避孕与流产英文精解.ppt

ContraceptionandAbortion Agenda DiscussHistoryandConsiderationsAssociatedwithMethodsDiscussContraceptionMethodsDiscussAbortion ClassExercise ContraceptionValuesClarification Completethehandoutentitled ContraceptionValuesClarification Afteryouhavecompletedthehandout discussyourresponseinsmallgroups Introduction MajorityofU S pregnanciesarenotplannedandmostarearesultofnotusingcontraceptionFactorsincreasingmotivationtousecontraception goodcommunicationwithpartner lowercost effectivenessrates frequencyofintercourse motivationtoavoidpregnancy sideeffects opennessaboutsexuality Contraception History ContraceptioninAncientTimesContraceptionintheU S 1800sandEarly1900sContraceptionOutsidetheU S ContraceptioninAncientTimes AncientGreeks magic superstition herbsEgyptians fumigatingfemalegenitalia tamponsoakedinherballiquid honey insertingamixtureofcrocodilefeces sourmilk honeySouthAfrica insertvegetableseedpodsAfrica insertagrassycervicalplugPersia insertalcoholsoakedspongesGreece insertemptypomegranatehalves ContraceptionintheU S 1800sandEarly1900s Concerninearly1800swastocurbpovertybycontrollingfertility1873Comstocklawsprohibiteddispersinginformationaboutcontraceptives includingbydoctors Contraceptionuseisaffectedby Socialissues e g desiredfamilysizeEconomicissuesKnowledgeforsomeitistheresponsibilityofboth ChoosingaMethodofContraception FDAApprovalProcessLifestyleIssues FDAApprovalProcess TheU S FoodandDrugAdministration FDA mustformallyapprovethemethod10 14yearprocesstodevelopanewcontraceptivedrugDrugcompanysubmitsanewdrugapplicationdemonstratingsafetyinanimaltests adesiretoconducthumantrials FDAApprovalProcess 3phasesPhase1 20 80volunteerstotesteffectivenessPhase2 severalhundredtotesteffectiveness sideeffects risksPhase3 hundredstothousandsaretestedforgeneralizationAnimaltrialsareconductedthroughouttheprocess ClassDiscussion LifestyleIssuesAssociatedwithContraceptive Thefollowingfactorsseemtobeassociatedwithchoosingacontraceptivemethod Ownhealth risksNumberofsexualpartnersFrequencyofintercourseRiskofacquiringaSTIResponsibilitylevelMethodcostAdvantages disadvantagesofthemethodDiscussinfluenceofeach ContraceptionMethods BarrierMethods CondomsandCaps PreventspermfromenteringtheuterusBarrierMethods CondomsTheDiaphragmTheContraceptiveSpongeTheCervicalBarriers Condoms 1850 latexcondomsavailableintheU S 10 15 dozenNon expiredcondomisrolledontoanerectpenis foreskinpulledback inchemptyspaceatthetipWater basedlubricantsforlatexcondomsCondomgraspedatbasewhenwithdrawingLatexcondomshavelowerratesofslippage breakage andofferbetterSTIprotection Condoms In1994 femalepolyurethane nonlatexcondomswereavailable 2each7incheslongwith2flexibleringsInnerringsqueezedandinsertedclosetothecervixOuterringliesoutsidethevaginaAdequatelubricationisnecessary Condoms EffectivenessratesLatexcondoms 85 98 Femalecondoms 79 95 Latex polyurethaneprotectagainstSTItransmissionLambskincondomsblocksperm butcontainholeslargeenoughforvirusestopassthroughHeatcandamagecondoms Condoms Advantages STIprotectionEncouragesmaleparticipationInexpensiveNoprescriptionnecessaryCanreduceprematureejaculationCanreducepostcoitaldripNomedicalsideeffects Condoms Disadvantages ReducesspontaneityCanreducesensationFemalecondomscanbedifficulttouse uncomfortable noisyFemale malecondomsshouldneverbeusedtogetherPopularinsomecountries notusedinothers TheDiaphragm Notwidelyused almost0 in2002MadeoflatexorsiliconeManysizesandshapes afittingbyahealthcareproviderisnecessary 20 35diaphragm 13spermicidaljelly cream officevisitchargeTheycanlastformanyyears Diaphragmscomeinavarietyofdifferentshapesandsizesandmustbefittedbyahealth