Contraceptive devices

Introduction to contraceptive devices

Population explosion and sexually transmitted diseases have been the burning issues in India since the 1960s. Keeping these 2 issues in mind, contraceptive usage has been promoted by many government and private health organizations.  A contraceptive is a barrier that blocks the fusion of sperm with ovum Contraceptives can be temporary or permanent applications used for both males and females. “Any birth control method used deliberately to prevent fertilization is called contraception”.

 

Table of Content

1. Introduction to contraceptive devices

2. Characteristics of good contraceptive

3. Common contraceptive methods

4. Types of contraceptive devices

    4.1 Natural/Traditional methods

    4.2 Barrier methods like IUDs (intrauterine devices)

    4.3 Medicinal methods like oral contraceptives, injectable           devices.

    4.4  Permanent hormonal implants 

    4.5 Surgical methods such as vasectomy and tubectomy

5. Need for contraceptives

Characteristics of good contraceptive

  1. It must be easy to insert and user-friendly

  2. Cheap and easily accessible/available from any outlet.

  3. Easily available

  4.  Must have tolerable side effects or no side effects.

  5.  They must not interfere with sexual drive.

 

Common contraceptive methods

Depending upon whether the couple wants to space( increase the gap between  2 children) or to permanently stop conception, contraceptives are of 2 types; temporary and permanent methods. In addition to birth control, one of the most chronic and dangerous disease categories is STDs, hence, contraceptives are a must to safeguard from STDs.There are a wide variety of contraceptive devices available and people need to be educated on their uses, drawbacks, and precautions. Types of contraceptives are explained as under.

 

Types of contraceptive devices

 A number of contraceptive techniques are being under practice, out of which, few are effective and safe than others. Contraception is a personalized choice depending upon what couple aspire becasue some of the methods focus solely on birth control whereas majority of the devices help in controlling STDs also. Depending upon the budget and purpose, they are grouped into

  1.  Natural/Traditional methods

  2. Barrier methods like IUDs (intrauterine devices)

  3. Medicinal methods like oral contraceptives, injectable devices,

  4.  Permanent hormonal implants 

  5.  Surgical methods such as vasectomy and tubectomy

Different methods of contraception

 

 

A. Natural methods of contraception

calendar method :

Natural methods are safe and easy. They are nothing to do with the insertion of devices or medicines, instead, they work on the principle of prohibiting the contact between the sperm and ovum. There are many natural methods, one of which is the calendar method that works on a mathematical formula. Menstruation is divided into 4 phases,  ovulation is the critical period where the ovum is released from female system. In a calendar method, the couple should be advised to avoid intercourse during the ovulation period. According to the calendar method, the safest period for intercourse is the 1st 7 days and the last 7 days of the menstrual cycle, this is because ovulation generally happens during these 2-time slots.

Coitus interruptus or withdrawal method:

In this method, the penile end is withdrawn just before the ejaculation of sperms. Ejaculation is the ejection of semen from the male reproductive system. This will prevent the entry of sperms inside women’s vagina, however it might fail sometimes because very sperms present in the pre-ejaculatory fluid can enter the female`s system.  

Locational amenorrhea (absence of menstruation):

This is an automatic process occur as a result of breastfeeding. The prolactin found in the milk will suppress the action of estrogen and progesterone, as a result, fertilization cannot happen. But, practically, this method will be effective only up to 6 months from the day of childbirth, after which, estrogen and progesterone become active despite the feeding.  The advantage of this method is that, it has no adverse effects as the couple will not be using any sort of medicines. 

 

B. Barrier methods

Barrier methods work on the principle of not allowing the sperm and ovum to come in contact. This will ensure they don’t get fertilized. Barrier methods are available for both males and females.

Condoms :

Condoms are widely used barriers that prevent fertilization. Condoms are made up of a thin, transparent, smooth rubber latex sheath that is used to cover the penis of the male or vagina and cervix of the female. Condoms will not allow the entry of the ejaculated semen into the female reproductive tract.  Condoms are cheaper and effective methods, however,10-14% of the times they can fail.  Condoms are a great way to prevent STDs.

Cervical diaphragms, caps and sponges:

The cervical diaphragm is a small, flexible rubber cup-like structure inserted into the vagina to fit over the cervix. It should always be used with spermicide that kills sperms. There are chances that 16 out of 100 users may get pregnant per year. The cervical cap (Fem Cap) is a small, bowl-shaped latex or silicone cup. It is inserted into the vagina and fits snugly over the cervix. The cervical cap is similar to the diaphragm but smaller in size. The sponge is a disposable device, made of soft foam containing spermicide but the failure rate is as high as  24%.

