Tag: Contraception

Female sterilization means that you can never get pregnant again. The procedure is an operation in which the fallopian tubes are cut and closed.

Female sterilization is a permanent procedure to prevent pregnancy. It works by surgically or nonsurgical blocking the fallopian tubes.

There is a difference between surgical and nonsurgical sterilization? While the surgical procedure requires tubal litigation, cutting and sealing of the fallopian tubes, the nonsurgical procedure involves no incision at all. Instead, devices are inserted through the vagina and uterus into the fallopian tubes to seal them.

Before the operation, the doctor conducts a detailed discussion with the patient to ensure that she really does not want any more biological children, since the operation is very difficult to reverse. He must also inform the patient about possible side effects and risks, and she must agree to the operation before sterilization can be carried out.

Female sterilization: the surgical procedure

There are different ways to do the surgery. Some clinics offer outpatient surgery, while others stay in the clinic for between one and seven days. The patient is given general anesthesia. Then her fallopian tubes are severed and the ends sealed. This is done by scab formation or by plastic or metal clips. From then on, the egg cell only reaches this point and is absorbed by the mucous membrane of the fallopian tube. Sperm cells can no longer reach them, so contraception is very reliable. Sterilization has no effect on sexual experience.

If blocking the fallopian tubes does not work, the tubes may be completely removed – a process called salpingectomy.

Disorders in the hormone production of the ovaries sometimes occur after the operation, which can result in spotting before and after the menstrual period. If the decision against further biological children was not well thought out, the patient can get mental problems because this form of contraception is permanent. In very rare cases, problems with the anaesthetic, internal bleeding or damage to the intestines can occur during the operation. However, the doctor must inform the patient about these risks before the procedure.

How effective is female sterilization

Female sterilization is 99% percent effective in preventing pregnancy. Some studies have shown that some women might still get pregnant after the procedure.

The procedure is irreversible so one needs to be absolutely sure it is right for them. In addition, a condom should be used to prevent STIs.

 

Even if a contraceptive fails, the morning-after pill can prevent an unwanted pregnancy. However, the drug can have side effects and should therefore only be taken in exceptional cases.

It is not just unprotected sex that can lead to an unwanted pregnancy. If a condom bursts or the pill is taken too late, contraception may fail. However, the morning-after pill can still prevent pregnancy.

How does the morning-after pill work?

The morning-after pill cannot reverse an existing pregnancy, but only prevents the egg cell from maturing and implantation. This is done by the hormone levonorgestrel. If ovulation has already taken place, pregnancy can still be possible – namely if the unprotected sex takes place immediately after ovulation. Since sperm can survive in the fallopian tube for up to a week, the morning-after pill should be taken as soon as possible after the mishap. If you take the morning-after pill within the following 24 hours, there is a 95 percent protection against an unwanted pregnancy.

Side effects of the morning after pill

Even if the morning-after pill is usually well tolerated by healthy women, side effects can occur. Headache, nausea, dizziness, abdominal pain or light bleeding may occur after taking the morning-after pill. If the symptoms persist or worsen, you should definitely consult a doctor. Since the morning-after pill contains a high dose of hormones, your cycle may be shifted in the month after you take it. Particular caution is required if another disease is present, such as liver damage. The doctor treating you must be informed about such diseases in order to be able to weigh up the risks.

A vasectomy can be reversed. The process is called vasectomy reversal. However, the chances of becoming fertile again depend on various factors.

Microsurgery is required to reverse a vasectomy. The vasectomy reversal procedure is much more complicated than the sterilization itself – and so is the healing process. The operation takes up to three hours and the patient usually has to spend a day or two in the hospital.

Procedure for vasectomy reversal

During vasectomy reversal, the doctor works with a microscope or magnifying glasses. He first exposes the vas deferens and frees the scarred or stuck ends so that they become permeable again. Then he sews them back together. If he finds during the operation that no more semen is getting into the vas deferens via the spermatic cord, he places a kind of bypass from the epididymis to the vas deferens. However, this procedure is very complicated and should only be performed by very experienced doctors.

Successful reversal depends in part on the skill of the surgeon, but also in part on how long ago the vasectomy that is being reversed was performed: the longer the surgery and the older the scarring, the less likely it is to success. Men often develop autoantibodies against their sperm after sterilization if sperm components get into the blood during the vasectomy.

Success rates for vasectomy reversal

Below are estimates:

• 75% if you have your vasectomy reversed within 3 years
• up to 55% after 3 to 8 years
• between 40% and 45% after 9 to 14 years
• 30% after 15 to 19 years
• less than 10% after 20 years

When the woman is 40 or older, chances for fertilization are minimal.

