“The following

presentation contains
slides not suitable
for very young
audiences.
Parental guidance is
recommended.”
 Family Planning

Responsible Parenthood
MARGIE REYES-POSADAS, MD
 
DEFINITION
a joint effort of the husband and wife to
space or limit the number of children in the
family
 What is Contraception?

CONTRACEPTION: is the intentional prevention
of pregnancy during sexual intercourse.

BIRTH CONTROL: is the device and/or practice

to decrease the risk of conceiving, or bearing an
offspring.
 OBJECTIVES / GOALS

1. To ensure safe motherhood and
child survival
2. To improve the quality of life
3. To contribute in prevention or
reduction of social problems in
particular and national problems
in general
To improve the quality of
life by:
a. Birth spacing -
 allowing mothers to
rest (2-3 yrs) and
regain their health
before the next
pregnancy
b. Birth limitation -
when the desired
number of children
has been reached
c. Helping infertile
couples to have
children
To contribute in prevention or reduction of
social problems in particular and national
problems in general:
a. poverty
b. overcrowding
c. malnutrition as a
result of
overpopulation
d. energy crisis over
all effect
e. air/water pollution
f. deforestation &
floods
 Eye View on the Population

Philippine population – 94 million
12th largest population in the world
Population growth rate - 2.36%
Population will double in 29 years
40% of population (4 out of 1O Filipinos) living in
poverty
 Women’s choices

About one half of pregnancies in the Philippines
are unplanned.
Most women can become pregnant from the
time they are in their early teens until they are in
their late 40’s.
Birth control can help couples postpone having
a baby until the time it is right for them-if ever.
 Choosing a method

How well the method works and the side effects.
How likely you are to use it according to the directions.
Your age and overall health.
How often you have sex.
Whether a prescription is needed.
Whether you want to have children later.
Whether it helps protect against STD’s.
 Things to consider about contraceptive
methods:

Personal values
Ability to use a method correctly
How the method will affect sexual enjoyment
Financial factors
Status of a couple’s relationship
Prior experiences
Future plans
 Ideal Characteristics:

Safe
100% effective
Free of side effects
Easily obtainable
Affordable
Easy to use and acceptable to both user and sexual
partner
Free of effects on future pregnancies
 FAMILY PLANNING

WHO: the use of a range of methods of a fertility
regulation to help individuals or couples attain certain
objectives:
 Avoid unwanted birth.
 Bring about wanted birth.
 Produce a change in the number of children born.
 Regulate the intervals between pregnancies.
 Control time at which birth occur.
3 Important Elements in Family Planning

Proper spacing
Proper timing
Number of pregnancies
 Benefits to Mother

Reduce the health risk by helping woman bear children
during their healthiest years ( BELOW 20 y/o and
ABOVE 35 y/o) at risk of developing complications
during pregnancy.
Help mother to fully recover from physical strain of child
bearing. Those more than 4 children- CONSIDERED
HIGH RISK.
Help reduce number of maternal death due to abortion.
 Health Benefits to Children

Ensures better chance of survival at birth.
Promote better childhood nutrition.
Promote physical growth and
development.
Prevent birth defects.
 Health Benefits to Father

Allows father to keep a constant balance between
their physical, mental, and social well being.
More relaxed sexual relationships- confident not
produce unwanted pregnancy.
Increase father sense of respect because he is
able to provide the type of education and home
environment.
Benefits to Whole Family Health


Help the family enjoy

the better kind of life.
 TYPES OF FAMILY PLANNING

Natural
Mechanical/Artificial
Permanent/surgical
Natural Family Planning Methods

No introduction of chemical or foreign material into the
body.
Practice maybe due to religious belief, “natural” way is
best for them.
Effectiveness varies greatly, depends on couples ability
to refrain from having sex on fertile days.
Failure rates: 25%
Poses no risk to fetus.
 Natural Family Planning

Rhythm (CALENDAR) method
Basal Body Temperature (BBT)
Ovulation or Cervical mucus (Billings Method)
Symptothermal method
Ovulation awareness
Lactation Amenorrhea Method
Coitus Interruptus
 A. Rhythm (Calendar) Method
“it’s a date”

