Diaphragm (birth control)
The diaphragm is a barrier method of birth control. It is moderately effective, with a one-year failure rate of around 12% with typical use, it is placed over the cervix with spermicide before sex and left in place for at least six hours after sex. Fitting by a healthcare provider is required. Side effects are very few. Use may increase the risk of urinary tract infections. If left in the vagina for more than 24 hours toxic shock syndrome may occur. While use may decrease the risk of sexually transmitted infections, it is not effective at doing so. There are a number of types of diaphragms with different spring designs, they may be made from silicone, or natural rubber. They work by holding spermicide near the cervix; the diaphragm came into use around 1882. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. In the United Kingdom they cost the NHS less than 10 pounds each. In the United States they cost about 15 to 75 USD and are the birth control method of 0.3% of people.
These costs do not include that of spermicide. Before inserting or removing a diaphragm, one should first wash one's hands to avoid introducing harmful bacteria into the vaginal canal; the rim of a diaphragm is squeezed into an arc shape for insertion. A water-based lubricant may be applied to the rim of the diaphragm to aid insertion. One teaspoon of spermicide may be placed in the dome of the diaphragm before insertion, or with an applicator after insertion; the diaphragm must be inserted sometime before sexual intercourse, remain in the vagina for 6 to 8 hours after a man's last ejaculation. For multiple acts of intercourse, it is recommended that an additional 5 mL of spermicide be inserted into the vagina before each act. Upon removal, a diaphragm should be cleansed with warm mild soapy water before storage; the diaphragm must be removed for cleaning at least once every 24 hours and can be re-inserted immediately. Oil-based products should not be used with latex diaphragms. Lubricants or vaginal medications that contain oil will cause the latex to degrade and increases the chances of the diaphragm breaking or tearing.
Natural latex rubber will degrade over time. Depending on usage and storage conditions, a latex diaphragm should be replaced every one to three years. Silicone diaphragms may last much longer—up to ten years; the effectiveness of diaphragms, as of most forms of contraception, can be assessed two ways: method effectiveness and actual effectiveness. The method effectiveness is the proportion of couples and using the method who do not become pregnant. Actual effectiveness is the proportion of couples who intended that method as their sole form of birth control and do not become pregnant. Rates are presented for the first year of use. Most the Pearl Index is used to calculate effectiveness rates, but some studies use decrement tables. For all forms of contraception, actual effectiveness is lower than method effectiveness, due to several factors: mistakes on the part of those providing instructions on how to use the method mistakes on the part of the method's users conscious user non-compliance with methodFor instance, someone using a diaphragm might be fitted incorrectly by a health care provider, or by mistake remove the diaphragm too soon after intercourse, or choose to have intercourse without placing the diaphragm.
Contraceptive Technology reports that the method failure rate of the diaphragm with spermicide is 6% per year. The actual pregnancy rates among diaphragm users vary depending on the population being studied, with yearly rates of 10% to 39% being reported. Unlike some other cervical barriers, the effectiveness of the diaphragm is the same for women who have given birth as for those who have not; the diaphragm does not interfere with a woman's natural cycle, therefore, no reversal or wait time is necessary, if contraception is no longer wanted or needed. The diaphragm only has to be used during intercourse. Many women those who have sex less prefer barrier contraception such as the diaphragm over methods that require some action every day. Like all cervical barriers, diaphragms may be inserted several hours before use, allowing uninterrupted foreplay and intercourse. Most couples find; the diaphragm is less expensive than many other methods of contraception. There is some evidence that the cells in the cervix are susceptible to certain sexually transmitted infections.
