Ira
20.05.2004, 12:41
To me 21. Has more recently got the first sex experience. You could offer what most effective contraceptives to me.
Просмотр полной версии : To me 21. Has more recently got the first sex experience. What most ef...
VLADIMIR
20.05.2004, 16:24
I ADVISE YOU TO USE NOT HORMONAL SVECHAMI-FARMATEKS OR DR
BUT IT IS BETTER TO PICK UP THE SCHEME or PLAN OF CONTRACEPTION INDIVIDUALLY
BUT IT IS BETTER TO PICK UP THE SCHEME or PLAN OF CONTRACEPTION INDIVIDUALLY
Isaev D.D.
20.05.2004, 22:31
Dear Ira! You should solve independently this question, preliminary to consult at vracha-the gynecologist, t. To. It is necessary to consider both features of your organism and individual preferences It is necessary to result or bring again endurances or quotations from my future book (" the Illustrated encyclopedia of sexuality "):
Choice of a contraceptive - very important decision. It should be carried out meaningly on the basis of acquaintance to various methods of contraception. The choice of a concrete contraceptive depends on its or his reliability (efficiency), harmlessness for an organism, simplicity of use, positive and negative by-effects, cost, convertibility and an individual acceptability.
Till now there is no ideal contraceptive which would be effective on 100 % and approached or suited absolutely to all. During the different periods of a life even it will be better to one woman to use different methods of contraception. On popularity hormonal tablets all over the world are in the lead - them use nearby 100 million women annually. The second on popularity there are endometrial agents (Naval Forces) to which prefer nearby 60 million women. To the most effective and safe methods of contraception, except for them, carry the hormonal preparations entered in the form of injections and implantov, possessing long obratimym action, and also surgical sterilization, both women, and men. The big variety of modern methods of adjustment of birth rate gives freedom for planning family, reduces a maternal mortality due to refusal of abortion, as basic way of planning of family in the past.
According to interrogation, in the USA approximately 90 % of women from group of risk of undesirable pregnancy used any contraceptive. Now the most popular methods of preservation from pregnancy in pairs or steams genesial age are oral contraceptive tablets (them 19 % use), sterilization of women (17 %), condoms (9 %) and sterilization of men (7 %).
In our country, according to Ministry of Health of the Russian Federation (1998) endometrial and hormonal contraceptions, accordingly 18 % and 8 % are most popular. About 40 % of women fertilnogo age use ineffective methods of prophylaxis of undesirable pregnancy.
Level of unreliability of various contraceptive agents.
The percent or interest beremennostej after a year of use of a contraceptive method is presented. Theoretical parameters of reliability (in brackets) and real results of use are given.
For an effective utilization it is important to choose such way of contraception which arranges (does not stir) or prevent) to both partners.
And *61623; Sterilization of women 0, 4 (0, 4)
And *61623; Sterilization of men 0, 15 (0, 1)
And *61623; Endometrial agents 2 (0, 6)
And *61623; the Combined tablets 3 (0, 1)
And *61623; Hormonal implants 0, 05 (0, 05)
And *61623; Injections of preparation Depo-Provera 0, 3 (0, 3)
And *61623; mini-tablets 3 (0, 5)
And *61623; Condoms 12 (3)
And *61623; Caps + spermitsidy 18 (6)
And *61623; Physiological methods 20 (9)
And *61623; Spermitsidy 21 (6)
And *61623; Interrupted the sexual certificate or act 19 (4)
Preferences of a method kontrantseptsii women in Sankt-Petersburg in two age groups 18 till 34 years and from 35 till 54 years has shown, what kinds of contraception were used as an exclusive or primary agent: condoms 35, 9 % and 17, 2 %;
Tablets 19, 1 % and 8, 7 %: Naval Forces 9, 9 % and 17, 8 %; the interrupted sexual certificate or act of 21 % and 9, 5 %; a physiological method 25, 7 % and 18, 2 %; postcoital tablets 5, 5 % and 1, 6 %; spermitsidy 1, 6 % and 1, 2 %; abortions 2, 4 % and 3, 8 %; used nothing (though it is necessary) 11, 5 % and 8, 1 %; consider or count, that contraception is not necessary to them 12 % and 23, 9 %.
The important step in development of contraception became successful creation of contraceptive tablets. They contain the synthetic hormones similar to that are developed or produced by a female organism and are necessary for it or him. The tablets containing an admixture of two hormones - estrogen and progestagena are most widely used. Them also name the combined oral contraceptives (OK). Estrogen warns an ovulation (an output or exit of a female ootid from an ovary), and the synthetic hormone Progestinum influences slime shejki uteruses, promoting its or her geling and an obstruction for a semen. He also influences internal layers of a wall of a uterus, doing or making impossible an attachment of the impregnated ootid.
Now are used OK the third generation. In them the share of estrogen with which some complications - thrombophlebites earlier have been connected, serdechno-vascular diseases is considerably lowered, and also hormones Progestinums of new generation (dezogestrel, norgestimat, gestoden) are included or switched on. It has led to essential decrease of by-effects and has made OK even more safe and attractive to long application. Their efficiency makes 97 99 %.
The parameter of reliability is closely connected with correctness of the use of tablets: OK usually are issued in packings on 21 tablet. They need to aspire to be accepted daily approximately in one and too time. After three-week reception of tablets, the woman does or makes a week break during which there comes a monthly bleeding. Upon termination of this term new packing OK opens. The packings containing 28 tablets, calculated on their constant reception during all cycle Sometimes are issued. In this case the part of tablets is not contained with hormones, as provides offensive or approach monthly. If in any day the woman has forgotten to accept a tablet next day it is necessary to accept two tablets.
All over the world OK use 180 million women, and in Russia them 8 % of women (data for 1998), while in the Great Britain - use 26 % of women.
