Contraception

Transcription

Contraception

Contraception
TO EACH HIS OWN
Condoms are measured in length and width. For opti-
ONLY A CONDOM THAT FITS
GUARANTEES A SAFE SPRITZ
mal safety and comfort, however, the width of a con-
Often condoms don´t properly fit their owner – they
dom is decisive and more relevant than the length. This
are either too big or too small. For a condom to be
is why often only the width is displayed (in mm) on the
effective, however, it has to have a firm fit.
packaging.
› Condoms that are too small can
› Example for a small condom:
width 49 mm, length 170 mm
› be difficult to slip over the hardened penis
› fit too tightly and cause pain
› rip or burst
› Example for a standard condom:
› Condoms that are too big can
› Example for a large condom:
› fit too loosely
› slip off during sex and remain in the vagina or
rectum
FOR FURTHER INFORMATION
SAFE USE OF CONDOMS
› Brochure „mach´s mit… Kondom!
For further information on how to properly use condoms consult p. 24 of this brochure or visit the website
Safer Sex – wie und wozu?“
www.familienplanung.de
(Order no.: 70520000)
Safe and Sure
› www.kondometer.de
What color
do you see?
8
9
10
11
12
13
14
15
Contraception for Her and Him
16
The circumference of your penis
back
Guide to proper-sized condom
The sizes given in mm refer to those
printed on the condom packaging.
Try a smaller size!
(e.g., 49 mm and less)
Standard-sized condoms should fit
you (e.g., 52 mm)
Try a larger size!
(e.g., 55 mm and more)
When measuring the
size of your penis,
apply this side first!
Bundeszentrale für gesundheitliche Aufklärung (BZgA), 51101 Köln
Imprint | table of contents
Imprint
Published by: Bundeszentrale für gesundheitliche Aufklärung,
BZgA (German Federal Centre for Health Education)
www.bzga.de
All rights reserved.
Managing editor: Anke Erath
Expert consultants: Helga Seyler, Gynecologist, Family Planning
Centre Hamburg; Dr. Beate Ziegeler, Bundesinstitut für Arzneimittel
und Medizinprodukte (German Institute for Pharmaceuticals and
Medical Products)
Photo credits:
Title page: Jens Brüggemann, pp. 20, 24, 28, 30, 31, 32,
33, 35, 36, 38, 40, 41, 42, 48, 49, 51, 71 Thomas Behrendt
fotolia.com © p. 7 Kurhan, p. 8 godfer, p. 9 Klaus-Peter
Adler, p. 10 Kica Henk, p. 12 efired, p. 15 Sven Bähren,
p. 31 ISO K°-photography, p. 34 Monika Adamczyk,
p. 37 DXfoto.com, p. 43 Robert Kneschke, p. 45 drubigphoto, p. 49 Yuri Arcurs, p. 49 Tripod, p. 52 scalesy,
p. 57 Albert Schleich, p. 58 photofey, p. 75 Liv FriisLarsen, p. 77 BK, p. 78 Infinite XX
photocase.com © p. 2 AllzweckJack, p. 72 cydonna
istockphoto.com © p. 4 nullplus, p. 27 pierredesvarre,
p. 50 © Anastasia Pelikh Photos Contraceptives
HauptwegNebenwege, Cologne
Design: Medienwerkstatt Petzinka, Haarmann, Dortmund
Illustrations: Christina Hummelbeck, Dortmund
Translation: Joseph A. Smith, Nörten-Hardenberg
Printer: Kunst- und Werbedruck, Bad Oeynhausen
Last updated: 5-2014
Print run: 2.15.05.14
Order address: BZgA, D-51101 Köln or by e-mail: order@bzga.de
Order no.: 13060070
This publication is provided by the BZgA free of charge. It is not
Measure.
Choose.
Try it on.
Help and advice
Answers to all your questions concerning sexuality, contraception, the desire to
have children or pregnancy are available
at no cost to both men and women from
the many family-planning centers. If you
are experiencing a pregnancy conflict,
THE KONDOMETER
The attached Kondometer can help you to find the
right-sized condom for your needs. Cut out the measuring tape printed on this page and punch a hole in it
where the dot is.
such a counseling center can help you to
weigh the various pros and cons in order
FIND THE RIGHT-SIZED CONDOM
WITH THE “KONDOMETER”
to reach the best decision. These coun-
1
When using the Kondometer be careful of the paper
edges, which may be very sharp and can cut the skin.
seling centers also provide information
2
about financial support and other assis-
To be effective, a condom has to have a firm fit – which also
makes it less noticeable during sex.
tance available to families and children
1
in need. Further, they can assist in cases
of family conflicts regarding matters of
or health agencies or online under
tion exempt from punishment within
family planning. These counseling cen-
www.familienplanung.de/beratung/
the first 12 weeks. The Caritas organiza-
ters are obligated to confidentiality, and
beratungsstellensuche/
tion and the Social Service of Catholic
anonymity is also possible.
Condoms are produced in many different sizes and forms.
Which condom best fits your needs can be determined by trying out the various ones available.
Women do not provide such certifiAnyone contemplating getting an
cates, though they do provide coun-
Centers for abortion counseling are
abortion should seek out special con-
seling concerning pregnancy conflict.
run by church associations and other
flict counseling offered in an accred-
social-welfare organizations as well as
ited counseling center for pregnancy
More on the topics of contraception,
other nongovernmental and munici-
conflicts. A certificate proving one´s
the desire to have children, pregnancy
pal agencies. The addresses of such
attendance at such counseling is also
and counseling may be found under
centers may be found in the local tele-
one prerequisite for getting an abor-
➔www.familienplanung.de
What color
do you see?
HOW TO USE THE KONDOMETER
2
To assist you in your search for the perfect condom, we have
developed the “Kondometer.”
On the back you´ll find at the right a white arrow.
Apply it to your penis first and then wrap the rest of
the tape around your rigid penis.
Now look through the hole you punched. What
color do you see?* That color corresponds to the
recommended condom size.
Further information may be found under
www.kondometer.de.
HERE, WIDTH MATTERS
Condoms are designated by their width, even though
we are in fact measuring the circumference of the penis. The Kondometer helps to translate those figures.
The color scale printed on the back of the tape allows
you to decide whether the standard-sized condoms –
or rather smaller/larger ones – are your best choice.
phone directory, obtained from social
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
intended for resale by the recipient or by third parties.
kondometer
Which size fits your needs? The width is what matters!
02 |
| 91
front
1
On the back you´ll find at the right a
white arrow. Apply it to your penis
first and then wrap the rest of the
tape around your rigid penis.
2
Now look through the hole you
punched. What color do you see?*
That color corresponds to the
1
2
*
Information on using condoms may also be found in the BZgA
brochure “Safe and Sure. Contraception for Her and Him”
(Order no. 13060070)
Table of contents
PREFACE ..................................................................................................04
BIRTH CONTROL FOLLOWING BIRTH .........................................56
CONTRACEPTION – MORE THAN JUST A WORD ..................06
CONTRACEPTION IN THE MIDDLE YEARS ...............................60
Contraception for both men and women ................................. 08
Changes in the menstrual cycle .....................................................62
What a contraceptive method must offer ................................. 09
How long contraception? .................................................................62
The female body ................................................................................... 10
Which contraceptives are recommended
The male body ........................................................................................12
during menopause? ............................................................................63
Combining hormonal treatment for menopause
with contraception .............................................................................65
Fertilization ..............................................................................................12
Hormones .................................................................................................13
Pregnancy and prenatal development ....................................... 14
Visits to the gynecologist ...................................................................15
UNSAFE METHODS OF CONTRACEPTION
(IF INDEED METHODS AT ALL) .....................................................66
THE VARIOUS CONTRACEPTIVE METHODS .............................18
Coitus interruptus ................................................................................67
The contraceptive pill/The minipill/The new minipill ...........20
Knaus-Ogino ..........................................................................................67
The condom ...........................................................................................24
The female condom (femidom) ......................................................28
CONTRACEPTIVE ACCIDENTS AND
The copper coil (IUD) ..........................................................................29
UNWANTED PREGNANCIES ...........................................................68
The hormone implant ........................................................................ 32
The “morning-after pill” ......................................................................70
The three-month depot ..................................................................... 33
The “morning-after IUD” .................................................................... 72
The vaginal ring ....................................................................................34
Pregnancy test ....................................................................................... 72
The contraceptive patch ....................................................................36
Pregnancy counseling and legal issues:
The diaphragm ......................................................................................38
Legal regulations and indications ................................................. 73
The cervical cap (aka Lea’s Shield®) .............................................. 40
Abortion ...................................................................................................74
The FemCap™ ......................................................................................... 41
Natural family planning (NFP) .........................................................42
FINDING THE RIGHT CONTRACEPTIVE ..................................... 78
Technical tools for calculating ovulation ....................................48
Contraceptives at a glance .............................................................. 80
Chemical methods ...............................................................................50
Decision guide ...................................................................................... 90
Sterilization ............................................................................................. 52
| 03
Preface
04 |
Preface
Dear Readers,
This brochure has been prepared to assist both men and women
in choosing an appropriate contraceptive. It provides information
concerning the mechanisms of action, application, safety as well
as the respective advantages and disadvantages of the individual
methods. This information corresponds to the state of the art at the
time this brochure was printed. It does not presume to be complete. It describes only the most popular and best-known contraceptive methods.
A brochure on contraceptives cannot replace a careful study of the
package information delivered with the individual product. It also
cannot replace a visit and a conversation with one’s gynecologist
or family doctor. Each product has its own peculiarities, as do the
individuals who apply them. Their use should always be monitored
by a physician.
The Editors
For further information on the subject of contraception, please visit our website ➔ www.familienplanung.de
| 05
Contraception – more than just a word
Contraception
– more than
just a word
Behind the term contraception lie many aspects that go beyond simple facts.
First, there’s the question of if and when contraception is to be implemented in
one’s lifeplan. Is it primarily a matter of controlling when to have children – or
the desire to avoid becoming pregnant altogether?
This type of family planning has now become a nearly routine matter – luckily
for both sexes.
To have children or not to have children? This question must be posed over and
again. Today, enjoying a partnership in which both partners can deal emotionally, socially and materially with the subject of having children is considered
the most important prerequisite to raising well-adapted, emotionally secure
and happy children. Whether this means navigating conception or preventing
it, it will have to be grappled with many times throughout one’s lifetime.
06 |
| 07
Contraception for both men and women
the act of conceiving and having chil-
Studies have shown that switching from
dren – something no one now would
one type of contraception to another
want to do without.
type in fact increases the risk of an unwanted pregnancy since the change
But more and more men are assum-
itself, particularly from a hormonal to
ing responsibility for contraception in
a natural method, means adjusting to
their partnerships. And even if they
new habits and methods of application.
cannot play an active role, they want
Switching means of contraception thus
to participate directly in the decision-
demands more attention to details and
making. Contraception, of course, is not
safety measures. Which birth-control
without its own inherent problems. This
method (or a combination of methods)
may be seen alone in the fact that the
one chooses will, in the end, always be a
timespan in which women can become
compromise between one’s desires and
pregnant stretches for some 35 years,
one’s needs – and these can sometimes
whereas men remain fertile for many
contradict each other.
years longer! That is indeed a long time
in which circumstances can change
radically. Many factors influence one’s
08 |
For women, the matter of preventing
choice of contraception, ranging from
pregnancy has changed tremendously
one’s age, type of relationship, body
in recent years. Today, they can plan
awareness, need for sexual spontaneity
more freely and independently than
and security. Medical considerations are
ever before; they can fulfill their profes-
also important to many couples when
sional needs and remain autonomous in
choosing their methods of birth control.
their relationships to their partner, fam-
Further, the fact that only condoms and
ily and children. Modern birth control
the so-called femidoms offer effective
enables a relatively anxiety-free and re-
protection against sexually transmitted
laxed approach to sexuality, which can
infections and HIV/AIDS can play a ma-
be viewed as something separate from
jor role in one’s decision.
What a contraceptive method must offer
Unfortunately, no single method is
all at once. Most likely, no such method
partner about your wishes and priori-
optimal for everyone and at all times.
will ever be invented that can serve all
ties can make this search considerably
That would be asking too much. Secur-
men, all women, all couples and all cir-
easier since then the choice would be
ing total protection from an unwanted
cumstances. Still, there are a number
acceptable to both sides. This brochure
pregnancy is a very tall order. Ideally,
of good alternatives readily available
wants to assist you in that search and
the method should be safe and reliable,
today to prevent unwanted concep-
to help to determine whether your pre-
while at the same time free of side ef-
tion. And scientists are working on even
sent method is still optimal. In order to
fects and all drawbacks; it must remain
better ones. If you are presently search-
understand how each contraceptive
unseen, be odorless, unnoticeable, easy
ing for an acceptable method of birth
method functions, you will need to
to use and cause no discomfort during
control, you should first write down
have information about how our bodies
intercourse; it should have no psycho-
what your most important require-
function. The two cross-sectional fig-
logical aftereffects, be cheap and im-
ments are (➔ p. 90) and which type of
ures on page 17 show us the workings of
mediately interruptible – and have no
contraception would thus best fit your
the male and female sexual organs.
lasting effects on fertility. Of course,
present situation (➔ pp. 18ff.). The task
it should also be practicable for both
is to weigh the advantages and disad-
men and women and acceptable to all
vantages of each method and then to
races, religions and cultures. The best
decide which of them would presently
would be, of course: All of the above,
be the best choice. Speaking with your
| 09
The more you know about what goes
on in the male and female body, the
better you will understand how conception occurs – and how the individual methods to prevent it function,
how safe they are and which one is
best for you. Because contraception
is always of concern to both sexes, it
is important to learn about the bodily
processes of one’s own sex as well as
of the opposite sex.
The female body
› THE REPRODUCTIVE CYCLE: The › OVULATION:
10 |
A girl is born with
during ovulation. Some women experi-
time between the first day of a woman’s
about 400,000 immature eggs in her
ence a sort of tugging in their abdomen
period and the last day preceding her
ovaries. Upon her entering puberty a
during this event, and there may be
next period is referred to as her men-
new egg matures during each cycle.
some spotting. The mucous membranes
strual cycle. Thus, the first day of her pe-
Once it has reached a certain degree of
that normally close off the woman’s cer-
riod is also the first day of the next cycle,
maturity, it is set loose from the ovary
vix very tightly now become looser so
and the day before the next period be-
and travels into the Fallopian tube,
that the man’s sperm can reach the egg.
gins is the last day of a cycle. How long
which at this point in time is pulled over
Following ovulation the egg is fertile for
a cycle lasts can vary greatly, not only
the ovary with rather frayed borders.
about 24 hours. Impregnation occurs in
between women, but also between
This is what is called ovulation. During
the outer third of the Fallopian tube, af-
a woman’s individual cycles. Every
a typical 28-day menstrual cycle ovula-
ter which the fertilized egg continues its
woman has her own individual rhythm,
tion occurs about midway through the
journey down the tube toward the uter-
which normally lasts between 25 and 32
cycle, though in some women it can
us. During this time, under the influence
days. But external circumstances such
take place up to a few days before or
of female hormones, the uterus fills with
as stress, illness, climate changes, travel
after this date (➔ the temperature and
blood and builds up a thick layer of mu-
and environmental factors can influ-
mucous curves shown on p. 47). The
cous so that the egg can properly lodge.
ence the cycle and ovulation.
chance of getting pregnant is highest
If the egg, however, is not fertilized, the
lining of the uterus (the so-called endometrium) is shed after about two weeks’
time and excreted during the woman’s
Week 1
Week 2
Week 4
Week 3
menstruation, sometimes also called
her period, monthly, menses or bleeding. And so begins a new cycle.
Girls can become pregnant
from their very first ovulation
on – even before having had a
single period!
›MENSTRUATION: A girl’s first period
– her menarche – usually occurs in early
puberty, between the ages of 9 and 15.
Presently, the average age at menarche
is 12.3 years. It is not possible to predict
when a girl will have her first period,
though the body usually announces
its arrival some six to 12 months in advance by excreting a white discharge
(the so-called leucorrhea) triggered by
hormones. The last menstrual cycle –
the menopause – occurs equally irregularly, whereby the statistical average
lies at around 52 years. Contraceptive
measures are generally necessary until
about one year after the last period, to
The menstrual cycle consists of two phases: the follicular phase when
preclude any danger of becoming preg-
the egg matures, and the luteal (or secretory) phase following ovula-
nant.
tion. If the egg remains unfertilized, the uterus lining is excreted during the next period.
| 11
The male body
In boys the sexual organs begin to
change at the onset of puberty. The
penis and testicles, the latter of which
begins to produce sperm cells after
receiving a hormonal “message,” begin to grow. Millions of sperm cells
are produced daily and stored in the
Much as a young girl can be
impregnated from her first
ovulation on, so a young boy
can impregnate from his first
ejaculation on. For this reason,
every male and every female
must attend to the matter of
contraception from the very
“first time” onward.
epididymis.