Cervical barriers such as diaphragms may offer some protection against these infections. However, research conducted to test whether the diaphragm offers protection from HIV found that women provided with both male condoms and a diaphragm experienced the same rate of HIV infection as women provided with male condoms alone; because pelvic inflammatory disease is caused by certain STIs, diaphragms may lower the risk of PID. Cervical barriers may protect against human papillomavirus, the virus that causes cervical cancer, although the protection appears to be due to the spermicide used with diaphragms and not the barrier itself. Diaphragms are considered a good candidate as a delivery method for microbicides that are in development. Women who are allergic to latex should not use a latex diaphragm. Diaphragms are associated with an increased risk of urinary tract infection Urinating before inserti
Fertility awareness refers to a set of practices used to determine the fertile and infertile phases of a woman's menstrual cycle. Fertility awareness methods may be used to avoid pregnancy, to achieve pregnancy, or as a way to monitor gynecological health. Methods of identifying infertile days have been known since antiquity, but scientific knowledge gained during the past century has increased the number and variety of methods. Systems of fertility awareness rely on observation of changes in one or more of the primary fertility signs, tracking menstrual cycle length and identifying the fertile window based on this information, or both. Other signs may be observed: these include breast tenderness and mittelschmerz, urine analysis strips known as ovulation predictor kits, microscopic examination of saliva or cervical fluid. Available are computerized fertility monitors. Symptoms-based methods involve tracking one or more of the three primary fertility signs: basal body temperature, cervical mucus, cervical position.
Systems relying on cervical mucus include the Billings Ovulation Method, the Creighton Model, the Two-Day Method. Symptothermal methods combine observations of basal body temperature, cervical mucus, sometimes cervical position. Calendar-based methods rely on tracking a woman's cycle and identifying her fertile window based on the lengths of her cycles; the best known of these methods is the Standard Days Method. The Calendar-Rhythm method is considered a calendar-based method, though it is not well defined and has many different meanings to different people. Systems of fertility awareness may be referred to as fertility awareness–based methods; the term natural family planning is sometimes used to refer to any use of FA methods, the Lactational amenorrhea method and periodic abstinence during fertile times. A method of FA may be used by NFP users to identify these fertile times. Women who are breastfeeding a child and wish to avoid pregnancy may be able to practice the lactational amenorrhea method.
LAM is distinct from fertility awareness, but because it does not involve contraceptives, it is presented alongside FA as a method of "natural" birth control. Within the Catholic Church and some Protestant denominations, the term Natural Family Planning is used to refer to Fertility Awareness pointing out it is the only method of Family Planning approved by the Church, it is not known when it was first discovered that women have predictable periods of fertility and infertility. It is clearly stated in the Talmud tractate Niddah, that a woman only becomes pregnant in specific periods in the month, which refers to ovulation. St. Augustine wrote about periodic abstinence to avoid pregnancy in the year 388. One book states that periodic abstinence was recommended "by a few secular thinkers since the mid-nineteenth century," but the dominant force in the twentieth century popularization of fertility awareness-based methods was the Roman Catholic Church. In 1905 Theodoor Hendrik van de Velde, a Dutch gynecologist, showed that women only ovulate once per menstrual cycle.
In the 1920s, Kyusaku Ogino, a Japanese gynecologist, Hermann Knaus, from Austria, independently discovered that ovulation occurs about fourteen days before the next menstrual period. Ogino used his discovery to develop a formula for use in aiding infertile women to time intercourse to achieve pregnancy. In 1930, John Smulders, Roman Catholic physician from the Netherlands, used this discovery to create a method for avoiding pregnancy. Smulders published his work with the Dutch Roman Catholic medical association, this was the first formalized system for periodic abstinence: the rhythm method. In the 1930s, Reverend Wilhelm Hillebrand, a Catholic priest in Germany, developed a system for avoiding pregnancy based on basal body temperature; this temperature method was found to be more effective at helping women avoid pregnancy than were calendar-based methods. Over the next few decades, both systems became used among Catholic women. Two speeches delivered by Pope Pius XII in 1951 gave the highest form of recognition to the Catholic Church's approval—for couples who needed to avoid pregnancy—of these systems.
In the early 1950s, John Billings discovered the relationship between cervical mucus and fertility while working for the Melbourne Catholic Family Welfare Bureau. Billings and several other physicians, including his wife, Dr. Evelyn Billings, studied this sign for a number of years, by the late 1960s had performed clinical trials and begun to set up teaching centers around the world. While Dr. Billings taught both the temperature and mucus signs, they encountered problems in teaching the temperature sign to illiterate populations in developing countries. In the 1970s they modified the method to rely on only mucus; the international organization founded by Dr. Billings is now known as the World Organization Ovulation Method Billings; the first organization to teach a symptothermal method was founded in 1971. John and Sheila Kippley, lay Catholics, joined with Dr. Konald Prem in teaching an observational method that relied on all three signs: temperature and cervical position, their organization is now called Couple to Couple League International.
