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**info thread** birth control methods - permanent & temporary


Forum: Done Having Children

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  #1  
February 26th, 2010, 06:36 PM
Gaby&Emmy'sMama's Avatar aka NZ-Emma
Join Date: Aug 2005
Location: Christchurch, NZ
Posts: 56,619
Permanent methods of contraception - recommended only if you are 150% sure you are done having children
  • Vasectomy
  • Tubal Ligation
  • Hysterectomy
  • Essure


VASECTOMY
failure rate: stated as less than 1%
most failures occur when a couple have sex too soon after a vasectomy, while some sperm are still present.



Sperm are made in the testicles and are stored in a structure called the epididymis. During ejaculation sperm flow from the epididymis through two muscular tubes called the vas deferens to the prostate gland. Here the sperm mix with fluid produced by the prostate gland and the seminal vesicles to form semen.

A vasectomy is a surgical sterilization procedure in which the vas deferens are cut and sealed. Following vasectomy, sperm continue to be produced in the testicles, but are no longer contained in the semen. As the sperm produced in the testicles die, they are reabsorbed by the body.

Vasectomy is regarded as a simple, safe and effective form of male sterilization and is intended to be permanent. It is estimated that vasectomy is between 99% and 99.6% effective.

Vasectomy can fail if a canal develops between the two ends of the vas deferens through which the sperm can travel (recanalisation). This occurs in less than 1% of cases.

A vasectomy is performed by a general surgeon, a urologist or a general practitioner. It is usually performed under a local anaesthetic, and a light sedative may be given. However, some men choose to have the procedure performed under a general anaesthetic so that they are not awake during the procedure.

There are two main surgical techniques for performing a vasectomy - the traditional vasectomy and the no-scalpel vasectomy. The type of surgical technique used will depend on the patient's medical history and the preference of the patient and the doctor. Men who have thick scrotal skin, or have had previous operations for groin hernias or torsion (twisting) of the testicle, may not be suitable for the no-scalpel technique.

In preparation for vasectomy the scrotum must be shaved and cleaned with an antiseptic solution. During the vasectomy the man will be lying on a surgical table and the area around the penis and scrotum will be draped with sterile surgical guards in order to keep the area clean.

Both vasectomy techniques are performed in either a doctor’s surgery or a day stay clinic and take approximately 30-45 minutes. The no-scalpel technique has been shown to produce less bleeding and discomfort, and has a lower risk of complications than the traditional technique.


The procedure

Traditional vasectomy:
This technique involves making either one or two small incisions in the scrotum near the base of the penis. One at a time, the vas deferens are located and a loop carefully lifted out through an incision. The vas deferens are cut and a 1-2cm section removed. The ends of the vas deferens are then folded over and are sealed with special clips or stitches. In some cases the ends of the vas deferens may be cauterised (sealed using heat). Once both vas deferens have been cut and tied, they are returned to the scrotum and the incision(s) in the scrotum are closed with fine stitches. A small dressing may be used to cover the incision(s).

No-scalpel vasectomy:
The no-scalpel technique avoids the need for incisions in the scrotum that require stitches.

During a no-scalpel vasectomy the doctor locates the vas deferens by feeling them beneath the skin of the scrotum. Once located, both vas deferens are held in place with small clamps.

Using a special surgical instrument, a single small puncture is then made in the midline of the scrotum, just below the penis. The same surgical instrument holds the puncture hole open while a loop of vas deferens is lifted out. The vas deferens is cut and a 1-2cm section removed. The ends of the vas deferens are then folded over and cauterised, or sealed with special clips or stitches. The vas deferens is then returned to the scrotum through the puncture hole and the other vas deferens is brought out through the same puncture hole and the procedure is repeated. After the procedure the puncture wound contracts to about 2mm in length, is not visible to the man and does not require stitches or a dressing.


Recovery:

Some bruising and tenderness is to be expected following a vasectomy. After the procedure the doctor will give detailed recovery instructions and it is important to follow these carefully. Guidelines generally include:
  • Resting and restricting activity for two to three days following the procedure.
  • Wearing two pairs of supportive underpants during the day and one pair at night to give good support to the healing scrotum.
  • Taking pain relief such as paracetamol for any discomfort
  • Applying ice packs to the area to help decrease pain and swelling.
Most men can return to light work two days after the procedure. It is usually recommended that heavy lifting or vigorous exercise be avoided for at least a week.

