Women's Health Clinic: Contraceptive Class
The following objectives will be met by completing this on-line class:
The annual gynecological examination includes the following:
The Pelvic Examination:
This is an examination of your uterus, fallopian tubes and ovaries to check for size, position, tenderness and any abnormal growths.
The Pap Smear:
During the pelvic exam, a small sample of cells is collected from your cervix.
All women should being having a pap smear done yearly at the age of 18 or sooner if they are sexually active.
The pap smear is a test that is done to check for pre-cancerous changes in the cells of the cervix.
If you are sexually active and/or smoke cigarettes you may be at increased risk for pre-cancerous changes of the cervix.
In order to obtain the best possible pap smear sample it is important to follow these instructions:
Do NOT douche or use any vaginal creams, spermicidal, suppositories or lubricants for 48 prior to appointment.
Refrain from sexual intercourse 24 hours prior to the appointment.
Do not schedule an appointment during menstruation. Pap smears done at this time are usually unsatisfactory and need to be repeated.
Pamphlets explaining gynecological examinations are available at the Winona State University Student Health Services:
If this is your first pelvic exam, please visit this web site: http://www.firstvisit.org/
For more information click on Pamphlets available at WSU Student Health Services
Sexually Transmitted Infection Screening
To test for STI's cultures may be taken from the cervix to test for Chlamydia and Gonorrhea. If indicated, further testing may be done for HPV and herpes. Blood tests for HIV and Hepatitis B may also be done at Student Health Services.
Are you at risk for Chlamydia?
Chlamydia and Gonorrhea often causes NO symptoms in women, but they can lead to serious pelvic infection and infertility.
Human Papilomavirus (HPV) infection is a very common sexually transmitted infection. HPV may trigger pre-cancerous cervical changes in some women.
The Hepatitis B vaccine is available at Student Health Services and is recommended as protection against the Hepatitis B blood borne pathogen.
The Breast Examination:
An examination of your breasts will be done to check for any abnormal lumps or thickening.
A woman's best protection against breast cancer is early detection of abnormal breast tissue.
It is important that you do self-examination of your breasts once a month (after your menstrual period ends).
The breast self-examination is the best way for you to detect any abnormal lumps that may occur in your breasts. Your ability to detect abnormal lumps increases with practice so be sure to check every month.
Contraceptive Choices:
There are many contraceptive choices. Be sure to examine each of them carefully and ask questions of your provider, so that you may choose the right one for you. Many of these methods are available at the Student Health Services.
BIRTH CONTROL OPTIONS-
Abstinence:
Consistent abstinence is the only reliable way to prevent pregnancy and most sexually transmitted infections (STI's). With the increasing incidence of serious sexually transmitted infections, young adults should consider this option until or unless they are in a permanent monogamous relationship.
Four our of every 10 college students practice abstinence and 54 percent of sexually active young adults claim they wish they had waited longer to become sexually active.
Hormonal Methods:
There are several contraceptive methods that involve the use of hormones (Oral contraceptive pills, contraceptive patch, Nuva ring, Depo-Provera injection, emergency contraception "morning after" pills).
Oral Contraceptive Pills (O.C.'s)
One pill taken each day
95 - 99.95% effective in preventing pregnancy with prescribed use.
There are two types of "pills"
Combined - estrogen and progesterone
Mini-pills - progesterone only for those who cannot use estrogen
Some Advantages:
Reduction in menstrual flow and cramping.
Decrease in iron-deficiency anemia.
Regulation of periods.
Reduction of risk for uterine and ovarian cancer and fewer ovarian cysts.
Reduced risk of pelvic inflammatory disease (PID).
Fewer ectopic pregnancies (pregnancy outside of the uterus or in the fallopian tubes).
Fewer fibro adenomas (benign fibrous tissue tumors of the breast).
Some Disadvantages:
Oral contraceptive pills do not protect you from AIDS or other STI's. (Use condoms if you are at risk!)
Oral contraceptives must be taken at the same time every day.
Effectiveness may be reduced by some commonly used medications like antibiotics and seizure medication.
Side effects may occur in some users. Breakthrough bleeding is the most common side effect.
Other side effects include nausea, breast tenderness and mood swings.
Increase risk of blood clots, especially for women over 35 who smoke cigarettes.
Danger Signs of Oral Contraceptives (A.C.H.E.S.)
Pain in the Abdomen, chest or arm.
Sudden or constant Chest pain.
Severe Headaches.
Eye problems or blurred or double vision.
Swelling in the leg.
Other danger signs include worsening depression, spitting up blood or sudden shortness of breath (could signify a blood clot in the lung).
Click here for General Birth Control Information.
See a health care provider IMMEDIATELY if you develop any of these danger signs!
