How Not To Get Pregnant

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Sex has for a long time been misconceived as a means to nothing but procreation. Whether or not that depends on one’s moral views or religious background, there is no denying that sexual intercourse has outstanding health benefits. And unlike the dogs and fowls roaming about the streets, humans have evolved to enjoy love making for its pleasures besides the natural consequence of the act termed conception.
So we can get ahead of the game and decide our fate because it’s our fundamental human right.
There are simple facts to note. The act of reproduction should first be understood by both partners. It gets easier than the formal lectures we receive at the fertility clinics of hospitals although this cannot replace them, as it’s wiser to make a well informed choice. Conception implies that a sperm, his seed, has successfully found its way into an egg, her seed, and the process of cell multiplication that would produce an embryo has been triggered. The knowledge of the female body which houses a womb where this union occurs cannot be downplayed. Getting down to the business of preventing that fruitful union let us note that the reproductive cycle is made of 28days averagely. So how do we stop a cannonball from hitting its target?
You can either decide to go the old fashion way or jump on the wagon for the newer/modern methods. It is entirely up to you. Remember, there is no perfect method. Each has got its pros and cons. Here are your options.

Traditional method
This includes: fertility awareness method, coitus interruptus, post coital douching and lactational amenorrhea. Just as the name implies, fertility awareness method requires that a woman is aware of when the fertile period of her cycle begins and ends. She is to know her peculiar menstrual cycle length (which is the number of days from the first day of her period to the last day of the next period) and determine her safe and unsafe period. The former being when she is more likely to get pregnant as opposed to the latter, when she is least likely to get pregnant. This method has been shown to be the most effective of all four, provided the principles are adhered to. Do not worry if your cycle length is irregular, that’s completely normal. All you need do, is keep track of your menstrual cycle noting the fertile days which are fewer and avoiding sexual intercourse on such days. This can be determined by monitoring your body temperature, cervical mucus – normal vaginal discharge and by more standards ways using a calendar rhythm or a string of colour-coded beads that corresponds to each day of your cycle. A rise in body temperature than most days and an egg white-like vaginal discharge are pointers to ovulation (when a mature egg is released into the womb), which announce the fertile period, otherwise known as unsafe period. So, just avoid sexual intercourse around that ovulatory period- a few days to, the assumed day and a few days after. Isn’t it as easy as locking the dog up when the fowls come out to play? If your cycle length is never below 27 days, the calendar rhythm method can be used which entails subtracting 18 from your shortest cycle length and 11 from your longest cycle length, so that your fertile period then becomes the days of your cycle between your two answers. If your cycle length is pretty much regular, ranging from 26 to 32 days, then the colour beaded string should be a reliable pick. Each string has 32 beads grouped into three colours: white, red and brown. It has a black rubber ring which a woman continues to move over a bead each day of the cycle at a time, starting from the red bead which corresponds to the first day of the cycle. When the black ring is on the brown bead, she is on that day of the cycle when getting pregnant after intercourse is least likely. The white beads represent fertile day from day 8 to 19 of a cycle, when a woman is to abstain from intercourse. The good thing about the natural method is that they have no side effect and can be combined with other methods; say the barrier method, especially when abstinence becomes an albatross. Be sure to keep those bad boys restrained!
Breastfeeding mothers need not have a headache; pregnancy is kept at bay from the time of delivery up to 6 months after provided menstruation hasn’t returned. It is called lactational amenorrhea meaning a temporary infertility that results when a woman is constantly breastfeeding and not menstruating, because the maternal hormone known as prolactin released by the body during breastfeeding prevents ovulation. It is not advisable to rely solely on this method if you are not exclusively breastfeeding your baby as ovulation could occur when breastfeeding is not constant. Some ladies could go to lengths of douching the vagina with plain water, vinegar and so on immediately after intercourse. However this is fraught with lots of failures. And when you trust that disciplined partner enough, you can just wait there while he rolls out hurriedly to ejaculate as far away as possible from the vagina, hence, the name coitus interupticus which means interruption of intercourse.

