Physiological contraception. Barrier methods of contraception are divided into. Thus, COCs meet all the requirements for modern contraceptives.

Contraceptives are drugs used to prevent pregnancy. The purpose of contraception is family planning, the preservation of the health of a woman, and partly her sexual partner, the realization of a woman's right to a free choice: to become pregnant or refuse to do so.

Why are all types of contraception necessary:

• any method of contraception reduces the number of abortions - the causes of gynecological diseases, premature birth, maternal and infant mortality;
• protection helps to plan the appearance of a child, depending on the living conditions of the family, the health of the parents and many other factors;
• some effective methods of contraception at the same time help fight gynecological diseases, osteoporosis, and infertility.

The effectiveness of contraceptives is assessed by the Pearl index. It shows how many women out of a hundred who used the method during the year became pregnant. The smaller it is, the higher the protection efficiency. Modern methods of contraception have a Pearl index close to 0.2-0.5, that is, pregnancy occurs in 2-5 women out of 1000.

Classification of contraceptive methods:

• intrauterine;
• hormonal;
• barrier;
• physiological (natural);
• surgical sterilization

Consider the listed types of contraception, the principle of their action, effectiveness, indications and contraindications.

intrauterine methods

Use foreign objects placed in the uterine cavity. Intrauterine contraception is widespread in China, Russia, Scandinavian countries.

The method was proposed at the beginning of the 20th century, when it was proposed to introduce a ring of different materials into the uterine cavity to prevent pregnancy. In 1935, intrauterine contraception was banned due to the large number of infectious complications.

In 1962, Lipps proposed the famous device made of curved plastic with an attached nylon thread for removing a contraceptive, the Lipps loop. Since then, intrauterine contraception has been constantly evolving.

Intrauterine devices are divided into inert and medical. Inert ones are not currently used. Only medical contraceptives containing metal supplements or hormones are recommended, including:

• MultiloadCu-375 - F-shaped coil, copper-plated and designed for 5 years;
• Nova-T - a device in the form of the letter T, covered with a copper winding;
• CooperT 380 A - T-coil, designed for 6 years;
• - the most popular spiral to date, gradually releasing levonorgestrel into the uterine cavity - a progesterone derivative that has a contraceptive and therapeutic effect.

Mechanism of action

The intrauterine contraceptive has the following effects:

• the death of spermatozoa that have penetrated the uterus due to the toxic effect of the metal;
• increased viscosity of cervical mucus due to the hormone, which prevents spermatozoa;
• endometrial atrophy under the influence of levonorgestrel; ovulation and the effect of estrogen on the female body is preserved, and menstruation becomes shorter, less frequent or completely disappears;
• abortive action.

The abortion mechanism includes:

• active movement of the tubes and entry into the uterine cavity of an immature egg;
• local inflammatory process in the endometrium, which prevents the attachment of the embryo;
• activation of uterine contractions that eject the egg from the genital tract.

The Pearl index for spirals with a copper content is 1-2, for the Mirena system 0.2-0.5. Thus, this hormonal system is the best method of intrauterine contraception.

The introduction of a contraceptive

The intrauterine device is installed after an abortion or removal of an old one, 1.5-2 months after the birth of a child, or six months after a cesarean section. Before this, the patient is examined, paying attention to signs of infection.

After 7 days, the woman visits the gynecologist. If all went well, she should see a doctor at least once every 6 months.

The contraceptive is removed at the request of the patient, with the development of complications or at the end of the period of use, by pulling on the "antennae". If the "antennae" broke off, the removal is carried out in a hospital. It happens that the spiral grows into the thickness of the myometrium. If a woman does not have any complaints, she is not removed, and the woman is advised to use other methods of protection.

Complications and contraindications

Possible complications:

• perforation of the myometrium (1 case per 5000 injections);
• pain syndrome;
• bloody issues;
• infectious diseases.

If you experience severe pain in the abdomen, cramping sensations with bleeding, heavy menstruation, fever, heavy discharge, "falling out" of the spiral, you should immediately consult a doctor.

The introduction of the spiral is absolutely contraindicated in pregnancy, infection or tumors of the genital organs. It is better not to use it if the menstrual cycle is disturbed, there is endometrial hyperplasia, anatomical features of the genital organs, blood diseases, large ones, allergies to metals, severe concomitant conditions. Women who have not given birth can use intrauterine contraception, but the risk of pregnancy pathology in the future is higher.

The advantages of this method of contraception are the possibility of using during lactation, the absence of side effects caused by estrogens, and less impact on body systems. Disadvantages - less efficiency and the likelihood of metrorrhagia.

