Contraceptives

So, here we go, talking about the salient features of various contraceptive means.

Natural means

If you and your husband practise contraception without using any contraceptive, you are adopting natural means. Two categories of natural methods are employed. In the first category are included abstinence or celibacy, coitus interrupts, safe period, and breastfeeding. In the second category, the wife employs self-recognition of certain signs as an aid to determine ovulation, the time when there is a peak chance to conceive.

Abstinence or celibacy means restraining completely from sexual activities unless and until the couple has decided to have the baby. This involves suppression of natural desire. This may well be practicable with some people but is surely no reasonable method of contraception to be advocated to the couples at large.

The noted author Kinsley, mentions categorically how forced abstinence led to nervous breakdown in one or the other spouse in his famous study on the sex habits of the Europeans under the spell of a particular quack sexologist.

Coitus interrupts means withdrawing the male organ before ejaculation, thereby preventing the deposition of semen into the vagina.

This act, as you can see, is very simple. This is a traditional method and continues to be quite popular till date.

But, you may well ask: Is it foolproof ? Does it indeed give the couple full satisfaction?

Taking up the first query – well, it is not a foolproof means at all. A slight mistake in timing the withdrawal of the male organ may lead to deposition of some semen into the vagina and all that is needed to cause conception is a drop of it.

As regards the second point – well, the method certainly does not give the couple full satisfaction. More often than not, it has been found as the cause of unhappiness and anxiety.

Safe period or rhythm method is having sexual intercourse during a period when least or no chance of conception exists.

In a woman with 28-days regular cycle, seven days before the forthcoming menstrual period are considered the safest. Generally speaking, some three to four days after the period and some seven to ten days preceding the next period are more or less safe. Few days before and after ovulation i.e. the 14th day of the menstrual cycle are vulnerable for conception. The doctors call them “unsafe period”.

An oft-asked question is: if intercourse is done during the safe period only, can one let one’s hair down and relax? Well, the answer is NO with capital letters. Experience has shown that the safe period method fails one in five instances. The failure is usually ascribed to mistaken calculations, taking chances or lack of cooperation between the husband and the wife.

This method is never, never to be recommended to women with irregular menstrual cycles.

Breastfeeding is said to offer some safeguard against an unwanted pregnancy. However, it should be exclusive rather than be supplemented by the other milk or soft foods.

Nevertheless, in individual cases, one can not bank upon breastfeeding as a dependable way of birth control.

Basal body temperature method means maintaining daily body temperature record very carefully. You are supposed to record the temperature just before getting out of bed in the morning. An elevation by 0.3 to 0.5^°C is a sign of ovulation. The elevation in body temperature is maintained until the onset of the next period.

If intercourse is restricted to post-ovulatory period which starts two days after the temperature elevation and continues up to the beginning of the menstruation, this method becomes quite dependable.

Its snag is that celibacy is warranted for almost half of the menstrual cycle, before the ovulation as well.

Ovulation method, also called Billigs’ method or cervical mucus method, consists of observing cervical mucus discharge by the woman. The mucus, if watery, clear, resembling a raw egg white, smooth, slippery and profuse, points to ovulation. No sooner does ovulation stops than it becomes thick and scanty.

As you can appreciate, these few days of ovulation would require abstinence on your and your husband’s part.

Symptothermic method consists in daily palpation of the opening of the womb into the vagina. If the opening gradually becomes patent and the cervix soft, in all probability, ovulation is round the corner.

If the cervical secretion in the vagina shows an increase and also becomes watery, smooth and slippery like the white of an egg, chances are that the time of ovulation is approaching. Once ovulation is over, secretion lessens and becomes thick. This method combines palpation and cervical mucus methods and, therefore, double-checks the interpretations.

Chemical means

Douching is the method of washing the vagina with a weak solution of soap and water, a solution of vinegar, lemon, tepid water or some antiseptic solution. It is claimed that this method leads to creation of an environment in the vagina that proves fatal to the sperms.

Though douching is frequently employed as a domestic means for safeguarding against pregnancy, particularly in the rural settings, its effectiveness is dubious.

Contraceptive foam tablets, jellies, pastes, creams etc., introduced deep into the vagina, constitute a very popular birth control measure. These agents are supposed to block the entry of the sperms into the uterus, slow down their speed and kill or render invalid a proportion of them.

The success rate in terms of prevention of pregnancy by these agents is around 75 per cent. However, success rate zooms very high when they are used in combination with the condom.

Though foam tablets are cheap, jellies, pastes and creams are very expensive.

Mechanical means

This group refers to devices which aim at interrupting the meeting of the husband’s sperm with the wife’s ovum.

Condom, also called rubber, leather or sheath, is a device for use by the husband. It is rolled over the penis when erect, so as to cover it fully. During intercourse, semen collects within its teat rather than in the vagina. Once the act is over, the condom is discarded. Each piece is meant to be used once only.

