GENERAL

What 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: (i) Female condom (ii) Spermicides (iii) Oral pills (iv) Injectable contraceptives (v) Intra uterine device (vi) 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:

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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: ( I) Condoms are one of the most reliable methods of birth control when use properly and consistently.(ii) Condoms are user friendly. With a little practice, they can also add confidence to the enjoyment of sex. (iii) 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.(iv) Condoms are the only contraceptive that also helps prevent the spread of sexually transmitted diseases (STDs) including HIV when used properly and consistently. (v) Can be used by men of any age. (vi)Usually easy to obtain and sold at most places.

What are the disadvantages of using a condom?

The disadvantages of using a condom are as follows: (i) May cause itching for a few people who are allergic to latex.(ii)There is a small possibility that the condom might slip off or break during sexual intercourse. (iii) If used with oil based lubricants such as vaseline or oil, condoms can go weak and break.

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

If the partners of 100 women start using condoms, coreectly 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.

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

Improper or incorrect usage may result due to reasons such as- wearing the condom before complete erction, not wearing the condom upto the shaft etc.

What is the technique of correct usage of a condom?

The technique of correct usage of a condom is as follows: (i) 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. (ii) Open the condom package at one corner being careful not to tear the condom with your fingernails, your teeth, or  by being too rough. (iii) Place the rolled condom over the tip of the hard penis. (iv) 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).(v) Leave a space of atleast half an inch at the tip of the condom for the semen to accumulate.(vi) 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?

Don't use two condoms at once, the latex rubbing against each other may cause the latex to tear.

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.

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: (i) Try using a dry condom without spermicide. (ii) Female partner can be asked to try putting on the condom for the man, which would help to make its use more enjoyable. (iii) 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.

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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: (i) Opportunity for women to share the responsibility for the condoms with their partners  (ii) A woman can use the female condom if her partner refuses to use the male condom (iii)The polyurethane, the material the female condom is made of, is less likely to cause an allergic reaction than a male latex condom. (iv)The female condom will protect against most STDs and pregnancy if used correctly .(v)It can be inserted up to 8 hours before intercourse so it does not interfere with the moment (vi)The polyurethane is thin and conducts heat well so sensation is preserved (vii)The female condom can be used with oil-based lubricants (v) 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 effectivenss rate drops.

What is the correct technique in using female condom?

The correct technique in using a female condom is as follows: (i) Open the package carefully. Choose a position that is comfortable for insertion - squat, raise one leg, sit or lie down. (ii) 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.(iii)  Place the index finger inside of the condom and push the inner ring as far as it will go. (iv) 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.(v) The penis should be guided into the condom in order to ensure that the penis does not slip into the vagina outside the condom.

How easy to use are female condoms?

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 FC 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.

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.

What are the disadvantages in using a female condom?

The disadvantages encountered in using the female condom are as follows: (i)The outer ring is visible outside the vagina, which can make some women feel self-conscious  (ii)The female condom can make noises during intercourse. Adding more lubricant can help this problem. (iii) Some women find the female condom hard to insert and to remove (iv)It has a higher failure rate in preventing pregnancy than non-barrier methods such as the pill.

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.

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SPERMICIDES

What is a spermicide?

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

What is its effectiveness?

Its efficacy ranges from 80 %  to 85 %. Efficacy is improved if spermicides are used in conjunction with mechanical barrier methods, most commonly condom.

What is its mode of action?

Spermicides destroy or immobilize the  sperm.

Are spermicides protective against STIs  and HIV/AIDS?

Spermicides are somewhat protective, but are not recommended for protection. On the contrary,  using the spermicide called  nonoxynol-9 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  supposed to be  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, and suppositories usually 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.

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COMBINED ORAL CONTRACEPTIVE PILLS (COCs)

What are combined oral  contraceptive pills?

The combined oral contraceptive pill, often referred to as "the Pill", is a combination of an oestrogen and a progesterone , taken by females by  mouth to inhibit normal fertility.

How does the  combined oral pill work?

The pill works mainly by (i) changing the body's hormone balance so that you do not ovulate (you do not release an egg each month from your ovary). (ii) It causes the mucus made by the cervix to thicken and form a 'mucus plug' in the cervix. This makes it difficult for sperm to get through to the uterus (womb) to fertilise an egg.  (iii) The pill also makes the lining of the uterus thinner. This makes it unlikely that a fertilised egg will be able to attach to the uterus.