Injectable contraceptives and implants

This method is used for long-term protection against unwanted pregnancy. The Depo-Provera preparation is used, containing only the progestogen component, it is injected into the muscle 1 time per quarter. Pearl index 1.2.

Benefits of injectable contraception:

• fairly high efficiency;
• duration of action;
• good tolerance;
• no need for daily pills;
• you can take the drug for uterine fibroids, and other contraindications for drugs with an estrogen component.

Disadvantages of the method: the ability to conceive is restored only after 6 months - 2 years after the last injection; a tendency to the development of uterine bleeding, and subsequently to their complete cessation.

This method is recommended for women who need long-term contraception (which is, however, reversible), while breastfeeding, with contraindications to estrogenic drugs, and for patients who do not want to take daily tablet forms.

According to the same indications, it is possible to install the implantable drug Norplant, which is 6 small capsules. They are sutured under local anesthesia under the skin of the forearm, the effect develops during the first day and lasts up to 5 years. The Pearl Index is 0.2-1.6.

barrier methods of contraception

One of the advantages of barrier methods is protection against sexually transmitted diseases. Therefore, they are widely distributed. They are divided into chemical and mechanical methods of contraception.

Chemical methods

Spermicides are substances that kill sperm. Their Pearl Index is 6-20. Such drugs are produced in the form of vaginal tablets, suppositories, creams, foams. Solid forms (candles, films, vaginal tablets) are inserted into the vagina 20 minutes before sexual intercourse so that they have time to dissolve. Foam, gel, cream act immediately after application. With repeated coitus, it is necessary to re-introduce spermicidal agents.

The most common means are Pharmatex and Patentex Oval. Spermicides slightly increase protection against sexually transmitted diseases, since they have a bactericidal effect. However, they increase the permeability of the vaginal walls, which increases the likelihood of contracting HIV infection.

The advantages of chemical methods of contraception are the short duration of their action and the absence of systemic effects, good tolerance, and protection against sexually transmitted diseases. The disadvantages that significantly limit the use of such drugs include low efficiency, the risk of allergies (burning, itching in the vagina), as well as the direct connection of the use with coitus.

Mechanical methods of contraception

Such methods hold the spermatozoa, creating a mechanical obstacle on their way to the uterus.

The most common are condoms. They are for men and for women. Men's should be worn during an erection. Female condoms consist of two rings connected by a latex film forming a cylinder closed at one end. One ring is put on the neck, and the other is brought out.

The Pearl Index for condoms ranges from 4 to 20. To maximize their effectiveness, you must use these accessories correctly: do not use oil-based lubricants, do not reuse the condom, avoid prolonged intense acts during which the latex can break, and pay attention to expiration date and storage conditions of the contraceptive.

Condoms protect quite well against sexually transmitted diseases, but do not completely protect against infection with syphilis and some viral diseases transmitted by skin contact.

This type of contraception is most indicated for women with infrequent or promiscuous sexual intercourse.

Which method of contraception to choose for the most complete protection against pregnancy and sexually transmitted diseases? In this case, a combined method is recommended - taking hormonal contraceptives and using a condom.

Vaginal diaphragms and caps are not widely used. These devices are worn on the cervix before sexual intercourse, and are removed 6 hours after it. They are usually used together with spermicides. They are washed, dried, stored in a dry place and reused if necessary. The use of these tools requires training. They are not used for deformation of the neck, vagina, inflammatory diseases of the genital organs. The undoubted advantage of such devices is their reusable use and low cost.

Mechanical methods of contraception have the following advantages: safety, protection against sexually transmitted diseases (for condoms). Cons associated with insufficient effect and the relationship between application and coitus.

Natural Ways

Natural methods involve abstaining from sexual intercourse on days close to ovulation. The Pearl index reaches 40. To determine the fertile ("dangerous" period), the following methods are used:

• calendar;
• measurement of temperature in the rectum;
• examination of cervical mucus;
• symptothermal.

calendar method of contraception

It is used only in women with a regular cycle. It is believed that ovulation occurs on the 12-16th day of the cycle with a duration of 28 days, the sperm cell lives 4 days, the egg cell - 1 day. Therefore, the "dangerous" period lasts from 8 to 17 days. These days you need to use other methods of protection.

Sufficient awareness and awareness of a woman about the most likely time of ovulation (and hence the onset of pregnancy) throughout the entire menstrual cycle (from the first day of menstrual bleeding to the start of the next menstruation) helps to avoid an unplanned pregnancy. This requires consistent daily monitoring and analysis by the woman herself of the following indicators of cyclically occurring physiological changes in her body:

Rectal (basal) body temperature;

Quantity and properties of cervical mucus;

The duration of the menstrual cycles.