Contraceptive Patch
Thin plastic patch placed on the skin that releases hormones that protects against pregnancy. The patch is placed on the skin of the stomach, buttocks, upper outer arm or upper torso once a week for three out of four weeks.
Each patch should be removed before a new one is applied. It releases combined hormones that protect against pregnancy for one month.
95 - 99% effective in preventing pregnancy with prescribed use.
Some Advantages:
Effective pregnancy protection.
No pill to take everyday.
Ability to become pregnant returns quickly when use is stopped.
Some Disadvantages:
The contraceptive patch does not protect you from AIDS or other STI's. Use condoms if at risk.
Possible skin reaction at the site of application.
May not be effective for women who weigh more than 198 pounds.
For wearers of contact lenses, a change in vision or the inability to wear the lenses due to eye dryness.
Danger Signs (A.C.H.E.S.)
Pain in the Abdomen, chest or arm.
Sudden or constant Chest pain.
Severe Headaches.
Eye problems or blurred or double vision.
Swelling in the leg.
Other danger signs include worsening depression, spitting up blood or sudden shortness of breath (could signify a blood clot in the lung).
See a health care provider IMMEDIATELY if you develop any of these danger signs!
Nuva Ring
Small flexible ring inserted into the vagina once a month that releases hormones that protect against pregnancy.
95 - 99% effective in preventing pregnancy with prescribed use.
Some Advantages:
Protects against pregnancy for one month.
No pill to take every day.
Does NOT require a "fitting" by a clinician.
Does NOT require the use of spermacide.
Ability to become pregnant returns quickly when use is stopped.
Some Disadvantages:
The Nuva ring does not protect you from AIDS or other STI's. Use condoms if at risk.
May be some increased vaginal discharge.
Cannot use a diaphragm or cervical cap for a backup method of birth control.
Cannot use oil-based vaginal medicine to treat yeast infections while the ring is in place.
Danger Signs (A.C.H.E.S.)
Pain in the Abdomen, chest or arm.
Sudden or constant Chest pain.
Severe Headaches.
Eye problems or blurred or double vision.
Swelling in the leg.
Other danger signs include worsening depression, spitting up blood or sudden shortness of breath (could signify a blood clot in the lung).
See a health care provider IMMEDIATELY if you develop any of these danger signs!
Depo-Provera
Injection (shot) of hormone given every 12 weeks in your arm or buttock.
99% effective in preventing pregnancy with prescribed use.
Some Advantages:
Nothing needs to be taken daily. Effective for 12 weeks.
Women lose less blood using Depo-Provera and have less menstrual cramps. Frequently after three injections women have no periods.
Privacy is a major advantage - no one needs to know you are using this method.
Helps prevent cancer of the lining of the uterus.
Nursing mothers can receive Depo-Provera injections.
It is OK to start a new contraceptive if it is less than 13 weeks since last shot.
Some Disadvantages:
Depo-Provera does not protect you from AIDS or other STI's. Use condoms if you are at risk.
Depo-Provera injections can lead to very irregular, unpredictable, heavy periods (occur in 30% of women within the first year and 10% thereafter).
Some women gain weight (> 5%). To avoid weight gain, watch your calories and get adequate exercise.
You have to return every three months for your injections.
Depression and premenstrual symptoms may become worse.
Loss of monthly periods. It may be a number of months before your periods return to normal after your last shot - average time until period resumes is 6 - 12 months.
Hair loss or increased hair on the face or body may occur.
May experience a change in sex drive.
Skin rash or spotty darkening of the skin may occur.
Depo-Provera may cause bone loss (although this has not been proven). Get regular exercise and get advice about taking extra calcium to protect your bones from osteoporosis.
A few women are allergic to Depo-Provera. Fortunately, allergic reactions are very rare.
Depo-Provera is non-reversible. Once you have an injection it is in your body for the next 3 months. Side effects are not reversed until medication wears off (up to 12 weeks).
Danger Signs:
Yellow coloring in the eyes or skin (jaundice).
Chest pain and/or shortness of breath.
Increased dizziness/fainting.
Increase in frequency and/or severity of headaches. Swelling of arms/legs.
Usually heavy or continuous vaginal bleeding.
Increased depression.
Sudden severe stomach or abdominal pain.
Frequent urination.
Vision problems.
A lump in the breast.
Bleeding and/or persistent pain at the injection site.
See a health care provider IMMEDIATELY if you develop any of these danger signs!
Methods of preventing pregnancy after unprotected vaginal intercourse is provided in two ways.
Emergency Contraceptive Pills: "The Morning After Pill" - Two doses of hormonal pills taken 12 hours apart. It can reduce the risk of pregnancy up to 120 hours after unprotected vaginal intercourse. It works best when the first dose is taken within 72 hours - during this time it can reduce the risk of pregnancy by 75% to 89%. Nausea, vomiting and cramping are common side effects when combined hormones (estrogen and progestin) are used.
