Contraception Contraception is defined as the intentional prevention of conception through the use of various devices, sexual practices, chemicals, drugs or surgical procedures. The preventive methods to help women avoid unwanted pregnancies are called contraceptive methods. Need for contraception • To avoid unwanted pregnancies. • To regulate the timing of pregnancy. • To regulate the interval between pregnancy. Ideal Contraceptive • Safe • Effective • Acceptable • Reversible • Inexpensive • Long lasting • Requires little or no medical supervision Contraceptive methods Spacing methods Natural Barrier IUDs Emergency contraception Terminal methods Male fertilisation Female fertilisation Natural Methods Coitus inteyrruptus / withdrawal Rhythm Method Lactational Amenorrhoea Barrier Methods Mechanical Male : Condom Female : Condom, Diaphragm, Cervical cap Chemical Creams - Deleen Jelly – Koromex, Volpar paste Foam tablets – Aerosol foams, Chlorimin T or Contab Combination Combined use of Chemical and Mechanical methods. Male condom • Most commonly known and used contraceptive. • Better known in India as NIRODH. Female condom Femidom Diaphragm Spermicides Spermicides are surface active agents which attach themselves to spermatozoa and kill them. Available in various forms like Intrauterine Contraceptive Devices Cu T200 T shaped device Polyethylene frame. 215 mm2 surface area of Cu wire. Contains 124 mg of copper Cu is lost at the rate of 50 µg/day. Polyethylene monofilament tied at vertical stem. Cu is radio opaque so additionally barium is incorporated in the device. Supplied in a sterilised sealed packet. Lifetime 4 years. Cu T 380A 380 mm square surface area of copper wire. Replacement 10 years. Multiload Cu 250 60-100 ug/day Replacement 3 years Multiload - 375 Mode of action Biochemical and histological changes in endometrium. Increased tubal motility. Endometrial inflammatory response. Prevents implantation. Contraindication for insertion of IUCD Presence of pelvic infection Genital tract bleeding (undiagnosed) Suspected pregnancy Uterine fibroid Severe dysmenorrhoea Ectopic pregnancy history Caesarean section Cu allergy Time of insertion Interval 2-3 days after menstrual phase. During lactational amenorrhoea. Postabortal Done immediately following termination of pregnancy. Postpartum After 6 weeks of delivery. Postplacental delivery Post delivery of placenta. Method of Insertion Preliminary steps: History taking and examination Patient is informed and consent is obtained. Insertion is done in OPD aseptic conditions. Placement of device in inserter. Steps of operation The patient is asked to remain empty bladder. The patient is placed in lithotomy position. Local antiseptic cleaning is done. Posterior vaginal speculum is introduced. Anterior lip of cervix is grasped with Allis tissue forcep. The device is placed in the inserter and introduced through cervical

1. CONTRACEPTION
Dr.Yashika

2. Contraception
 Contraception is defined as the intentional prevention of
conception through the use of various devices, sexual
practices, chemicals, drugs or surgical procedures.
 The preventive methods to help women avoid unwanted
pregnancies are called contraceptive methods.

3. Need for contraception
• To avoid unwanted pregnancies.
• To regulate the timing of pregnancy.
• To regulate the interval between pregnancy.

4. Ideal Contraceptive
• Safe
• Effective
• Acceptable
• Reversible
• Inexpensive
• Long lasting
• Requires little or no medical supervision

5. Contraceptive methods
 Spacing methods
 Natural
 Barrier
 IUDs
 Emergency
contraception
 Terminal methods
 Male fertilisation
 Female fertilisation

6. Natural Methods
 Coitus inteyrruptus / withdrawal
 Rhythm Method
 Lactational Amenorrhoea

7. Barrier Methods
 Mechanical
Male : Condom
Female : Condom, Diaphragm, Cervical cap
 Chemical
Creams - Deleen
Jelly – Koromex, Volpar paste
Foam tablets – Aerosol foams, Chlorimin T or Contab
 Combination
Combined use of Chemical and Mechanical methods.

8. Male condom
• Most commonly known and used contraceptive.
• Better known in India as NIRODH.

9. Female condom
 Femidom

10. Diaphragm

11. Spermicides
Spermicides are surface active agents which attach
themselves to spermatozoa and kill them.
Available in various forms like
1. Foams
2. Creams
3. Suppositories
4. Soluble films

12. Intrauterine Contraceptive Devices
Types Example
i. Open Lippe’s loop, Cu T, Cu 7,
Multiload
ii. Closed Grafenberg Ring,
Birnberg Bow
iii. Hormone containing IUD Progestasert
LNG-IUS

13. Cu T200
 T shaped device Polyethylene frame.
 215 mm2 surface area of Cu wire.
 Contains 124 mg of copper
 Cu is lost at the rate of 50 µg/day.
 Polyethylene monofilament tied at vertical stem.
 Cu is radio opaque so additionally barium is
incorporated in the device.
 Supplied in a sterilised sealed packet.
 Lifetime 4 years.