The creation of sperm cells is a very
Fertilization
complicated procedure and can be
thrown off by many factors such as dis-
Fertilization – and thus pregnancy – oc-
ease, stress, nicotine and environmental
curs when the male sperm cells enter
poisons. Upon sexual arousal the tubu-
the vagina of the female in the form
lar structures in the penis, the corpora
of semen and then progress to travel
cavernosa, fill with blood. The penis be-
through the uterus to the woman’s Fal-
comes erect, grows in size and becomes
lopian tubes. If the two – sperm and
hard (erection). At the pinnacle of sexu-
egg – happen to come together at the
al arousal (orgasm) the sperm cells are
right time, they merge. The egg can be
discharged through muscle contrac-
fertilized for ca. 24 hours after leaving
tions of the penis (ejaculation). Only
the ovary on its path to the uterus. The
a very small portion of the sperm cells
sperm cells, however, can “wait” even
ever reaches the egg – which is why the
longer on the egg to arrive: In the pro-
body produces and sends so many on
tective environment of the uterus or
their way. However, it only takes a sin-
the Fallopian tubes they can survive
gle sperm cell to fertilize the egg. Thus,
and thus still fertilize the egg for up to
any effective contraceptive method for
two to five days (and in rare cases even
the man must be able to affect all sperm
seven days).
cells ejaculated. Should no ejaculations
occur, after a while the sperm cells are
reabsorbed by the body.
12 |
That means: Unprotected intercourse
progesterone; the most important male
and progesterone are produced in the
even days before ovulation can result in
hormone is testosterone.
ovaries.
These female hormones and
their derivatives are present in
some drug-based contraceptives, such as the “pill,” the minipill, the IUC and the hormone
implant, to prevent pregnancy.
Among other things, estrogens are re-
fertilization and pregnancy!
Even simple petting can transport
sperm cells into the vagina via the
hands. Remember: some sperm cells are
emitted by the penis even before ejaculation (so-called preseminal fluid). Here,
too, safety is of absolute priority.
Hormones
sponsible for building up the lining of
the uterus. Progesterone fulfills a number of roles, but above all it tries to prevent the egg, which may or may not be
fertilized, from being discharged by the
uterus. It also sees to it that the uterus is
The central controlling organ for hor-
well supplied with blood and has all the
mone production is the pituitary gland,
nutrients it needs. These are the prereq-
which directs the hormones to the
uisites for a successful pregnancy.
ovaries and testicles and triggers them
Hormones are the body’s transmit-
to take certain actions. In women, this
If the egg is not fertilized, the level of
ters, usually carrying messages from
causes the egg to mature so that the
progesterone falls after about 14 days,
the glands. The most important hor-
woman ovulates and produces further
triggering the woman’s period, and the
mones for sexuality and reproduction
hormones. The gonads and the brain
reproductive cycle begins anew with a
are formed in the so-called gonads – in
communicate continually through hor-
new maturing egg in the ovary.
women the ovaries, in men the testi-
mones traveling through the circulation
cles. In women these are estrogen and
system. The two hormones estrogen
| 13
Pregnancy and prenatal development
Once the egg and the sperm cell have
lated time are still considered “normal.”
of 20 and 30. The most important factor,
united, growth commences at a high
The child’s organs and limbs develop in
however, is not age but the woman’s in-
rate. The cells of the fertilized egg divide
the first three months of the pregnancy.
ner attitude.
continually. The small ball of cells then
During this time any diseases or disrup-
travels to the uterus where it lodges
tions experienced by the mother may
itself in the lining after about a week.
have very negative effects on the devel-
Now the entire female organism be-
oping fetus. A pregnant woman should
gins to prepare itself for pregnancy. The
avoid alcohol, nicotine and all unneces-
first and often most obvious sign that
sary medicines during this time and also
a woman is pregnant is the absence of
try to reduce her overall stress level.
To minimize these risk factors, it is of
If the pregnancy is in the planning, it is recommended that
the woman begin taking folic
acid supplements (0.4 mg/day)
about four weeks before fertilization to reduce the risk of certain birth defects (neural tube
defect or spina bifida). (➔ for
The time between fertilization of the
great importance that a woman deter-
more information, see the website
egg and the birth of the child is ap-
mine early on whether she is pregnant.
www.familienplanung.de/schwanger-
proximately 266 days (ca. nine calendar
Biologically speaking, a woman’s fertil-
schaft/die-schwangerschaft/gesund-
months), although births that occur
ity decreases with age; the best age to
heit-und-ernaehrung/ernaehrung/)
two weeks before or after this calcu-
become pregnant is between the ages
her subsequent period (➔ pp. 10ff.).
14 |
Visits to the gynecologist
A woman using hormones or a cop-
Before the first visit to a gynecologist,
per coil (IUD) as contraception should
young women should determine for
visit her gynecologist regularly every
themselves whether they would prefer
six months for a control examination.
going to a male or female doctor. Some-
A routine examination as part of yearly
times it is helpful to talk with peers and
cancer screening is suggested for all
get recommendations on a practice or a
women 20 years and older.
counseling service.
When to go to see a gynecologist
A woman should see her gynecologist as soon as possible at the following
signs:
› Itching and smelly discharge from the vagina
› Bleeding between periods
› Problems urinating or defecating
› Abdominal pain
› If there is severe pain on nonmenstrual days
› If pain occurs regularly after intercourse
› If bleeding occurs regularly after intercourse
› If menstrual bleeding goes on for longer than ten days
› If the menstrual cycle is repeatedly too short (less than 25 days)
› If menstrual bleeding produces large blood loss
› If the period is more than 30 days overdue
› If no signs of puberty and menstrual activity occur by age 15
› If headaches and vision disorders occur while taking the contraceptive pill.
Many women describe their first visit to
the gynecologist as unpleasant. That is
understandable. Nevertheless, regular
control visits, especially as one grows
older, are vital. The best thing is to prepare oneself for the gynecological examination, which the doctor will explain
in detail.
| 15
The examination
portant to you that the hymen remain
measures paid for by German health in-
intact, talk to your gynecologist about
surance for women 25 years and young-
The gynecologist will first ask some
this in advance. The gynecologist is also
er (➔ see www.g-ba.de).
questions – think about the an-
able to do the examination by placing
swers before you go:
two fingers in the woman’s vagina and
Young women who are insured through
using the other hand to palpate the
the German national insurance program
uterus, ovary and Fallopian tubes from
have the right to have their contracep-
the outside. In adult women the doctor
tion paid for up through the age of 20,
will generally also examine the breasts
inasmuch as it has been prescribed by
and armpits and prepare a smear from
a physician. Women 18 and older have
the mucous surrounding the cervix.
to pay the usual prescription fee. The
› When did you get your first period?
› How regular is your period?
› How long does a normal period
last?
› How heavy is the bleeding?
› When was your last period?
› What contraceptives are now
contraceptive means covered include
A tip in this regard: Many women find
all hormonal preparations such as the
being used or have been used in
this examination unpleasant. Wearing a
contraceptive pill and minipill, hormone
the past?
longshirt or a long T-shirt that remains
IUD, hormone implant (a subcutaneous
on during the exam often provides the
rod), three-month depot, vaginal ring
feeling of being protected.
and contraceptive patch. But other, me-
› Do you have any serious diseases
or health problems? Any such
problems in your family?
› Have you ever been pregnant/had
a child before?
16 |
chanical methods such as the copper
All women, regardless of their age, have
coil (IUD) can also be prescribed by one’s
the right to say and ask whatever they
doctor. The woman should decide which
want to under such circumstances.
method is best for her by speaking to her
Then the doctor carries out the actual
Make your needs known! It is your body!
gynecologist.
gynecological examination, which does
It is suggested that all women also have
not take long nor does it hurt. The gy-
a test done every year for chlamydia in-
Further information on the reproduc-
necologist inserts two so-called specu-
fection, a sexually transmitted disease,
tive biology of men and women may
lums (a mirrored instrument used to ex-
even if they are experiencing no symp-
be found in the brochure entitled “Ein
amine inner cavities) into the vagina to
toms (➔ see www.familienplanung.de/
`kleines Wunder’: Die Fortpflanzung”
look at the state of the vagina itself and
schwangerschaft/die-schwagerschaft/
(“Reproduction: A Small Wonder”),
the cervix. In girls and women who have
beschwerden-und-krankheiten/
which may be ordered directly from
not yet had intercourse there is a certain
krankheiten-und-infektionen/chlamy-
BZgA (order no. 13621001).
chance of being “deflowered,” that is, of
dien-infektion/). In 2008 this test be-
having the hymen broken. If it is im-
came part of the regular prevention
› MALE REPRODUCTIVE ORGANS
ureter
pubic bone
bladder
ductus deferens
coccyx
prostate gland
ampulla of the ductus
defererens
corpus cavernosum
seminal vesical
glans
bulbourethral
(Cowper’s) gland
foreskin
urethra
testicle
scrotum
bulbospongiosus
muscle
rectum
anus
epididymis
› FEMALE REPRODUCTIVE ORGANS
ovary
Fallopian tube
ureter
bladder
coccyx
pubic bone
urethra
uterus
mons veneris
cervix
clitoris
vaginal fornix
labia minora
rectum
labia majora
vagina
anus
| 17
The various contraceptive methods
18 |
The various
contraceptive
methods
In the following you will find a detailed discussion of the various
different methods of contraception. You will learn about their respective modes of action and application as well as their benefits
and disadvantages.
| 19
›EFFECTS/USE: The hormones con-
A new product came to the market in
tained in the pill (with the exception
2008 – a “24 + 4” rhythm: After taking 24
of the minipill, ➔see p. 23 below) have
pills containing hormones, the woman
three different effects:
takes four hormone-free pills and then
› They inhibit ovulation, making fertilization impossible.
› They change the mucous surrounding
The contraceptive pill
starts a new package.
The two- or three-phase pills have differ-
the cervical canal so that the sperm
ent doses of hormones for the first and
cells cannot enter.
second half of a woman’s cycle. The vary-
› They prevent the proper build-up of
ing combination of estrogen and gesta-
the lining of the uterus, so that the fer-
gen in these pills attempts to replicate
tilized egg cannot lodge in the uterus.
the woman’s normal cycle. However,
these pills must be taken very diligently:
The contraceptive pill (“the pill”) is still
› AVAILABLE
considered to be one of the safest and
various compounds available have dif-
most popular contraceptive means
ferent amounts of hormones, which
available to prevent pregnancy. Espe-
determines how they are to be taken.
cially girls and younger women tend to
The so-called one-phase pills have the
take the pill.
same amount of estrogen and gesta-
Today, there are many different types,
gen in each pill: This type of pill is taken
though all contain some amounts of
every day for 21 or 22 days in a row. Then,
the two female hormones estrogen and
for six or seven days, no pill is taken,
gestagen. Only the so-called minipill
and the woman’s period usually sets
contains only one ingredient, gestagen;
in. The pills are taken regardless of the
it is described separately below. The
woman’s normal cyclical activity. Some
newest pills have in part very low doses
one-phase pill packages contain 28 pills,
of hormones and have thus fewer side
whereby the last six or seven pills con-
effects than was previously the case.
tain no active ingredients. This method
Nevertheless, the pill – regardless of
avoids mistakes in taking the pills. The
which type – remains a drug that, like
pills are thus taken continually, without
every other drug, should not be swal-
interruption, the period commencing
lowed lightly.
when the row of ineffective pills has
been taken.
20 |
COMPOUNDS: The
Taking the pills in the wrong order can
disrupt the contraceptive effect.
› SAFETY: Today it is normal to begin
taking the pills on the first day of the
menstrual cycle. This guarantees that
the contraceptive effect is present from
Before going on vacation, particularly if jetlag is involved, discuss the proper use of the pill
with your gynecologist.
the very first day onward. It also pro-
In Germany women up through the
age of 20 who are insured by the statutory health insurance have the right to
receive the pill free of charge. Besides
paying a prescription fee from age 18
vides protection even during the week-
It is generally not recommended that a
on, however, they may have to make co-
long period of bleeding. If a pill is forgot-
woman stop taking the pill periodically
payments if the price of the particular
ten, there is no danger of pregnancy as
to check whether her cycle is function-
pill prescribed is higher than the stand-
long as the forgotten pill is taken within
ing normally. This only serves to con-
ard fixed sum allotted.
12 hours. A missed minipill, on the other
fuse the entire hormonal system. Even
hand, has to be taken within the next
after having taken the pill for extended
New studies reveal that women over 35
two hours to still be effective. In either
periods of time a woman should have
also can safely take the pill as long as
case, the row of pills is then continued
no problem subsequently getting preg-
they are healthy, do not smoke and use
without interruption. Still, that should
nant by choice. In some cases, however,
the low-dose types.
not happen all too often, and if it does
it can take up to six months for the body
then some additional form of contra-
to return to its normal rhythm and expe-
- DISADVANTAGES: The contracep-
ception such as a condom should be
rience ovulation.
tive pill is a high-potency drug. Even if it
has been constantly improved over the
used for the next week or so until the
hormone concentration has once again
+ BENEFITS: By taking the pill a wom-
past years, it can still have adverse side
been established at a level necessary to
an can feel relatively safe and protected
effects, such as nausea with vomiting,
prevent conception. Problems can also
from getting pregnant. This contracep-
weight gain, lack of sexual interest,
occur when the woman is simultane-
tive method is especially well suited for
spotting, mood swings, and tension or
ously taking other medicines, such as
girls and young women who want to
tenderness in the breasts.
laxatives, antibiotics, antiinflammatory
prevent their getting pregnant under all
In rare situations more dangerous side
drugs, St. John’s wort, etc.), or when a
circumstances. Women taking the pill
effects have been reported. For exam-
bout of stomach flu with vomiting and
have somewhat shorter and less intense
ple, after early and extended use of
diarrhea has been experienced. To avoid
periods than normal. Many girls and
the pill a woman’s risk of getting breast
unwanted pregnancy, in such cases it
young women also get very clear skin
cancer increases slightly. Further, the
has proved best to use some additional
while taking the pill. Scientific studies
pill can, under some circumstances,
form of contraception (e.g., a condom)
have also shown that the pill protects
pose a danger to a woman’s cardiovas-
for up to seven days thereafter.
against certain types of cancer (particu-
cular system. For this reason, it should
larly of the uterus and ovaries).
be taken only by healthy women and
must be prescribed by a doctor. The pill
| 21
is not an appropriate method of contra-
high the risk is depends on the amount
ception in the presence of certain liver
of estrogen and the type of gestagen
conditions as well as with an inclination
in the pill one is taking. Yet, the over-
toward thromboses (formation of blood
all risk for the formation of dangerous
clots inside the blood vessels, usually in
blood clots is low. For women who
the legs or pelvic area). In women with
have taken the pill for a longer period
diabetes each case must be decided on
of time and have experienced no side
its own merit. In any case women tak-
effects, there is no reason to stop its
ing the pill should not smoke under any
use. They should speak with their physi-
circumstances. And women with an in-
cian about how best to lower their risk.
creased risk of developing thrombosis
The most important thing is to have an
or who are taking hormonal contracep-
honest conversation and to determine
tion for the first time should consult
together which sort of pill is best suited
their doctor about the method best
for them. For this reason, prescription
consult a doctor. Sometimes it suffices
suited for them.
of the pill is allowed only after a thor-
to change the particular type or brand
ough consultation (or sometimes even
of pill used.
A higher risk of thrombosis is present
an examination) by a gynecologist and
in
should be followed up every six months
Read carefully the package leaflet or in-
by a control visit. If these safety precau-
structions provided by the doctor/phar-
tions are attended to, there is generally
macy, which also include detailed infor-
no reason to worry. Some women ex-
mation on what side effects may occur
perience the daily routine of having to
with the respective pill. In any case, if
enced thrombosis or suffer from vari-
remember to swallow the pill as nega-
she experiences discomforts, a woman
cose veins
tive. At first the body has to get used
should not make any spontaneous deci-
to the hormones. With the low-dosage
sions: If she stops taking the pill without
combinations available today some
setting up some other additional means
spotting may occur at the beginning,
of contraception she is risking getting
but it does not affect the contraceptive
pregnant. And postponing one’s period
safety and generally disappears after
indefinitely by simply continuing to take
› Smokers
› Women who have a history of thrombosis in the family (parents, siblings)
› Women who have already experi› Women who are very overweight
(obesity)
› Women who have just given birth
› Women who suffer from a congenital
lack of the proteins C and S.