The next decade saw the founding of other now-large Catholic organizations, Family of the Americas, teaching the Billings method, the Pope Paul VI Institute, teaching a new m
Lactational amenorrhea is the temporary postnatal infertility that occurs when a woman is amenorrheic and breastfeeding. Breastfeeding delays the resumption of normal ovarian cycles by disrupting the pattern of pulsatile release of GnRH from the hypothalamus and hence LH from the pituitary; the plasma concentrations of FSH during lactation are sufficient to induce follicle growth, but the inadequate pulsatile LH signal results in a reduced estradiol production by these follicles. When follicle growth and estradiol secretion does increase to normal, lactation prevents the generation of a normal preovulatory LH surge and follicles either fail to rupture, or become atretic or cystic. Only when lactation declines sufficiently to allow generation of a normal preovulatory LH surge to occur will ovulation take place with the formation of a corpus luteum of variable normality, thus lactation delays the resumption of normal ovarian cyclicity by disrupting but not inhibiting, the normal pattern of release of GnRH by the hypothalamus.
The mechanism of disruption of GnRH release remains unknown. In women, hyperprolactinemia is associated with amenorrhea, a condition that resembles the physiological situation during lactation. Mechanical detection of suckling increases prolactin levels in the body to increase milk synthesis. Excess prolactin may inhibit the menstrual cycle directly, by a suppressive effect on the ovary, or indirectly, by decreasing the release of GnRH. Suckling intensity directly correlates with the duration of the amenorrheal period following birth. Suckling intensity has several dynamic components: frequency of suckling, duration of the suckling bout, duration of suckling in a 24 hour period, it is not clear. Suckling intensity is variable across populations. Studies of U. S. and Scottish women show that at least six bouts per day and 60 minutes of suckling in a 24 hour period will sustain amenorrhea. Concurrent studies of! Kung women in Botswana and Gainj women in Papua New Guinea have shown that frequent short suckling bouts of about 3 minutes, 40 to 50 times per day correlate with typical amenorrhea of up to two years postpartum.
When an infant suckles, sensory receptors in the nipple send a signal to the anterior pituitary gland in the brain, which secretes prolactin and oxytocin. Prolactin and oxytocin trigger the release of milk and its ejection from the nipple in a positive feedback loop, it was thought that prolactin hormone, released by the anterior pituitary in response to the direct nerve stimulation of suckling, was responsible for creating the hormonal pathways necessary to sustain amenorrhea. Now, however, it seems that this relationship is one of correlation not causation as prolactin levels in the blood plasma are an indicator of suckling frequency. Suckling, the subsequent release of prolactin, is not directly responsible for postpartum infecundity. Rather it is one mechanism that increases milk production, thereby increasing the metabolic cost of breastfeeding to mothers, which contributes to sustained infecundity. Suckling as proxy indicator of infecundity rather than a direct, hormonal causal factor is supported in studies contrasting the nursing intensity hypothesis, which says that more intense breastfeeding will result in a longer period of lactational amenorrhea, the metabolic load model, which posits that maternal energy availability will be the main factor determining postpartum amenorrhea and the timing of the return of ovarian function.
Postpartum ovarian function and the return of fecundity depend on maternal energy availability. This is due to the consistent metabolic costs of milk production across populations, which fluctuate but represent a significant cost to the mother; the metabolic load hypothesis states that women with more available energy or caloric/metabolic resources will resume ovarian function sooner, because breastfeeding represents a proportionally lower burden on their overall metabolic function. Women with less available energy experience a proportionally higher burden due to breastfeeding and therefore have less surplus metabolic energy to invest in continued reproduction; the metabolic load model is therefore consistent with the nursing intensity hypothesis, in that more intense nursing increases the relative metabolic burden of breastfeeding on the mother. It takes into account the overall energy supply of the mother in determining whether she has enough caloric/metabolic resources available to her to make reproduction possible.
