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Contraception

Contraception is the prevention of conception or pregnancy by using various methods, devices, drugs or surgical procedures. Contraception allows us to enjoy sexual life without worrying about an unwanted pregnancy. Due to the research and resulting medical discoveries and inventions, there are presently many ways to prevent a pregnancy. You should seek professional advice for the best of choice, as the method chosen will be depend on individual's health, social life style and interval to her next pregnancy.  All contraceptive methods are created based on two concepts; prevents fertilization or embryo implantation.

Let us have a look on the contraceptives available. Thanks to contraceptive, we enjoy recreation without procreation.

1. Oral contraceptive pills (OCP)
2. Intrauterine contraceptive device (IUCD)
3. Contraceptive implant (Implanon)
4. Injection contraception
5. Cervical cap
6. Diaphragm
7. Condom for woman
8. Condom for man
9. Tubal ligation
10. Vasectomy
11. Rhythm method (natural family planning)
12. Withdrawal (interrupted coitus)
13. Breast feeding contraception

1. Oral Contraceptive Pills (OCP)

(i) Combined oral contraceptive

- This OCP contains synthetic oestrogen and progestogen (progesterone-like hormone).
- It stops ovulation, makes endometrium (lining of the uterus) thin so that embryo implantation is unlikely to occur and the cervical mucus thick so that it is difficult for the sperm to swim through the mucus into the uterine cavity.
- It tends to make menses very short in duration and scanty in amount.
- It may produce headache, sensation of nausea and slight weight gain during the initial period of usage.
- It is taken around the same time everyday for 21 days continuously, followed by a 7-day break (that's when menses usually occurs). After the 7-day break, a new course of pill begins.
- This OCP can be bought at the phamarcy or clinic.
- Examples are: Nordette, Microgynon, Marvelon, Mercilon and Gynera.
- Failure rate: 0.1%

(ii) Progesterone-only pills (mini pills)

- Mini pills contain progesterone hormone only.
- It makes the endometrium thin and the cervical mucus thick. Sometimes it stops ovulation as well.
- The menses will be very short and scanty. The menstrual cycle will be very irregular. This makes the mini pills unpopular among OCP users.
- It is considered a "milder" pill, freer of major side-effects, but is less effective compared to combined oral contraceptive.
- It is taken every single day of the year without break in between.
- Failure rate: 2%.

(iii) Emergency contraceptive pills (post coital pills)

- Post coital pills are used for pregnancy prevention after unprotected sex, forced intercourse or suspected contraceptive failure such as ruptured condom.
- It is taken within 72 hours (3 days) after sexual intercourse.
- It is not as effective as ongoing contraceoptives.
- It should not be used as regular contraceptive because of its high failure rate.

- Example: Postinor.

- Failure rate: 5%.
- As alternative way of emergency contraceptive is by insertion of IUCD in the first 4 days after unprotected intercourse.

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2. Intrauterine Contraceptive Device (IUCD)

  • IUCD is a small device (3cm in length), which is placed inside the womb to induce an inflammatory reaction in the adjacent endometrium so that no embryo implantation occurs.
  • The IUCD insertion is best done immediately after menstruation has stopped, at the same time following termination of pregnancy or during postnatal examination (1 month after delivery).
  • There are 2 types of IUCD:

(i) Copper IUCD

- It contains sopper which helps to inhibit the sperm from entering the Fallopian tubes.
- Its effectiveness is best for 3 years after insertion.
- The menstrual flow will be heavy and prolonged for few months after insertion.
- Failure rate: <1%.

(ii) Progestogen IUCD (Intrauterine Contraceptive System)

- It contains Levonorgestel (progesterone-like hormone) which makes the cervical mucus thick and forbids the sperm from entering the womb.
- Its effectiveness is best for 5 years after insertion.
- Its advantage over the copper IUCD is that the menstrual flow will be lighter and less cramping.
- Failure rate: 0.1%

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3. Contraceptive Implant (Implanon)

  • Implanon is a small white matchstick-like rod contains etonogerstel which is inserted under the skin of upper arm.
  • It is inserted by trained doctor under local anaesthesia.
  • It stops ovulation, makes endometrium (lining of the womb) thin so that embryo implantation is unlikely to occur and the cervical mucus thick so that it is difficult for the sperm to swim through the mucus into the uterine cavity.
  • It is effective for 3 years. At the end of the 3 years, it is renewed under local anaesthesia.
  • The menstrual flow will be light and less cramping.
  • It may lead to irregular cycle or amenorrhea ( no menses for a few months).
  • Failure rate: <1%

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4. Injection Contraceptive

  • It's also known as bithr control shot.
  • This injection contains progesterone-like hormone which prevents woman from ovulating (release of mature egg).
  • It is injected at the buttock at 2 months interval between the first and second dose and subsequently every 3 months.
  • It will make the menses short and scanty which may lead to irregular menstrual cycle or amehorrhea (no menses for a few months). This is a common reason for discontinuation of usage.
  • Example: Depo Provera.
  • Failure rate: 1%

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5. Cervical Cap

  • Cervical cap is a small firm cup-shaped rubber cap which is fits over the cervix. So that the sperm is forbidden from entering the cervix.
  • It is normally used together with spermicide (sperm killer) which is spread around the cervical cap.
  • It should be removed at least 6 hours after the last ejaculation and should not be placed inside vagina more than 48 hours.
  • It must be fitted by clinician.
  • It may increase risk of cervical inflammatory.
  • Failure rate: 20%.