Sexual activity can be resumed 2-3 days following the surgery, or when it is comfortable to do so. Until the success of the operation has been confirmed, another form of contraception must be used. The success of the operation is confirmed when two successive semen samples are shown to be free of sperm. These laboratory tests are usually undertaken 2-3 months after the vasectomy, or after 16 to 20 ejaculations.


Complications:

Complications following vasectomy are uncommon. If any complications are suspected, medical advice should be sought.

As with any surgical procedure there is a risk of infection and bleeding. If infection occurs (pain, redness, swelling) antibiotics may need to be given. Any bleeding from the incision site is usually minimal and resolves quickly.

Blood that pools within the tissues is known as a haematoma. A haematoma in the scrotum can cause the area to be bruised, swollen and painful. The haematoma should resolve over several days as the blood is absorbed by the body. Other complications that can occur as a result of a vasectomy include:

Granuloma - where scar tissue forms between the two cut ends of the vas deferens. It feels like a small lump the size of a pea and should resolve after a few months.

Testicular pain - some men experience an aching discomfort in the testicles after a vasectomy. This usually resolves after a few days, however in some cases the discomfort may last for some months or longer. The discomfort is thought to be due to congestion in the area where the sperm is stored.





TUBAL LIGATION
failure rate: stated as less than 1%
if pregnancy does occur, there is a 33% chance of it being an ectopic pregnancy




Tubal ligation, sometimes referred to as female sterilization or getting one’s “tubes tied”, is a form of permanent contraception in which the fallopian tubes are blocked or cut. The fallopian tubes, approximately 10cm long and 0.5cm wide, connect the ovaries to the uterus. Each month, an egg released by an ovary travels along one of the fallopian tubes to the uterus. If the egg is met by a sperm, fertilisation can occur. Cutting or blocking the tube prevents the egg and sperm from meeting, thus preventing fertilisation.

Tubal ligation should not be undertaken if there is any doubt about wanting another pregnancy. Reversal of the procedure is possible but it is difficult and often unsuccessful. If there is any thought about reversal before a tubal ligation, another form of contraception is a better option.

As tubal ligation does not remove any organs or disrupt hormonal balance, it does not affect menstruation or menopause and sex drive should not be affected.


Procedure:

Tubal ligation can be performed in several ways. This includes cauterizing (burning) the tubes with a heated needle connected to an electrical device, placing a clip, ring or band around the tubes.

Laparoscopic Tubal Ligation
Tubal ligation is usually performed using a laparoscopic approach. This involves making two small incisions in the abdomen. A laparoscope (a long thin tube with a camera and light source at its tip) is inserted through one incision and surgical instruments are inserted through the other incision. The abdomen is inflated with carbon dioxide gas to help separate the organs and allow the area to be seen clearly on a television monitor. The fallopian tubes are then able to be located and the tubal ligation performed. The incisions in the abdomen are closed with steristrips (small paper tapes) or small stitches.

Laparoscopic tubal ligation is usually performed under a general anaesthetic. The procedure takes approximately 30 minutes and is usually performed on a day stay basis.

Mini-Laparotomy
Occasionally an “open” surgical approach known as mini-laparotomy may be required if the laparoscopic approach is deemed inappropriate. This may be the case if there is scarring in the pelvis from previous surgery, or medical conditions such as endometriosis.

With this approach a single incision, approximately 4-5 cm long, is made just above the pubic hair line. The fallopian tubes are located and the tubal ligation performed. The incision is closed with dissolvable stitches. This type of tubal ligation usually requires a hospital stay of one to two days.

After both types of surgery, some pain or discomfort may be experienced in the abdomen and at the incision sites. Whilst in hospital, pain relieving medications may be given through a drip in the back of the hand. After going home, pain-relieving medications such as Voltaren and paracetamol should be adequate to relieve any pain or discomfort experienced.

There may also be some nausea and tiredness as a result of the anaesthesia. Rest is important in relieving this and in assisting with overall recovery. Recovery and activity guidelines will be given prior to being discharged from the hospital or clinic.

Sterility is achieved immediately after tubal ligation, however it is important to use contraception right up to the time of the operation.

Tubal ligation has a less than 1% failure rate. Failure can occur however if the fallopian tubes were not cut or blocked properly, if the cut ends grow back together, or if the clips on the tubes slip. If pregnancy does occur after a tubal ligation, it is more likely to be ectopic (an abnormal pregnancy that occurs outside the uterus - usually in the fallopian tubes - in which the foetus can not survive). If pregnancy is suspected – ectopic or otherwise - after tubal ligation, seek immediate medical advice.