The market is flooded with various brands of condom. One should always go for a good quality stuff.

The most popular and economical condom available in India is “Nirodh” – Sanskrit word meaning “prevention”.  It protects both partners from sexually-transmitted disease (STD), including HIV infection and AIDS, hepatitis B infection, gonorrhoea and syphilis.

If it is used in conjunction with a spermicidal chemical, failure rate is virtually negligible.

Of course, there are some minus points of condom. Some couples grumble that since the genitals of the partners are slightly interrupted by the sheath, it takes away some pleasure. Also, there is some chance of the condom tearing off or slipping off during intercourse. However, this is related to carelessness in employing it rather than the inherent defect in the device.

Diaphragm, a mechanical barrier, is made of synthetic rubber or plastic. It is 5 to 10 cm in diameter and is meant to be inserted well up and high into the vagina before intercourse. It must remain for at least six hours after the act in this very position.

You are supposed to consult your doctor for the right size of the diaphragm for you. For added advantage smear it with a contraceptive cream or jelly before inserting into the vagina.

The merit of diaphragm lies in its being relatively cheap. If you exercise proper care in handling it, it lasts for quite a long time without losing its effectiveness. Unlike condom, it does not interfere with sexual satisfaction.

But, then, the snag is that you have got to consult a doctor or a midwife to fit it in the beginning.

Intra-uterine contraceptive devices (IUCD) are innumerable but the one most popular and officially recommended by the Family Welfare Department of Government of India is what is called Lippe’s loop. It has stood the test of time in most of the countries.

Lippe’s loop consists of a loop, inserter, plunger, guard and threads. The threads made of nylon keep projecting into the vagina as a reminder that the device is still in place.

The device should best be introduced at the end of the menstrual period by a qualified doctor in a hospital or a clinic.

In India, IUCD facility is available fairly widely in a network of centres throughout urban and rural areas.

A woman who has gone in for IUCD must:

There are advantages in wearing a loop. It is inexpensive and simple to insert – a matter of minutes. It may be retained for several years, if desired, and yet it is an absolutely reversible contraceptive method.

The success rate is as high as 95 to 98 per cent. Whatever risk of pregnancy exists is in the first year of use. In subsequent years, risk is negligible.

More recently, our Family Welfare Department has introduced in the National Family Welfare Programme the copper IUCD which is supposed to have some advantages over the Lippe’s loop, namely:

a. Less loss of blood during the period;

b. Less chance of spontaneous expulsion;

Oral contraceptive pill

The contraceptive pill is a hormonal preparation that suppresses the release of egg, i.e., the ovulation, in the woman.

The combined pill, containing small amounts of two hormones (oestrogen and progestrogen) is the most effective reversible method of contraception available at present.

Taken regularly, the combined pill (also called 21-day pill ) offers almost 100 per cent protection. It is required to be taken orally by the woman for 21 days, starting from the fifth day of the menstrual cycle, followed by a break of seven days during which time menstruation occurs.

The second type of pill is what is known as micro pill. Also called 28-day pill, it contains only one hormone, i.e., progestrogen and is required to be taken everyday of the month without breaking the sequence. It is said to be less effective than the combined pill.

However, that some users of oral pill may have such side effects as breakthrough bleeding, suppression of lactation if pill is started soon after previous childbirth, excessive weight gain and psychological depression.

If you are considering to take the pill, do remember to see your doctor and take his advice. Generally speaking, the pill should be used by women who are below the age of 35 years. The doctor would see to it that you do not suffer from migraine, epilepsy, diabetes, severe allergy, asthma, eczema and such other diseases that contradict its use.

Once you are on the pill after taking the doctor’s advice, do make it a point to get your medical examination at least once a year.

Today more and more women are taking to the oral pill. This is, perhaps, the only method of contraception that does not operate directly at the time of the sexual act, thus having a lot to say in its favour, particularly from the point of psychological and emotional needs of the couple. The new low dose pill, Mala-D, specially made for the Indian women is available at a highly subsidised price of Rs. 2 per cycle.

Injectable contraceptives

Two types of injectable hormonal contraceptives administered intramuscularly are now available –  depot-medroxyprogesterone acetate (DMPA); and norethisteroneenantate (NET-EN).

They act primarily by suppressing ovulation. The injection is required to be given every 90 days in case of DMPA and every 60 days in case of NET-EN.

This measure gives protection from pregnancy in 99 per cent women. Moreover, it is a safe, effective and reliable means requiring minimal or no motivation.

Nevertheless, some users may suffer from disturbance of the normal menstrual cycle.

A new introduction is what is called Norplant. It is a subcutaneous implant of a long-acting hormone (progesterone, to be specific). The implant gradually releases the drug in the blood, thereby providing protection against contraception for around five years.

Postcoital pill is the best choice in case of an accidental unprotected intercourse when pregnancy is not desirable. It is available as Mifepristone and is taken as a single dose.