22 |
about 1–2 months. Some women taking
the pill without interruption should be
Women taking the pill should be aware
the pill experience an increase in yeast
done only in exceptional cases, as such
that there is a slightly higher risk of
infections and weight gain. If this is the
irregularities can overtax one’s body
thrombosis during the first year. How
case or if any other irregularities occur,
and cycle considerably.
The minipill
basis are often prescribed the minipill,
since the normal pill would cause the
› EFFECTS/USE: The minipill contains
baby to absorb too many hormones.
only gestagen, which has the effect of
Also the presence of additional estro-
preventing the proper build-up of the
gen might reduce the amount of milk
uterus lining and thickens the cervical
the mother’s body produces.
mucous. In many women it also prevents ovulation altogether.
- DISADVANTAGES:
The
minipill
very often leads to spotting and irreguThe rules for taking the minipill are
larities in a woman’s overall cycle. For
more stringent than with the com-
this reason it is generally prescribed
pound pill: It must be taken every day at
only in special cases, e.g., for women
the same exact time, without interrup-
who do not tolerate estrogen very well.
tion. If it is taken more than two hours
Because it has to be taken very precise-
after the usual time, its contraceptive
ly, it demands a disciplined regimen
effect can no longer be guaranteed. In
from its user, which is not always easy in
the compound mentioned below with
daily life.
desogestrel, intake can be delayed for
up to 12 hours.
› SAFETY: The minipill does not have
The new minipill
the triple-action effect of the other
The new minipill contains a low dose of
types of contraceptive pill, i.e., it gener-
the gestagen desogestrel, which has a
ally does not prevent ovulation. For this
three-pronged effect: It prevents ovula-
reason, its safety is not considered as
tion, it prevents the proper build-up of
high as the other combination pills.
the uterus lining, and it thickens the cervical mucous, thereby reducing the abil-
+ BENEFITS: The minipill has fewer
ity of sperm cells to reach the uterus. It
side effects than the combination pill,
is generally considered very safe, com-
but its reliability is not as high since it
parable to the combination pills. The
does not generally prevent ovulation.
contraceptive effect of the new minipill
Women who are nursing a child and
is not reduced if taken no more than 12
want to take precautions on a hormonal
hours late.
| 23
› EFFECTS/USE: Use of the condom is
doms that are too large can easily slip
easy to understand but does require
off during sex and land in the vagina
Before the introduction of the pill and
some practice. The rubber-tube-like de-
or the rectum.
IUD, the condom was the most widely
vice is closed at one end and is rolled
› Damage to the condom: usually upon
used type of contraception. Today it
over the erect penis so that semen are
opening the package with scissors or
has once again taken second place on
stored at the end and do not come into
sharp nails, etc.
the list, especially because of its ability
contact with the woman’s vagina, thus
› Slipping the condom on too vigorously:
to protect against HIV infection and to
preventing insemination (if used prop-
it should be rolled over the penis very
reduce the risk of infection from other
erly, of course). The penis and the vagi-
carefully.
sexually transmitted diseases (STDs).
na thus have no direct contact with
Like the femidom, the condom is the
each other. This is also how the condom
rolled-up part should lie on the outside
only contraceptive that can prevent in-
lowers the risk of infection from nearly
and not on the inside. If you discover
fection stemming from an STD and pro-
all STDs.
it has been applied incorrectly, don’t
The condom
› Putting the condom on wrong:
the
turn it over and reuse it!
tect against an unwanted pregnancy.
For persons starting sexual contact with
›
SAFETY: The contraceptive efficacy
› Putting the condom on without pressing
a new partner or for persons with multi-
depends greatly on correct handling.
out the air: leave enough space at the
ple partners the condom is still the ideal
Proper use of a condom should be prac-
tip for the semen.
method of preventing pregnancy and
ticed in advance to prevent errors from
lowers the risk of becoming infected
occurring in the heat of the moment.
› Poor hold or fit: the condom can slide
off when the penis is withdrawn from
the vagina.
with HIV or STDs.
The most common errors are as follows:
›
› Using condoms together with substanc-
Wrong-sized condom: Condoms that
es that contain fats or oils (e.g., lotions,
are too small can break or burst; con-
creams, Vaseline, medicines or salves for
the genital area) to ensure lubrication:
these can damage the condom and
make it permeable for sperm. Always
use only water-soluble lubricants,
available in pharmacies or drug stores.
Used properly, however, the condom
is a very safe method of contraception. These errors can easily be avoided if one attends to a few basic rules.
24 |
top part of the condom with the other
›
USING A CONDOM
3.
hand. The condom should unroll easily.
If that is not the case, use the proper size
The condom must be rolled
over the erect penis at the
proper moment: before it
comes into contact with the
vagina! There is otherwise
always the danger of some
sperm cells reaching the vagina before actual ejaculation.
or form. Never tug on the condom!
5.
Take the tip of the condom between
the index finger and the thumb in
order force out any air and to make
room to collect the semen. Then
1.
place the still rolled-up condom on
the tip of the penis with the rolled-
The tip of the condom with the reservoir
up part on the outside. If the con-
for the semen should not sit too tightly,
dom is initially put on incorrectly,
leaving enough space for the semen.
with the rolled-up part on the inside,
then a new one must be used as the
After ejaculating do not wait for the pe-
old one could already be contami-
nis to become limp once again, but hold
nated with semen.
onto the condom at the base of the
Carefully open the package
penis (so that it can’t slip off ) and care-
4.
fully pull the penis out of the woman’s
vagina.
2.
After slipping the condom off the penis,
remember some semen may be on the
fingers or the hand. No semen must be
allowed to make its way into the vagina if fertilization is to be prevented!
Carefully unroll the condom with one
Pull back the foreskin, inasmuch as
hand all the way down to the base of
present
the penis. Continue to hold on to the
| 25
If the condom should manage to slip
off unexpectedly or tear, the woman
should go to her gynecologist or to a
counseling center as soon as possible
to check whether fertilization has taken
place and whether the so-called “morning-after pill” is indicated (➔ see p. 70).
If an HIV infection in one’s partner cannot be excluded, there are some measures that can be implemented to reduce
the risk of becoming infected oneself.
Examples are showering off the penis
(pull the foreskin back completely),
urinating and forcing the sperm out of
the vagina or rectum. Internally flushing
What else to watch out for:
the vagina or rectum, however, is not
recommended as the risk of infection
› Use only quality condoms from well-known manufacturers with a seal of
is increased by possible small injuries.
quality (e.g., in Europe watch for the CE label with the number of a certified
Following oral sex, any infected semen
testing center). Condoms also generally have an expiration date printed on
should be spit out immediately and
them. These measures guarantee a high level of safety.
the mouth disinfected with high-proof
› When going on vacation, take enough high-quality condoms along with
alcohol of some sort. Do not brush the
you since the ones you find away from home may not have the same high
teeth! If there is an imminent danger of
quality you’re used to.
infection with HIV (e.g., if you are certain your partner is a carrier of HIV), go
as soon as possible to your physician or
to a counseling center (AIDS center) to
be counseled about being treated with
high-potency drugs (so-called PEP).
› Condoms do not tolerate heat very well. Don’t let them lie around in the
sun.
› Always check the expiration date before using. Condoms are usually good
for about 4–5 years.
› Don’t store condoms where they may be damaged – in pockets, purses, cosmetic bags, etc.
› Condoms are intended to be used only once. Used condoms belong in the
waste basket, not in the toilet.
26 |
+ BENEFITS: Condoms protect not
ipate in a couple’s contraceptive efforts.
A note:
only against unintentional pregnancy,
For both men and women with several
A major factor in the safety offered by
they are also the only contraceptive to
simultaneous relationships the condom
a condom is picking the right size for
offer effective protection against sexu-
offers important protection against
your own personal needs. Particularly
ally transmitted diseases such as HIV.
sexually transmitted infections. In cou-
adolescents are not served well with
With a little practice they are easy to use
ples that have a relaxed and open sex
the standard sizes available. If you need
and can be readily purchased most eve-
life with each other, one can even make
more information on the proper size
rywhere.
the use of condoms part of the foreplay
and fit of condoms, go to the website
and not experience it as an interruption
www.kondometer.de
The condom also does no damage to
to one’s desires.
the body, and it has no side effects or
Another note:
after effects. Even in the rare case of an
- DISADVANTAGES:
The condom
There is also an anonymous hotline
allergy to the latex in the condom, one
must actually be used in intimate situa-
available from the BZgA (German Fed-
can purchase special condoms made of
tions! Left in your purse or pocket it is of
eral Centre for Health Education), daily
polyurethane in drug stores and phar-
no use to anyone and does not prevent
from 10 a.m. under the number 01805–
macies which have no known allergenic
pregnancy. If you tend to forget about
555444 (EUR 0.14/minute from a land-
properties. Further, condoms must be
birth control during sex, then another
line, max. EUR 0.42 from a cell phone). It
used only when intercourse actually
method may be better suited for you.
can answer all your questions concern-
takes place – and it is the only form of
ing HIV/AIDS, safer sex and other sexual
contraception employed solely by the
Especially when you are just getting to
man, who can in this way actively partic-
know someone it can be awkward to
matters of interest.
have to talk about using a condom.
Women who rely on condoms are depending on the man taking and accepting responsibility. Not everyone is comfortable demanding the use of a
condom – but that is your right! It is not
Injectable contraception for the
a token of your love to fail to protect
man: The research on a hormonal
yourself against an infection.
means of contraception for males
was stopped in 2007, so that it will
presumably not become available
any time in the near future.
| 27
bricant. The female condom stops any
sperm from entering the cervix and goUsing the female condom
ing into the uterus.
› SAFETY: Used properly, the female
condom is just as effective as the male
condom.
+ BENEFITS: Although the male condom offers good protection again sexually transmitted infections, the female
condom offers the woman a way of protecting herself if her partner does not
want to or fails to use a condom. Like
the male condom, the female condom
is the only means of contraception that
protects against infection from sexually
transmitted diseases including HIV/
AIDS. It can be inserted before the act of
intercourse begins.
The female condom
(femidom)
flexible rings at each end, each of which
- DISADVANTAGES:
looks like a diaphragm (➔ p. 38). One
the female condom requires inserting
ring is inserted into the vagina and held
two rings to exactly the proper position,
In Germany at least the condom for fe-
tight between the pubis (pubic bone)
which is not easy at first. Like the male
males is not easy to come by in super-
and the rear part of the vagina (the
condom, it can be used only once. The
markets and drug stores. It is, however,
co-called vaginal vault) so that it com-
female condom is available on the inter-
available under various labels in phar-
pletely covers the cervix. The other ring
net under various different names and
macies and on the internet. A prescrip-
remains on the outside of the vagina
from different makers.
tion is not necessary.
over the labia (lips of the vulva), which
keeps it from slipping into the vagina.
28 |
Proper use of
› EFFECTS/USE: The female condom
This “pipe”-like construction is covered
consists of a plastic sheath connected to
on both the inside and outside with lu-
The copper coil (IUD)
› EFFECTS/USE How this device works
as it does is not completely understood.
The copper apparently changes the nature of the mucous around the cervix
and in the uterus.
The spiral itself is a T-shaped piece of
plastic wrapped with a very thin copper coil. This means of contraception,
also called an IUD, is manufactured in
several different forms and sizes (ca.
2.5−3.5 cm). An IUD must be inserted by
a gynecologist through the cervix and
into the uterus. The best time to do so is
in the last few days of the woman’s period, which also reduces the risk of inserting an IUD when the woman is already
pregnant. The gynecologist checks
the position immediately, and regular
› SAFETY The IUD is a very safe means
Most women consider it a major advan-
checkups using ultrasound should be
of contraception. The only drawback is
tage of the IUD that they continue to
carried out every six months. Whether
the somewhat higher rate of rejection
experience their normal menstrual cy-
one’s health insurance pays for these
in some women who have yet to bear a
cle. Especially women who have already
visits varies. One can test the proper
child, which of course can translate into
given birth experience few problems
position by checking after one’s period
a higher failure rate.
with the IUD.
spiral, which hangs out of the cervix by
+ BENEFITS: As long as the IUD has
- DISADVANTAGES: In some wom-
about 2 cm, is still there.
been properly fitted in the woman’s
en the IUD can cause very heavy men-
uterus, she basically doesn’t have to
strual bleeding and menstrual cramps.
worry about getting pregnant any
This may be a hint that the coil is not (or
more. Modern IUDs have to be replaced
no longer) properly positioned. When
only every five years or so.
this occurs, the woman should go to her
has passed that the safety thread of the
| 29
gynecologist to have it checked. At the
the egg is fertilized outside the uterus)
very beginning the IUD may sometimes
tend to occur more frequently. Thus, if a
wash out with the menstrual blood –
woman with an IUD does become preg-
which is why one should periodically
nant, she should have her gynecologist
check for the presence of the safety
exclude the possibility of a tubal preg-
thread and also have it regularly con-
nancy. If the pregnancy is normal, how-
trolled by a gynecologist. Especially
ever, then the coil should still be re-
young girls and women have a higher
moved since it can otherwise cause an
risk of pelvic infection in the first few
infection over the course of the preg-
months of use, which even increases if
nancy. Although miscarriage occurs in
they have multiple sexual partners. This
one-fifth of all cases when the coil is re-
risk can be reduced by ensuring that no
moved, the danger of miscarriage is
infections, particularly with chlamydia
even larger if the coil is not removed.
or gonorrhea, are present at the cervix
There is, however, no greater risk of the
when the coil is inserted for the first
child having a birth defect: Children
time. If the women does get pregnant
born to mothers with intact IUDs are
despite having used an IUD, tubal preg-
usually healthy.
nancies (aka ectopic pregnancy, where
30 |
Women who have yet to give
birth should weigh the pros
and cons of using the IUD as
means of contraception, also
with an eye toward ensuring
later fertility.
The hormone IUD
ally the same as with the normal copper
The hormone IUD too can lead to pelvic
IUD. Another advantage of the hor-
infections or perforations of the uterus.
› EFFECTS/USE: The hormone IUD (al-
mone IUD lies in reduced overall men-
Other risks include a higher risk of breast
so called intrauterine system, IUS, or in-
strual bleeding in women who normally
cancer as well as ectopic pregnancy
trauterine contraceptive, IUC) is an IUD
have very heavy menstrual bleeding. Up
once the IUD has been inserted. Before
outfitted with a small hormone depot
to 50% of women with a hormone IUD
having this IUD inserted, women must
that releases the hormone called lev-
stop having a period altogether after a
sign a written release saying that they
onorgestrel. This sort of IUD makes the
few months’ time. Also there is no need
have been informed about the risks and
mucous around the cervix thicker and
to remind oneself daily about imple-
are agreed to having it inserted. Since
thus impassable for sperm during ovu-
menting contraception, reducing possi-
the tube used to insert this sort of IUD is
lation. Should sperm cells nevertheless
ble errors considerably.
somewhat larger than with other IUDs,
get through, they are generally inhib-
the procedure is overall somewhat
ited in their movement. The hormone
- DISADVANTAGES: Women with a
more difficult. Especially in very young
IUD also inhibits the proper buildup of
hormone IUD usually experience vari-
women who have yet to give birth in-
the uterus lining, thus stopping any fer-
ous changes to their menstrual cycles.
sertion may be more complicated since
tilized egg from nesting in the uterus.