Complications:

Dr. Vicki Hufnagel, a surgeon who specializes in restoring women’s reproductive organs, has written "Many post-tubal patients who come to my office seeking relief complain bitterly if more severe cramps, heavier. longer periods, dysfunctional uterine bleeding, pain with intercourse, and pelvic pain or pressure."





HYSTERECTOMY
failure rate: 0%




Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries, fallopian tubes and other surrounding structures.

Hysterectomy may be recommended to treat heavy or abnormal uterine bleeding; fibroids (non cancerous growths or tumours) in the uterus; endometriosis (growth of endometrial tissue outside the uterus); pelvic inflammatory disease; prolapse (ie falling down or slipping out of place) of the uterus and/or vagina; cancer of the uterus, cervix or ovaries.

The type of hysterectomy performed will depend on the condition being treated. Types of hysterectomy include:
  • Sub-total hysterectomy - where only the uterus is removed.
  • Total hysterectomy - the removal of the uterus and cervix.
  • Total hysterectomy with bilateral salpingo-oopherectomy - the removal of the uterus, cervix and ovaries.
  • Radical hysterectomy (Wertheim’s hysterectomy) - the removal of the uterus, cervix, ovaries, fallopian tubes, lymph nodes and sometimes part of the vagina.
Following hysterectomy a woman will no longer have periods and she will no longer be able to have children. If the ovaries have been removed the woman will experience menopause and may need to take hormone replacement medication.


Before surgery:

Prior to surgery several diagnostic and investigative procedures may be conducted. These will assist with deciding the type of hysterectomy required and the surgical method to be used. Investigations may include:
  • Blood tests (eg. to check for anaemia or iron deficiency).
  • Urine tests.
  • Ultrasound scans (eg. to assess the size of the uterus).
  • Hysteroscopy – where a small telescopic instrument with a camera at its tip is used to view the inside of the uterus.
  • Endometrial biopsy – where a sample of the endometrium (lining) of the uterus is taken and analyzed.

Surgery:

A hysterectomy is usually performed under a general anaesthetic, but a spinal or epidural anaesthetic (where the area below the level of the waist is numbed via an injection into the back) may be used instead. There are three ways hysterectomies can be performed. The choice of method will depend on the type of hysterectomy and the reason for the hysterectomy, as well as the preference of the surgeon and patient.

Abdominal hysterectomy:
The surgeon makes an incision in the lower abdomen. The uterus (and other structures if required) is removed through this incision. This method allows the surgeon to check surrounding tissue and organs in case further treatment is required. This is the usual method of choice for cases of large fibroids or
cancer of the uterus, cervix or ovaries.

Vaginal hysterectomy:
This is where the uterus is removed via the vagina without the need for an abdominal incision. An incision is made near the top of the vagina and the surgeon is able to work through this incision to remove the uterus and tie off blood vessels, ligaments and the fallopian tubes. This is the usual method of choice for women who have a prolapsed uterus, as weakened structures supporting the vagina can be repaired at the same time.

Laparoscopically assisted vaginal hysterectomy (LAVH):
A narrow fibre optic telescope (a laparoscope) is inserted into the abdomen through a small incision in the tummy button. The laparoscope has a camera at its tip, allowing the surgeon to view the internal organs on a television monitor during the surgery. Carbon dioxide gas is used to inflate the abdomen to enable the internal organs to be more easily seen.

Surgical instruments are inserted through two further small incisions in the abdomen. The uterus is freed, blood vessels, ligaments and the fallopian tubes are tied, and the uterus is removed through an incision at the top of the vagina.


Recovery:

During the post-operative recovery period there will be a drip in the arm or hand to provide fluid and medications.

There may also be a tube (catheter) draining urine from the bladder. This is usually removed 24 to 36 hours after surgery.

There may be vaginal packing to help reduce vaginal bleeding. This is usually removed the first day following surgery.

A thin tube to drain excess fluid and blood may be inserted into the abdomen during surgery. This is usually removed 24 to 36 hours after surgery.

Any pain or discomfort will be managed with pain medication either as tablets, or an injection into the drip.

Recovery time will vary depending on the type of hysterectomy and the surgical method used. Hospital stays vary from about two days for the laparoscopically assisted vaginal hysterectomy, to about five or six days for an abdominal radical hysterectomy.

Prior to discharge home the surgeon and/or nurse will advise on how soon to return to normal activities – again depending on the type of hysterectomy and surgical method used. With vaginal hysterectomy this may be as little as two weeks, and with abdominal hysterectomy it may be up to six to eight weeks. Full recovery from a hysterectomy can take up to several months.