If net energy supply is high enough, a woman will resume ovarian cycling sooner despite still breastfeeding the current infant. Amenorrhea itself is not an indicator of infecundity, as the return of ovarian cycling is a gradual process and full fecundity may occur before or after first postpartum menses. Additionally, spotting or the appearance of first postpartum menses can be a result of either lochia or estrogen withdrawal and not actual ovulation. Lactational amenorrhea has evolved as a mechanisms for preserving the health of the mother; this period of infecundity allows the mother to focus her energy on breastfeeding as well as allow time for her body to heal between births. The frequency and durations of the feedings determine how long the mother will continue to be infecund during breastfeeding; however there is variation across different cultures. The Turkana and Quechua societies all breastfeed on demand until their child is around 2 years old; the timing of returned ovulation for these women is however varied.
Because of this interbirth intervals vary across these three societies. Return of menstruation following
Mathematics includes the study of such topics as quantity, structure and change. Mathematicians use patterns to formulate new conjectures; when mathematical structures are good models of real phenomena mathematical reasoning can provide insight or predictions about nature. Through the use of abstraction and logic, mathematics developed from counting, calculation and the systematic study of the shapes and motions of physical objects. Practical mathematics has been a human activity from as far back; the research required to solve mathematical problems can take years or centuries of sustained inquiry. Rigorous arguments first appeared in Greek mathematics, most notably in Euclid's Elements. Since the pioneering work of Giuseppe Peano, David Hilbert, others on axiomatic systems in the late 19th century, it has become customary to view mathematical research as establishing truth by rigorous deduction from appropriately chosen axioms and definitions. Mathematics developed at a slow pace until the Renaissance, when mathematical innovations interacting with new scientific discoveries led to a rapid increase in the rate of mathematical discovery that has continued to the present day.
Mathematics is essential in many fields, including natural science, medicine and the social sciences. Applied mathematics has led to new mathematical disciplines, such as statistics and game theory. Mathematicians engage in pure mathematics without having any application in mind, but practical applications for what began as pure mathematics are discovered later; the history of mathematics can be seen as an ever-increasing series of abstractions. The first abstraction, shared by many animals, was that of numbers: the realization that a collection of two apples and a collection of two oranges have something in common, namely quantity of their members; as evidenced by tallies found on bone, in addition to recognizing how to count physical objects, prehistoric peoples may have recognized how to count abstract quantities, like time – days, years. Evidence for more complex mathematics does not appear until around 3000 BC, when the Babylonians and Egyptians began using arithmetic and geometry for taxation and other financial calculations, for building and construction, for astronomy.
The most ancient mathematical texts from Mesopotamia and Egypt are from 2000–1800 BC. Many early texts mention Pythagorean triples and so, by inference, the Pythagorean theorem seems to be the most ancient and widespread mathematical development after basic arithmetic and geometry, it is in Babylonian mathematics that elementary arithmetic first appear in the archaeological record. The Babylonians possessed a place-value system, used a sexagesimal numeral system, still in use today for measuring angles and time. Beginning in the 6th century BC with the Pythagoreans, the Ancient Greeks began a systematic study of mathematics as a subject in its own right with Greek mathematics. Around 300 BC, Euclid introduced the axiomatic method still used in mathematics today, consisting of definition, axiom and proof, his textbook Elements is considered the most successful and influential textbook of all time. The greatest mathematician of antiquity is held to be Archimedes of Syracuse, he developed formulas for calculating the surface area and volume of solids of revolution and used the method of exhaustion to calculate the area under the arc of a parabola with the summation of an infinite series, in a manner not too dissimilar from modern calculus.
Other notable achievements of Greek mathematics are conic sections, trigonometry (Hipparchus of Nicaea, the beginnings of algebra. The Hindu–Arabic numeral system and the rules for the use of its operations, in use throughout the world today, evolved over the course of the first millennium AD in India and were transmitted to the Western world via Islamic mathematics. Other notable developments of Indian mathematics include the modern definition of sine and cosine, an early form of infinite series. During the Golden Age of Islam during the 9th and 10th centuries, mathematics saw many important innovations building on Greek mathematics; the most notable achievement of Islamic mathematics was the development of algebra. Other notable achievements of the Islamic period are advances in spherical trigonometry and the addition of the decimal point to the Arabic numeral system. Many notable mathematicians from this period were Persian, such as Al-Khwarismi, Omar Khayyam and Sharaf al-Dīn al-Ṭūsī. During the early modern period, mathematics began to develop at an accelerating pace in Western Europe.
