The following are the methods under non-terminal category:
Important non-terminal methods for preventing pregnancy are listed below:
(a) Nirodh
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(b) Diaphragm
(c) Spermicides
(d) Intrauterine Device (I.U.D.)
(e) Pill.
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(a) Nirodh:
‘Nirodh’ or condom is a superfine contraceptive rubber sheath which covers the penis during intercourse and prevents the flow of semen into the vagina. It prevents pregnancy as well as protects against VD infections.
Generally it is quite effective but sometimes pregnancy may result from a break or tear of the rubber sheath or from the escape of semen at the open end of the ‘Nirodh’ if withdrawal is delayed. There are no side-effects of its use.
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Nirodh is one of the most popular conventional contraceptive devices used in India. It is freely available from the Family Welfare/Planning Centres, Public Health Centres and Sub-centres and is widely sold at very cheap rates.
Types of condom:
All condoms are a standard 7 in (18 cm) size but they do come in a variety of types including plainended (a) or teat-ended (b, c). They may also be colored (d), textured (e) or lubricated. Lubricated brands are claimed to increase penile sensitivity. Condoms are sold in sealed packets and, kept from heat, have a shelf life of up to 2 years.
(b) Diaphragm:
It is also known as pessary. It is made of soft rubber and has a flexible metal spring around its circumference. It is used by women. It lies diagonally across the vaginal canal. The Diaphragm covers cervix, the upper part of vaginal opening into the uterus.
Diaphragm is always prescribed by doctors and should be used in combination with vaginal jelly or cream which acts as a spermicide as well as lubricant for inserting the Diaphragm.
The Diaphragm is of different sizes i.e., from 50 mm to 105 mm. A physician or a trained health worker can select the correct size. It should be fitted properly only then it is effective. The user women must know how to insert and how to remove it.
Diaphragm is a very effective means of avoiding pregnancy.
Normally there are no side-effects of the use of Diaphragm. In rare cases, however, reactions to rubber or to one of the components of jelly or cream may be there.
Cap is also used by women to control her own fertility:
Of the various types of cap, the diaphragm is the most commonly used. But other smaller caps are sometimes recommended; the cervical cap, for example, is especially suitable for women with weak pelvic floor muscles.
Types of cap:
Four different types of cap are illustrated here.
(a) The diaphragm is the largest type of cap, and is the most commonly used. It consists of a soft rubber dome mounted on a pliable metal rim.
(b) The cervical cap is a smaller thimble-shaped cap. Most are rubber with a raised hollow rim.
(c) The vault cap is a bowl-shaped cap with a thin center and a thicker rim. It is held in position by suction when the center is depressed.
(d) The vimule cap combines features of the cervical and the vault cap. It is dome-shaped with a flanged rim that holds it in position by suction.
Once in place, the cap acts as a “barrier” to sperm. Used carefully, always with a spermicide, it is extremely effective; one study, at the Margaret Sanger Research Bureau, New York in 1976, showed an effectiveness rate of 98%.
The cap must be fitted by a trained person, and then checked at regular intervals. Instructions on insertion and on the use of spermicides are given at the time of fitting.
Basically, spermicide is applied to the cap before insertion and then more spermicide may be put into the vagina. The cap must be left in position for at least 6 hours after intercourse.
If intercourse is delayed more than 2 hours, extra spermicide should be used. If intercourse is repeated, the cap must on no account be taken out but additional spermicide should be put into the vagina.
After use, the cap should be washed gently with warm water and unper-fumed soap, rinsed, dried, and stored in a cool place. Check it regularly for holes and tears.
Cap in position:
Here we show three types of cap in position in the vagina.
(a) The diaphragm fits across the vaginal vault, shielding the cervix during intercourse by fitting closely into the upper vaginal walls.
(b) The cervical cap fit closely around the base of the cervix.
(c) The vault cap clings to the vaginal vault by suction.
(c) Spermicides:
Jellies, creams, foam tablets, etc. containing chemicals which kill the sperms are called spermicide. These are used without a diaphragm.
Creams and jellies are applied in the vagina with the help of applicator and foam tablets are inserted with the help of fingers. Foam tablets dissolve in vagina on contact with moisture to release carbon dioxide, producing dense foam.
These materials immobilize sperm on contact with the ejaculate. They destroy the sperms in the semenal fluid in the vagina and so the woman cannot become pregnant.
They are relatively simple to be use and do not require pelvic examination. The foam tablets are inexpensive.