careprovider TheDiaphragm DiaphragmrimiscoveredinspermicidaljellyitisfoldedinhalfandinsertedintothevaginawiththefrontrimtuckedunderthepubicboneItshouldnotbefelt shouldcoverthecervixItcanbeinsertedupto6hourspriortointercourseLeftinforatleast6 8hours nomorethan24Afteruseitiswashedwithsoap water Instructionsforproperinsertionofadiaphragm TheDiaphragm 84 94 effective lowerforthosewhohavegivenbirthAdvantages IncreasesspontaneitySomeSTI PIDprotectionReducesriskofcervicaldysplasia cancerDoesnotaffecthormonallevelsRelativelyinexpensive TheDiaphragm Disadvantages PhysicianfittingandprescriptionInsertion removalinvolvestouchingthegenitalsIncreasedriskoftoxicshocksyndromeandurinarytractinfectionPostcoitaldripLowusageoutsidetheU S TheContraceptiveSponge TheTodaycontraceptivespongewastakenoffthemarketforadecadeduetoissueswiththemanufacturingplant reintroducedin2005AvailableoverthecounterinonesizeThespongecoversthecervixitblocks absorbs deactivatesspermOneboxof3spongesis 13 TheTodaycontraceptivespongewasbackonthemarketinlate2005intheUnitedStates TheDiaphragm Spongeismoistenedwithwatertoactivatethespermicide foldedinhalf insertedtocoverthecervixCanbeinsertedupto24hoursinadvance withintercourseoccurringasmanytimesasdesirableinthattimeperiodMustbeleftinatleast6hoursafterintercourse75 89 effectivenessrates Instructionsforproperinsertionofacontraceptivesponge TheDiaphragm Advantages NoprescriptionnecessaryCanhaveintercourseseveraltimeswithin24hoursIncreasesexualspontaneityDonotaffecthormonallevelsDisposable TheDiaphragm Disadvantages Increasedriskoftoxicshocksyndrome urinarytractinfectionCannotbeusedwhilemenstruatingRequirestouchingofthegenitalsHighexpenseiffrequentlyusedSomemencanfeelitLowusageratesinothercultures TheCervicalBarriers Thimble shaped siliconebarriersthatfitoverthecervixBlockentrancetotheuterus deactivatespermwiththespermicideFittingbyahealthcareproviderisnecessaryTwotypes FemCapLea sShield TheFemCapisasiliconecupshapedlikeasailor shatthatfitssecurelyoverthecervix Lea sShieldisasiliconecupwithaone wayvalveandaloopforeasierremoval TheCervicalBarriers 15 75pluscostofspermicideLeftinplacefor8hoursafterintercourseAfteruse itiswashedwithsoap waterNottobeusedduringmenstruation86 effectivenessrate lowerforthosewhohavehadchildren TheCervicalBarriers Advantages Leftinplaceforupto48hoursDonotaffecthormonallevelsImmediatelyeffectiveNotpermanentOne wayreleasevalveinLea sShieldreducesriskoftoxicshocksyndrome TheCervicalBarriers Disadvantages AbnormalPapsmearsIncreasedriskofurinarytractinfectionsIncreasedvaginalodorsCervicaldamageIncreasedpostcoitaldripFittingisnecessarySomemalepartnersfeelit maydislodgeit TheCervicalBarriers WidelyusedinEnglandLea sShieldisavailableoverthecounterinGermany Austria Switzerland Canada HormonalMethodsforWomen ThePill thePatch andMore Changinghormonallevelscandeterproductionofova fertilization andimplantation HormonalMethodsforWomen ThePill thePatch andMore Combined HormoneMethodsBirthControlPillsHormonalRingHormonalPatchProgestin OnlyMethodsSubdermalImplantsHormonalInjectibles Combined HormoneMethods Combinationofestrogen progesteroneCanrepressovulationandthickencervicalmucus BirthControlPills Federallyapprovedin1960MostpopularcontraceptiveintheU S andaroundtheworldMoststudiedtypeofmedicationCombinationbirthcontrolpillsare 12 25permonthDesignedtomimicamenstrualcycle with21daysofhormonesandoneoffweekBleedingismedicallyinduced BirthControlPills Sometake2to3packsofactivepillsinarowtoreducethenumberofmenstrualperiodsSeasonale 84 dayactivepillwith7 dayplaceboReducingperiodscanhelpthosewithheavybleedingandcramping60 