All users tend to have irregular periods,
the coil is thicker than the copper coil
The hormone IUD can be left in place for
sometimes over long stretches of time.
and may make dilation of the cervix
up to five years. As with the normal IUD,
Spotting, headaches, tension or tender-
necessary. For women who have not
it has to be inserted by a gynecologist.
ness in the breasts, mood swings and
yet given birth the hormone IUD is not
sometimes acne may occur, especially
the method of choice and should be
› SAFETY: The hormone IUD has a very
during the first few months after inser-
considered only when all other reliable
high rate of safety.
tion, though these side effects usually
methods have been exhausted.
disappear after a while. In some women
+ BENEFITS: The benefits are gener-
periods stop occurring altogether.
| 31
The hormone implant
› EFFECTS/USE: The hormone implant › SAFETY: The safety of the hormone
is a soft rod that is inserted by specially
implant is very high.
trained gynecologists under the skin of
a woman’s inside upper arm with the
+ BENEFITS: For women who shun
help of an applicator. Small amounts
regularly taking the pill or using other
of gestagen are delivered to the body
means of contraception, this method
which prevent pregnancy from occur-
can be a viable alternative as it requires
ring for a period of about three years.
no further effort on the part of the re-
The gestagen stops ovulation and also
cipient.
induces changes to the mucous lining
around the cervix and in the uterus. It is
- DISADVANTAGES:
imperative that an existing pregnancy
fects, such as acne, headaches, tension
be excluded before the rod is implanted.
or tenderness in the breasts, depression
The implant protects against unwanted
and weight gain, can occur very often,
pregnancy for about three years. This
i.e., in more than 10% of all users. Most
rod, called Implanon, can be implanted
women also experience longer lasting
between the first and the fifth day of
or frequent bleeding while using the
the woman’s menstrual cycle and later
implant. In other women menstrual
removed at any point in time. The hor-
bleeding becomes seldom or is absent
monal agent is immediately active, and
altogether (in about 20% of the users).
after removal thereof fertility is reestab-
Especially for younger girls this can be
lished very quickly. This type of contra-
unnerving. Having the implant removed
ception is appropriate for women of all
after less than three years also renders it
ages, though to date studies have been
a very expensive method of contracep-
carried out only on women aged 18 to
tion.
45. Cases of improper implantation have
led to unwanted pregnancies. Thus, it is
paramount that the gynecologist regularly control the proper position of the
implant. A follow-up examination is recommended after three months’ time.
32 |
Some side ef-
The three-month depot
› EFFECTS/USE: This method consists
with this solution. This injection has also
been given, it can last a long time,
of injecting a long-acting hormone
proved advantageous in women who
sometimes up to an entire year, before
(gestagen) into the gluteal muscle
do not tolerate other hormonal contra-
the woman’s menstrual cycle becomes
(buttocks). It works by inhibiting ovula-
ceptives because of certain illnesses
normal again and fertility returns. This
tion and must be repeated every three
(such as sickle-cell anemia).
method is not appropriate for women
months. This method should be used
who cannot commit for such a long
only by women who do not tolerate
- DISADVANTAGES:
other drug-based methods. And it is ap-
such as spotting or intermenstrual
propriate only for women with a regular
bleeding occur relatively often. Also
menstrual cycle.
common are headaches, nervousness,
Side effects
time.
vertigo, depression, acne, temporary
› SAFETY: The safety of the three-
nausea and high weight gain. Studies
month depot injection is very high.
have shown that using this method
over a longer period of time can also
+ BENEFITS: Women who prefer not
lead to loss of bone density. The latter
to have to constantly think about con-
risk is highest among women from 18 to
traception receive a high level of safety
21 years of age. After the last shot has
| 33
The vaginal ring
gina by the woman herself between the
(after about three days’ wait), a new ring
first and the fifth day of her menstrual
is inserted, even if menstrual bleeding
This method of contraception consists
cycle. During the initial seven days after
has not yet subsided.
of a plastic ring containing a low dose
insertion an additional means of con-
of a combination of estrogen and gesta-
traception, e.g., a condom, should be
gen which must be prescribed by a phy-
employed. If a hormonal contraceptive
sician. It is a “one-size-fits-all” solution.
such as the pill was previously in use,
Protection against unwanted
pregnancy is also present during the “ring-free” days.
the optimal time for inserting the ring
›
EFFECTS/USE: The vaginal ring has
should be determined together with a
The ring should always be inserted eve-
the same efficacy as the contraceptive
gynecologist, since there are different
ry month on the same day of the week
pill. The hormones emitted hinder ovu-
brands available. After inserting the
and at the same time. For example, if
lation as well as change the consistency
ring (while lying down or standing up),
the ring is inserted on a Sunday at 9
of the mucous at the cervix, thus pre-
one can leave the ring in place for the
p.m., then it should be removed exactly
venting sperm from entering. The hor-
coming three weeks, after which it must
three weeks later on a Sunday at 9 p.m.
mones are absorbed by the lining of the
be removed. After a further week’s time,
and after seven days’ time a new ring
vagina. The ring is inserted into the va-
during which the normal period occurs
inserted on Sunday at 9 p.m. Like a tampon, it is inserted into the vagina and
pushed up as far as it will go. It makes
no difference exactly where in the vagina the ring is placed: The contraceptive effect is the same everywhere. Of
course, it should not be a nuisance to
the woman and her partner. To remove
the ring, the woman puts her finger in
her vagina, catches the lower part of the
ring and pulls it out.
Should the ring slip out of the vagina
by accident during intercourse or when
removing a tampon, it can be reinserted
within the next three hours without any
negative effects. The vaginal ring can
34 |
be washed off with lukewarm water,
but should not come into contact with
soap or disinfectants of any kind. When
kept at room temperatures not exceeding 30 °C it has a shelf-life of about four
months after being bought in the pharmacy. Should yeast infections incur,
speak with your gynecologist about
what to do since some antifungal ingredients may counteract the contraceptive effects of the ring. In cases of severe
descensus of the vagina the ring is not
an appropriate method.
› SAFETY: Studies have demonstrated
ders such as bulimia or intestinal disor-
epileptic drugs and St. John’s wort may
a very high level of contraceptive safety,
ders where the absorption of hormones
lead to a reduced efficacy. In such cases
comparable to that of the contraceptive
in pill form is not guaranteed.
additional (mechanical) means of con-
pill.
traception such as a condom should be
- DISADVANTAGES: The most com-
employed during their intake and in the
+ BENEFITS: The vaginal ring is easy
mon side effects of the vaginal ring are
seven days following ingestion. Women
to use. Women can insert it and remove
headaches, vaginitis (inflammation of
who cannot take the pill for medical rea-
it themselves and thus need not consult
the vagina) and vaginal discharge.
sons (➔ p. 22) should also not use the
a gynecologist. Once is has been insert-
Mood swings, intestinal pain, nausea,
vaginal ring.
ed, contraception is no longer a worry –
tension or tenderness in the breasts,
something that is of great value espe-
painful menstrual periods and acne
cially for women who have trouble
have also been observed. Women who
sticking to an exact schedule. Also,
use the vaginal ring have a greater risk
stomach ailments of all kinds as well as
of developing thromboembolism than
vomiting and diarrhea do not affect the
women who use the contraceptive pill.
contraceptive efficacy of the vaginal
As with the pill, the simultaneous use
ring. Other medical reasons for using
of antibiotics (with the exception of
the vaginal ring include eating disor-
amoxicillin
and
doxycycline),
anti-
| 35
The various
arious contraceptive method
methods
The contraceptive patch can be applied to the skin of the upper arms,
the buttocks, the stomach or anywhere else on the body except the
breasts.
To ensure proper adhesion, do not use
creams, lotions, makeup or other cosmetics near the patch.
On the 22nd day of the menstrual cycle the patch is removed, triggering a
normal menstrual period. Then, after
another week’s time, a new patch is ap-
The contraceptive patch
plied (even if no bleeding has occurred
or even if menstrual bleeding is still in
This transdermal, skin-colored patch
monal method to another, one should
progress), and the process begins anew.
must be prescribed by a physician. It
talk to a gynecologist about selecting
If you forget to change the patch on
contains a combination of estrogen and
the optimal time for changing over. The
the designated “patch day,” this can be
gestagen and can be applied to the skin
patch is pressed firmly to the skin until
remedied within 48 hours. However, a
of the upper arms, buttocks, stomach or
the edges adhere well, where it remains
pause of more than seven days means
anywhere else on the body with the ex-
for the next week. To ensure that the
losing the contraceptive effect, and
ception of the breasts.
patch adheres to the skin, it should be
some other (nonhormonal!) means
checked every day. The patch is then re-
of contraception must be employed,
EFFECTS/USE: The principle behind
moved and replaced on every 8th and
such as a condom. Studies have shown
this means of contraception is similar to
15th day of the menstrual cycle. The time
that the patches remain intact and safe
that of other hormonal contraceptives
of day is not important, but one should
even when swimming, going to the
such as the pill. The patch is applied
take care that the patch is always placed
sauna, during sport activities or under
on the first day of the menstrual cycle
at a different spot every time. It can be
other circumstances. However, should
to a clean, dry and healthy spot of the
applied to skin of the upper arms, but-
the patch lose its adhesion or come off
body (i.e., not to reddened or damaged
tocks, stomach or anywhere else on the
completely, it should not be re-applied.
skin). When switching from one hor-
body with the exception of the breasts.
The contraceptive effect is still in force
›
36 |
for about 24 hours, in which time a new
- DISADVANTAGES:
patch can be applied. Only one patch
hormonal contraceptives that combine
should be applied at any given time.
different ingredients, irregular bleeding
As with other
can occur here too. The most common
› SAFETY: Studies have reported a very
side effects in clinical studies include
high contraceptive safety for the patch,
tension or tenderness in the breasts,
albeit only for women between the ages
headaches, local skin reactions to the
of 18 and 45. Efficacy is not guaranteed
patch and nausea. The patch should not
for women who weigh more than 90 kg.
be used with past or present venous or
As with the pill, the simultaneous use of antibiotics, antiepileptic drugs and St. John’s wort
may lead to reduced efficacy.
arterial thromboses, with abnormal
+ BENEFITS: The patch is easy to ap-
vaginal bleeding (e.g., spotting be-
ply and causes no discomfort. It is one
tween periods, very strong or very long
of the safest means of contraception
menstrual bleeding) that has not been
available. The hormones in the patch go
properly diagnosed by a gynecologist,
directly through the skin into the blood-
with existing or presumed breast can-
stream and thus pose less of a threat to
cer, with migraine headaches with focal
the liver than other hormonal methods.
aura, with liver diseases or with hyper-
Problems such as vomiting or diarrhea
sensitivity toward the ingredients in the
have no influence on its efficacy as con-
patch. Compared to contraceptive pills
traception. Simultaneous medical disor-
containing levonorgestrel, this method
ders such as eating disorders, particu-
carries with it a higher risk of thrombo-
larly bulimia and chronic intestinal
sis. Read the package insert carefully
disorders, where hormonal uptake is
before applying the patch.
not guaranteed, are of no consequence
here.
| 37
The diaphragm
Used properly the diaphragm is a very
› EFFECTS/USE: The diaphragm pre-
below). The proper position should be
vents the egg and sperm from coming
checked with the fingers every time it
together by blocking entry of the sperm
is inserted by ensuring that one can feel
to the uterus. Additional protection is
the cervix through the diaphragm.
afforded by use of a spermicidal jelly
A new product on the market is an oval
containing all-natural ingredients such
diaphragm better adapted to the form
as cellulose, lactic acid and citric acid,
of the vaginal vault which no longer
which is thick and lowers the pH value
needs to be fitted individually. A dim-
in the vagina and thus inhibits the mo-
ple on the diaphragm also makes its re-
tility of the sperm. About a teaspoon
moval from the vagina after intercourse
of jelly is applied to the side of the
much easier.
diaphragm that faces the cervix. Also
safe method of contraception. Its reli-
the inner rim of the diaphragm should
ability, however, depends considerably
be smeared with jelly. When exposed
on choosing the proper size, on correct
to body temperature and the natural
employment and on exact positioning.
fluids of the vagina, this jelly dissolves
The diaphragm consists of a round plastic spring, covered by silicone and molded into the rim. It resembles a small cap
and is available in many different sizes.
The diaphragm must be fitted by a
health-care professional in the doctor’s office, a family-planning center or
counseling services office. The perfectly
sized diaphragm is one that is large
enough to cover the entire cervix but
goes unnoticed and causes no discomfort. Choosing the proper size is important because a woman’s vagina dilates
somewhat during sexual arousal. It is
important that the diaphragm entirely
cover the cervix and be a tight fit (positioned between the rear vaginal vault
38 |
and the pubic bone, see the illustration
and thus eventually stops working.
› SAFETY: The safety of the diaphragm
+ BENEFITS: One only needs to use
For this reason the diaphragm should
depends greatly on its proper employ-
the diaphragm when actually having in-
be inserted no longer than two hours
ment. When unsure, practice inserting
tercourse. It contains no latex (allergic
before intercourse and should remain
the diaphragm at the doctor’s or coun-
reactions), does not influence the natu-
in place for at least eight hours follow-
seling office. Studies have shown that
ral hormonal situation in any way and is
ing intercourse, during which time the
the diaphragm is as safe a method of
a relatively inexpensive method of con-
sperm are still viable. Only then can it
contraception as the condom. Inser-
traception. Generally speaking it has no
safely be removed (at the latest after 24
tion is no more difficult than inserting
negative side effects or long-term ef-
hours). Should it come to intercourse
a tampon, and the level of security in-
fects of any kind. Indeed, some women
once again, the jelly must be reapplied
creases with the length of use. It may
feel using the diaphragm is a boon to
with an applicator or with the fingers.
be advantageous to practice inserting
self-awareness by their better getting to
To keep the diaphragm clean, wash it
the diaphragm at the doctor’s or coun-
know their own bodies.
with warm water after use and dry com-
seling office after the initial fitting. It is
pletely. Then apply some corn starch or
recommended that additional means of
- DISADVANTAGES:
potato starch to keep it dry.
contraception such as a condom be em-
the diaphragm must be practiced. Only
ployed until use of the diaphragm has
once its use has been mastered does it
been mastered.
offer a sufficient level of contraceptive
Proper use of
safety. If the uterus has extremely deShould the material of the diaphragm
scended or if there are increased urinary
become brittle or show cracks of any
tract infections, then the diaphragm
kind, have it replaced. A well-kept dia-
may not be the best choice of contra-
phragm has a life expectancy of up to
ception. Also, some women have very
two years. After experiencing a weight
little space beneath their pubic bone so
change of more than 5 kg or after giv-
that the diaphragm cannot get a suffi-
ing birth one should have the size of the
cient foothold. Here, the FemCap™ may
diaphragm checked and if necessary
be a good alternative.
adapted to the new conditions.
Insertion of the diaphragm
| 39
The cervical cap (aka Lea’s Shield®)
though to date no scientific data are
available to support this claim. It is recommended that the proper position of
the cervical cap initially be checked by
a practiced professional to ensure that
it doesn’t slip out of place during intercourse.
+ BENEFITS: The cervical cap need
not be individually fitted, but rather is
available in a universal size that covers
the cervix of any woman due to its overInsertion of the cervical cap
all size and form. The control loop makes
it easy to remove from the vagina, and
the built-in valve means it can remain in
cer.
After intercourse it should remain in the vagina for at least
eight hours.
›
EFFECTS/USE: Like the diaphragm
The vaginal cap is available as one-size-
the cervical cap is inserted through the
fits-all since it “automatically” adapts to
- DISADVANTAGES: The vaginal cap
vagina and placed in front of the cervix.
the cervix. The proper position should
must be replaced after no more than 12
Its level of safety can be increased by
be checked both before and after inter-
months since it often becomes discolored
use of a spermicidal jelly. An additional
course. It can be purchased in a phar-
and takes on an unpleasant scent. This of
valve on the side allows cervical mu-
macy without a prescription.
course makes it overall more expensive to
The cervical cap is a contraceptive barrier device about the size of a small sau-
the vagina for up to 48 hours after intercourse. This provides couples with
somewhat greater spontaneity than the
diaphragm.
use than the diaphragm.
cous and menstrual blood to flow off,
protecting the natural vaginal flora. The
›
integrated control loop also allows it to
device is not very widespread, although
be easily removed.
users report high acceptance. The level
SAFETY: This type of contraceptive
of safety is considered comparable to
that of the condom and the diaphragm,
40 |
The FemCap™
The FemCap™ is a further development
› SAFETY: The FemCap™ should be fit-
- DISADVANTAGES: Some women’s
of the classical cervical barriers that are
ted by a competent healthcare profes-
vaginal mucous membranes may be ir-
no longer available. This sort of cap con-
sional. Like all other barrier methods,
ritated by the jelly used. In this case, try
sists of a brim, a cap made of silicone
it too can slip off position during inter-
switching to another brand. Proper use
and a circular recess in between. This
course, so that a definitive safety prog-
of the FemCap™ demands sufficient
cap, which is available in three different
nosis cannot be made: Its safety de-
practice.
sizes, has a loop attached for quickly re-
pends greatly on the reliability of its use.
moving it from the vagina.