How effective is the  combined oral pill?

It is over 99% effective if used correctly. Correct use means not missing any pills and taking the pill at the scheduled time.

What are the advantages of the pill?

The advantages of the pill are as follows: (i) It is very effective. (ii)It does not interfere with sex. (iii) Periods are often lighter, less painful, and more regular. It may relieve pre-menstrual tension. (iv) It helps to protect against some benign (non cancerous) breast disease. (v) It reduces the risk of developing certain types of cysts in the ovary. (vi)It reduces the risk of developing cancers of the ovary and uterus (womb).

Does the pill protect  against Sexually transmitted infections or HIV/AIDS?

No, the pill does not offer any protection.

What are side effects when taking the pill?

Most women who take the pill do not develop any side-effects. However, some women develop minor side effects like  (i) nausea (feeling sick), (ii) headaches,  (iii) sore breasts (iv) tiredness (v) change in sex drive (vi) skin changes like acne and oily skin  and skin pigmentation (vii) mood changes. (viii) bleeding/spotting between periods. There are certain side effects which call for immediate attention. These include: (i) severe headache,(ii) bad pains in the chest or leg,(iii)  leg swelling, (iv) breathing difficulty, (v) if you cough up blood, (vi) sudden problems with sight or speech,(vii) weakness or numbness in an arm or leg.

Under what circumstances is the pill not advised?

The pill may not be advised in these circumstances. (i) if you have had previous  blood clot in a blood vessel (ii) severe obesity (iii) immobility (eg wheelchair bound) (iv) poorly controlled diabetes .(v) high blood pressure  (vi) if you have a close family member who has had a thrombosis, heart attack, or stroke before the age of 45  (viii) severe migraine  (viii) History of smoking - particularly if you are over 35 years.(ix) Breast feeding mothers. (x) Those with history of migraine.

How are the pills used?

The combined pills usually come in a package of 28 pills. The first pill has to be taken on the  5th  day of the menstrual cycle (counting the first day of bleeding as first day of the menstrual period).

Start taking the tablets from that side where START is written.

Continue to take one pill everyday at the same time  for 21 days.

The last 7 pills contain iron. During this time  one’s menstrual period occurs.

Start  with a new pack again.

What if one forgets to take a pill?

If one forgets to take one  pill, -----------it is necessary to take it as soon as one remembers and take the next pill at the usual time.

If one misses 2 consecutive pills, -----------one should take 2 pills each day for 2 days and then go back to the regular schedule.

If one misses 3 or more pills, ----------stop taking the pills and use a different birth control method until the next menstrual cycle starts. If the menstrual cycle does not start on schedule, it is necessary to get in touch with a doctor.

What is to be done if one has nausea when taking the pills?

The pills may be taken at night or with food.

How is one supposed to deal with minor headache as a side effect of taking the pill?

A painkiller such as Ibuprofen, paracetamol or other painkiller may be taken.

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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 do progestogen only pills work?

This contraceptive does three things. (i) 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 egg.
(ii) Second, the mini-pill causes changes in your uterus (where a baby grows) that makes your uterus is less likely to let a pregnancy get started even if an egg is released. (iii) 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.) Sperm 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 (i)  if you are breast-feeding because the mini-pill will not change your milk production. (ii) Women who are older than 35. (iii) Women who smoke. (iv) Those with history of  high blood pressure.(v) Overweight  (vi) A history of blood clots

Who shouldn't take the Progestin only Pill? 

Doctors may refuse to prescribe the Progestin only Pill  for you: (i)If you have already had an abnormal pregnancy in which the foetus was lying outside the uterus.(ii) If you have severe artery disease, or an abnormally high cholesterol or other blood fats. (iii) If you have breast cancer.(iv) 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 like : (i) 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. (ii) Weight gain (iii)Breast tenderness.

How is the mini pill to be 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 POPs at any time during your cycle.

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

When you first start POPs, 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?

(i) 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. 

(ii) 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.

(iii) 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, consult a doctor.

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EMERGENCY CONTRACEPTION

What is emergency contraception (or emergency birth control)?

Emergency contraception, or emergency birth control, is used to help keep a woman from getting pregnant after she has had unprotected sex (sex without using birth control).

