CONTRACEPTION ......CONTINUED

Female barrier methods of contraception

These have been used for generations, off course we were ignorant, and we did not understand what was dangerous for women. Whatever women came across and thought it would help they used it. Leaves, lemons and sponges, were all used. Sponges were stopped from the developed countries however they are still available in some developing countries. In 1882 a diaphragm was invented which proved useful. This has under gone many changes and is slowly becoming a very useful method of contraception. Cervical caps, female condoms and diaphragms prevent contact between the cervix and the penis thus preventing you from pregnancy. They have some protection from STI’s.
Female condoms for general use became available in 1992. It was made from polyurethane and was sold as femidom. It came in different sizes and needed some clinical output as to how to use it. Besides it proved to be expensive being made from polyurethane. Now it is made by various companies round the world in different materials from nitrile, silicone or even latex. If bought in bulk it is much cheaper. The WHO (World Health Organisation) is trying to make this a popular method in developing nations as birth control is then in the women’s hand, particularly if a partner is not cooperative. It also provides protection from STI’s. The other big advantage is that woman can insert it, up to 8 hours before sexual activity occurs. Lubricants can be oil based or water based unless it is made of latex. Oil based lubricants cannot be used with Latex products as they destroy them. It does not interfere with your hormones, menstrual cycle or any other medications, that you may be taking.    

Female condom (FC2) originally its cost was a bit of a problem but now this has been resolved. It was made with polyurethane which was expensive and now it is mainly made from nitrile and latex. The female condom had another problem of making a crinkling (Rustling) noise when in use. This Problem has been overcome by newer varieties. Medtec in India( Reddy ) , Company called Path (Program for appropriate technology in Health) Female health company in Chicago and many others are making these (FC2) in different countries and are trying to cut the cost down. A lot of publicity and education is now being done by nations all over the world.                         

The latest version of the female condom called (FC2).It is a 17 cm long pouch. 

It has a flexible rubber ring at each end.

One of these rings goes inside the vagina and is closed, this end is narrow .All the instructions, as to how to use these are on the package, however it is a good idea to know how to use these while you are on another method.  It works the same way like the male condoms, by preventing the semen to go into the vagina. Not only that, it prevents you from getting STD’s. In that respect it is better than the condoms as it protects your, vulval skin from infection such as HPV, HERPES, and ULCERS.

With female condoms the woman is in charge. You do not have to stop at the crucial time to put the condom on. It can be inserted up to 8 hrs before intercourse. There is some lubrication provided with the FC2, but you can use more lubricant if required but make sure about the type. Water soluble is better. Open the pack carefully, read the instructions put the closed end in the vagina and gently push in until you can feel the cervix. When you start the act the penis does not have to be rigid, but make sure the penis goes in the pouch, not between the vagina and the pouch.

After intercourse twist the outer ring 3 times when pulling the condom out. Making sure that nothing spills out and then throw it in the rubbish, never in the toilet.

It is almost as effective as the condoms 5% failure rate with perfect use and 21% failure with typical use. (Some what casual) Thousands of STI’s are saved by FC2.

And to just reiterate the same benefits as the male condom but even better as women are in control and return to fertility is immediate.

No health issues, no hormones, no menstrual problems. Better protection from STI’s as it protects the skin STI’s as well. The cost and noise factors were a problem but both are now being resolved.

It has been said to use the FC2 only once. However recent study by the FDA (food and drug administration) showed that an FC2 can be used several times after being washed and being cared for. It still met the structural standards of the FDA. 
Imagine how great it will be for women of poorer countries.

In closing FC2 is gaining ground and looks to be successful product for contraception and prevention of STD’s.
The latest news on the female condom is women and others, are trying to make condoms to protect them from rape. It would be great if this could be achieved particularly in some countries like Africa and India.I understand that women in India have made a FC2 that sends an electronic message to the police and their relatives if they are being raped. The penetration of the vagina sets off the electronic implant in the FC2. In Africa they are experimenting with an FC2 with teeth. This FC2 has not been approved by authorities. When a penis enters the vagina the barbs or hooks in the FC2 attach to the penis and when the penis withdraws the FC2 comes with it and it can only be removed with medical assistance. The female inventor of this product is quoted as saying "This is a medieval device for a medieval deed"

I have already mentioned the SILCS diaphragm and we will talk about it in the next few posts. 

CONTRACEPTION..CONTINUED

Barrier Methods of Contraception

These first started with males in Egyptian culture. They were like decoration’s to cover the penis, often they were made of cloth, moistened by some chemicals to work as a spermicide.

Later on these penis covers were called Condoms and they were made from animal intestines.

By 1930 they were being made from latex. These became popular as a method of contraception to be used during intercourse. It protected the probability of pregnancy and STI’S as well as HIV and other infections. This does not totally protect against Human Papilloma virus, the virus which is implicated in the causation of cervical cancer. This (HPV) can be contracted by skin contact outside the vagina.