Don't use emergency contraceptive pills if you are pregnant or are allergic to the medication.
Emergency Intrauterine Device (IUD) insertion: An IUD inserted within five days of unprotected intercourse is 99.9% effective in preventing pregnancy.
For more information on ECP, click here: Emergency Contraception
Emergency contraception does not protect you from AIDS or other STD's. Use condoms if you are at risk.
Barrier Methods:
Condoms
Sheaths made of thin latex, polyurethane or animal membranes to keep sperm from joining the egg - available for male or female use.
Consistent use of condoms has been shown to reduce the risk of sexually transmitted disease (STD's) and protect future fertility.
Available without a prescription - purchase over the counter (Latex condoms are available at the Student Health Services for $1.00/ dozen).
Male condoms are 86 - 98% effective in preventing pregnancy with perfect use.
Female condoms are 75 - 95% effective in preventing pregnancy with perfect use.
Male condoms are available in latex, polyurethane and animal membrane. Animal membrane condoms are not effective in preventing HIV infection.
Spermacides
Substances inserted into vagina before sexual intercourse that immobilize sperm and keep them from joining the egg.
72% to 94% effective in preventing pregnancy with perfect use.
Available without a prescription - purchase over the counter.
Spermacides increase the contraceptive effectives of condoms and provide mild additional protection against some sexually transmitted infections.
"Spermicidally lubricated" condoms do not provide additional protection.
Can be messy.
Available as foams, jelly, cream and Vaginal Contraceptive Film (VCF).
Nonoxyl 9 spermacide appears to make it easier to contract HIV.
Diaphragm or Cervical Cap
A shallow latex cup (diaphragm) or a thimble-shaped latex cap (cervical cap) that is coated with spermacide and put into the vagina to keep sperm from joining the egg. Each individual user must be fitted because they come in different sizes.
Diaphragm is 80% to 94% effective in preventing pregnancy.
Cervical cap is 80% to 90% effective for women who have not had a child and 60% to 80% for women who have had a child.
Some Advantages:
No major health concerns.
Can last several years.
The cervical cap can be left in place up to 48 hours.
The diaphragm can be left in place up to 24 hours.
Some Disadvantages of these barrier devices:
Does not protect you from AIDS or other STD's. Use condoms if you are at risk.
Should not be used during vaginal bleeding or infection.
Should not be used if allergy to latex or spermacide exists.
Diaphragm Disadvantages:
Increased risk of bladder infection.
Can only be left in place for up to 24 hours.
Cervical Cap Disadvantages:
Difficult for some women to use.
Only comes in four sizes - difficult to fit some women.
Can only be left in place for up to 48 hours.
Sponge
The sponge is a barrier device inserted into the vagina. The sponge is made of polyurethane and contains a formulation of three spermacides in low concentrations. It acts as a barrier, it absorbs sperm and it also has a spermicidal action to kill the sperm. There is no fitting required. It can be purchased over the counter, without a prescription. Cost is about $2.50 each. It is 90% effective when used correctly and in combination with a condom it is even more effective.
Some Advantages:
May be inserted anytime prior to intercourse.
May be left in place up to 12 hours after intercourse.
Discrete, no one knows that it is being used.
Some Disadvantages:
Not available in the U.S.
Can cause vaginal and/or pelvic infections.
Other Methods:
Withdrawal
Male will pull penis out of the vagina before ejaculation to keep sperm from joining the egg. Effective 81% to 96% of the time in preventing pregnancy with perfect use.
Some Advantages:
Can be used when no other method is available.
Some Disadvantages:
Pregnancy is possible if sperm are spilled on the vulva.
Does not protect you from AIDS or other STD's. Use condom if at risk.
Requires great self-control, experience and trust.
Not for men who ejaculate prematurely.
Not for men who don't know when to pull out.
Not recommended for teens.
Fertility Awareness - Based Methods
These methods include daily checks of temperature and cervical mucus, recording menstrual cycles and keeping very accurate records of when the period starts each month. A professional can teach you how to chart the menstrual cycle and how to detect certain physical signs to help predict fertility or "unsafe" days. Abstinence from intercourse or use of condoms, diaphragms, cervical caps or spermacide during the nine or more "unsafe" days is required.
Effective 75% to 99% in preventing pregnancy with strict adherence to above recommendations.
Some Advantages:
No medical or hormonal side effects.
Some Disadvantages:
Does not protect you from AIDS or other STD's. Use condoms if at risk.
Requires expert training before effective use.
Uncooperative partners.
Taking risks during "unsafe" days.
Poor record keeping.
Illness and lack of sleep affect body temperature and may interfere with the temperature method.
Changes caused by vaginal infections and douches may interfere with the cervical mucous method.