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 :  (i) She did not expect to have sex and was not using any contraception (ii) Sex was forced upon her without her consent (iii) A condom broke or slipped (iv) She ran out of contraceptives or missed   two to three  birth control pills in a row.

How does emergency contraception work?

Emergency contraception can keep you from becoming pregnant by : (i) Keeping the egg from leaving the ovary (ii) Keeping the sperm from meeting the egg. (iii) Keeping the fertilized egg from attaching to the uterus (womb)

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 after unprotected sex.

What are the types of emergency contraception?

There are two types: (i) Emergency contraceptive pills (ECPs) (ii) Intrauterine devices (IUDs)

What is an  Emergency Contraceptive Pill and how is it used ?

Pills containing a compound known as Levonrgestrel  are made for use as emergency contraception. The two pills can be taken in two doses (one pill right away, and the next pill 12 hours later), or both pills can be taken at the same time.

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:  (i) Keeping the sperm from meeting the egg  (ii) 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.

Are there any side effects when taking Emergency contraceptive pills?

The most common side effects experienced when taking EC are the following: (i) nausea and vomiting  (ii) irregular vaginal bleeding  (iii) fatigue  (iv) headache  (v) dizziness (vi) breast tenderness

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

To reduce nausea:  (i) try to eat something before taking the pills  (ii) take  an over-the-counter anti-nausea drug before the second set of pills  (iii) take the pills with milk not water

Is emergency contraception always effective?

Yes, emergency contraception s quite effective. If all 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:  (i) Abdominal pains (severe) (ii) Unusually light bleeding in the subsequent period. (iii) If next period does not occur.

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PROGESTIN ONLY INJECTABLES

What are Progestin only injectables?

Progestin only injectables injections containing 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 injections work by (i) inhibiting ovulation (ii) Cause thickening of the cervical mucus to prevent upward passage to the sperm

What are the advantages of using DMPA?

The advantages are as follows: (i) It is very effective (ii) Provides long term pregnancy protection and is reversible (iii) Convenient to use: avoids the hassles of daily intake of pills. (iv) Free from the side effects of estrogen such as danger of   formation of blood clot in blood vessels. (v) Helps prevent ectopic pregnancies (pregnancy outside the uterus) and ovarian cancer.

Are there  any side effects of DMPA?

Most women have some changes in their menstrual periods while using DMPA, including  (i) irregular and unpredictable bleeding or spotting, (ii) 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 DMPA is stopped. If unusually heavy or continuous bleeding occurs, you should see your doctor.

How effective is DMPA?

DMPA 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 DMPA permanent?

No. DMPA only works for about 3 months. The shot must be repeated every 3 months to prevent pregnancy. After a woman stops using DMPA, 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 shot.

How is DMPA administered?

DMPA is given as 1 shot in the buttock or upper arm every thee months.

When should DMPA be started?

Who are eligible to use DMPA?

DMPA can be used safely by women who: (i) Are breastfeeding (ii) Smoke cigarettes (iii) Have no children (iv) Any age group- from adolescents to those over 40 years of age (v) have benign breast disease (vi) have mild to moderate blood pressure

Who should not use DMPA?

Women who have any of the following should not use DMPA: 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 DMPA.

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INTRA UTERINE DEVICE

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 office visit. Once in place, the IUD stays in your uterus until your 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: (i) Copper bearing IUDs- These contain a copper wire inserted inside a plastic tube (ii) Hormone releasing IUDs  (newer form of IUDs) : These are made of plastic and contain small amounts of hormone progesterone.

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

Hormonal IUDs are: (i) More effective than Copper bearing IUDs. (ii) Make the menstrual period lighter.

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

Hormonal IUDs are  (i) costlier as compared to Copper IUD (ii) Can cause irregular bleeding or spotting in the first six months of use.

What are the advantages of an IUD?

The IUD has many advantages: (i) It's very effective in preventing pregnancy, (ii )Convenient –no hassle of taking the pill is involved. (iii) It's inexpensive. (iv) An IUD can be removed by your doctor at any time.  (v) It starts working right away. (vi)There's a low risk of side effects. (vii) Mothers who use an IUD can breast-feed safely.

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 – TCU 380A, which is now available under the National Family Welfare Programme 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. 

What are the disadvantages?

The disadvantages are as follows : (i) You may have cramps and backache for the first few hours after an IUD is put in your uterus. (ii)  Some women have bleeding for a couple of weeks after the IUD is inserted, and heavy periods after that. (iii) Rarely, the uterus can be injured when the IUD is put inside. (iv)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.

