Chapter 8.docx

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Department
Family Relations and Human Development
Course
FRHD 1020
Professor
Robin Milhausen
Semester
Summer

Description
Chapter 8: Birth Control Choices and Pregnancy Summary Conception  1 sperm+ 1 egg = equals fertilized egg  Spermatogenesis (creation of sperm) starts in the male at puberty and is regulated by hormones  Sperm cells form in the seminiferous tubules of the testes and are passed into the epididymis where they are stored until ejaculation  A single ejaculation can contain 500 million sperm  Each sperm released into the vagina propels itself toward the ovum, in order to do this it must move through the acidic secretions of the vagina, enter the uterus travel up the fallopian tube containing the ovum, than fuse with the nucleus of the egg- this is fertilization  Each woman is born with her lifetime supply of ova, eventually 300-500 eggs mature and leave the woman’s ovaries during ovulation  Every month one of the ovaries releases an ovum to the fallopian tube, where it travels through until it reaches the uterus  An unfertilized egg can last between 24-36 hours, after this time the egg will disintegrate, and is expelled during menstruation with the uterine lining  A sperm on the other hand can last between 2-5 days in the female reproductive tract, however sperm meeting egg does not guarantee fertilization  In order for fertilization to occur the sperm must penetrate the layer of cells and jellylike substance that surround the egg; how this occurs is that as sperm touch the egg they releases an enzyme that removes part of the barrier, than a sperm bumps into a bare spot penetrating the membrane and merging with the egg  The now fertilized egg will travel through the fallopian tube, dividing to form a tiny clump of cells called a zygote  About a week after fertilization the zygote burrows into the endometrium- this process is called implantation  Contraceptive methods are used to prevent conception, by either preventing ovulation/implantation or by blocking the sperm from reaching the egg Birth Control Basics  90% of a women’s life is spent trying to prevent pregnancy, 10% is spent trying to conceive/being pregnant  No birth control is 100% effective, convenient or safe  Birth control is costly, although sometimes it may be covered  Even when it is affordable some university, college students do not use it consistently  Using birth control can help to reduce stress because of the risks that come with not using it  If you are a women it is important to understand that there are potential long term risks associated with birth control Choosing a Birth Control Method  To choose a method of contraception that is right for you, you must first educate yourself  First you should consult with a doctor, to determine whether you may be at a higher chance of risk due to your family medical history  You should also consider the failure rate of the specific method that you would like to use; failure rate-refers to the number of pregnancies that occur per year/100 women  Some couples use coitus interruptus (withdrawal) which is the removal of the penis from the vagina before ejaculation, men find this unsatisfactory though because they either do not know when they are about to ejaculate or because they cannot withdrawal quick enough  Using back-up methods of pregnancy can greater decrease the risk of pregnancy- this is using more than one method of birth control simultaneously Abstinence and Outercourse  People may choose abstinence because they are waiting until they are ready, until they find the right partner, to respect their religious view/moral values, to enjoy friendship without sexual involvement, to recover from a breakup or to prevent STI’s/pregnancy  Abstinence is the only form of birth control that is 100% effective and risk free  Health benefits from being abstinent include; being less likely to get STI’s, suffer infertility or to develop cervical cancer  Outercourse is commonly seen among those who choose abstinence from vaginal intercourse it may consist of; kissing, hugging, sensual touching, and mutual masturbation  Outercourse is almost 100% effective except that pregnancy is possible if there is genital contact Prescription Contraceptives  Most effective and commonly used methods in Canada include oral contraceptives, intrauterine device (IUD), diaphragm, and cervical cap  Recently the contraceptive ring and patch have been created  All of these contraceptives are available only from health care professionals, and all are reversible Birth Control Pill-“The Pill”  The birth control pill is an oral contraceptive that is the most preferred method of birth control by unmarried women  This pill has been used for 40 years and is one of the most researched, tested and carefully followed medications- it is also the most controversial  Introduction of the pill encouraged women to have a career, and enabled men and women to delay marriage  Risks associated; many women believe that the risks are greater than those of pregnancy and childbirth, however recent research has shown that there is not an increased frisk of breast cancer, diabetes, MS or liver disease as previously thought and that in fact the risk of ovarian and endometrial cancer is reduced in some women who take the pill  One risk however is that those who smoke and women who used earlier types of oral conception may be subject to blood clots and pulmonary embolism  There are three types of pills; constant-dose combination pill, multiphasic pill, progestin-only pill  Constant-Dose Combination (AKA monophasic)- releases two hormones, synthetic estrogen and progestin, which play an important role in controlling ovulation and menstrual cycle, it is at constant levels throughout the menstrual cycle  Multiphasic Pill- mimics normal hormonal fluctuations of the natural menstrual cycle by providing different levels of estrogen and progestin at different times of the month  The multiphasic pills reduce the hormonal dose and side effects but may heighten a woman’s sex drive  Both constant-dose and multiphasic block the release of hormones that would stimulate the process of ovulation as well as thickening and altering the cervical mucus so that it is more hostile to sperm  Progestin-Only (AKA Minipill)- contains a small amount of progestin and no estrogen, they work by making the mucus in the cervix so thick and tacky that the sperm cannot enter the uterus, as well these pills interfere with implantation by altering the uterine lining  While on these pills women ovulate, at the least occasionally  Advantages to the pill include; effectiveness, reversibility, do not interrupt sexual activity, have more regular periods, less cramping, fewer tubal or ectopic pregnancies, after 5 years the pill halves the chance of endometrial