Contraception

CONTRACEPTION is prevention of unplanned pregnancy during accidental or regular sexual life. Humanity has been facing contraception problems since ancient times. Even in antiquity there were attempts to use some methods of contraception.

The problem of contraception sooner or later arises for all people who lead sexual life and think about their future.

Many men and women, especially young ones, use no contraceptives, relying on luck. Others share paradoxical beliefs about conception probability like “if a girl doesn’t have an orgasm there would be no conception”, “pregnancy cannot occur after the first time”, “if you make love very often conception won’t happen”, and many others. However this is very risky practice.

Modern medicine has an arsenal of contraception methods and devices. This allows to choose a method of pregnancy prevention that suits the needs of virtually any couple.

Ideally the contraception method should be chosen by a gynecologist. However every woman who lead or is preparing to sexual life should know advantages and disadvantages of various contraception methods.

There is only one ideal method of contraception – total sexual abstinence. All other cases require some kind of compromise, depending on needs or situation of a certain couple. Unfortunately no method guarantees 100 % contraception so it is sometimes necessary to choose the lesser of two evils.

Today there are a lot of contraception methods. The main of them are barrier (mechanical), chemical, hormonal and intrauterine contraceptives.

Barrier contraception

Traditional methods of barrier contraception are:

    * Condoms

    * Cervical caps

A condom is a male mechanical contraceptive for prevention of pregnancy, infection with venereal diseases and AIDS.

Condoms are most popular contraceptives in the world. This is caused by their simplicity in use, cheapness, and high efficiency in prevention of pregnancy and STD.

Condom is a thin latex sheath that tightly fits the penis when unfolded. Condom is covered by special lubricant that makes penis introduction into vagina easier. Condoms vary in shape, size, color, thickness of latex, and various embellishments and appliances that are considered to increase a woman’s pleasant sensations during sexual act. However it is necessary to remember that most often all condom embellishments negatively influence their reliability.

Folded condom should be put onto erected penis prior to sexual act in such way that the closed end is free to gather the sperm. After that it is recommended to smear the condom with some spermicidal substance (e.g., gramicidin paste). With good mutual adaptation of partners the condom put on before the sexual act causes no negative reactions and can increase the duration of sexual intercourse. Main disadvantages of condoms are weakening of sexual feeling of one or both partners, possibility of its rupture, possibility of allergic reactions on latex (rarely).

When used correctly, condoms are very reliable contraceptives. Their efficiency is about 95 % and increases to 99 % if used together with spermicidal lubricants. Additional advantage of latex condoms is their preventive action against STD which is very important for people who lead irregular sexual life and have many partners. Condoms prevent infection with STD by 90 %.

Cervical caps

A cap tightly closes cervix of the uterus. It can stay inside for 48 hours. This enables to enjoy the spontaneity of sex because there is no need to use additional contraceptives like creams, foams, etc. Cervical caps are not widely used because they must be introduced by a doctor.

The main disadvantage of this method is the necessity of its correct use during sexual act which is not always possible. Individual selection of cap and diaphragm should be done by a specialist. The method’s advantage is low probability of side reactions. As for spermicides that are introduced into vagina immediately prior to sexual act, they are quite effective, especially when used in combination with condoms. This approach is a cheap, effective and safe contraception method.

Chemical contraception

Chemical contraceptives that have appeared recently on our market are a unique combination of contraceptives, antimicrobic and antiviral drugs.

This group of contraceptives is also known as chemical vaginal contraceptive substances. It mainly consists of vaginal suppositories.

They create high acidic medium in the vagina that hurts or kills spermatozoa that get into it and make conception improbable.

Because of high diversity of this group of preparations it is necessary to carefully study the instruction before using the spermicidal suppository. In any case they have to be introduced into vagina immediately before the sexual act. The efficiency of these preparations is up to 95 % if they are used properly. However usually it is lower because of peculiarities of their usage. In additions preparations of this group usually have low keeping time.

The main advantage of vaginal suppositories is complete absence of side effects apart from possible allergy for the components of a preparation. At the same time there is data that confirms that the risk of transmission of STD is slightly lower when using vaginal suppositories (however they do not provide reliable protection against these diseases).

Hormonal contraception

Hormonal contraceptives consist of:

    * Contraceptive pills

    * Hormonal plasters

    * Hormonal ring.

Contraceptive pills (oral contraceptives)

Oral contraceptives have become part of modern women’s life. However their usage is still accompanied with incorrect ideas about their mechanisms of action and possible problems caused by these preparations.

