Couple in early 40's wanting to know healthiest contraceptive practice with the most effective results
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Background
The reproductive systems for both male and female vary quite a bit but in general have 4 main things in common: Gonads that produce gametes, Sex hormones that affect maturation and development, Accessory Reproductive System Organs that perform functions not directly to production but are still essential, and Copulation(Coitus/Sexual Intercourse) which is the sexual union between male and female that leads to fertilization.
Sexual Maturation in both Male and Female have 3 main hormones that are responsible: Gonadotropin-Releasing Hormone(GnRH) released by the hypothalamus and initiates puberty, GnRH also stimulates anterior pituitary to release Follicle-Stimulating Hormone(FSH) and Lutenizing Hormone(LH) which stimulate the gonads.
Types of Contreception
The Uterine Cycle aka the Menstrual Cycle are the cyclical changes in the endometrial lining due to the influence of changing levels of progesterone and Estrogen. It typically lasts 28 days but varies from person to person with 3 phases of endometrium development.
Perineum in both male and female is Diamond-shaped region between the thighs. It is bound anteriorly by the pubic symphysis, laterally by the ischial tuberosities, and posteriorly by the coccyx. It is formed by 2 distinct triangular regions: Urogenital Triangle that is the anterior portion of the perineum, female contains urethral and vaginal openings, male contains the base of the penis and scrotum. Anal triangle is the posterior portion of the perineum where anus is located in both sexes.
Changes that occur during Puberty initially: External sex characteristics such as breasts for females and penial growth, Pubic Hair Grows, Reproductive Organs become fully functional, and Gametes mature and secrete sex hormones.
Gametogenesis is the process of making gametes(secondary oocytes in females, sperm in males) and is accomplished by meiosis, a specific type of cell division used only for the formation of gametes.
The female reproductive system has one primary organ and 5 secondary organs.
The male reproductive tissue is made of 1 primary organ and 3 secondary organs.
Primary reproductive organ are the Ovaries
The Secondary organs are: Uterine tubes, Uterus, Vagina, Clitoris, and Mammary Glands.
Vagina is a muscular tube that connects the uterus to the outside world made of 3 tunics: The mucosa is highly vascularized lamina propria with Epithelial cells that produce acidic secretion to deter bacterial infection and rugae that project near the vaginal orifice forming the hymen. Muscularis the outer and inner layers of smooth muscles. Adventitia contains inner layer of elastic fibers outer of areolar connective tissue. This is the path for which sperm enter and the baby if conceived comes out.
The Clitoris is the Erectile body at the anterior region of the labia minora and is homologous to the penis of males. It provides pleasure and contains the Corpus Cavernosa-2Erectile bodies, Crus extends from the corpus cavernosum, the Glans caps the body of the clitoris and the Prepuce is a hood-like fold of the labia minora that covers the clitoris.
The Uterus is a pear-shaped, thick-walled, muscular organ angled across the superior surface of the urinary bladder. Blood is supplied via the uterine arteries from the internal iliac arteries. It has 4 main regions: Funus the curved superior region where the uterine tubes connect, the Body most substantial part made of thick smooth muscle. Isthmus is a constricted region inferior to the body and conncects to the Cervix. The Cervix is the most inferior portion with the cervical canal made of the Internal and External canals.
The Mammary Glands aka the Breasts are located in the anterior thoracic wall and protruding anteriorly, they secrete breastmilk with the necessary nutrients for an infant. The breast is made of 8 structures. Lactation is induced by internal and External stimulation. Prolactin stimulates milk production and Oxytocin is released that is responsible for milk ejection.
Uterine tubes aka Fallopian tubes or oviducts are two tubules that extend laterally from the uterus and almost connect to the ovaries. They are suspended by Mesophalynx that is part of the Broad ligament. Each tube is made of 3 parts: Infundibulum, Ampulla, and Isthmus. The Uterine tube is made of mucosa that is simple ciliated columnar epithelium with areolar connective tissue. The cilia beat and cause current in the fluid to move the oocyte towards the uterus. There are also linear folds to reduce the diameter making it easier for the sperm to find the oocyte.