It is usual to have a bloodstained discharge for a couple of weeks after the operation. Tampons should not be used until after this discharge has stopped.
For all types of hysterectomy it is usually recommended that sexual intercourse is not resumed until six weeks after the surgery.


Complications:

Possible complications following hysterectomy include:
  • Haemorrhage.
  • Infection.
  • Deep vein thrombosis (blood clots).
  • Bladder function problem.
  • Constipation.
  • Adhesions (internal scar tissue).
Rarely, the surgery can cause damage to the ureters (the tubes connecting the bladder and kidneys), bladder, or bowel.


ESSURE

There is also a relatively new form of permanent sterilisation for women - it is called Essure. A brief overview from the essure website states:

"an Essure trained doctor inserts soft, flexible inserts through the body’s natural pathways (vagina, cervix, and uterus) and into your fallopian tubes. The very tip of the device remains outside the fallopian tube, which provides you and your doctor with immediate visual confirmation of placement."

For further information check out their website:
Essure - Permanent Birth Control by Conceptus
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Last edited by Gaby&Emmy'sMama; February 26th, 2010 at 06:49 PM.
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  #2  
February 26th, 2010, 08:08 PM
Gaby&Emmy'sMama's Avatar aka NZ-Emma
Join Date: Aug 2005
Location: Christchurch, NZ
Posts: 56,619
Temporary methods of contraception - recommended if you aren't absolutely sure if you are done having children, OR if you would prefer to not use a permanent method of contraception (as discussed in post 1)

Temporary methods of contraception fall under four main categories - the categories are listed here, along with examples of the most commonly used, of each. Some methods can fall under more than one category.
  • Barrier methods - condoms, sponge, diaphragm, cervical cap
  • Natural methods - natural family planning (NFP), fertility awareness method (FAM)
  • Hormonal methods - oral contraceptive pill, vaginal ring, the patch, depo provera
  • Long term methods - IUD (hormonal & non-hormonal), the implant (norplant & implanon)

BARRIER METHODS

Condoms
effectiveness - 98-82%
The condom itself is a type of thin shield that is worn on an erect penis. It is put on before sex occurs and is taken off immediately afterwards in order to avoid leakage. When the condom is on, sperm are trapped in the tip of the condom when a man ejaculates, thereby preventing the sperm from coming into contact with the vagina. A new condom must be used every time you have sex.


The Sponge
effectiveness - 91-68%
Contraceptive sponges are small, disposable sponges. They are usually made of polyurethane foam and are infused with spermicide. Sponges work by not only blocking sperm from entering the uterus but also by absorbing and killing off the sperm.


Diaphragm
effectiveness: 94-61%
The diaphragm is a type of birth control, that is used to prevent sperm from entering the uterus. Made out of a thin, flexible silicone rubber, the diaphragm looks much like a small dome or cup. Designed with a flexible ring around the top, the diaphragm is inserted into the vagina prior to sexual intercourse. The diaphragm should be used along with a spermicidal cream or jelly in order to increase its effectiveness. Diaphragms are available by prescription from your health care provider.


Cervical Cap

effectiveness: 91-68%
Like the diaphragm, the cervical cap works to prevent sperm from entering the uterus. Unlike the diaphragm, however, the cervical cap is much smaller and fits more tightly around the cervix when in place. Made out of silicone rubber, there is currently only one type of cervical cap available on the American market. Known as the FemCap, this cervical cap consists of a dome that covers the cervix, a brim which holds the cap tightly in place, and a groove which can hold spermicide jelly or cream.


NATURAL METHODS

Note: for the Natural Methods of contraception (mostly known under the banner of Natural Family Planning, or NFP, it is highly recommended that you are taught the methods, by a qualified instructor/trainer/teacher. For that reason, I will supply a couple of relevant links, and also the link to the NFP & FAM board, here on JM
effectiveness: (when method used 100% properly) 99-95%

Natural Family Planning - methods & comparisons
http://www.catholicmom.com/nfp_methods.pdf

Natural Family Planning & FAM board
Natural Family Planning and FAM - JustMommies Message Boards


HORMONAL METHODS

Oral Contraceptive Pill - combination & progesterone only
combination pill effectiveness: 99.7-92%
progesterone only pill effectiveness: 99.5-92%