OK possess the whole spectrum of advantages: simplicity in the use and high efficiency; a menses become more regular, less long, plentiful and morbid. Often decreases or the premenstrual syndrome disappears. The majority of women restore ability to become pregnant within two months after the termination or discontinuance of reception of tablets. Ability to conception even raises or increases. Approximately in 2 times the probability of a cancer of ovaries and endometrija decreases. This effect is saved within 10 15 years after the termination or discontinuance of reception OK. The quantity or amount decreases and the risk of occurrence of good-quality tumours of a mammary gland (in 4 times) and cysts of ovaries (in 14 times) decreases. Inspissation of slime shejki uteruses in 2 times reduces risk of bacteriemic or bacterial diseases of organs of a small basin, disappearance or eradication of acnes on the face is possible or probable.
Now the most frequent reason of refusal of reception OK are side effects of hormones - a nausea, a headache, augmentation of mass of a body (at regular reception the mass of a body increases on the average or is on the average enlarged for a year on 400), morbidity of mammary glands, rising of pressure and a mood swing.
Undesirable or dangerous there is use OK by smoking women 35 years (risk of an insult and an infarct), women suffering a hypertonia, disturbances of a circulation, illnesses or diseases of heart, a thrombophlebitis, some forms of a migraine, and also excessively full are more senior.
There are tablets containing only the minimal dose of one hormone - gestagena (" mini-drank or saw "). In them there is no estrogen that removes or takes out a question on some collateral signs (a complex of "pseudopregnancy": a nausea, a vomiting, giddinesses, edemas). They are a little less reliable, than the combined tablets. Their effect is based or founded;established on a condensation of a mucous fuse shejki uteruses that appears an insuperable obex to spermatozoons. Peak efficiency of a contraceptive is necessary on 3 - 21 hour after reception of a tablet. "Minitabletki" can be used smoking, and also after sorts or labors.
Necessity concerns to minuses to accept tablet every day at a time day - only in this case they provide reliable preservation. There can be krovjanisty allocation not connected with a monthly cycle, pains in the field of a breast, sharp changes of mood and depression are possible or probable. Reception for the women had extrauterine pregnancies or salpingocueses is not recommended. Women with mass have more 70 kg reliability. It is silent tablets can to decrease.
Efficiency of contraception "minitabletok" hardly below - 95 97 %.
Hormonal implants.
Hormonal preparations of long action have been developed for the decision of a problem of a regularity of reception of contraceptive pills.
One of them is Norplant - six soft capsules in the size about a match from silikonovoj rubbers which are located under a skin of a brachium through a small cut or section and within 5 years the woman appears is protected from pregnancy owing to constant allocation progestagena (levonorgestrela). Time capsules are not felt as All this, and after proprocession of this term they is taken by the surgeon under a local anesthesia.
Minuses: vzhivlennaja the capsule appears through through a skin, after excision there is a small scar. By-effects are possible or probable as well as at use of tablets. The most widespread is the irregularity of monthly cycles, long bleedings. Efficiency decreases at weight of the woman more than 60 kg a little. Usually pregnancy comes only in 6 months after excision of capsules.
Inektsionnyj a hormonal contraceptive.
Other alternative to tablets is inektsionnyj preparation Depo-the Probelief. The method consists in an injection of Progestinum which warns pregnancy within 3 months. The first injection is done or made in area of a brachium or a breech in one of first seven days of a cycle. The subsequent repeat in 12 weeks. The preparation interferes with an ovulation and implantation of an ootid in a wall of a uterus.
Its or His efficiency appears even hardly above, than at the combined contraceptive tablets, t. To. The opportunity of an irregularity of reception of a preparation is excluded.
Not always it is possible to foresee what influence a preparation will render on a cycle. Sometimes there are headaches, depression, addition of weight. After a cancelling of injections genital function is restored after 6 months.
During perfection inektsionnyh contraceptives, have been developed and introduced combined monthly inektsionnye contraceptives (Perlutal, Mezigina, TSiklofen, etc.), deprived the by-effects of preparations of long application containing only gestageny (Depo-Probelief, Noristerat). At application of these contraceptives frequency of bleedings not connected with a menses below, by the efficiency and safety they are close to OK.
The endometrial agent (Naval Forces) or "spiral" is entered into a uterus. It small on the size (nearby 2, 5 sm), is made of plastic, can be wound by the most thin copper wire or contain a hormone Progesteronum. One spiral can be established or installed for some years (according to all available information - till 10 years). Naval Forces influences change of an internal environment of a uterus and in 5 7 times accelerates passage of an ootid on uterine pipes, as a result of it or this the ootid has not time to find the qualities necessary for implantation, as prevents pregnancy.
Usually Naval Forces are recommended healthy and given birth or travailled women 25 years (at not given birth or not travailled women of complication in the form of inflammatory diseases arise in 7 times more often) which conduct a sexual life with the constant partner are more senior. It is considered, that at chaotic contacts the spiral does or makes sexual system of the woman of more vulnerable for an infection. But at the settled attitudes or relations this variant of contraception can be ideal. The world organization of public health services considers or examines;surveys Naval Forces as one of the most safe and effective time or temporary methods of a contraception. In the world 60 million women, and efficiency of endometrial contraceptives - 98 99 % uses it or him. In Russia they even are more popular, than contraceptive tablets.
Advantages: the adaptation cheap, long-term, does not demand leaving or care; any hormonal influences, the woman for some years is relieved of pavors and efforts that promotes rising of sexuality; the female organism receives biologically active substances containing in a semen; at will of the woman, Naval Forces can be removed at any time.
Possible or Probable intensifying bleedings concerns to minuses during monthly, occurrence be ill or sick during this period. Within 20 days after the equipment or installation the risk of a becoming infected raises or increases. There are cases of abaissement of Naval Forces (in 7 % of cases).
The barrier method consists in use of a mechanical obex to an occurring of sex cells - spermatozoons and an ootid. This use of the cap which is put on on shejku of a uterus, man's and female condoms, and also of some the agents perniciously acting on spermatozoons.
Condom.
Man's condom - a contraceptive, in the form of the thin cover which is densely put on on eregirovannyj a penis before the sexual certificate or act for prevention of hit of an ejaculate in a vagina, and also an agent of protection against venereal illnesses or diseases and AIDS.
The Modern condom represents a rubber tube in diameter 3, 5 sm, sealed-in with one extremity or end, length from 18 up to 20 sm and thickness stenok from 0, 09 up to 0, 3 mm. A condom make from very thin, but strong latex (a product from juice rezinnogo a tree).