The development of calculus by Newton and Leibniz in the 17th century revolutionized mathematics. Leonhard Euler was the most notable mathematician of the 18th century, contributing numerous theorems and discoveries; the foremost mathematician of the 19th century was the German mathematician Carl Friedrich Gauss, who made numerous contributions to fields such as algebra, differential geometry, matrix theory, number theory, statistics. In the early 20th century, Kurt Gödel transformed mathematics by publishing his incompleteness theorems, which show that any axiomatic system, consistent will contain unprovable propositions. Mathematics has since been extended, there has been a fruitful interaction between mathematics and science, to
The contraceptive sponge combines barrier and spermicidal methods to prevent conception. Three brands are marketed: Pharmatex and Today. Pharmatex is marketed in the province of Quebec. Sponges work in two ways. First, the sponge is inserted into the vagina, so it can cover the cervix and prevent any sperm from entering the uterus. Secondly, the sponge contains spermicide; the sponges are inserted vaginally prior to intercourse and must be placed over the cervix to be effective. Sponges provide no protection from sexually transmitted infections. Sponges can provide contraception for multiple acts of intercourse over a 24 hour period, but cannot be reused beyond that time or once removed; the manufacturer of the Today sponge reports effectiveness for prevention of pregnancy of 89% to 91% when used and consistently. When packaging directions are not followed for every act of intercourse, effectiveness rates of 84% to 87% are reported. Other sources cite poorer effectiveness rates for women who have given birth: 74% during correct and consistent use, 68% during typical use.
Studies of Protectaid have found effectiveness rates of 77% to 91%. Studies of Pharmatex have found perfect use effectiveness rates of over 99% per year. Typical use of Pharmatex results in effectiveness of 81% per year. Sponges may be used in conjunction with another method of birth control such as condoms to increase effectiveness. To use the Today sponge, it must be run under water until wet, about 2 tablespoons; the water is used as a mechanism to activate the spermicide inside the sponge. No extra spermicide is needed; the Protectaid and Pharmatex sponges come ready to use. The sponge can be inserted up to 24 hours before intercourse, it must be left in place for at least six hours after intercourse. It should not be worn for more than 30 hours in a row; the sponge should never be reused. The devices have had periods of unavailability in some markets since being introduced. All three brands are available outside their normal marketing areas through internet retailers; the Today Sponge was developed beginning in 1976 and introduced in the United States in 1983.
Today was removed from the market in 1994 due to manufacturing problems. Following several delays, the Today brand became available again in Canada in March 2003, in the U. S. in September 2005. After the manufacturer's parent company declared bankruptcy in 2007, production was shut down again, until the new manufacturer, Mayer Laboratories Ltd. reintroduced Today to the U. S. market in 2009. The Pharmatex sponge was introduced in France and the Canadian province of Quebec in 1984; the Protectaid sponge was introduced in Canada in 1996, in Europe in 2000. Sponges are a physical barrier, trapping sperm and preventing their passage through the cervix into the reproductive system; the spermicide is an important component of pregnancy prevention. The Today sponge contains 1,000 milligrams of nonoxynol-9. Protectaid contains 5,000 mg of the F-5 gel, with three active ingredients. Pharmatex contains 60 mg of benzalkonium chloride; some people are allergic to the spermicide used in the sponge. Women who use contraceptive sponges have an increased risk of yeast infection and urinary tract infection.
Improper use, such as leaving the sponge in too long, can result in toxic shock syndrome. The Today sponge contains the spermicide nonoxynol-9, which may contain certain risks for those using the sponge multiple times a day, or for those at risk for HIV. In these cases, nonoxynol-9 can irritate the tissue, which leads to an increased risk of HIV and other sexually transmitted infections. Shortly after they were taken off the U. S. market, the sponge was featured in an episode of the sitcom Seinfeld titled "The Sponge". In the episode, Elaine Benes conserves her remaining Today sponges by choosing to not have intercourse unless she is certain her partner is "sponge-worthy"; this was revisited in the series finale when the pharmacist testifies against Elaine and her morality for buying a whole case of the sponges. The film Clueless features a scene where the characters Dionne and Tai are discussing sex and Dionne is heard to ask Tai if the sponge would still work if the user has sex in water. On the TV series My So-Called Life, the doctor tells Angela to use a sponge if she's thinking of having sex.
