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  Contraception

Contraception which is typically termed birth control is a therapeutic regimen consisting of one or more actions, devices or medications prescribed to intentionally prevent or avoid pregnancy. The term contraception literally means any method that prevents the fertilization of a mature ovum with spermatozoa. There are different methods of contraception and these are essential ingredients to family planning. Contraception is different from abortion because the former prevents fertilization, while the latter is a terminating an already established pregnancy.

Contraception
Contraception


In many cultures and religions, birth control still remains to be a controversial political and ethical issue which is still opposed by many. Contraception though is generally less controversial than abortion. Others support the natural method of birth control and most forms of birth control that prevent fertilization but object any “unnatural” method like those methods of birth control which prevent the implantation of an already fertilized embryo to the uterus if fertilization occurs. Some opponents contradict this “unnatural” method because they considered these methods as abortifacients.

The following are some of the most common methods of contraception: physical or barrier methods; hormonal methods; intrauterine methods; emergency contraception; induced abortion; sterilization; lactational method and some behavioral methods such as avoiding vaginal intercourse, abstinence, fertility awareness methods and withdrawal method.

Physical or barrier methods work by placing a physical hindrance to the movement of sperm into the female reproductive tract to meet the mature ovum thereby preventing fertilization. The most popular among the barrier methods is the male condom, a latex rubber sheath placed over the penis. There is also an available female version of the male condom which has a flexible ring at each end to make it more secure when attached to the vaginal area. If instructions on how to use the condom is followed properly, the female condom is 95% effective in preventing pregnancy. An advantage of using condom as a method of contraception is its protective function in both sexual partners against sexually transmitted diseases such as HIV, gonorrhea, herpes, Chlamydia and genital warts.

Another form of physical method is the use of cervical barriers. The cervical cap is the smallest cervical barrier and these barriers are staying in place by suction to the cervix or to the vaginal walls. The diaphragm is another device that acts as a barrier. It fits into place behind the pubic bone of the woman and usually has a firm but flexible ring. This flexible ring helps the diaphragm as it press against the vaginal walls. Others use a contraceptive sponge with a spermicide (creams, gels or pessaries, dissolvable tablets, inserted into the vagina). These spermicides contain chemicals that kill sperms. The effectivity of diaphragms in preventing pregnancy is around 92 to 96% if used accordingly as instructed.

Among the hormonal methods, the commonly used in the clinical practice are combinations of synthetic estrogen and progestins (synthetic derivatives of progesterone). These may include the combined oral contraceptive pill ("The Pill"), the Patch, and the contraceptive vaginal ring ("NuvaRing"). Other hormonal methods contain only progesterone, or a progestin such as the progesterone only pill (the POP or 'minipill'), and Depo Provera, an injectable drug given every three months. A new contraceptive implant called Implanon in replacement for the older Norplant was recently approved (July 2006) and now available in the market. These different progesterone-only hormonal methods may have an adverse reaction which is irregular bleeding for several months.

Intrauterine devices (IUD) are usually shaped like a "T" coil, the arms of which hold the device in place inside the uterus. The major advantage of a coil is that, once inserted into the uterus, there is no need to worry about contraception anymore. It can be left inside the uterus for as long as three to ten years provided the coil remains in place. These devices are up to 98% effective in preventing pregnancy. Although not recommended by most obstetric-gynecologists, an emergency contraception in the form of high doses of combined pills and progesterone only pill (POPs) to prevent pregnancy after a birth control failure (e.g. a condom breaks) or after unprotected sexual intercourse. This hormonal emergency contraception is also known as the "morning after pill," although it can be used up to the 3rd day after unprotected sex.

The use of induced abortion as a form of birth control remains to be a very controversial issue. Induced abortions can be performed with surgical methods, usually suction-aspiration abortion (in the first trimester) or dilation and evacuation (in the second trimester). Chemical abortion also known as medical abortion uses drugs (e.g. misoprostol) to end a pregnancy which is only approved for pregnancies of less than 7 weeks up to 9 weeks of gestation. Late trimester abortions may use prostaglandins to induce premature delivery. Some utilizes an injection to deliberately stop the fetal heart from beating which may be used prior to induction. Others use traditional herbs believed to act as abortifacients, causing abortion but not recommended for use by doctors.

A more permanent method of contraception is the procedure called vasectomy for males and bilateral tubal ligation for females. These operations permanently prevent fertilization and are not easily reversed therefore, should only be recommended for people who are sure they do not want to have any more children in the future. The failure rate of sterilization is low, around one in 2,000 for men and about one in 200 for women. Vasectomy is a more minor operation as compared to bilateral tubal ligation. Vasectomy is usually performed only under local anesthesia which involves cutting and ligating (tying) the vas deferens, the tubes which carry sperm from the testes to the penis. The equivalent procedure for women employs often a laparoscopic surgery under general anesthesia wherein the fallopian tubes are cut then tied. An alternative surgery is hysterectomy (removal of the womb), after which conception is impossible.

Behavioral methods of contraception namely the fertility awareness methods involve a woman's observation and monitoring of her body's primary fertility signs such as basal body temperature, cervical mucus (e.g. Billings ovulation method) and other bodily cues. The purpose is to instill awareness in order to determine the fertile and infertile phases of her menstrual cycle. In this way, unprotected sex is restricted to the least fertile period while barrier methods may be availed, or abstinence during the fertile phase. Those with regular menstrual cycle, the fertility awareness method can be 80 to 98% effective at preventing pregnancy. This method is sometimes used interchangeably with the term 'natural family planning' (NFP), the only set of birth control methods approved by the Roman Catholic Church. Coitus interruptus (literally means "interrupted sex"), also known as the withdrawal method. This is the practice of ending sexual intercourse by "pulling out" the penis before ejaculation takes place but it is not a reliable method of contraception. The main risk is the possibility of pregnancy due to the presence of sperm in pre-ejaculation.

Avoiding vaginal intercourse and abstinence are two behavioral methods that require a lot of discipline. Although the risk of pregnancy from non-vaginal sex is low, such as outercourse or sex without penetration, anal sex, or oral sex but still this method is considered unreliable. On the other hand, sexual abstinence (also known as celibacy), is the practice of avoiding all sexual activity. If practiced consistently, it is considered to be highly effective in preventing pregnancy but this method is very difficult to adhere to especially among teenagers. Another method of contraception occurs among breastfeeding women. Those who have a period of infertility after childbirth while breastfeeding, also called the Lactational Amenorrhea Method, or LAM.

An experimental contraceptive for males is called RISUG (Reversible Inhibition of Sperm Under Guidance). This contraception is injected into the vas deferens that coats the walls of the vas with spermicides to inhibit the sperms but it can be reversed by washing out the vas deferens with a second injection.

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