Condoms always were a valuable contraceptive, but special popularity have got after in the world AIDS began to extend promptly. Now in all civilized countries demands to quality of the latex, assuming presence of micropores which size does not pass or miss viruses of AIDS operate or work. In the European Community the uniform quality standard, objazyvajushchy carrying out of electron testing of micropores and thickness stenok and filling of a condom in 15 litres of compressed air operates or works.
Now the diversified condoms are made: with greasing and without it or her, usually greasing contains bactericidal substances (for example, Nonoxynol-9), killing an infection, including and a HIV. There were condoms with various gustatory and aromatic additives (fruit, karamelnymi), calculated on use during oral sex. The special stronger thick-walled condoms intended for proctal or anal sexual certificates or acts began to be issued. Relief condoms with short moustaches, pimples, rozhitsami and other amusing veneering more suit as a toy, than practical application, t. To. Decorative additions "are soldered in" in latex that reduces its or his durability, increases or enlarges a load by separate sites of a condom, breaks tightness stenok.
Last years there were plastic condoms by which do or make of polyUrethanum. They are twice stronger, than rubber, is more thin, do not cause or cause an allergy, have no smell, do not reduce sensitivity, are better stored or kept and do not collapse or are not blasted from greasings on an oil basis. They put on as nosok, instead of raskruchivaniem as lateksnye.
The period of validity of the condoms stored or kept a dry, dark, cool premise or room, in packing makes 5 years. The condom unpacked in 8 10 hours under influence of solar beams reduces reliability on 80 90 %. It is recommended to avoid storage of condoms under beams of the sun, a ultraviolet, at the raised or increased humidity and heat as these factors also reduce durability of latex. Contact of a surface of a condom with mineral or vegetable oils within several minutes sharply reduces their durability. Therefore use for greasing of Vaselinum, liquid creams and alimentary vegetable oils is inadmissible, as it will lead only to break of a condom during the sexual certificate or act. Glycerinum, special greasings (ljubrikanty) and the jellies created on a water basis and an egg white do not damage or injure a surface of a condom and can be certainly used.
Advantages: it is widely accessible, practically there are no restrictions for use, not only isolates a seed or spermatic liquid from hit in a vagina, but also provides protection to both partners from the diseases passed sexual by and from AIDS.
Disadvantages: necessity to have constantly near at hand; the cautious and correct reference or manipulation is required; it is possible to apply only at a high-grade erection, the some people mark or celebrate depression of brightness of sensations or occurrence of a barrier in psychological affinity.
Efficiency of a condom with spermitsidom - 98 97 %.
Female condom (femidom).
He has appeared approximately 10 years ago as alternative to a man's condom. Femidom represents long and much wider, than at a man's condom a tube with two elastic rings on the extremities or ends. One is located in depth of a vagina, and the second, wider - at an input or entrance in a vagina. He is made of polyUrethanum, disposable, entered before the sexual certificate or act and leaves after its or his end.
Diaphragm and cap.
Diaphragm - a soft round rubber cap in diameter of 5 10 sm with utolshchennym elastic edge or territory. From cervical caps the greatest diffusion was received with aluminium or plastic caps Kafki. A diaphragm establish or install across a vagina, and the cervical cap is less on the size and puts on immediately on shejku uteruses. They happen different forms and 20 sizes, therefore originally the size is selected by the doctor. The diaphragm is entered into a vagina by an arm or a hand shortly before the sexual relations and fixed directly ahead of fauces of a uterus. It is not enough one mechanical obex more often, therefore caps and should be applied diaphragms with spermitsidami which put or render on edges or territories and an internal surface of a cap. For rising efficiency it is desirable to leave them at least at 6 o'clock after the sexual certificate or act. After their use wash with soap in warm water, dry up and store or keep in a firm rectangular approach traffic pattern. After sorts or labors, abortion or at change of weight more than on 3 kg it is necessary to select the size of a cap repeatedly.
The diaphragm almost does not give by-effects, inexpensive, reliable enough at skilful use. A minus: during the sexual certificate or act it can be displaced.
The theoretical level of efficiency should be 95 %, but in practice makes 80 90 % iz-for misuse (the incorrect equipment or installation, the improper size, shift during affinity).
Spermitsidy
Spermitsidy are the substances, having pernicious an effect on the spermatozoons killing them or depriving to mobility before their hit in a uterus. Spermitsidy, containing nonoksinol-9, reduce risk of infection with the diseases passed sexual by. One dose spermitsidov operates or works approximately within an hour. They are issued in the form of candles, creams, tablets, jelly, foams, pessaries (the uterine capsule entered into a vagina). All of them are entered into a vagina up to the sexual certificate or act. Insufficiently high efficiency (70 75 %) forces to use them together with barrier methods (a condom, a cap or a diaphragm). Before each subsequent sexual certificate or act the new dose spermitsida is required.
Contraceptive sponge
The round sponge moistened spermitsidom, is entered into a vagina before the sexual certificate or act and there is there a minimum of 8 hours after the relations. Similarly to a condom, it is widely accessible way of contraception well suitable those who conducts an irregular sexual life. Unlike other barrier methods of contraception the sponge can be in a vagina for a long time (till 24 o'clock). However tests have shown, that its or her efficiency does not exceed 80 %.
Physiological methods.
Some people for religious, moral, medical and aesthetic reasons do not wish to use artificial technics or technical equipment of contraception. In these cases the physiological methods of a contraception assuming continence from affinity in days, optimum to conception (t can be applied. e. During an ovulation). In each monthly cycle the female ootid is capable to a fertilization within one day, but the spermatozoon can save the activity within 3 4 day after hit in a vagina.
The basic complexity consists in exact definition of terms of an ovulation, t. To. Absolutely exact attributes does not exist, and many women have fluctuations in duration of a cycle. Unfortunately, stable 28 dnevnyj 8 % of women have a cycle only.
The combination of a calendar method, temperature and a quality monitoring behind slime (simptomo-) raises or increases a thermal method efficiency of preservation, and regular observation over a status of an organism leads to that some women start to notice day of an ovulation on a weak pain in the bottom part of a stomach or belly.