The Ovaries are paired, oval organs that are lateral to the uterus and anchored to the pelvis cavity by 3 main features: Mesovarium is a double-fold of peritoneum and attaches to each ovary at its hilum(where blood vessels and nerves enter and leave) Broad Ligament is a drape of peritoneum that hangs over the uterus and is secured to each ovary via the Mesovarium and an Ovarian Ligament. Suspensory Ligament is attached to the lateral edge of the ovary and projects to the pelvis wall.
The ovaries are fed via the Ovarian Artery and Vein.
Ovaries are innervated via the Sympathetic Nervous System at T10 segments of the Spinal cord and Parasympathetically by the CN via the Vagus Nerve
Each Ovary is made of 4 main layers: Germinal Epithelium which is the outermost later that surrounds the ovary made of simple cuboidal epithelium. The Tunica Albuginea is a fibrous capsule deep in the germinal layer. The Cortex is the section containing ovarian follicles. Medulla is the innermost section made of areolar connective tissue that contains blood vessels, lymph vessels, and nerves.
The Ovarian Follicles are made of Oocytes and surrounding cells called follicular cells. The different types of follicles are based off of the stage and maturation/development.
Vesicular follicle aka Graafian follicle or mature follicle is fromed once a moth from a secondary follicle that continues to fill with fluid and contains a secondary oocyte which has continues meiosis where the primary follicle left off(Prophase I) and pauses again in metaphase II
Corpus Luteum is formed from the vesicular follicle that has ruptured and expelled its oocyte and becomes yellowish. Secretes Progesterone and Estrogen that support the build up of the urterine lining.
Secondary follicle is made of primary oocyte, many layers of granulosa cells and Antrum(Fluid-filled space that accumulates more fluid forcing the oocyte to one side) where it is surrounded by a cluster of cells called cumulus oophorus. The primary oocyte is surrounded up Zona Pellucida made of glycoproteins and Corona Radiata the innermost later of cumulus oophorus.
Corpus Albicans is a connective tissue scar that forms from the breakdown of the corpus luteum, no longer secretes hormones and is usually completely reabsorbed into the ovary.
Primary follicle formed after the onset of puberty from maturing primordial follicles made of primary oocyte, Granulosa cells which is follicle cells that are cuboidal, and Thecal cells derived from connective tissue located on the periphery of the primary follicle that secretes androgens that are converted into estrogen. Estrogen stimulates the changes in the Uterine lining.
Primordial follicle is made of Primary oocyte that is paused at prophase I (of Meiosis I) and follicle cells one flattened layer surrounding the oocyte.
Ampulla is the wider portion that curves down from the infundibulum. This is usually the portion where fertilization occurs.
Isthmus is the thin section that extends form the infundibulum to the uterine tube's point of entry in the wall of the uterus.
Infundibulum is the funnel shaped lateral end that contains the fingerlike projections called fimbriae that help to sort of enclose the ovary.
Areolar glands are just between the surface that cause the little bumps on the areola.
Suspensory Ligaments are bands of fibrous connective tissue that extend from the skin and attach to the deep fascia.
Areola is darkened skin around the nipple to help the infant better find the nipple for eating.
Glands are subdivided into lobes and those are subdivided into lobules
Nipple is the projection off of the breast that contains many openings for the milk to come out.
Lobules contain alveoli the secretory units that grow and increase in number during pregnancy and produce the milk for lactation.
Lactiferous Ducts drain breastmilk from a single lobe.
Lactiferous Sinus are where milk is stored before being released from the nipple.
The scrotum is a skin sack that holds the testes away from the body and is homologous to the Labia Majora of the female. The primary functions are to keep the testes about 3 degrees cooler than the rest of the body for sperm production. The dartos muscle relaxed to unwrinkled the skin to keep the testes cool and the cremaster muscle contracts to elevate the scrotum to make it warmer.
The Testes main function is to produce sperm and androgens. Each is made of Serous Membrane known as Tunica Vaginalis that covers each testis anteriorly and laterally. It is derived from peritoneum and is made of 2 layers with serous fluid in-between the outer parietal layer and the inner visceral layer. The Tunica Albuginea lies deep to the visceral layer of the tunica vaginalis and projects into the testis at the mediastinum testis forming the septa that divide the internal space into lobules that contain the seminiferous tubules where sperm is made.
