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Christopher J. Murphy
Contraception, more commonly known as birth control, refers to any number of methods or procedures used to prevent pregnancy and sexually transmitted infections (STIs). Women and men have used methods of birth control since ancient times. This includes withdrawal and forms of abortion. Today, there are many methods and procedures at women’s and men’s disposal that prevent pregnancy and the risk of contracting an STI. When choosing a contraceptive method, women and men must discuss all possibilities regarding their sexual health. Some of the most effective methods are sterilization and the use of intrauterine devices; followed by hormone replacement methods such as injections, medicated rings, and patches; less effective methods of contraception include condoms and other barrier methods; last, “pulling-out” or withdrawing is the least effective method. Specifically, I will discuss the female condom, transcervical sterilization, abstinence, and the contraceptive patch. For each method of contraception, I will discuss its history, effectiveness, convenience, side-effects, and cost.
Created as an alternative to the traditional male condom, the Female condom is a female-initiated form of contraception aimed to prevent pregnancy and reduce sexually transmitted infections, STIs. Currently, there are two versions of the female condom on the market; the original female condom and FC2. The original female condom, approved in 1993, is a polyurethane sheath with rings on either end. Either the female or the male inserts the closed end so it covers the cervix and the other, open, end covers the vulva. Though this condom allowed intercourse for those with latex allergies, the noises produced caused some discomfort for both partners. Consequently, researchers created the FC2 in 2009. FC2’s material is thinner, the rings are softer, and is less noisy overall. Since this form of contraception is female-initiated, the female can insert the condom up to 8 hours before intercourse. Per Hoffman, Mantell, Exner, & Stein (2004), “more than 90 developing countries have introduced the method through public distribution, social marketing campaigns or commercial outlets” (p. 120). Funding and support for this project came from public and private funders, the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the manufacturers of the female condom. Accordingly, several countries that had high STI rates such as South Africa, Brazil, Ghana, and Zimbabwe, showed increased female condom when the government promoted and distributed the product.
In Alabama, 1,159 STD clinic clients received a promotional package for the female condom. Nurses supervised these women while they practiced inserting the condom. After proving they could properly insert the condom, nurses gave the women take-home materials. After 6 months, the episodes of condom-protected intercourse went from 40% to 50%. Admittedly, this study did not have a control group where the women did not receive the materials. However, the increase of protected intercourse over a six-month period proves that the female condom was influential for couples actively using protective measures.
One barrier to continued use of female condoms is the price. It costs roughly 60 cents to produce the female condom whereas the male condom costs less than 4 cents. Some brands have the female condom priced at around $4 a piece; certain brands of male condoms sell several in a pack for the same price. This price difference is why most sexual health organizations distribute male condoms more widely than female condoms. Another barrier is the ease of use. Some women are not comfortable enough insert the condom and others do not insert the condom properly. The text, “Exploring the Dimensions of Human Sexuality” distinguishes between perfect use and typical use. Clinicians determined these measures by looking at the number of women out of 100 who will become pregnant within a year of using the contraceptive. Perfect use is the ability of the method to prevent pregnancy through consistent and correct use, often by or under the supervision of a professional. Typical use is the ability of the method to prevent pregnancy when the individual uses the method at home, unmonitored. Perfect use of the female condom is 95% effective in preventing a pregnancy. In contrast, the typical use is lower, at only 79% effectiveness.
Sterilization is a form of birth control that renders a person biologically incapable of producing offspring. Both men and women can choose to become sterilize; however, individuals age 35 and older usually undergo the procedure more than younger individuals. This method is highly effective. According to Exploring the Dimensions of Human Sexuality, only 1 woman out of every 1000 sterilized women become pregnant and only 1 in every 2000 sterilized men cause a pregnancy. This discrepancy is often because those individuals fail to go back to their physician for a follow-up exam to make sure that the procedure was successful. Generally, sterilization is permanent and irreversible.
Two forms of sterilization for women are the Essure and Adiana transcervical systems. Per Palmer & Greenbert (2009), “a microinsert is placed into the interstitial portion of each fallopian tube under hysteroscopic guidance” (p. 85). For Essure, contains 3 to 8 (at the most 18) coiled stainless steel rings, polyethylene terephthalate (PET), and nickel-titanium (nitinol). PET fibers are known to cause an ingrowth of tissue into medical devices because surgeons use PET fibers when they place stents for procedures such as arterial grafts. First, a surgeon places the coils in the proximal fallopian tube. Then, the surgeon expands the device and anchors it within the tube. PET fibers begin to stimulate a benign tissue response and within several weeks, fibrotic growths cause tubal occlusions. Afterward, women who had Essure placements must confirm the placement after 12 weeks by their physician. Doctors suggest using backup contraception until they confirm the proper placement. “Combined data from the phase II and pivotal trials demonstrate no pregnancies in 643 study participants who contributed 29,357 women-months of follow-up, with an average surveillance time of 52.9 and 42.5 months, respectively” (Palmer & Greenbert, 2009, pp. 86-87). Though no pregnancies occurred in the Palmer and Greenbert study; from 1997 through 2004, 37 users worldwide reported their pregnancy to the manufacturer.
Adiana sterilization involves lesioning the lining of the fallopian tubes followed by insertion of a nonabsorbable biocompatible silicone elastomer matrix. As with the Essure placement, over several weeks, fibrotic growths cause occlusions in the fallopian tubes. The women must use other forms of contraception until the doctor confirms placement after 3 months. From 1998 to 2001, there were no major adverse events reported from the trials of Essure Although patients mentioned perforations in 2.8% of the cases; the surgeon was able to fix the issue.
