CONTRACEPTION - 1

Dr Vaibhav Khairnar
 OBJECTIVE
S
 Aims of contraception
 Idealcontraceptive.
 Contraceptive methods in females.
 Spacing methods
 Terminal methods

 Pregnancy vaccines.

 Contraceptive methods in males.

 Spacing methods.
 Terminal methods.

 Miscellaneous methods.
 Introduction
. :-
 DEFINITION

Prevention Of Pregnancy.
 AIMS:-

Family Planning
Prevents STD’S – AIDS.
Medical Grounds – To control stress
of pregnancy, labour & lactation.
The characteristics of an ideal
contraceptive are listed
below:
 Highly effective.  Widesprea
 No side effects. d
 Independent availability.
 Acceptable to all
of intercourse.
 Rapidly cultures and
reversible. religions.
 Administration and
 Cheap.
healthcare
personnel not
required.
 Easily distributed.
CONTRACEPTIVE METHODS
IN FEMALES
 Spacingmethods
 Terminal methods
 Pregnancy vaccines.
 SPACING
METHODS.
 Rhythm Methods.
 Barrier Methods.
 Chemical Methods.
 Intrauterine contraceptive devices.
 Rhythm
Methods.
 Calender method / safe period
method / natural method.
 Depend on time of ovulation.
 Dangerous period – ovulation occurs on 14 day
& ovum viable for 48-72 hrs & sperm remain
alive for 24-48 hrs. so pregnancy occurs if coitus
occur in this period.
 Rhythm
Methods.
 Safe period – rest of cycle i.e. 5-6 days
after mensturation & 5-6 days before next
cycle.
 Advantage – most natural
 Disadvantage – most unreliable when
cycle are irregular & ovulation time is
variable.
 Barrier
Methods.
 Mechanical
.
 Diaphargm. –
 Flexible
rim made
up of
spring.
 Cup shaped synthetic

rubber or plastic.
 Inserted into vagina over

the cervix.
 Cervical caps.
 Mechanica
 Advantage l
s.
 Inexpensive.
 Do not

require
medical
consultation
.
 Disadvanta
ges.
 Demonstration by trained person needed for
 Chemica
 Spermicidal l  Advantages –
agents.– inexpensive, well
destroy sperms. tolerated, provide good
 Ricinoleic acid protection.
 Nanoxynol-9.  Disadvantages –
 Octoxynol-3.
 Available messiness, local irritation
in different forms–
& burning sensation.
foam tablet, pastes, creams,
jellies & vaginal sponge  Combined
( TODAY --Polyurethane
sponge imprignated with
nanoxynol- 9.)
 Chemical
 Methods.
Locally applied chemicals –
anti- spermicidal.
 Foams,
jellies.
 Drugs
– Steroidal –
 Oral contraceptives and depot preparation.
 Non-steroidal --
 Steroida
l
 ORAL CONTRACEPTIVE PILLS (OCP)
 Recommended in women of younger age
group ( up to 35 yrs )
 Mechanism of action.

 Synthetic preparation of estrogen &

Progesterone.
 When taken orally, hormone level rises

 Negative feedback effect act on Anterior

pituitary
 Inhibit Gonadotrophins (FSH & LH)

 Inhibit Ovulation.
 Type
 Combined s.
pill.
 Sequential pill.
 Minipill pill.
 Postcoital (Morning
After) pill.
 Combined
pill.
 Contains both
 Oestrogen (ethyl
estradiol/mestranol) 20-
50 Mg.
 Progesterone(norethiste

r one, norgestrel) 0.5-

2mg.
 Availability
 MALA-N (21 Tab) &
MALA-D (28 Tab-7
ferrous fumarate)
 Combined
 Dosage – pill.  Mechanism of action.
 Everyday orally at night  Prevents Ovulation.
for 21 days. ( from 5thday  Prevents Implantation.
to 25th day of cycle)  Makes cervical
 7 day break for MALA-N
secretions thick &
 During this bleeding viscid & prevent entry
occurs, which is not of sperm in female
menstrual bleeding but genital tract.
is withdrawal
bleeding.
 Sequential Mini-
 pill
High dose of estrogen pill.
 Micro-pill.
with moderate dose  Only progesterone.
of progesterone.  Dose – daily through
 Dose – oestrogen 5th- to whole of menstrual cycle.
15th day, then both  Action – ovulation
oestrogen+progesterone not inhibited but
for 5 days. prevents fertility.
 High incidence of
 Makes cervical mucosa
thick & decrease motility
endometrial carcinoma so of fallopian tube.
not used.
 POSTCOITA
L
 Within 72 hrs of  Mechanism of
unprotected intercourse. action.
 Dose – 2 combined pills  Prevents fertilization &
immediately followed by implantation by
hypermotility of
2 pill after12 hrs.
fallopian tube &
 Indication – only in uterus.
emergency– rape,  If ovulation &