There are 3 Secondary Organs the Ducts, Glands, and Penis
Wall of the scrotum is made of the external skin layer, the superficial fascia internal to the skin and the Dartos Muscle internal to the fascia
The Spermatic Cord is a bundle that contains the blood vessels and nerves that supply each testis. It originates in the inguinal canal of the inferior abdominal wall. The wall of the spermatic cord has 3 layers and contains the testicular artery which is surrounded by vein plexus called pampiniform plexus.
Raphe is a ridge-like seam at the midline
The 3 layers of the spermatic cord are: Internal spermatic fascia, Cremaster Muscle/Cremaster Fascia and External Spermatic Fascia
The Interstitial Spaces surround seminiferous tubules and contain interstitial cells aka Leydig that produce androgens such as Testosterone.
There are 2 types of cells contained in the seminiferous tubules: Sustentacular cells aka Sertoli cells or nurse cells, and the dividing germ cells that become sperm
Sustentacular Cells support the developing sperms by nourishing them with cytoplasm, release inhibin when sperm count is high in inhibit FSH and are sealed together with tight junctions to form a blood-testis barrier similar to the blood-brain barrier.
the Blood-Testis Barrier protects developing sperm from toxins in the blood to decreast mutation of sperm cells that could cause deformities in a fetus. It also protects the sperm from the body's own Leukocytes because they are perceived as foreign to do the different proteins and number of chromosomes.
There are 2 paired glands and 1 single gland in the male reproductive tract.
The ducts are divided into 6 different portions for separate purposes.
The Penis is the external genitalia of the male along with the scrotum and is attached internally via the root which also forms the bulb and crus.
Epididymis has 3 portions.
The Ductus Deferens aka Vas Deferens is a tube that takes mature sperm away from the epididymis to the prostate gland. It wraps around the ureter and terminates where the bladder and prostate meet and enlarges near its end to form the Ampulla
Efferent Ductules are formed from the merging of the rete testis and connect to the epididymis. They are lined with ciliated columnar epithelia to move sperm that are not able to swim yet.
The Ejaculatory Duct is where the ductus deferens passes by the seminal vesicle
Rete Testis are channels in the mediastinum testis that receive sperm from the seminiferous tubules
The Urethra transports semen from the ejaculatory duct to outside of the body and has 3 regions.
The Prostate is a single gland located immediately inferior to the bladder and secretes milky fluid that contains citric acid to nourish the sperm, seminalplasmin and antibiotic to combat UTIs in males and Prostate-Specific Antigen and enzyme that helps liquify semen after ejaculation.
The Bulbourethral Glands are paired glands located in the urogenital diaphragm on each side of the membranous Urethra. They secrete clear mucin that protects the Urethra and lubricates things during intercourse.
The Seminal Vesicles are a paired set of glands found on the posterior side of the Urinary Bladder that look grey/white and lumpy. They secret alkaline substance to neutralize acidity of the Vagina and also contains fructose for nourishment and Prostaglandins to widen and dilate the cervix.
The Glans is the tip of the Penis that contains the external Urethral Orifice covered by the prepuce a thin layer of skin on uncircumcised penises.
The Body aka the Shaft is the moveable portion that contains 3 erectile bodies ensheathed in the tunica albuginea. 2 layers of Corpus Cavernosa superior and lateral to the urethra and only extend through the shaft. the Corpus Spongiosum layer surrounds the Urethra through the glans.
The Body and Tail contact the posterior surface of the testis.
The Epididymis also contains the Duct of epididymis a long squiggly duct that holds sperm while they complete maturation.
The Head is the part that contacts superior surface of the testis
The wall is made of the Inner mucosa, middle muscularis, and outer adventitia.
Membranous Urethra passes through the Urogenital diaphragm
The Spongy Urethra extends through the penis
Prostatic Urethra passes through the Urethra
The Proliferative phase is from day 6 through 14. A new functional layer develops due to increased estrogen levels being secreted from the Ovarian Follicle
The Secretory phase is from day 14 through 28 that has increased amounts of Progesterone and Estrogen being secreted from the Corpus Luteum. This causes increased vascularization of the functional layer and increased secretion from the glands.
