Contraceptives

Contraceptives The practice of birth control prevents conception, thus limiting reproduction. The term birth control, coined by Margaret SANGER in 1914, usually refers specifically to methods of contraception, including STERILIZATION. The terms family planning and planned parenthood have a broader application. METHODS OF BIRTH CONTROL Attempts to control fertility have been going on for thousands of years. References to preventing conception are found in the writings of priests, philosophers, and physicians of ancient Egypt and Greece. Some methods, though crude, were based on sound ideas.

For example, women were advised to put honey, olive oil, or oil of cedar in their vaginas to act as barriers. The stickiness of these substances was thought to slow the movement of sperm into the uterus. Wads of soft wool soaked in lemon juice or vinegar were used as tampons, in the belief that they would make the vagina sufficiently acidic to kill the sperm. The Talmud mentions using a piece of sponge to block the cervix, the entrance to the uterus. Sperm Blockage Several modern methods of birth control are practiced by creating a barrier between the sperm and the egg cell.

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This consists of the use of a chemical foam, a cream, or a suppository. Each contains a chemical, or spermicide that stops sperm. They are not harmful to vaginal tissue. Each must be inserted shortly before COITUS. Foams are squirted from aerosol containers with nozzles or from applicators that dispense the correct amount of foam and spread it over the cervix; creams and jellies are squeezed from tubes and held in place by a diaphragm or other device; and suppositories–small waxy pellets melted by body heat–are inserted by hand. More effective at keeping sperm and egg apart are mechanical barriers such as the diaphragm and cervical cap (both used with a spermicide), the sponge, and the condom.

A diaphragm is a shallow rubber cup that is coated with a spermicide and positioned over the cervix before intercourse. Size is important; women need to have a pelvic examination and get a prescription for the proper diaphragm. The cervical cap, less than half the size but used in the same way, has been available worldwide for decades. It was not popular in the United States, however, and in 1977 it failed to gain approval by the Food and Drug Administration (FDA); in 1988, the FDA again permitted its sale. The contraceptive sponge, which keeps its spermidical potency for 48 hours after being inserted in the vagina, was approved in 1983.

Like the diaphragm and cervical cap, the sponge has an estimated effectiveness rate of about 85%. The devices only rarely produce side effects such as irritation and allergic reactions and, very rarely, infections. The condom, a rubber sheath, is rolled onto the erect penis so that sperm, when ejaculated, is trapped but care must be taken so that the condom does not break or slip off. A fresh condom should be used for each sexual act. Condoms also help protect against the spread of VENEREAL DISEASES, and, unlike other barrier devices, condoms made of latex do provide some protection–but not foolproof–protection against AIDS (see AIDS). Another method of preventing the sperm from reaching the egg is withdrawal by the man before ejaculation. This is the oldest technique of contraception and, because of the uncertainty of controlling the ejaculation, is considered one of the least effective.

Altering Body Functions Even in ancient times, attempts were made to find a medicine that would prevent a woman’s body from producing a baby. Only within the last century, however, have methods been developed that successfully interrupt the complex reproductive system of a woman’s body. The first attempt, made in the 19th century, was based on a legend that camel drivers about to go on long journeys in the desert put pebbles in the wombs of female camels to keep them from becoming pregnant. Researchers tried to find something that would work similarly in a woman’s cervix. The earliest such objects were made of metal and were held in by prongs. Later, wire rings were placed beyond the cervix, in the uterus itself, thus giving rise to the term intrauterine device, or IUD.

IUDs appear to work by altering the necessary environment in the uterus for the fertilized egg. It was only with the introduction of modern plastics such as polyethylene, however, that IUDs were widely accepted. Their pliability led to simpler insertion techniques, and they could be left in place until pregnancy was desired unless a problem arose with their use. Copper-containing IUDs, and those that slowly released the hormone progesterone, had to be replaced periodically. Some users of IUDs, however, complained increasingly of the side effects of the devices. The most common problem was bleeding, and the devices could also cause uterine infections. More dangerous was the possible inducement of pelvic inflammatory disease (see UROGENITAL DISEASES), an infection that may lead to blockage of the Fallopian tubes and eventual sterility or an ectopic pregnancy.

Studies in the 1980s confirmed this link with the increased risk of infertility even in the absence of apparent infections, especially with plastic IUDs. The A. H. Robins Company, in particular, was ordered in 1987 to set aside nearly $2.5 billion to pay the many thousands of claims filed against it by women injured through use of its Dalkon Shield. By that time only a single, progesterone-releasing IUD remained on the U.

S. market, but a copper IUD later became available and other steroid releasing devices were being planned for issue. The birth control pill, taken once a day, has become the most popular birth control method among American women. Oral contraceptives are similar in composition to the hormones produced naturally in a woman’s body. Most pills prevent ovaries from producing eggs.

Use of the pill, however, does not prevent MENSTRUATION; usage may even cause periods to be more regular, with less cramps and blood loss. Recent studies seem to indicate that the pill may also protect its users against several relatively common ailments, including iron deficiency anemia (the result of heavy menstrual bleeding), pelvic inflammatory disease, and some benign breast disorders. In addition (and contrary to fears that were expressed when the pills were first marketed and contained much higher levels of hormones), long-term statistical studies point to a lower incidence of ovarian and uterine cancer among women who use contraceptive pills. Other studies, however, have linked its use with the increased occurrence of breast cancer. Ongoing studies by such organizations as the American Cancer Society continue to study a possible breast cancer link.

For some users, the pill may have undesirable and sometimes serious side effects such as weight gain, nausea, hypertension, or the formation of blood clots or noncancerous liver tumors. The risk of such effects increases above the age of 35 among women who smoke. Pills are obtainable only by prescription and after a woman’s medical history and check of her physical condition. In 1991 the FDA approved the use of Norplant, a long-lasting contraceptive that is implanted under the skin on the inside of a woman’s upper arm. The implant consists of six matchstick-size flexible tubes that contain a synthetic hormone called progestin.

Released slowly and steadily over a five-year period, this drug inhibits ovulation and thickens cervical mucus, preventing sperm from reaching eggs. Avoiding Intercourse The time to avoid sex, when conception is not desired, is about midway in a woman’s menstrual cycle; this was not discovered until the 1930s, when studies established that an egg is released (ovulation) from an ovary about once a month, usually about 14 days before the next menstrual flow. Conception may occur if the egg is fertilized during the next 24 hours or so or if intercourse happens a day or two before or after the egg is released, because live sperm can still be present. Therefore, the days just before, during, and immediately following the ovulation are considered unsafe for unprotected intercourse; other days in the cycle are considered safe. The avoidance of intercourse around ovulation, the rhythm method, is the only birth control method approved by the Roman Catholic church. Maintenance of calendar records of menstrual cycles proved unreliable, because cycles may vary due to fatigue, colds, or physical or emotional stress.

A woman’s body temperature, however, rises slightly during ovulation and remains high until just before the next flow begins. Immediately preceding the rel …

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