Who are eligible to use an IUD for contraception?

IUD can be used in any circumstances by women who: (i) are breastfeeding (ii) Smoke (iii) Have any of the medical conditions like high blood pressure, heart disease, liver or gall bladder disease, diabetes, epilepsy.

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.

How is the IUD fitted?

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.

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

A woman is advised to check her IUD : (I) once a week during the first month after insertion (ii) After noticing any unusual symptoms (iii) 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: (i) Wash her hands (ii) Sit in a squatting position (iii) Insert 1 to 2 fingers in her vagina as far as she can until she feels the strings (iv) 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: (i) her sex partner feels the IUD strings during sex and this bothers  him (ii) Heavy or prolonged bleeding that bothers the client (iii)  Increasing or severe pain in the lower abdomen , especially if associated with fever (iv) Missed a menstrual period  (v) Vaginal discharge with an unpleasant odour (v)  Wants to opt for  some other family planning method or would like to have the IUD removed.

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CENTCHROMAN

What is Centchroman?

Centchroman is a novel non - steroidal once - a – week oral contraceptive unrelated to hormonal oral contraceptives.

What are the advantages of using Centchroman?

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

When must Centchroman  NOT be used?

Administration of  Centchroman is not recommended in the following conditions: (i) Recent history of clinical evidence of jaundice or liver diseases. (ii) ovarian disease (iii) Tuberculosis (iv) Kidney disease.

How should these 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 its side effects?

Some of its side effects are: (i) Prolongation of menstrual cycles (ii) Delayed menstruation. In case of delay exceeding 15 days, a doctor should be consulted to rule out pregnancy.

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FEMALE STERLIZATION - TUBAL LIGATION

What is Tubal Ligation?

Tubal ligation, commonly knows as “getting your tubes tied,” is a surgical sterilization technique for women. This procedure closes the fallopian tubes, and stops the egg from traveling 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 : (I) A minilaparotomy involves making a small incision in the abdomen, locating the tubes, and cutting and closing them off. (ii) 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 sterlization.

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.

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MALE STERLIZATION- VASECTOMY

What is a vasectomy?

A vasectomy is an operation that make a man permanently unable to get a woman pregnant. It involves cutting the 2 tubes called vas deferens so that sperm can no longer get into the semen.

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 (an incision) 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 the first year after a vasectomy.

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

Don't have a 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 should I prepare for the operation?

On the day of the operation, bring a  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.

What can I expect after the operation?

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.

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  (i) bleeding,(ii)Pain (iii) infection

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: (i) You have a fever.  (ii) You have swelling that won't go down or keeps getting worse.  (iii) You have trouble urinating. (iv) You can feel a lump forming in your scrotum. (v) 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.

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 prostrate cancer?

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

Can an HIV infected person undergo vasectomy?

Yes an HIV infected person can  undergo vasectomy

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NATURAL FAMILY PLANNING METHODS

What are natural family planning methods?

Natural family planning methods are methods in which a woman tries to avoid intercourse during the fertile time of her menstrual cycle.

When is a woman said to be fertile?

A woman is fertile when she is ovulating and for a few days before ovulation. Ovulation usually occurs mid cycle. More precisely, ovulation usually occurs 14 days before the onset of bleeding.

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 assumptions, 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 or who do not have menstrual cycles that are exactly the same number of days every month.

What is cervical mucus method?

The cervical mucus method is based on the idea that near the time or at the time of ovulation, your cervical mucus will become thinner and stickier your cervical mucus will be clear, slippery and very stretchy, similar to a raw egg white. Thus, If you do not want to get pregnant, then sex should be avoided from the time you begin to notice 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 it 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 you know ovulation has taken place, it can be assumed that having sex during the rest of your menstrual cycle will not result in pregnancy.

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

A woman needs to take her temperature every day, first thing in the morning before she gets out of bed. Once you have taken  your temperature, record it on a chart so that you can follow the fluctuations in your temperature from day to day. Avoid sex during the days when the body  temperature is steadily high 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:

(i)  Conventional Method: Keep track of how long your menstrual cycle is, in order to determine when Days 8 through 19 occur. (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.

(ii) 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: (i) Your menstrual cycles are regular  (ii) 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).  (iii) You and your partner are willing to abstain from intercourse or use 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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