Preventing undesirable
pregnancy
Introduction
Our teenagers receive inadequate, incorrect and inaccurate information about sex from peers, folklore, internet and pornography. It is necessary to inform them about the
methods of preventing undesirable pregnancy especially before marriage. Nobody ever wants to bear a child every time they have sex.
History of
contraceptionTo avoid pregnancy Egyptian women inserted vaginal tablets made from mildly acidic substances. The French women
used a hair from horse’s mane and honey or oil was poured into the vagina soon after intercourse to prevent conception. The Chinese were the first to use female condoms – a cervical blocking cap made of oiled paper. The first male condoms were made of animal intestine and were used in the 17th century. These methods were not always effective and were unpleasant. This gave way to develop the science of contraception to evolve more reliable and efficient methods that we use today. Principles and practices of contraception
1. Women can prevent pregnancy by abstinence – not having sex at all.
2. Unprotected intercourse in ‘
safe period’ is least likely to lead to pregnancy. Ovulation occurs in woman on the fourteenth day before the onset of the next period. This is the time of maximum fertility. The period leaving five days before and five days after the fourteenth day is considered to be safe period. Menstrual cycle can lengthen or shorten. To calculate the safe period accurately one need to watch the consistency of the cervical mucus. In the safe period, this change from clear and transparent to sticky and opaque. Also the body temperature rises by 0.50C during ovulation.
3. ‘Coitus interruptus’ – controlling ejaculation and taking place outside the vagina.
4. Oral contraceptive
pills (OCP) are most popular nowadays. These can be safely
taken for a long period. These are risk free and do not decrease the chances of subsequent pregnancy. OCPs are taken continuously for 21 days with a seven days pill-free period. If a pill is missed two should be taken the next day. Pill best suited to an individual can be prescribed by a medical practitioner. Pills are contra-indicated in those with complicated diabetes, thrombo-embolism, sickle cell disease, cancer of any reproductive organ and undiagnosed vaginal bleeding.
5. For women who cannot remember to take pills regularly there are long acting progesterone injections like medroxyprogesterone or norethisterone which are administered every 12 and 8 weeks respectively.
6. Alternatively, an IUD (intrauterine device) can be inserted and left in situ to prevent pregnancy for around three years.
7. Proper use of condoms by either male or female from the beginning to the end of intercourse protect against both pregnancy and STD (sexually transmitted diseases). Their efficacy is increased if they are combined with a spermicidal cream.
8. People may have sex first and remember afterwards. In such situation ‘emergency contraceptive morning after pills’ may be used. These are effective if taken within 72 hours. 9. If pregnancy is detected Medical termination of pregnancy (MTP) can be resorted to. Within 49 days of conception medicines like mifepristone and misoprost can be used. If pregnancy is more advanced, surgical methods like suction or dilatation curettage are needed. However, MTP after 24 weeks is risky and is likely to complicate subsequent pregnancy.
10. Permanent contraception can be achieved by surgical sterilization, a tubectomy in woman or vasectomy in man.
Responsibility of safe sex rests with both partners. Unfortunately, the woman is the victim of an unprotected sexual encounter. The mothers have the responsibility of educating their young daughters about the ill effects of unprotected sex.
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