Sexual adjustment: Sex is resumed as soon as wound healing occurs, bleeding stops, and client feels comfortable with it. Fatigue, body image, and hormonal changes can influence desires.
Natural Family Planning - avoidance of coitus during fertile period
- Health Teachings
: daily body temperature recording plots of ovulation: usually 14 days before next menses.
: abstinence recommended from day 6 to day 14 for an average 28 day cycle
: Cervical mucus becomes stretchable at ovulation (spinnbarkeit)
Oral Contraception
- inhibits ovulation
- effective, reversible method
- should be taken everyday
- alters cervical mucus
- pills must be taken according to schedule
- teach patient to report side effects
- headache, edema, hypertension, amenorrhea, breakthrough bleeding
- protect against certain cancers, anemia and other conditions
- not recommended for breastfeeding women because it can reduce milk supply
- can be used for emergency contraception after unprotected sex
irregular vaginal bleeding, missed period, upset stomach
- effective and safe
- changes in vaginal bleeding are normal
- weight gain may occur
- do not prevent STD's
- do not contain estrogen
Long-acting progestin implants (norplant) - inhibit ovulation
- capsules are placed under the skin of a woman's upper arm
- can prevent pregnancy for at least 5 years
- effective within 24 hours after insertion
: six selastic capsules containing a progestin are implanted in the patient's arm
: side effects are spotting, irregular bleeding, amenorrhea, weight gain, headache, depression
Tubal Ligation - permanent interruption of reproductive capacity
- helps protect against ovarian cancer
- reversal surgery is difficult
- preparation of the patient for minilaparotomy or laparoscopy
After: rest for 2-3 days, avoid heavy lifting for a week, take paracetamol, avoid sex for at least 1 week
Reportable sign and symptoms: high fever in the first 4 weeks, pain, pus, abdominal pain, diarrhea, fainting, dizziness
Health Teachings
: procedures are theoretically reversible but permanency of effect should be emphasized
: Vasectomy- ligation of the vas deferens: pain and swelling on the incision site during the first week is common. Takes 4-6 weeks and upt to 36 ejaculations to clear sperm from vas deferens. Follow-up semen count is necessary
: Tubal Ligation- interruption of tubal patency by coagulation, ligation, or banding. Complications include hemorrhage, infection, bowel perforation
Vasectomy
- permanent
- no effect on sexual performance
- fully effective only after 20 ejaculations or 3 months. The man should use condom or his partner should use another method
- common complications: pain in the scrotum, swelling, bruising, brief feeling of faintness after the procedure
Condom - barrier method
- interrupts sex, reduces sensation
- comes in different sizes, shapes, colors and textures
- the only contraindication: LATEX allergy (severe redness, itching, swelling)
: sheath placed over the erected penis before intercourse to collect semen
: affords some protection against STDs
: side effects are perineal or vaginal irritation
IUD
- small flexible plastic frame
- it is inserted into a woman's uterus through her vagina
- a provider can remove the IUD by pulling gently on the strings with forceps
- common side effects: menstrual changes (longer, heavier menstrual periods, bleeding and spotting, cramps or pain during periods)
- check IUD once a week during the first month after insertion, after each menstrual period, if possible after noticing any possible symptoms of serious problems
- to check the IUD, a woman should: wash her hands, sit in a squatting position, insert 1 or 2 fingers into her vagina as far as she can until she feels the strings. Do not pull on the strings
- instruct the patient to return for a visit 3-6 weeks after IUD insertion
Vaginal Methods (spermicide, diaphragm, cervical cap)
- methods that women control and can be used when needed
- help protect against some STD's
- insert spermicide up to 1 hour before sex. Place it high in the vagina. Insert foaming tablets, films, and suppositories at least 10 minutes before sex. Do not douche for at least 6 hours after sex
- insert a diaphragm or cervical cap ahead of time when you might have sex. After sex leave the diaphragm or cap in place and do not douche for at least 6 hours
Action
: destroy sperm or neutralize vaginal secretions
- Health Teachings
: effectiveness increases if used with a condom
: report local tissue irritation
Fertility awareness-based methods
Cervical secretions: avoid unprotected sex from the first day of any cervical secretions or feelings of vaginal wetness until the 4th day after the peak day of slippery secretions
Basal Body temperature (BBT): avoid unprotected sex from the first day of menstrual bleeding until body temperature has risen and stayed up for 3 full days
Calendar or rhythm: determine the fertile time through calendar calculations. Avoid unprotected sex between the first and last days of the estimated fertile time
Cervical Secretions + BBT: avoid unprotected sex from the first day of cervical secretions until both the 4th day after the peak of slippery secretions and the 3rd full day after the rise in body temperature
LAM (Lactation Amennorhea method)
- temporary
- based on breastfeeding
- can be used when (1) the woman breastfeeds often both day and night (2) menstruation have not returned (3) baby is less than 6 months
- effective for up to 6 months after childbirth
- an ideal pattern of breastfeeding for LAM is at least 8-10 times a day including at least once a night
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