Advantages: there is no intervention in an organism, additional expenses or preparatory measures before affinity are not required.
Disadvantages: demands daily testing, a plenty of exact observations and accurate conducting records; the opportunity of a mistake or an error in calculations or failure in duration of a cycle is always saved; illness or disease, strong experiences or change of a situation can become the reason of disturbance of a cycle, it is not enough " safe days " (see calculation of days on the scheme or plan), it is necessary to abstain from affinity during an appreciable part of month, efficiency of a method - 80 85 %.
Calendar method.
It is theoretically known, that the ovulation takes place for 14 days before the beginning of a following cycle. In practice the ovulation can occur or happen on 13 - 17 day, 4 days should be added by day of a prospective ovulation at the rate of conservations during this period of activity of spermatozoons and day after an ovulation - on ability to a fertilization of an ootid. As a result of calculations it appears, that rather safe there are 11 days before the beginning of a following cycle; 12 20 day optimum for conception at calculation of a cycle from the extremity or end (" dangerous days "), also are less dangerous days till this period. This method can be used only if the woman on a regular basis marks or celebrates the schedule of a menses and on its or his basis settles an invoice a prospective ovulation.
If a cycle irregular, it is necessary to write down dates of a menses during on an extreme measure of six cycles. To subtract or deduct 18 from the shortest cycle, to define or determine the first day when you should refrain from sex. Then to subtract or deduct 11 from the longest cycle, to define or determine last unsafe day.
Temperature method.
About occurrence of an ovulation it is possible to learn or find out daily measuring vaginalnuju or a rectal body temperature every morning right after a dream (basal temperature). At the majority of women the body temperature before an ovulation decreases on some tenth degree, and in day of an ovulation rises on 0, 6 and *61616; With also it is saved such prior to the beginning of a following cycle. Usually in three day after rise of temperature there comes the "safe" period.
This method is better to use in parallel with calendar for more exact definition of terms of an ovulation.
Quality monitoring behind slime.
Inspection mucous shejki uteruses allows to define or determine offensive or approach of an ovulation. 1 2 days prior to an ovulation allocation of slime amplifies, she becomes to a swill, transparent and viscous, on a consistence reminds an egg white. Till this period and in some days after an ovulation slime muddy, opaque (belovato-yellowish), dense also does not last.
Discontinuing of the sexual certificate or act.
Extraction of a sexual member before an ejaculation is the oldest and most a simple contraceptive method, and even he is now very widely widespread all over the world. This method is not reliable, t. To. The small amount of spermatozoons contains in a secret of glands of Cooper which is allocated at exaltation (up to an ejaculation) and it or this it can appear enough for a fertilization.
The interrupted sexual certificate or act is interfaced or integrated to a greater or big emotional strain of partners, stirs or prevents to high-grade satisfaction as men which should supervise constantly itself, and women who is afraid of pregnancy. Besides it or this the drop of an ejaculate can get on genitals of the woman and it or this will be enough for activly moving spermatozoons.
The probability of pregnancy at use of this method reaches or achieves 28 %.
Emergency contraception.
One of methods of contraception is the contraception after the made sexual certificate or act without preservation (not protected sexual certificate or act). Such method is called emergency, or postcoital contraception (EK).
The most effective methods EK are purpose or appointment of high doses of hormonal preparations or postcoital introduction of an endometrial contraceptive.
" Morning tablets "
Abroad tablets for EK often name " morning tablets ". They are effective in cases of reception within 72 hours after not protected sex. But the earlier tablets, the above their efficiency are accepted! One dose, and in 12 hours - repeated first is accepted. The basic mechanism of action hormonal EK is influence on a mucosa of a uterus and disturbance of process of implantation of the impregnated ootid.
With purpose EK it is possible to use practically any combined oral contraceptive available on sale (OK), but the number of tablets will vary depending on their structure and a dosage.
So, if with purpose EK Rigevidonum in the first dose there should be 4 tablets, and in the second, accepted through 12 hours - 2 tablets is used.
At use of preparation Ovidon it is necessary to accept 2 tablets, and later 12 hours - 2 more tablets.
At reception modern OK type marvelona, mikroginona, silesta acceptance of three tablets for the first time and repeatedly in 12 hours is recommended.
Other type of tablets for EK contains only a hormone Progestinum. These tablets are more effective combined OK, and risk of occurrence of by-effects below. From this group of preparations in our country diffusion was received with Hungarian preparation postinor. Its or his efficiency - 98 % at double reception with a break at 12 o'clock, not later than 48 hours after the certificate or act.
At its or his use at 8 % of women the nausea and at 8 % - disturbance of a menstrual cycle in the form of intermenstrual krovjanistyh vydeleny was observed. postinor it is not recommended to apply more than 4 times a month.
Emergency hormonal contraception has shown the efficiency, however it or she cannot be recommended for constant use for a long time as thus high doses of hormones are used. Therefore after application EK it is necessary to pass to any other method of preservation from pregnancy.
Emergency contraception should be applied in extreme situations (for example, after rape or at doubts in integrity of a condom). She also is recommended to the women, seldom living a sexual life and after casual sexual communications or connections.
Contraindications to use: thrombophlebites, age are more senior than 35 years in a combination to smoking (more than 15 cigarettes in day), diseases of a liver, an idiopathic hypertensia, a diabetes mellitis, disturbance of a lipide exchange.
Efficiency of a method depends on duration of an interval between the sexual relations and application EK (the less interval, the above efficiency).
In the first day - 2 % (combined OK) and 0, 4 % (postinor).
In the second day - 4, 1 % and 1, 2 %.
In the third day - 4, 7 % and 2, 7 %.
Introduction of Naval Forces.
Emergency introduction of an endometrial contraceptive effectively if it is made not later than 5 7 days after sexual contact.
Advantages: efficiency (more than 99 %), absence hormonal dependent by-effects, an opportunity of application later 72 ch after not protected sexual certificate or act and an opportunity of further long use do or make this method EK perspective, especially when hormonal method EK to use already late.
It is undesirable to enter Naval Forces to young, not given birth or not travailled women at presence of the big number of sexual partners, casual sexual communications or connections as endometrial contraception is connected with risk of inflammatory diseases of genitals.