+ BENEFITS: One only needs to use
› EFFECTS/USE: Like the diaphragm,
the FemCap™ when actually having in-
the FemCap™ is inserted into the va-
tercourse, leaving the woman’s hormo-
gina and put directly over the cervix. It
nal situation untouched. Because it is
comes to lie against the vaginal wall.
made of silicone, it is also safe for wom-
The FemCap™ is always used in conjunc-
en with a known allergic reaction to la-
tion with spermicidal jelly. About a half
tex.
teaspoon of jelly is put into the inner cap
and a half teaspoon in the recess facing
the cervix. The FemCap™ should remain
in the vagina for at least six hours after
intercourse. The proper position should
be checked with the fingers both before
and after intercourse. It should then be
removed no later than 48 hours after
being inserted. The level of contraceptive safety may be increased if the cap is
inserted only shortly before intercourse
commences.
Insertion of the FemCap™
| 41
Natural family planning (NFP)
SYMPTOTHERMAL METHOD
though a woman is normally fertile on
the basal temperature curve to indicate
only about 6–7 days of her cycle, there
when ovulation has been completed.
The symptothermal method has two
is no exact scientific method available
Observing other physical signs, such as
duties to fulfill: It reveals the days of the
to determine that period with absolute
the state of the cervix or the cervical os,
menstrual cycle on which the woman
sureness. The symptothermal methods
can increase the reliability of one’s con-
is fertile in order to (1) help the couple
described here can at least reduce that
clusions. The symptothermal method,
to achieve fertilization and have a child
window to 12–14 days of the cycle – as-
however, must be trained: The learning
or to (2) prevent fertilization by show-
suming the woman’s cycle is regular.
phase lasts up to three menstrual cycles
ing when they must use some form of
contraception. This method puts great
The symptothermal method depends
vation on the part of the couple. The de-
demands on both the man and the
on determining two or more differ-
scriptions given of this method can pro-
woman.
ent physical characteristics: basal body
vide only a rough sketch of how it works
temperature in the morning as well as
and do not suffice to carry through with
More than with any other method of
the state of the vaginal mucous and
it. Much additional informational mate-
contraception, with NFP the woman
the cervix. Observation of the mucous
rial or direct counseling is necessary to
is dependent on her partner showing
membranes serves to indicate when
this end.
involvement and responsibility: Both
ovulation is taking place, and recording
persons must exhibit high constraint
on the fertile days and resort to sexual
practices that exclude conception, such
as petting or masturbation, or employing other methods of contraception,
such as condoms. The idea behind this
form of contraception is to observe various physical characteristics (temperature, mucous, state of cervix) in order
to determine the woman’s fertile days
during a menstrual cycle and to avoid
allowing sperm to enter the vagina on
these days by using other methods
of contraception (e.g., a condom). Al-
42 |
and thus demands considerable moti-
BASAL TEMPERATURE METHOD
Such information can be obtained in the
Taking morning temperature
is usually more accurate than a digital
respective counseling centers. Providers
The basal temperature upon awakening
thermometer, though the latter has the
of such services often offer courses to
in the morning is somewhat lower dur-
advantage of being quicker.
learn the method (see p. 91). In addition,
ing the first half of the menstrual cycle
the Swiss SymptoTherm Foundation
– from the beginning of the woman’s
A number of factors can lead to measur-
and the Maltese Work Group NFP (Kalk-
period up to probable ovulation – than
ing too high temperatures: measuring
er Hauptstraße 22–24, D-51103 Cologne,
in the second half of the cycle. Follow-
too late, previous alcohol intake, a late
www.natuerliche-familienplanung.de)
ing ovulation it then rises by about 2/10
meal the previous evening, illnesses,
offer introductory courses and further
of a degree centigrade and remains so
stress, jetlag, climate change, using a
brochures on this theme.
until the menstrual cycle ends with the
different thermometer, drugs and medi-
first sign of bleeding. The temperature is
cines. Which of these actually influence
Note: Examples of how to fill out tem-
taken directly after awakening – before
the temperature must be determined
perature and mucous state curves are
getting up. The woman should have
during the practice phase and should
given on p. 47. An empty curve to fill out
slept at least one hour before check-
be denoted carefully on an observation
yourself is available on the internet at
ing her temperature. Temperature can
sheet. Other possible disturbing factors
www.familienplanung.de/tabellen. Ta-
be taken in the mouth, in the vagina
should also be written down so that
bles in various languages may be found
or anus; the important thing is that it
they can be considered when looking at
under the address www.nfp-online.de.
always be taken at the same place. A
the curve.
simple glass thermometer suffices and
| 43
Cervical mucous
Determining the fertile and infertile
days
If a calendar of the last 12 cycles is avail-
Here one observes the state of the cervical mucous that forms around the
The records made of the fertile and in-
shortest cycle in order to calculate the
cervix and at the cervical os. This mu-
fertile days according to the tempera-
number of infertile days at the begin-
cous changes its form in the course of
ture and the mucous methods should
ning of the menstrual cycle (from the
the menstrual cycle. At the beginning
first be viewed independent of each
first day of the woman’s period on).
of the cycle it is usually rather dry and
other before being compared.
can neither be felt nor seen. A few days
Conservative use of this method means that intercourse can
take place only on the “safe
days” following ovulation and
leading up to the next period.
before ovulation the vaginal orifice feels
The end of the fertile period is easier to
moist – only then can one even see the
determine than its beginning using the
mucous (e.g., on toilet paper) and feel it
symptothermal method. The fertile pe-
with the finger. It also changes its color,
riod begins on the evening of the third
from initially milky white to a clear fluid.
day of increased temperature or on the
The viscosity also changes, from sticky
evening of the third day of greatest
If temperature curves of the previous 12
and viscous to fluid and stringy (like
mucous change (most fluid, clear and
cycles are available, eight days are sub-
egg-white). Once the cervical mucous
stringy), depending on which of the two
tracted instead from the earliest day of
has turned into a stringy fluid, the vagi-
signs is seen first. The criteria for judg-
temperature rise, and the fertile period
nal orifice feels slippery; during ovula-
ing raised temperature following ovula-
begins at the first signs of moist mucous
tion the mucous changes its consist-
tion are as follows: The temperature on
in the vagina.
ency once again and becomes sticky
three consecutive days must be higher
and murky.
than that of the previous six days, and
› SAFETY:
the value on the last of those three days
takes place exclusively on the abso-
Recording the state of the cervical mu-
must be at least 2/10 of a degree centi-
lutely infertile days, this method is very
cous can be disturbed by any sort of
grade higher than the highest value of
reliable. Its safety, however, depends
vaginal infection. Also, sexual arousal or
the previous six low-temperature days.
on avoiding errors of all kinds and on
male ejaculate as well as various chemi-
The criteria for judging changes in the
the diligence with which it is practiced.
cal forms of contraception (spermicidal
mucous consistency are as follows: The
Particularly the beginning of the fertile
creams) can change the nature of the
beginning of the fertile period is de-
period is often determined too late, and
mucous. Taking mucolytics to treat a
termined based on observations of the
the fact that sperm can survive in the
cold also causes the cervical mucous to
mucous consistency from the previous
uterus for up to six days is not properly
become more fluid.
12 menstrual cycles; the fertile period
observed.
begins when the first feeling of moistness presents itself in the vaginal orifice.
44 |
able, 20 days are subtracted from the
Inasmuch as intercourse
Many women like this method because
it provides them with a natural and
relaxed relationship to their own bodies. Living according to a natural and
biological rhythm strengthens one’s
self-confidence
and
self-awareness.
Unlike the hormonal methods of contraception, the natural methods of
family planning include no invasive
procedures and require no doctor visits (though they should not tempt one
to neglect regular preventive checkups
at the gynecologist’s office). Especially
women who have a positive relationship to their own bodies and know their
own anatomy will feel comfortable with
For this reason, this method is appropri-
vent pregnancy, but rather to realize
ate only for couples who have taken the
their desire for children: The calculated
time to learn it and who are capable of
fertile days are pointedly chosen for in-
Some women report experiencing a
adhering to it even in very arousing mo-
tercourse to increase the chances of
more regular menstrual cycle upon re-
ments.
getting pregnant.
cording their curves. Counseling servic-
this method.
es have additional informational mate-
+ BENEFITS:
symptothermal
Patience is an important factor here,
rial about this method as well as tables
method of birth control is not a true
The
since it can take many cycles to achieve
one can fill out with data on tempera-
means of contraception in the classical
actual fertilization. The major advan-
ture and mucous consistency (➔ p. 47).
sense of the word, but rather a way of
tage is that the approaching ovulation
designing one’s partnership. It is one
can be adjudged based on changes in
- DISADVANTAGES:
way to become and remain aware of
the mucous consistency and the state
demands that the woman observe her
one’s fertility and to address it directly.
of the cervix, and with the temperature
body and its signs of fertility – and it
Especially feelings of belongingness
method one can determine when the
means that her partner must be very co-
and communication within the pair re-
fertile period has passed – or whether
operative. The learning phase of some
lationship are strengthened. Many cou-
ovulation has occurred at all.
three months is time-consuming, but as a
ples in fact use this method not to pre-
This method
rule can be integrated into a daily routine.
| 45
Women with irregular ovulation will
vagina. During the fertile period, on the
not be able to determine their fertile
other hand, it becomes softer (like one’s
and infertile days. Women with very
upper lip), is slightly open and shifts to-
long or irregular menstrual cycles may
ward the upper part of the vagina. A dai-
experience very long periods of time
ly examination with the finger can reveal
These two tables show examples of
in which fertility suddenly is indicated.
these changes and mark the beginning
curves of body temperature and
Such phases may occur while nursing,
of the fertile period. The infertile period
mucous structure recorded during a
during puberty and menopause, or due
begins three days later with a once again
menstrual cycle.
to stress and illness.
firm and closed cervix. This can addition-
This method – more so than any other
TEMPERATURE AND
MUCOUS CURVES
ally be controlled by the temperature
An empty table to fill out yourself
method.
may be downloaded from the following address:
method of contraception – requires
close cooperation and great responsi-
A final important note:
bility on the part of the woman’s part-
This method is not recommended as
ner. Sexuality must comply with the cal-
sole method of determining fertility as
culated fertile and infertile periods, that
it is too uncertain.
www.familienplanung.de/tabellen
is, barrier methods such as a condom
must be employed on the fertile days
or one must revert to sexual practices
that bear no risk of pregnancy. Some
Abbreviations:
couples using this method suffer from a
* Mucous structure
lack of spontaneity.
F = fluid, transparent, stringy
S = sticky, viscous, little mucous
An additional tool for NFP: Close obser-
O = without mucous
vance of the state of the cervix or the
cervical os. Self-observing these two
** Position of cervix
areas can expand the symptothermal
h = high
method and increase its level of safety.
l = low
The cervix and the cervical os change
Consistency:
their consistency over the menstrual cy-
f = firm
cle: Immediately after menstrual bleed-
s = soft
ing the cervix feels hard (like the tip of
one’s nose), is closed and lies deep in the
46 |
month
January
Period
Time of measurement
Midpoint cramps (M)
Spotting (S)
38.0
37.9
37.8
37.7
37.6
37.5
37.4
37.3
37.2
37.1
37.0
36.9
36.8
36.7
36.6
36.5
36.4
36.3
36.2
36.1
36.0
Day of cycle 1
7 6.456.45 7 7.15 7.30 8 7 7 7.15 7.15 7.30 7 7 6.45 7 7 7.15 7.15 7.306.45 7.15 7.307.307.30 7 6.456.45 7 8
M
month
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40
Seasonal cold
Seasonal cold
Specifics
*Mucous structure
Sexual activity
**Position of cervix
-Consistency
2
O O O O O O O O OO O O O O F F S S S S F F OO O O O O O O
X
X
X X
l l l l l l l l l l h h h h h h l l l l l l l l l
f f f f f f f f f f s s s s s s f f f f f f f f f
August
Period
Time of measurement
Midpoint cramps (M)
Spotting (S)
38.0
37.9
37.8
37.7
37.6
37.5
37.4
37.3
37.2
37.1
37.0
36.9
36.8
36.7
36.6
36.5
36.4
36.3
36.2
36.1
36.0
Day of cycle 1
7 6.45 7 7 6.50 8 8 7 6.50 7 7 7.30 8 8 7 6.50 6.45 7 7 7.30 8 8 7 7.307.45 7
M
3
4
5
little sleep
Specifics
*Mucous structure
Sexual activity
**Position of cervix
-Consistency
2
X
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40
O O O O O F F F S S S S F FO O O OO O O
X
X
X
t t t t t t t t h h h h h h t t t t t t t
f f f f f f f f w w w w w w f f f f f f f
| 47
Technical tools for calculating ovulation
The tools introduced below should not
be seen as true methods of contraception. They do nothing to change the
basic advantages and disadvantages
of the symptothermal method. Indeed,
they were originally developed to help
women who wanted to use natural
birth control methods without the effort involved in learning the complicated procedures otherwise necessary.
Without prior knowledge of the underlying method, however, many user
THE TEMPERATURE COMPUTER
errors may occur. And women who are
well acquainted with the symptother-
›EFFECTS/USE: A number of small ap-
+ BENEFITS: These devices can be of
mal method generally do not need the
paratus are available that record and
great help to some women who use the
computer-assisted tools.
evaluate basal temperature. These bat-
NFP method.
tery-operated minicomputers measure
They can, however, be very
useful when one is trying to
get pregnant.
the temperature, evaluate the data and
- DISADVANTAGES:
calculate the fertile and infertile periods
the symptothermal method the devices
of a woman’s cycle, providing the results
tend to calculate longer periods of fer-
with a series of LEDs. They may be pur-
tility, which impedes sexual activity
chased on the internet or in pharmacies.
even further. User errors are common if
Compared to
sufficient knowledge of the sympto-
›
SAFETY: Insufficient data exist to
judge the exact safety of these devices.
They tend to determine longer fertile
periods than the manual symptothermal methods do.
48 |
thermal method is missing.
THE HORMONE COMPUTER
› EFFECTS/USE: Hormone computers
determine the fertile days of the cycle
by analyzing the hormones present in
a woman’s urine. They request data input on certain days from hormone test
strips dipped in the woman’s morning
urine. These are then analyzed and the
infertile days determined and marked
with LEDs.
› SAFETY: Hormone computers tend
- DISADVANTAGES:
The need for
days of the cycle as well as comparisons
to designate shorter fertile periods than
new test strips every month make this
with previous cycles. A timer can also be
the temperature computers, which low-
method a relatively expensive contra-
set to alert the user to enter the data dai-
ers the overall safety. For this reason
ceptive method with a relatively low
ly. These mobile programs are good re-
they are not considered safe.
level of safety.
placements for paper-and-pencil sheets.
+ BENEFITS: Unlike with the sympto-
NFP CELL-PHONE APPS
The hormone computers are
generally appropriate only for
women with cycles of between
23 and 35 days.
thermal method or a temperature computer, the woman does not need to
Cell-phone apps supporting the symp-
make daily measurements, but rather
tothermal method or natural family
prepares urine test strips only on certain
planning (NFP) take over the work of re-
days of the menstrual cycle. The hor-
cording and organizing the data on
mone computer best suits couples who
length of cycle, basal temperature and
are trying to get pregnant and want to
consistency of cervical mucous. The data
have intercourse on the fertile days with
entered into the cell-phone app result in
the help of a urine test.
a curve showing the fertile and infertile
| 49
Chemical methods
50 |
› EFFECTS/USE: Generally speaking,
citric or lactic acid, which however only
effect since the foam better distributes
all chemical methods function simi-
reduce the motility of the sperm. There
the active ingredient throughout the
larly, examples being spermicidal sup-
is presently no scientific evidence on
vaginal area.
positories and jellies: They consist of a
whether the natural formulations are
wax-like or jelly-like substance that dis-
better than the chemical ones, but they
solves in the vagina through body heat
are certainly less hazardous to one’s
and spreads as a viscous slime to cover
health. In order that these agents dis-
the cervix. The ingredients used nearly
solve and spread sufficiently to protect
always include as active substance non-
against getting pregnant, they must
oxynol-9, which kills sperm cells. There
be inserted into the vagina at least ten
It is very important to carefully read and
are also substances available without
minutes before intercourse. Supposito-
follow the instructions on the package!
this ingredient based on acids such as
ries that create a foam offer the greatest
Only after dissolving completely and spreading widely do
these means of contraception
reach complete effectiveness.
› SAFETY: How reliable these chemical
+ BENEFITS: These substances are
substances really are depends on the
available over the counter in pharma-
respective product and how it is used.
cies and drug stores. They have no ef-
For example, the leadtime printed on
fect on the hormonal system, and they
the packaging must be adhered to very
need only be used when intercourse
exactly. A better solution is to use these
actually takes place.