For Adiana, the only significant complications were cases of hyponatremia. The doctor gave these women a diuretic which relieved the symptoms. Removal of Essure and Adiana requires a skilled surgeon should the woman want the devices removed. Women must make sure they want this procedure because reversing a sterilization is costly and the failure rate is high.
People define abstinence in several different ways. Some do not engage in sexual activity at all and others describe how they limit their sexual activities. Abstinence proves to be the only method of contraception and STI prevention that is 100% effective. If you do not engage in sexual activities, you are less likely to get pregnant and contract an STI. Per Exploring the Dimensions of Human Sexuality, the only government sanctioned method of reducing the pregnancy and STI rates of teens is Abstinence only until marriage. The government spent over $1.7 billion on sexuality education. However, the programs seem to ignore the effectiveness of other forms of contraception.
The text also mentions that teens often sign virginity pledges. Results show that those who signed the pledges were just as likely to engage in sexual acts as those who did not sign the agreements. Additionally, those who signed the pledges were less likely to use other forms of contraception, less likely to get tested for STIs, and may have the infections for longer than those who did not sign the pledges.
Only one abstinence-only program shows some progress. This program delays sexual activity “until a later time in life when the adolescent is more prepared to handle the consequences” (Greenberg, Bruess, & Oswalt, 2017, p. 193) of engaging in intercourse. Even though abstinence is the least costly and easiest form of contraception to use, it is difficult to practice consistently due to temptation.
Ortho Evraâ„¢, the first contraceptive patch, became available in the United States in 2003. The patch releases a steady dose of estrogen and progestin through the skin. Though the patch holds enough hormone for 9 days, clinicians suggest the user only wear the patch for 7 days. Generally, the user wears the patch for 3 weeks followed by a patch-free week. This patch free week is so menstruation can occur. Per Exploring the Dimensions of Human Sexuality, the patch is equally effective as oral contraceptives. It has a 99.7% effectiveness when used perfectly and 91% for typical use. Though the patch prevents pregnancy, there are some disadvantages that comes with use.
Clinicians recommend that the patient uses another method if she weighs more than 198 pounds. Some patients even experience some headaches, nausea, and skin reactions. Some individuals report fears that the effects of heat and vasodilation will increase hormonal responses for those who wear the patch. However, a study done by Abrams, et al. (2001) states that Ortho Evraâ„¢ delivers continuous concentrations of hormones even under conditions of heat, humidity, and exercise. The mean serum concentrations of the hormones were unchanged during the study. However, there were cases where serum levels showed increased concentrations of hormone after a placing a new patch on the skin. For the first two days, of which the woman exercised, tests showed elevated serum levels. However, the levels dropped to typical concentrations for the remaining 5 days of patch use.
The Ortho Evraâ„¢ patch costs around $40 a month depending upon the doctor’s prescription. The woman must also undergo a physical examination to receive the prescription. Health insurance companies usually cover these expenses. Users can place the Ortho Evraâ„¢ patch on the lower abdomen, upper arm, buttocks, or the upper torso. It is ill-advised to place the patch on or near the breasts. The patch offers no protection against STIs so it is wise to use other forms of contraception in addition to the patch.
Abrams, L. S., Skee, D. M., Natarajan, J., Wong, F. A., Leese, P. T., Creasy, G. W., & Shangold, M. M. (2001). Pharmacokinetics of Norelgestromin and Ethinyl Estradiol Delivered by a Contraceptive Patch (Ortho Evraâ„¢/Evraâ„¢) under Conditions of Heat, Humidity, and Exercise. The Journal of Clinical Pharmacology, 41(12), 1301-1309. doi:10.1177/00912700122012887
Delavande, A. (2008, July 23). PILL, PATCH, OR SHOT? SUBJECTIVE EXPECTATIONS AND BIRTH CONTROL CHOICE. International Economic Review, 49(3), 999-1042. doi:10.1111/j.1468-2354.2008.00504.x
Greenberg, J. S., Bruess, C. E., & Oswalt, S. B. (2017). Contraception. In EXPLORING THE DIMENSIONS OF HUMAN SEXUALITY (6 ed., pp. 190-221). Jones & Bartlett Learning.
Hoffman, S., Mantell, J. E., Exner, T., & Stein, Z. (2004, October). The Future of the Female Condom. International Perspectives on Sexual and Reproductive Health, 30(3), 139-45. doi:10.1111/j.1931-2393.2004.tb00200.x
Landry, D. J., Kaeser, L., & Richards, C. L. (1999). Abstinence Promotion and the Provision Of Information About Contraception in Public School District Sexuality Education Policies. Family Planning Perspectives, 31(6), 280-286. Retrieved February 2017
Mosher, W. D., Martinez, G. M., Chandra, A., Abma, J. C., & Wilson, S. J. (2004). Use of Contraception and Use of Family Planning Services in the United States: 1982-2002. Factsheet, Centers for Disease Control and Prevention, Division of Vital Statistics. Retrieved February 2017
Palmer, S. N., & Greenberg, J. A. (2009, February). Transcervical sterilization: A comparison of Essure permanent birth control system and Adiana permanent contraception system. Reviews in obstetrics and gynecology, 2(2), 84-92. Retrieved February 2017
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