Syringing.
Use of a lavage of a vagina by any solution after the sexual certificate or act is the extremely unreliable way of contraception. By the moment of the termination or ending of affinity the appreciable part of spermatozoons appears outside of striking distances. It is considered also, that the lavage chemically active substances breaks a natural microflora of a vagina, raises or increases risk of inflammatory processes. Probability of offensive or approach of pregnancy at constant use of syringing - 39 %.
Choice of a contraceptive - very important decision. It should be carried out meaningly on the basis of acquaintance to various methods of contraception. The choice of a concrete contraceptive depends on its or his reliability (efficiency), harmlessness for an organism, simplicity of use, positive and negative by-effects, cost, convertibility and an individual acceptability.
Till now there is no ideal contraceptive which would be effective on 100 % and approached or suited absolutely to all. During the different periods of a life even it will be better to one woman to use different methods of contraception. On popularity hormonal tablets all over the world are in the lead - them use nearby 100 million women annually. The second on popularity there are endometrial agents (Naval Forces) to which prefer nearby 60 million women. To the most effective and safe methods of contraception, except for them, carry the hormonal preparations entered in the form of injections and implantov, possessing long obratimym action, and also surgical sterilization, both women, and men. The big variety of modern methods of adjustment of birth rate gives freedom for planning family, reduces a maternal mortality due to refusal of abortion, as basic way of planning of family in the past.
According to interrogation, in the USA approximately 90 % of women from group of risk of undesirable pregnancy used any contraceptive. Now the most popular methods of preservation from pregnancy in pairs or steams genesial age are oral contraceptive tablets (them 19 % use), sterilization of women (17 %), condoms (9 %) and sterilization of men (7 %).
In our country, according to Ministry of Health of the Russian Federation (1998) endometrial and hormonal contraceptions, accordingly 18 % and 8 % are most popular. About 40 % of women fertilnogo age use ineffective methods of prophylaxis of undesirable pregnancy.
Level of unreliability of various contraceptive agents.
The percent or interest beremennostej after a year of use of a contraceptive method is presented. Theoretical parameters of reliability (in brackets) and real results of use are given.
For an effective utilization it is important to choose such way of contraception which arranges (does not stir) or prevent) to both partners.
And *61623; Sterilization of women 0, 4 (0, 4)
And *61623; Sterilization of men 0, 15 (0, 1)
And *61623; Endometrial agents 2 (0, 6)
And *61623; the Combined tablets 3 (0, 1)
And *61623; Hormonal implants 0, 05 (0, 05)
And *61623; Injections of preparation Depo-Provera 0, 3 (0, 3)
And *61623; mini-tablets 3 (0, 5)
And *61623; Condoms 12 (3)
And *61623; Caps + spermitsidy 18 (6)
And *61623; Physiological methods 20 (9)
And *61623; Spermitsidy 21 (6)
And *61623; Interrupted the sexual certificate or act 19 (4)
Preferences of a method kontrantseptsii women in Sankt-Petersburg in two age groups 18 till 34 years and from 35 till 54 years has shown, what kinds of contraception were used as an exclusive or primary agent: condoms 35, 9 % and 17, 2 %;
Tablets 19, 1 % and 8, 7 %: Naval Forces 9, 9 % and 17, 8 %; the interrupted sexual certificate or act of 21 % and 9, 5 %; a physiological method 25, 7 % and 18, 2 %; postcoital tablets 5, 5 % and 1, 6 %; spermitsidy 1, 6 % and 1, 2 %; abortions 2, 4 % and 3, 8 %; used nothing (though it is necessary) 11, 5 % and 8, 1 %; consider or count, that contraception is not necessary to them 12 % and 23, 9 %.
The important step in development of contraception became successful creation of contraceptive tablets. They contain the synthetic hormones similar to that are developed or produced by a female organism and are necessary for it or him. The tablets containing an admixture of two hormones - estrogen and progestagena are most widely used. Them also name the combined oral contraceptives (OK). Estrogen warns an ovulation (an output or exit of a female ootid from an ovary), and the synthetic hormone Progestinum influences slime shejki uteruses, promoting its or her geling and an obstruction for a semen. He also influences internal layers of a wall of a uterus, doing or making impossible an attachment of the impregnated ootid.
Now are used OK the third generation. In them the share of estrogen with which some complications - thrombophlebites earlier have been connected, serdechno-vascular diseases is considerably lowered, and also hormones Progestinums of new generation (dezogestrel, norgestimat, gestoden) are included or switched on. It has led to essential decrease of by-effects and has made OK even more safe and attractive to long application. Their efficiency makes 97 99 %.
The parameter of reliability is closely connected with correctness of the use of tablets: OK usually are issued in packings on 21 tablet. They need to aspire to be accepted daily approximately in one and too time. After three-week reception of tablets, the woman does or makes a week break during which there comes a monthly bleeding. Upon termination of this term new packing OK opens. The packings containing 28 tablets, calculated on their constant reception during all cycle Sometimes are issued. In this case the part of tablets is not contained with hormones, as provides offensive or approach monthly. If in any day the woman has forgotten to accept a tablet next day it is necessary to accept two tablets.
All over the world OK use 180 million women, and in Russia them 8 % of women (data for 1998), while in the Great Britain - use 26 % of women.
OK possess the whole spectrum of advantages: simplicity in the use and high efficiency; a menses become more regular, less long, plentiful and morbid. Often decreases or the premenstrual syndrome disappears. The majority of women restore ability to become pregnant within two months after the termination or discontinuance of reception of tablets. Ability to conception even raises or increases. Approximately in 2 times the probability of a cancer of ovaries and endometrija decreases. This effect is saved within 10 15 years after the termination or discontinuance of reception OK. The quantity or amount decreases and the risk of occurrence of good-quality tumours of a mammary gland (in 4 times) and cysts of ovaries (in 14 times) decreases. Inspissation of slime shejki uteruses in 2 times reduces risk of bacteriemic or bacterial diseases of organs of a small basin, disappearance or eradication of acnes on the face is possible or probable.