ofwomenprefertonothaveaperiod BirthControlPills Increaseinestrogen progesteronepreventthepituitaryfromsendinghormonestoripentheovariesCervicalmucusthickens endometriumbuildupisminimalThebodyistrickedintothinkingitispregnantMayexperienceothersignsofpregnancythatusuallydisappearwithinafewmonths BirthControlPills Initiallyprescribedalow doseestrogenpill increasedifbreakthroughbleedingoccursMonophasicpillscontainthesamedoseofhormonesineachpillMultiphasicpillsvaryinhormoneamountTriphasilpillshave3sets eachweekthehormonaldosageincreases92 99 7 effectiveNeedtotakeiteachdayatthesametime BirthControlPills Advantages HigheffectivenessrateDoesn tinterferewithspontaneityReducedmenstrualflow cramps PMSIncreasedmenstrualregularityReducedriskofovariancysts uterine breastfibroids facialacne ovarian endometrialcancers PID benignbreastdisease BirthControlPills Disadvantages NoSTIprotectionFemale sresponsibility takendailyCanbeexpensiveLowereffectivenessifoverweightNotappropriateforsmokersUsedthroughouttheworld althoughnotpopulareverywhere someplaceshaveitoverthecounter HormonalRing NuvaRingintroducedin2003Plasticringinsertedintothevaginaonceamonthfor3weeks removedfor1weekAffectsthebodyascombinationpillsdoBodyheatlowerdosethanpills 30 35permonth99 7 effective TheNuvaRingisinserteddeepintothevagina moistureandheatcauseittotime releasehormonesthatinhibitovulation HormonalRing Advantages HigheffectivenessDoesn tinterferewithspontaneityReducesmenstrualflow cramps PMSIncreasesmenstrualregularityProtectionfromovarian endometrialcancerandovariancystsFertilityrestoreduponremoval HormonalRing Disadvantages ComfortabletouchinggenitalsNoSTIprotectionSideeffectsthattypicallydisappearwithregularuse breakthroughbleeding weightchange breasttenderness nausea moodchanges changesinsexualdesire increasedvaginalirritation dischargeNodataoncross culturaluse HormonalPatch OrthoEvrapatchisathin peachcoloredstickerattachedtotheskinwithtime releasedhormonesPlacedonbuttock stomach oruppertorsofor3weeks nopatchforthe4thweekAffectsthebodyascombinationpillsdo 30 35permonth99 7 effective lowerifweighmorethan198pounds TheOrthoEvrapatchiswornonthebuttock abdomen oruppertorsoforthreeweekseachmonth HormonalPatch Advantages HigheffectivenessDoesn tinterferewithspontaneityReducesmenstrualflow cramps PMSIncreasesmenstrualregularityProtectionfromovarian endometrialcancerandovariancysts HormonalPatch Disadvantages NoSTIprotectionSideeffectssimilartohormonalringSkinirritationChangeinvision discomforttocontactwearersCollectslintNearlyimpossibletoconcealfrompartnerNodataoncross culturaluse Progestin OnlyMethods Donotcontainestrogenandcanbeusedbywomenthatcannottakeestrogen suchasthosewhoarebreastfeeding smokersOvertime mayeliminateperiodsMaycauseslightweightgain bloatedness breasttenderness Progestin OnlyMethods Minipill POPs progestin onlypills InhibitovulationandthickenmucusFewersideeffectsthancombinationpills92 99 7 effectiveMoreexpensivethancombinationpillsCancauseirregularbleedingHigherrateofectopicpregnanciesifgetpregnantwhiletakingtheminipill SubdermalImplants Constantdoseofprogestinistimereleasedforupto5yearsNorplantisnolongeravailableJadelleisFDAapprovedbutnotmarketedintheU S 2siliconecylindersimplantedintheforearmina10minuteprocedure 500 Implanonisasingle rodapprovedin2004Fertilityrestoreduponremoval SubdermalImplants Suppressesovulation thickenscervicalmucus unreceptiveendometrium99 95 effective decreasesafterthe3rdyearLowereffectivenessratesifover154poundsAdvantages Effective long lasting reversibleSimpleimplantationprocedureNoestrogensideeffectsDecreasedmenstrualflow cramping