Understanding human sexuality by Hyde and DeLamater - a summary
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Sexology
Chapter 7
Contraception and abortion
Both babies and mothers are healthier if pregnancies are spaced three to five years apart.
Hormonal methods of contraception are highly effective and come in a number of forms
The combination pill
Combination birth control pills: birth control pills that contain a combination of estrogen and pregestin (progesterone), both at higher than natural levels.
A women takes the pill for 21 days, and then no pill or a placebo for 7 days, after which she repeats the cycle.
Variations have been introduced.
How it works
The pill works mainly by preventing ovulation.
When a women starts taking the birth control pills, estrogen levels are high. This high level of estrogen inhibits FSH production, and the message to ovulate never sends out.
The high level of progesterone inhibits LH production, further preventing ovulation.
The progestin provides additional backup effects
When the estrogen and progestin are withdrawn, the lining of the uterus disintegrates, and withdrawal bleeding or menstruation occurs.
The flow is typically reduced because the progestin has inhibited development of endometrium.
Effectiveness
Failure rate: the pregnancy rate occurring using a particular method; the percentage of women who will be pregnant after a year of use of the method.
Effectiveness: 100 minus the failure rate.
Two kinds of failure rate
Combination pills are one of the most effective methods of birth control.
The perfect-user failure rate is 0.3 percent.
The typical user failure rate is 9 percent.
Failures occur primarily as a result of forgetting to take a pill for 2 or more days.
If a women forgets the pill for 3 or more days, she should use a condom or abstain from sex until she has taken hormonal pills for 7 days in a row, at which point she will again be well protected.
Side effects
Women of the following groups should not use the pill
Advantages and disadvantages
The pill as a number of advantages
Disadvantages
Reversibility
When a women wants to become pregnant, she simply stops taking pills after the end of one cycle.
Drug interactions
If you are taking birth control pills, you are taking a prescription drug that may interact with other prescription drugs you take.
Other kinds of pills
There are many kinds of combination pills and several kinds of pills other than combination ones.
Combination pills vary from one brand to the net in the dosages of estrogen nad progestin.
Depending on what side-effect the women wants to avoid, she can choose a brand for its high or low estrogen or progestin level.
Triphasic pills: a birth control pill containing a steady level of estrogen and three phases of progesterone, intended to mimic more closely women’s natural hormonal levels.
Progestin-only pills have been developed.
Sometimes called minipills.
Work by changing the cervical mucus such that sperm cannot get trough, inhibiting implantation, and inhibiting ovulation.
Progestin-only pills have a typical-user failure rate that is higher than that of combination pills.
Their major side effect is that they produce very irregular menstrual cycles.
The patch
The patch contains the same hormones as combination birth control pills but is administered transdermally, through the skinn.
The patch is thin, beige, and about the size of a double band-aid.
It consist of
The patch lasts for seven days, so the woman places a new one once a week for three weeks and then has a patch-free week.
The first time it is used it takes a couple of days for the hormones to reach effective levels, so a backup method should be used for a while.
Advantages
The patch is new, so we do not have extensive data.
Because the hormones are the same as in the pill, the expectation is that the side effects will be quite similar to those of the pill.
The patch has a slightly higher rate of thromboembolic disorders.
Women also get more estrogen from the patch than with a combination pill.
The vaginal ring
The vaginal ring is a flexible, transparent ring made of plastic and filled with the same hormones as those in the combination pill, at slightly lower doses.
The ring is placed high up in the vagina and remains in place for 21 days.
It is removed and the women goes ring-free for 7 days, then a new ring.
The ring is only recently introduced, so the scientific data are limited.
Because the hormones are the same as in the pill, the side effects should be the same.
It has a higher risk of thromboembolic disorders.
About the same typical-user failure rate as the pill.
It acts mainly by stopping ovulation.
Depo-provera injections
Depo-provera (DMPA) is a progestin administered by injection.
The injections must be replaced every 3 months for maximum effectiveness.
How it works
It inhibits ovulation, thickens the cervical mucus, and inhibits the growth of the endometrium
Effectiveness
Highly-effective, with a typical-user failure rate of 6 percent, making it somewhat more effective than the pill.
