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Case Study: A healthy couple seeks advice on contraceptive strategies &…

- - - - Happily married
        
        This is good information to know b/c it shows that this couple may have a better chance of being more committed to a more permanent option of birth control
        
        Another clue this gives is that the couple may be quite sexually active
        
        Meaning that they may need a birth control that is either more permanent or something that provides a low or no risk of conception
        
        At this point they most likely want to steer clear of condoms for sure
      - Currently utilizing birth control
        
        Being that she has already been exploring w/this option shows she ready to move forward w/a different method
        
        Being that the patient sounds concerned about the risks associated w/birth control, she may be seeking for more natural alternatives
      - Age
        
        Being that the patient is in her 40's, it seems that she may of had already put much thought into this consideration
        
        The patient is possibly close to the average menopause age
        
        Therefore, this can mean that she may not want to go through the process of permanent birth control
        
        In this case, if the couple is exploring permanent birth control options, it may be worth her husband getting a vasectomy
      - Have 2 already almost grown kids
        
        Being that the couple seems to have prior experience w/kids & these kids are most likely teens
        
        Which may compel the couple to explore more permanent birth control options if they do not object to that
      - Health
        
        Sounds like the couple has more options to work w/birth control being that they seem to be in good health
        
        What this could mean for
        
        Patient
        
        Being healthy can possibly mean that she is quite fertile
        
        Patient's husband
        
        For him, it could mean that his reproductive organs may be in great condition to produce viable sperm capable of inseminating her easily
- - - - Process
        
        2) Either the vas deferens are cut through & ligated or the deferens is cauterized
        
        Sperm will still be produced however, they will not be able to reach the exterior of the body. They deteriorate & are phagocytoced
        
        1) A small incision is made in the scrotum
      - Reason
        
        I would say it is safer for the male to get the permanent birth control because they don't have to worry about hormones being in the vas deferens like the women have to worry about the hormones progesterone & estrogen in the ovaries
        
        I deduce that going w/this permanent option is the best choice being that it will not affect the patient's uterine cycle
        
        To add to that, the couple would not have to worry about the effectiveness of the method
        
        Also due to the reason the couple have kids & therefore had experience raising them at this point should make it easier for them to decide on a permanent option
        
        Another idea to add to this case is that the couple both are above their 30s so they may be more sure about their choice
    - - Process
        
        The patient would need to be precise in calculating her cycle
        
        So starting from day 1 of menstruation
        
        From there, count -> 28 days, subtract 14
        
        On the 12th -14th day of ovarian cycle, the couple would have to refrain from intercourse to avoid pregnancy
        
        This is what I would deem to be effective, if done right & consistently b/c the oocyte is only viable for 12-24 hours after ejaculated from ovary
        
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      - Reason
        
        Usually I would be against this b/c there are is a risk still of getting pregnant
        
        However, it could be a very low one if done absolutely correct
        
        This could be an option due to the patient possibly not being to far off from menopause
        
        This way, the patient would not have to worry about anything disrupting her hormones
        
        & Being that the patient is healthy, I would not want to disrupt that if it can be avoided
      - Feedback: Many claim to use this method yet come out pregnant
        
        So I would have a physician help w/this process to make certain the patient is on the right track
    - - Reason
        
        This seems to have safer effects than methods containing estrogen & progesterone
        
        These thicken the cervical mucus so as to block sperm from entering the uterus & make it harder for implantation
        
        This is a better option than using estrogen along w/it b/c there is less long term effects & symptoms
        
        This method is one of the most effective means of contraceptive
  - - - Reason
        
        This do not recommend this to be a good option b/c these contain estrogen & progesterone
        
        If estrogen & progesterone are taken together, they trick the HPG axis into making it seem as the the woman is pregnant
        
        Both of these together can really disrupt the uterine cycle & other hormones
        
        This can lead to intolerable side effects
        
        Such as hypertension & nausea
        
        Another reason is that these pills can cause adverse cardiovascular effects
    - - Reason
        