An analysis of the degree of change in the studied parameters makes it possible to identify the period of greatest fertility. It should be emphasized that the successful use of physiological (natural) methods of contraception (PEMK) requires self-discipline and careful recording and recording of the above indicators.

FEMC can be used if women have regular menstrual cycles or are unable or unwilling to use other methods of contraception, including for religious or ethical reasons. Such methods can be used by couples who are strongly motivated to them, willing to avoid sexual intercourse for more than a week during each cycle and carefully observe, record and interpret signs of the fertile phase. In addition, in the presence of all of the above conditions, these methods can be used by sexual partners in situations where modern contraceptive methods are not available to them.

Physiological methods of contraception have both advantages and disadvantages (Blumenthal P. et al., 1995; Mikolajczyk R.T. et al., 2003).

Advantages:

The possibility of using both for the purpose of contraception, and when a woman is interested in pregnancy;

No side effects;

Contraceptive methods are free;

The partner takes part in the implementation of the methods;

Increasing the level of self-knowledge of a woman (spouses);

Greater satisfaction from sexual contact after abstaining during the "dangerous period" (in some couples).

Flaws:

"the need for constant and daily monitoring (at least 3-4 menstrual cycles);

Difficulties in determining the fertile phase for a woman / couple in the first months of using the methods, for example, in interpreting the state of cervical mucus;

Certain obligations of both partners, the need for abstinence or the use of coitus interruptus, the use of barrier methods of contraception during the fertile phase;

Dependence on living conditions, work schedule (night shifts), concomitant conditions and diseases accompanied by changes in body temperature, etc.;

Lack of protection against STIs;

Often there is uncertainty about the effectiveness of the methods used.

There are several basic well-known ways to calculate "safe days" (Gnoth C. et al., 1995):

Calendar (rhythmic) method;

Method for measuring rectal (basal) body temperature;

Method for assessing the state of cervical mucus;

Symptomothermal method (most accurate).

The calendar (rhythmic) method is a method for determining the fertile phase based on daily observations for! menstrual cycle. You can use this method with a regular menstrual cycle. With an irregular cycle, the rhythmic method should not be used, since it is extremely difficult to determine the time of onset of ovulation, and hence the period of fertility.

Rules for calculating the fertile period ("dangerous days")

1. Track the duration of at least 3-4, and sometimes 6 menstrual cycles, depending on the regularity of menstruation.

2. Subtract 11 from the number of days in the longest of the cycles (for greater certainty, you can subtract 8-10 days). This is how the last fertile day of the cycle is determined. The number 11 is obtained as follows: after ovulation, before the onset of menstruation, 12-16 days pass in the fertile cycle (on average 14) and for greater safety and efficiency of the method, a few more days are added to the average number.

3. 18 days are subtracted from the number of days in the shortest cycle (19-21 days can be subtracted to increase efficiency). This is how the first fertile day of the cycle is calculated. This figure is determined by the duration of the viability of spermatozoa in the genital tract of a woman (up to 4-6, on average 5 dry).

Obviously, on fertile days it is necessary to avoid sexual intercourse or use additional methods of contraception (coitus interruptus, barrier methods).

According to various studies, the effectiveness of the method is 85-90%. According to a study conducted in the USA in 2003, the Pearl index when using the method was 9 (Hatcher R.A., Trussell J., 2004).

The temperature method is a method for determining the fertile phase by changes in basal (rectal) temperature. During the menstrual cycle, due to changes in the concentration of female sex hormones in the blood, body temperature also changes. So, in the first (follicular) phase of the cycle until ovulation, the temperature is low, it does not exceed 36.4-36.8 ° C. Before ovulation, the temperature drops, and immediately

After ovulation, it rises by 0.3-0.7°C (up to 37.1-37.5°C). This temperature is maintained until the onset of menstruation. If you measure the temperature daily and record it in the form of a graph, then you can determine the day of ovulation with a certain accuracy (Fig. 2.29).

1. You can measure the temperature not only in the rectum, but also in the mouth or in the vagina. You can choose any of these methods, but always use it with an exposure of at least 5 minutes.

2. Take the temperature at the same time every morning without getting out of bed, and immediately record the readings. During menstruation, continue measuring temperature.

3. Measure the temperature after continuous sleep for at least 3 hours.

4. Always measure the temperature with the same thermometer.

5. It is necessary to measure the temperature for at least 3-4 months.

It should be emphasized that the basal temperature decreases 12-24 hours before ovulation, and after ovulation it rises by an average of 0.3-0.7°C.

