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April 2017
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CONTRACEPTION

Questions & answers

This refers to any method that prevents unwanted pregnancies.

A person’s contraceptive choice depends on many factors including medical, psychological, cultural, moral and relationship factors, and it is worth remembering the position that religious institutes take on the use of contraceptives.

Catholicism disapproves of the use of chemical or mechanical methods for preventing pregnancy, however natural methods are not disapproved. In Judaism, women can only use contraception after having two children by the same partner. In Islam, contraception is allowed if it is agreed on by both spouses. In orthodox Christianity, sexual relations are only allowed in marriage for the purpose of procreating therefore the only contraception permitted is abstinence from sex.

Clearly, though, there are also other considerations taken into account when choosing a contraceptive, such as medical ones and whether the patient can take oestrogens and progestins, which will be discussed in more detail later on. Psychological considerations may also be affected by religion, but they may also be affected by the refusal of the woman to have to assume the burden of contraceptive protection.

Contraception can be achieved using various methods which fall into four groups: natural, mechanical (or barrier), chemical and surgical.

Natural methods
The most common is coitus interruptus which involves interrupting intercourse before ejaculation, however this is not a secure method and it depends on the male’s self-control. What is more, before ejaculation, a small amount of lubricant usually comes out of the penis and it contains some sperm, and this method also means that sexual intercourse is interrupted rather abruptly.
The Ogino-Knaus method, also called the 'calendar', was determined by Dr Ogino and Dr Knaus and, according to this method, the couple must abstain from intercourse during fertile days. The fertile days of the menstrual cycle must therefore be calculated but, to get the most out of this method, the start date of each cycle should be recorded for one whole year. Then, to calculate the fertile period, take the shortest and longest cycles and take away 20 from the length of the shortest cycle and 10 from the length of the longest cycle; for example, if the shortest cycle was 25 days, 25-20=5, and if the longest cycle was 29 days, 29-10=19. Then, using these two results, it is possible to calculate the days in which the female is supposed to be most fertile: from the 5th-19th day of her cycle. However, this method is not very safe.
The Billings method (cervical mucus) was thought up by the Billings couple at the Melbourne Catholic Family Welfare Bureau. It involves checking the presence of cervical mucus (whitish vaginal discharge), which will start to become fluid (like egg white) when ovulation is near and which will disappear on the last day of ovulation. Transparent discharge means that the female is fertile and, four days after, it becomes dense and no longer transparent and this means that couples can start to have sex again. However, this method is also not 100% safe, but it does have slightly better results than the previous method.
The basal body temperature method involves the woman taking the temperature of her vagina and rectum when she wakes up because the temperature varies with ovulation: it drops just before ovulation and increases by a few tenths when it begins. Thus, couples should refrain from having sex from the beginning of the cycle to four days after the temperature increase. This method requires a graph to be drawn so that the woman’s temperature can be followed during each day of the cycle. Out of all the natural methods, this gives the best protection against unwanted pregnancies.

Barrier methods
The most common barrier method is the condom. As long as there are no accidents (it breaks or comes off when the penis is not erect but inside the vagina), it is a very safe method and it is also the best way to avoid contracting sexually transmitted diseases.
Women can use the diaphragm which is a rubber dome that is supported by a metal ring. It is inserted into the back of the vagina so that it covers the neck of the uterus and inhibits the sperm’s route. A spermicide cream must be applied to it and it must be inserted at least 2 hours before having sex, but should not be removed until at least 6 hours after sexual intercourse. This method is quite efficient even though method failure is about 10%. The woman needs to have good experience with this method and, of course, she has to know and be comfortable with her genitals.
The coil (IUD- Intra Uterine Device) is a device that is placed in the uterus by a gynaecologist. There are various models available including those made of plastic which contain a strip of copper, and those which gradually release a progesterone hormone, which increases effectiveness. After being inserted into the uterus, the coil can be left there for some years, however, it is best to have regular gynaecological checks. This contraceptive method is 98% effective, but it is not recommended for adolescents and, in general, for women who have not yet had children.

Chemical methods
The best chemical method is the pill; it contains artificial oestrogens and progestin which prevent ovulation. It can only be prescribed after carrying out health checks such as a blood test, urine test, listening to the chest, exam of the circulation system and the pap test. These products have reduced the negative effects that women faced in the past given that they have low doses of hormones. If it is taken correctly, this contraceptive method can be completely effective.

Surgical methods
Women can have their tubes tied which is a small operation performed in order to block the two Fallopian tubes so that sperm cannot travel down them, however, this is an irreversible operation therefore it must be considered carefully because it has psychological repercussions and it means the female cannot get pregnant after having it done. Men can have a vasectomy which involves tying the two tubes which carry sperm from the testicles to the urethra. Again, this is an irreversible method of contraception therefore the operation and its repercussions should be considered carefully, but not just psychological ones, but also those related to the experience of sexuality. Fortunately, this operation does not interfere with any of the phases of sexual response.

CONTRACEPTION

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