CONTRACEPTIVE MEASURES IN MALES AND FEMALES

CONTRACEPTIVE METHODS IN MALES AND FEMALES

CONTRACEPTIVE MEASURES IN MALES

A. Conventional methods

It means those methods that require action at the time of sexual intercourse, such as use of condom (trade name Nirodh, a Sanskrit word, meaning prevention). 

The aim of these methods is to prevent live sperm from meeting the ovum. They are effective only if used consistently and carefully.

Advantages 

1. Easy to use;

2. Free from side-effects, and

3. Provide protection against sexually transmitted diseases (STD).

B. Coitus interruptus 

i.e. withdrawal of penis before ejaculation.

Disadvantage: Slightest mistake in timing the withdrawal or even a drop of semen is sufficient to cause pregnancy.

C. Vasectomy 

i.e. bilateral ligation of the vas deferens. 

Advantage: It is relatively safe and convenient method.

Disadvantage: 50% of vasectomized patients develop antibodies against sperms, therefore, in case of those patients wishing to restore fertility at a later stage, success rate after restoration of patency of the vas is only about 50%.

D. Drugs 

which inhibit spermatogenesis.

¶ Testosterone. Administration of testosterone in high doses decreases the sperm count. Therefore, testosterone therapy has been suggested as a measure of male contraception. However, in such a high dose, it causes sodium and water retention.

Disadvantage: These drugs are too toxic to be used clinically.

CONTRACEPTIVE MEASURES IN FEMALES

A. Conventional methods

1. Use of diaphragm on the cervix.

Disadvantages:

(i) trained persons will be needed to demonstrate the technique of use.

(ii) it can cause local infection if left in the vagina.

2. Use of douches, spermicidal jellies and creams. For example, Today (trade name) is a small polyurethane foam sponge saturated with spermicide, monoxynol-9. Disadvantage: Besides producing messiness it produces burning sensation and irritation locally.

3. Rhythm method or calendar method.

This method involves confinement of sexual intercourse to safe period only. The method is not practical and has not been satisfactory as a means of preventing pregnancy.

B. Tubectomy 

i.e. bilateral ligation of the fallopian tubes. This method is relatively safe, convenient and permanent means of preventing pregnancy.

C. Intrauterine Device

Implantation of a foreign body (a piece of metal or plastic) into the uterine cavity for contraceptive purposes is called intrauterine device (IUD).

Mechanism of action

1. It speeds the passage of the fertilized ovum through the uterus and prevents its implantation in the endometrium.

2. It disturbs the orderly sequential changes taking place in the endometrium during the menstrual cycle.

Types - IUDs are of three types:

1. Non-medicated IUD e.g. Lippes loop. It is double S-shaped, made of polyethylene, a plastic which is non-toxic, non-tissue reactive. It has an attached thread or a tail made of fine nylon, which projects into the vagina after insertion.

2. Copper IUD e.g. Copper-T. It acts by altering the composition of cervical mucus and also decreases sperm motility.

3. Hormone releasing IUD  It is filled with progesterone and acts by increasing the viscosity of cervical mucus. It also makes the endometrium unfavourable for

implantation of fertilized ovum.

D. Contraceptive pills

If correctly used contraceptive pills are 100% successful in preventing fertilization. The commonly employed contraceptive pills are:

1. Classical pill or combined pill

It contains orally active progesterone norethynodrel, (nor-ethioesterone, chromadinone etc.), combined with small amounts of oestrogens (ethinyloestradiol). The pill is given for 21 consecutive days beginning on the 5th day of the menstrual cycle (pill is given from the 5th to 25th day of the menstrual cycle). When the bleeding occurs this is considered as the first day of the next cycle. The bleeding is from an incompletely formed endometrium caused by the withdrawal of exogenous hormones. Therefore, it is called withdrawl bleeding rather than menstruation.

Mode of action

(i) By an action or hypothalamus which inhibits the secretion of LH. This, in turn, inhibits ovulation.

(ii) It makes the cervical mucus thick which renders the cervical mucus (unfriendly) to sperm penetration. hostile

(iii) It induces endometrial changes which prevent implantation of the blastocyst.

2. Sequential pill

It involves administration of high dose of oestrogen for 15 days followed by 5 days of oestrogen plus progesterone. This inhibits ovulation by suppressing the release of both FSH and LH.

Disadvantage: This increases the incidence of carcinoma (cancer) of the endometrium.

3. Administration of large doses of oestrogen 

decrease FSH level with multiple irregular bursts of LH secretion rather than a single mid-cycle peak thereby producing anovulatory cycles.

4. Mini pill or micropill 

It involves the administration of 'low dose of progesterone' through whole of the menstrual cycle. This prevents fertility without inhibiting ovulation. It may act on:

(i) cervical mucus

(ii) endometrium

(iii) decrease the motility of fallopian tubes

5. Post-coital pill or 'Morning after' pill 

It is recommended within 48 hours of an unprotected intercourse. The method employed is to give a double dose of 'combined pill', that is 2 pills immediately followed by another 2 pills 12 hours later. It is advocated as an emergency method; for example, after unprotected intercourse, rape or contraceptive failure.

Disadvantages of contraceptive pills 

Long use of oral contraceptives significantly produces:

1. hight risks of thrombo-embolic phenomenon

2. precipitate diabetes mellitus 

3. increases systemic arterial BP by their salt retaining properties.

6. Progesterone antagonist

such as 'Mifepristone', is helpful in producing abortion following the conception. It acts by inhibiting the progestational effects on the uterus.