Rice. 2.29. Graph of basal temperature during the ovulatory menstrual cycle.

Fertile can be considered the period from the beginning of the menstrual cycle until the basal temperature rises and will be increased for 3 consecutive days (since the egg loses its ability to fertilize 3 days after ovulation and pregnancy is impossible).

Since basal temperature is affected by various factors, the interpretation of basal temperature readings requires special attention. Therefore, it is necessary to make special notes about these factors. These include: a disease with fever, drinking alcohol the day before, stress, sleepless night.

To determine the day of ovulation, you should carefully study the chart of basal temperature:

Find the day when the temperature rose by 0.3-0.7°C. For convenience, the previous 6 days should be marked in a different color;

Select the highest temperature for these 6 days and draw a horizontal line 0.0°C above it. If the temperature on one of the following days falls below the horizontal line, ovulation may not have occurred yet;

In the case of a persistent increase in temperature for at least three consecutive days, pregnancy cannot occur until the start of the next menstrual cycle;

If high or very low values ​​are recorded on the graph once, the accompanying circumstances must be analyzed, and after 6 consecutive days with normal temperature, these deviations can be ignored.

A woman is not able to conceive in the first 5 days of the menstrual cycle, if a week before that there was a noticeable rise in temperature. It does not matter when the menstruation ended (this matters for cycles longer than 25 days). With shorter cycles, inability to fertilize will be only in the first 3 days. With irregular menstrual* cycles, this rule cannot be taken into account. In such a situation, it is necessary to use additional methods of contraception.

With regular and correct application of the method of measuring basal temperature, the Pearl index decreases to 3.5 (Jennings V. et al., 2004).

Assessment of the state of cervical mucus

Cervical mucus is a specific secret produced in the cervix of a woman and changes its properties during the menstrual cycle, in particular under the influence of female sex hormones (estrogens). The closer to ovulation, the more mucus is secreted, while the viscosity of the secret decreases.

Immediately after menstruation, there is no mucus at all or there is very little of it. The vagina feels dry or feels a little wet. These days are called "dry" days and conception is not possible during this time. After a few days, the character of the mucus changes: it becomes more viscous, resembling glue. In such mucus, spermatozoa cannot exist.

Further, the mucus continues to thin and becomes like a thick cream. Such mucus can be cloudy, white or yellowish. During this period, a feeling of moisture appears in the vagina, traces appear on the underwear. Such mucus is already suitable for the life of spermatozoa and their promotion. These days you should refrain from sexual activity.

During the period accompanying ovulation, the mucus becomes more watery, transparent, similar to egg white, viscous. There is a feeling of very strong moisture in the vagina, “slippery” sensations, very noticeable wet spots remain on the underwear. This type of mucus is most favorable for the life of spermatozoa, their movement and, consequently, for fertilization. This is the period of greatest fertility.

After ovulation, the amount of estrogen decreases sharply and the cervical mucus begins to change: it becomes thicker and quickly becomes “dry”.

Observing changes in cervical mucus is also useful because, knowing what kind of mucus is normal, a woman can quickly notice deviations caused by the inflammatory process.

When using the method, the following rules should be observed:

At the end of menstruation, up to 3 times a day, it is necessary to determine the nature of cervical mucus: wash your hands thoroughly with soap and take a sample of mucus from the vagina. It is possible to take a sample with a finger directly from the cervix;

Determine the quality of the mucus (liquid, sticky, "dry");

Check the consistency and viscosity of the mucus, for which you can simply spread your fingers apart;

Determine the amount and color of mucus;

Record the results of the study in detail: note the consistency of the mucus (dry, sticky, like a cream, like an egg white), its viscosity, the presence of stains on linen, sensations in the vagina (dry, wet, slippery);

In the absence of cervical mucus (“dry days”), conception is impossible.

The effectiveness of the method averages 85-95%, and with proper and regular use it reaches 98% (Bige-low J.L. et al., 2004; Fehring R.J. et al., 2004).

The symptothermal method of contraception is one of the most effective methods of natural family planning, since, unlike others, it takes into account not just one fertility indicator, but their combination.

When using the symptothermal method, the following indicators should be noted daily, related to:

Measurement of basal temperature;

The study of cervical mucus;

Change in the position of the cervix and its consistency;

Physiological indicators of ovulation.

The method is based on the change in these indicators throughout the entire menstrual cycle.