        This method is unreliable b/c
        
        Control of ejaculation is not ensured
        
        It can cause stress b/c the couple may always be wondering any semen seeped in
    - - Reason
        
        Part of the blood supply is removed from ovaries
        
        This can be a major issue b/c the ovary may not get the O2 or nutrients it need to function properly
        
        This this affect progesterone levels causing it to lower
        
        Could lead to premenopausal systoms
        
        Migraines
        
        Fatigue
        
        Playing with sex hormones can throw some of the body's homeostatic rhythms out of place
        
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        Hot flashes
        
        This could lead to unbalance between progesterone & estrogen
        
        These two need to work together in order to maintain balance not only for the reproductive organs but the other organs that work in tandem w/the reproductive organs
        
        Once these are not in a rhythmic balance, the body can produce proteins that block cells ability to use thyroid hormone
        
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      - If this was an option that was heavily wanted, I would add some natural thyroid & progesterone to the mix so that the hormones can be in balance
- - - - Structures of reproductive structures
        
        Female
        
        Uterine tubes
        
        3 regions
        
        Infundibulum
        
        This is the opening of the tube into the peritoneal cavity
        
        The margin of it is surrounded by ciliated projections called fimbriae
        
        Ampulla
        
        Next to infundibulum, this is the fertilization site
        
        Isthmus
        
        This empties into the superolateral region of uterus
        
        Fallopian tubes (oviducts)
        
        They recieve the ovulated oocyte & is the site where fertilization occurs
        
        Bends around ovary during ovulation to capture the oocyte while fimbriae sweep the the ovarian surface
        
        These tubes are covered by peritoneum & supported by the mesosalpinx (a broad ligament)
        
        Uterus (womb)
        
        Wall of uterus
        
        Composed of 3 layers
        
        Myometrium
        
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        Perimetrium
        
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        Endometrium
        
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        A hollow, thick walled muscular organ that receives, retains & nourishes a fertilized ovum
        
        Regions
        
        Body
        
        Major portion of uterus
        
        Fundus
        
        Rounded superior region
        
        Isthmus
        
        Narrowed region between the body & cervix
        
        Cervix
        
        A narrow neck that projects into vagina
        
        Cervical canal
        
        Empties into vaginal canal via external os & connects w/ uterine body via the internal os
        
        The mucosa of this canal contains cervical glands that secrete mucous
        
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        Vagina
        
        Copulatory organ
        
        A thin walled tube extending from cervix -> body exterior
        
        The wall consists of 3 coats
        
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        Mucosa is stratified squamous epithelium
        
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        Receives the penis during intercourse along w/semen, provides passageway for delivery of infant & for menstrual flow
        
        Other structures
        
        Hymen
        
        Mucuosa near vaginal orifice broken by sexual intercourse if that penetration has occurred for the first time
        
        Vaginal fornix
        
        Upper end of vaginal canal surrounding cervix
        
        External genitalia
        
        Clitoris
        
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        Mons pubis
        
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        Vestibule
        
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        Labia majora
        
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        Bulb of vestibule
        
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        Male
        
        Ducts
        
        Vas deferens
        
        Transports sperm during ejaculation
        
        Also contains pseudostratified epithelial cells
        
        Urethra
        
        Serves the urinary sys. & the reproductive sys. in males
        
        Transports semen & urine
        
        3 regions
        
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        Ejaculatory duct
        
        Sperm & seminal fluid mix here & then enter the prostatic urethra
        
        Epididymis
        
        Contains pseudostratified epithelial cells
        
        Allows for absorption of of excess testicular fluid & pass nutrients -> sperm stored there
        
        Sperm are ejaculated from here
        
        Copulatory organ
        
        Penis
        
        Prepuce
        
        Loose skin around the glans that is ordinarily removed at birth
        
        Corpus spongiosum
        
        Extends to form the glans
        
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        This area also fills w/ blood during excitement
        
        Urethral orifice
        
        The final region urine exits
        
        Corpus cavernosum
        
        Fills w/blood during excitement -> cause an erection
        
        A copulatory organ that delivers sperm -> female reproductive tract
        
        Accessory glands
        
        Prostate
        
        During ejaculation, prostatic smooth muscle squeezes prostatic secretion into prostatic urethra
        
        Such as
        
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        Accounting for 1/3 of semen vol.
        