contraceptive failure, or fertilization occurred

unprotected sex. then it prevents
implantation of
blastocyst.
 OC
 Advantages– 100
P  Contra-indications.
% effectivity  Women having
 Dis-Advantages. – carcinoma of breast
& uterus.
 Hypertension.
 Liver diseases
 Thromboembolism.
 Hyperlipidemia.
 Metabolic effects –
 Age group above 35
diabetes &
obesity. yrs.
 Carcinogenic effect –

breast & cervix.

 Depot preparation.
Injectable
 Oily solutions  Combined –
given  Both estrogen &
intramuscularly. progesterone
 IM , monthly .
 Progestrin –
 Medroxyprogesterone
acetate (DMPA) – IM  MOA –
every 3-6 months, 150-  Prevent ovulation &
400mg. alter cervical mucosal
secretions.
 Norethindrone enanthate
(NET-EN) – IM every 3
months , 200 mg.
 Sub-dermal
 Types –
implants
 Norplant – 6 flexible
silastic (silicon) tubes
 35 mg
progesterone.
 Norplant 2 – 2 rods
of levonorgesterol
 Location – beneath skin
of arm or forearm.
 Contraception – 5-6
yrs.
 vaginal
 Contains rings.
norgestrel.  Advantages –
 Progesterone  No daily intake
 Long lasting.
absorbed through
vaginal mucosa.  Dis-Advantages –
 Leads to sterility.
 Alterations in

menstrual bleeding
pattern.
 Non-steroidal
contraceptives  Mechanism of action
 Centchroman.
 Developed by Central  Suppress corpus luteal
Drug Research Institute function.
(CDRI)  Interfere with motility
 Trade name – Saheli of fallopian tube
 Dose – 30mg  Advantages.
twice/week for 12  Menstrual cycle remains
weeks followed by normal.
once in a week.
 Complete reversibility

after withdrawal..
 Intrauterine contraceptive
device (IUCD)
 Ideal candidate.  Mechanism of action.
 Has born one child.  Prevents implantation &
 Normal menstrual growth of ovum.
cycle.
 By aseptic inflammation & causing
endometrium not suitable for
 No pelvic implantation.
inflammation  Sperm phagocytization – by
. neutrophils &
 Ready to check macrophages.

the device.  Cu affects enzymes, motility
Makes cervical mucus
thick prevent entry of
sperm.
 Intrauterine contraceptive
device (IUCD)
Types.
Non-  Medicate
medicated.
 1ST generation IUCD.
d.
 2ndgeneration Cu made
 Lippes Loop- serpentine  2 types.
or S shaped.  Cu T
 Made up of Plastic.  Cu T 200
 Newer like NOVA-7,
NOVA-T
 3rd generation.
 Hormone releasing containing
progesterone reservoir
release continuously for 1 yr.
Cu –
T.Most commonly

used .
 Made up of Cu.
 ‘T’ shaped attached
with a nylon
thread. (tail)
 Method of
insertion.
 Withdrawl method.
 Ideal time – during
mensturation or
within 10 days.
( As cervical cavity
diameter is more)
 Also during 1st after
delivery.
 

IUC Disadvantages.
 May cause heavy bleeding.

 May come out accidently.

D
 Advantages.  Risk of ectopic

 Safe pregnancy.
 Effective  Contraindications.
 Reversible  Suspected pregnancy.

 Easily pulled out when  Pelvic inflammation.

not required.  Heavy bleeding during
 Long term mensturation.
contraception without  Suffering from
adverse effect. carcinoma cervix.
 Terminal
methods.
 Permanent method.
 Indication.
 When family
is complete.
 Medical

grounds.
 Termina
l
methods
 Surgical methods.
.
 Tubectomy.
 Fallopian tubes
identified , cut , cut ends
ligated & buried.
 Laparoscopic
occlusion.
 Tubes occluded using
silicon rubber bands, rings
or clips
 Method – quicker, simple,

no hospitalization.
 MEDICAL TERMINATION OF
PREGNANCY.
 Medical termination of pregnancy or MTP
or abortion is allowed under MTP act 1971.

 Criteria.
 Person who can do MTP
 Place where it should be performed.
 MEDICAL TERMINATION OF
PREGNANCY.
 Indications.
 Medicals – continuation of pregnancy is
hazardous to the mother.
 Eugenic – substantial risk to the child if born.