Frequently asked questions about vasectomy reversal

• What is the recovery process? Recovery is variable and can take anywhere from 5 to 14 days. It is recommended to avoid heavy lifting and sexual intercourse during the first 4 weeks after this surgery.
• Does insurance pay for vasectomy reversal? The cost of the surgery, as well as whether or not it is covered by insurance, is variable, and dependent upon where the surgery is performed and the patient’s individual insurance policy.
• What is the typical cost of vasectomy reversal? Cost can vary widely, depending upon the surgeon, the type of practice where it is performed, and what part of the country the patient lives in.
• Who is not a good candidate for vasectomy reversal? There are certainly some patients who are better candidates than others; time from the vasectomy is not necessarily a reason not to have a reversal. However, in the case of a couple where the woman has, for instance, had a tubal ligation, surgical sperm retrieval combined with in-vitro fertilization is probably a better choice than performing vasectomy reversal followed by tubal ligation reversal.
• What are side effects of vasectomy reversal? Side effects are typically minimal and usually would include swelling, pain or bruising; however, the vasectomy itself and the reversal should not have any effect upon potency or urinary function.
• What is the effective rate of reversal? The success rate varies based on several factors. Time from the vasectomy certainly helps to predict how likely it would be to be able to put the two ends of the vas deferens back together; however, getting return of sperm into the ejaculate does not guarantee pregnancy, so pregnancy rates typically vary from 30 to 70 percent, whereas patency rate, that is the return of sperm, can be as high as 95 percent.
• What are other fertility options? The only other option to a reversal that would allow use of a man’s sperm with the woman’s egg would be surgical sperm retrieval (through either extraction or aspiration) combined with in-vitro fertilization. The sperm removed from the testicle can be injected directly into the eggs that have been retrieved from the woman after she has been stimulated with hormone injections. This is a very effective but expensive treatment with relatively good success rates. However, it is not possible to remove enough sperm from the man’s testicle to inseminate the woman.
• How do post procedure antibodies affect pregnancy rates? There is some debate about the effects of antibodies on pregnancy rates after vasectomy reversal. Approximately 70 to 80 percent of men who have had vasectomies will have antibodies to their sperm. However, these antibodies rarely prevent the sperm from fertilizing the egg. Therefore,  patients should know that it is usually unnecessary to routinely test for antibodies, as they rarely will have a bad effect upon the success rate.
• Is cancer risk increased with the reversal? There was a report several years ago stating that men with vasectomies had a higher rate of prostate cancer. This report has since been challenged and, for the most part, disproven. There is also no evidence to show that reversal of the vasectomy would have any effect upon risk of cancer.
• How many times can a reversal be done? There is no maximum number of times that a man can have a reversal, although the success rate may decrease with increased number of reversals. However, there is good data to show that “redo-reversals” can have as high a success rate as first-time reversals. The more surgery is performed, the greater the likelihood of scarring in the scrotum, making subsequent surgeries more difficult.
• What if there is no sperm in the vas at the time of surgery? If the surgeon is experienced in doing vasectomy reversals, they should be able to find the blockage, which is likely to be in the epididymis, and perform the bypass above that point. However, if the surgeon is not able to perform this bypass, then the best thing to do is reattach to two ends of the vas and hope for the best. That is why it is important that prior to surgery, the patient question the surgeon regarding their experience in vasectomy reversals to determine if they would be able to perform both types of reconstruction.
• Six weeks post vasectomy reversal, is scarring a concern? Scarring can occur at any time after a vasectomy reversal although it typically occurs within the first six months. Therefore, even if there was sperm in the ejaculate after six weeks, it is possible that scarring could occur later on.
• How would I find a good surgeon for the procedure? It is important to choose a surgeon who performs reversals on a regular basis, preferably someone with fellowship training or other special training in male infertility. Patients should ask the surgeon how often they perform the procedure, what their own personal success rate is, both in obtaining sperm and pregnancy rates, and if they have the ability to perform both types of reversals.
• Does a vasectomy reversal effect sperm quality? The sperm quality should return to normal 3 to 6 months following a reversal as it takes that long for the testicles to make new sperm. However, the count and the motility may be lower after reversal due to partial blockage or scarring.
• Is a vasectomy safe/healthy for an 18-year-old? Vasectomy reversals do not always work and in someone who is both young and never fathered children, it is probably not a good idea. This patient should reconsider having a vasectomy. Prior to a vasectomy, the patient and his partner should be absolutely sure that they are done having children.
• How does one prepare for the vasectomy or the reversal? Prior to a vasectomy, the patient and his partner should be absolutely sure that they are done having children. There are no special preparations in terms of abstaining from ejaculation prior to either the vasectomy or the reversal. The patient should be aware that a vasectomy reversal is a more expensive procedure than the original vasectomy and likely will take longer to recover.
• What is the recovery for a vasectomy and the reversal? Most men will recover from a vasectomy in a couple of days. It is typically recommend taking it easy for 2 days, using ice packs and scrotal support, and then going back to work 2 or 3 days later. However, vasectomy reversals tend to take longer, depending on the type of work that the patient does. While some men can return to a desk job in 3 or 4 days, it is recommended that heavy construction and lifting should be avoided for 4 weeks after a vasectomy reversal.
• What is the age limit for a reversal? The success of the reversal is related more to the age of the female rather than the male. Therefore, there is no age limit for a reversal.
• What are psychological/emotional problems related to a vasectomy? A report on psychological factors prior to a vasectomy has suggested that most men are not worried about having a vasectomy, but they are a little concerned regarding the recovery of a vasectomy. Very few men have reported serious psychological or emotional problems following their vasectomy.

