LECTURE NOTES

1. Introduction to Contraception and Sexual Health

1.1 Overview

• Contraception enables individuals and couples to plan pregnancies and prevent unintended conception.
• Sexual health encompasses physical, emotional, mental, and social well-being related to sexuality.
• A comprehensive understanding is essential for informed decision-making and public health improvement.

1.2 Learning Objectives

By the end of this module, students should be able to:

• Explain the principles behind various contraceptive methods.
• Describe mechanisms of action, effectiveness, and side effects of contraceptives.
• Discuss sexual health, STI prevention, and safe sexual practices.
• Counsel patients on contraceptive choices based on individual needs.
• Identify contraindications and complications of common contraceptive methods.

2. Principles of Contraception

2.1 Goals of Contraception

• Prevent fertilization
• Prevent implantation
• Prevent ovulation
• Modify cervical mucus or uterine environment
• Provide spacing or limitation of childbirth

2.2 Ideal Characteristics of a Contraceptive Method

• Safe
• Effective
• Easily reversible
• Long-lasting
• Convenient
• Affordable
• Few side effects
• Does not interfere with sexual activity

3. Natural Methods of Contraception

3.1 Fertility Awareness-Based Methods (FABMs)

• Calendar (rhythm) method
• Basal body temperature method
• Cervical mucus (Billings) method
• Symptothermal method

3.2 Lactational Amenorrhea Method (LAM)

• Effective in the first 6 months postpartum if:
• Exclusive breastfeeding
• Amenorrhea persists
• Frequent nursing day and night

3.3 Coitus Interruptus

• Highly user-dependent
• Least reliable due to pre-ejaculate sperm presence

3.4 Advantages & Limitations

• No medical side effects, inexpensive
• Lower effectiveness, requires discipline, abstinence during fertile window

4. Barrier Methods

4.1 Male and Female Condoms

• Prevent sperm deposition
• Also protect against STIs and HIV
• May reduce sensation; require correct use every time

4.2 Diaphragms and Cervical Caps

• Used with spermicides
• Lower effectiveness than condoms
• Require fitting and training

4.3 Spermicides

• Nonoxynol-9 most common
• Disrupt sperm motility
• Frequent use may irritate the vagina

5. Hormonal Contraceptives

Forms:

• Combined oral contraceptive pills (COCs)
• Transdermal patch
• Vaginal ring

Mechanism:

• Inhibit ovulation
• Thicken cervical mucus
• Thin endometrium

Benefits:

• Regulate cycles
• Reduce dysmenorrhea, acne, endometriosis symptoms

Risks:

• Increased risk of hypertension, thrombosis (especially smokers >35 years)

5.2 Progestin-Only Methods

Forms:

• Progestin-only pills (POPs)
• Injectables (e.g., Depot medroxyprogesterone acetate)
• Implants

Mechanism:

• Thickens cervical mucus
• Inhibits ovulation (variable with POPs)

Common effects:

• Irregular bleeding
• Amenorrhea (especially with injectables)

5.3 Long-Acting Reversible Contraceptives (LARCs)

• Implants: 3–5 years protection
• Hormonal IUDs (levonorgestrel): 3–7 years
• Highly effective, low maintenance

6. Intrauterine Devices (IUDs)

6.1 Copper IUD

• Prevents fertilization via copper-mediated sperm toxicity
• Effective for 10+ years
• May increase menstrual bleeding and cramps

6.2 Hormonal IUD (LNG-IUS)

• Thickens cervical mucus
• Thins endometrium
• Reduces menstrual bleeding—also used therapeutically

6.3 Side Effects & Complications

• Cramps
• Expulsion
• Rare: uterine perforation
• Infection risk slightly increased during insertion only

7. Permanent Methods

7.1 Female Sterilization (Tubal Ligation)

• Blocks or seals fallopian tubes
• Permanent; suitable for women who have completed family size

7.2 Male Sterilization (Vasectomy)

• Blocks vas deferens
• Does not affect sexual function or testosterone
• Requires semen analysis to confirm azoospermia

8. Emergency Contraception

8.1 Options

• Levonorgestrel pill (Plan B type)
• Ulipristal acetate (Ella type)
• Copper IUD – most effective emergency method

8.2 Mechanisms

• Delay ovulation
• Prevent fertilization
• Copper IUD prevents implantation

8.3 Timing

• Most effective within 72 hours (pills)
• Copper IUD effective up to 5 days after unprotected intercourse

9. Sexual Health and STI Prevention

9.1 Components of Sexual Health

• Safe and consensual relationships
• Protection from STIs
• Emotional and psychological well-being
• Access to accurate information

9.2 Major STIs

• Bacterial: chlamydia, gonorrhea, syphilis
• Viral: HIV, HPV, HSV, Hepatitis B
• Parasitic: trichomoniasis

9.3 Prevention Strategies

• Correct and consistent condom use
• STI testing and treatment
• HPV vaccination
• Reducing number of sexual partners
• Abstinence or mutual monogamy

10. Contraceptive Counseling

10.1 Factors to Consider

• Age
• Fertility goals
• Medical conditions
• Breastfeeding status
• Personal preferences
• Side effect profiles

10.2 WHO Medical Eligibility Criteria (MEC)

• Categorizes safety of contraceptive methods
• Helps guide selection based on medical history

10.3 Effective Counseling Approach

• Clear, nonjudgmental communication
• Shared decision-making
• Address myths and misconceptions
• Provide instructions on correct use

11. Self-Assessment Questions

1. List four types of long-acting reversible contraceptives.
2. Explain the mechanism of action of combined oral contraceptives.
3. Identify three STI prevention strategies.
4. What are the criteria for using lactational amenorrhea as contraception?
5. Compare the copper IUD with the hormonal IUD with respect to action and side effects.