Abstaining from coitus on the days of
menstrual cycle when a woman is likely to
conceive ( 3 or 4 days before until 3 or 4
days after ovulation ).
Woman keeps a diary of 6 menstrual
cycles
 A. Rhythm (Calendar) Method
“it’s a date”

 To Calculate:
- Subtract 18 from the shortest cycle
- subtract 11 from the longest cycle
- ANS: represents her last fertile day
Example:
if she has 6 menstrual cycles ranging from 25 to 29 days, fertile
period would be from 7th day to the 18th day.
- To avoid pregnancy, avoid coitus/use contraceptives during
those days.
 B. Basal Body Temperature
“I’m so Hot”

Identifying fertile and infertile period of a woman’s cycle
by daily taking and recording of the rise in body
temperature during and after ovulation.
Just before ovulation, a woman’s BBT falls about 0.5ºF.
At time of ovulation, her BBT rises a full degree
(influence of progesterone).
This higher level is maintained the rest of menstrual
cycle.
 B. Basal Body Temperature
“I’m so Hot”

HOW:
- Woman takes her temperature each morning
immediately after waking, before she undertake any
activity.
- She has ovulated, slight dip in temp. followed by
increase.
- Usually combined with Calendar method
- Failure rate: 9%
 C. Cervical Mucus/Billing’s Method
“stretch”

Use changes in the
cervical mucus with
ovulation
Woman: should be
conscientious in
assessing her vaginal
secretions
Failure rate: 3%
 C. Cervical Mucus/Billing’s Method
“stretch”

Before Ovulation:
- thick & does not stretch
With Ovulation (peak day):
- copious, thin, watery, transparent. Feels
slippery & stretches at least 1 inch before the
strand breaks= KNOWN AS “SPINNBARKEIT”-
these are fertile days.
 D. Symptothermal Method

Combines the cervical mucus and BBT method
Watches temp. daily and analyzes cervical mucus daily
Watch for midcycle abdominal pain (MITTELSCHMERZ)
Couples must abstain from sexual intercourse until 3 days
after rise in temp. or 4th day after peak of mucus change.
More effective than BBT or CM Method alone
Failure rate: 2%
 E. Ovulation Awareness

Use an OTC Ovulation detection kit
These kits detect the midcycle surge of
Luteinizing Hormone (LH) that can be detected
in urine 12 to 24 hours before ovulation.
98% to 100% accurate in detecting ovulation.
Expensive
F. Lactation Amenorrhea Method

Temporary introductory postpartum method of
postponing pregnancy based on physiological infertility
experienced by breastfeeding mothers.
Universally available to all postpartum breastfeeding
women.
No other family planning commodities required.
Contributes to improve maternal and child health and
nutrition.
 F. Lactation Amenorrhea Method

Only temporary, effective only up to 6 months
postpartum.
Effectiveness may decrease if mother and child are
separated for extended periods of time (working
mothers).
Difficult to maintain (up to 6 months) due to variety of
social circumstances.
F. Lactation Amenorrhea Method

If the mother is giving supplemental feeding,
introduce other Family Planning method during
LAM.
Baby is older than 6 months, introduce other FP
methods.
1-2% chance of getting pregnant
 G. Coitus Interruptus
“The pulling out”

One of the oldest methods of contraception
Couple proceeds with coitus until the moment of
ejaculation
Then the man withdraws & spermatozoa are emitted
outside the vagina
Offers little protection
Adolescent boys may lack the control or experience to
use the method effectively
 MECHANICAL/ARTIFICIAL

 Barrier Methods
 Prevent the man’s sperm from reaching the woman’s egg.
 TYPES:
- IUD
CONDOMS ( male & female )
SPERMICIDAL
SPONGE
DIAPHRAGM
CERVICAL CAP
 IUD

