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Contraception
• Variety of methods
• Categorized by methodology
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Barriers
Hormonal methods
Fertility awareness methods
Sterilization
• Contraceptive prevalence (Excel, pdf map) across the world (United
Nations, 2012)
• Contraceptive prevalence by method (United Nations, 2011)
• Contraceptive issues vary across countries
• Contraceptive methods in the U.S. (Guttmacher Institute, 2010)
• Contraceptive methods in the U.S., 1995 vs. 2006-10 (CDC)
Why Does Contraception Matter?
• We (taxpayers) pay
for many unexpected
pregnancies
– How much (Guttmacher Institute)
– Rates of unintended
pregnancy (Guttmacher Institute)
Contraception
Barrier Methods
Barrier Contraceptive Methods
• Physical barriers
– Prevent sperm from
entering cervix
– Block sperm from
fertilizing ovum
Barrier Contraceptive Methods
• Historically, pessaries
used
– Objects or substances
inserted into vagina
– Pregnancy prevention
effectiveness
– Infection effectiveness
• Current barrier methods:
spermicide, male condom,
female condom,
diaphragm, cervical cap,
sponge
Spermicide
• Over the counter
– $0.50-1.50 per application
• Inserted into vagina
• Different forms
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Foams
Suppositories
Creams
Jellies
Film
• New application for each act
of intercourse
• Kills sperm
Spermicide
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Applied 15-60 minutes before
intercourse
– Inserted into vagina near cervix
– Can be messy
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Directions for insertion can vary
Effectiveness:
– Perfect use: 85-94%
– Typical use: 74-85%
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Little disease protection
May irritate vagina
Effect of Coke on Sperm Motility
Mythbusters (1:04-4:00)
Nonoxynol-9
• Ingredient in spermicides
• Originally thought nonoxynol-9 protected against HIV
• In late 1990’s, early 2000’s, nonoxynol-9 was no longer
thought to provide that protection
– Among commercial sex workers in Africa, Thailand
– Frequent use
– Nonoxynol-9 may increase risk for disease transmission
• Increases vaginal irritation, which can lead to lesions/sores
• Lesions typically result in disease transmission vulnerability
• 2007: FDA required manufacturers to provide warning
What Other Active Ingredients
Are There?
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Octoxynol-9
Benzalkonium Chloride
Menfegol
Sodium cholate
Above ingredients may
be difficult to find, not
FDA approved
• Lemon juice
Male Condoms
• Over the counter
• Barrier placed on an erect
penis
• Prevents ejaculate from
entering vagina
• Also used to prevent
disease transmission
• New condom for each act
of intercourse
• Expiration date
Male Condoms
• Variety of colors, sizes, textures
• Latex
– Some individuals are allergic to latex
– Spermicide may worsen allergic reaction
– Free-$1 per condom
• Polyurethane
– More likely to break
• 4% vs .4%
• $1-3 per condom
• Lambskin
– Sheep – intestinal membrane
– Less effective against disease transmission
– $2-5 per condom
• Kitemark Condom Testing (National Geographic, via YouTube; 2:33)
Male Condoms
• Lubricants may be added
– Pre-packaged lubricants or self added
– Oil-based may increase breakage
• Spermicides may be added
– Nonoxynol-9
– Amazon search for condoms & spermicidal
Male Condoms
• Effectiveness:
– Perfect use: 95%+
– Typical use: 85-90%
• How to Use a Condom
( Planned Parenthood, via YouTube)
Female Condoms
• FC2 brand available over the counter
• Made of nitrile (synthetic rubber)
– Older version made of polyurethane (noisier)
• Resembles traditional male condom
– Two rings: closed, open ends
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Inserted prior to intercourse, up to several hours
Prevents ejaculate from reaching vagina
Prevents disease transmission
Not to be used with male condoms
Female Condoms
• Cost: $1.25-$4 per
condom
• New condom for each
act of intercourse
– WHO developed a
protocol for re-use in
2002, but still
recommends new
condom for each use
World Health Organization. The safety and feasibility of
female condom reuse: report of a WHO consultation (PDF, 194
KB). Unpublished paper. (World Health Organization, 2002b)1415.
Female Condom
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Cost: $1.25-$4 per condom
Effectiveness
Perfect use: 95%
Typical use: 75-80%
– Alabama STI study, 1990s
– 11% slipped during first use
– 3% slipped after practice &
nurse’s assistance
– < 1% slipped if used more
than 15 times
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Source: Guttmacher Institute, Perspectives
on Sexual and Reproductive Health, Vol.
