A healthy, happily married couple in their early 40s has sought your advice on contraceptive strategies. The woman is concerned about the long-term effects of birth control pills and wants to stop taking them. They have two kids in high school and are certain they do not want more children. They seek your advice on what to do. What do you tell them?
Downstream Causes
Background Information
Upstream Effects
Male Anatomy
Female Anatomy
Uterine/Ovarian Cycles
Contraceptive Methods
Factors important for this couple that might not be in a different couple or individual seeking birth control options?
Contraceptive Options
Vagina
Hymen
Labia Majora
Uterus
Labia Minora
Fallopian Tube
Clitoris
Ovary(ies)
Epididymis
Testis(es)
Vas Deferens
Urethra
Scrotum
Prostate
Bladder
Fundus
Body of Uterus
Endometrium
Myometrium
Infundibulim
Fimbriae
Penis
Corpus Spongiosum
Corpus Cavernosum
Glans Penis
Most Effective
Effective
Least Effective
Menstruation
Ovulation
"Monthly" Cycles that occur about every 28 days and involve the maturation of female gametes (eggs) and preparing the body for fertilization
Female gonads, two on either side of the uterus
Important functions
Secrete Hormones
Protect the eggs the female is born with already
Release eggs into the uterus through the fallopian tubes for possible fertilization
Two tubes connected to each ovary that let eggs travel from the ovaries to the uterus
Funnel shaped tube that catches the egg and pushes it through the tube
Projections that surround the ovary and release hormones to allow the mature egg into the fallopian tube
Curved upper region where the fallopian tubes connect to the uterus
The main, central part of the uterus
The innermost lining of the uterus
Prevents adhesions between the myometrium
During the menstrual cycle, it thickens and then sheds in the event of no egg fertilization
The middle layer of the uterine wall
Consists of smooth muscle, stromal and vascular tissue
Responsible for uterine contractions
Cervix
The lower portion of the uterus that opens into the vagina
Widens (10 cm) in childbirth to allow the passage of the baby
Female reproductive tract
Responsible for some sexual arousal and intercourse
Canal in which the baby is delivered during childbirth
Membrane of tissue that surrounds or partially covers the vaginal opening
Located where the vulva and labia minora meet at the front
Highly sensitive, containing many nerve endings and aides in sexual arousal
Where the mons pubis separates into two separate skin folds
The two soft folds of skin within the labia majora
Sac that holds urine and excretes it through the urethra which exits through the penis
Works with the seminal vesicles and contracts, forcing semen into the urethra
Gland that rests under the bladder but above the penis and testes
Tube which extends through the penis and releases urine and semen
External organ of the male reproductive system that has reproductive and urinary function
End of the penis that supports the foreskin and retracts to expose the glans
Erectile tissue that ends on the glans
Prevents the urethra from being closed when an erection occurs
Two columns of spongy tissue that run through the penis
Forms most of the penis, and is filled with blood vessels
Forms erections when the blood vessels fill
Sperm ducts
Extends from the epididymis to the spermatic cord
Transports mature sperm to the urethra to be released
Narrow, tightly coiled tube that connects the testes to the vas deferens
Transports and stores sperm cells that are produced in the testes
Brings sperm to maturity and pushes sperm into the vas deferens
Male gonads, primary reproductive organ
Sperm production
Hormone production, primarily testosterone
Loose pouch like skin sac that stores the testes and lies posterior to the penis
Protective function
Climate control system for the testes
AKA Period
Period lasting approximately 5 days and the beginning of the cycle
Endometrium is shed from the uterus due to know fertilization
New egg is maturing in the ovaries as this happens
Egg has been released from the ovary and traveled down the fallopian tube into the uterus
Egg attaches to the uterine wall, ready for fertilization
The peak time of the ovarian cycle for pregnancy to occur
Oestrogen levels are very high at this point in the cycle
Peak ovulation is around day 14 of the cycle
Following Ovulation
The endometrium continues to thicken regardless of fertilization
Corpus Luteum is formed
If not fertilized the egg dies, and the corpus luteum and endometrium shed, beginning menstruation and the cycle again
Progesterone levels are high as the corpus luteum is formed
IUD
Surgical Sterilization
Implant
Pill
Patch
Injection
Ring
Withdrawl
Sponge
Fertility-awareness based methods
Spermicide
Female Condom
Male Condom
Diaphragm
MOST Effective due to having little to remember once they contraception is placed
Male
Female
Vasectomy
Abdominal
Laparoscopic
Hysteroscopic
Emergency Contraception
Best Options
Worst Options
Age
Her concern about the long-term effects of pills
The fact that they already have two children
Mid 40's to 50's are around when menopause can begin for women
As men age erections can become difficult or sparse
Women are born with the number of the amount of eggs they have in their lives, so the older they get the less eggs they have
Birth control pills are often used to help balance hormones in women as well
Birth control pills are often seen as a short term solution or to be used to prevent ovary problems
They made it clear that they don't want any other children
Other couples might only want to temporarily prevent pregnancy
Surgical Sterilization
Implant
IUD
Fertility-based method
Withdrawl
Spermicide
Since both of them are confident in their decision to not have any more children, this is the most logical option
With their age it also makes sense
Wether only one of them or both of them do it, it has a very high success rate and low rate of failure
The most effective form of contraception because there is such a low chance of mistake
99% success rate
Definitely a good alternative if they don't want any kind of procedure done
Another good alternative, a birth control implant for the arm
99% success rate as well
Another good alternative if the couple doesn't want to go through something as invasive as a procedure or IUD
This is only slightly effective, because there is significantly less chance of pregnancy if intercourse happens after or before ovulation
It is definitely not full proof, and there is still a high chance of pregnancy even if it's not peak ovulation time
AKA "Pull-out" Method
Still not full proof, as if there is even slight hesitation fertilization can still occur
Any sperm could work to fertilize an egg
A chemical that works to kill sperm
28% chance of failure
Has to be used before intercourse, which can be difficult for some to remember
Can be difficult to be concious of
Works better with a combination of a condom or another birth control, but still not as effective as an IUD or Implant