FAMILY PLANNING. CONTRACEPTION.

DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

Corina Cardaniuc, Stelian Hodorogea,Mihail Surguci

FAMILY PLANNING. CONTRACEPTION.

Reasons of family planning:

pregnancy planning
limiting the number of children
avoiding medical risks of
pregnancy
controlling the world population

FAMILY PLANNING. CONTRACEPTION.

Birth control techniques and methods

include:
Contraception (the prevention of
fertilization),

Contragestion (the prevention of

blastocyst
implantation) and

Abortion (the removal or expulsion

of a fetus
or embryo from the uterus).

FAMILY PLANNING. CONTRACEPTION

The ideal contraceptive should be safe, harmless,

and not interfere with the sexual enjoyment of
either partner.
The failure rate of any method of contraception is
judged by the Pearl Index (PI): the number of
women having regular intercourse who become
pregnant within a year out of 100 couples using the
method.
Number of pregnancies
PI= --------------------------------------------- x 100
Number of couples using the method

FAMILY PLANNING. CONTRACEPTION

There is no perfect contraceptive. All

contraceptives have advantages and
disadvantages, which must be
integrated carefully with the patients
status. Therefore, careful
individualization is necessary to avoid
undesirable side effects and to
optimize patient acceptance.

METHODS OF CONTRACEPTION

BEHAVIORAL ALTERNATIVES

Coitus interruptus ("interrupted sexual intercourse"), is the

practice of ending sexual intercourse before ejaculation. This is
the oldest and a widely practiced method.
Is moderately effective in preventing pregnancy. Average
Failure Rate: 27%
Advantages:
- requires no devices
- involves no chemicals or artificial hormones
- is available in any situation at no cost
Disadvantages :
- the occurrence of pregnancy from semen escaping before
ejaculation or semen deposition at the vaginal introitus
- may prevent complete satisfaction to both partners
- does not offer complete protection from STDs

BEHAVIORAL ALTERNATIVES
Total abstinence
Abstinence is 100% effective in
preventing pregnancy
AVERAGE COST: No cost
Advantages:
- almost 100% effective
- protection against STD's
- free
- no prescription is needed

LACTATIONAL AMENORRHEA METHOD (LAM)

Thelactational amenorrhea method

(LAM)is a method of avoiding pregnancies
which is based on the natural
postnatalinfertility that occurs when a woman
is amenorrheicand fully breastfeeding. If not
combined with chemicals or devices, LAM may
be considerednatural family planning.
EFFECTIVENESS: 98% if no menses has
occurred, only breast feeding is used to feed
the baby, at least every four hours during the
day and every six hours through the night, or
prior to six months of age for the baby

LACTATIONAL AMENORRHEA METHOD (LAM)

ADVANTAGES:
- effective immediately
- does not interfere with intercourse
- no side effects
- no cost
- gives infants passive immunity
- decreased post-partum bleeding
DISADVANTAGES:
- offers no STD protection
- highly effective only until period returns or up to 6
months
- may need to use a lubricant because of vaginal dryness
- must feed on demand and at least 6-10 times a day
including night feedings
- not reliable if period has returned.

NATURAL FAMILY PLANNING

Natural birth control methods teach women to

determine the fertile phase of their menstrual
cycle.
Four Basic Methods:
basal body temperature,
cervical mucus changes,
excretion of LH (luteinizing hormone - the
ovulation triggering hormone) and
menstrual calendars
The BEST METHOD is to combine all of them into
one called the Sympto-Thermal Method

BASAL BODY TEMPERATURE

METHOD

The woman should refrain from

intercourse seven days before the
temperature rise until four days after.
Temperature changes do not predict
ovulation before it happens. To be
completely safe, the woman should
consider unsafe days from the first day
of your period until the fourth day after
the temperature rise.