Now the most frequent reason of refusal of reception OK are side effects of hormones - a nausea, a headache, augmentation of mass of a body (at regular reception the mass of a body increases on the average or is on the average enlarged for a year on 400), morbidity of mammary glands, rising of pressure and a mood swing.
Undesirable or dangerous there is use OK by smoking women 35 years (risk of an insult and an infarct), women suffering a hypertonia, disturbances of a circulation, illnesses or diseases of heart, a thrombophlebitis, some forms of a migraine, and also excessively full are more senior.
There are tablets containing only the minimal dose of one hormone - gestagena (" mini-drank or saw "). In them there is no estrogen that removes or takes out a question on some collateral signs (a complex of "pseudopregnancy": a nausea, a vomiting, giddinesses, edemas). They are a little less reliable, than the combined tablets. Their effect is based or founded;established on a condensation of a mucous fuse shejki uteruses that appears an insuperable obex to spermatozoons. Peak efficiency of a contraceptive is necessary on 3 - 21 hour after reception of a tablet. "Minitabletki" can be used smoking, and also after sorts or labors.
Necessity concerns to minuses to accept tablet every day at a time day - only in this case they provide reliable preservation. There can be krovjanisty allocation not connected with a monthly cycle, pains in the field of a breast, sharp changes of mood and depression are possible or probable. Reception for the women had extrauterine pregnancies or salpingocueses is not recommended. Women with mass have more 70 kg reliability. It is silent tablets can to decrease.
Efficiency of contraception "minitabletok" hardly below - 95 97 %.
Hormonal implants.
Hormonal preparations of long action have been developed for the decision of a problem of a regularity of reception of contraceptive pills.
One of them is Norplant - six soft capsules in the size about a match from silikonovoj rubbers which are located under a skin of a brachium through a small cut or section and within 5 years the woman appears is protected from pregnancy owing to constant allocation progestagena (levonorgestrela). Time capsules are not felt as All this, and after proprocession of this term they is taken by the surgeon under a local anesthesia.
Minuses: vzhivlennaja the capsule appears through through a skin, after excision there is a small scar. By-effects are possible or probable as well as at use of tablets. The most widespread is the irregularity of monthly cycles, long bleedings. Efficiency decreases at weight of the woman more than 60 kg a little. Usually pregnancy comes only in 6 months after excision of capsules.
Inektsionnyj a hormonal contraceptive.
Other alternative to tablets is inektsionnyj preparation Depo-the Probelief. The method consists in an injection of Progestinum which warns pregnancy within 3 months. The first injection is done or made in area of a brachium or a breech in one of first seven days of a cycle. The subsequent repeat in 12 weeks. The preparation interferes with an ovulation and implantation of an ootid in a wall of a uterus.
Its or His efficiency appears even hardly above, than at the combined contraceptive tablets, t. To. The opportunity of an irregularity of reception of a preparation is excluded.
Not always it is possible to foresee what influence a preparation will render on a cycle. Sometimes there are headaches, depression, addition of weight. After a cancelling of injections genital function is restored after 6 months.
During perfection inektsionnyh contraceptives, have been developed and introduced combined monthly inektsionnye contraceptives (Perlutal, Mezigina, TSiklofen, etc.), deprived the by-effects of preparations of long application containing only gestageny (Depo-Probelief, Noristerat). At application of these contraceptives frequency of bleedings not connected with a menses below, by the efficiency and safety they are close to OK.
The endometrial agent (Naval Forces) or "spiral" is entered into a uterus. It small on the size (nearby 2, 5 sm), is made of plastic, can be wound by the most thin copper wire or contain a hormone Progesteronum. One spiral can be established or installed for some years (according to all available information - till 10 years). Naval Forces influences change of an internal environment of a uterus and in 5 7 times accelerates passage of an ootid on uterine pipes, as a result of it or this the ootid has not time to find the qualities necessary for implantation, as prevents pregnancy.
Usually Naval Forces are recommended healthy and given birth or travailled women 25 years (at not given birth or not travailled women of complication in the form of inflammatory diseases arise in 7 times more often) which conduct a sexual life with the constant partner are more senior. It is considered, that at chaotic contacts the spiral does or makes sexual system of the woman of more vulnerable for an infection. But at the settled attitudes or relations this variant of contraception can be ideal. The world organization of public health services considers or examines;surveys Naval Forces as one of the most safe and effective time or temporary methods of a contraception. In the world 60 million women, and efficiency of endometrial contraceptives - 98 99 % uses it or him. In Russia they even are more popular, than contraceptive tablets.
Advantages: the adaptation cheap, long-term, does not demand leaving or care; any hormonal influences, the woman for some years is relieved of pavors and efforts that promotes rising of sexuality; the female organism receives biologically active substances containing in a semen; at will of the woman, Naval Forces can be removed at any time.
Possible or Probable intensifying bleedings concerns to minuses during monthly, occurrence be ill or sick during this period. Within 20 days after the equipment or installation the risk of a becoming infected raises or increases. There are cases of abaissement of Naval Forces (in 7 % of cases).
The barrier method consists in use of a mechanical obex to an occurring of sex cells - spermatozoons and an ootid. This use of the cap which is put on on shejku of a uterus, man's and female condoms, and also of some the agents perniciously acting on spermatozoons.
Condom.
Man's condom - a contraceptive, in the form of the thin cover which is densely put on on eregirovannyj a penis before the sexual certificate or act for prevention of hit of an ejaculate in a vagina, and also an agent of protection against venereal illnesses or diseases and AIDS.
The Modern condom represents a rubber tube in diameter 3, 5 sm, sealed-in with one extremity or end, length from 18 up to 20 sm and thickness stenok from 0, 09 up to 0, 3 mm. A condom make from very thin, but strong latex (a product from juice rezinnogo a tree).
Condoms always were a valuable contraceptive, but special popularity have got after in the world AIDS began to extend promptly. Now in all civilized countries demands to quality of the latex, assuming presence of micropores which size does not pass or miss viruses of AIDS operate or work. In the European Community the uniform quality standard, objazyvajushchy carrying out of electron testing of micropores and thickness stenok and filling of a condom in 15 litres of compressed air operates or works.