Oral contraceptives are considered the most effective non-surgical method of pregnancy prevention. If all instructions on their intake are observed, only one of 10,000 women gets pregnant. Even taking into account all cases when a woman forgets to take the pill (not more than 5 pills and not in a row), the method’s efficiency is over 99 %.

Oral contraceptives promote thickening of the mucous coat of cervical canal. This impedes spermatozoa movement and significantly decreases conception probability.

The pills are taken in series for three weeks during menstrual cycle. Some packages contain 7 pills without hormones to make women get used to take a pill every day. If you forget to take the pill, take it immediately when you remember about it even if this means you have to take two pills on the same day. However it is possible only once for one pills package. If you forget to take two pills during one menstrual cycle you should use an additional contraceptive.

Contraceptive pills can cause breast pain, headache, weight gain and feeling of inflation. Nausea and blood-tinged discharge between menstruations can also appear. After two or three cycles of pills intake these side effects usually diminish. In some cases pills have positive effect. Some women experience more regular and painless menstruation, its duration decreases.

Hormonal plaster

HORMONAL PLASTER is a very thin and smooth piece of plaster (20 sq. cm) used to prevent pregnancy. It is glued to one of four areas (buttocks, breast, shoulder, abdomen) once a week for three weeks in a row, after which a break should be made.

The plaster releases a constant doze of hormones (luteosterone and oestrogen) that detains ovulation so the ovary does not release an ovule that can be fertilized. The plaster also changes discharge from the cervix of the uterus that impedes sperm introduction into uterine cavity.

Advantages of this method lie in absence of necessity of everyday manipulations and lack of any impact on the liver and therefore, of any side effects.

The disadvantage of the plaster is the possibility of its coming off, local side reaction and lack of protection against HIV infection.

Hormonal ring

When it is said about modern contraception methods, hormonal ring gets mentioned in increasing frequency. Many women know a lot about contraceptive pills but hormonal rings are virtually unknown to them.

The new method was proclaimed a breakthrough in contraception. It is convenient in usage, contains low dose of hormones that are released constantly and evenly so there are no such hormonal leaps as during intake of contraceptive pills. The contraceptive is applied locally and does not pass through the gastrointestinal tract therefore decreasing the probability of side effects. In addition, women need to remember about it only once a month.

Hormonal ring is a flexible transparent circle. A woman places it into her vagina by herself and forgets about it for three weeks. During this time the ring constantly releases into blood the hormones in low concentrations that prevent ovule going out from ovaries (ovulation) and provide stable contraceptive effect. After three weeks the ring is removed and menstruation starts. In a week a new ring is placed into the vagina. During this break the contraceptive effect remains.

This form of contraception can be very convenient because many women often forget to take the pill in time and then panic because of this. In addition such way of contraception does not involve hormones passage through stomach and liver thus reducing the probability of side effects.

Like with a tampon, it is possible to do sport exercises and visit a bath with the ring. Doctors recommend removing the ring temporarily before sexual act but many women make sex without removing it.

Intrauterine contraception

Intrauterine contraception includes loops that are introduced into the uterus.

Loops are small plastic devices introduced into the uterus of a woman. Some loops contain copper or hormones that are released cyclically. It is considered that they prevent conception by not allowing the impregnation of ovule or its implantation into the uterus.

Exact mechanism of intrauterine loops action is still not known completely. The doctor introduces the loop through the vagina and cervix of the uterus into the uterine cavity. It is better to be done during menstruation. This period is ideal because it is known exactly that the woman is not pregnant.

The loop has a thin plastic thread that goes through the cervix of the uterus to the vagina. The woman should check the thread after each menstruation to confirm that the loop is in place.

This method is appropriate for women who already have children and not plan to have others, with one sexual partner.

Endocrine disturbances in gynecology

Endocrine disturbances in gynecology declare themselves as:

    * Menstrual cycle disturbance

    * Ovarian cyst

    * Uterine fibromyoma

    * Polycystic ovary

    * Adenomyosis

    * Endometriosis

Menstrual cycle disturbance

Any disturbances of menstrual cycle indicate some disturbances in sexual or endocrine system of the female organism and therefore are the reason to visit gynecologist and examine the organism.