Have a high use effectiveness
Intrauterine Device
Effectiveness: 98-99%
Failure rate: 0.8%
 of IUD

inserted once
long term use
provides complete protection against pregnancy
with progesterone containing devices, it dec menstrual blood
loss and can be use to treat menorrhagia
dec menstrual blood loss is assoc w/ dec dysmenorrhea
cost effective (1 device for years)
used by women w/ contraindication for using COC and
Norplant's
 Types of IUD
1. Chemically Inert
 composed of non-absorbable material (Polyethylene) impregnated with Barium
SO4 for radiopacity
 E.g.: Lippes Loop
2. Chemically Active-Medicated
 containing Copper or progestational agent
 E.g.: Copper T 380 A
 Cu T 380 - currently use in the Phil.
- covered w/fine Copper wire
- stem = 314 mm2
- arm = 33 mm2 each
- w/ a total of 380mm2 copper
- its end w/ enlarged bulbous stem base so it wont perforate
 Types of IUD
 LIPPES LOOP IUD  COPPER T 380 IUD
NOTE: The device should not be "loaded' into its
inserter tube more than 5 minutes before it is inserted.

DURATION OF USE: REPLACEMENT:

Cu T 380 A = 10 years

Lippe Loop = indefinite
Others = 5 years (Levonorgestrel)
(LNg - IUD)
Progestosert = yearly
 WHEN TO START IUD:
 During menstruation 
 After childbirth
Lippe loop
 immediate postpartum - 1O mins after delivery of placenta
 anytime within 48 hrs postpartum
Cu T 380 A
 4 weeks postpartum
 After an abortion:
 no infection = immediately
 with infection = treat infection, after 3 months
 Timing of Insertion of IUD

8 wks after delivery
near the end of normal menses when the
cervix is softer, and the canal is dilated.
 Side Effects of IUD
Bleeding/Uterine Cramping 
- Tx. lbuprofen 400mg 1 st 3 days
of cycle
Pelvic Infection – inc. risk of PID, Actinomyces, HIV, Sterility.
Missing IUD string
Uterine perforation - during sounding, during insertion
Syncope - Vasovagal Rxn
Ectopic Pregnancy - seen in women using progestosert.
Expulsion - during 1st month, after insertion- seen after
delivery
 Indications of IUD

Multiparity
Alternative to oral
contraception
Older women
 ABSOLUTE CONTRAINDICATION

Active, Recent, Recurrent Pelvic Infection
Pregnancy
Abnormal, Irregular, Uterine bleeding
Cervical / Uterine Malignancy
 RELATIVE CONTRAINDICATIONS


Nulliparous
Uterine Abnormality

 Hx of STD, HIV
 Multiple Sex partners
 Hx of Ectopic Pregnancy
 Endometriosis
 Valvular Heart Disease
 Wilson Disease
 Impaired Coagulation
 Impaired response to infection
 DM
 steroid treatment
 Hx of Fallopian tube Surgery
 Hx of Vasovagal reactivity/ fainting
 PREGNANCY WITH A DEVICE IN UTERO

 leads to: Abortion, Sepsis, Preterm Delivery
 Management:
 Pregnancy with IUD tail visible at cervixRemove the IUD
 Pregnancy with IUD tail not visible  Do not attempt to remove
IUD
 Pregnant + IUD + Uterine Infection  Antibiotics + Prompt
uterine evacuation of pregnancy products with device.
 Pregnant + IUD  proceed to term  inc risk of fetal
malformations.
 HOW TO LOCATE A LOST IUD:
Dx: either Expelled / Perforation

1. Gentle probing of the uterine cavity w/ a rod w/
terminal hook to retrieve the string.
2. Utrasound - to determine if the device is within the
uterine cavity.
3. Plain x-ray of the abdomen & pelvis w/ a sound
inserted into the uterine cavity
4. Hysterography - instillation of radio contrast
5. Hysteroscopy
LOCAL BARRIER METHODS

Male condom
Female condom
Vaginal spermicidal agents
Vaginal diaphragm
Contraceptive sponges
Cervical caps
 A: CONDOMS “The Shield”

 Male version
 Made of Latex, Polyurethane, or Animal skin
 Latex condoms also protect against STD’s, including HIV

 Female version
 Thin plastic pouch that lines the vagina
 Can be difficult to insert
 Use if partner can not be sure will use a male condom
 Can be inserted up to 8 hrs before sexual intercourse
Female Condoms