Intra-Uterine Device (IUD)
A small plastic device is placed in the uterus. The IUD contains copper or hormones that keep sperm from joining the egg or preventing a fertilized egg from implanting in the uterus.
97.4% to 99.2% effective in preventing pregnancy.
Some Advantages:
Nothing to put in place before intercourse.
IUD's may be left in place from one to ten years depending on the type used.
No pill to take every day.
IUD's with hormones may reduce menstrual cramps.
Ability to become pregnant returns quickly when use is stopped.
Some Disadvantages:
Does not protect from AIDS or other STD's. Use condoms if at risk.
May be some increase in cramps and heavier and longer periods (copper IUD's).
Spotting between menstrual cycles.
Increased chance of tubal infection, leading to infertility if inserted when a woman has a sexually transmitted disease.
Rarely: wall of uterus is punctured during insertion.
Rarely: insertion can cause infection.
Pregnancies (which can occur) are more likely to be ectopic (in fallopian tubes).
Informed Consumer Section - Question and Answer
The following questions are for you and your partner to think about, talk about and plan when choosing a contraceptive method.
Additional questions can be submitted to the "Ask a Nurse"
1. Is the method effective?
You should ask questions about the percent success rate for the typical user.
A contraceptive method's effectiveness rate is increased by combining it with a second method (for instance: oral contraceptives plus condoms).
2. Is the method medically safe? Will it affect my ability to become pregnant in the future?
The health risks of pregnancy are greater than those of available contraceptive methods for most young women.
Having a discussion with your health care provider can help determine if you may have specific conditions that may increase your risk with certain contraceptive methods.
Contraceptive methods available today, including birth control pills and Depo-Provera have not been proven to affect long-term fertility.
It is important to use condoms to protect yourself from sexually transmitted diseases (STD's) and pelvic inflammatory disease (PVD) that cause scarring. These are the most common causes of infertility in young women.
3. Does the method fit my current lifestyle? Am I confident that I can use the method consistently and correctly?
Ask yourself:
Is it my choice or is it the method that someone else thinks I should use?
Do I have worries or concerns about the method?
Am I going to be comfortable inserting things into my body?
What's my partner's attitude towards the method?
Do I feel confident using the method consistently and correctly?
It is important that you use your contraceptive method consistently and correctly each and every time to prevent an unplanned pregnancy!
Equally important is that you understand the correct way to use your method. If you don't understand, ask your health care provider, nurse, health educator or pharmacist AND always read and keep the package information inserts.
4. Will the method protect me from sexually transmitted infections?
Remember That:
The major risk for contracting an STI is high risk sexual contact with more than one lifetime partner. Lifetime risk of an STI with 1 partner is five percent. Two to three partners increase the risk of STI by five times. Four to six partners increase the risk of STI by 10 times and 16 partners increase the risk by 30 times.
The absence of symptoms does NOT indicate the absence of infection in either women or men.
Annual screening for STI's is effective in detecting STI's most of the time.
Only condoms reduce the risk of sexually transmitted infections. (Remember male condoms are available in latex, polyurethane and animal membrane - Animal membrane condoms are not effective in preventing HIV infection)
PROTECT YOURSELF AND YOUR PARTNER! TAKE CHARGE!
It is very important that you have open, honest communication between you and your partner - as well as between you and your health care provider!
5. What do I do if I may be pregnant?
If you suspect you may be pregnant, you can come to the Student Health Services to have a pregnancy test done. Having your suspicions confirmed or denied will help you decide what to do next.
To get a pregnancy test: Call the Student Health Services at 507-457-5160. You will be asked to come in and pick up a urine specimen cup. You will need to take the cup and collect a sample of your first urine of the day and make an appointment to bring it back to the Student Health Services and learn the results.
If the test is negative: You will be asked to return for a second test if you do not have your period within 10 -14 days. You will be asked to schedule a gynecological exam if you have not had one within the last six months. If you are not pregnant, talk to the clinician about the symptoms you are having that made you suspect pregnancy. You may also want to schedule an appointment to learn more about your contraceptive options. Perhaps you may want to try a different method of birth control. If you haven't been using one, you may want to start.
If the test is positive: You will receive counseling and referrals which address your options (carrying the pregnancy to full term, adoption alternatives, terminating the pregnancy). You need to make sure to give yourself time to explore your feelings and your options.
For more information or question concerning pregnancy testing, please call or stop by the Student Health Services, 507-457-5160.
| Pregnancy Care Resources | Pregnancy Counseling Resources | ||
|---|---|---|---|
| Winona County Public Health | 507-457-6400 |
WSU Counseling Center | 507-457-5330 |
| Family Medicine of Winona | 507-454-5050 |
SEMCAC | 507-452-4307 |
| Winona Clinic, LTD | 507-454-3680 |
Birthright | 507-452-4221 |
| Catholic Charities | 507-454-2270 |
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