Normal menstrual cycle consists of 21-35 days. The cycle should be regular, duration of bleeding should not exceed 5-7 days, and blood loss should be not more than 80-100 ml. Everything beyond these limits is considered a disturbance: absence of menstruations, too frequent and too rare menstruations, painful menstruations, too voluminous menstruations, intermenstrual haemorrhage and so called premenstrual syndrome (PMS).

All these menstrual cycle disturbances have similar reasons. They can be caused by change of hormonal background because of gynecological and endocrine diseases, improper feeding, insufficient or excess weight of the woman. Menstrual cycle disturbances can be caused by neoplasms in female sexual tract (cysts, polyps). In this case menstrual cycle is disturbed regardless of the fact whether these neoplasms are benign or malignant. Disturbances can also be caused by inflammatory process in the vagina or cervix of the uterus. Other reasons are also possible, such as usage of inappropriate oral or intrauterine contraceptives, change of climate, strong overfatigue or stress.

Ovarian cyst

Ovarian cyst is a benign neoplasm of the ovary. It is a tumor-like cavity filled with liquid.

Ovarian cyst is most often diagnosed in young women of reproductive age. Elder women (over 50 years of age) are very seldom afflicted with it.

There can be one or several neoplasms (cystoma). Cystoma is usually benign; however it can be malignant too. It is necessary to remove cystomas.

Various types of cysts have various causes of appearance. Some cysts develop because of hormonal disturbances, others are congenital but develop only because of some factors. Ovarian cyst is a disease that requires surgical intervention. Only functional cysts that can dissolve by themselves or after hormonal therapy do not require treatment. Cysts can twist and break causing acute surgical situation. Some cysts can undergo malignant transformation. Therefore if a cyst is not functional, i.e. has not developed because of ovary function disturbance, it has to be removed. If a functional cyst does not dissolve in 3 months, it also has to be removed.

Cysts can be treated medicinally or surgically. Of course you may hope that it will disappear by itself. But remember that some types of cysts without proper treatment can cause urgent surgical intervention.

Uterine fibromyoma

Uterine fibromyoma is the most widespread benign gynecological tumor. It is found in 25-30 % of women older than 35 and in 30-35 % of women in premenopausal age. The disease declares itself as nodes in the body of womb that grow in various directions: outwards, into the uterine cavity, or continue to grow inside the uterus.

The reasons of appearance and development of uterine fibromyoma are still unknown. One of the factors that affect fibromyoma growth is an increased level of oestrogen hormones and deficiency of progesterone.

Complaints of fibromyoma patients depend on node sizes, peculiarities of their position and growth, disease duration and other factors. Haemorrhages, anemia because of prolonged loss of blood, pain, signs of compression of adjacent organs are encountered most often. Menstruations are profuse and long, often there are haemorrhages not related to menstruation. Pains are caused by tension of uterine ligamentous apparatus and its abdominal integument, and by pressure of the growing tumor on adjacent organs.

If specialists recommend surgical intervention, do not fear that they will cut “something unnecessary” – histological analysis of the tumor is performed directly during the operation and only its results determine the amount of surgeon’s work.

Polycystic ovary

Polycystic ovary is a hormonal disease that prevents ovulation (release of the ovule from the ovary) and causes infertility.

Polycystic ovary may be observed because of dysfunction of various organs: hypothalamus, hypophysis, adrenal glands, thyroid gland and the ovaries themselves. Therefore the disease may declare itself in various ways depending on its reasons, and one diagnostic indication or method is not enough to diagnose it.

Most frequent symptoms of polycystic ovary are disturbances of menstrual cycle (mostly delays), excessive hair growth on the body, ovaries size increase (but not always), obesity in approximately one half of patients. Basal temperature remains approximately the same throughout the cycle and not increases during its second half as it normally should. In the most pronounced (primary) form of the disease these indications appear as early as in juvenile age after menstruations.

Primary polycystic ovary mostly develops in juvenile age when menstrual cycle is stabilizing. It disturbs the process of ovule maturation, i.e. the ovule does not go out of the ovary.

Secondary polycystic ovary appears in older age. It is caused by various inflammatory diseases of female sexual organs. If the ovary function is disturbed completely, a woman cannot become pregnant.

Adenomyosis

Adenomyosis is a disease that is characterized by diffusion of endometrium-like tissue (mucous coat of the uterus) into the uterine muscle.

The essence of disease consists in the fact that endometrium (mucous coat of the uterus) tissues penetrate into other parts of the organism (in this case into the uterine muscle) and begin to grow causing disturbances of the normal functioning of the system. This process is usually accompanied by abnormal hormone production and loss of immunity that causes diseased symptoms.