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6. Diaphragm

  • Diaphragm is rubber dome-shaped device which is put into vagina so that it covers the cervix. This blocks the sperm from entering the cervix.
  • It is used togetherwith spermicide (sperm killer) which is spread around the diaphragm.
  • It must be fitted by clinician.
  • It should be removed at least 6 hours after the last ejaculation.
  • Failure rate: 20%.

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7. Condom for Woman

  • It is made of plastic (polyurethane).
  • It is placed inside the vagina, so that it blocks the sperm from entering vagina and womb.
  • It also helps to prevent sexual transmitted diseases (STDs).
  • This is more expensive than male condom.
  • Failure rate: 20%.

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8. Condom for Man

  • It is made of latex (rubber), plastic (polyurethane) or natural membrane.
  • It blocks the sperm from entering vagina and womb.
  • It also helps to prevent STDs.
  • Failure rate: 4-10%.

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9. Tubal Ligation

  • Tubal ligation is done to block the Fallopian tubes so that sperm cannot reach the egg.
  • The blockage is done by placing rings on the tubes or cutting part of the tubes off.
  • This is a day care procedure and there will be a 1cm incision wound at the umbilica.
  • It will not affect your sex drive or ability to have sex.
  • It is an irreversible contraceptive. You must ensure that you do not plan to have additional children and will not change your mind on this.
  • It is done during the first week of menstrual cycle, within 5 days after delivery or during Caeserean Section.
  • Failure rate: <1%.

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10. Vasectomy

  • Vasectomy is minor surgery which blocks the vas deferens (the tubes that carry man's sperm from testis to urethra) by cutting and tying off the vas deferens.
  • It is a day care procedure and is done under local anaesthesia.
  • There will be some pain or disconfort for several days in the scrotum area post-vasectomy. Firm supporting underwear will help to relieve the discomfort.
  • Contraception is not immediate. You will need to use an alternative contraceptive method until your semen is free of sperm. Semen analysis is done 3 months after the surgery to confirm that the semen is free of sperm.
  • Vasectomy does not affect sex drive or ability to enjoy sex. The semen produced is slightly reduced.
  • It is less expensive and causes fewer complications compared to tubal ligation on the female.
  • It is an irreversible contraceptive. You must ensure that you do not plan to have additional children and will not change your mind on this.
  • Failure rate: <1%.

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11. Rhythm Method (Natural family planning)

  • Based on the assumption that the egg's capability to be fertilised lasts for only 24 hours (1 day) after it is released from the ovary and the sperm's capability to fertilise the egg lasts for only 72 hours (3 days) after deposited in the vagina.
  • This method is only applicable to those ladies who have regular 28 to 30 days menstrual cycle.
  • Ovulation (releasing of the mature egg) occurs between Day 12 and Day 16 of a regular 28 days menstrual cycle. So, the potential fertile period is between Day 9 (=12-3) and Day 17 (=16+1) of the cycle. In other words, you should avoid sexual intercourse from Day 9 until Day 17 to prevent an unwanted pregnancy. (Day 1 is considered as the first day of menses)
  • During the fertile period (Day 9 to Day 17), condom can be used during sexual intercourse.

If you strictly followed the rhythm method it has a low failure rate in the vacinity of 2%. If it is not strictly followed the failure rate can increase up to 20%. Failure rate is increased if a woman's cycle is irregular. An attempt may be made to pin-point the time of ovulation by:

(i) recording the basal body temperature (BBT) immediately after wake up every morning. A rise in temperature of about half a degree Fanrenheit suggests that ovulation has occured.

(ii) noting the changes of your cervical mucus. The mucus becomes less viscous, more watery and stingy around ovulation time.

Failure rate: 20%

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12. Withdrawal (Interrupted coitus)

  • Withdrawal of the penis before ejaculation, so that the man ejaculates outside the vagina and no semen is deposited in the vagina.
  • This method needs very good self-control by the man.
  • Failure occurs when there is delay in withdrawal or because the pre-ejaculatory fluid contains some sperm cells.
  • Some men may not like it because there is interruption before climax.
  • Failure rate: 20%.

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13.Breast Feeding Contraception

  • Breast feeding has contraceptive effect by delaying ovulation and menstruation.
  • It is effective when you are exclusive breast feeding (without supplement feeding to your newborn) for the first 6 months after delivery and before the menses returns.
  • It is unreliable after the first 6 months when the baby starts to take solid food.

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