, similar to a raw egg white. Sex should be avoided from the time one notices the slippery, stretchy mucus until at least two days after it is gone.

How can the cervical mucus be tested?

Use your finger or toilet paper to wipe across the opening of vagina and then take a look at the mucus. Examine the consistency and try to stretch the mucus between your fingers. If you can stretch it at least three inches without breaking, then ovulation is about to occur

What are the drawbacks of the cervical mucus method?

This method has a high failure rate of about 20 %

What is Basal Body temperature (BBT) Method?

The BBT Method is based on the fact that the body temperature rises about 0.5 degree to 1 degree above the body temperature around the time of ovulation. Seeing a sustained increase in your temperature, one that lasts for at least three days, indicates that ovulation has taken place. When know ovulation has taken place, it can be assumed that having sex during the rest of your menstrual cycle is likely to result in pregnanc

How is the Basal Body temperature (BBT) Method performed?

A woman should take her temperature every day, first thing in the morning before she gets out of bed. She should record it and watch fluctuations in your temperature from day to day. Avoid sex during the days when the body temperature increases and for 7 days thereafter.

What is the effectiveness of the BBT Method?

On average, the basal body temperature method has a failure rate of 15% but as low as 2% per year for perfect users

What is the Standard Days Method (SDM)?

The Standard Days Method is a new natural family planning method for women with menstrual cycles ranging between 26 and 32 days. This method involves identifying the fertile days during each menstrual cycle. Women with menstrual cycles between 26 to 32 days can prevent pregnancy by avoiding unprotected sexual intercourse on days 8 to 19.

How is the Standard Days Method practiced?

The Standard Days Method is fairly straightforward to use. There are two methods which can be practiced:

  1. Conventional Method: Keep track of how long your menstrual cycle is, in order to determine when Days 8 through 19 occurs. (i) When the first day of your period arrives, this is Day1 of your cycle. Mark this on your calendar. (ii) Between Day 1 and Day 7, it is highly unlikely that you will become pregnant, so it is safe to participate in sexual intercourse without using birth control. (iii) Between Day 8 and Day 19, you are at your most fertile. You and your partner should abstain from sex or you should use an alternate type of birth control, such as a condom. (iv) Between Day 20 and 32 you are unlikely to get pregnant, so you can resume sexual intercourse.
  2. Cycle Beads: Cycle Beads are a string of 32 color-coded beads, shaped into a necklace. There is a rubber ring that can be placed around individual beads on the necklace to help identify what day you are on in your cycle. There are three colors of beads on the Cycle Bead necklace: (a) Red: There is one red bead on the Cycle Bead necklace. This red bead stands for the first day in your menstrual cycle. It is on this day that you get your menstrual period. (b) Brown: The brown beads signify the days during your cycle when it is highly unlikely that you will get pregnant. (c) White: The white, glow-in-the-dark beads represent the fertile days of your menstrual cycle (Days 8 to 19). As you move through each day of your cycle, you slip the rubber ring on a different bead. When the rubber ring is moved onto the white beads, you will know to abstain from sex or to use a form of contraception.

Who Can Use the Standard Days Method?

The Standard Days Method can be used by the majority of women; however, before you try the method it is important that you meet the following criteria

  1. Your menstrual cycles are regular.
  2. Your cycle is between 26 and 32 days long (SDM is less effective if your cycles are shorter than 26 days or longer than 32 days).
  3. You and your partner are willing to abstain from intercourse or use some contraceptive like condom for protection during your fertile days

How effective is the Standard Days Method?

When used regularly and consistently, SDM has been shown to be a highly effective birth control method. When used perfectly, only five out of every 100 women will get pregnant. This means that the method is 95% effective against pregnancy. If you do not follow the method consistently, or if your cycle falls outside of the 26 to 32 day range, SDM will be less effective, that is about 88 %.

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