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A healthy, happily married couple in their early 40s has sought your…

- - - - 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
- - - - 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
    - - Sperm ducts
      - Extends from the epididymis to the spermatic cord
      - Transports mature sperm to the urethra to be released
    - - Tube which extends through the penis and releases urine and semen
    - - Loose pouch like skin sac that stores the testes and lies posterior to the penis
      - Protective function
      - Climate control system for the testes
    - - Works with the seminal vesicles and contracts, forcing semen into the urethra
      - Gland that rests under the bladder but above the penis and testes
    - - Sac that holds urine and excretes it through the urethra which exits through the penis
    - - Corpus Spongiosum
        
        Erectile tissue that ends on the glans
        
        Prevents the urethra from being closed when an erection occurs
      - Corpus Cavernosum
        
        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
      - Glans Penis
        
        End of the penis that supports the foreskin and retracts to expose the glans
      - External organ of the male reproductive system that has reproductive and urinary function
  - - - 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
    - - Where the mons pubis separates into two separate skin folds
    - - Fundus
        
        Curved upper region where the fallopian tubes connect to the uterus
      - Body of Uterus
        
        The main, central part of the uterus
      - Endometrium
        
        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
      - Myometrium
        
        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
    - - The two soft folds of skin within the labia majora
    - - Infundibulim
        
        Funnel shaped tube that catches the egg and pushes it through the tube
      - Fimbriae
        
        Projections that surround the ovary and release hormones to allow the mature egg into the fallopian tube
      - Two tubes connected to each ovary that let eggs travel from the ovaries to the uterus
    - - Located where the vulva and labia minora meet at the front
      - Highly sensitive, containing many nerve endings and aides in sexual arousal
    - - 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
  - - - 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
    - - 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
        
        Male
        
        Vasectomy
        
        Female
        
        Abdominal
        
        Laparoscopic
        
        Hysteroscopic
      - Implant
      - MOST Effective due to having little to remember once they contraception is placed
    - - Pill
      - Patch
      - Injection
      - Ring
      - Diaphragm
    - - Withdrawl
      - Sponge
      - Fertility-awareness based methods
      - Spermicide
      - Female Condom
      - Male Condom
      - Emergency Contraception
- - - - Surgical Sterilization
        
        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
      - Implant
        
        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
      - IUD
        
        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
    - - Fertility-based method
        
        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
      - Withdrawl
        
        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
        
        Can be difficult to be concious of
      - Spermicide
        
        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
        
        Works better with a combination of a condom or another birth control, but still not as effective as an IUD or Implant