BASAL BODY TEMPERATURE

Basal body temperature is the body

temperature measured immediately after
awakening and before any physical activity
has been undertaken. In women, ovulation
causes an increase of one-quarter to one-half
degree Celsius in basal body temperature
(BBT). Monitoring of BBTs is one way of
estimating the day of ovulation. The
tendency of a woman to have lower
temperatures before ovulation, and higher
temperatures afterwards, is known as a
biphasic pattern.

CERVICAL MUCUS METHOD

Checking the cervical mucus for consistency

may assist in determination of ovulation.

After the period, there are a few days when

there is no mucus. These are called dry
days and are safe. Then the mucus changes
to the slippery, clear pattern a few days
before ovulation. This is the beginning of an
unsafe (THE MOST UNSAFE) time. The
amount of mucus becomes the greatest just
before ovulation.

CERVICAL MUCUS METHOD

Finger Testing
A finger-tip is used to test the capacity of
the cervical mucus to stretch. It may feel
sticky and break easily, or it may feel
smoother and slippery like raw egg white
and stretch between the thumb and first
finger, from a little up to several inches
before it breaks.

FINGER TESTING
Sensation
at Vulva

Finger Test

Appearance

Moist
or
Sticky

Early Mucus
Scanty
Thick
White
Sticky
Holds its shape

Wetter

Transitional Mucus
Increasing Amounts
Thinner
Cloudy
Slightly Stretchy

Slippery

Highly Fertile Mucus

Profuse
Thin
Transparent
Stretchy
(like raw egg white)

THE CALENDAR METHOD

The calendar method is based on

working out the fertile period from previous
cycles (by careful documentation of the
womans menstrual cycle). This method is
also known as the 'Rhythm Method'.
Average Failure Rate: 13-20%
For a woman with very regular cycles, it
may be possible to predict the day of
ovulation.
The unsafe period lasts from 7 days before
the day of ovulation to 4 days after
ovulation.

DETERMINATION OF LH SURGE

The laboratory determination of abrupt

surge of LH and progesterone with ovulation is
the most reliable method of determining
ovulation.
Ovulation predictor kits can be used with the
temperature charts to more accurately pinpoint
your day of ovulation. They work by detecting
the small amounts of LH that is present in the
urine before ovulation. There is a rise in the
amount of LH in the body approximately 24
hours before ovulation. This increase is
registered by a color change.

NATURAL FAMILY PLANNING

Effectiveness
95-98% effective with perfect use
75-88% for typical use
Benefits
Has no negative health side effects
An alternative for women who cannot or do not want to use hormonal
methods
Consistent with many religious beliefs and lifestyles
Encourages male involvement
Disadvantages
Provides no protection from sexually transmitted infections
Requires time to learn (usually 3 to 6 cycles)
Requires discipline to chart fertility signs and follow the rules to avoid
pregnancy
Difficult to use with irregular periods.
Illness can alter temperature.
Vaginal infections can alter cervical mucus changes

BARRIER CONTRACEPTION
MECHANICAL

Barrier methods place a physical

impediment to the movement of sperm
into the female reproductive tract.

MALE CONDOM
Male Condom Is penile sheath made of latex or polyurethane or animal membrane
that serves as a barrier.
Mechanism of action: Prevents sperm from reaching the cervix. The addition of a
vaginal spermicide makes the method very effective. EFFECTIVENESS: 80-90%
(INCREASES IF USED WITH SPERMACIDE);
Advantages:
Widespread availability
Low cost
Protection against STD
No prescription needed
Safe
Fertility returns upon discontinued use
Disadvantages:
manufacturing defects;
if withdrawal of the penis occurs after detumescence, semen may leak into the
vagina
both partners may complain of decreased sensation during intercourse
woman may be allergic to spermacidal or latex.
can be used only once
may interfere with spontaneity

FEMALE CONDOM
Female condom is a latex or polyurethane membrane (bag)
that can be inserted into the vagina. It has a higher rate of
pregnancy than the male condom. EFFECTIVENESS: 75-85%
AVERAGE
ADVANTAGES:
Protects against some sexually transmitted diseases
No prescription needed
Fertility returns immediately upon discontinued use
Can be inserted anytime - up to eight hours before
intercourse
Medically safe
DISADVANTAGES
Decreased vaginal sensation
May be difficult to insert