Side-effects
No lethal side effects of Depo-Provera have been found.
Long-term studies have not yet been done.
Advantages and disadvantages
Advantages
Disadvantages
Reversibility
The method is reversible by not getting another injection.
Many women are infertile for 6 to 12 months after stopping its use, but then they are able to become pregnant at normal rates.
Emergency contraception
The treatment is most effective if begun within 24 hours and cannot be delayed longer than 120 hours (5 days).
Regular birth control pills containing levonorgestrel (a progestin) are taken at higher doses.
Nausea is a common side effect.
Emergency contraception may work in any of several ways, depending on when in the cycle it is taken
Its action is almost always to prevent pregnancy, not to cause abortion.
It is between 75 and 89 percent effective during the most fertile part of the cycle.
An IUD can also be used for emergency contraception for a woman who wants continuing protection.
The failure rate is less than 1 percent if inserted within 5 days of unprotected intercourse.
LARC: long-acting, reversible, contraceptives; implants and IUDs.
These methods last more than a year, and can be reversed.
These methods are even more effective than the pill.
Implants
Implants are thin rods or tubes containing progestin.
They are inserted under the skin in a woman’s arm and are effective for 3 years.
How it works
It suppresses ovulation, thickens the cervical mucus, and inhibits the growth of the endometrium.
Effectiveness
Implanon is highly effective, with a typical-user failure of 0.05.
It is more effective than the pill.
Side effects
No lethal side effects of implanon have been detected.
Advantages and disadvantages
Advantages
Disadvantages
Reversibility
If a women wishes to become pregnant, she can have the implant removed.
In most cases, the menstrual cycle returns to normal within 3 months, and the woman can become pregnant.
IUDs
Intrauterine device (IUD): a plastic device sometimes containing metal or a hormone that is inserted into the uterus for contraceptive purposes; also called intrauterine contraceptive (IUC).
It remains in the uterus until the woman wants to have it removed.
One or two plastic strings hang down from the IUD through the cervix, enabling the women to check to see whether it is in place.
How it works
The foreign body in the uterus creates an environment that is toxic to both sperm and eggs.
In the rare event of fertilization, the IUD prevents implantation.
Mirena and Skyla (two IUDs) release progesterone directly into the uterus.
One effect is to reduce the endometrium.
This results in reduced menstrual flow and reduced risk of anemia.
It also disrupts ovulation and thickens cervical mucus.
The small amount of copper that is added to the coper T (and IUD) is thought to have an additional contraceptive effect.
It seems to alter the functioning of the enzymes involved in implantation.
Effectiveness
The IUD is extremely effective.
Most failures occur during the first 3 months of use, either because the IUD is expelled or for other, unknown reasons.
The expulsion rate is about 2 to 10 percent in the first year.
Side effects
Advantages and disadvantages
Advantages
Reversibility
When a women who is using an IUD wants to become pregnant, she simply has a health care provided remove the device.
She can become pregnant immediately.
The male condom
Male condom: a contraceptive sheath that is placed over the penis
To be effective, condoms must be used properly.
It must be unrolled onto the penis before the penis enters the vagina.
It is best to withdraw the condom soon after ejaculation, while the man still has an erection, in order to minimize the chances of leakage.
A new condom must be used at each act of intercourse.
How it works
The condom catches the semen, preventing it from entering the vagina.
For condoms coated with a spermicide, the spermicide kills sperm and in theory provides extra protection. But they may create allergies to the spermicide for the man or his partner, and the amount of spermicide is probably not sufficient to be effective.
Effectiveness
The perfect-user failure rate is about 2 percent.
The typical-user rate about 18 percent.
Side effects
The condom has no side effect, except that some users are allergic to latex.
For them non-latex condoms are available.
Advantages and disadvantages
Disadvantages
Advantages
Reversibility
The man stops using condoms if conception is desired.
The female condom
The female condom resembles a clear balloon.
There are two rings in it
The penis must be guided into the female condom so that the penis does not slip in between the condom and the vaginal wall.
The condom is removed immediately after intercourse, before the women stands up.
How it works
It prevents the sperm from entering the vagina.
Effectiveness
The typical-user rate is 21 percent.
The perfect-user rate is 5 percent.
