Types and uses of popular Contraceptives

According to Microsoft Encarta Encyclopaedia contraception is a “deliberate prevention of pregnancy using any of several methods.” (Microsoft Encarta Encyclopaedia, 2004)

There are many different forms of contraception available on today’s market, but these can be broken down into two main types; hormonal and barrier contraceptives.

Barrier method contraceptives are a physical barrier that prevents sperm from fertilizing the ovum. Some like the male and female condom totally prevent the sharing of bodily fluids, while others such as the cervical cap and the diaphragm allow the sharing of bodily fluids, but create a barrier over the cervix that sperm cannot pass through. (Wikipedia online encyclopaedia, 2006)

Hormonal methods of contraception deliver oestrogen and/or progesterone or the synthesised form of progesterone, progestin. These hormones affect ovulation and the development of the uterus lining to prevent sexual reproduction. (Microsoft Encarta Encyclopaedia, 2004)

Sexual reproduction ensures greater genetic variation because both parents contribute 23 chromosomes to their offspring, resulting in a unique combination of genes. (In class lesson: 16/10/06) it is controlled by the interaction of the hormones secreted by the pituitary gland and the ovaries There are four main hormones involved in sexual reproduction, these being Luteinising Hormone (LH), Follicle Stimulating Hormone (FSH), Oestrogen and Progesterone. LH and FSH are both released from the pituitary gland and stimulate progesterone and oestrogen production and release by the ovaries. (Microsoft Encarta Encyclopaedia, 2004) (Class lesson: unknown date in October)

In females LH stimulates ovulation; in males LH stimulates the production of androgen. FSH is complimentary to LH as it stimulates the production of the ovum (in females) and sperm (in males). (Class lesson: unknown date in October)

Oestrogen is produced in the ovaries and production peaks when LH and FSH peaks, roughly when ovulation occurs (14 days), and then slowly decreases as the corpus luteum disintegrates (Class hand out: date unknown). Oestrogens are important in the development of the uterus lining and maintenance of the female reproductive system and the secondary characteristics such as metabolic processes and changes in breast tissues. Oestrogens also regulate sexual development and some sexual behaviour. (Class lesson: unknown date in October) (Microsoft Encarta Encyclopaedia, 2004)

Encarta Encyclopaedia states that progesterone is “formed by the granulosa cells of the corpus luteum of the ovary.” (Microsoft Encarta Encyclopaedia, 2004)

Progesterone prepares the uterus lining for the implantation of ovum (Class lesson: unknown date in October), prevents the prolactin hormone from being released and prepares the mammary glands for milk production (Microsoft Encarta Encyclopaedia, 2004). Production of progesterone peaks during the luteal phases, between day 20 and 25. (Class hand out: date unknown)

There are two reproductive cycles present in human females; the ovarian and menstrual cycles. The ovarian cycle is the process involved in the growth, release and subsequent deterioration of an ovum in the process known as ovulation. As oestrogens increase during the follicular phase the ovum grows and develops. Oestrogen peaks between day 10 and day 14, just before ovulation. At day 14, ovulation occurs and the developed ovum is released into the fallopian tubes. The secretion of progesterone is stimulated by ovulation and increases during the first half of the luteal phase. After day 20 the corpus luteum begins to disintegrate, triggering a decrease in progesterone and oestrogen. By day 28 primary follicle growth begins and the ovarian cycle begins again. (Class lesson: unknown date in October) (Class hand out: date unknown). (Microsoft Encarta Encyclopaedia, 2004)

In the menstrual cycle the endometrium is shed through the cervix and vagina in bleeding called menstruation. There are three phases in the menstrual cycle; the menstrual flow phase, proliferative phase and the secretory phase. During the menstrual flow phase the endometrium (uterus lining) is shed. This is caused by decreased levels of progesterone and oestrogens and coincides with the beginning growth of the follicle. (Class lesson: October)