THE CERVICAL CAP

The cervical cap is a barrier device covering the cervical portion.
The cervical cap is the smallest cervical barrier. It is made of
rubber or plastic. Depending on the type of cap, it stays in place
by suction to the cervix or to the vaginal walls. Cervical caps
should not be left in place for >48-72 hours to avoid infection. The
cap must be used with a spermicide, which destroys sperm.
EFFECTIVENESS:
85% for women who have never a a baby
70% for women who have had a baby
ADVANTAGES
Safe
Fertility returns immediately with discontinued use
Disposable cap does not need to be fitted nor needs a
prescription
Can be inserted several hours before intercourse

THE CERVICAL CAP

DISADVANTAGES
Must be individually molded for every patient because
cervical anatomy varies greatly
Limited sizes available
Must be left in place 6-8 hours after intercourse
Must be used each time
May become dislodged
Some women may be allergic to spermicides, latex
Need more frequent pap smears the first 1-2 years of use
because it may cause changes in the cells of the cervix
It doesn't protect against STIs, and the cap itself isn't
protective
MUST stay in place at least 8 hours after the last sex act

VAGINAL DIAPHRAGM
Vaginal diaphragm is a soft, rubber dome that forms
a barrier to prevent sperm from reaching the cervix.
It covers the cervix and is held securely in place
behind the pubic bone and rear wall of the vagina.
They are made in various sizes and for maximum
safety must be used with a spermicide jelly or
cream. EFFECTIVENESS: 85%
ADVANTAGES
Safe
Fertility returns immediately with discontinued use
Can be inserted 2-3 hours before lovemaking
May reduce the risk of cervical cancer
Some STD protection

VAGINAL DIAPHRAGM
DISADVANTAGES
Must be fitted by a health care professional
Needs prescription
Must be left in place 6-8 hours after intercourse but no
more than 24 hours
Must be used each time
May become dislodged
Some women may be allergic to spermicides, latex
Must be replaced periodically
Must apply spermicide with each new act of intercourse
May have an increase in urinary tract infections
May decrease spontaneity

CHEMICAL CONTRACEPTIVES

Douching after coitus

Douching immediately after intercourse
is a time honoured but ineffective
method. The intent of the method is to
wash semen out of the vagina before
sperm can enter the cervix.
It does not affect those sperm which
have already passed up the cervical
canal.

SPERMICIDES
Spermicides contain a chemical called nonoxynol-9. It comes in the form of
cream (only for use with diaphragms), gel, foam, film, or suppository. All of
these agents require insertion into the vagina before each coitus. By
inserting spermicide in the vagina, in front of the cervix, it destroys sperm
on contact. EFFECTIVENESS: 80%
ADVANTAGES
Available without a prescription
No known risk to general health
Fertility returns immediately upon discontinued use
Some protection from bacterial infections and pelvic inflammatory
disease
DISADVANTAGES:
Less effective than other methods
Must wait 8 hours before taking a bath or douche
Usually last only one hour
Side effects: Vvginal irritation, some women are allergic to spermicides
Need insertion at least ten minutes before intercourse
Nonoxynol-9 does not protect against STIs

CONTRACEPTIVE SPONGE
The sponge is a soft, round barrier device that is about two inches in diameter. It is
made of solid polyurethane foam, contains spermicide, and has a nylon loop attached
to the bottom for removal. The sponge must first be moistened with water and then the
woman inserts it into her vagina before intercourse. It covers the cervix (opening to the
uterus), and it blocks sperm from entering it. The sponge also releases a spermicide
that can immobilize sperm, thus, preventing the sperm from reaching an egg.
EFFECTIVENESS: 75 85%
ADVANTAGES
Fertility returns immediately upon discontinued use
Can be inserted several hours prior to intercourse
It provides 12-hour protection
It contains three types of spermicide and does not appear to be allergenic nor as
irritating as previous sponges
Does not require a prescription
May protect against some STD's
Does not require insertion of a new sponge for each act of intercourse
DISADVANTAGES:
Cannot be used by women allergic to nonoxyl-9 or those who have had toxic shock
syndrome
a higher risk of vaginal yeast infections