Now the diversified condoms are made: with greasing and without it or her, usually greasing contains bactericidal substances (for example, Nonoxynol-9), killing an infection, including and a HIV. There were condoms with various gustatory and aromatic additives (fruit, karamelnymi), calculated on use during oral sex. The special stronger thick-walled condoms intended for proctal or anal sexual certificates or acts began to be issued. Relief condoms with short moustaches, pimples, rozhitsami and other amusing veneering more suit as a toy, than practical application, t. To. Decorative additions "are soldered in" in latex that reduces its or his durability, increases or enlarges a load by separate sites of a condom, breaks tightness stenok.
Last years there were plastic condoms by which do or make of polyUrethanum. They are twice stronger, than rubber, is more thin, do not cause or cause an allergy, have no smell, do not reduce sensitivity, are better stored or kept and do not collapse or are not blasted from greasings on an oil basis. They put on as nosok, instead of raskruchivaniem as lateksnye.
The period of validity of the condoms stored or kept a dry, dark, cool premise or room, in packing makes 5 years. The condom unpacked in 8 10 hours under influence of solar beams reduces reliability on 80 90 %. It is recommended to avoid storage of condoms under beams of the sun, a ultraviolet, at the raised or increased humidity and heat as these factors also reduce durability of latex. Contact of a surface of a condom with mineral or vegetable oils within several minutes sharply reduces their durability. Therefore use for greasing of Vaselinum, liquid creams and alimentary vegetable oils is inadmissible, as it will lead only to break of a condom during the sexual certificate or act. Glycerinum, special greasings (ljubrikanty) and the jellies created on a water basis and an egg white do not damage or injure a surface of a condom and can be certainly used.
Advantages: it is widely accessible, practically there are no restrictions for use, not only isolates a seed or spermatic liquid from hit in a vagina, but also provides protection to both partners from the diseases passed sexual by and from AIDS.
Disadvantages: necessity to have constantly near at hand; the cautious and correct reference or manipulation is required; it is possible to apply only at a high-grade erection, the some people mark or celebrate depression of brightness of sensations or occurrence of a barrier in psychological affinity.
Efficiency of a condom with spermitsidom - 98 97 %.
Female condom (femidom).
He has appeared approximately 10 years ago as alternative to a man's condom. Femidom represents long and much wider, than at a man's condom a tube with two elastic rings on the extremities or ends. One is located in depth of a vagina, and the second, wider - at an input or entrance in a vagina. He is made of polyUrethanum, disposable, entered before the sexual certificate or act and leaves after its or his end.
Diaphragm and cap.
Diaphragm - a soft round rubber cap in diameter of 5 10 sm with utolshchennym elastic edge or territory. From cervical caps the greatest diffusion was received with aluminium or plastic caps Kafki. A diaphragm establish or install across a vagina, and the cervical cap is less on the size and puts on immediately on shejku uteruses. They happen different forms and 20 sizes, therefore originally the size is selected by the doctor. The diaphragm is entered into a vagina by an arm or a hand shortly before the sexual relations and fixed directly ahead of fauces of a uterus. It is not enough one mechanical obex more often, therefore caps and should be applied diaphragms with spermitsidami which put or render on edges or territories and an internal surface of a cap. For rising efficiency it is desirable to leave them at least at 6 o'clock after the sexual certificate or act. After their use wash with soap in warm water, dry up and store or keep in a firm rectangular approach traffic pattern. After sorts or labors, abortion or at change of weight more than on 3 kg it is necessary to select the size of a cap repeatedly.
The diaphragm almost does not give by-effects, inexpensive, reliable enough at skilful use. A minus: during the sexual certificate or act it can be displaced.
The theoretical level of efficiency should be 95 %, but in practice makes 80 90 % iz-for misuse (the incorrect equipment or installation, the improper size, shift during affinity).
Spermitsidy
Spermitsidy are the substances, having pernicious an effect on the spermatozoons killing them or depriving to mobility before their hit in a uterus. Spermitsidy, containing nonoksinol-9, reduce risk of infection with the diseases passed sexual by. One dose spermitsidov operates or works approximately within an hour. They are issued in the form of candles, creams, tablets, jelly, foams, pessaries (the uterine capsule entered into a vagina). All of them are entered into a vagina up to the sexual certificate or act. Insufficiently high efficiency (70 75 %) forces to use them together with barrier methods (a condom, a cap or a diaphragm). Before each subsequent sexual certificate or act the new dose spermitsida is required.
Contraceptive sponge
The round sponge moistened spermitsidom, is entered into a vagina before the sexual certificate or act and there is there a minimum of 8 hours after the relations. Similarly to a condom, it is widely accessible way of contraception well suitable those who conducts an irregular sexual life. Unlike other barrier methods of contraception the sponge can be in a vagina for a long time (till 24 o'clock). However tests have shown, that its or her efficiency does not exceed 80 %.
Physiological methods.
Some people for religious, moral, medical and aesthetic reasons do not wish to use artificial technics or technical equipment of contraception. In these cases the physiological methods of a contraception assuming continence from affinity in days, optimum to conception (t can be applied. e. During an ovulation). In each monthly cycle the female ootid is capable to a fertilization within one day, but the spermatozoon can save the activity within 3 4 day after hit in a vagina.
The basic complexity consists in exact definition of terms of an ovulation, t. To. Absolutely exact attributes does not exist, and many women have fluctuations in duration of a cycle. Unfortunately, stable 28 dnevnyj 8 % of women have a cycle only.
The combination of a calendar method, temperature and a quality monitoring behind slime (simptomo-) raises or increases a thermal method efficiency of preservation, and regular observation over a status of an organism leads to that some women start to notice day of an ovulation on a weak pain in the bottom part of a stomach or belly.
Advantages: there is no intervention in an organism, additional expenses or preparatory measures before affinity are not required.
Disadvantages: demands daily testing, a plenty of exact observations and accurate conducting records; the opportunity of a mistake or an error in calculations or failure in duration of a cycle is always saved; illness or disease, strong experiences or change of a situation can become the reason of disturbance of a cycle, it is not enough " safe days " (see calculation of days on the scheme or plan), it is necessary to abstain from affinity during an appreciable part of month, efficiency of a method - 80 85 %.