SubdermalImplants Disadvantages Expensiveimplantationfees armpain painfulremoval possiblescarringIrregularbleeding crampingHeadaches nausea dizziness weightchange rash acne hairgrowthorlossVisionproblemsPopularinSouthAfrica HormonalInjectibles Depo medroxyprogesteroneacetate Depo Provera syntheticprogesteroneMostpopularnon oralcontraceptiveInjectedintothearmorbuttockmuscleevery3months 30 125perinjectionWorkswithin24hoursFertilityresumes10monthsafterlastinjection HormonalInjectibles 97 99 7 effectiveAdvantages LonglastinginjectionModeratelyexpensiveNoestrogenDecreasedmenstrualflow crampingDecreasedriskofendometrial ovariancancersAllowsforspontaneity HormonalInjectibles Disadvantages Officevisitsevery3monthsIrregularbleedingFatigue dizziness weakness headachesAppetiteincreasesDecreaseinbonedensityRiskofliver cervical andbreastcancersLongreturntofertilityLowusageratesinmanycountries ChemicalMethodsforWomen Spermicides Spermicidescomeasfoams gels suppositories creams foamingtablets films andcapsulesInsertedintovaginawithapplicatororfinger10 30minutespriortointercourse 5 10overthecounterCanalsohelpreduceSTIsLikelytoseemicrobicidesintroducedthatwillprotectfromHIV otherSTIs ChemicalMethodsforWomen Spermicides 71 82 effectiveEffectivenessisreducediftamponsordouchesareusedwithin6 8hoursFoamismoreeffectivethanothervarietiesAdvantages OverthecounterProvidelubricationSomeprotectionfromSTIsNoserioussideeffects ChemicalMethodsforWomen Spermicides Disadvantages UsedeachtimeIncreasedpostcoitaldripMayproduceallergicreactions skinirritationsIncreasedriskofurinarytractinfectionsUnpleasanttasteWidelyusedinsomecountries andnotusedmuchinothercountries IntrauterineMethodsforWomen IUDsandIUSs IntrauterineDevice IUD ParaGardCopperT canbeleftinfor12yearsIntrauterineSystem IUS Mirena IUDthatcontainstime releasedprogestin canbeleftinfor5yearsMostIUD IUSusersare35orolder 150 300plusofficevisit IntrauterineMethodsforWomen IUDsandIUSs IUDs IUSscreateaslightinfectionintheuterusthatobstructsspermmobilityProgesteronefromtheIUSalsoaffectstheendometrium hamperingimplantationHealthcareprovidersinserttheIUDEachmonththewomanmustcheckforthestringtoassureitisstillinplace99 2 99 9 effective lowerifneverpregnant InsertionofanIUD IntrauterineMethodsforWomen IUDsandIUSs Advantages LeastexpensivemethodovertimeAllowsforspontaneityDecreasesmenstrualflow Mirena Longlastingeffects IntrauterineMethodsforWomen IUDsandIUSs Disadvantages NoSTIprotectionRiskofuterineperforationandPIDIrregularbleedingPainfulinsertion removalIncreasedmenstrualflowandcrampingMaybeexpelledfromuterusMaycausediscomforttothepartnerWidelyusedthroughmostoftheworld NaturalMethodsforWomenandMen NaturalFamilyPlanningandFertilityAwarenessWithdrawalAbstinence NaturalFamilyPlanningandFertilityAwareness InvolvesawomanchartinghermenstrualperiodsanddeterminingovulationbydailymonitoringofbasalbodytemperatureandcheckingcervicalmucusBodytemperaturerises0 4 0 8 Fbeforeovulation remainselevateduntilmenstruationCervicalmucusisthin stretchyduringovulation NaturalFamilyPlanningandFertilityAwareness AbstinenceispracticedduringovulationOraformofbirthcontrolisusedduringovulation fertilityawareness MostlyusedbywomenspacingpregnanciesthatarenotasconcernedaboutpreventionOvulationkitscanalsobeused75 99 effective NaturalFamilyPlanningandFertilityAwareness Advantages UsefulifothermethodsarenotacceptableforreligiousreasonsInexpensiveEducatesaboutthemenstrualcycleEncouragespartnercommunicationNosideeffects NaturalFamilyPlanningandFertilityAwareness Disadvantages NoSTIprotectionRestrictsspontaneityLoweffectivenessTakestime