Family Planning Methods
Before describing the methods we can use for birth control, it would be appropriate to give a brief information about the physiology of reproduction.
The Reproduction Physiology
In adolescents, that is between 11-14 years old boys and girls, their bodies and moods will begin to change, and this will continue until the age of 17-21. This is a maturation process that will wait for our children. First of all, let’s take a brief look at the formation of female and male reproductive organs and pregnancy:
The reproductive organ in the female has large and small lips at the entrance, perineum at the bottom and clitoris at the top and hymen slightly inside, and then 8-10 cm. It consists of a vagina in length, and in the west, there are pear-shaped tubes in the upper corners of the uterus and uterus, with extensions at the ends, and the lateral walls of the abdomen on both sides and the tubes attached to the uterus. Ovulation in women usually occurs in 11-18 days (average 14th day) from the first day of menstruation, and the appendages at the ends of the tubes cover the egg thrown from the ovaries. After ovulation, the egg can maintain its fertilization capacity for 24-48 hours.
In the male reproductive organ, the penis and scrotum tissue that covers the testicles at the bottom of the penis settle like a bag. The scrotum, which contains the testicles known as the male ovary, produces and protects the sperm, 2 degrees less than the body temperature. The tubes carrying the sperm from the testicles pass through the abdomen and reach the tube through which urine flows to the penis. In the event that millions of sperm reaching the vagina after ejaculation exceed the vagina, cervix and intrauterine tissue, their number will drop to hundreds of thousands of errors, but a single sperm will pierce the membrane of the egg cell in the tube. When the sperm is able to pierce the membrane, it will create a barrier for the passage of other sperm and will not allow it. The reproductive capacity of sperm discharged into the vagina is limited to 48-72 hours.
Thus, as a result of the merger of the sperm and the egg, the pregnancy will actually start first in the tubes, and then the uterus will migrate to the inner tissue and form the gestational sac in the intrauterine tissue.
The purpose of family planning or birth control methods is to enable couples to have as many children as they want and whenever they want.
The statistics given for our country must of course be interpreted by considering socioeconomic and cultural differences. The percentage of couples who do not want any child and do not apply any protection method is 13%. Couples who practice low-retention methods (withdrawal, calendar method, vagina washing, suppository etc.) are around 28%. Almost 40% of couples do not use an effective method. For these reasons, optional pregnancy termination is found around 15%. In our country, termination of pregnancy is legal up to 10 weeks with the mutual approval of couples. However, serious problems may arise in terms of maternal health and socially difficult for the family. Pregnancy may also occur in a couple with an effective prevention method in the diabetes and can be terminated at the request of the couple. However, we can reduce the rate of curettage by using the effective method.
The Classification of Family Planning Methods
Perhaps it would be appropriate to divide the methods of protection into two:
1) Traditional methods: Withdrawal, washing the vagina after intercourse, calendar method and breastfeeding. The effectiveness of this group is low.
2) Modern methods: Birth control pills, intrauterine device, Mirena (hormonal intrauterine device), subcutaneous implant, tube ligation, vasectomy, monthly or quarterly needles and sperm-killing gel, foam, wick etc. are located.
The couples who are informed about the methods should choose the most appropriate method themselves. Because sexuality is a couple’s experience and lifestyle. Among the methods, they will need to choose the most appropriate method for their personal health conditions and spiritual structure, and of course their relationship dynamics.
Now let’s review the methods one by one:
Just before orgasm, the penis is pulled out from the vagina and emptied out. Some couples use this method as a method for a very long time, but it will require very serious control of the man. So the effectiveness of the method is entirely up to the user. Even if very little semen comes before the withdrawal and it infects the woman’s vagina, healthy sperm can come out of the female reproductive system in a short time. It should be remembered that the sperm moves very quickly.
It is based on avoiding unprotected sex on days when ovulation is estimated. If the woman’s period is every 28 days, the 14th day from the first day of her menstruation is accepted as the average ovulation day and is the time when the probability of pregnancy between 11-18 days is highest. However, for those who have had menstruation for the first time, postpartum, during breastfeeding, and those who have just given birth control pill, perimenopause, stress, weight and hormonal changes may change with the day of ovulation and its effectiveness may decrease. Its failure rate is between 13-25% and it cannot provide protection from sexually transmitted diseases.
Breastfeeding is still accepted by many women as an absolute method of protection. However, even though it is irregular six weeks after birth, ovulation returns and the possibility of pregnancy appears.
Again, washing the vagina after sexual intercourse will not only go beyond giving the woman spiritual comfort at that time. Because when the vagina is washed, the sperm may have already crossed the upper part of the female genital tract.
Oral Contraceptive Pills
Contraceptive pills, which are socially perhaps the most pre-judged method of protection, are one of the most modern methods of protection.
Birth control pills, which normally contain estrogen and progesterone secreted from the ovaries, block ovulation, change cervical secretion and thin the intrauterine tissue. By providing a combined control management with all these effects, it gives a pregnancy rate of less than 1% in 100 women in a year.
Let’s first look at who shouldn’t use it:
* Over 35 years old and smokers
* Smokers (unfortunately over and over again !!!)