The proliferative phase starts as menstrual flow ends. The levels of progesterone and oestrogen increase, which causes the remaining endometrium to regenerate and thicken. In the secretory phase the endometrium continues to thicken and becomes vascularised in preparation for fertilisation. Oestrogen and progesterone maintain the endometrium, but the levels of progesterone decrease as the corpus luteum deteriorates. (Class lesson: unknown date in October)

The cervical cap is a barrier method contraceptive. It is a soft rubber cup with a round rim that is adhered by surface tension or suction. Like the condom the effects of the cervical cap are immediately reversible. But they must be sized and fitted by a health professional/doctor to fit snugly around the cervix. Each cervical cap fits differently over the cervix; a female fitted for one type of cap cannot use that measurement as her size for a different type of cap. It is available by prescription only and, like the diaphragm, is most effective when used with spermicide. Some types of cervical cap such as the FemCap have a higher failure rate than other brands of cap. (Wikipedia online encyclopaedia, 2006)
In the US it is recommended that the cervical cap be removed after 48 hours, but in other countries 72 hours is the maximum time. Cervical caps can be used for multiple acts of intercourse, but there is a small risk of it becoming dislodged or developing a side effect. (Wikipedia, 2006)
Wearing a cervical cap for more than 48 hours is not recommended because of the risk, though low, of toxic shock syndrome. Also, with prolonged use of two or more days, the cap may cause an unpleasant vaginal odour or discharge in some women. (Mayo Clinic, 2005) In women who haven’t given birth before the failure rate can range from 9% during perfect use to 16% in typical use. The failure rate of the cervical cap is greatly increased if the person using it has previously carried and given birth to children. In cases such as these failure rates range from 26% (perfect use) to 32% (typical use). This can be explained by the fact that the cervix changes shape after childbirth has been undertaken. (Wikipedia online encyclopaedia, 2006) Despite the great failure rates of the cervical cap there are certain thing that can be done to help prevent fertilisation.
For the cervical cap to work effectively it must remain in place, after a man’s last ejaculation, for 8 hours minimum. (Mayo Clinic, 2005) Oil based lubricants degrade the latex present in some cervical caps and increase the probability that it may tear or break. Therefore oil based products should not be used in conjunction with any latex contraceptive products. (Wikipedia online encyclopaedia, 2006)
Although the cervical cap does prevent the sperm fertilising ovum it does not protect against all sexually transmitted diseases. Infections such as Chlamydia and gonorrhoea are prevented by the cervical cap, but infection such as syphilis, HIV and herpes are not. (Sutterhealth.org, 2005). Hormonal IUDs also do not prevent STDs.

The hormonal IUD is a ‘T’ shaped device that is inserted into the uterus. It slowly delivers LNG (a synthesized form of progesterone) to the endometrium after insertion, causing the uterine lining to become inactive. Menstrual shedding is reduced and the uterine lining thins. Thickening of cervical mucus also occurs, making penetration of sperm less. This makes it more difficult for sperm to pass through the cervix and the thinner uterine lining ensures that if fertilization was to occur implantation could not. Mirena IUDs have a high initial outlay ($250 $300), but can left for five without the need to replace. (BUPA Health Info Team, 2003).

The hormonal IUD is over 99% effective as a birth control method as it is almost impossible to misuse. Side effects from the hormonal IUDs are uncommon and usually dissipate after 3 6 months. (BUPA Health Info Team, 2003) Side effects can range from tearing of the uterus, increased risk of PID to ectopic pregnancies, although these results are rare. With IUD use periods are usually lighter or might be missed altogether, but there is a slightly increased risk of irregular spotting or bleeding. Other side effects could include breast pain/tenderness, acne, and weight gain and mood changes. (www.suite101.com). There is a possible risk of ovarian cysts. (Turner, 1994)

The effects of the Hormonal IUD are completely reversible, more than 90% of people conceive during a year of having the Intrauterine Device removed. (BUPA Health Info Team, 2003). Despite the low risk of impregnation the IUD does not protect against any STDs such as syphilis. (Greenfield, 2004)
“In women who have STDs, an IUD will increase the risk of PID.” (Wikipedia online encyclopaedia, 2006)

