Phar 461 - Non Oral Contraceptives (Part 2/2)

Front 1

Can douching be used as a contraceptive?

Back 1

Not recommended due to its association with Vaginal irritation, bacterial vaginitis, STIs, PID and not even that effective

Front 2

How do you properly store condoms?

Back 2

1) Avoid excess heat and light

2) Store at room temp in a dry location [NOT IN BACK WALLET]

3) If when opening it is brittle, stiff, or sticky then throw it away and use another

4) Check expiry date [regular in 5 years, spermicidal in 2 years]

Front 3

What are Female Condoms?

Back 3

Flexible, unattached inner ring at the closed end of the thin, soft pouch is inserted into the vagina over the cervix and anchored using the upper inner ring.

Slightly larger, attached outer ring is at the open end and rests outside the vagina

Front 4

"When the female condom is correctly placed during sexual intercourse, there will be contact of the vagina and cervix with skin of the penis" True or False?

Back 4

FALSE

Front 5

What are the different types of Female Condoms?

Back 5

FC1-original made from polyurethan

FC2-newer model made from nitrile rubber

Front 6

Why is FC2 favored over FC1?

Back 6

More cost effective, softer material that is quieter during use HOWEVER it is LESS tear resistant (tears easier than FC1)

Front 7

What are the advantages of Female Condoms?

Back 7

1) Can be placed autonomously & full control of effectiveness

2) Can provide a high level of protection against pregnancy and STIs

3) Adjusts well to the anatomy of the Vagina

4) Less likely to tear or break than latex in male condoms

5) Can be used with oil based lubricants

6) Withstands storage better than Latex

7) Can be inserted ahead of time

Front 8

What are the disadvantages of Female Condoms?

Back 8

1) Need to practice insertion & use several times before confident enough on how to use

2) Inner ring may cause some discomfort during coitus

3) Cost is somewhat high

4) Noise during coitus (FC1 problem)

5) Slippage has been cited as a problem

Front 9

What are the contraindications of Female Condoms?

Back 9

1) Abnormalities in vaginal anatomy that interfere with a satisfactory fit of stable placement

2) Inability to learn correct insertion technique

3) Allergy to polyurethane-FC1

Front 10

What are the instructions for using a Female Condom?

Back 10

1) Find a comfortable position

2) Hold the condom with the open end hanging down, squeeze the inner ring with your thumb and middle finger

3) Insert the ring into the vagina and push the inner ring and pouch into the vagina past the pubic bone

4) If the condom appears to be moving with the penis rather than resting in the vagina, stop and add lubricant to the inside of the condom or to the penis

5) To remove the female condom after intercourse; while lying down, squeeze and twist the outer ring the keep the semen inside the pouch

6) Pull it gently out the vagina and throw it in the garbage

Front 11

"Female condom can be inserted up to 4 hours before intercourse" True or False?

Back 11

False, it can be inserted up to 8 hours before intercourse

Front 12

"Female condoms can be used with male condoms" True or False?

Back 12

False, the two may adhere to each other and may slip or become displaced

Front 13

"Female condoms should NOT be re-used" True or False?

Back 13

TRUE

Front 14

What is a diaphragm?

Back 14

A soft silicon shallow dome with an encased flexible steel ring around its edge

Front 15

What is a cervical cap?

Back 15

A small hat-shaped device with a flared brim

Front 16

What is the MOA of a diaphragm and a cervical cap?

Back 16

Acts as a physical barrier between sperm and the cervix, and should always be used in conjunction with a spermicide (Physical + Chemical Barrier)

Front 17

What are some brand names of Diaphragms?

Back 17

Milex Wide Seal

Front 18

What are the two rim types of Diaphragms?

Back 18

1) Arching 2) Omiflex

Front 19

What are some contraindications to Diaphragms?

Back 19

1) Sensitive to Silicon or Spermicides

2) Some women with Recurrent UTIs

Front 20

What is a brand name of Cervical Caps?

Back 20

Femcap

Front 21

What are the different sizing of Cervical Caps?

Back 21

i) 22mm = never been pregnant

ii) 26mm = never given vaginal birth before

iii) 30mm = Has given vaginal birth before

Front 22

What are some contraindications to Cervical Caps?

Back 22

1) Abnormally shaped cervix

2) A history of recurrent PID

3) Severe Cervicitis

4) Abnormal Pap Smears

Front 23

What are the instructions for using a Diaphragm or Cervical Cap?

Back 23

1) Empty bladder (urinate) and wash hands thoroughly

2) Examine device closely for any tears, holes, or weak spots

3) Place approx 5ml (1tsp) of spermicidal jelly in the diaphragm dome and spread it around. For Caps put (1/4tsp) spermicide in dome and spread it around (1/2tsp) between brim and dome

4) Recommended to insert device into vagina 30MIN prior to intercourse according to instructions

Front 24

What is the proper way to insert a Diaphragm?

Back 24

i) Hold diaphragm with the dome down (spermicide up) and press the opposite sides of the rim together between thumb and third finger [a plastic inserter/introducer can be used if insertion is difficult]

ii) Insert compressed diaphragm, dome down (spermicide up) into the vaginal canal, directing it backwards as far it will go; behind the mouth of the cervix.

iii) Check to see if the diaphragm is covering the whole cervix. Run finger around the rim to confirm that is is firmly in place

iv) It is normal to feel folds in the diaphragm when it is in place

v) If any discomfort is felt after inserting the diaphragm, remove the diaphragm and reinsert it so that it is comfortable

Front 25

What is the proper way to insert a Cervical Cap?

Back 25

i) The cervical cap is designed to fit tightly over the cervix & is held in place by suction. The groove inside the cap creates the seal.

ii) Suction is created by pressing on the dome & twisting the cap onto the cervix like a lid of a jar

Front 26

When do you remove the diaphragm.cap?