* brain, heart or peripheral vascular disease
* liver disease
* suspected pregnancy
* suspected breast cancer
* un-diagnosed vaginal bleeding
Women who are excluded from these conditions can use birth control pills easily. The most common side effects are headache, nausea and breast tissue tenderness. Intermittent bleeding that may occur with low dose contraceptives is mostly eliminated when returning to routine doses. It is very important that the woman is loyal and regular to use. If the tablet is missed one day, it should be taken immediately the next day and added as the second tablet of that day. If two tablets are missed in the same month, both the risk of pregnancy (using an additional method such as a condom) and the risk of intermediate bleeding will increase.
Birth control pills should be used under the supervision of a physician and with the recommendation of a physician. The risk of thromboembolism is seriously increased with smoking. However, this detail is often overlooked. There is no compromise between smoking and birth control pills.
The additional advantages of this group are that it reduces the amount of menstrual with an average of 50%, thus providing support in the treatment of anaemia and significantly reduces menstrual pain. It also reduces the risk of ovarian cancer by reducing ovulation.
1-5 of menstruation. Between the days of birth control pill is started and one is taken every day at about the same time. After 21 days of regular use, there is a 7-day break, and in the middle of these 7 days, menstruation occurs on any day. After the 7-day break, the new box is started again on the 8th day.
Monthly and Three Monthly Depot Injections
Depot medroxyprogesterone acetate preparations known as 3-month-old needles contain only progesterone, not estrogen. It will provide long-term protection like subcutaneous implants. It is repeated every 3 months and is an easy method since it does not need to be remembered constantly.
The most common side effects are bleeding irregularities. It may cause intermittent bleeding or rarely prolonged bleeding, or it may cause menstruation for a long time. Nausea and edema are also side effects. After the depot product is released, fertility can return in 3 months or in 18 months.
Pregnancy rate found in 100 women in a year is below 1%.
Monthly injections include estrogen and progesterone. Implementation once a month, since it does not have to be remembered, it brings ease of use. Since it has the same content as birth control pills, the conditions of use and side effects are the same. However, since it is not possible to give the whole dose at the same time and to take it back when injection, it will have to be waited until the side effect passes.
Vaginal rings containing estrogen and progesterone work on the same principle, just like birth control pills. Instead of just oral use, the vaginal ring is placed in the vagina for 21 days and removed for 7 days. It is very comfortable to use. The probability of the partner to feel the ring is around 5%. Risk, indication and complication possibilities are like birth control pills. Vaginal rings, which are not widely used in our country, are widely used in European Union countries. Not having to remember everyday can bring birth control pills to the upper hand. However, they think that vaginal application to woman is uncomfortable from time to time and they have the worry that their partners will feel.
Implants applied to the inner part of the upper arm are flexible rod-shaped capsules containing progesterone. It is applied under local anesthesia and is very easy to apply. It can be applied to women who have varicose veins, who smoke, who cannot use other protection methods and who want long-term contraception. It can provide up to 6 years of protection. It provides control by preventing ovulation and complicating the acceptance of pregnancy with changes in the uterus. It is very successful and works with an error rate of 0.2 -0.5 in 100 women a year.
The side effect profile includes irregular intermediate bleeding, tenderness and pain in the breast, inability to menstruate, hairiness and hair loss. It is not always easy to remove implants, which are very easy to apply. It is removed under local anesthesia, but capturing and fixing the tip of the capsule may require patience, but it can be removed.
A condom is a rubber sheath that is put on the erected penis just before sexual intercourse. The method has a serious success in preventing pregnancy, and it is a very successful weapon in the prevention of sexually transmitted diseases. The basic condition that increases the success of the process will always be to comply with the correct usage conditions.
Condoms sold without a prescription in pharmacies and even in grocery stores can be stored intact for about 2 years. Some condoms added spermicidal substances to increase their effectiveness. The tight fit of the condom is not suitable as it may cause sperm to escape during ejaculation. Extra space should be left at the end to store the semen after ejaculation. If the woman’s vagina is too dry, a lubricant can be used to prevent the condom from tearing.
In condoms, 100 women can see 3-15 pregnancies in 1 year. Here, delays in application timing are key factors that increase failure. In proper use, the risk is given as 2-5%. Of course, when it comes to rupturing or getting out unluckily and rarely to stay in the vagina of the woman, the possibility of pregnancy and sexually transmitted diseases will increase. In such cases, the next day pills can be used as an additional method and the possibility of pregnancy can be reduced.
There may be couples who think it reduces sexual pleasure and do not prefer to use it. Since condoms are made of latex, those with latex allergies may not use it.
If the woman or man is polygamous, it will be appropriate to use contraceptive pill or intrauterine device in addition to the presence of sexually transmitted diseases.
The Next Day Pills
It is a method that should be applied within 72 hours after sexual intercourse, but ideally, if there is unprotected sexual intercourse or if there is a problem with the current method. Only preparations containing progesterone can be used, as well as preparations containing estrogen and progesterone together.
Its mechanism of action is to try to delay ovulation and change the intrauterine tissue. There are 75-85% success probabilities. Nausea is the most common side effect.