Pregnancy – 4aaq.com Spongeworthiness – Salon.com The Contraceptive Sponge – DrDonnica.com Contraceptive Sponges – FAQ thread on Ovusoft.com message boards
A condom is a sheath-shaped barrier device, used during sexual intercourse to reduce the probability of pregnancy or a sexually transmitted infection. There are both female condoms. With proper use—and use at every act of intercourse—women whose partners use male condoms experience a 2% per-year pregnancy rate. With typical use the rate of pregnancy is 18% per-year, their use decreases the risk of gonorrhea, trichomoniasis, hepatitis B, HIV/AIDS. They to a lesser extent protect against genital herpes, human papillomavirus, syphilis; the male condom is rolled onto an erect penis before intercourse and works by blocking semen from entering the body of a sexual partner. Male condoms are made from latex and less from polyurethane or lamb intestine. Male condoms have the advantages of ease of use, easy to access, few side effects. In those with a latex allergy a polyurethane or other synthetic version should be used. Female condoms are made from polyurethane and may be used multiple times. Condoms as a method of preventing STIs have been used since at least 1564.
Rubber condoms became available followed by latex condoms in the 1920s. They are on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system; the wholesale cost in the developing world is about 0.03 to US$0.08 each. In the United States condoms cost less than US$1.00. Globally less than 10% of those using birth control are using the condom. Rates of condom use are higher in the developed world. In the United Kingdom the condom is the second most common method of birth control while in the United States it is the third most common. About six to nine billion are sold a year; the effectiveness of condoms, as of most forms of contraception, can be assessed two ways. Perfect use or method effectiveness rates only include people who use condoms properly and consistently. Actual use, or typical use effectiveness rates are of all condom users, including those who use condoms incorrectly or do not use condoms at every act of intercourse.
Rates are presented for the first year of use. Most the Pearl Index is used to calculate effectiveness rates, but some studies use decrement tables; the typical use pregnancy rate among condom users varies depending on the population being studied, ranging from 10 to 18% per year. The perfect use pregnancy rate of condoms is 2% per year. Condoms may be combined with other forms of contraception for greater protection. Condoms are recommended for the prevention of sexually transmitted infections, they have been shown to be effective in reducing infection rates in both women. While not perfect, the condom is effective at reducing the transmission of organisms that cause AIDS, genital herpes, cervical cancer, genital warts, chlamydia and other diseases. Condoms are recommended as an adjunct to more effective birth control methods in situations where STD protection is desired. According to a 2000 report by the National Institutes of Health, consistent use of latex condoms reduces the risk of HIV/AIDS transmission by 85% relative to risk when unprotected, putting the seroconversion rate at 0.9 per 100 person-years with condom, down from 6.7 per 100 person-years.
Analysis published in 2007 from the University of Texas Medical Branch and the World Health Organization found similar risk reductions of 80–95%. The 2000 NIH review concluded that condom use reduces the risk of gonorrhea for men. A 2006 study reports that proper condom use decreases the risk of transmission of human papillomavirus to women by 70%. Another study in the same year found consistent condom use was effective at reducing transmission of herpes simplex virus-2 known as genital herpes, in both men and women. Although a condom is effective in limiting exposure, some disease transmission may occur with a condom. Infectious areas of the genitals when symptoms are present, may not be covered by a condom, as a result, some diseases like HPV and herpes may be transmitted by direct contact; the primary effectiveness issue with using condoms to prevent STDs, however, is inconsistent use. Condoms may be useful in treating precancerous cervical changes. Exposure to human papillomavirus in individuals infected with the virus, appears to increase the risk of precancerous changes.