When using the symptothermal method, the position of the cervix and its consistency are determined. This sign allows you to more accurately decipher the temperature charts and changes in cervical mucus, it is an additional indicator of ovulation. For the accuracy of the determination, it is necessary to conduct observations during several menstrual cycles.

The difficulty lies in the correct interpretation of the state of the cervix. The position of the cervix depends on the level of sex hormones. The closer to ovulation, the higher the position of the cervix. After ovulation, the cervix descends again. In addition, as ovulation approaches, the cervix becomes softer.

When determining the condition of the cervix, the following rules must be followed.

Conduct a study daily, 1 time per day during the entire cycle, with the exception of menstruation, thoroughly washing your hands with soap and water;

Conduct research in the same position (the easiest option is squatting) at the same time;

Pay attention to the position and consistency of the cervix, the condition of the cervical mucus;

Be sure to record all indicators;

Do not conduct research in inflammatory and infectious diseases of the genital organs.

In addition to these signs, there are also so-called physiological indicators of ovulation. These symptoms should also be noted if they occur.

Additional physiological indicators of ovulation:

Increased sensitivity of the mammary glands and skin;

The onset of pain associated with ovulation, which can be sharp, dull, crampy. The cause of pain may be a rupture of the follicle and, as a result, irritation of the peritoneum;

Feeling of heaviness in the lower abdomen;

Bloody discharge from the vagina;

Bloating and water retention in the body;

Increased libido;

Increased performance.

Thus, when using the symptothermal method, it is necessary to measure daily basal temperature, determine the state of cervical mucus, the position and condition of the cervix, and additional physiological indicators of ovulation.

The effectiveness of the method, if performed correctly, reaches 93-98% (Mikolajczyk R.T. et al., 2003).

Coitus interruption method

This is a traditional natural method of family planning, the basic principle of which is that a man, during intercourse, removes the penis from the woman's vagina before he ejaculates, as a result of which sperm does not enter the vagina and fertilization does not occur.

The withdrawal method (MPPA) can be used by:

Couples who are highly motivated to use it and do not want to use other methods of contraception;

Couples whose religious beliefs do not allow them to use other methods of contraception;

Sexual partners who need immediate affordable contraception;

Couples using MPPA as a temporary and short-term method before using another method of contraception;

Couples who need to increase contraceptive effectiveness when using natural methods of contraception, spermicides;

Sexual partners who have infrequent sexual intercourse. Advantages of the method:

"the ability to use at any time;

No need for any special preparation;

Lack of systemic effects on the body of partners;

The possibility of its combination with other, insufficiently effective methods of contraception, such as natural methods;

No effect on lactation during breastfeeding;

No material costs when using the method. In addition, this method involves the involvement of a man

In family planning, which leads to closer relationships between partners and mutual understanding. Disadvantages of the method:

The need for high motivation of both partners to use it;

The possibility of sperm entering the vagina before ejaculation (especially with repeated sexual intercourse);

The probability of reducing the sharpness and incompleteness of the sec | sexual sensations;

Insecurity against sexually transmitted infections.

A significant drawback of the method is its low efficiency, which on average does not exceed 70-75%. At the same time, with the correct and regular use of MPPA, its effectiveness increases significantly - the Pearl index decreases to 4 (Ortayli N. et al., 2005).

Couples in need of highly effective contraception and, in particular, in cases where pregnancy poses a threat to the health of the woman;

Partners at high risk of contracting sexually transmitted infections;

Couples who wish to use methods that are not related to sexual intercourse;

Men who suffer from premature ejaculation and are unable to control it;

Men with any physical or mental disorders for which it is impossible to use this method.

Thus, despite the not insufficiently high efficiency of the coitus interruptus method, this method can be used by couples who are highly motivated and capable of performing it, in the absence of the risk of contracting sexually transmitted infections, rare sexual intercourse, both alone and in combination with others (natural , barrier) methods of contraception.

About 90% of women of childbearing age use any method of contraception. But despite this, 55% of pregnancies are unwanted. About 43% of pregnancies end in childbirth, 13% in spontaneous miscarriages, and 44% in medical (elective abortions).

There are numerous methods of contraception, but none of them is 100% effective. The theoretical effectiveness of contraceptives is somewhat greater than clinical, which is associated with the peculiarities of the individual use of these methods.

Natural methods of contraception

Natural methods of contraception include intermittent withdrawal, coitus interruptus, lactational amenorrhea, the rhythm method (symptothermal or calendar), and differ in that they use mechanical or chemical barriers. Many religious or philosophical couples use these methods of contraception, although they are the least effective.