Side effects
A few women experience vaginal irritation and a few men experience irritation of the penis as a result of using it.
Advantages and disadvantages
Advantages
Disadvantages
Reversibility
The women stops using the condom when wanting to become pregnant.
The diaphragm
The diaphragm: a cap-shaped rubber contraceptive device that fits inside a woman’s vagina over the cervix.
In order to be used effectively, a contraceptive cream or jelly must be applied tot the diaphragm. The cream is spread on the rim and the inside surface.
It may be inserted up to 6 hours before intercourse, and it must be left in place for at least 6 hours afterwards. It may be left in for as long as 24 hours.
Wearing it longer than that is thought to increase the risk of toxic shock syndrome.
How it works
The diaphragm blocks the entrance to the uterus so that sperm cannot swim up into it.
The contraceptive cream kills any sperm that manage to get past the barrier.
Any sperm remaining in the vagina die after about 6 hours.
Effectiveness
The typical-user failure rate has been estimated to be 12 percent.
Because the proper fit of the diaphragm is essential to its effectiveness, it is important for the women to be individually fitted for one by her health care provider.
Side effects
Advantages and disadvantages
Disadvantages
Advantages
Reversibility
If a woman wishes to become pregnant, she stops using the diaphragm.
FemCap
FemCap is a vaginal barrier device similar to the diaphragm.
Made of silicone and comes in three sizes.
It should be used with a spermicide or one of the microbicides.
The sponge
A vaginal barrier method made of polyurethane.
It is small and shaped like a pillow with a concave dimple on one side. The other side has a woven loop to aid in removal.
It contains a spermicide and is inserted much like a diaphragm.
Effective for 24 hours, with multiple acts of intercourse.
Overall, not every effective.
It should not be left in place for more than 24 hours because of a risk of toxic shock syndrome.
Spermicides: a substance that kills sperm.
They come in a tube or can, along with a plastic applicator.
The applicator is filled and inserted into the vagina.
The applicator’s plunger is then used to push the spermicide into the vagina near the cervix.
It must be left in for 6 to 8 hours after intercourse.
One application provides protection for one act of intercourse.
How they work
Effectiveness
Failure rates can be as high 28.
Spermicides are highly effective only when used with a diaphragm or condom.
Side effects
Some people experience an allergic reaction to spermicides.
Advantages and disadvantages
Advantages
Disadvantages
Withdrawal: a method of birth control in which the man withdraws his penis from his partner’s vagina before he has an orgasm and ejaculates.
Effectiveness
It is not very effective.
The failure rate is around 22 percent.
Side effects
It produces no direct physical side effect.
Advantages and disadvantages
Advantage
Disadvantage
Rhythm (fertility awareness) method: a method of birth control that involves abstaining from intercourse around the time the woman ovulates.
The calendar method: a type of rhythm method of birth control in which the woman determines when she ovulates by keeping a calendar record of the length of her menstrual cycles.
Basal body temperature (BBT) method: a type of rhythm method of birth control in which the woman determines when she ovulates by keeping track of her temperature.
It determines safe days only after ovulation.
Cervical mucus method: a type of rhythm method of birth control in which the woman determines when she ovulates by checking her cervical mucus.
Sympto-thermal method: a type of rhythm method of birth control combining the basal body temperature method and the cervical mucus method.
Effectiveness
The effectiveness of the rhythm method varies considerably depending on a number of factors.
Basically, it is not very effective with typical users.
The typical-user failure rate is around 25 percent for all methods.
Failure rates are lower when the woman’s cycle is very regular and when the couple are highly motivated and have been well instructed in the methods.
Advantages and disadvantages
Advantages
Disadvantages
Sterilization: a surgical procedure by which and individual is made sterile, incapable for reproducing.
Male sterilization
Vasectomy: a surgical procedure for male sterilization involving serving one the vas deferens.
Typically, the man can return to having intercourse within a few days, but, some of the sperm may still be lurking in his ducts beyond the point of the incision.
Men should not rely on the vasectomy until 3 months after it was performed.
The ejaculate is completely normal, except that is does not contain any sperm.
How it works
The vasectomy makes it impossible for sperm to move beyond the cut in the vas.
