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Salient. Victoria University Student Newspaper. Volume 39, Number 21, September 6, 1976.

What they don't Tell you

page 16

What they don't Tell you

Contraception

Intra-Uterine Device (I.U.D.)

This is a plastic or copper coil inserted in the uterus to set up a low-grade inflammation of the uterine lineing that kills sperm prevents implantation or it may cause the ovum to reach the uterus before it is ready to receive it. The two safest ones, Lippes Loop and Saf-T-Coil, are large and therefore, unsuitable for women who've not had children. They have a failure rate of 3% and must be checked weekly. 2-20% are expelled in the first year and most trouble occurs in the first three months e.g. painful insertion, painful intercourse, painful to sit down, heavy periods which may cause anaemia. Women have taken aminocaproic acid to lessen the extensive menstrual flow and this has side effects e.g. nausea, headache, dizziness.

The smaller, bioactive devices, Copper T and Copper 7 were produced for nulliparous (childless) women and were tested on poor, young, working class women. The long-term effects of copper on the body are not known

They cause greater in flammation than the plastic ones and alter the metabolism of the endometrium (uterine lining). Experiments show that toxicity effects sperm motility and therefore, may also be unsafe for the unterus.

Women are being exploited by the manufacturers and used in experiments for profit. Information on side effects are kept from them so that those who fear the Pill's side effects will turn to I.U.D.s. The information should be made known and weighed against the very similar effects of the Pill.

Complications and Symptoms:
1.Perforation of the Uterus - this usually occurs on insertion, therefore it should be inserted by a Family Planning Clinic doctor or gynaecologist. It may migrate into the abdominal cavity and require an operation to be removed. The symptoms are pain and loss of the string.
2.Pelvic infection - a) Pelvic Inflammatory Disease occurs in 5% of users and the I. U.D. has to be removed. Symptoms are:- Pain - long heavy periods, cramping between periods, fever, b) Progressive Endometritus symptoms are:-persistent vaginal discharge, spotting
3.

Pregnancy a) Ectopic (outside uterus) pregnancy is more likely since intrauterine pregnancies are prevented.

b) Spontaneous abortion and miscarriage 50% of pregnancies end in septic abortion in the second trimester. 35/39 deaths in the U.S. from I.U.D.s since 1965 were caused by septic abortions.

c) The duration of pregnancy may be misleading since non-period bleeding may occur and one may be 10-14 weeks pregnant without knowing it.

Major Advantages over the Pill:
1.Hormonal levels and general metabolism undisturbed.
2.No pill-taking.
3.No danger of loss of cover through illness.
4.No headache, depression or lethargy.
5.No impairment of sexual response if working properly.

The Pill

This has been in use for about 15 years and long-term side effects are now coming to light. There are four types:-
1.Combined - This is the most effective and contains oestrogen and progesterone.
2.Sequential - This is a high oestrogen pill. There is oestrogen only at the beginning, followed by combination pills and then dummy pills. These are good for women suffering from progesterone side effects.
3.Continuous - This is a progesterone only pill. It is not so effective and is still experimental. (Mini pill).
4.Tailor-made - These are made to individual prescriptions. The last two are not in general use in N.Z. Sequential, mini and tailor-made pills cannot be missed.

It functions by : 1. Inhibiting ovulation, and 2. Altering cervical mucus which inhibits sperm movement, 3. Somehow preventing ovum, if present, from being transported down the fallopian tubes. 4. Affecting the endometrium thus preventing implantation.

Disadvantages and Side-effects include:

Thrombosis, hypertension, weight-gain, depression, tiredness, loss of interest in sex. Spotting, missing periods, nausea, sickness and stomach ache may indicate the need for a different type of pill.

Advantages:

It is reliable and convenient with small periods less premenstrual symptoms, less pain, improved muscle tone, delayed menopause, generally reversible, improved periods with less pain even after stopping.

Before getting a prescription the doctor should be given a medical history and he/she should do an internal examination, breast examination, pap smear, blood pressure and test and weight test.

The Morning-After-Pill

DES (diethylstilbestrol) is a high dose of oestrogen given over a period of about five days starting within 72 hours of intercourse. It has severe side effects such as nausea and vomiting and may cause cancer in 25% of female offspring if it does not prevent pregnancy. It should only be used for emergencies.

Depo-Provera (depot medroxyprogesterone acetate)

This is a three-monthly 150 mg injection that is as effective as the Pill and has been a commercial success. Research is still in the experimental stages and in some countries has been taken off the market because of side effects.

Diaphragm

The diaphragm or cap is made of soft rubber with a flexible metal spring rim. It fits over the cervix and prevents entry of sperm. It is used with spermicidal cream or jelly. They vary in size and must be fitted by a well-trained doctor. Failure may be due to:
1.Improper fit.
2.Improper care.
3.Inconsistent use.
4.Slipping during intercourse due to;
a)Expansion of the vagina.
b)Cream on the rim,
c)Frequent, deep insertion of the penis.
d)Certain positions in which the penis may get in behind it.

The pregnancy rate with proper use is 2 - 4 %. Abstaining during about four days over ovulation increases its effectiveness.

Advantages:
1.No side effects if used properly.
2.No other effect than preventing pregnancy.
3.Non-disruptive to sexual activity.
4.Good for women who cannot or will not use the Pill or an I.U.D.
Disadvantages:
1.May find it hard to insert.
2.May be allergic to rubber or spermicides.
3.Cannot be used by:
a)women with a prolapsed uterus.
b)Women with a severely displaced uterus.
c)Virgins because the vagina is small.

Spermicides

Spermicidal jellies, creams or pessaries are used to kill sperm. Some contain mercury e.g. Lorophyn and Koromex and should be avoided. Delfen, Ortho Gynol Jelly and Ortho Cream, and Ramses jelly do not have mercury but Delfen may be ineffective. They should be used in conjunction with other forms of contraception.

Coitus Interruptus

This involves withdrawal of the penis before ejaculation. This is very unreliable because sperm can enter before the main ejaculate and also it requires a degree of control by the male.

Condom (sheath)

This has a 10 - 15% failure rate and may impair sexual satisfaction.

Sterilization

Vasectomy, tubal ligation and hysterectomy are permanent operations and therefore restricted to older women and men with completed families.

Rhythm Method

This depends on the accurate pinpointing of the time of ovulation and abstaining for enough time on either side of this point so that sperm do not come in contact with the ovum. The life of both sperm and ovum is taken into account. If periods are irregular, even if a temperature chart is kept, this exact time is hard to determine and consequently the failure rate is very high.

Effectiveness of Method
Method Theoretical Failure Method Failure
Oral contraceptives 0 0.5
I.U.D. 1.5 - 8 1.5 - 8
Diaphragm & Jelly 5.0 - 10
Vaginal Spermicides 15.0 - 25
Condom 10.0 - 15
Coitus Interruptus 20.0 - 30

Sue Aitchison-Windeler

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