Chemical means are not appropriate as sole agents of contraception.
products together with a diaphragm
(with a spermicidal jelly) or a condom
- DISADVANTAGES:
(inasmuch as possible, check the in-
stances should not be used as exclusive
structions on the package). Supposi-
means of contraception since they are
tories that are not water-based cannot
not completely reliable and safe. The
be used together with condoms as they
chemicals included can cause a feeling
may damage them.
of warmth in the vagina, and some peo-
These
sub-
ple complain of a burning sensation in
the vagina or on the tip of the penis. If
this happens, try another brand. The
smell and taste also take some getting
used to.
| 51
Sterilization
Sterilization, i.e., the clamping off or sev-
dren emerges. Recent advances in mi-
ering of the woman’s tubes or the male
crosurgery allow some sterilizations, at
seminal ducts (vasectomy), is the safest
least in principle, to be reversed (refer-
of all possible contraceptive methods.
tilization): In both men and women the
Such an operation leads to long-term
severed tubes/ducts can be operatively
infertility in both sexes.
reconnected – but there is no guarantee that fertility will return. The opera-
But this step should be carefully consid-
tion is also complex and expensive: in
ered beforehand and above all should
Germany between EUR 3000–4000 in
be considered only when all family plan-
woman and somewhat less in men. For
ning has been completed. Plans can
this reason, the pros and cons should
Following ovulation the egg travels
change, and the once certain belief that
be carefully weighed before having the
from the ovaries through the Fallopian
sterilization is the right way to go can
operation carried out. Counseling cent-
tubes to the uterus. Sterilization inter-
change, too. Statistics show that some
ers have further information available
rupts this path in the tubes, so that the
5–10% of all sterilized women later re-
(➔ p. 91). Both partners should be com-
egg and sperms cannot come together,
gret their decision, and in men the rate
pletely agreed to taking such a step as
thus preventing fertilization. The most
is similar. Often the reason lies in a new
their means of contraception and be
common method is carried out laparo-
relationship in which the desire for chil-
aware of what it means for their rela-
scopically, whereby the surgeon makes
tionship – including their sexual rela-
small incisions in the intestinal area
tionship. This is true as well for men and
and inserts instruments and a camera
women who are not in a stable relation-
to carry out the procedure. A 1-cm sec-
ship.
tion of tubes is then either melded with
STERILIZATION IN WOMEN
heat (cauterized) or clamped off with
No one should be pressured
into a sterilization, and no one
should be sterilized to please
one’s partner or spouse. In the
end, every individual has to decide for themselves whether
this is the proper step to take.
a clamp made of plastic and titanium.
Sterilization is normally carried out during the first half of the menstrual cycle
(i.e., before ovulation) to exclude the
woman being pregnant at the time of
the operation. This method of sterilization can be carried out on an inpatient
or outpatient basis; in either case a
52 |
(short) general anesthesia is required.
Following the operation, the woman
should rest for a while, but can commence having intercourse whenever
she feels comfortable with it.
Another, relatively new method for
which little empirical data exist is the
so-called Essure® technique. Here, a
flexible device made of metal and plastic fibers is inserted with a catheter
through the vagina and uterus directly
into the Fallopian tubes. The fibers trigger the growth of surrounding tissue,
+ BENEFITS: Sterilization reliably pre-
It is not a seldom occurrence that wom-
which then block off the tubes within
vents conception over a long period of
en later regret the decision to undergo
about three months.
time and is also considered to carry a
a sterilization. The reason most often
low risk. Sterilization does not affect the
given is a change in one’s personal life
SAFETY: Sterilization is a very safe
women’s menstrual cycle, her hormone
situation, for example, when the wom-
method of preventing pregnancy. Only
production or her libido, nor does it in-
an has a new partner, wants to have a
some 1–2 of 1000 sterilized women
fluence the beginning of menopause in
child or loses a previous child. Women
eventually become pregnant. The risk
any way.
sometimes also regret having the op-
›
of failure of the procedure is slightly
eration because of the subsequent side
higher among younger women, though
- DISADVANTAGES:
As with all in-
effects or complications. Some women
this depends on the method chosen
testinal operations, complications such
who have completed their family plan-
and the operative skills of the physician
as bleeding, damage to the inner or-
ning and request a sterilization directly
carrying out the sterilization. In very
gans or infections can occur, but they
following the birth of a child, a Caesar-
rare cases can the tubes and the uterus
are rare. The risk of experiencing a tubal
ian section or an abortion later regret
become rejoined, especially after proce-
or abdominal pregnancy is, however,
it, more so than women who choose
dures employing clips. Still, even after
higher following sterilization. In rare
sterilization without time pressure and
considering the possible failures, the
cases the hormone production is dis-
some triggering event.
safety of this method of contraception
turbed in the Fallopian tubes, leading to
is comparable to that of the contracep-
mood swings, sexual apathy, hot flashes
tive pill and other hormonal methods.
and sleep disorders.
| 53
STERILIZATION IN MEN
REVERSAL
Sterilization in men (vasectomy) is car-
20 ejaculations). It is wise that a urolo-
ried out by cutting and then clamping
gist be consulted several times after the
off the loose ends of the seminal ducts
operation to take a sperm count. Only
(vas deferens) so that sperm cells can no
after this test has turned up completely
longer be mixed with the semen. The
negative can one forego all means of
procedure is usually done on an outpa-
contraception.
tient basis.
› SAFETY: Properly carried out a vasecModern
microsurgical
techniques
First, local anesthesia is applied, then
tomy is a very safe method of contra-
theoretically allow fertility to be re-
the surgeon makes a small cut on the
ception. In very rare cases the seminal
established at a later point in time by
left and right side of the scrotum. The
ducts can spontaneously reattach, ren-
having the severed ends of the tubes
ducts are pulled out and severed, the
dering the man fertile once again.
reattached. About 1–2% of all sterilized
loose ends tied off, fused together with
women undergo such an operation to
heat (coagulation) or closed with titani-
+ BENEFITS: The vasectomy is a rela-
reverse the sterilization.
um clips. Finally, the two ends of the re-
tively simple surgical procedure that
spective ducts are positioned in differ-
only rarely results in complications.
Refertilization is a relatively compli-
ent tissue levels of the scrotum so that
cated procedure and carries with it the
they cannot spontaneously become re-
usual risks of any operation. Whether
joined. As a rule only the two small cuts
the operation succeeds cannot be guar-
mentioned are necessary, which are
anteed, and the changes of success fall
then closed with Band-Aids. The opera-
with increasing age of the woman in
tion takes about 20–25 minutes. Follow-
question. Further, whether a refertilized
ing the operation the man should rest a
woman can in fact become pregnant
while. In principle he could have unpro-
also depends greatly on the fertility of
tected sex only a few days after the pro-
the woman’s partner. Most sterilizations
cedure, but it is recommended that oth-
in fact cannot be reversed and result
er contraceptive means be used in the
in long-term infertility (➔ http://www.
interim since remaining sperm cells can
familienplanung.de/kinderwunsch/
survive in the ducts for many weeks. The
behandlung/refertilisierung-der-frau/).
more one ejaculates, the quicker these
“reserves” are used up (after some 15 to
54 |
consists of only about 5% sperm cells.
Sperm cells continue to be produced
by the testicles, but only as many as the
body can safely absorb. Many men worry that sterilization will impair their sex
life, but this fear is unfounded. A man’s
sexual desire and his ability to reach
orgasm remain unchanged as does the
production of the sex hormones in the
testicles. Nevertheless, some men, now
stripped of their fertility, do tend to
doubt their virility. For this reason, this
operation should not be undertaken
lightly and only after careful consideraSterilization in the woman, on the other
feelings of pressure in the testicles or
hand, involves an intestinal operation to
infections of the epididymis (a part of
sever the Fallopian tubes and is consid-
the testicle). However, when promptly
erably more difficult and carries higher
treated these discomforts usually disap-
overall risks.
pear quickly. In addition to unexpected
Modern microsurgical techniques theo-
mental anguish at dealing with one’s
retically allow the severed ends of the
- DISADVANTAGES:
tion.
REVERSAL
Though com-
own infertility there may be other, more
ducts to be reattached at a later point
plications are rare, they can occur in in-
long-term side effects of a vasectomy,
in time. However, this does not auto-
dividual cases and be severe. This de-
such as chronic pain in the testicles,
matically ensure that the man again
pends greatly on the operative skills of
which in some increases during inter-
becomes fertile. The physical situation
the physician. For this reason, it is rec-
course and can negatively influence life
inside the body may have changed in
ommended that such procedures be
quality considerably. Between 2.2% and
the meantime; sperm production may
carried out only in clinics or private
5% of all sterilized men end up needing
be impaired or have deteriorated over
practices that do at least 50 such proce-
subsequent medical attention (➔ www.
time. Refertilization is a relatively com-
dures yearly.
familienplanung.de/sterilisation-mann).
plicated procedure lasting between
The amount of semen produced re-
two and four hours under general an-
In the days immediately following this
mains virtually unchanged following
esthesia (➔ www.familienplanung.de/
operation, up to 6% of men complain
sterilization, since this occurs in the
refertilisierung-mann).
about wound bleeding or infection,
prostate gland and other glands and
| 55
Birth control following birth
Birth control
following birth
The thought that a woman could become pregnant shortly after giving birth to
a child serves to inhibit many couples’ sex life. Thus, many seek a safe method
of contraception for the time immediately after pregnancy – during which of
course contraception was not an issue. It is particularly difficult to find a reliable method of birth control when the mother is still nursing: It should be safe
but not affect the quality or amount of milk produced – and of course it should
have no negative effects on the baby!
56 |
| 57
Birth control following birth
NURSING
THE MINIPILL
When women completely nurse their
The minipill is a different matter. Since
babies, i.e., at least six times within 24
it contains only gestagen – and that at
hours for a total of no less than 80 min-
a lower dosage than in the combination
utes, do not supplement their breast
pills – it has no negative effects on the
milk by other means and do not have
milk ingested by the baby. It must, how-
a monthly period (afterbirth discharge
ever, be taken at exactly the same time
can be disregarded here), then they
every day. Use of the minipill should not
enjoy a high level of protection against
commence less than six weeks after giv-
becoming pregnant: At every act of
ing birth.
nursing the body emits the hormone
prolactin, which retards activity in the
ovaries. If the mother, however, takes
es means that an old diaphragm gener-
longer pauses from nursing or reduces
ally no longer fits. There is also an initial
her nursing by feeding the child other
waiting time of about three months fol-
foods, then this effect may disappear.
lowing birth since the uterus first has to
Combined with nursing, this
estrogen-free pill has a high
level of contraceptive safety.
IUD
reach its normal size and state.
Thus, an additional form of
contraception should be con- Generally speaking, of course,
sidered during nursing.
barrier methods are only as
safe as the caution and consequence their users apply.
BARRIER METHODS
Barrier methods such as condom or dia-
THE CONTRACEPTIVE PILL
phragm are well suited for women who
58 |
are nursing since they have no negative
There are a number of restrictions to us-
effects on milk production or the new-
ing the contraceptive pill while nursing.
born baby. The diaphragm, however,
The combination pill is not appropriate
should be (re)fitted by a healthcare pro-
while nursing since it contains estro-
fessional following a birth, even if one
gens that would decrease milk produc-
was being used before the pregnancy.
tion and supply the nursed baby with
The physical changes a pregnancy caus-
too many hormones in the breast milk.
IUDs can be used by nursing women
since they have no influence either on
milk production or on hormones that
reach the baby. However, they should
be inserted (by a healthcare profession-
CONTRACEPTIVE PATCH
al) only after the uterus has returned
recommended. Small amounts of the
completely to its normal size. The hor-
ingredients from a hormone implant
mone IUD can also be used while nurs-
do pass to the breast milk, but this does
The homones present in the patch can
ing since it too contains only gestagen
not negatively influence the quality or
change the amount and makeup of the
(➔ “The Minipill,“ p. 23). Remember that
the quantity of breast milk the mother
breast milk. Thus, this method is not rec-
choosing the IUD as a means of contra-
produces. If the mother is not nursing
ommended during nursing.
ception is generally a long-term com-
her child, the implant can be inserted
mitment.
between the 21st and the 28th day af-
THE “MORNING-AFTER PILL”
ter the birth of the child. Under these
NATURAL METHODS
circumstances, no additional means of
The hormone levonorgestrel is passed
contraception is necessary. However, if
on to the breast milk. For this reason, it
Natural family planning methods such as
the implant is inserted at a later point in
is suggested that the mother nurse the
recording the woman’s basal temperature
time, then additional methods such as a
baby directly before taking the two tab-
or cervical mucous are normally not ap-
barrier method should be employed for
lets and then wait for six hours before
propriate for nursing women who have
the first seven days.
starting to nurse again.
THREE-MONTH DEPOT
With the newer “morning-after pill,”
not gathered much previous experience
with this method: Following a birth and
the hormonal changes it can cause there
which contains the ingredient ulipristal
is no way to know when the woman’s
The ingredients in this injection do pass
acetate, nursing should be interrupted
menstrual cycle, and thus her fertile and
to the breast milk, but to date no nega-
for at least 36 hours.
infertile times, will once again become
tive effects for the child have been reg-
regular. Women who have considerable
istered.
experience with these methods and feel
is best used while nursing, one should
THE HORMONE IMPLANT
This method should not be
used in the first six weeks after childbirth as it may lead to
heavy bleeding.
The hormone implant should not be im-
VAGINAL RING
safe in using them may have less of a
problem preventing a new pregnancy.
When deciding which contraceptive
always consult with one’s gynecologist
and discuss the benefits and disadvantages at length. This can also form the
basis for a new decision about what
forms of birth control are best em-
plemented in the first four weeks follow-
ployed in the future and thus how to
enjoy sexual activity without fear of get-
ing a birth. During the first week of use
Like the contraceptive pills that contain
additional contraceptive means such
estrogen, the vaginal ring should not be
as a barrier methods (e.g., condom) is
used while nursing.
ting pregnant again.
| 59
Contraception in the middle years
60 |
Contraception
in the middle years
From the age of 40 years onward a woman’s fertility slowly declines. Changes to the monthly cycle are usually the first signs that menopause is approaching. These changes give
reason to ponder how long contraception will still be necessary, and what other changes
menopause will precipitate. During this stage some women deliberate intensely whether
or not to have a (or another) child. For some, their family planning has long been finished,
so the question of contraception changes with increasing age. Whereas young women in
particular tend to use contraceptive pills of some sort, older women are more inclined to
use an IUD or to be sterilized.
| 61
Changes in the
menstrual cycle
At about age 45 the menstrual cycle
of many women begins to change. In
some, it becomes shorter; in others,
there are phases with irregular bleeding or complete cycles without ovulation. In most women, however, the
menstrual cycle becomes completely
irregular only during the final years of
menopause. Sometimes months can
pass without a period; or they occur in
very short timespans; or long-lasting
periods of bleeding crop up. Whether
a woman experiences the typical side
effects of menopause, e.g., hot flashes,
sleeping disturbances and vaginal dryness, varies greatly from one individual
to another. In some women they occur only after all menstrual activity has
How long
contraception?
long ceased, whereas in other women
they may accompany relatively normal
An important question in this period is
been absent for many months, it may
cycles. And not every woman feels the
how long one has to practice birth con-
suddenly return and be accompanied
negative effects of the hot flashes.
trol. The chance of a woman 45 years
by ovulation. For this reason, hormonal
and old of getting pregnant is very
blood tests are of little value and reflect
small, but individual fertility can vary
only the situation at the moment of the
widely, making it nearly impossible to
examination.
adequately judge the risk of an unwant-
62 |
ed pregnancy in any particular woman.
When a woman fails to have a normal
Activity in the ovaries can also vary over
menstrual cycle, either because she is
time. Even though one’s period has
taking a hormonal contraceptive or be-
cause of the effect of menopause, there
is no way to know whether contraception is still necessary. Generally speaking, a woman should use contraception
up to at least the age of 51. Only a hormonal blood test after having stopped
all hormonal means of contraception
can determine the true risk of pregnancy.
Whether hormonal contraceptives are appropriate during
menopause should be discussed in detail with one’s gynecologist.
Which contraceptives are recommended during menopause?