Calendar method.
It is theoretically known, that the ovulation takes place for 14 days before the beginning of a following cycle. In practice the ovulation can occur or happen on 13 - 17 day, 4 days should be added by day of a prospective ovulation at the rate of conservations during this period of activity of spermatozoons and day after an ovulation - on ability to a fertilization of an ootid. As a result of calculations it appears, that rather safe there are 11 days before the beginning of a following cycle; 12 20 day optimum for conception at calculation of a cycle from the extremity or end (" dangerous days "), also are less dangerous days till this period. This method can be used only if the woman on a regular basis marks or celebrates the schedule of a menses and on its or his basis settles an invoice a prospective ovulation.
If a cycle irregular, it is necessary to write down dates of a menses during on an extreme measure of six cycles. To subtract or deduct 18 from the shortest cycle, to define or determine the first day when you should refrain from sex. Then to subtract or deduct 11 from the longest cycle, to define or determine last unsafe day.
Temperature method.
About occurrence of an ovulation it is possible to learn or find out daily measuring vaginalnuju or a rectal body temperature every morning right after a dream (basal temperature). At the majority of women the body temperature before an ovulation decreases on some tenth degree, and in day of an ovulation rises on 0, 6 and *61616; With also it is saved such prior to the beginning of a following cycle. Usually in three day after rise of temperature there comes the "safe" period.
This method is better to use in parallel with calendar for more exact definition of terms of an ovulation.
Quality monitoring behind slime.
Inspection mucous shejki uteruses allows to define or determine offensive or approach of an ovulation. 1 2 days prior to an ovulation allocation of slime amplifies, she becomes to a swill, transparent and viscous, on a consistence reminds an egg white. Till this period and in some days after an ovulation slime muddy, opaque (belovato-yellowish), dense also does not last.
Discontinuing of the sexual certificate or act.
Extraction of a sexual member before an ejaculation is the oldest and most a simple contraceptive method, and even he is now very widely widespread all over the world. This method is not reliable, t. To. The small amount of spermatozoons contains in a secret of glands of Cooper which is allocated at exaltation (up to an ejaculation) and it or this it can appear enough for a fertilization.
The interrupted sexual certificate or act is interfaced or integrated to a greater or big emotional strain of partners, stirs or prevents to high-grade satisfaction as men which should supervise constantly itself, and women who is afraid of pregnancy. Besides it or this the drop of an ejaculate can get on genitals of the woman and it or this will be enough for activly moving spermatozoons.
The probability of pregnancy at use of this method reaches or achieves 28 %.
Emergency contraception.
One of methods of contraception is the contraception after the made sexual certificate or act without preservation (not protected sexual certificate or act). Such method is called emergency, or postcoital contraception (EK).
The most effective methods EK are purpose or appointment of high doses of hormonal preparations or postcoital introduction of an endometrial contraceptive.
" Morning tablets "
Abroad tablets for EK often name " morning tablets ". They are effective in cases of reception within 72 hours after not protected sex. But the earlier tablets, the above their efficiency are accepted! One dose, and in 12 hours - repeated first is accepted. The basic mechanism of action hormonal EK is influence on a mucosa of a uterus and disturbance of process of implantation of the impregnated ootid.
With purpose EK it is possible to use practically any combined oral contraceptive available on sale (OK), but the number of tablets will vary depending on their structure and a dosage.
So, if with purpose EK Rigevidonum in the first dose there should be 4 tablets, and in the second, accepted through 12 hours - 2 tablets is used.
At use of preparation Ovidon it is necessary to accept 2 tablets, and later 12 hours - 2 more tablets.
At reception modern OK type marvelona, mikroginona, silesta acceptance of three tablets for the first time and repeatedly in 12 hours is recommended.
Other type of tablets for EK contains only a hormone Progestinum. These tablets are more effective combined OK, and risk of occurrence of by-effects below. From this group of preparations in our country diffusion was received with Hungarian preparation postinor. Its or his efficiency - 98 % at double reception with a break at 12 o'clock, not later than 48 hours after the certificate or act.
At its or his use at 8 % of women the nausea and at 8 % - disturbance of a menstrual cycle in the form of intermenstrual krovjanistyh vydeleny was observed. postinor it is not recommended to apply more than 4 times a month.
Emergency hormonal contraception has shown the efficiency, however it or she cannot be recommended for constant use for a long time as thus high doses of hormones are used. Therefore after application EK it is necessary to pass to any other method of preservation from pregnancy.
Emergency contraception should be applied in extreme situations (for example, after rape or at doubts in integrity of a condom). She also is recommended to the women, seldom living a sexual life and after casual sexual communications or connections.
Contraindications to use: thrombophlebites, age are more senior than 35 years in a combination to smoking (more than 15 cigarettes in day), diseases of a liver, an idiopathic hypertensia, a diabetes mellitis, disturbance of a lipide exchange.
Efficiency of a method depends on duration of an interval between the sexual relations and application EK (the less interval, the above efficiency).
In the first day - 2 % (combined OK) and 0, 4 % (postinor).
In the second day - 4, 1 % and 1, 2 %.
In the third day - 4, 7 % and 2, 7 %.
Introduction of Naval Forces.
Emergency introduction of an endometrial contraceptive effectively if it is made not later than 5 7 days after sexual contact.
Advantages: efficiency (more than 99 %), absence hormonal dependent by-effects, an opportunity of application later 72 ch after not protected sexual certificate or act and an opportunity of further long use do or make this method EK perspective, especially when hormonal method EK to use already late.
It is undesirable to enter Naval Forces to young, not given birth or not travailled women at presence of the big number of sexual partners, casual sexual communications or connections as endometrial contraception is connected with risk of inflammatory diseases of genitals.
Syringing.
Use of a lavage of a vagina by any solution after the sexual certificate or act is the extremely unreliable way of contraception. By the moment of the termination or ending of affinity the appreciable part of spermatozoons appears outside of striking distances. It is considered also, that the lavage chemically active substances breaks a natural microflora of a vagina, raises or increases risk of inflammatory processes. Probability of offensive or approach of pregnancy at constant use of syringing - 39 %.
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