or ovarian cancer, reduces the risk of benign breast lumps, ovarian cysts, iron-deficiency anemia, pelvic inflammatory disease  Disadvantages to the pill include; does not protect against HIV or other sti’s, some pills must be consistently taken at the same time each day, may cause side effects(weight gain or loss, spotting, nausea and vomiting, breast tenderness, decreased sex drive), emotional changes (mood swings, depression), can interact with other medication, risk of CVD (especially among women over 35 with high blood pressure, who smoke) Contraceptive Ring-NuvaRing  First contraceptive vaginal ring, available in the United States in 2002, now available in Canada  Releases a low dose of estrogen and progestin into surrounding tissue, contains lower amount of hormones than pills  Two-inch ring compresses so a woman can easily insert it where it stays in place for 3 weeks, is removed for the 4th week of menstrual cycle, works by preventing ovulation  Advantages; no need for daily pill, ability to become pregnant returns quickly once she stops using the ring  Disadvantages; increases complaints of vaginal discharge, irritation, infection, cannot use oil-based vaginal medicine to treat yeast infections while the ring is in place or a diaphragm or cervical cap for backup birth control, women who cannot take the pill for medical reasons can not use the ring either Contraceptive Patch  4 square centimeter beige patch that has been available in Canada sine 2004, which continuously releases estrogen and progestin into the blood stream and can be applied to the skin of the upper arm, abdomen, back or buttocks  The patch is replaced every seven days for three weeks, with the fourth week patch free  Advantages; more than 99% effective at preventing pregnancy when used perfectly, 3% failure rate for typical users, woman does not have to remember to take pill every day, less likely to cause breakthrough bleeding or spotting, woman can become pregnant as soon as she stops use  Disadvantages; increased risk of blood clots, heart attack and stroke (smoking increases these risks), less effective in women who weight more than 89.8kg/198lbs, contact lens users may experience a change in vision or be unable to wear lenses Contraceptive Injectables  Depo-provera- hormonal birth control method that contains a progestin, provides three months of contraceptive protection  Raises levels of progesterone which stimulates pregnancy so that the pituitary gland doesn’t produce FSH and LH which normally causes egg ripening and release, the endometrial lining of the uterus also thins which prevents implantation of a fertilized egg  Advantages; women do not need to take a daily pill, can be used by women who cannot take oral contraceptives containing estrogen, may have some protective action against endometrial and ovarian cancer  Disadvantages; no protection against HIV or STIs, causes menstrual irregularities in most users, small % or users causes delayed return of fertility, excessive endometrial bleeding, decreased libido, depression, headaches, dizziness, weight gain, frequent urination and allergic reactions, loss of bone-density, associated with bone fracture and osteoporosis Intrauterine Devices  Small T-shaped device with a nylon string attached that is inserted into the uterus through the cervix, protecting against pregnancy by interfering with implantation  IUDs were once popular until many brands were removed due to serious complications of pelvic inflammation and infertility, currently however none of the available IUDs have not shown an increased problem in women in mutually monogamous relationships  In Canada, there are two types; Nova-T and Mirena. Nova-T is a polyethylene T-shaped frame with a coil of copper wire on the outside (copper acts as an effective spermicide), it is recommended that women change this every 30 months, though it is effective for five years (1/100 users per year it fails), Mirena is also a polyethylene T-shaped device, but it is surrounded by progestin levonorgestrel, which is released directly to the lining of the uterus, mirena contains no estrogen and is 99% effective for up to 5 years  Advantages; safe, highly effective, estrogen-free, rapidly reversible, convenient, practical, long duration of use, does not alter period timing, lower rate of ectopic pregnancy, decreases menstrual bleeding and cramping  Disadvantages; gynecologists often wont recommend this method to childless women who may someday want to have a family as those women may have a more difficult time trying to conceive, women with many sexual partners, who are at the highest risk for PID, are not good candidates, some women are allergic to copper, women using Nova-t may find their periods to be severely heavy, while those using Mirena find that their periods may disappear, 5- 10% users expel an IUD within the first year, if a woman using an IUD becomes pregnant she may have a miscarriage  How to use; physician inserts IUD into a woman’s uterus through the cervix and trims the IUD strings so that they can be felt at the entrance to the cervix Diaphragm  A bowl-like rubber cup with a flexible rim that is inserted into the vagina to cover the cervix and prevent the passage of sperm into the uterus during sex; when used with spermicide the diaphragm becomes both a chemical and physical barrier to sperm  Advantages; become increasingly popular because of the concern of side effects associated with hormonal contraceptives, offer privacy and control because they can be inserted before sex  Disadvantages; diaphragm is inconvenient, interferes with sexual spontaneity, spermicidal cream or jelly is messy, detracts from oral-genital sex, causes irritation, poorly fitted diaphragm can cause discomfort during sex, bladder discomfort, urethral irritation, recurrent cystitis  How to use; fitted and prescribed by a doctor, main function is to serve as a container for spermicidal foam or jelly and should remain in the vagina for at least 6 hours after intercourse to ensure that all sperm are killed, if intercourse occurs again within this time additional spermicide must be inserted with an applicator tube, every year during an annual pap test doctor must recheck the fit and condition Cervical Cap  Much like the diaphragm the cervical cap, combined with spermicide serves as a chemical and physical barrier, the rubber or plastic cap resembles a large thimble that fits snugly around the cervix and is 84-91% effective if the woman has not yet had a baby  Advantages; women who cannot use a diaphragm because of pelvic-structure problems or loss of vaginal muscle tone can often use the cap, less messy and nod does not require additional applications of spermicide if used within several hours more than once  Disadvantages; more di
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