 Latex sheaths made of polyurethane and prelubricated with
spermicide.
 Inner ring (closed end)= covers the cervix
 Outer ring (open end)= rests against vaginal opening
 Maybe inserted anytime before sexual activity begins, then
remove after ejaculation occurs
 Like Male condoms, one time use only
 Offer protection against both conception and STD
 More expensive than Male condoms
 B. Spermicides “The killer”

Spermicides are often
used in suppositories,
foam, cream, jelly and
film (thin sheets that
contain spermicide to
kill sperm or make
them inactive).
 C. Sponge

Sponge is a dough-nut shaped device made of
soft foam coated with spermicide.
To use the Sponge, it must be moistened with
water.
 Once inserted in the vagina, it covers the cervix
and blocks the sperm from entering the uterus.
D. Diaphragm

 Small Latex, dome-shaped device that fits inside the vagina &
covers the cervix.
 It is used with spermicide.
 Requires a prescription and needs to be fitted by a doctor.
 It should remain for 6 hours following coitus & maybe left for 24
hours.
 To be effective, use with vaginal creams.
 Wash the diaphragm after use with soap and water
 It can be used repeatedly for 2-3 years
 Contraindicated for females with abnormalities in cervix.
E. Cervical Cap

Small, thin, dome-shaped device made of Latex
or plastic.
It fits tightly over the cervix and stays in place
by suction.
Cervical cap maybe fitted and prescribed by a
doctor.
 HORMONAL METHODS
“The Pill”

 HORMONAL BIRTH CONTROL= woman takes hormones
similar to those her body makes naturally.
 These hormones prevent ovulation & change the lining of
the uterus.
 It also cause the cervical mucus to thicken, w/c makes it
hard for the sperm to get through the cervix to the uterus.
 It comes in several forms: PILL, SKIN PATCH, VAGINAL
RING, INJECTION, IMPLANT.
Birth Control Pills


ORAL CONTRACEPTION
 PILLS OR COC’S (Combined Oral Contraceptives)
 Contains varying amounts of synthetic estrogen combined with
a small amount of synthetic progesterone (progestins)
 Estrogen- acts on FSH & LH thus suppresses ovulation
 Progesterone- cause a decrease in the permeability of cervical
mucus thereby limiting sperm motility & access to ova.
 It also interferes with tubal transport & endometrial
proliferation
Estrogen Progestins Combined
Effect
1. inhibit ovulation by
suppressing pituitary
gonadotrophins FSH &

1. provide thick scanty
cellular cervical mucus
impairing sperm
1. ovulation
suppression

LSH transport

2. inhibit implantation 2. endometrium is 2. blocks sperm

by altering normal unfavorable to penetration by cervical
endometrial maturation blastocyst implantation mucus

3. 3. inhibit ovulation by 3. unfavorable

suppressing endometrium for
gonadotrophins implantation

4. Available: 4. Available:  

ethinyl estradiol 19 nortestosterone

mestranol norgestrel
desogestrel
norgestimate
gestodene
 Administration:
 Begin OC within the 1st 7 days of the menstrual cycle


Consideration
 if 1 dose is missed - double the next dose to minimized
breakthrough bleeding
 if several doses are missed - use another form of
contraception (Barrier technique)
The pill can be started after withdrawal bleeding
Without bleeding, possibility of pregnancy must be
considered
 TYPE OF PILLS /PREPARATION:
MONOPHASIC - each tablet has a fixed dosage of estrogen & progestin

e.g. Nordiol (high dose); Logentrol (low dose)
e.g. : 21 day pill - 21 days ff by 7 day free
  28 day pill - 28 days w/ 7 placebo tablet

MULTIPHASIC - 3 consecutive phases w/ varying amount of estrogen &

progestin e.g. : Trimordiol, Logynon
- highly effective in preventing pregnancy.
Disadvantage:
a. confusion due to multicolored pills
b. breakthrough bleeding (spotting) 2x than monophasic
c. loss of flexibility due to difficulty in doubling up if a pill is missed
 PILLS

 EFFECTIVENESS: 95%
 99.6 % effective in combined oral contraceptive pill
 97.0 % effective in progestin only pill

 FAILURE RATE: 0.32 / 100 women

 DRUG INTERACTIONS

A. Effectiveness is DECREASED by Oral Contraceptives
 acetaminophen
 benzodiazepine tranquilizers
 guanithidine
 methyldopa
 oral anticoagulants
 oral hypoglycemics
 DRUG INTERACTIONS