It is put on an erect penis; it blocks the ejaculated semen from entering the vagina thus preventing pregnancy and spread of STI’s. The male partner has to be very careful so that no semen ejects before he puts the condom on. Spermicides can be used with the condoms. Latex condoms cause allergic reactions and are damaged by oil based lubricants. A new polyurethane condom was launched in the UK in 1997; this was stronger, less sensitive to humidity and heat and caused less sensitivity reactions.

Things improved further a new non latex condom made from polyisoprone was again launched in the UK in 2005.

Condom’s come in different colours and packaging. Many of them are already impregnated with spermicide (N9) and microbicides. Recent research so far has not shown any great  benefit  either as a spermicidal or microbicide. However research continues.

A male condom is the only method of contraception as it not only protects against pregnancy but also protects from STD’s.

When you buy a condom see that it is FDA approved. If so it will tell you that you are protected from STD’s. If it does not say so on the packaging it may not be a standard condom. Also look at the expiry date. Old condoms become dry and frail and tear easily.

If used properly it provides 99% protection from pregnancy. If you are using a latex condom do not use oil based lubricant these include baby oil, Vaseline, hand creams and lipstick. I mention lipstick in case you are having oral sex; please make sure you remove your lipstick. Although the risk of pregnancy is not there you can still get sexually transmitted diseases.

When you are going to start to using condoms, look around to find the one that suits you best either for size or sensitivity so that you can still get the pleasure and not break the condom. Do not use two condoms together as there is friction and this can cause them to break.Two condoms: male and other one female; have also not proven to be satisfactory. Use only water based lubricants. If you are not able to roll the condom down properly, you are putting it on incorrectly. Do not use old condoms or condoms past their expiry date and do not use a condom twice. Even if you are on the pill, and your partner does not use a condom you are not protected from STI’s. At times such as using Antibiotics or you have gastro, even if you are on the pill request your partner to use a condom because antibiotics and gastro compromise the pill.

If by chance your condom bursts you can ask for help by going to emergency contraception, which we will discuss later and also have yourself tested for any STI’s.This can protect you from getting pregnant for up to 5 days, the sooner you do this the better. If used properly the success rate of condoms is 98 % safe. That means if 100 women use it for one year only 2 can get pregnant at the end of the year.In my view the male condom is an excellent method of contraception for all ages.  Initially you need to learn how to use it and which one is best for you and your partner. It has no medical contra indications except for latex allergy, if so you can get non latex condoms. They are in fact safer and can be used with oily lubricants; they are finer in   texture and better in sensitivity. Cost wise they are cheaper than most contraceptives. They do not require any medical input, do not alter your hormones or menstrual cycles, and above   all  at  present they are the only method of contraception that protects you from STD’s.If you have a fast life style it is not a bad idea to keep a condom and lubricant in your handbag. However change it often so that it is not dry or gone past its expiry date. As I have said before it is better to be safe than sorry. 

CHEMICAL CONTRACEPTION

Chemical contraception

As discussed earlier Chemical contraceptives were used for thousands of years in form of fruit jellies, pastes and sponges soaked in quinine sulphate were used. In 1885 a suppository was made by an English pharmacist using cocoa butter and quinine sulphate. There after many products hit the market. In 1950 an effective   spermicide was developed called nonoxinol-9(N-9).This proved to be very effective and is still in use. Depending on what kind of preparation you are using they have to be inserted into the vagina10 minutes before or 30 minutes before.  The Pessaries (or suppositories) require more time to dissolve in the vagina. Do not use sponges if you are menstruating.

The chemical contraceptives do not last all night. If you have sex second time round, you will need to top up. These chemical contraceptives can cause irritation burning sensation and allergies for both partners. One woman once told me that she felt as if her vagina was on fire.  One serious problem with chemical contraceptives is that they can cause vaginal erosions and thus increase the risk of STI infections including HIV. Many peri menopausal women tend to use chemical contraceptives thinking that there fertility is low so it is ok to use just these. However this is not good as in menopausal years the vaginal skin is more delicate, it is more likely to be eroded. The risk of infections is higher, in these women so it is not uncommon for them to get infected. I have come across two such women in the past two years .Many woman use vaginal douches as contraceptives, but these have a high failure rate and a high risk of infection. I have come across women using coco cola douches this is like “closing the gate after the horses have bolted”.

The best chemical contraceptive available is Nonoxinol -9(N-9)

It is available as creams, jelly, foams, films and suppository. It is used to lubricate some condoms.  So far there is no published evidence that is helps to prevent pregnancy or infection. The failure rate of chemical contraceptive varies between 8% to 28%. It does not protect you from STI’s.

In the United Kingdom N-9 is sold as Gygel.  It is also available through the National Health Service. The best use of chemical contraceptive (N-9) is with barrier methods, e.g. with cervical caps, diaphragm and condoms. There is   ongoing research that looking at how we can combine contraception with microbicides. It seems that the researchers are close to this with their new diaphragm.  I will discuss this further when I talk about barrier methods.