 Humanitarian ground.– when pregnancy is

result of rape.
 Failure of contraceptive methods.
 MEDICAL TERMINATION OF
PREGNANCY.
 Methods –

 Dilatation & curettage (D & C).

 Cervix dilated with dilator & implanted ovum removed
by curettage of the endometrium.
 Vacuum aspiration. (up to 12 weeks)
 Same cervix is dilated & contents are aspirated
by vacuum / suction.
 Administration of prostaglandins.
 Prostaglandins are administered intravaginally
 Causes uterine contractions – expulsion of product

of conception.
Thursday, May 21, 2015
 Pregnancy
vaccines.trials.
 Under experimental
2 types.
 Active immunization.
 Β subunits of HCG – antibodies against beta HCG
destroy HCG produced by syncytiotrophoblast.
 Tetanus toxoid – increases antigenecity

capacity.
 Vaccine against Zona Pellucida proteins
CONTRACEPTIVE METHODS
IN MALES
 Method
s
 Spacing methods.
 Natural.
 Barrier.

 Chemical.

 Terminal methods.
 Miscellaneous
methods.
 Spacing
Methods
Natural Method ( Coitus Interruptus)
 Oldest method of voluntary fertility.
 Male withdraws penis before ejaculation

into vagina.
 Failure rate – high

 As precoital secretions may contain sperm & even

a drop is enough to cause fertilization.
 Wrong Timing of Withdrawl
Barrier
 Condom
method–
 Most widely used.
 Made up of fine latex sheath.
 Instructions –
Should be worn on erect
NIRODH


penis before intercourse.

 Air must be expelled
 Held carefully when
withdrawing from
vagina.
 A new condom should be
used for each sexual act.
 Barrier
method
 Mechanism of action,
 Prevents
deposition of semen into vagina.
 Advantages –
 Easily available , safe, inexpensive
 Use dose not require medical supervision.
 Provide protection against STD.
 Dis-advantage
 May slip off or tear off.
 Interfere with sexual sensation.
 Chemical method.
 Antispermatogenic Drugs – inhibit
spermatogenesis.
1. Male pill
(Gossypol)
2 Hormonal
preparation
--
Testosterone
--
Testosterone
with Danazol
 Male pill
( Gossypol)
 Composition –
 Mechanism of action
– exact action not
Gossypol, phenolic
 known.
derivatives of
 Causes azoospermia.
cottonseed oil.
Advantages – neither
 Dose – orally. hormone nor antihormonal
200mg/D.– 2 months  activity
followed by No change in libido
60mg/wk.  & potency.
Disadvantages –
permanent azospermic
after 6 months
 Hormonal
preparation
 Testosterone  Testosterone with
 400 mg orally Danazol.
causes azospermia.  Cyproterone
acetate.
 Related to
progesterone.
 Potent anti-androgenic

agent.
 Causes oligozoospermia &

loss of libido.
 Calcium channel
blockers.
 Block Ca channel on cell membrane of sperm.
 Prevents Ca influx – membrane becomes
rigid & loaded with cholesterol.
 Rigid membrane prevents its binding to Zona
Pellucida.
 So patient on Ca channel blockers
(Nifedipine) for hypertension becomes
sterile.
 Terminal
 methods.
Vasectomy
 Vas Occlusion with No-
scalpel technique
1.
Elastomeric Plugs
2 SHUG
3 RISHUG
 Vasectom
y
 One cm vas deference
removed after
clamping.
 Both ends ligated
& sutured.
 Mechanism of action
– entry of sperm into
semen prevented.
 Sperm production &
hormones not
affected.
 Vasectom
y
 Post-operative  Advantages.—
instructions – use  Simple, fast, less
contraceptive expensive & no
measures (condom) hospitalization.
as he is not  Disadvantages.

sterile ,after 30  Failure rate -

ejaculations semen is 0.15%
 Spontaneous
free from sperm.
recalalization.
 Autoimmune

response.
 No scalpel vas
occlusion.
 Newer technique.  Methods

 Safe, convenient  Elastomer

& acceptable plugs.
 MEDICAL GRADE

POLYURETHANE
 Principle – Elastomer  (MPU)

injected get hardened MEDICAL GRADE

SILICON
insitu within 20 min  SHUG –
RUBBER(MSR)
& occlude it. preformed silicon
plug used.
 RISUG – reversible

inhibition of
sperm under
guidance.
 Miscellaneous
 Hotmethods.
baths.
 Hot bath (460 for few weeks.)
 Suspensories.
 It holds testes close to the
body.
 Insulated scrotal sack
THANK YOU