Items in AFP with MESH term: Contraception

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Counseling Issues in Tubal Sterilization - Article

ABSTRACT: Female sterilization is the number one contraceptive choice among women in the United States. Counseling issues include ensuring that the woman understands the permanence of the procedure and knowing the factors that correlate with future regret. The clinician should be aware of the cumulative failure rate of the procedure, which is reported to be about 1.85 percent during a 10-year period. Complications of tubal sterilization include problems with anesthesia, hemorrhage, organ damage, and mortality. Some women who undergo tubal ligation may experience increased sexual satisfaction. While the procedure is commonly performed postpartum, it can be done readily, without relation to recent pregnancy, by laparoscopy or, when available, by minilaparotomy. Surgery should be timed immediately postpartum, or coincide with the first half of the woman's menstrual cycle or during a time period when the woman is using a reliable form of contraception.


Insertion and Removal of Intrauterine Devices - Article

ABSTRACT: The intrauterine device (IUD) is an effective contraceptive for many women. The copper-releasing IUD can be used for 10 years before replacement and is a good choice for women who cannot, or choose not to, use hormone-releasing contraceptives. However, some women experience an increase in menstrual blood loss and dysmenorrhea. The progestin-releasing IUD can be used for five years. It may reduce menorrhagia and dysmenorrhea, although some women have increased spotting and bleeding during the first months after insertion. The ideal candidates for IUD use are parous women in stable, monogamous relationships. Pregnancy, unexplained vaginal bleeding, and a lifestyle placing the woman at risk for sexually transmitted diseases are contraindications to IUD use. Insertion of the IUD can take place at any time during the menstrual cycle provided the woman is not pregnant. Before insertion, a bimanual examination and a sounding of the uterus are necessary to determine the uterus position and the depth of the uterine cavity. The IUD is inserted into the uterus according to individual protocols, with the threads cut at a length to allow the patient to check the device's position. Expulsion may occur with both types of IUDs.


Diaphragm Fitting - Article

ABSTRACT: When used with a spermicide, the diaphragm can be a more effective barrier contraceptive than the male condom. The diaphragm allows female-controlled contraception. It also provides moderate protection against sexually transmitted diseases and is less expensive than some contraceptive methods (e.g., oral contraceptive pills). However, diaphragm use is associated with more frequent urinary tract infections. Contraindications to use of a diaphragm include known hypersensitivity to latex (unless the wide seal rim diaphragm is used) or a history of toxic shock syndrome. A diaphragm is fitted properly if the posterior rim rests comfortably in the posterior fornix, the anterior rim rests snugly behind the pubic bone, and the cervix can be felt through the dome of the device. The diaphragm should not be left in the vagina for longer than 24 hours. When the diaphragm is the chosen method of contraception, patient education is key to compliance and effectiveness. An extended visit with the physician or a nurse may be required for a woman to learn proper insertion, removal, and care of the diaphragm.


New Contraceptive Options - Article

ABSTRACT: Almost one half of pregnancies in the United States are unintended. Primary reasons for the high rate of unplanned pregnancy include dissatisfaction with or underuse of effective contraceptive methods and poor compliance with contraceptive methods that require daily adherence. Several effective forms of contraception have become available in the United States within the past four years. The combined hormonal vaginal ring is inserted into the vagina for three weeks and then removed; after one ring-free week, a new ring is inserted. The contraceptive patch works in much the same way as oral contraceptive pills but requires only once-weekly application by the patient. A new intrauterine system that releases levonorgestrel provides the same contraception as traditional intrauterine devices but is associated with less menorrhagia and dysmenorrhea. The intrauterine system is highly effective and carries minimal risk of pelvic inflammatory disease. In providing counseling about contraception, the physician should consider the woman's preference and determine the likelihood of adherence to the regimen. In case of contraceptive failure, emergency contraception is effective.


An Approach to the Postpartum Office Visit - Article

ABSTRACT: The postpartum period (typically the first six weeks after delivery) may underscore physical and emotional health issues in new mothers. A structured approach to the postpartum office visit ensures that relevant conditions and concerns are discussed and appropriately addressed. Common medical complications during this period include persistent postpartum bleeding, endometritis, urinary incontinence, and thyroid disorders. Breastfeeding education and behavioral counseling may increase breastfeeding continuance. Postpartum depression can cause significant morbidity for the mother and baby; a postnatal depression screening tool may assist in diagnosing depression-related conditions. Decreased libido can affect sexual functioning after a woman gives birth. Physicians should also discuss contraception with postpartum patients, even those who are breastfeeding. Progestin-only contraceptives are recommended for breastfeeding women. The lactational amenorrhea method may be a birth control option but requires strict criteria for effectiveness.


Appropriate Use of the Intrauterine Device - Article

ABSTRACT: The intrauterine device, a common form of birth control in the early 1970s, is now avoided by American physicians and women because of concern about complications. This concern is largely the result of the problems reported with use of an intrauterine device that is no longer manufactured. More recent intrauterine devices have an improved design, and reevaluation has shown them to be a safe, efficacious and cost-effective form of birth control. Careful patient selection and preinsertion counseling are crucial to success with the device. Recent studies conclude that the intrauterine device poses no increased risk of pelvic inflammatory disease or infertility when used by appropriately selected patients.


Care of a Sexually Active Adolescent - Curbside Consultation


New Contraceptive Options: Patient Adherence and Satisfaction - Editorials


Lower- vs. Higher-Dose Estrogen for Contraception - Cochrane for Clinicians


Cyclic vs. Continuous or Extended- Cycle Combined Contraceptives - Cochrane for Clinicians


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