Effectiveness
The vasectomy is essentially 100 percent effective.
A failure rate of 0.1 percent.
Side effects
The physical side effect of the vasectomy are minimal.
Some psychological based problems may arise.
The man’s attitude towards having a vasectomy is extremely important.
Only about 5 percent regret having had one.
Reversibility
There are techniques for reversing vasectomies, but men should assume that it is irreversible.
After a vasectomy some men also begin forming antibodies to their own sperm.
Advantages and disadvantages
Advantages
Disadvantages
Female sterilization
Several surgical techniques are used to sterilize a woman
These techniques differ in terms of the type of procedure used.
They involve the blocking of the fallopian tubes in some way so that sperm and egg cannot meet.
The female sterilization procedures do not interfere with the ovaries and does not bring on premature menopause.
How it works
Female sterilization makes it impossible for the egg to move down the fallopian tube toward the uterus.
It also prevents sperm from reaching the egg.
Effectiveness
These procedures are essentially 100 percent effective.
The failure rate of 0.5 percent is due to an occasional rejoining of the ends of the fallopian tubes, and rare cases in which the women was pregnant before the sterilization procedure was performed.
Side effects
Occasionally there are side effects arising form the surgery
Generally, only 1 percent of women undergoing the surgery experience complications.
Reversibility
A woman should assume that sterilization is irreversible.
Five years after sterilization, only 7 percent of women regret having had the procedure.
Advantages and disadvantages
Same as for men.
Factors that experts believe are crucial for teens to be consistent users of contraception
Fantasy may play an important role in contraceptive behaviour.
The media doesn’t quite show contraceptives.
Abortion: the termination of pregnancy.
Abortion procedures
Which method of abortion is used depends in part on how far the pregnancy has progressed.
Surgical abortion
Vacuum aspiration method: a method of abortion that is performed during the first trimester and involves suctioning out the contents of the uterus; also called suction curettage.
It is simple and entails little risk.
Dilation and evacuation
Is used especially for second trimester abortions.
Similar to vacuum aspiration.
Medical abortions
Mifepristone (RU-486): the abortion pill.
Can induce a very early abortion.
It has a powerful antiprogesterone effect, causing the endometrium of the uterus to be sloughed off and thus bringing about an abortion.
It is administered as a tablet, followed 2 days later by a small dose of prostaglandin, which increases contractions of the uterus, helping to expel the embryo.
Can be used during the first 7 to 9 weeks of pregnancy.
Effective in 92 percent of cases.
There is little evidence for side effects.
The use of the drug methotrexate, which is toxic to the embryo, with misoprostol, which causes uterine contractions that expel the embryo.
Psychological aspects
Most women do not experience severe negative psychological responses to abortion.
But, some women benefit from talking about their experience, and it is important that postabortion support groups be available.
Men and abortion
Among men who new their partner was having an abortion, 80 percent were supportive of the decision.
Counselling for men who are involved is rarely available.
Male methods
New condoms
Several new models are being tested.
Male hormonal methods
The basic idea underlying the development of male hormonal methods is to suppress the production of LH and FSH by the pituitary, so that sperm would not be produced or would not develop properly.
By, most hormone preparations that have been tried also shut down the user’s sex drive.
RISUG
RISUG: reversible inhibition of sperm under guidance
Involves injection of a porous polymer into the vas through a small injection.
Sperm can pass through the polymer, but the polymer disrupts the membranes of the sperm cells ts they pass through, so that they are not viable.
Immunocontraceptives
A contraceptive vaccine that would increase the individual’s immune system to react in a way that would interrupt one of the steps in the fertility system.
Female methods
Microbicides
Substances that kill microbes and, preferably, sperm.
A better pill
A new pill is being developed that adds an androgen to the combination pill.
Vaginal rings
A ring ring is being developed that would last 12 months.
Reversible, nonsurgical sterilization
Injecting liquid silicone into the fallopian tubes.
The silicone hardens and forms a plug.
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This is a summary of the book Understanding human sexuality by Hyde and DeLamater. The book is about topics ranging from sex is different cultures to sexual disfunctions. The book is used in the course 'Sexology' at the university of Amsterdam. Because of this only the
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