B. Effectiveness is INCREASED by Oral Contraceptives
 alcohol
 antidepressants
 benzodiazepines
 beta blockers
 corticosteroids
 theophylline
 DRUG INTERACTIONS
C. Alters effectiveness of Oral Contraceptives
 Phenytoin 
 Ampicillin
 Carbamazepine
 Sulfonamides
 Barbiturates
 Penicillin
 Primidone
 Tetracycline
 Griseofulvin
 vitamin C
 Rifampin 
 Management of Drug Interaction

increase dose of estrogen
take 50 mcg ethinyl estradiol
give alternative contraception for added protection
 Benefecial Effects of COC

 dec incidence of PID, salpingitis
 prevention of ectopic pregnancy
 dec menstrual blood loss, dec iron deficiency anemia
 dec dysmenorrhea associated with endometriosis
 dec endometrial & ovarian cancers
 dec incidence of benign breast tumor & breast CA
 protection against functional ovarian cyst (corpus luteum or
follicle)
 dec. premenstrual syndrome
 less rheumatoid arthritis
 Precautions
to use of COC

• known pregnancy
• undiagnosed vaginal bleeding of suspicious nature
• history of thromboembolic disorder
• history of CVA
• history of coronary artery disease or ischemic heart disease - dec plasma
prostacycline >> vasoconstriction
• known or suspected estrogen dependent neoplasm
• impaired liver function/ benign/malignant liver tumor
• headache, vascular or migraine
• history of HPN
• DM
• history of renal or cardiovascular disease
• Active gallbladder disease
 EFFECT OF COC ON REPRODUCTION

 discontinuation of the pill > resumption of ovulation within 3-6 months
 Patient who conceived while taking the pill > fetal limb reduction
deformities, fetal congenital malformation
 Lactation: the use of COC dec the volume/amount of breast milk
(Progestin only Pill is advise for lactating mothers)
 Estrogen in COC > cervical mucorrhea > vaginitis or vulvovaginitis sec
to Candida ( the use of antibiotic therapy in pill users inc the frequency
of such infections)
EFFECT OF COC ON
REPRODUCTION

 Chloasma - hyperpigmentation of face and forehead.
 Acne - may improve or not depending on use of Progestin. COC
suppress gonadotropin > dec ovarian androstenedione production and
testosterone Production.
 Low Progestin content (Desogestrel or Norgestimate) improves acne
formation.
 Uterine myoma - do not inc in size with COC
 Weight gain – COC:
 1. inc tissue resistance to insulin > inc dietary intake
 2. sec to fluid retention
 HOW TO USE
1. 
any day - within the 1 day of
st

bleeding
2. after childbirth
 6 months after BF;
 2-3 weeks after delivery if not
BF
3. after an abortion - after 1-2 weeks
 # of missed pill/s WHAT TO DO:

1 MISSING Take
of 11pill
or more
as soon pills:
as you
then take the rest as usual
remember


2 of the 1st 14 Take 1 now and the rest as usual. Use
back up for 1 wk

> 1 of the 1st 15-21st Take 1 pill now and the rest as usual.
No brown intake. Start a new pack
after the last pill. Use back up for 7
days

Many of the brown or Throw the missed pill and take the rest
remainder pill as usual.
 
 Absolute Contraindications
 Thrombophlebitis disorders 
 Cerebrovascular or CAD
 Breast CA
 Endometrial CA
 Estrogen-dependent neoplasm
 Abnormal genital bleeding
 Liver tumor / disease
 Impaired liver function
 Pregnancy
Relative Contraindications
 Cardiac / renal dysfunction
 Migraine / vascular headache

 Gestational or pre DM
 HPN
 Depression
 Varicose vein
 Age over 35 & smoker
 Sickle cell, sickle C, sickle B
thalassemia
 Ulcerative colitis
 Cholestatic jaundice
 Hepatitis
 Asthma
 PROGESTIN ONLY PILLS
 DOSAGE:

 0.5 mg of Lynestrenol in a 28 pill pocket preparation

 ACTION:
 induces cervical mucus that impedes sperm penetration
 Alters endometrial maturation w/c is not conducive to implantation