Periodic withdrawal (rhythm method)

Operating principle. The rhythm method is a physiological method of contraception based on the fact that fertility is most likely during the periovulatory period, so it is during this period that abstinence is recommended. This method requires precise control of menstruation and instructing patients in the physiology of menstruation and fertilization and signs of ovulation. Signs of ovulation are determined by the nature of the cervical mucus (thin, clear mucus on the eve of ovulation), basal body temperature (increase above 37 ° C in the postovulatory phase), documentation of preovulatory (may be short-term pain, slight spotting) and premenstrual changes (premenstrual syndrome). The efficiency of this method is low - 55-80%.

Advantages and disadvantages ki. The advantages of the method are the absence of the use of exogenous both mechanical and chemical means, which is important for certain groups of people according to religious or philosophical beliefs. The disadvantages are the need for abstinence, the possibility of using only married couples, the need to learn methods of controlling ovulation, use only with regular.

Coitus interruptus

Coitus interruptus is the removal of the penis from the vagina before ejaculation - one of the oldest methods of contraception. Most of the seminal fluid is outside the female reproductive tract, reducing the chances of egg fertilization.

Efficiency. The application failure rate is 15-25% of cases, which may be due to the deposition of seminal fluid in the vagina (prejaculation) before orgasm or its deposition at the entrance to the vagina. The disadvantages of the method are the high failure rate and the need for self-control of ejaculation.

lactational amenorrhea

There is hypothalamic suppression of ovulation caused by breastfeeding. Extending the period of breastfeeding is used by many couples as a method of contraception.

Efficiency. The duration of the period of hypothalamic suppression of ovulation during the feeding period is highly variable. In 50% of lactating women, ovulation is restored 6-12 months after delivery, even if lactation continues. So, 15-55% of women who breastfeed can become pregnant.

An increase in the effectiveness of lactational amenorrhea can be achieved using certain principles:

1) breast milk should be the only food for a newborn (on demand and without a night break);

2) the duration of the use of this method should not exceed 6 months. If these principles are observed, the failure rate of the lactational amenorrhea method can be reduced to 2%.

Advantages and disadvantages. Lactational amenorrhea does not affect breastfeeding. But low efficiency in violation of the rhythm and nature of feeding a newborn reduces the number of supporters of this method.

barrier methods of contraception

The principle of operation of barrier methods of contraception is based on preventing sperm from entering the uterine cavity and further into the fallopian tubes and abdominal cavity.

Male condom (condom)

The effectiveness of latex male condoms is 85-90% and increases with strict adherence to the rules of use, avoiding semen leakage before using the condom, using condoms with spermicides, or when condoms and spermicides are used together.

Advantagesand shortcomings. Condom really protects against STDs, including HIV infection. The disadvantages are the possibility of hypersensitivity to latex, lubricants or that are part of the condom; the need to interrupt intercourse and a possible decrease in sensitivity.

female condom

The female condom is made of polyurethane and has 2 elastic rings on both sides. One ring is inserted deep into the vagina, and the other is placed near the entrance to the vagina. The effectiveness of women's condoms is somewhat less than men's, and the failure rate is 15-20%.

Advantagesand shortcomings. The female condom also protects against STDs; use is controlled by women. The disadvantages are its high cost and large size, the need to use immediately before sexual intercourse. Acceptability of this method of contraception is higher in men (75-80%) than in women (65-70%).

Vaginal diaphragm

The vaginal diaphragm is a round rubber or latex device surrounded by an elastic ring that is inserted into the vagina just before intercourse and covers the cervix. The diaphragm and spermicides should be inserted into the vagina immediately before intercourse and remain there for 6-8 hours after intercourse. If another sexual intercourse occurs within 6-8 hours after the first intercourse, additional spermicides are introduced into the vagina without removing the diaphragm.

Efficiency. Although the theoretical effectiveness of this method of contraception is 94%, the real one does not exceed 80-85%.

Advantages and disadvantages. A side effect of using a diaphragm can be bladder irritation, colonization of microorganisms, including Staphylococcus aureus, which can lead to the development of toxic shock syndrome. Women may be sensitive to latex, rubber, or spermicide. The diaphragm must be fitted and inserted by a physician and replaced every 5 years or when weight gain or loss is >5 kg. Women with pelvic prolapse cannot use this method of contraception.

Cervical caps

Cervical caps are small, soft rubber cups that fit directly over the cervix to prevent semen from entering the uterine cavity. Caps are selected by a doctor and applied together with a spermicidal gel. The effectiveness of using cervical caps is similar to vaginal diaphragms - 80-85%.