 

C. Intra-Uterine Devices (IUDs).

The IUDs are excellent, effective and safer. They are one-time investment does not require long-term followup.

Adverse effects of IUDs

  1. Irregular bleeding from the vagina for weeks to several months

  2. Absence of menstruation.

  3.  Premenstrual syndrome (PMS) having symptoms of headaches, vomiting sensation, tenderness of breast skin discolouration

  4.  Rarely the device can expel or falls out of place.

  5. Sin extremely complicated cases, uterine perforation with heavy bleeding is seen.

  6. Pelvic inflammatory disease (PID), is seen when IUD s are inserted under an unclean condition.

  7. IUDs can be non-medicated or medicated ones.

 

1. Non-medicated IUDs

They are made of plastic or stainless steel. The most common one is the  Lippes loop made up of polyethene. Many copper IUDs are available in the market. Some of them are Copper-T, CuT-380 A, Multiload- CuT -380A,  CuT-380-Ag,CuT 380,  Multiload -375  etc. Copper-T is a t shaped device inserted through the vagina that fits the fallopian tube and uterus so that there is no space for fertilization.

 

2. Medicated/Hormone-Releasing IUDs

1. Progestasert is a T- shaped IUD made of ethylene and vinyl acetate copolymer containing titanium dioxide. The vertical stem contains a reservoir of 38 mg progesterone together with barium sulfate dispersed in silicone fluid. The progesterone is released at the rate of 65 µg per day.

2. LNG - 20 (Mirena) - This is also a T-shaped device that has a collar attached to vertical arm. It is medicated with 52 mg of levonorgestrel. It releases 15µg of levonorgestrel per day that will not allow fertilization. It works best for up to 10 years.

 

D. Oral pills

Oral pills have to be taken daily over 21 days of the entire menstrual period starting from the 5th day of the Menstrual Cycle. The pills act on the surface of the mucus layer of uterus and ovaries to inhibit ovulation and implantation of fetal products. It also acts by altering the quality of cervical mucus to prevent the entry of sperms into the female system. Pills are very effective with fewer side effects and are well accepted by the females. Estrogen and progesterone pills are taken at different doses individually or in combination. Estrogen can also be used in the form of injections or implants under the skin. Subcutaneous or intradermal implants (between the skin layers) also have a similar mode of action as that of oral pills but the implant releases the hormone in a sustainable manner.

 

E. Permanent methods (surgical methods) or sterilization

These are decided based upon whether the couple wants children in the future or not because once these are done, they cannot be reversed. Surgical intervention on the fallopian tubes (females) or vas deference (in males) can permanently block the gamete transport and implantation thereby prevent conception. There are 2 types of permanent sterilization; vasectomy for males and the tubectomy for females. Vasectomy is the removal of a small part of the vas deferens through a small incision along the scrotum. Tubectomy is the removal of a small part of the fallopian tube and then ligating (stitching the ends) through a small incision on the abdomen. These techniques are highly effective but careful decision must be taken as the future chances of childbearing is completely lost. After the surgery, there may be pain and swelling in the area along with Infection.

 

Need for contraceptives

1.Use of contraceptives to control population explosion ( birth control measure)

There has been a surge in the total world population for the last 2 decades. This is closely linked with a lack of knowledge and cultural stigma that the use of contraceptives is not acceptable behaviour. The total global population was around 2 billion (200 crores) in the year 2000. At present, it has gone up to 6 billion with India`s share being almost a quarter of the world population. Indian population by far, very much advanced because the ratio at which the Indian population has raised very high. At the end of the last century, the Indian population in the 1950s was around 35 crores which became 3 times 350 million by 2000. The current population is 3 times the population when compared to 2000. Imbalance in the death rate and birth rate is the major factor that is causing population explosion in India, the rates could be maternal mortality rate (MMR) and infant mortality rate (IMR). Uncontrolled growth of population could lead to various unwanted effects like exploiting the resources beyond the limit which includes but not limited to the crude materials, animal products, plant sources, etc. Human activity is a bane because it creates a huge imbalance in the demand and supply of resources which eventually causes pollution and ecological imbalance. Precisely, deforestation, dehydration of groundwater, excessive hunting of animals and cutting of commercial trees lead to the extinction of species. Although the RCH programs are not directly linked with these problems they can have an impact by reducing the population growth so that demand and supply chain will be in balance. The birth rate of India at present is 1.19% against 1.7% in the 1990s which is due to the awareness and availability of contraceptive devices.

2. Contraceptives as  protective devices against STDs

Apart from population explosion, there is a growing concern over sexually transmitted diseases like HIV, Gonorrhea, syphilis, and hepatitis. Contraceptive devices like condoms can be highly beneficial in creating a barrier.



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