37, Number 2, June 2005
Female Condom
• In 2008, experimental study
showed skills training increased
likelihood for female condom
use [San Francisco area; four-session
trainings; AJPH: 98 (10) ]
• Animation (Female Health Company,
via YouTube)
• Although approved by FDA for
disease protection in vaginal
intercourse, the female condom
has also been used for
protection during anal sex
– FC for MSM (YouTube, signin required)
Female Condom Removal
http://www.femalehealth.com/theproduct.html
Female Condom Global Use
• Largely coordinated by PATH (Program for Appropriate Technology
in Health)
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Sustainability
Culturally relevant
Health improvement
Headquarters in Seattle, WA
PATH female condom version
• PATH version research: Thailand, Mexico, South Africa,
Seattle
• Sold production to China company
• Female condom promotion research across world, esp in
Africa
Female Condom Global Use
• At right = O’Lavie
condom, Dahua
Medical Company,
previously created by
PATH
• Panty condom
• Other female condoms
in production (Female Condoms
Market Intelligence)
Diaphragms
• Requires fitting in a clinic
• Made of latex or silicone
• Variety of styles
(cervicalbarriers.org)
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Ortho All-Flex no longer available
Milex available
• Refits are necessary
– Significant weight change
– Childbirth
– When new diaphragm
needed
– If diaphragm slips/feels
uncomfortable
Diaphragms
• Inserted up to two hours before intercourse
• Spermicide applied
– New spermicide application for each act of intercourse
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Leave diaphragm in for six-eight hours
Blocks sperm from entering cervix
Spermicide kills sperm
Effectiveness (via Planned Parenthood):
– Perfect use: 94%
– Typical use: 78%
Diaphragms
• Video (Illumistream
via Youtube, 0:411:45)
• Toxic shock syndrome
• May increase risk of
urinary tract infections
Future Diaphragm: Caya (formerly SILCS)
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Researched by PATH
No fitting required
Silicone
Per PATH, color was important
component across cultures in
feedback
• Research in Thailand & South
Africa showed women could
easily use Caya
• Plan is to offer Caya in Europe
and U.S.
– FDA granted market clearance in
9/2014 (PATH.org)
– Available within year (?)
• Video (through 4:15)
Cervical Caps
• Traditional cervical cap was
Prentif; no longer available
• Four sizes, smaller than
diaphragm (thimble size)
• Required fitting
• More difficult to insert
• Like diaphragm, required
spermicide application, could
be inserted a couple hours prior
to intercourse, removed hours
afterward
• More spermicide with each act
• Effectiveness: 91/60-80%
Current Cervical Caps: FemCap
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FDA approved in 2003
Made of silicone
Three sizes
Inserted prior to
intercourse, with
spermicide
More spermicide with new
act of intercourse
Can remain in place
Women should not be able
to feel FemCap
TSS
Cervical Caps: FemCap
*FemCap™ with removal strap: ease of removal, safety and
acceptability
Christine K. Mauck,a,* Debra H. Weiner,b Mitchell D. Creinin,c David F.
Archer,d Jill L. Schwartz,c Helen C. Pymar,c Susan A. Ballagh,d Deborah
M. Henry,d and Marianne M. Callahana Contraception. 2006 January;
73(1): 59–64.
• FemCap blocks sperm from
entering cervix
• Spermicide kills sperm
• Cost: $0-75 (Planned Parenthood)
• Video (via YouTube, 7:00)
• Effectiveness: PP does not
provide “perfect use”
statistics; typical
effectiveness: 71%
• Increased risk for slippage,
difficult removal vs.
diaphragm*
• Replace in two years
The Sponge
• Polyurethane foam
• Non-oxynol-9 spermicide
within foam
• Loop on bottom side of
contraceptive
• Today sponge has been on
and off the market since
1995
– Distributed again in May
2009 via Mayer Labs
(Alvogen owns rights)
The Sponge
• Cost: $0-15 for three-pack
• Effectiveness: 91% with perfect use, more
typically 76%
• TSS Risk
(Planned Parenthood)
Contraceptive Methods:
Advantages & Disadvantages
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Effectiveness
Side effects
Availability
Reliability
Accessibility
• Cost
• Suitability/appropriate
ness
• Education/awareness
• Religion
• STI