The Hormonal method
This method of birth control makes use of hormones. Hormones are chemical substances produced in the body that controls and regulate the activities of certain cells or organ. Two sex hormones- oestrogen and progesterone which prevent ovulation and alter the reproductive tract of the woman respectively have been proven to prevent pregnancy when used right. Let’s just say they either eliminate the target or the environment unfavourable for the bad guys to successfully reach their target. But be sure to consult a health practitioner before jumping on this wagon of no abstinences and drugs
Pills. Now, for the pill lovers, two hormonal drug formulations are available- combined oral contraceptives (COCs) and the progesterone only pill in several doses. Go for the lower doses as they have less side effects. Follow the instructions for each pill and ensure that you never miss your pills. Watch out for breakthrough bleeding (bleeding that occurs between periods), headaches, breast enlargement and tenderness which are common side effects of these pills. It is advisable not to take these pills for too long as they’ve been shown to have serious long term consequences. Less than 10 pregnancies would occur if 1000 women use COC in a year.
Injectables. For those of you who detest pills you can pick from either one of these two: Depo-Provera (DMPA), Norethisterone enanthate or combined injectable contraceptives (CIC). Most women prefer DMPA because they last longer. Each injection lasts for about 12 weeks with a two-week free interval before the next injection. Norethisterone enanthate only lasts for about 8weeks. There could be weight gain, irregular periods and delay in return to fertility when discontinued associated with the use of injectables. Be sure to discontinue them six months prior to the time when pregnancy is desired. Less than 20 pregnancies would occur if 1000 women use this method for a year
Implants .They are synthetic rods containing hormones which are inserted under the skin of the upper arm for slow release namely- norplants and implanon. The former lasts for up to five year whereas the latter, up to three years. And ofcourse, you are not to be bothered about pain as the procedure is carefully done under local anaesthetics. It is recommended for those who desire highly effective long-term contraception. One common concern of users is irregular bleeding. Only about one pregnancy would occur if 1000 women use this method in a year
Vaginal rings. These plastics rings containing oestrogen and progesterone are desired to fit in no particular place in the vagina. They are worn for 21days and removed for 7 days to allow for bleeding and provide birth control for up to a month. Can be taken out during intercourse but should not be removed for more than three hours prior to the act. The good news is that they are easy to insert and remove. Nonetheless the have the same benefits and risk as COCs save for their better cycle control
Patches. They are another close alternative to the COCs. The have the similar content and are applied to the skin of the upper outer arm, buttocks, abdomen or thigh for 21days and removed for 7days.
Hormone releasing Intrauterine device. Popularly called Mirena, this device is anchored in the womb and releases levonorgestrel a form of progesterone and can offer birth control for up to 5 years.

The Barrier Method
This method cannot be talked about without bringing in the men. Barriers could either be used by male or female. Most times it is entirely up to the woman for her partner to have a barrier on. It is pity how some women carry it about. And you are right, am referring to the male condom. That latex rubber scoop can trap millions of those bad boys, saving the day. They come in varying shapes and sizes and should be worn just before genital contact. The erect penis should be withdrawn from the vagina immediately after ejaculation. The sad news is that they can burst or slip of during the act and many men have complained of allergy to latex. Thankfully you have female barriers such as, female condom which is yet to gain widespread popularity, vaginal diaphragm, cervical cap, spermicidal gels, foams and tablets. The condom, diaphragm and cap should be used together with spermicidal creams. Diaphragm should be carefully fitted and inserted prior to intercourse and should not be removed earlier than 6 hours after. Interestingly, both male and female barriers could be used concomitantly, like male condoms and spermicidal creams. Ladies, isn’t it refreshing to know that if some of those bad boys escape the scoop, they won’t reach that goldmine if some extra measures are put in place here and there? Sadly, women should be weary of urinary and tract infection and vaginal irritation associated with female barriers. Comparing male condoms to diaphragms, about 20 to 50 pregnancies would occur if 1000 women use male condoms versus 10 to 150 pregnancies that would occur if those same numbers of women use diaphragms in a year.

The Intra Uterine Device.
These have no hormones. The newer copper containing device do not cause any reaction in the body and has spermicidal activity. They are inserted and anchored in the womb under anesthesia and offer birth control for up to 5 years. They are known to predispose to bleeding, pelvic infections and uterine perforations. Be sure to find out if you qualify for this option as there are contraindications to the use of all intrauterine devices. About 10 to 20 pregnancies would occur, if about a thousand women use this method in a year.

Sterilization Method.
And yet again the men would not be left out. Two options available for the women are tubal ligation and hysterectomy- removal of the womb. Now, you wouldn’t want to take out your womb or would you? So, your best bet is tying those tunes, designed to carry the released eggs into the womb. It can be done with or without incisions. This way you can hide that goldmine forever! And those bad boys would search forever! Although this highly effective, there have been reported cases of failure with this method. Studies show that 13 pregnancies would occur if10,000 have their tubes ligated in a year. If pregnancy does occur the chances there is 30% chance it’ll be ectopic. And for that loving male partner who wants to relieve her of that trouble, you can choose to have a vasectomy which means ligating the channel through which sperm travels to form the ejaculate. Those bad boys can then be jailed indefinitely. Vasectomy is said to be complete 12 to 16 weeks after the procedure has been carried out. Please note that this procedure is reversible but pregnancy may not occur due to inactivated sperm cell.
There is no better way to end than with emergency contraception. Cheer up, because there’s still a chance that you can prevent pregnancy up to five days after unprotected sex. The odds are lower if measures are taken within the succeeding 72hrs. Note that this does not disrupt an existing pregnancy and it is safe for all women. So what’s this saving grace? Hormone again? Yes, oestrogen and progesterone formulated in higher doses. Popular formulations are levonorgestrel of 1.5mg (Postinor), norgestrel and Yuspe method using COCs.

Having known the possible options you can choose from to keep that unwanted pregnancy a way, be sure to look a second time before you leap. Most of these methods can’t guaranty 100% prevention. Weigh the risk against the benefit and be sure to seek professional advice.

Submitted by Dr Juliet Chinonye Nwankwo. (MBBS UNN)

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