The risk of cardiovascular diseases must
contraception are feasible, one can con- and are the contraceptive of choice in
always be factored into the decision to
tinue to use low-dose, combination pills such cases. They do, however, cause ir-
use hormonal contraceptives. This risk
through menopause, assuming other regular periods.
generally increases with age and is ex-
cardiovascular risks have been eliminat-
acerbated by hormonal contraceptives.
ed. Nevertheless, it is recommended that Many women in this age range switch
If a woman at this age does not smoke,
the woman’s blood pressure, blood fats from the pill to an IUD. Particularly
have high blood pressure, increased
and other cardiovascular risk factors be women who have already given birth
blood fats or other risk factors, all of
checked regularly.
which can raise the risk of having a heart
will experience fewer problems with an
IUD. If heavy bleeding does make use of
attack or stroke, then taking a pill with
The minipill (➔ p. 23, must be taken on the copper-coil IUD impossible (➔ pp.
a combination of estrogen and gesta-
a rigid schedule) and the gestagen im- 29f.), or if the IUD has proved to increase
gen (➔ p. 20ff.) should pose no further
plant (➔ p. 32), both of which contain bleeding, then the hormone IUD (IUC)
risk. Risk of thrombosis is ca. 3−6 times
only a low dose of gestagen, have less may be a good alternative to reduce
higher, however. If no other means of
of an effect on the cardiovascular system the amount of bleeding. Middle-aged
| 63
women often have myomas (benign
Sterilization (➔ pp. 52ff.) is a good al-
worry about. Especially since other safe
muscle nodes in the uterus) that can
ternative for many women of this age.
and convenient alternatives such as the
disform the uterus and make insertion
Family planning may have been con-
IUD or hormonal contraceptives are
of an IUD impossible.
cluded, and there is subsequently no
available. Because the operation is easi-
need to worry about contraception.
er and less invasive in men, a vasectomy
Barrier methods such as condoms (➔
Many women eschew the operation,
may be a good alternative for couples
pp. 24ff.), the diaphragm (➔ pp. 38f.) or
however, because of the costs and the
who have definitively concluded their
the FemCap™ (➔ p. 41) are widely used
potential dangers, particularly in light of
family planning.
methods among older women: Their
the fact that only a few years remain to
years-long experience and familiarity
with their bodies enables them to employ these methods with ease. Weak
muscles in the pelvic region, however,
may prevent them from properly using
a diaphragm. Sometimes special gymnastic exercises to strengthen the pelvic
muscles can help – and incidentally also
prevent bladder weakness. The cervical
cap may no longer fit well if the uterus
has slipped down (prolapse). One can,
of course, use the symptothermal method – but only for as long as the menstrual cycles are more or less regular and
ovulation is present. If ovulation is often
absent or if the cycles last very long,
then the fertile days of the cycle can no
longer be satisfactorily determined. The
potentially fertile periods would then
be very long indeed, defeating the purpose of this method.
64 |
Combining hormonal treatment for
menopause with contraception
Relatively few women are plagued by
such massive problems during menopause that they resort to hormonal
treatment. The presence of hot flashes
does not necessarily signal the end of
Natural means of contraception are not possible since the
hormones change the consistency of the cervical mucous as
well as the basal temperature.
fertility, making contraception a continuing matter of concern. Combination
pills are effective against hot flashes
but also carry with them a higher risk
of cardiovascular events than those
drugs prescribed to treat the afflictions
of menopause. Combining hormonal
treatment and contraceptives, such
as the hormone IUD, the three-month
depot, the minipill or the hormone implant, is not recommended. The copper
coil IUD and barrier methods, however,
can very easily be used in combination
with hormonal treatment.
| 65
Unsafe methods of contraception (if indeed methods at all)
Unsafe methods
of contraception
(if indeed methods at all)
66 |
Coitus interruptus
Knaus-Ogino
The idea of a “timely withdrawal” or sim-
The same is true for the so-called
ply “watching out” belongs to the oldest
Knaus-Ogino method, named after its
and decidedly worst ways to prevent
discoverers Hermann Knaus from Aus-
pregnancy simply because it doesn’t
tria and Kyusaku Ogino from Japan. It
work. In this scenario the man pulls
is also known under the name “calendar
his penis out of the vagina in advance
method” or “rhythm method.” Here, the
of his orgasm and ejaculation, which
fertile time in a woman’s cycle is calcu-
now takes place outside the woman’s
lated on a calendric basis. A logbook of
body. This method offers no safety
the menstrual cycles of the previous six
since a certain amount of semen always
months is used to determine the long-
comes out of the penis before complete
est and the shortest cycle. From this
ejaculation. Coitus interruptus is easy: It
one calculates the presumed fertile and
needs no tools or materials, no advance
infertile days of the cycle. This method,
preparation, no major discussion. That’s
however, is clearly not a safe contracep-
what makes it so tempting. And yet we
tive method since it is based solely on a
can only advise against it with all due
calculation of the infertile days and, un-
emphasis!
like the symptothermal method, does
Nursing is, as noted above
(pp. 56ff.), a reliable method of
contraception – but only under very certain select circumstances.
not measure the body’s actual cyclical
signs. We can only advise against this
method, too.
| 67
Contraceptive accidents and unwanted pregnancies
Contraceptive
accidents
and unwanted
pregnancies
If a woman has had unprotected sex during ovulation or if an “accident” has
occurred – a torn condom, for example – she may become pregnant (➔ p. 24).
The absence of the next period is always a first sign that she may be pregnant.
Later, other typical changes occur that point toward a pregnancy – morning
sickness, frequent nightly urge to urinate, moodiness, fatigue, loss of appetite
and food cravings.
68 |
| 69
In some cases, if unprotected
intercourse took place or an accident happened before ovulation, the “morning-after pill” or
the “morning-after IUD” may be
used.
Before the second type (ellaOne®) is
employed, a possible existing pregnancy must be excluded. This need not
be done via a gynecological examination; rather, it often suffices that the
gynecologist determines when the last
period occurred and when unprotected
The
“morning-after pill”
intercourse took place. In Germany, the
“morning-after pill” must be prescribed
by a physician and can be obtained only
Two different drugs are available for use
in a pharmacy.
in emergencies –not for regular use – as
so-called “morning-after pills.” Both con-
Both types consist of a single tablet,
sist of hormone preparations available
best taken within 12 to 24 hours after
the next monthly period sets in. A wom-
only by prescription.
unprotected intercourse. A little some-
an taking the normal contraceptive pill
thing (e.g., sandwich) should be eaten
who chooses also to take the “morning-
› EFFECTS/USE:
The first type (Pi-
beforehand since these pills should not
after pill” to compensate for improper
DaNa®) contains levonorgestrel and
be taken on an empty stomach as they
use should continue taking the normal
must be taken no more than 72 hours
might otherwise be vomited up. If vom-
pill through the end of the menstrual
(three days) after unprotected inter-
iting does take place within three hours
cycle. Here, too, it is recommended that
course; the second type contains uli-
after swallowing the pill, a new pill must
additional, nonhormonal contracep-
pristal acetate (ellaOne®) and must be
be prescribed and taken to guarantee
tives (e.g., condoms) be employed until
taken no more than 120 hours (five days)
the proper effect.
the monthly period occurs.
after unprotected intercourse. However,
70 |
there is a high probability of protection
After taking the emergency pill, the
› SAFETY: When taken before ovula-
against unwanted pregnancy only if ovu-
woman usually has her normal monthly
tion has occurred, the “morning-after
lation has not yet occurred at the time of
period within the expected timeframe
pill” prevents pregnancy with a high
ingestion. For this reason, it is important
and with the usual intensity. However, if
level of safety. It is most effective if tak-
that the “morning-after pill” (regardless
this does not occur within about three
en within the first 12 to 24 hours follow-
of what type) be taken as quickly as pos-
weeks’ time, then a pregnancy test
ing unprotected intercourse; thereafter,
sible after the contraceptive “accident”
should be taken. It is especially impor-
the effectiveness slowly decreases. The
– if at all possible within 12 to 24 hours.
tant to use nonhormonal methods of
“morning-after pill” is no longer effec-
Both types suppress or delay ovulation.
contraception, such as condoms, until
tive if ovulation has already taken place
or if the egg has already become lodged
should inform their physician before
Hotline “Morning-After Pill”
in the folds of the uterus. Thus, “morn-
being prescribed a “morning-after pill.”
Pro familia has an interactive hotline
ing-after pills” are not “abortion pills” as
is often falsely attributed.
available in four languages (Turkish,
Extreme overweight can also hinder the
Russian, English, German) to dispense
effectiveness of the “morning-after pill.”
reliable information on the “morning-
+ BENEFITS: The “morning-after pill”
Also, women at a greater risk of tubal in-
after pill.” Calls to this service cost 0.14 €/
is a very efficient method of suppress-
flammations or ectopic and tubal preg-
min from a landline and max. 0.42 €/
ing or delaying ovulation and thus pre-
nancy should consult with their doctor
min from a cell phone. The number
venting an unwanted pregnancy fol-
whether the “morning-after pill” is ap-
01805/776326 is reachable around the
lowing unprotected intercourse or
propriate for them in an emergency.
clock.
when no or insufficient means of contraception have been used or have
Women with severe liver disorders are
failed.
advised not to use the “morning-after
pill.” Severe asthma should also be dis-
- DISADVANTAGES: Side effects can
cussed with a physician beforehand.
occur with the “morning-after pill,” too,
but generally they are not severe. This
includes headaches, nausea and stomach pains. Irregular menstrual bleeding,
spotting, breast tension or tenderness,
vertigo and vomiting may also occur.
Should severe pain or other side effects
that give rise to concern occur, do not
hesitate to consult your doctor.
The efficacy of the “morning-after pill”
may be affected by the simultaneous
use of certain antibiotics, antidepressives, viral inhibitors (incl. anti-HIV
drugs), antiepileptic drugs or pharmaceuticals containing St. John’s wort.
Women who are taking or have previously been taking such medicines
| 71
The
“morning-after IUD”
+ BENEFITS: The “morning-after IUD”
an wants to continue its use thereafter
The first sign of pregnancy following un-
EFFECTS/USE: Up to five days after
as a normal means of contraception.
protected sex is usually the absence of
unprotected intercourse it is possible to
The comments in the section above on
the woman’s normal period. Later, other
prevent the egg from attaching to the
the benefits and disadvantages of IUDs
typical changes occur that point to a
wall of the uterus by inserting a copper
are thus generally valid for the “morn-
pregnancy – morning sickness, frequent
IUD. This must be done by a gynecolo-
ing-after IUD” as well.
nightly urge to urinate, moodiness, fa-
›
gist. The emergency IUD has the same
72 |
Pregnancy test
is particularly called for when the wom-
tigue, loss of appetite and food cravings.
effect of a normal IUD (➔ pp. 29f.). The
- DISADVANTAGES:
The “morning-
If a woman suspects she is pregnant she
hormone IUD, however, cannot be used
after IUD” should not be removed be-
can obtain a pregnancy test in a phar-
for this purpose.
fore onset of the next period. The side
macy or drug store. This should not be
effects of the IUD mentioned in the re-
done, however, before her expected
› SAFETY: The “morning-after IUD” has
spective section above are valid for this
period as the test results are not gener-
a relatively high level of safety.
emergency method too (➔ p. 30).
ally reliable at this point in time. Such an
early test should in any case be repeated
after a week’s time. Pregnancy tests used
from the first day of the missing period
onward, on the other hand, are more reliable and can determine within minutes
whether the woman is indeed pregnant.
These tests all function similarly: They
test the woman’s urine for a particular
pregnancy hormone the body produces
once the fertilized egg has landed in the
uterus. Note: This hormone is also produced with ectopic pregnancies. One
can, however, also go to the gynecologist’s office to take such as test since they
are generally done free of charge and
have a high level of reliability. A doctor’s
Pregnancy counseling and legal issues:
Legal regulations and indications
office also has the advantage of having
someone there to talk with afterwards.
When a woman becomes pregnant
and is confronted with a major conflict, she should go to see a physician
or a pregnancy counseling agency as
soon as possible. It is often helpful if
the woman’s partner goes along. Such
counseling centers can provide both
This counseling should serve
to encourage the couple and
show empathy for their situation, not to lecture or patronize
them. It should support their
efforts to reach their own careful and informed decision.
help and information about what legal
alternatives the couple has, whether
Such counseling is one of the prereq-
they choose to carry the child to term or
uisites that must be met if a woman is
have an abortion.
to have her pregnancy legal terminated through abortion. But abortion, it
should be mentioned, is not a means of
contraception!
| 73
Abortion
LEGAL STIPULATIONS
There are two basic ways to terminate a
Pregnancy counseling
pregnancy: surgically and pharmaceutically.
According to German law on abortion counseling, abortion is generally deemed
illegal, but is nevertheless allowed under certain exceptional circumstances:
SURGICAL ABORTION
› No more than 12 weeks (first trimester) must have passed since conception.
› The pregnant woman must want the abortion and the physician doing the
Surgical abortion is usually carried out
procedure must prove that the woman received counseling at least three
on an outpatient basis, i.e., the woman
days before the scheduled abortion at an accredited counseling service (§219,
can go home 1–2 hours after the proce-
para. 2, 2 StGB).
dure. Thus, it can take place in a doctor’s
› The abortion must be carried out by a physician.
› The physician doing the abortion cannot be the same person who counseled
the woman.
private practice, an outpatient clinic or
in a hospital. Only in situations where
the pregnancy is already beyond the
12-week limit or in the presence of major
Indications for abortion
illnesses is it necessary for the woman
An abortion is not subject to prosecution if a proper legal indication has been
to stay in the hospital for a few days.
determined by a physician:
Criminological indications
›
› If, in the opinion of a physician, the pregnancy was incurred through a sexual
No more than 12 weeks (first trimester) must have passed since conception.
The most common – and least burdensome – method is when the fetal material is removed by suction (vacuum aspi-
crime to the woman (rape, sexual abuse, e.g., if the girl was under the age of 14
ration). To this end the cervical os – the
at the time of conception).
opening to the cervix – is carefully di-
Medical indications
lated. The entire procedure lasts about
Only if a medical indication is present can an abortion be done beyond the first
10–15 minutes. It can be done with local
trimester, in order to
anesthesia of the cervix or under gen-
› avert imminent danger to the woman’s life or to avert severe impairment of
eral anesthesia.
her physical or mental state, should no other reasonable means be available.
Both types carry little risk to the woman. The woman can choose which type
of anesthesia best fits her needs. Following the abortion she should rest for
a few days. A further examination at a
74 |
which retards the hormone progesterone necessary to establish a successful pregnancy. After taking the pill in a
doctor’s office, the woman can usually
go home. Some 36–48 hours later, again
in a doctor’s office, she must then take
prostaglandins, which trigger labor and
induce the actual abortion in most cases.
Mifepristone also dilates and softens up
the cervical os. If abortion has not taken
gynecologist’s office should be done
about two weeks after the operation.
PHARMACEUTICAL ABORTION
(MIFEGYNE™)
This procedure entails few complica-
place three hours after taking the dose of
prostaglandins (and this is the case in up
to 25% of all woman), then a second dose
tions. During the operation itself some
Mifegyne can be prescribed by a doc-
of prostaglandins is again given after
discomfort can arise due to the anesthe-
tor for women whose pregnancy has
three hours’ time. In this case, the woman
sia or through slight injuries to the uter-
not progressed beyond the
week of
remains under medical observation for
us, but only rarely does heavy bleeding
gestation, i.e., a drug-based abortion
up to three hours. In most cases the fetal
9th
day after
or an infection ensue. The procedure
is possible only up to the
should have no effect on later child-
the 1st day of the last period. This phar-
bearing or fertility.
maceutical is not available in pharma-
A third visit to the doctor’s office or
cies but only from institutions specially
clinic is necessary for a postprocedure
authorized to distribute it. The regula-
examination and to ensure that all fetal
tions governing legal abortion (➔p. 74)
material has indeed been aborted.
This method has the advantage
of being over relatively quickly
and having fewer side effects
than the drug-based abortion.
63rd
material is then successfully shed.
are valid for this method as well. Drugbased abortion is done by taking a pill
containing the ingredient mifepristone,
This control examination is absolutely necessary
| 75
Experience in other European countries
The pharmaceutical abortion is clearly
with the “morning-after pill,” which
such as Sweden, England and France
the physically less stressful method. It
causes the mucous in the uterus to be
shows that this method overall has
is especially appropriate for women
sloughed off within 72 hours after un-
fewer health risks than the operative
who are willing to openly face their
protected intercourse.
method.
abortion. Psychologically speaking, it
is a longer drawn-out procedure that
However, the drug-based method
demands more active “participation”
should not be used by women with
on the part of the woman, who has to
›
›severe asthma
›an allergy toward mifepristone or
some other ingredient in the pills
›known intolerance of prostaglandins.
chronic adrenal diseases
take the pills herself and shed the fetal
material. Some women expressly prefer
this hormonal method because it gives
them more control over their body. The
drug used here should not be confused
Because not all gynecologists offer
this type of abortion, one should
contact local counseling services
(➔ p. 91) to obtain the respective
addresses.