 DIRECTION:
 Start on the 1st day of menstrual cycle (D1)
 Taken daily without break whether mens occur or not
 PROGESTIN ONLY PILLS

• DRUG INTERACTION
• All anticonvulsants except Valproic acid markedly reduce the
contraceptive effectiveness for oral Progestin-only contraceptives and
Norplant's
• Mx: used other forms of contraception

• RECOMMENDATION/BENEFITS
• breastfeeding mothers - do not suppress lactation
• women over 40y/o w/ risk of reproductive tract malignancy and
cardiovascular diseases
• women who experienced headache
• women who have varicose veins/ leg pains
• hypertensive women
 INJECTABLE PROGESTIN
CONTRACEPTIVES
• Contents: Progestins
• EFFECTIVENESS

• same or better than COC (99.6%)
• Long lasting action
• Minimal impairment of lactation

• EXAMPLES/ Preparations:
• Medroxyprogesterone acetate (Depo-Provera) / DMPA
• Norethindrone Ethanthate (Norgest) / Net-En

• MECHANISM OF ACTION
• inhibit ovulation
• inc cervical mucous viscosity ( thick, viscid)
• produce an endometrium w/c is unfavorable for ovum implantation endometrium is
shallow, atrophic w/ inactive glands)
 INJECTABLE PROGESTIN
CONTRACEPTIVES
DIRECTION OF USE 
 DMPA
 injected IM upper outer quadrant of buttocks without massage to
ensure that the drug is released slowly
 Dosage : I ml of 150 mg synthetic progesterone given every 90
days (3 months/12 weeks)
 EFFECT: No ovulation occurs for at least 14 weeks after
injection
 Plasma Levels:
 1.5-3.0 ng/ml within days
 0.2 ng/ml at 6 months
 undetectable by 7-9 months
 INJECTABLE PROGESTIN
CONTRACEPTIVES
WHEN TO INJECT? 
 1st 7 days of menses
 when women is not pregnant
 14 days after an abortion
  after childbirth
 28 days after delivery if not BF
 6 wks after delivery if partially BF
 Injection follow-up for DMPA
 3 months after the last injection
 4 wks earlier or 2 wks later can still be given
 of IPC

Long term contraception
Convenient
Ease for administration
No side effects of estrogen
Does not affect lactation
 Disadvantages of IPC

Prolonged amenorrhea
Uterine bleeding during / after its use
Prolonged anovulation after d/c
Delayed return of fertility
 SIDE EFFECTS
headache 
breast tenderness
depression
dizziness
weight gain
mental disturbances
 amenorrhea in DMPA
 Management

With heavy bleeding:
14- 21 day course of. oral contraceptives
Ibuprofen
Do not do D & C
 Skin Patch

The contraceptive skin patch is a small (1.75 inch)
adhesive patch that is worn on the skin to prevent
pregnancy.
With the patch, estrogen & progestin are absorbed
through the skin into the blood stream.
The patch may offer many of the same benefits & risks
as the combined birth control pill.
Once a woman obtains a prescription for the patch, she
does not need to visit her doctor to apply or remove it.
Vaginal Ring

Flexible, plastic vaginal ring that is placed in the
upper vagina. It releases both estrogen and
progestin.
The ring may have the same benefits and risks
as those of the combined birth control pill.
 Implants

A single rod that is inserted under the skin of
the upper arm.
It protects against pregnancy for 3 years.
The Implant releases a progestin that works
similar to other hormonal methods of birth
control- it prevents ovulation.
 Emergency Contraception
Definition:

 a number of methods used by women within a few hours or a
few days following unprotected intercourse to prevent
pregnancy
ACTION:
 interrupts a woman's reproductive cycle
 prevent/ delay ovulation or interfere w/ fertilization or block
implantation
MOST COMMON METHOD USED:
 take elevated dose of COC within 72 hours followed by a
second dose of 12 hours later
 Effectiveness: 75-85%
 Emergency Contraception

