Contraception
IUC’s, Sterilization
Intrauterine Contraceptives (IUC’s)
• IUC’s are made of
flexible plastic,
available only
through prescription
• Three types
– ParaGard (copper)
– Mirena (hormone)
– Skyla (hormone)
IUC’s: ParaGard
• ParaGard contains copper
• Copper prevents sperm
from fertilizing an ovum
• Copper also makes
implantation of fertilized
ovum difficult
• Amount of copper
released is less than
needed in daily diet
• Copper intolerance or
insensitivity would
preclude use of ParaGard
IUC’s: Paragard
• Requires insertion into uterus by healthcare
provider
– Takes only a few minutes
– Insertion may cause cramping, dizziness
• Once inserted, may remain in place for ten years
– Patient should not feel IUD
• Since no hormones present, monthly cycle should
remain unchanged
• Effectiveness: 99%+ against pregnancy
• Requires monthly checking for IUD slippage
IUC’s: ParaGard
• Side effects: heavier and longer periods,
cramping, spotting in between periods
– May lessen after a few months on ParaGard
• Complication risks: pelvic inflammatory disease
shortly after insertion, perforation of uterus,
expulsion
• Copper may provide protective benefit against
endometrial cancer
• Cost: $0-1000 (Planned Parenthood)
IUC’s: Mirena
• Progestin-only
intrauterine
contraceptive
• Lasts for five years
• Mirena:
– Prevents sperm from
fertilizing ovum
– Prevents release of egg
– Changes uterine lining
IUC’s: Mirena
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Insertion: Similar to ParaGard
Effectiveness: 99%+ against pregnancy
Cost: $0-400 (Consumer Reports)
Side effects: Abdominal cramping (10% of users
during first few months), acne, breast tenderness,
headache, mood changes, back pain
– May lessen after a few months
– As use continues, less menstrual bleeding
• Complication effects: ovarian cysts, pelvic
inflammatory disease shortly after insertion,
perforation of uterus, expulsion
IUC: Skyla
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FDA approved in 2013
Hormone
Smaller than Mirena
Lasts three years instead
of five
• Marketed to women who
have not had kids
– Mirena marketed to women
with child (research done
only on this group)
– IUC’s appropriate for all
women
IUC’s
• Internal Birth Control- IUD’s (via Youtube)
• Paragard insertion (via YouTube, 0-0:53)
• Mirena insertion (via YouTube, for
healthcare providers)
• Insertion of IUC (Medialvideos.us)
Sterilization
Sterilization
• Sterilization = permanent contraception
– Women undergo tubal ligation
– Men undergo vasectomy
• The most common contraceptive method used in
the United States (men’s and women’s methods
combined)
– No formalized data collection system exists
– Data retrieved from surveys, questionnaires
– Numbers vary across the U.S. (vasectomy-information.com)
Sterilization: Tubal Ligation
• Surgical technique
• Close fallopian tubes,
preventing egg from
traveling to uterus,
preventing sperm from
reaching egg
• Neither organs nor glands
are removed
• Effectiveness: 99%+
• Considered irreversible
Sterilization: Tubal Ligation
• Tubal sterilization:
– Tubal
coagulation/cauterization
– Tubes can be tied and cut
(Pomeroy & Parkland
techniques)
– Tubes can be clipped,
clamped
– These incision methods
often performed after
childbirth/abortion
– Animation (SMART imagebase)
Sterilization: Tubal Ligation
• Cost: $1000-3000
• Side effects: thought by many to be rare;
hormonal imbalance may lead to increased
menstrual bleeding, cramping; adhesions
• Complications: infection, internal bleeding,
ectopic pregnancy
• Before/after photos (private Flickr account)
Sterilization: Implants
• Non-incision method
– No general anesthesia
– Under an hour
• Coils inserted into
fallopian tubes
• In following months, coils
and tissue grow together,
forming barrier to prevent
sperm from reaching egg
Sterilization: Implants
• Side effects: expulsion of coil inserts, risk
for ectopic pregnancy, cramping, menstrual
changes, nausea/vomiting
• Demo (YouTube, 1:04)
Sterilization: Vasectomy
• Vasectomy blocks sperm
from traveling through the
vas deferens, preventing
sperm from mixing into
semen
• No glands or organs are
removed
• Effectiveness: 99%+
• Considered irreversible
Sterilization: Vasectomy
• Vas deferens must be
isolated
• Similar to tubal ligation,
the vas deferens can be cut
and tied, clamped,
cauterized, no scalpel
technique
• Another form of
contraception must be
used for a few months
Sterilization: Vasectomy
• Cost: $450-700 (vasectomymedical.com)
• Side effects: bruising, sensitivity/pain, sperm
leaking from tubes may lead to small lump
(usually clears up on its own), antibodies to sperm
may develop, reducing chances of fertility in a
reversal
• Complications: rare, usually associated with
infection (fever, pus/blood from incision site,
swelling, pain); ends of tubes may grow back
together (very rare); decreased sexual desire (4 out
of 1000 cases per Planned Parenthood) - no
apparent physical cause
Sterilization: Vasectomy
• Animation (BUPA Health via YouTube, 2:36)
• Open-ended (no scalpel) vasectomy
(medicalvideos.us)
• Video (vasectomymedical.com)