76 |
COSTS
› According to German law (§218a, sect. 1 StGB) women who want to have an
abortion in accordance with abortion-counseling regulations must pay for
the procedure themselves. However, if they do not have the means to do so,
they are eligible for support to cover the costs in accordance with a special
law covering abortions under special circumstances. The costs are then assumed by the respective state government. This coverage can be applied
for at one’s normal health insurance company.
› This is also true for women who are uninsured, in which case the health
insurance company issues a voucher to cover the costs and settles with the
responsible state authorities.
› The costs involved are those of the actual abortion and any routine postprocedure examinations.
› All other costs, such as examinations carried out during pregnancy or for
treatment due to complications of the abortion procedure, are assumed by
the woman’s regular health insurance company.
› In cases of medical or criminological indications, the woman’s health insurance covers all costs.
| 77
Finding the right contraceptive
78 |
Finding
the right
contraceptive
Deciding which contraceptive (or contraceptives) to use depends on many
different criteria and personal preferences. Every woman and every man will
decide differently about the advantages and disadvantages of each method.
The following pages provide a complete list of all contraceptives available.
LIST OF CONTRACEPTIVES AS A DECISION GUIDE
The checklist given on page 90 serves as a guide for finding the right contraceptive for your own particular situation. We hope it can help you make your
own decision. You can also take this checklist along with you when you visit
your doctor or a counseling center.
| 79
Contraception at a glance
METHOD
Contraceptive
pill
(combination
pill)
Minipill
New minipill
EFFECTS/USE
BENEFITS
› Prevents ovulation with hormones
› High level of safety
Prevents
the
sperm
cells
from
reaching
the
uterus
and
›
› Relatively short and weaker periods
prevents the egg from lodging in the lining of the uterus
as well as menstrual cramps
› Taken daily
› Improves acne in some women
Is
taken
on
the
first
day
of
the
woman’s
period
(menstrual
›
cycle)
› Must be monitored by a physician
› Similar to contraceptive pill, but generally does not
suppress ovulation since it contains only gestagen
› Is taken without pausing, but must be taken daily at
exactly the same time
› Generally prevents ovulation
› Fewer side effects than the
combination pill
› Can also be taken while nursing
› In exceptional cases can be taken up
to 12 hours later
Condom
› Prevents fertilization by collecting the semen
› Low leadtime
› Easy for both partners to use
› Effective immediately,
Lubricating
substances
containing
Vaseline
or
other
fats/
no waiting necessary
›
oils as well as certain genital medicines or salves should
› Can be used only when necessary
not be used at the same time
› Cheap and available everywhere
› Modern condoms cause no
discomfort or nuisance
› Only means of contraception for
the male
› Protects against HIV infection and
against other sexually transmitted
diseases
80 |
DISADVANTAGS/SIDE EFFECTS
APPROPRIATE FOR WHOM?
› Vaginal infections
› Irregular periods
› Tenderness/tension of the breasts
› Loss of libido
› Headaches (vision disorders)
› Weight gain
› Danger of thrombosis
› Women looking for a safe and
convenient method of
contraception
COSTS INVOLVED
(AS OF FEB. 2010)
› Ca. €5−20/month
› 3- or 6-month packs
SAFETY
Very high
are cheaper
› Women willing to live with the
side effects
› Not suitable for women who smoke
› Can be taken by women over 40 if
they are healthy, nonsmokers and
use the low-dose versions
› Must be taken very diligently
› Disorders of the menstrual cycle
possible
› Spotting common
› Similar to the combination pill › The minipill with
› Appropriate also for women with levonorgestrel:
estrogen intolerance
3-month pack ca. €25
› Minipill with
desogestrel:
Very high
Very high
3-month pack ca. €30
High
› May interrupt sexual arousal
› Essential for persons with multiple › Ca. €0.20−1.20/
condom*
› Must be thought of and used in due partners
› Important
Appropriate
also
for
adolescents
Latexfree
condoms
time
to find the
›
›
proper size
› Can be used while nursing or with cost about €1/
irregular menstrual cycle
condom
to ensure
good contraceptive
effect
*Some products may be
cheaper on the Internet
| 81
METHOD
Female condom
(Femidom)
Copper coil
(IUD)
Hormone IUD
Hormone
implant
82 |
EFFECTS/USE
› Vaginal sheath that prevents sperm cells from reaching
the egg; lubricant recommended in addition
BENEFITS
› Also protects women against HIV
infection
› Irritates the uterus and thus prevents the egg from
becoming lodged in the uterus lining
› Must be inserted by a gynecologist
› May stay in place for up to 5 years
› Requires no further effort at
› Prevents build-up of the uterus lining through the
hormone gestagen
› Causes cervical mucous to become viscous
› Must be inserted by a gynecologist
› May stay in place for up to 5 years
› Prevents ovulation
› Changes mucous lining of cervix to prevent sperm from
getting through
› Hormonal rod must be inserted by specially trained
physician or gynecologist
› Effective for up to 3 years
› Similar to normal IUD
› May cause weaker and less painful
contraception
periods
› No regular ingestion or applicaton
necessary
› Very safe
› Long-lasting protection
› Proper insertion must be practiced
› Women who want to retain
control of contraception
› Menstrual pains
› Increased blood flow
› Distrubances of menstrual cycle
› Tubal inflammations possible, esp.
in young women
› May lead to infertility
› Ectopic pregnancies possible
› Miscarriages
› Initial depressive moods, weight
gain, tenderness/tension in breasts,
›
› Older women who already have
COSTS INVOLVED
(AS OF FEB. 2010)
› Ca. €12 for 3-piece
› Price ranges from
children or have completed their
€30−85. Insertion
family planning
costs between €120
› Similar to normal IUD
› Ca. €250−400 incl.
› IUD is not method of choice in child- insertion, remains in
less women and should be used
place for up to 5
only when all other (safe) methods
years
period (amenorrhea)
have proved to be impractical
depressive moods
› Expensive method if removed early
› Often irregular periods
Very high
and €300
Irregular periods or absence of
tenderness/tension in breasts,
High
pack
headaches, nausea
› May cause acne, headaches,
SAFETY
› Women seeking high level of
safety
› Women who have difficulty
regularly taking pills
› Women willing to commit to a
› Ca. €300−350 incl.
Very high
Very high
insertion
contraceptive for up to 3 years
| 83
METHOD
Three-month
depot
Vaginal ring
EFFECTS/USE
BENEFITS
› Primarily prevents ovulation
› Must be (re)injected every 3 months by physician
› Works safely without much thought
› Works like the contraceptive pill
› Ring can be inserted into the vagina by the woman
› Easy to use
› No daily reminder necessary
directly and is left in place for 3 weeks. After 3 weeks she
removes it, and her normal period begins shortly
thereafter. Then a new ring is inserted.
Contraceptive
patch
› Effectiveness similar to that of hormonal contraceptives › Easy-to-use method of hormonal
contraception that does not put
› Can be applied to most parts of the body and must be
renewed on the 8 and the 15 day of the menstrual cycle
strain on the liver
Menstrual
bleeding
commences
in
the
4
week
after
›
th
th
th
removal of the patch
Diaphragm
84 |
› Prevents fertilization of the egg by blocking the entrance › Relatively easy to use
to the uterus with a plastic cap
› Can be used spontaneously as
necessary
› Best used with spermicidal jelly
Can
be
used
by
women
alone
(with
or
without
the
›
› No side effects
cooperation of one’s partner)
› Instructions and practice of proper use necessary
› Many women do not tolerate it well › Women who have a normal
menstrual cycle and do not
› Even if poorly tolerated, the 3
months must be completed
tolerate other methods
Headaches,
nervousness,
depressive
›
COSTS INVOLVED
(AS OF FEB. 2010)
› Per dose ca. €31−35
SAFETY
Very high
for 3 months of
protection, costs of
injection up to €15
moods, acne
› Some side effects, such as
› Women who want to use a
› Ca. €38−48/3 months
Very high
› Irregular periods, tenderness/tension › Women who want to use a
in breasts, headaches, nausea
hormonal contraceptive without
having to take it daily
› Local reaction to patch
› Ca. €40/3 months
Very high
› Practice necessary
› May inhibit sexual spontaneity
› Ca. €50 plus cost for
High
headaches, vaginal infections,
hormonal contraceptive without
vaginal discharge
having to take it daily
› Women who have no problem
touching themselves and are
jelly ca. €9
looking for a method with few
side effects
| 85
METHOD
Cervical cap
(aka Lea’s
Shield)
FemCap™
EFFECTS/USE
BENEFITS
› Similar to the diaphragm
› Can be left in place for up to 48 hours
Additional
loop
for
easy
removal
and
valve
allows
›
› This ensures a greater spontaneity
cervical mucous and blood to flow off
than other barrier methods
Increased
effectiveness
when
used
with
spermicidal
jelly
›
› Available in three sizes
› Does not strain hormonal status
› Increased effectiveness when used with spermicidal jelly › Suitable also for women with latex
allergy
Natural family
› Determination of fertile and infertile days, consisting of
planning (NFP)
measurement of basal temperature and observation of
mucous consistency
› Noninvasive
› Provides opportunity for physical
self-exploration and self-observation
› Data must be closely analyzed
› Proper interpretation must be learned (courses,
counseling centers, books)
› Temperature must be measured daily at same time and
mucous conscientiously observed
Technical tools
for calculating
ovulation
86 |
› Fertile and infertile days are calculated, evaluated and
displayed on a small computer
› Tools may also be used to explicitly
calculate the days when sex will likely
lead to pregnancy
› Practice necessary
› Women who have no problem
Must
be
replaced
every
6−9
months
touching themselves and are
›
looking for a method with few
› Relatively expensive
COSTS INVOLVED
(AS OF FEB. 2010)
› Ca. €50
SAFETY
High
side effects
› May cause irritations to the mucous › Women who need contraception › Ca. €60
membranes
only when necessary
› Women looking for a
Relatively
high
contraceptive with few side effects
› Long learning period necessary
› Regular periods of abstinence or
use of additional contraceptives
necessary
› Not a very safe method of
contraception
› Expensive
› Women looking for a natural
› No set costs involved
alternative to hormones
› Costs for courses/
› Women who want to get to know literature may incur
their body better
› Women with regular life patterns
› Women willing to forego
spontaneity
› Women with a responsible partner
› Women who want to get pregnant › Ca. €100–700
› Women looking for a
› Depending on
contraceptive with few sides
model, between
effects and are willing to take the
€8–35/month for test
risks involved
strips
Relatively
high
Unsafe
| 87
METHOD
Chemical
methods
EFFECTS/USE
BENEFITS
› Jellies or suppositories create a viscous slime that covers › Easy to use
the cervix
› Available over the counter
› 10-minute leadtime
› Can be used spontaneously
The
instructions
on
the
package
must
be
carefully
›
heeded
Sterilization
“Morning-after
pill”
(single-agent
preparation)
› Interrupts the woman’s tubes or the man’s seminal ducts › Once completed assurance that no
impregnation can occur
› Operation necessary
› In women usually under general anesthesia
› No worries about contraception
In
men
as
outpatient
with
local
anesthesia
necessary thereafter
›
› Suppresses or delays ovulation
› Should be used only in emergencies
› Available only by prescription
› “Morning-after pill” must be taken no later than 72/120
› Emergency measure to prevent
unwanted pregnancy
hours after unprotected intercourse, depending on the
preparation
“Morning-after”
IUD
› Prevents or delays the (fertilized) egg from lodging in the › Only for emergencies to prevent
uterus
unwanted pregnancy
› A normal copper coil IUD can be inserted for up to 5 days
after unprotected intercourse
88 |
COSTS INVOLVED
(AS OF FEB. 2010)
› Feeling of warmth or sometimes
› Should not be used exclusively as › €10–38 depending
burning in vagina and on penis
means of contraception
on product
› May become too fluid and flow out
of the vagina
› Not compatible with some condoms
SAFETY
Unsafe
(attacks rubber)
› Temporary pain from sutures
› Decision must be well thought out
› Women and men with no further › Depends on local
wish to have children
circumstances
› Women and men in stable, long- › Woman: ca. €600–
term partnerships
1000
› Women and men over 35 years › Man: ca. €450–500
Very High
of age
› Disrupted period, nausea, abdominal › Women who in an emergency
pains, vertigo, vomiting
situation (“accident” or failure to
› Fewer side effects than combination use a contraceptive) want to
preparation
› Similar to copper coil IUD
› PiDaNa® ca. €16−18
› ellaOne® ca. €35
Relatively
high
prevent pregnancy
› For use only in emergencies
› Women who subsequently want
› Ca. €25−40 plus
costs for insertion
Relatively
high
to use normal IUD as
contraception
| 89
›How regular is my menstrual cycle?
›Does my partner feel responsible for
birth control?
Decision guide
›How important is it to me not to get
pregnant?
›Have I ever used contraceptives?
›How well acquainted am I with my
body, including everything that goes
on in my body?
›Do I only seldom have intercourse?
›Am I allergic to any known substances
(e.g., latex)?
›Is the price of contraceptives a
criterion for me?
›Is it difficult for me to talk about
sexuality?
›Do I want to get pregnant in the fore- ›How do I feel about my own body? ›How important is it to me to have
seeable future?
spontaneous sex?
›Am I well organized and disciplined?
›Do I already have children and would
›How do I feel about having to prepare
Do
I
have
a
chronic
illness
of
any
kind?
like to have no more?
for sex in advance by setting up con›
traception?
When
was
my
last
pregnancy?
Can
I
adjust
to
using
a
particular
con›
›
traceptive for a longer period of time?
›Do I prefer to take care of birth control
Do
I
want
to
have
a
baby
but
haven’t
myself or leave it to someone else?
›
yet found the right partner or right
›Do I have severe menstrual symptoms
circumstances to fulfill that wish?
›Do I have multiple sexual partners?
›Am I in a stable partnership or am I
presently single?
›How regular is my lifestyle?
90 |
(such as cramps or pain)?
›Do I regularly take any medicine?
›Do I smoke?
›Am I older than 35 years?
Imprint
www.bzga.de
Medical Products)
Photo credits:
33, 35, 36, 38, 40, 41, 42, 48, 49, 51, 71 Thomas Behrendt
Print run: 2.15.05.14
Order no.: 13060070
Measure.
Choose.
Try it on.
Help and advice
THE KONDOMETER
where the dot is.
1
2
1
What color
do you see?
2
www.kondometer.de.
HERE, WIDTH MATTERS
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
kondometer
02 |
| 91
front
1
2
1
2
*
(Order no. 13060070)
Imprint
www.bzga.de
Medical Products)
Photo credits:
33, 35, 36, 38, 40, 41, 42, 48, 49, 51, 71 Thomas Behrendt
Print run: 2.15.05.14
Order no.: 13060070
Measure.
Choose.
Try it on.
Help and advice
THE KONDOMETER
where the dot is.
1
2
1
What color
do you see?
2
www.kondometer.de.
HERE, WIDTH MATTERS
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
kondometer
02 |
| 91
front
1
2
1
2
*
(Order no. 13060070)
Contraception
TO EACH HIS OWN
packaging.
› rip or burst
› fit too loosely
rectum
SAFE USE OF CONDOMS
(Order no.: 70520000)
Safe and Sure
What color
do you see?
8
9
10
11
12
13
14
15
16
back
Try a smaller size!
you (e.g., 52 mm)
Try a larger size!
When measuring the
size of your penis,
Contraception
TO EACH HIS OWN
packaging.
› rip or burst
› fit too loosely
rectum
SAFE USE OF CONDOMS
(Order no.: 70520000)
Safe and Sure
What color
do you see?
8
9
10
11
12
13
14
15
16
back
Try a smaller size!
you (e.g., 52 mm)
Try a larger size!
When measuring the
size of your penis,
Contraception
TO EACH HIS OWN
packaging.
› rip or burst
› fit too loosely
rectum
SAFE USE OF CONDOMS
(Order no.: 70520000)
Safe and Sure
What color
do you see?
8
9
10
11
12
13
14
15
16
back
Try a smaller size!
you (e.g., 52 mm)
Try a larger size!
When measuring the
size of your penis,

Contraception

Transcription

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