Some content in this article is copyrighted material used with permission of the author, University of Iowa Hospitals & Clinics, uihc.org.

The diaphragm (vaginal pessary) is one of the contraceptive methods for women that protects against pregnancy but not against sexually transmitted diseases. Proper handling requires some practice.

The diaphragm is placed over the cervix before intercourse and prevents sperm from entering the uterus. Since there are different sizes of silicone membranes, you must have your gynecologist determine which one is right for you. Then you can simply buy your diaphragm in the pharmacy – it lasts for about two years.

How to correctly use the diaphragm

Always use the vaginal pessary in conjunction with spermicides that kill sperm: apply the agents to both sides and to the edges of the membrane. Insert at least ten minutes and no more than two hours before intercourse. Make sure you wash your hands before doing this. Pinch the edges of the diaphragm and insert it into the vagina. When you let go, the rim springs back up and the membrane covers the cervix.

Push it further back until it fits into a niche behind the pubic bone. Before sexual intercourse, check the fit of the vaginal pessary by feeling the cervix through the membrane. If you can’t feel it, it’s an accurate fit. After intercourse, the diaphragm should remain in the vagina for between eight and 24 hours to ensure optimal contraceptive protection: then you can be sure that the spermicide has killed all sperm.

To remove the diaphragm, grasp the front edge with your index finger. Then clean it thoroughly with mild soap and lukewarm water. Let it dry completely before storing it in its case.

Contraception is quite safe with the correct use of the vaginal pest with spermicides.

The female condom works in the same way as traditional male condoms, except that the lady inserts it into her vagina before intercourse. The application is fairly simple with a little practice.

The advantage of the female condom is that it is the only contraceptive method that a woman can use to protect herself from sexually transmitted diseases.

Some people report that it interferes with intercourse and that it can slip. However, couples who have practiced using it do not complain. No conclusive statements can be made about the safety of the contraceptive method as there are limited studies.

How to use the female condom

The female condom is made of polyurethane and is 17 cm long like other condoms, but less narrow than these.

It is placed in the vagina before intercourse – unlike traditional condoms, this can happen before the penis is hard.

When inserting the penis, the outer ring of the condom, which rests on the labia, must be held tightly so that the condom does not slip.

After ejaculation, you should twist the outer ring of the condom and carefully remove the condom – this way the sperm cannot escape and the contraceptive protection remains in place.

The copper coil is inserted directly into the uterus. It constantly emits small amounts of copper. As a result, the sperm are blocked on their way to the uterus and restricted in their mobility, so that fertilization does not normally occur.

In addition, the copper disrupts the structure of the lining of the uterus, so that no implantation takes place if fertilization is successful.

Advantages and disadvantages of the copper spiral

Since the copper spiral does not require hormones, the natural hormonal balance of the female body is not affected.

In addition, contraceptive protection is guaranteed for several years without the woman having to worry about it. The contraception is considered reliable.

The copper spiral can lengthen and intensify the menstrual period, sometimes there is pain or intermenstrual bleeding at the same time.

Rarely, the abdomen can become inflamed. If this is the case, medical treatment must be sought quickly, otherwise there is a risk of infertility.

Contraception with the spiral can also lead to ectopic pregnancies. If, which happens rarely, a fertilized egg nests in the uterus despite the IUD, you should see your doctor as soon as possible, who then must remove the spiral otherwise infections may occur during pregnancy.

When the IUD is pulled, a miscarriage occurs in about one fifth of the cases. However, the risk of this is even higher if the coil remains in the uterus.

During a vasectomy, i.e. male sterilization, the vas deferens are severed. It is a small operation with a big effect: the patient is now infertile.

The vasectomy is a short procedure that is largely painless. If you want, you can have it done under general anesthesia, but it is not necessary. Depending on the type of operation, 15 to 20 minutes can be enough. The patient should abstain from alcohol the day before the procedure and should not take any blood-thinning medication. He usually only gets a local anesthetic.