14. Cu T 380A
 380 mm square surface area of copper wire.
 Replacement 10 years.
Multiload Cu 250
 60-100 ug/day
 Replacement 3 years

15. Surface area of Cu wire 375
mm2.
Replacement 5 years.
Multiload - 375

16. • Polydimethylsiloxane membrane
around stem.
• Levonorgestrel 52 mg
• 20 ug/day
• Replacement 7 years.
Levonorgestrel IUS (LNG-IUS)

17. Mode of action
 Biochemical and histological changes in endometrium.
 Increased tubal motility.
 Endometrial inflammatory response.
 Prevents implantation.

18. Contraindication for insertion of IUCD
 Presence of pelvic infection
 Genital tract bleeding (undiagnosed)
 Suspected pregnancy
 Uterine fibroid
 Severe dysmenorrhoea
 Ectopic pregnancy history
 Caesarean section
 Cu allergy

19. Time of insertion
 Interval
2-3 days after menstrual phase.
During lactational amenorrhoea.
 Postabortal
Done immediately following termination of pregnancy.
 Postpartum
After 6 weeks of delivery.
 Postplacental delivery
Post delivery of placenta.

20. Method of Insertion
Preliminary steps:
 History taking and examination
 Patient is informed and consent is obtained.
 Insertion is done in OPD aseptic conditions.
 Placement of device in inserter.

21. Steps of operation
 The patient is asked to remain empty bladder.
 The patient is placed in lithotomy position.
 Local antiseptic cleaning is done.
 Posterior vaginal speculum is introduced.
 Anterior lip of cervix is grasped with Allis tissue forcep.
 The device is placed in the inserter and introduced through
cervical canal right upto the fundus. After, positioning off guard the
inserter is withdrawn.
 Excess of nylon thread is cut beyond 2-3 cm of external os.

22. Instructions to the patient
 Possibility of pain
 Vaginal bleeding
 Advice the patient to feel the thread periodically by finger.
 Routine check up 1 month then annually.

23. Complications
 Immediate
 Cramp-like Pain
 Syncopal attack
 Partial or complete perforation
 Remote
 Pain
 Abnormal menstrual bleeding
 PID
 Spontaneous expulsion

24. Indications for removal of IUD
 Persistent excessive uterine bleeding.
 Flaring up of uterus.
 Expulsion of IUD.
 Pregnancy with device in situ.
 Missing thread.
 One year after menopause.
 Women desiring issue.

25. Steroidal Contraception
 Parenteral
 Injectables
 DMPA
 NET-EN
 Combined
 Implant
 Implanon
 Norplant
 LNG rod
 Oral
 Combined Prep
 Monophasic
 Biphasic
 Triphasic
 Emergency
 Single Prep
 Progestin only pill
 Oestrogen only

26.  Device
 IUD
 LNG-IUS
 Vaginal ring
 LNG ring
 Combined
 Transdermal patch
 Nestorone

27. Combined Oral Contraceptives
Mode of action
1. Inhibition of ovulation.
2. Producing static endometrial hypoplasia.
3. Alteration of cervical mucosa.
4. Alters tubal motility.

28. Progestin Only Contraceptive
 Contains very low dose of progestins in form of
Levonorgestrel 75 ug.
Mechanism of action:
1. Thicker cervical mucous.
2. Atrophic endometrium.

29. Injectable Progestins
 Depomedroxy progesterone acetate (DMPA).
 Norethisterone enethate (NET-EN).
 IM deltoid/gluteus muscle.
 OTC: Depo-Sub Q provera 104.

30. Implant
 Implanon progestin only delivering system containing 68 mg
of 3 Ketodesogestrel.
 3 years life
 The capsule is inserted subdermally.

31. Emergency Contraception
 Hormones
 IUD
 Anti-progesterone

32. Sterilisation
 Permanent surgical contraception.
 Voluntary sterilisation.
 Male - vasectomy
 Female - tubal occlusion/tubectomy

33. Vasectomy
A segment of vas deferens of both the sides are resected and both the
ends are ligated.
Methods:
1. No-Scalpel Vasectomy.
2. Electrocoagulation.
3. Fascial interposition.
Selection of candidate:
1. Psychologically adjusted.
2. Sexually active.

34. Precaution:
The man doesn’t become soon after the operation. Hence, additional
contraceptive are advised up to a period of 3 months.

35. Complications
 Immediate
 Wound sepsis
 Scrotal hematoma
 Remote
 Impotency
 Granuloma
 Pain and discomfort
 Testicular cancer

36. Female sterilisation
Occlusion of fallopian tubes.
Indication:
1. Family planning
2. Socioeconomic
3. Medicosurgical indications

37. Time of operation:
1. Post puerperium.
2. Interval.
3. Concurrent with MTP.
Methods of female sterilisation:
1. Tubectomy
2. Minilaparotomy

38. Thank you