HORMONAL CONTRACEPTIVES
COMBINED ORAL CONTRACEPTIVES

Most combination oral contraceptives are packaged as "active

pills" for 21 days followed by a seven day pill-free or "inactive"
pill interval to allow for withdrawal bleeding (menstruation).
The seven inactive pills are usually in another color.
Monophasic OCs contain the same amount of each hormone
in each active pill.
Biphasic OCs alter the progestin-estrogen ratio in two phases.
Triphasic OCs alter the progestin-estrogen ratio in three
phases by varying the amounts of progestin, estrogen, or both.
Biphasic and triphasic regimens attempt to approximate a
woman's natural hormonal fluctuations more closely by
varying the progestin-estrogen ratios. One important goal of
these formulations is to minimize the occurrence of irregular
bleeding while maintaining efficacy.
EFFECTIVENESS 96-99%

COMBINED ORAL CONTRACEPTIVES

Mechanism of action: Combination hormonal contraceptives act by suppression of
gonadotropins. Although the primary effect of this action is inhibition of ovulation, other
alterations include changes in the cervical mucus (which increase the difficulty of sperm entry
into the uterus) and the endometrium (which reduce the likelihood of implantation).
ADVANTAGES
Reduces the risk of ovarian and uterine cancer
Reduces the risk of pelvic inflammatory disease
Reduces the risk of ovarian cysts
May decrease: pre-menstrual syndrome, acne, bleeding, anemia
less breast tenderness
Does not interfere with intercourse
DISADVANTAGES
Does not protect against STD's
Must be taken daily
Cannot be used by those with a history of: breast cancer, blood clots or at risk to develop
blood clots, liver disease, kidney disease, unexplained uterine bleeding, smokers over age 35,
melanoma
Should not be used by those with: light periods, high blood pressure, diabetes, migraine
headaches, depression, sickle cell disease, fibroids
Serious side effects (rare): blood clots, liver disease, high blood pressure, migraine headaches
Common side effects include: loss of libido, nausea, breast tenderness, mid-cycle bleeding
the first few months, weight gain, increased appetite, mood swings, depression, headaches,
skin problems
Hormonal contraceptives may increase the risk of breast and cervical cancer

PROGESTIN-ONLY ORAL CONTRACEPTIVES

The Mini-Pill Progestin-Only Pills (POP), are estrogenfree oral contraceptive pills taken daily to prevent
pregnancy.
The estrogen-free mini-pill has fewer unwanted sideeffects than traditional combined oral contraceptives.
Mini-pils are less effective and can cause irregular
menstruation.
Popular brands of progestin-only pills include Micronor,
Nora-BE (0.35 mg norethindrone).
Estrogen-free oral contraceptives are available by
prescription only.
The mimi-pil always comes in 28-day packs, and all
the pills within a pack contain the same progestin.
Average Failure Rate: 1 - 13%

PROGESTIN-ONLY ORAL
CONTRACEPTIVES
BENEFITS
May be recommended to breastfeeding women
Mini-pills are also considered safer than combined OCs,
as many of the vascular risks are greatly reduced with
the omission of the estrogen component. That means
less risk for older women, smokers, and those with heart
problems.
SIDE EFFECTS
ectopic pregnancy
depression
menstrual cycle disturbances
Oral contraceptives do not protect against STDs
oral contraceptives increase the risk of acquiring HIV
from an infected partner

CONTRACEPTIVE PATCH
The contraceptive patch (Evra) is a 4 cm x 4 cm beige patch that sticks to a
woman's skin and continuously releases the hormones estrogen and a progestin into
the bloodstream. Each patch is worn on the skin for seven days. One patch is worn
each week for 3 weeks. The Patch should be changed on the same day each week
(called the "Patch Change Day"). The patch can be worn on the buttocks, back or
upper arms, but not on the breasts.
Mechanism of action

The Patch prevents pregnancy by stopping the ovaries from releasing an egg,
and it may also thicken the cervical mucus and make the uterine lining thin.