There are, at times, complaints of vaginal leakage from users. A few minutes time is also required for melting of tablets. If the quantity, of tablets is inadequate or quality is not good, it may not prove effective.
In some cases, they cause irritation oblique and/or inflammatory changes of the mucous membrane.
Spermicides are chemical products that either destroy sperm or create a barrier of foam or fluid. They come in various forms including creams, jellies, aerosol foams’ and pessaries.
Inadequate if used alone, they greatly increase the effectiveness of a cap or condom.
Fitting:
Caps must be fitted by a trained person, who will make a thorough vaginal examination. Each type is available in different sizes, and correct fit is essential.
The cap must be checked for fit every six months. It checked after the birth of a baby, a miscarriage or an abortion, and after a weight gain or loss of more than 71b (3 kg).
Caps and Spermicides:
Caps give inadequate protection unless used with spermicides. Individual instructions are given when a cap is fitted; we give the basic procedures of one method. It is essential always to apply spermicidal cream or jelly to the cap before it is inserted.
As shown here, the cap should be held dome down and spermicide squeezed into it. A thin film of spermicide should then be applied to the rim – not too much or the cap may slip during intercourse.
The cap is then inserted into the vagina, to be followed by more spermicide. An applicator may be used to squirt spermicidal cream, jelly or foam deep into the vagina, or spermicidal pessaries may be used; all instructions must be followed with care.
Insertion:
Inserting a diaphragm is probably easiest if you stand with one foot on a stool or lavatory seat. Hold the edges of the diaphragm together and push it by hand into the vagina (a).
Push the diaphragm against the back wall of the vagina as far as possible so that it passes behind the cervix (b).
The diaphragm will then spring back into its normal shape so that it is held in place over the cervix. Check the diaphragm with a finger to ensure that it is fully covering the cervix (c).
When the cap is correctly in place it will not interfere with lovemaking and neither partner should be able to feel it.
(d) Intra-Uterine Device (I.U.D.):
IUD is also known as loop/copper T. It is placed by the doctor inside the uterus. Its presence there prevents pregnancy.
The Intra-Uterine Device is one of the safest, simplest and most effective devices used by women for contraception and for ensuring the desired spacing between the birth of the first and the next child.
The IUD is of two types – one is a small plastic device of double ‘S’ (lippes loop) and the other, also of plastic, of ‘T’ shape with copper wire wrapped around it (7u-T). Both types of IUD are equally effective and good.
So long as IUD remains in place, the woman will be free from fear of any unwanted pregnancy. The process does not require any operation or hospitalisation.
The IUD (loop) can remain in the uterus for years without the woman feeling its presence. It does not interfere with the sexual activity.
The Cu-T should, however be got replaced every third or fourth year. The chances of failure with IUD are negligible.
It can be easily removed when a pregnancy is desired. After child birth the woman can have IUD inserted again which will start providing her the desired protection against conception once again?
At times, there is a little bleeding or backache for few days. In the first one of two months the menses may also be more than usual, but after two or three months these become normal. In such cases, the woman should be use other methods of birth control.
The IUD device does not cause any disease or cancer. Around the world some 50 to 60 million women are estimated to be used IUD at present.
Facilities for IUD insertion are available free of cost at all public hospitals, Primary Health Centres and Family Welfare Centres throughout the country.
Insertion:
An IUD must be fitted by a doctor or other trained person, ideally during a period or immediately afterwards. The process takes only a few minutes. For insertion, IUDs are elongated in a double-barreled plastic inserter. ”
Checking:
The IUD’s tail threads hang down from the cervix into the vagina. As a result a woman can- and should-learn to feel for these threads with her finger.
She can then make regular checks to ensure that the IUD is still in place. If the threads cannot be felt, extra contraception should be used and a doctor must be consulted as soon as possible.
(e) Pill or Oral Pill:
The pill is taken by mouth. Starting from the fifth day after menstrual flow begins; a woman has to take one pill a day for 21 consecutive days.
She can wait for 7 days and start taking the pill all over again. The pill should not be missed even for a day because its stoppage increased chances of pregnancy.
The pill should be taken only when prescribed by doctor after thorough medical examination.
In some cases it causes tiredness of dizziness, weight gain, nausea, stoppage of the menstrual period, vomiting, feeling of sickness, tenderness of the breasts, in between period bleeding are reported.
Generally they disappear after regular use for three to four months.
The pill should be taken regularly, as prescribed irrespective of any in- between period bleeding and full course of the pill should be taken.