The use of condoms helps promote regression of these changes. In addition, researchers in the UK suggest that a hormone in semen can aggravate existing cervical cancer, condom use during sex can prevent exposure to the hormone. Condoms may slip off the penis after ejaculation, break due to improper application or physical damage, or break or slip due to latex degradation; the rate of breakage is between 0.4% and 2.3%, while the rate of slippage is between 0.6% and 1.3%. If no breakage or slippage is observed, 1–3% of women will test positive for semen residue after intercourse with a condom."Double bagging", using two condoms at once, is believed to cause a higher rate of failure due to the friction of rubber on rubber. This claim is not supported by research; the limited studies that have been done found that the simultaneous use of multiple condoms decreases the risk of condom breakage. Different modes of condom failure result in different levels of semen exposure. If a failure occurs during application, the damaged condom may be disposed of and a new condom applied before intercourse begins – such failures pose no risk to
Comparison of birth control methods
There are many different methods of birth control, which vary in what is required of the user, side effects, effectiveness. It is important to note that not each type of birth control is ideal for each user. Outlined here are the different types of barrier methods, spermicides, or coitus interruptus that must be used at or before every act of intercourse. Immediate contraception, like physical barriers, include diaphragms, the contraceptive sponge, female condoms may be placed several hours before intercourse begins; the female condom should be removed after intercourse, before arising. Some other female barrier methods must be left in place for several hours after sex. Depending on the form of spermicide used, they may be applied several minutes to an hour before intercourse begins. Additionally, the male condom should be applied when the penis is erect so that it is properly applied prior to intercourse. With an insertion of an IUD, female or male sterilization, or hormone implant, there is little required of the user post initial procedure.
Intrauterine methods require clinic visits for installation and removal or replacement only once every several years, depending on the device. This allows the user to be able to try and become pregnant if they so desire, upon removal of the IUD. Conversely, sterilization is a permanent procedure. After the success of surgery is verified, no subsequent action is required of users. Implants provide effective birth control for three years without any user action between insertion and removal of the implant. Insertion and removal of the Implant involves a minor surgical procedure. Oral contraceptives require some action every day. Other hormonal methods require less frequent action - weekly for the patch, twice a month for vaginal ring, monthly for combined injectable contraceptive, every twelve weeks for MPA shots. Fertility awareness-based methods require some action every day to monitor and record fertility signs; the lactational amenorrhea method requires breast feeding at least every four to six hours.
Different methods require different levels of diligence by users. Methods with little or nothing to do or remember, or that require a clinic visit less than once per year are said to be non-user dependent, forgettable or top-tier methods. Intrauterine methods and sterilization fall into this category. For methods that are not user dependent, the actual and perfect-use failure rates are similar. Many hormonal methods of birth control, LAM require a moderate level of thoughtfulness. For many hormonal methods, clinic visits must be made every three months to a year to renew the prescription; the pill must be taken every day, the patch must be reapplied weekly, or the ring must be replaced monthly. Injections are required every 12 weeks; the rules for LAM must be followed every day. Both LAM and hormonal methods provide a reduced level of protection against pregnancy if they are used incorrectly; the actual failure rates for LAM and hormonal methods are somewhat higher than the perfect-use failure rates.
Higher levels of user commitment are required for other methods. Barrier methods, coitus interruptus, spermicides must be used at every act of intercourse. Fertility awareness-based methods may require daily tracking of the menstrual cycle; the actual failure rates for these methods may be much higher than the perfect-use failure rates. Different forms of birth control have different potential side effects. Not all, or most, users will experience side effects from a method; the less effective the method, the greater the risk of the side-effects associated with pregnancy. Minimal or no other side effects are possible with coitus interruptus, fertility awareness-based, LAM; some forms of periodic abstinence encourage examination of the cervix. Following the rules for LAM may delay a woman's first post-partum menstruation beyond what would be expected from different breastfeeding practices. Barrier methods have a risk of allergic reaction. Users sensitive to latex may use barriers made of less allergenic materials - polyurethane condoms, or silicone diaphragms, for example.
Barrier methods are often combined with spermicides, which have possible side effects of genital irritation, vaginal infection, urinary tract infection. Sterilization procedures are considered to have low risk of side effects, though some persons and organizations disagree. Female sterilization is a more significant operation than vasectomy, has greater risks. After IUD insertion, users may experience irregular periods in the first 3–6 months with Mirena, sometimes heavier periods and worse menstrual cramps with ParaGard. However, "ninety-nine percent of IUD users are pleased with them". A positive characteristic of IUDs is that fertility and the ability to become pregnant returns once the IUD is removed; because of their systemic nature, hormonal methods have the largest number of possible side effects. Male and female condoms provide significant protection against sexually transmitted diseases when used and correctly, they provide some protection against cervical cancer. Condoms are recommended as an adjunc