Effectiveness: the Patch is more than 99% effective at preventing pregnancy

when used perfectly
Benefits

a regular, lighter period

less PMS and cramping

reduces the risk of endometrial and ovarian cancers

helps to prevent benign ovarian cysts

It is completely reversible
Disadvantages

does not protect against sexually transmitted infections

side effects: breakthrough bleeding (between periods), breast tenderness,

headaches, nausea

VAGINAL RING (NUVARING)

NuvaRing is a thin, transparent, flexible ring that stays in the vagina, usually
around the cervix. The ring is worn continuously for three weeks followed by a
week off which triggers menstruation. Each vaginal ring provides one month of
birth control, even during the week when the ring is not worn. The ring slowly
releases on average 0.12 mg/day of etonogestrel and 0.015 mg/day of
ethinylestradiol. The walls of the vagina absorb the hormones and distribute them
into the bloodstream. These hormones work by stopping ovulation, thickening
cervical mucus as a barrier to sperm, and preventing implantation of the embryo if
fertilization occurs. Average Failure Rate: 8%
Benefits:

In addition to preventing pregnancy, the ring has the added benefit of making a
woman's periods more regular, lighter, and possibly less crampy. It is thought to
have similar benefits as the birth control pill, such as treating PMS,
endometriosis and acne, and preventing ovarian and endometrial cancers but
these haven't been studied. It is completely reversible.
Side Effects

Headaches, vaginal irritation, discomfort or discharge, nausea, breast

tenderness, breakthrough bleeding (bleeding between periods), especially in
the first few months, yeast infection

the vaginal ring is thought to increase the risk of heart attack and stroke,
especially among smokers

Contraindications:

heart attack, stroke or breast cancer, active liver disease,

DEPO-PROVERA INJECTABLE CONTRACEPTIVE

Depo Provera is a hormone (progesterone only) injection that a female takes every 12 weeks to
prevent pregnancy. Depo-Provera is estrogen-free, which means that it is safer and has fewer
serious side-effects than other hormonal methods. EFFECTIVENESS: 99%
Mechanism of action
prevents ovulation
affects the cervical mucous, making it more difficult for the sperm to penetrate the cervix
causes a thinning of the endometrium which prevents the egg from implanting.
ADVANTAGES:
One injection every 3 months
Highly effective
long-lasting
helps protect against uterine cancer
safe after childbirth and while breast-feeding
May decrease menstrual cramps
Does not interfere with intercourse
DISADVANTAGES
Does not protect against STD's
Long-acting: fertility returns 6-24 months after last injection (an average of 9 months)
Cannot be used by women with: blood clots, breast cancer, liver problems, unexplained uterine
bleeding
May not be good for women with: family history of breast cancer, abnormal mammogram, irregular
or light periods, high blood pressure, migraine headache's, asthma, epilepsy, diabetes, depression
Can cause bone density loss
Irregular bleeding
Weight gain