commitmentSeveralcyclesneedtoberecordedbeforeitisreliableWidelyusedinmanycountries particularlyCatholiccountries Withdrawal AlsocalledcoitusinterruptusJustbeforeejaculation themalewithdrawshispenisandejaculatesoutsideofthewoman73 96 effectiveSpermmayremaininurethrafrompreviousejaculations impregnatewithoutthemaleejaculatinginsideofthewoman Withdrawal Advantages UsefulifothermethodsarenotacceptableforreligiousreasonsNocostsGoodifcouplesaren tconcernedaboutprevention Withdrawal Disadvantages NoSTIprotectionLoweffectivenessMayleadtoprematureejaculationMaybestressfulRequirestrust restraintWidelyusedinmanycountries Abstinence Refrainingfromsexualintercourse100 effectiveProtectsagainstSTIs Permanent Surgical Methods Awomanmaybefertileuntil50 51yearsAmanmaybefertilemostofhislifeSterilizationinoneofthesafest mosteffectivecontraceptivemethodsSurgerythatistypicallyirreversibleTwotypes FemaleSterilizationMaleSterilization FemaleSterilization Alsocalledtubalsterilizationorgetting tubestied AsmallincisionismadeunderthenavelorlowerintheabdomenBothFallopiantubesareblockedthroughcauterization rings bands clips plugs orclamps orthetubesmaybecutThisprocedureusesgeneralanesthesiaasoutpatientsurgeryorafterchildbirth Essureisapermanentmethodofcontraception FemaleSterilization Awomanstillovulates buttheeggcan tentertheuterus 2000 5000Risks anesthesiasideeffects bleeding infection injurytootherorgansReducesriskofovariancancerMostwidelyusedbirthcontrolmethodintheworld MaleSterilization AvasectomyimpedesthetravelofspermthroughthevasdeferensCheaper safer simplerthantubalsterilizationTwo to inchincisionsaremadeinthescrotumandthevasdeferensissnipped clipped orcauterizedunderlocalanesthesia20minuteprocedureThemanejaculatessemenwithoutsperm Inavasectomy eachvasdeferensisclipped cut orcauterized Avasclipusesaflexibleplasticcliptoblockthevasdeferens MaleSterilization Aftersurgery spermfor20moreejaculationsremainsSpermcountsarechecked2 3monthslatertochecksterility 300 750Risks swelling bruising internalbleeding infection99 99 9 effective Permanent Surgical Methods Advantages HigheffectivenessPermanentAllowsforspontaneityDisadvantages Expensive irreversiblesurgeryNoSTIprotectionWidelyusedthroughouttheworld Abortion TheAbortionDebateWhyDoWomenHaveAbortions AbortionProceduresReactionstoAbortionTeensandAbortionCross CulturalAspectsofAbortion ClassExercise Abortion Afertilizedeggisahumanbeingfromthemomentthespermandeggunite Therightsofthefetusalwaystakeprecedenceovertherightsofthemother Parentalconsentshouldberequiredforteenagersseekingabortion Spousalconsentshouldberequiredformarriedwomenseekingabortion Isupportawoman srighttochooseinanyandallcircumstances Isupportawoman srighttochooseifthepregnancyresultedfromarape Isupportawoman srighttochooseifthepregnancyresultedfromcontraceptivefailure Exercise cont Ibelieveabortionisjustifiedifthewomanfeelsthatsheisnotreadyforthischild Ibelieveabortionisjustifiedifaseriousbirthdefecthasbeendetectedviaamniocentesis Ibelieveabortionisjustifiedifthecouplealreadyhas5childrenandthewomanunexpectedlybecomespregnantagain Ibelieveabortionisjustifiedifparentsoftwoboysdiscovertheyarepregnantagainwithathirdboy andtheywerereallyhopingforagirl Ibelieveabortionshouldbelegal Thereshouldbeamandatory24 hourwaitingperiodforallwomenseekinganabortion Adoptioncouldsolvetheproblemof unwantedchildren TheAbortionDebate Pro LifeversusPro ChoiceHistoricalPerspectivesLegalversusIllegalAbortions Pro LifeversusPro Choice Pro lifesupporters anembryoatanystageofdevelopmentisapersonandabortingafetusismurderPro choicesupporters itisawoman schoiceandthegovernmentshouldnotcontrolherbodyNog