An STD is an infection that can be transferred from one person to another through any form of sexual contact, including kissing, oral sex and use of ‘sex toys’. All forms of sexual contact carry risk, so as such there is no ‘safe sex’, abstinence from sexual activity is the only method that carries no risk. Most STIs can be treated if diagnosed early enough in the development. (Medicinenet.com)

Syphilis is caused by the microscopic bacteria Treponema pallium, which is a spirochete. It is passed from one person to another through direct contact with syphilis sores and cannot be transferred through the sharing of clothes etc. The Centres for Disease Control and Prevention (CDCP) states that:
“Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth.” (CDCP, 2004)

Syphilis is difficult to detect due to the nature of the visible symptoms, but spirochetes are visible under a dark field microscope. (CDCP, 2004) (Medicinenet.com)

According to the Centres for Disease Control and Prevention, 2004;
“Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late complications if they are not treated. Although transmission appears to occur from persons with sores who are in the primary or secondary stage, many of these sores are unrecognized. Thus, most transmission is from persons who are unaware of their infection” (CDCP, 2004)

When the spirochete is transferred it burrows into the moist mucous lining of the genitals or mouth. There are three stages of syphilis and there can be a latent phase. It can also be passed from mother to baby through the placenta.(Medicinenet.com)

The development of chancre/chancres signals the first stage. This develops anywhere from 10 to 90 days after the initial infection. The chancre is highly contagious and any skin contact with it will result in infection. The ulcers with disappear after 3 to 5 weeks, but recur in the secondary phase of syphilis. (Medicinenet.com)

The secondary (systemic) stage of syphilis can occur weeks or months after the initial symptom. It can last from four to 6weeks. During this stage internal damage can occur. Typically a highly infectious rash forms on the hands and feet; this rash can be unnoticeable and will spread with skin contact. The secondary phase can induce hair loss, and white patches on the nose mouth and genitals. Syphilis can also manifest itself in form of fevers, headaches, and genital legions. Both the rash and legions will spread though casual contact, such as handshakes, etc. (CDCP, 2004) (Medicinenet.com)

Sometimes the person infected may undergo a latent phase of syphilis, during this (which can last 20 years plus) the infected person may have no symptoms of the disease. The latent phase is NOT ALWAYS present. (Medicinenet.com)

The third stage may occur with or without the development of the latent stage. This stage of syphilis is not usually contagious, but it is the most dangerous. Syphilis can cause an abnormal development of the heart, especially the aorta, which leads to cardiovascular problems. (Medicinenet.com). The brain may become infected causing stroke, neurosyphilis, meningitis, loss of sensation and/or mental confusion. This could also develop into deafness or blindness and is usually fatal to the person infected. (Medicinenet.com) (CDCP, 2004)

Injections of penicillin can usually cure syphilis during the early stage of development. Treatment of syphilis will prevent further damage, but not repair previous damage. (CDCP, 2004)

The table below shows both advantages of disadvantages of the cervical cap and IUD

Intrauterine Device (IUD): small device inserted by a health care professional into the uterus; prevents eggs from being fertilized and/or implanting in uterus Cervical Cap: thimble-shaped latex cap inserted into vagina over cervix to prevent sperm from entering uterus; used with spermicide
• typical use effectiveness: 96% – 99% • typical use effectiveness: 82%
• Effective one to six years, depending on type used • Reusable
• No action required prior to sexual intercourse, permits sexual spontaneity • Can last for one to two years
• Not effective against STD transmission • Not effective against STD transmission
• May cause spotting between periods and longer, heavier periods • Needs to be fitted by a health care professional
• Increased risk of pelvic inflammatory disorder within first four months after insertion • Difficult to fit women with an unusual cervix size
• Rare risk of uterine perforation • Difficult for some women to insert

Neither the cervical cap nor Hormonal IUD prevents the spread of STDs. So basing just upon the percentages of success rate the Hormonal IUD and spermicide seems the better option as a form of birth control, with 99% + success rate as compared to 74% – 91% success rate. But as neither have STD prevention it would probably be best to use the IUD in combination with spermicide and a barrier method that reduces STD transmission such as a male or female condom.