Vasectomy: Safe way of birth control

During the procedure, the skin on the scrotum is either opened a little with a scalpel or punctured. Then the vas deferens are cut, and the doctor removes a piece that is about one to three centimeters long. Depending on the surgical method, the ends are electrically sclerosed and sewn up or grow back together on their own.

The operation is particularly low-risk; complications rarely occur. In very few cases, bruising, swelling of the scrotum, wound healing disorders, bleeding or adhesions can occur. However, the chances are really small and the doctor will explain these risks to the patient before the operation. Neither the libido nor the testosterone level nor the ability to have an orgasm are restricted by the procedure. After the operation, the patient should rest physically and cool their groins to prevent swelling.

He can also take painkillers for the first few hours after sterilization. In the first twelve weeks after the operation, fertilizable sperm can still be in the semen, so you should still use other contraceptive methods during this time. In two to three check-ups, the doctor checks whether fertilizable sperm are still present in the ejaculate. After that, prevention by sterilization is very safe.

Only in 0.4 percent of all cases do the vas deferens grow back together after a vasectomy. In the first twelve weeks after the operation, fertilizable sperm can still be in the semen, so you should still use other contraceptive methods during this time. In two to three check-ups, the doctor checks whether fertilizable sperm are still present in the ejaculate. After that, prevention by sterilization is very safe.

During the development of the male contraceptive pill, there have been problems for a long time for which no solution seemed in sight. However, scientists at Baylor College of Medicine in Houston, Texas, have apparently made a breakthrough.

The team discovered that the JQ1 molecule reaches the site of sperm development via the blood and can impede it. The process is reversible. So far, this impediment to sperm production has not been successful because the so-called blood-testicle barrier has stopped most of the active ingredients. This was the point at which previous research on the male ‘pill’, which had been limited to hormones, failed.

Various studies to the development of the male pill create a fundamentally new approach that will advance the process of finding one.

The molecule JQ1 inhibits the activity of the protein BRDT, which plays an important role in the development of sperm. Due to this inhibition, fewer sperm are produced, and the few mature specimens are significantly slower. The mice on which the substance was tested became infertile, but were able to father healthy offspring after stopping the medication. Neither testosterone levels nor sexual desire were affected.

Mice are known to be similar to humans but further studies involving men should be conducted. Researchers are confident that the drug will also work, since the key proteins in humans and rodents are very similar.

The male pill has not not yet hit the market, but the new research marks a breakthrough in research in this area.

The only available options for men to avoid unwanted pregnancies are:

• abstinence
• vasectomy
• condoms

Withdrawal of the penis during sex is not a contraception method because sperms can still be released before ejaculation, causing unwanted pregnancies.

Condoms are 98% effective at preventing pregnancy, but you need to make some further precautions while using them.

Other methods are not as nearly effective as condoms because the risky for pregnancy is 1 in 5, according to NHS UK. Of course abstinence is 100% but you will be deprived of sex.

Nevertheless, every new year we see headlines of a new contraception pill for men. However, most of these studies have never moved beyond clinical trials mainly due to the side effects they have on men. Researchers are optimistic that in the future there will be a male pill.

 

 

In contrast to conventional birth control and micro pills, the mini pill does not contain estrogen, but only the hormone progestin. As a result, it represents a much smaller intervention in the hormone balance of the body.

The mini pill was developed primarily as a contraceptive during breastfeeding, as the estrogen in conventional pills can have a negative effect on breast milk production. In fact, the gentle contraceptive is suitable for all women who cannot take estrogen, for example because they are overweight, have high blood pressure or have problems with blood clotting. The gentle pill is also a good and safe alternative to the more heavily dosed preparations for smokers who have reached the age of 35.

The use of the mini pill as a low-dose birth control

If you decide to use this contraceptive, you must ensure that you take it regularly: you must not exceed the usual time by more than three hours, otherwise effective contraceptive protection is no longer guaranteed due to the low hormone dose. But since, unlike other pills, there is no break of several days here, it is also easier to get used to a certain regularity. Since there is no break in the intake, there is no menstrual bleeding. The progestogen in the mini-pill ensures that the mucus in the cervix has a consistency that sperm cannot penetrate. It also alters the lining of the uterus itself in a way that makes it impossible for eggs to implant.

Disadvantages and contraindications of the low-dose birth control

Side effects such as dizziness and nausea, abdominal pain, a feeling of tension in the breasts, tiredness and mood swings, headaches or acne can occur, especially at the beginning of the intake. But that often goes away over time. If you have liver disease, ovarian cysts, or recent breast cancer, you should use another contraceptive method.

There you have it. The mini-pill contains progestin only, so it’s considered to be safer for breastfeeding mothers. The pill is typically only available by prescription, but may be found over the counter (OTC) in some cases.