Adenomyosis mostly affects women aged 35-40 and older.

Pathogenic process begins when immune system mistakenly recognizes the organism’s own tissues as alien ones. Allergic reaction in the mucous coat of the uterus causes its growth, edematization, and intumescence. It experiences the same processes as the skin or mucous membrane of an eye on allergy.

The woman usually feels unclear pains in groin or waist. Small discharge and menstrual cycle disturbances are possible.

These symptoms are often left unnoticed. The patient usually goes to see a gynecologist when the pains become strong and blood-tinged discharge out of usual time repeats more than once. Meanwhile this is a serious disease that must be treated.

Typical adenomyosis symptoms are:

    * pains in the pelvis area before the menstruation, during it, and several days after it;

    * dark brown discharge from the genital tracts some time before the menstruation and after it;

    * various menstrual cycle disturbances (usually its reduction);

    * change of the uterus shape and size (this symptom is determined by a special examination);

    * dyspareunia (pain during sexual act).

Endometriosis

Endometriosis is a gynecological disease that involves appearance of nodes similar in structure to the uterine inner mucous coat (endometrium) inside and outside the uterus. Endometriosis is one of the most widespread gynecological diseases; it affects about 15 % of women of reproductive age.

In most cases the cause of infertility is this disease that can combine with myoma or inflammatory processes in the sexual system.

Other typical symptoms of endometriosis are:

• painful menstruations;

• pains during sexual act;

• pains in the lower part of the abdomen not related to menstruation, irradiation of pains to waist and coccyx;

• dark blood-tinged discharge from genital tracts before and after the menstruation.

In 99% of cases endometriosis develops against the background of thyroid gland diseases, especially autoimmune thyroiditis, and disturbances of hypophysis hormones production. Therefore endometriosis treatment usually involves restoration of endocrine system, immunity, and small pelvis organs.

It is proven that abortion can trigger endometriosis development. It is a very strong psychological, physical, and hormonal stress for the female organism.

Pregnancy planning

It is customary to talk about pregnancy planning in the whole world. A married couple that is preparing for the pregnancy should undergo complete medical examination prior to conception to prevent possible problems in the future. The planning of a healthy child should start from the visit to a geneticist. This specialist will create a family tree, check whether the family belongs to a risk group, and recommend all necessary examinations.

Virus infections must be diagnosed and cured before the conception because they can cause miscarriage or malformation of the fetus. If a woman does not have immunity against rubella she has to be vaccinated three months before the pregnancy.

An important step in the planning of a healthy child is to determine chromosome sets of the future parents. This blood analysis in some countries is as common as determination of blood group and Rhesus factor. Chromosome sets should be determined for both parents because the child will receive one half of his chromosomes from his mother and another one from his father. Absolutely healthy people can be carriers of balanced chromosomal rearrangements and do not know about it.

When planning pregnancy, the married couple should quit smoking, drinking and using drugs several months before the conception. The most important period of the pregnancy is first 12 weeks when the child’s organs are formed. During this period the woman should receive proper feeding, vitamins, have minimal loads and stresses. Intake of medicinal preparations and negative factors (chemical or radiation effect) should be avoided when possible.

Each woman during pregnancy should undergo the complex of examinations including analysis for viral infections (herpes, cytomegalovirus, rubella) within first 10 weeks of the pregnancy, ultrasonic examination at 11-12 and 20-22 weeks, and determination of level of special proteins (alphafetoprotein, chorionic gonadotropin) at 16-20 weeks.

Timely examination of a pregnant woman allows to determine most congenital and hereditary pathologies and prevent birth of a diseased child.

Postinor

Postinor is an emergent contraceptive.

Postinor is a highly toxic drug. Its intake can cause not only disturbances of menstrual cycle but also difficult consequences for the liver.

Results of its use can be catastrophic: strong persistent nausea, strong uterine haemorrhages, ovaries dysfunction and their consequences, disturbance of hormonal balance in the organism, disturbance of menstrual cycle.

Virtually in all countries Postinor is not sold without prescription and can be used only after consultation with a doctor. Postinor efficiency is about 95% but as it is a very strong preparation that irremediably damages hormonal system it can be used not more than once in 6 months.

Frequent use of Postinor can cause ovaries dysfunction that can put under question the possibility of pregnancy. Thus it is better to avoid using Postinor or replace it with more modern preparations.