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A healthy 40 year-old couple seek contraceptive advise. They do not wish…

- - - - The nerve supply to the ovary is via the sympathetic axons from the T10 segments of the cord and
        parasympathetic axons from the vagus nerve (CN X).
        
        The uterus is where implantation occurs and where an embryo will grow to become a fetus. If an ovary is not fertilized then menstruation occurs where the lining of the uterus sheds.
        
        The vestibule engorges with blood and increases sensitivity during intercourse.
        
        The clitoris has many specialized sensory receptors that provide pleasure to a female during intercourse.
        
        The mammary gland produces milk with nutrients for the baby.
        
        Tiny ducts drain milk from the alveoli and lobules; the tiny ducts merge and form 10 to 20 larger
        channels called lactiferous ducts.
        
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- - - - The spermatic cord is composed of three layers; internal spermatic fascia, cremaster muscle and fascia,
        and the external spermatic fascia.
        
        Within the spermatic cord is the pampiniform plexus which provides thermoregulation to the testicular artery
        prior to it reaching the testes.
        
        When the testes are exposed to cold, the dartos muscle contracts, causing the scrotum to shrink, thus
        pulling the testes closer to the warmer body; in a very warm environment, the opposite occurs.
        
        the sustentacular cells and germ cells divide and produce sperm.
        
        Interstitial cells (Leydig cells), which produce various forms of androgens, the most common being testosterone.
        
        The ampulla of the ductus deferens unites with the proximal region of the seminal vesicle to form the
        terminal part of the reproductive duct system, called the ejaculatory duct.
        
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- - - - The first 13 days of a 28-day ovarian cycle is the follicular phase; during this phase, FSH and LH stimulate
        up to 20 primordial follicles to mature into primary follicles.
        
        On day 14 of a 28-day ovarian cycle there is a peak in LH secretion, known as the LH surge, which causes an increase in the formation of antrum fluid; the increased pressure of the fluid forces the secondary oocyte out of the follicle; the expulsion of the oocyte is termed ovulation.
        
        The ovarian cycle is regulated by the cycling of the gonadotropin-releasing hormone (GnRH) from the
        hypothalamus; this hormone stimulates the anterior pituitary to secrete LH and FSH.
        
        The corpus luteum lasts 10–13 days if the ovulated secondary oocyte is not fertilized; this causes a
        decrease and eventual cessation of the hormones secreted by the corpus luteum.
  - - - The menstrual phase occurs approximately during days 1–5 of the cycle; this phase is marked by
        sloughing of the functional layer and lasts through the period of menstrual bleeding.
        
        The proliferative phase follows the menstrual phase and spans approximately 6–14 days; the initial development of the new stratum functionalis occurs,
        which overlaps the time of the follicle growth and estrogen secretion by the ovary.
        
        The secretory phase occurs approximately during days 15–28; the secretion of progesterone increases which increases vascularization and development of uterine glands.
        
        If fertilization does not occur, the corpus luteum disintegrates, its hormone levels decrease, and the stratum functionalis, without hormonal influence, sheds, thus menstruation occurs and the start of a new uterine cycle begins.
- - - - Hormone Shot (Depo-Provera)
        
        Copper IUD
        
        Progesterone IUD
        
        Combined Pill (Estrogen/Progesterone)
        
        Minipill (Progesterone only)
        
        Cervical Cap (previous births)
        
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        Acne, nausea, fatigue, lower sex drive, breast pain, ovarian cysts, headache.
        
        Nausea, constipation/diarrhea, gingivitis, increase/decrease appetite, weight-gain, breast pain, changes in menstrual flow.
        
        Missed periods, ovarian cysts, migraine, nausea, bloating, breast pain, depression, possible complication after insertion or removal.
        
        Pain when placed and cramping afterwards, irregular or longer periods, possible complication inserting/removing the implant.
        
        Headache, nausea, weight-gain, breast pain, decrease sex drive, hot flashes, joint pain, injection-site irritation.
      - Breast pain, nausea, headache, weight-gain, ovarian cysts, infection or bruising after the implant has been inserted.
- - - - Hormone Shot: you only have to get it injected monthly vs taking pills. It is one of the most effective in preventing pregnancy. Only concern is that when you are older your joints already hurt and this might add to it.
- - - - Female Condoms: It is one of the least effective and it can be used improperly. It can effect the sensation and can slip/be pushed inside during intercourse.