NORPLANT IMPLANTS
Implanon is a type of long-term birth control that is inserted under the skin by a doctor. The implant consists of
one to six match-sized plastic rods which are surgically placed under the skin of a woman's upper arm.
Implanon contains a synthetic progestin hormone called etonogestrel. Implanon is effective for up to 3-5 years.
Average Failure Rate: less than 1%
Mechanism of action:
The primary way is by stopping release of an egg from the ovaries. Implanon also changes the mucus in the
cervix and this may keep sperm from reaching the egg. Implanon also has post-fertilization mechanisms,
whereby the hormone changes the lining of the uterus, making it harder for a fertilized egg to implant and
develop.
ADVANTAGES
The birth control effect is immediate
Works up to five years or until removed
Capsules can be removed anytime
Fertility returns immediately upon removal of implants
Helps protect against uterine cancer
Can be safely used after childbirth and while breast-feeding
Does not interfere with intercourse
DISADVANTAGES
Cannot be used by women with liver disease, breast cancer, unexplained uterine bleeding, blood clots
May not be good for women with high blood pressure, gall bladder disease, elevated cholesterol, irregular
periods, light periods, headaches, heart disease, seizure disorders.
Cannot be used by women who have a history of certain types of high blood pressure, breast cancer,
unexplained vaginal bleeding, liver growths, blood clots in veins, possible pregnancy
increased risk of ectopic pregnancy
implant does not offer any protection from STDs
Side effects: irregular bleeding, prolonged periods, light periods, hair loss, decreased interest in sex, acne,
depression, prolonged time between periods, weight gain, breast pain, headache

INTRAUTERINE DEVICE

The intrauterine device, or IUD, is a small

plastic or metal birth control device that
is placed inside the uterus for long term
pregnancy protectionan.
Types of IUD
Mirena Intrauterine System (hormonal)
Copper T IUD (hormone-free)

COPPER T IUD
This IUD is a non-hormonal birth control and contains copper. The IUD may prevent
pregnancy by interfering with: sperm movement (the ability of the sperm to fertilize the egg)
or implantation (nesting of a fertilized egg into the lining of the uterus).
EFFECTIVENESS: Copper-T IUD - 99%
ADVANTAGES
Requires no attention except for monthly checks for the string
Fertility returns immediately upon removal
Does not interfere with lovemaking
Can be used while breast-feeding
DISADVANTAGES
Does not protect against STD's
Should not be used by women who have: never had children or still want children; an
allergy to copper
Should not be used by women who have a history of decreased immune problems; multiple
sex partners; a history of pelvic inflammatory disease (PID) or tubal pregnancy
Have an increase risk for tubal pregnancy, PID, infertility
Side effects possible: cramps, backache, spotting, heavy periods
May be expelled
IUD's can be inserted by a qualified physician:
Days 1 to 7 of the menstrual cycle
Postpartum - Copper T 380A immediately to up to 48 hours after delivery, or 4-6 weeks.
Post abortion - immediately to 7 days if no infection is present

HORMONAL IUD: MIRENA INTRAUTERINE SYSTEM

This IUD is hormonal and releases small and balanced amounts of progestin, called
levonorgestrel, working similarly to most hormonal birth control pills, keeping you from
releasing eggs during ovulation and thickening your cervical mucus, creating an impenetrable
barrier.
Effectiveness of Mirena IUS : less than a 1% failure rate for perfect users
Benefits
The IUS does not contain estrogen so it can be used in women who cannot take or have a
sensitivity to estrogen.
The IUS is effective for up to five years
Mirena IUS decreases the amount of menstrual bleeding and may decrease menstrual
cramping
Disadvantages
The hormonal IUS does not protect against sexually transmitted infections (STIs) or HIV
Possible complications of inserting an IUS include irregular bleeding or spotting, perforating
the uterus, infection, or expulsion
Risk for ectopic pregnancy
It cannot be used by women with irregularly shaped uteruses or who have a condition of the
uterus that distorts the uterine cavity
Side-Effects
cramps, dizziness,
Irregular bleeding or spotting between periods, especially during the first few months
No periods (amenorrhea). Twenty percent of women completely stop having periods after
using Mirena for a year.

EMERGENCY CONTRACEPTION
Emergency contraception refers to back-up methods for
contraceptive emergencies which women can use within the first few
days after unprotected intercourse to prevent an unwanted
pregnancy. Emergency contraceptives are not suitable for regular use.
Forms of EC include:
Emergency contraceptive pills (ECPs)or the "morning-after
pill"are drugs that act both to prevent ovulation or fertilization
and possibly post-fertilization implantation of a blastocyst (embryo).
Intrauterine devices (IUDs)usually used as a primary
contraception method, but sometimes used as emergency
contraception.