        Bulbo-urethral gland
        
        A thick, clear mucous is released from this gland
        
        Some is released -> spongy urethra to neutralize traces of acidic urine
        
        Mucous also lubricates the glans when excitement is experienced
        
        Seminal vesicle
        
        Accounts for 70% of semen volume
        
        Adds elements -> sperm
        
        Yellow viscous alkaline fluid
        
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        Scrotum
        
        2 muscles serve to maintain a constant temp
        
        Cremaster muscle
        
        Bands of skeletal muscle arising from the internal oblique muscle
        
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        Dartos muscle
        
        Smooth muscle in superficial fascia
        
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        A sac of skin containing the testes
        
        Surrounded by 2 tunics
        
        Tunica vaginalis
        
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        Tunica albuginea
        
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        Designed to regulate temperature of the testes
        
        The location provides for the area to be 3 degrees lower than core body temp
    - - The ovarian cycle
        
        Process
        
        Large follicles are growing in the ovary
        
        As FSH levels rise, so does the follicle
        
        FSH is what allows vesicular follicles to grow & survive
        
        One of these follicles become more sensitive than the others
        
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        Monthly series of events asscoiated w/maturation of an egg
        
        This cycle repeats ~ 28 days
        
        10-15% of woman have 28-day cycles
        
        Even though the cycle may vary, the luteal phase remains the constant
      - Contraceptive methods
        
        Nexplanon - Birth control implant
        
        Possible side effects
        
        Changes in normal menstrual bleeding
        
        Deep vein thrombosis
        
        Cysts developing on ovaries
        
        Weight gain
        
        Headache
        
        How it works
        
        A rod full of progestin
        
        Inserted under the skin in the upper arm
        
        This lasts 5 yrs
        
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        99% effective
        
        Tubal ligation AKA sterilization
        
        Possible side effects
        
        Could cause a blood flow problem to each ovary
        
        Can mess w/many other hormones of the body
        
        Postmenopausal symptoms
        
        How it works
        
        Fallopian tubes are literally ties off each tube
        
        W/this in place, sperm cannot get to the oocyte to fertilize it
        
        99% effective
        
        Depo-Provera shot
        
        How it works
        
        This is a shot injected every 3 months
        
        It contains the hormone progestin
        
        This is NOT progesterone, its a synthetic form of it in which interacts w/receptors on progesterone
        
        It prevents ovulation by mimicking progesterone receptors
        
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        In addition, the cervical mucous thickens preventing sperm from going into uterus
        
        94% effective
        
        Possible side effects
        
        B/c progestins can potentially attach to other receptors in the body, they may attach to estrogens & androgens
        
        If attached to androgens
        
        Acne
        
        Changes in cholesterol
        
        Progestins can also attach to receptors on mineralocorticoids or glucocorticoids
        
        This can cause H2O & salt imbalances
        
        Progestin binding to glucocorticoids can cause bloating
        
        If bound to estrogen from another birth control
        
        This can cause blood clots in the VEINS!!!
        
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        The particular response of the individual may vary
        
        Progestin only methods were found to cause irregular bleeding in uterine cycle
        
        Or the absence of bleeding can occur
        
        My thinking on this is that when progestin mimics progesterone, the levels can be unpredictable
        
        Weight gain
        
        Barrier methods - Condoms
        
        85% effective
        
        How it works
        
        Prevents sperm from even reaching the vagina by encasing the penis
        
        Possible side effects
        
        Some may have latex allergies if a latex condom is used
        
        Some condoms may have substances that can cause reactions to the vagina or the penis, more common in the vagina from what I found
        
        Reduced sensation
        
        Some risk with it falling off during intercourse