Advantagesand disadvantages. The cap can remain on the cervix for 1-2 days. But most women complain of an increase in vaginal discharge after the first day, inconvenience when inserting and withdrawing caps. The main reason for failures is a violation of the localization of the caps. In this regard, the frequency of using this method is low, 50-70% of women refuse to use it after the first attempt.

Spermicides

Spermicides can be presented in various forms - creams, gels, suppositories, foams and contraceptive films. The most widely used spermicides are nonoxynol-9 and octoxynol-9. These agents rupture the cell membranes of the spermatozoa and also act as a mechanical barrier in front of the cervical canal. Spermicides must be inserted into the vagina at least 30 minutes before sexual intercourse in order to be able to be dispersed into the vagina. Spermicides can be used as a separate method of contraception. But their effectiveness is greatly increased when used simultaneously with condoms, cervical caps, diaphragms and other contraceptive methods.

Advantagesand disadvantages. The advantages are the variability of forms and the cheapness of the method, the ability of nonoxynol-9 to reduce the risk of STDs, including the transmission of HIV infection. The disadvantages are the possibility of side effects (irritation of the vagina and external genitalia), a relatively high failure rate when used alone.

Intrauterine contraception (spiral)

(Navy) - a plastic device that often has a metal component (copper, silver, etc.) and is inserted into the uterine cavity using a special cannula - conductor. This helix has tendrils that help control localization (possibility of expulsion or migration) and facilitate removal of the IUD. The IUD has been used for contraception since 1800.

In modern practice, the most common 3 typesNavy:

1) Navy with copper (Multiload, Sorreg-T);

2) IUD with progesterone;

3) IUD with levonorgestrel (intrauterine system "Mirena").

About 100 million women worldwide use the IUD, making it one of the most popular methods of contraception. Usually it is used by patients with contraindications to the use of oral contraceptives, with a low risk of STDs, married, multiparous women.

Principleactions. The mechanism of action of the IUD has not been fully elucidated. It is believed that the IUD leads to a sterile inflammatory process in the endometrium, contributes to the immobilization of spermatozoa and their destruction by inflammatory cells. This reaction to a foreign body is enhanced by the addition of copper, progesterone or levonorgestrel, etc. to the IUD. The IUD does not affect ovulation and does not cause miscarriages.

Progesterone-containing IUDs increase the density of cervical mucus and cause atrophic changes in the endometrium, preventing implantation. The IUD can also reduce the movement of fluid in the fallopian tubes, which interferes with the transport of eggs, sperm, and blastocysts. Copper disrupts sperm motility and capacitation.

Levonorgestrel-containing IUDs should be administered in the first 7 days of the menstrual cycle or immediately after the termination of pregnancy. Copper-containing IUDs can be inserted on any day of the menstrual cycle after pregnancy has been ruled out, as well as immediately after an abortion or after childbirth, or 6 weeks after childbirth (“interval IUD insertion”).

EfficiencyNavy very high. The failure rate is 0.1-2% and is the smallest (0.1%) when using Mirena. But during the first year of use, the failure rate can be somewhat higher - up to 3%, which is associated with undiagnosed expulsions or dispositions of the IUD.

Advantagesand disadvantages. Side effects are rare but can be dangerous and cause pain, bleeding, pregnancy, IUD expulsion, perforation, and pelvic infection. Women who use an IUD have a greater risk of pelvic inflammatory disease associated with contamination of the endometrial cavity during IUD insertion. But, on the other hand, pelvic infections are rare during the first 20 days after IUD insertion.

Prophylactic administration of antibiotics (doxycycline or azithromycin) during IUD insertion helps prevent ascending infection. Before the introduction of the IUD, screening for STDs, especially gonorrhea and chlamydia, is mandatory. Modern progestin-containing IUDs may even reduce the risk of ascending infection by thickening cervical mucus.

The frequency of spontaneous abortions against the background of the IUD reaches 40-50% of cases. When pregnancy occurs against the background of the IUD, the latter should be removed by gentle traction on the antennae. The use of an IUD is not associated with an increased risk of congenital malformations. The intrauterine device is inserted by the doctor. This is a long-term method of contraception. "" is introduced every 5 years, IUD with progesterone - annually.

The IUD does not increase the risk of ectopic pregnancy, as previously thought, but on the contrary, it has some protective effect, although it is less than when using oral contraceptives. Mirena and progesterone-containing IUDs have a therapeutic effect on dysfunctional uterine bleeding in women of reproductive age.

Natural contraception is based on the characteristics and taking into account the physiological specifics of sexual intercourse and the period of female fertility - an increase or decrease in the likelihood of fertilization, depending on the period of the woman's menstrual cycle.