___________________________________________

BIBLIOGRAPHY:

Bibliography

Birth Control: Cervical Cap, January 2005, (http://www.pamf.sutterhealth.org/teen/sex/birthcontrol/cervicalcap.html) Accessed: 19th November 2006

BUPA Health Information Team, Hormonal Contraception, November 2003, (http://hcd2.bupa.co.uk/fact_sheets/html/hormonal_contraception.html) Accessed: 14th November 2006

Centres for Disease Control and Prevention, Syphilis, May 2004, (http://www.cdc.gov/std/Syphilis/STDFact-Syphilis.htm) Accessed: 21st November 2006

Greenfield, Marjorie, The Dr. Spock Company, IUDs: Copper vs. Hormonal, last updated: August, 2004, (http://www.drspock.com/article/0,1510,5541,00.html) Accessed: 19th November 2006

Hormonal and Non-Hormonal IUDs: Lesson 1 – Begin at the Beginning, (http://www.suite101.com/lesson.cfm/17131/500/5) Accessed: 14th November 2006

Mayo Clinic Staff, Cervical Cap, December 2005, (http://www.mayoclinic.com/health/birth-control/BI99999/PAGE=BI00007) Accessed: 18th November 2006

Medicinenet.com, Sexually Transmitted Diseases (STDs in Women): What are sexually transmitted diseases (STDs)?, (http://www.medicinenet.com/sexually_transmitted_diseases_stds_in_women/article.htm) Accessed: 20th November 2006

Medicinenet.com, Sexually Transmitted Diseases (STDs in Women): Syphilis, (http://www.medicinenet.com/sexually_transmitted_diseases_stds_in_women/page4.htm) Accessed: 20th November 2006

Microsoft Corporation, Progesterone, 2003, Microsoft Encarta Encyclopaedia Deluxe 2004. Accessed: 15th November 2006

Microsoft Corporation, Estrogen, 2003, Microsoft Encarta Encyclopaedia Deluxe 2004. Accessed: 15th November 2006

Microsoft Corporation, Hormone, 2003, Microsoft Encarta Encyclopaedia Deluxe 2004. Accessed: 16th November 2006

Microsoft Corporation, Menstruation, 2003, Microsoft Encarta Encyclopaedia Deluxe 2004. Accessed: 16th November 2006

Microsoft Corporation, Pituitary Gland, 2003, Microsoft Encarta Encyclopaedia Deluxe 2004. Accessed: 15th November 2006

Microsoft Corporation, Cervical Cap, 2003, Microsoft Encarta Encyclopaedia Deluxe 2004. Accessed: 15th November 2006

Microsoft Corporation, Intrauterine Device, 2003, Microsoft Encarta Encyclopaedia Deluxe 2004. Accessed: 15th November 2006

Turner, Rebecca, The Alan Guttmacher Institute , Hormonal IUD users experience fewer side effects and pregnancy rates as low as copper IUD users, May 1994, (http://www.findarticles.com/p/articles/mi_qa3634/is_199405/ai_n8718441) Accessed: 17th November 2006

Wikipedia Contributors, IntraUterine Device, November 2006, (http://en.wikipedia.org/w/index.php?title=IntraUterine_System&oldid=88433469) Accessed: 20th November 2006

Wikipedia Contributors, Cervical Cap, November 2006, (http://en.wikipedia.org/w/index.php?title=Cervical_cap&oldid=87893227) Accessed: 20th November 2006

Wikipedia Contributors, Birth Control, November 2006, (http://en.wikipedia.org/w/index.php?title=Birth_control&oldid=89491478) Accessed: 22th November 2006

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