Combination Oral Contraceptive Pill
The combination birth control pill is a tiny pill that is taken daily and is made up of synthetic estrogen and progesterone. Since your menstrual cycle and ovulation is regulated by estrogen and progesterone, the artificial hormones work to mimic the hormones your body naturally produces. This causes a variety of changes in your reproductive system to occur, thereby preventing pregnancy. The main function of this type of oral contraceptive is to suppress ovulation, or the release of an egg from your ovaries. This is done through the increased levels of estrogen your body receives from the Pill. However, today's birth control pills contain far lesser amounts of estrogen than their predecessors. As a result, ovulation may still occur anywhere from 2 to 10% of the time. Although preventing ovulation is the primary method though which the Pill attempts to prevent pregnancy, the extra estrogen and progesterone in your system also work to thicken your cervical mucus. This makes it more difficult for sperm to reach an egg.

Progesterone Only Contraceptive Pill
This type of contraceptive pill contains only progestin and therefore has been dubbed "the mini-pill". While this pill may prevent ovulation, more often than not ovulation still occurs in women on the progestin-only pill. If the mini-pill does prevent ovulation, a woman is likely to stop having her period altogether. This type of contraceptive pill contains only progestin and therefore has been dubbed "the mini-pill". While this pill may prevent ovulation, more often than not ovulation still occurs in women on the progestin-only pill. If the mini-pill does prevent ovulation, a woman is likely to stop having her period altogether. Instead, this method of contraception works by thickening the cervical mucus in order to stop sperm from meeting an egg. However, if the pill is not taken at the same time everyday, the effect on cervical mucus will decrease. Moreover, it is thought that the mini-pill may also work by thinning the lining of the uterus and preventing implantation from occurring


Vaginal Ring
effectiveness: 99-98%
The Nuva Ring is a small, transparent ring that is inserted into the vagina, near the cervix and worn for three weeks. During this time, it slowly releases estrogen and progesterone into your body. Like the combination birth control pill, the hormones work to suppress ovulation and thicken cervical mucus (thereby creating a natural barrier for sperm). A new ring needs to be inserted each month.


The Patch
effectiveness: 99-98%
The Patch operates on the same premise as the combination birth control pill. It uses estrogen and progesterone to suppress ovulation, thicken cervical mucus and possibly thin the uterine lining. However, instead of taking these hormones orally, this contraceptive allows the hormones to be continuously delivered directly into the bloodstream through the skin via a thin patch. On the same day every week, users of Ortho Evra place a new patch on the buttocks, abdomen, upper torso (excluding the breasts) or the upper outer arm for three consecutive weeks. The patch is worn at all times, even when you are exercising, bathing or in hot, humid conditions. On the fourth week, users do not wear any patch and will most likely receive their period during this week.


Depo-Provera

effectiveness: 99.7-97%
Depo-Provera is a progestin injection that a doctor gives you every three months. Like the mini-pill & Norplant, this injection works to suppress ovulation, may thicken cervical mucus to create a hostile environment for sperm, and thins the uterine lining to make implantation of a fertilized egg difficult. Each injection offers protection from pregnancy for 12 weeks. Because Depo-Provera can have detrimental effects on a fetus, you can only receive your first shot during the first five days of a normal menstrual cycle; during the first five days postpartum if you are not breastfeeding or after six weeks postpartum if you are breastfeeding. The injection is usually administered to the buttocks or the upper arm


LONG TERM METHODS

Intra Uterine Device (IUD) - hormonal and non-hormonal
effectiveness : 99%

An IUD is a small, t-shaped device that is inserted into your uterus by your doctor. It is made out of flexible plastic and contains either copper or hormones. At the end of the IUD are two transparent strings that hang down into the vagina, which women can feel for to check that their IUD is still in place. Depending on the type you use, your IUD can provide you with continuous protection from pregnancy anywhere from five to 12 years. In the United States, there are two types of IUDs available: the Mirena, which continuously releases hormones for up to five years, and the ParaGard Copper T 380A IUD (non-hormonal) which contains copper and can be worn for up to 12 years. IUD's are effective as soon as they are inserted.


The Implanon Implant
effectiveness: 99%
Implanon is a hormonal form of birth control that prevents pregnancy. Made of soft medical polymer, an Implanon implant is just 1.5 inches long and 0.08 inches wide. Because Implanon is placed underneath the surface of your skin, your body receives a steady dose of progestin (specifically etonogestrel). This helps to make the contraception much more effective, as your body never misses a dose. While this type of birth control is long term, your fertility will return once the implants are removed. Although Implanon is new to the U.S., about 2.5 million women have used it worldwide since 1998. Effective for 3 years.


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