EMERGENCY CONTRACEPTIVE PILLS

There are two types of emergency contraceptive pill:

Levonelle (levonorgestrel 750 mcg) is the most commonly
used. It can be taken up to three days (72 hours) after having
unprotected sex
ellaOne (30 mg of ulipristal acetat) is a newer type of
emergency contraceptive pill that can be taken up to five days
(120 hours) after having unprotected sex
The effectiveness of the emergency contraceptive pill
decreases over time. If it is taken within 24 hours of having
unprotected sex, it prevents 95% of pregnancies.
The WHO-recommended regimen for emergency
contraception is: 1.5 mg of levonorgestrel as a single
dose.
The drug mifepristone (RU486, Mifeprex) may be used either as
an ECP or as an abortifacient, depeding on whether it is used
before or after implantation.

EMERGENCY CONTRACEPTIVE PILLS

Side effects
nausea
vomiting
abdominal pain
headache
dizziness
breast tenderness
The high doses of progestogen in levonorgestrel
treatments may induce progestogen withdrawal
bleeding a few days after the pills are taken. If
levonorgestrel is taken after ovulation, it may
increase the length of the luteal phase, thus
delaying menstruation by a few days.

INTRAUTERINE DEVICE (IUD) FOR EMERGENCY

CONTRACEPTION.

An alternative to emergency
contraceptive pills is the copper-T
intrauterine device (IUD) which can be
used up to 5 days after unprotected
intercourse to prevent pregnancy.
Insertion of an IUD is more effective than
use of Emergency Contraceptive Pills.
ONLY THE COPPER T CAN BE USED
FOR EMERGENCY CONTRACEPTION

PERMANENT CONTRACEPTION
TUBAL LIGATION

In tubal ligation the two fallopian tubes which transport the eggs from
the ovaries to the uterus are disconnected either by cutting or by
applying cautery, clips or silastic rings.A tubal ligation is generally
considered permanent. EFFECTIVENESS: 99%
Benefits
It's the most effective method of contraception that is controlled by
women. It is ideal for women who don't want to have any more kids.
Disadvantages
Surgical procedure required
Permanent
There are two main methods of Tubal Ligation used today
A laparoscopic tubal ligation can be done anytime when a woman is
not pregnant There are three ways to block the tube: Cautery
(Burning); Applying Clips (Hulka Clips); Applying Silastic Rings
Postpartum Tubal Ligations are done within two days of delivery
because the top of the uterus is at the level of the belly button at
that time.

PERMANENT CONTRACEPTION
MALE STERILIZATION (VASECTOMY)
A Vasectomy interrupts the travel through the Vas Deferens by
blocking it. Thus, if sperm cannot reach the egg, there is no
pregnancy. Sterilization is considered to be an irreversible,
permanent method of contraception. Rejoining the vas deferens is
very difficult, specialized surgery and moderately successful at best.
Vasectomy can prevent pregnancy it cannot protect against Sexually
Transmitted Diseases.
EFFECTIVENESS: 99%+
ADVANTAGES:
doesn't interfere with erection or ejaculation
no known side effects
doesn't interfere with spontaneity
DISADVANTAGES:
permanent
surgical procedure required
some discomfort at the time of procedure

REFERENCES

WHO. Medical eligibility criteria for contraceptive use. Third

edition. Geneva, 2004.
WHO. Selected practice recommendations for contraceptive
use. Second edition. Geneva, 2005.
Trussell, J., and E. J. Raymond. 2011. Emergency
Contraception. (A more recent summary of findings by the
same Dr. Trussell whose earlier work is cited above.)
"Mechanisms of the Contraceptive Action of Hormonal
Methods and Intrauterine Devices (IUDs)". Family Health
International. 2006. Retrieved 2006-07-05.
"Contraception: past, present and future". UK Family
Planning Association. April 2006. Archived from the original
on 2006-09-28. Retrieved 2006-11-09.