Population explosion and sexually transmitted diseases are the burning issues in India and many countries in the world from the past 5 decades. Contraceptive usage has been promoted by many government and private health organizations to counteract these issues. Besides the control of population, contraceptives ensure the safe sex practices that can prevent many STDs( Sexually transmitted diseases). A contraceptive is a barrier that blocks the fusion of sperm with the ovum. Contraceptives can be temporary or permanent applications available in a variety of options for both males and females. “Contraceptives or birth control methods are those that are used deliberately to prevent fertilization”.
Characteristics of a good contraceptive
A contraceptive device must be easy to use (user-friendly).
Cheap and easily accessible/available from any outlet.
Must have least to no failute rate.
Must be available with tolerable side effects or no side effects at all.
They must not interfere with sexual pleasure of the prospective couple.
Depending upon whether the couple wants to space( increase the gap between 2 children) or to permanently stop the conception, contraceptives are divided into temporary and permanent methods. A wide variety of contraceptive devices available in the market however, people need to be educated about their uses, drawbacks, and precautions. As each individual preferences of couples vary, the health care professionals should counsel, guide and facilitate the contraceptive devices after carefully analysing the requirement from the couple. Let us understand the basic aspects of contraceptives devices.
Types of contraceptive devices
A great variety of contraceptive devices are available in the market , however, one can decide the best possible option by carefully weighing their cost, risks, benefits and effectiveness. Moreover, the choice is also determined by the budget, effectiveness, and purpose of contraception, . Most commonly used devices are classified as :
Barrier methods like IUDs (intrauterine devices)
Medicinal methods like oral contraceptives, injectable devices,
Permanent hormonal implants
Surgical methods such as vasectomy and tubectomy
A. Natural methods of contraception
1. Calendar method : There are many natural methods, one of which is the calendar method.It is relatively safe and easy. Calender method is nothing to do with the insertion of devices or medicines as they work on the principle of blocking the the contact between the sperm and ovum on the day of ovulation. It is a mathematical formula by calculating the approximate date of ovulation of a women, therefore, it is important to understand the phases of menstruation before using this method. The menstrual cycle is divided into 4 secretory phase, proliferative phase, ovulation phase and the regeneration phase , out of which, ovulation is the critical period responsible for fertilization. Therefore, 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 leaving behind the 14 days at the middle of the calendar.
2. Coitus interruptus or withdrawal method:
In this method, the penile end is withdrawn just before the ejaculation of sperms. By doing this , it prevent the entry of sperms inside women’s reproductive system. Ejaculation is the release of semen from the male reproductive system. However, it is not a completely reliable method as the pre-ejaculatory fluid may contain some sperms which can enter the female`s system before withdrawing the penis.
3. Locational amenorrhoea (absence of menstruation):
This works on the fact that prolactin released during the breastfeeding suppresses the hormones responsible for reproduction in women. The prolactin found in the milk will suppress the action of estrogen and progesterone, as a result, fertilization cannot happen if the women is under breast feeding phase. But, practically, this method will be effective only up to 6 months from the day of childbirth, after which, the action of estrogen and progesterone become active despite she is 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 hindering the contact between the sperm and ovum. A good barrier technique aid in avoiding the fertilization. Some of the barrier methods available for both males and females are;
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. They are cheaper and effective methods, however,10-14% of the times they can fail. They are also a great way to prevent STDs.
2. 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 is effective when used with a spermicide that kills sperms. The rate of failure is 16% hence they must be used cautiously. 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. 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 follow-up.
Adverse effects and disadvantages of IUDs
Irregular bleeding from the vagina for weeks to several months
Absence of menstruation( amenorrhea).
Premenstrual syndrome (PMS) showing symptoms of headaches, vomiting sensation, tenderness of breast skin discolouration
Rarely the device can expel or fall out of its place.
In extremely complicated cases, uterine perforation with heavy bleeding may be observed.
Pelvic inflammatory disease (PID), is seen when IUD s are inserted under an unclean condition.
Types of IUDs
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
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. 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 as they are irreversible in nature. In other words, once they are done, they cannot be removed in the future. Surgical intervention on the fallopian tubes (females) or vasadeference (in males) can permanently block the gamete transport and implantation thereby preventing 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.
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 the lack of knowledge about the use of devices and the cultural stigma surrounding the contraceptives. 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 is so high. Fair usage of contraceptive devices has largely helped in spacing and permanently controlling the new births.
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.