Back 26

1) Remove the diaphragm/cap no sooner than 6-8 hours after intercourse and max 24 hours from insertion for Diaphragm and 48 hours for cap

2) If intercourse is repeated within this 6 hour period do NOT remove the diaphragm/cap. Vaginal application of additional spermicide is recommended with use of diaphragm.

3) To have intercourse safely again after the 6 hours remove diaphragm/cap, wash it with soap and water. Fill diaphragm/cap again with spermicide and then reinsert it

Front 27

What is the storage of Diaphragm/Cap?

Back 27

It should be patted dry, stored immediately back in its case, and away from heat and excessive light.

Need to be replaced periodically after 1-2 yrs.

Front 28

What are the advantages of Diaphragm ?

Back 28

1) Allows for more spontaneity - can be inserted before intercourse or up to 30-60mins

2) Offers some potential protection from STI, due to decreased cervical involvement with organisms

3) Rarely causes discomfort and reduced pleasure

4) Some protection against PID

5) Womens using a diaphragm for >5yrs have lower rates of cervical cancer

Front 29

What are the advantages of Cerical Caps?

Back 29

1) Smaller and more generally comfortable

2) Requires less spermicide than a diaphragm

3) Inexpensive and reusable

4) Offers some protection against STIs

Front 30

What are the disadvantages of Diaphragm?

Back 30

1) Uncertain protection of HIV

2) Must be used with spermicide

3) Not recommended during menstruation

4) Refitting is required after pregnancy, abortion, miscarriage, pelvic surgery or sig weight loss (10-20lb)

5) Proper insertion requires practice

6) Proper fitting requires trained clinician

7) Bathing after intercourse is not ok {showering is ok}may wash away spermicide

8) Must reapply spermicide before each sexual act if within 6hrs

9) May increase risk of UTIs

10) May increase risk of Toxic Shock Syndrome

11) Odour if left in place longer than recommended

12) Potential allergic reaction to latex or spermicide

Front 31

What are the disadvantages of Cervical Caps?

Back 31

1) Does not protect against HIV

2) May cause cervical changes (cervicitis)

3) Takes practice to become skilled in using

4) Bacteria may grow in the cap - infection

5) May reduce pleasure during intercourse

6) May have irritation or infection if not removed

7) May have an allergic reaction to spermicide or latex

8) Cap may get stuck in cervix

9) Cannot be used during menstruation

Front 32

What is a contraceptive sponge?

Back 32

A small one size fits all, disposable, polyurethane foam device intended to fit over the cervix impregnated with a spermicidal agent

Front 33

What is the MOA of a contraceptive sponge?

Back 33

Contraceptive action is primarily provided by the spermicide impregnated in the sponge, augmented by its ability to absorb and trap sperm

Front 34

What is the proper way to insert a Sponge?

Back 34

1) User should wash hands prior to insertion of sponge

2) Remove the sponge the from packaging

3) Moisten sponge with 2TBSP of clean water and squeeze once

4) Insert the sponge dimple size up facing the cervix, string loop down, using the index finger to push the sponge into place as deeply as possible inside the vagina, preferably against the cervix

Front 35

What is the proper timing of using a contraceptive sponge?

Back 35

Must be inserted into vagina before intercourse or any genital contact.

Insert at least 15min prior to intercourse.

Sponge must remain place for at least 6hours after intercourse and must be removed no later than 24hrs after insertion and should be disposed of in the garbage

Front 36

What is the proper way to remove a Sponge?

Back 36

a) Relax: Put a finger into the vagina and reach upward to find the string loop

b) Bear down and push the sponge toward the vaginal opening,

c) Hook the finger around the string loop or grasp sponge between thumb and forefinger

Front 37

What do you do if the sponge falls out?

Back 37

Unlikely to happen. However during a bowel movement or other form of straining it can be displaced. Insert finger and push it back.

If it falls into toilet DO NOT USE IT, use a new sponge

Front 38

What are the advantages of Sponges?

Back 38

1) Can be inserted prior to intercourse

2) No additional spermicides necessary

3) Portable, easily accesible

4) No fitting or physician intervention required

5) No systemic reactions

6) Continuous protection for 12-24 hours

7) Polyurethane (no latex)

8) Insertion does not interrupt intercourse

9) Short-term use is not associated with Toxic shock syndrome

Front 39

What are the disadvantages of Sponges?

Back 39

1) Must be left in place for at least 6 hours after intercourse

2) Must be used correctly and consistently to avoid failure

3) Women must be comfortable with vaginal manipulations

4) Higher failure rates in parous women (had a child before)

5) Sensitivity reactants to spermicidal

6) Potential for vaginal yeast infections or bacterial vaginosis

7) Potentially for toxic shock syndrome

8) Cannot be used during menstruation

9) May be forgotten and left in place

Front 40

What is Laparoscopic Surgery?

Back 40

Permanent method of contraception where fallopian tubes are surgically cut, tied, clamped or cauterized, preventing sperm from joining unfertilized egg

Front 41

What is Transcervical Sterilization?

Back 41

Incision free, minimally invasive procedure that can be performed that can be performed in an outpatient setting with less anaesthesia. Utilizes thermal, chemical or mechanical means to permanently occlude the fallopian tubes.

Front 42

"Transervical Sterilization is effective immediately" True or False?

Back 42

FALSE, Effective after 3-6 months

Front 43

What is a Vasectomy?

Back 43

Permanent method of contraception where the vas deferns are surgically clamped, cut or cauterized (convential, and no scalpel method).

Front 44

What is the procedure of Vasectomy?

Back 44

Procedure usually performed in a doctor's office using local anesthethic and takes less than 30mins