Natural contraception includes

• physiological method of preventing pregnancy
• coitus interruptus

Physiological method of preventing pregnancy

The physiological method is based on the fact that a woman has periods of the menstrual cycle during which she cannot become pregnant and sexual activity on such days is considered relatively safe. The essence of the physiological method is to refrain from sexual activity on those days when the probability of conception is highest.

To do this, the woman's menstrual cycle is studied, and the days of ovulation are determined - the most favorable period for conception. Days on which conception is not possible are called "safe" or fertile.

However, when determining the period of ovulation, taking into account the unequal duration of the first phase of the menstrual cycle in different women and even in the same woman in different menstrual cycles, in order to obtain more accurate data, it is necessary to observe at least 8-10 last cycles.

There are the following basic physiological methods for determining contraception:

• Calendar (rhythmic method)
• Method based on the measurement of basal temperature
• Method based on changes in cervical mucus
• Method of lactational amenorrhea after childbirth

Benefits of physiological methods of contraception:

• Does not require cash.
• Physiological methods of contraception are harmless.
• They have practically no contraindications and do not violate the chemical balance of the body.
• If contraception failed, you can give birth and not be afraid of a negative impact on the child, as with other methods of contraception.

Disadvantages of physiological methods of contraception:

• In order to master the method and study the graph of temperature fluctuations, certain skills and time are needed;
• The effectiveness of the method is low, because there is a high probability of error;
• The level of basal temperature can be affected by: stress, illness, climate change, alcohol intake the day before, insomnia;
• It is not recommended to focus on the calendar of "dangerous" and "safe" days after childbirth, since the menstrual cycle is not restored immediately, it may be irregular and its duration may differ from that before childbirth.
• Does not protect against sexually transmitted diseases.

Coitus interruptus

The essence of this method lies in the fact that the penis of a man during intercourse is removed from the vagina before ejaculation. Sperm does not enter the vagina and fertilization does not occur.

Efficiency: 70-85%

Benefits: This method of preventing unwanted pregnancy is available to almost everyone and does not require additional financial costs and medical advice.

Disadvantages: The effectiveness of this method depends entirely on the man and his experience. In addition, failures are possible due to the fact that a small part of the spermatozoa may be contained in the lubricant released during intercourse, so the effectiveness of the method is reduced because of this.

Also, in the process of sexual intercourse, there is some additional psycho-emotional burden on partners and the lack of complete satisfaction from sexual intercourse.

Even in the presence of an orgasm in both partners, with interrupted sexual intercourse, complete emptying of the genital tract from the blood that has flowed during sexual arousal does not occur. Subsequently, this affects the development in men of tendencies to accelerated ejaculation, and women may experience pain in the lower abdomen, in the lumbar region, menstrual irregularities, etc.

This method does not protect against sexually transmitted diseases.

About 43% of pregnancies end in childbirth, 13% in spontaneous miscarriages, and 44% in medical (elective abortions).
There are numerous methods of contraception, but none of them is 100% effective. The theoretical effectiveness of contraceptives is somewhat greater than the clinical one, which is associated with the peculiarities of the individual use of these methods.

Natural methods of contraception

Periodic withdrawal (rhythm method)

The effectiveness of this method of contraception is low - 55-80%.
Advantages and disadvantages. The advantages of the method are the absence of the use of exogenous both mechanical and chemical means, which is important for certain groups of people according to religious or philosophical beliefs. The disadvantages are the need for abstinence, the possibility of use only by married couples, the need for training in methods of controlling ovulation, use only with regular menstrual cycles.

Coitus interruptus

Efficiency. The failure rate with this method is 15-25% of cases, which may be due to the deposition of seminal fluid in the vagina (pre-ejaculation) before or with its deposition at the entrance to the vagina.
The disadvantages of the method are the high failure rate and the need for self-control of ejaculation.

lactational amenorrhea

Efficiency. The duration of the period of hypothalamic suppression of ovulation during the lactation period is highly variable. In 50% of lactating women, ovulation is restored 6-12 months after delivery, even if lactation continues. So, 15-55% of women who breastfeed can become pregnant. An increase in the effectiveness of lactational amenorrhea can be achieved using certain principles: 1) breast milk should be the only food of the newborn (on demand and without a night break); 2) the duration of the use of this method of contraception should not exceed 6 months. If these principles are observed, the failure rate of the lactational amenorrhea method can be reduced to 2%.

Advantages and disadvantages. Lactational amenorrhea does not affect breastfeeding. But low efficiency in violation of the rhythm and nature of feeding a newborn reduces the number of supporters of this method.