The Menstrual phase is from day 1 through 5 of the cycle when the functional layer is sloughed if fertilization has not occurred; this results in menstrual bleeding aka a Period.
IUDs are very effective types of contraception. They are small "T" shaped devices that are placed in the Uterus and depending on the type can be effective as soon as they are placed or up to a week at most. They can last anywhere from 3-10 years depending on which of the 2 types are placed.
More Permanently a Male can have a Vasectomy where the Vas Deferens are either cut or blocked not allowing Sperm to get into the Semen thus making the Male Infertile
Condoms are thin rubber sheaths placed over the shaft of the Penis. They are relatively effective and catch the sperm, however they are prone to breaking and thus being worthless.
Similar to a Male Vasectomy a Female can have her tubes "tied" called a tubal ligation in a similar manner where the Fallopian Tubes are cut, tied or blocked so that an Egg cannot travel and become fertilized.
The Birth Control Pill is one of the easiest contraceptives with around 98% protection against pregnancy. They pills are varying formulas of Progesterone and Estrogen to alter the levels in the body and therefore "tricking" the body into thinking it has ovulated when no oocyte has actually been released. The Pills are taken for 3 weeks and on the 4th week placebo pills are taken and the body is triggered into menstruation. These pills are effective but must be taken every single day preferably around the same time of day which can be inconvenient.
Most Permanently a Female can have a Hysterectomy where a surgeon removes the Uterus and sometimes the Fallopian Tubes. The woman will no longer have a Menstrual Cycle, however because the female hormones are innervated by the Uterus and Fallopian Tubes the woman is likely to be put on artificial Hormones.
The best known contraception is abstinence which is to abstain from having Sexual Intercourse.
The Copper IUD is effective immediately and works as a spermicidal agent killing sperm as it enters the Uterus and lasts for 10 Years.
Hormonal IUDs contain the progestin levonorgestrel that cause the cervical mucus to thicken and the Uterine wall to stay thin thus not allowing sperm to enter or the Egg to be able to Implant.
Unlike most individuals that are seeking Contraceptives this couple has children that are almost grown and out of the house.
They are also in their Early 40's and if they decided to have another child they would need to consider the fact that birth defects such as Cleft Lip and Cleft Palate become more prevalent when the mother is in her 40's and beyond.
This couple has not had a child in many years and has had plenty of time to decide whether or not they would like to have another one. They are more likely to seek out more permanent methods of Birth Control than a Couple or individual in their 20's or 30's
There are many options for Contraception these are the Top 3 and Bottom 3 options.
The top 3 options for this couple come from the fact that they are older and no longer desire to have more children EVER. These 3 options could be used singularly or in any combination for most security.
The Bottom 3 Options while some might be 100% effective are some of the least desirable options for most couples.
- Female Tubal Ligation is also a relatively quick procedure and more recently can also be done in the Doctors office with minimal recovery. After the woman has healed and has been checked by her Dr to ensure that the ligation was successful this is also a 100% effective contraceptive.
- A Copper IUD is extremely effective and lasts for 10 years. If the woman ends up going through Menopause before the end of the 10 years then it can be taken out because she is no longer fertile Post Menopausal.
- Male Vasectomy because it is a relatively quick, easy procedure that can be done in a regular doctors office with minimal recovery time. This option once healed and after being checked by the Dr can be one of the most effective as long as the Vasectomy "took" and the tubules did not re grow and essentially undo the procedure.
- Taking a Birth Control Pill while it can be around 99% effective is not desirable in that it can be very tedious to take the pill every day around the same time of day and if skipped even a single day pregnancy can occur.
- Using a Condom while can be relatively effective the likelihood of it breaking is high and if broken and not seen the Semen can leak and the woman can still be impregnated. This option can also be expensive depending on the amount of Sexual Intercourse taking place.
- A Hysterectomy is 100% effective in preventing pregnancy however the imbalance in hormones for most women can be very extreme. Often women are prescribed artificial hormones to regulate her hormones that are no longer being produced.