Women who cannot use birth control pills due to their medical condition should not use the pills the next day.
Intrauterine devices with T-shaped plastic small objects may contain copper or contain progesterone. The uterus is placed in the cavity and its activities are quite high. Intrauterine devices with a pregnancy risk below 1%. They create an unfavourable environment in the intrauterine tissue for pregnancy and also change the secretion in the cervix. In hormonal intrauterine devices containing progesterone, the intrauterine tissue is thinned thanks to progesterone, and cervical secretion also becomes quite dark and prevents the passage of sperm.
Its attachment is usually performed in an outpatient setting, and there is often no need for any anesthetic use. However, it can be worn under general anesthesia in women with cervical congestion (cervical stenosis) or if the fear of pain is very severe. The first few weeks after insertion can cause cramping pains and intermediate bleeding. Over time, these complaints will decrease and disappear. It should be ensured by means of ultrasonography that the device is in the right place in the intrauterine tissue, with regular controls one month after and after insertion.
The intrauterine device should not be preferred by women who have had more than one pelvic infection, or who are partners with multiple partners. Because it can facilitate the spread of the infection to the upper genital organs. In women carrying intrauterine devices, discharge complaints should be taken into consideration and vaginal infections should be treated effectively.
Intrauterine devices can increase the amount of menstruation. It should be kept in mind that in women who already have a lot of menstruation, the intrauterine device will further increase the amount of bleeding, and preferably vehicles with progesterone should be preferred. The physical findings of the woman and, if necessary, laboratory tests should be reviewed in terms of anaemia.
It should not be forgotten that the probability of ectopic pregnancy increases with intrauterine devices and pregnancy test should be performed in case of intermediate bleeding and abnormal bleeding, menstrual delays and pain complaints and should be evaluated in terms of ectopic pregnancy.
It is not the right approach that women who have never given birth should not use intrauterine devices. In pairs with monogamous and hygienic conditions, intrauterine device can be used if this is the preference of the couple.
Intrauterine vehicles with progesterone; It can be used freely in women with high menstrual bleeding and menstrual pain. They reduce the amount of menstrual by thinning the intrauterine tissue and 20% of women who are wearing the tool will not have menstruation. This has no harm to the woman’s hormone functions. Hormonal intrauterine devices that also reduce the risk of endometrial cancer (intrauterine tissue cancer); It significantly reduced hysterectomy operations performed due to abnormal bleeding that did not respond to medical treatment. They can rarely be the cause of oedema, nausea and acne. They may bleed intermittently.
Tube Ligation in Women
It is the surgical connection of the tubes permanently and permanently in couples who have completed their fertility number. The easiest is to be done laparoscopically, but it can also be done by mini-laparotomy with a small incision. Tube ligation can be easily applied during caesarean without any additional time. Pregnancy between 0.1% and 0.5% in a year is reported in 100 women after tube ligation.
After connecting the tubes, if it is desired to open again, microsurgery and a long-lasting surgery will be required and the probability of proper channelling again is around 50%. Without this, in vitro fertilization can also be done at any time.
After the careful procedure of preserving the vascular structures in the tube ligation, there is no other side effect, except that the woman cannot have children permanently. There will be no negative interaction with the menopausal process or the sexuality of the woman. In this context, it is not possible for the woman’s menstrual cycle to be affected by tube ligation.
In any case, life is variable and it is not appropriate to connect tubes before 35 years of age or in couples with only one child.
Vasectomy in Male
Vasectomy is the connection of the ducts that carry the sperm from the testicles to the penis in men. It is an outpatient procedure with local anesthesia. It does not require hospitalization. Surgery risks are much lower compared to tube ligation in women. After the application, it is necessary to wait 2-3 months for the activity and have nearly 20 discharges. Therefore, another method must be applied in the interim period.
Vasectomy has no negative effects on male sexual behaviour, sexual desire, erection or ejaculation.
As with the same woman, if a return is desired, a long surgical process that requires microsurgery will be required. Without the need for this, in vitro fertilization can be performed by obtaining sperm directly from the testicle.
It is a dome-shaped rubber sheath placed inside the vagina to fit in the cervix. It tries to block the entry of sperm from the cervix. Its effectiveness can be increased by adding spermicidal substances. It is used only during sexual intercourse and has no side effects. The woman can also use a diaphragm during menstruation.
It must be properly placed before sexual intercourse and must remain for at least 6 hours. Placing may not be an easy experience for every woman. Those with latex allergies should not prefer.
The pregnancy rate reported in 100 women in a year is 5-20.
Gel, suppository or foaming preparations containing nonoxynol 9 that are placed in the vagina and kill sperm. They break down the cell membranes of the sperm, limiting their movement and causing their death. For its effectiveness, it is inserted into the vagina as much as possible 30 minutes before sexual intercourse and is not washed for 6 hours after intercourse. Its effectiveness in practice is about 1 hour.
It can be preferred in terms of providing slipperiness to the vagina and no side effects. It can be used to increase the effect of the calendar method and condom and breastfeeding. However, if it is not applied correctly, the pregnancy rate in 100 women in one year can reach 10-25. It is stated that it can reduce sexual pleasure.