• INDICATION:
1. First 3 days ( 72 hrs.) after unprotected sexual
intercourse.
2. In cases of rape, condom break or slip during
sex, missing 2 or more pills, having unplanned sex.
3. Can be used up to 3 days after intercourse.
• PREPARATIONS:
1. Ethinyl Estradiol: 100 ug / day for 2 days.
2. Progestin: 0.75 mg Levonorgestrel.
3. IUD
• DOSAGES:
A. OCP – 2 doses at 12 hrs. interval
BIRTH 1st dose 2nd dose
CONTROL
OVRAL 2 pills 2 pills
LEVLEN 4 pills 4 pills
LO- OVRAL 4 pills 4 pills
NORDETTE 4 pills 4 pills
TRILEAFAN 4 pills 4 pills
TRIPHASAL 4 pills 4 pills
B. IUD - inserted within 5 days
 Surgical Methods
“the permanent”

Includes STERILIZATION:
TUBAL STERILIZATION- for women
VASECTOMY- for men
Preferred Method: most effective, no effect on
sexuality
Chosen with great thought & care & should be
considered permanent.
 Surgical Method


Tubal Ligation & Vasectomy

 PERMANENT FAMILY PLANNING
aka STERILIZATION

VSC - Voluntary Surgical Contraception
Effectivity:
99.97 %
most effective method
 MECHANISM OF ACTION
of the reproductive tract
obstruction of the continuity
for female sterilization
tubal ligation or occlusion of fallopian tube
tying and cutting
applying clips or rings
cauterizing the fallopian tubes
for male sterilization
occlusion of the vas deferens
preventing the sperms from mixing w/ the ejaculate
tying and cutting
INDICATION FOR STERILIZATION
1. simple contraception 
 family completed: qualification by ACOG - women 30y/o w/ 4
living children
 desirous for infertility/ sterilization
2. medical indication - heart disease,
endocrine problem
3. obstetrical indication - previous
uterine scar
4. genetic - history of familial traits
for congenital anomalies
 FEMALE STERILIZATION
TIMING
postpartum – D0 to D7 
postabortal
 After an abortion as long as no infection
 If with infection : treat
interval - D28 onward
 during menstruation
 anytime as long as not pregnant
 On family planning method
at the time of other pelvic or
abdominal surgery
 METHODS

1. Surgical - Abdominal - Minilap
 Laparoscopy
 Vaginal - Colpotomy
 Culdoscopy
2. Nonsurgical - Hysteroscopy

INCISION
1. Suprapubic - interval sterilization
2. Infraumbilical -postpartum
 SURGICAL METHODS
MINI LAPAROTOMY 
most widely used method for female
sterilization
incision 2-3 cm, suprapubic or infraumbilical
tubes are approached by the use of a uterine
retractor or an elevator
"minilap” = length of incision is 2-3 cm done
under local anesthesia, OPD case
 SURGICAL METHODS
INTERVAL MINILAPAROTOMY
Timing: 
 1. Within the 1ST 7 days of menstrual cycle
 2. Anytime during the cycle if she is taking pill properly, IUD intact and
regular menses.
 3. Interval period ff vaginal delivery or abortion
Approach:
 2.5-3cm transverse skin incision, 2 fingers above upper border of
symphysis pubis
Method:
 Pomeroy procedure or its modification - most common method use
 SURGICAL METHODS
 LAPAROTOMY
INTERMEDIATE POSTPARTUM
Timing:
within the 1ST 7 days (DO-D7) ff vaginal delivery
Approach:
incision made just below the umbilicus
Methods
Pomeroy procedure or its modifications
 MALE
STERILIZATION
(Vasectomy) 

done under local anesthesia within 20 minutes on

an OPD basis
midline (simple) or bilateral scrotal incision to
ligate the vas deferens (vas is cut and ligated)
 Disadvantages of

Vasectomy
1. Sterility is not immediate (not an instant sterility)
2. Patient have to wait 15-20 ejaculation before the tract
becomes devoid of sperm.
3. Semen should be checked until 2 consecutive sperm
counts are zero.
4. Another form of contraceptive method must be use
during this period.
5. Failure rate 1 in 100 cases.
 Complications of
  Vasectomy

bleeding or hematoma from the scrotal
incision or from the vas sheath

wound infection

congestive epididymidis

spermatic granuloma of the vas or epididymis

 

Thank
you!