CONTRACEPTION, PLANNING A FAMILY AND INFERTILITY: IUD (INTRA-UTERINE DEVICE; COIL; LOOP) AND CHEMICAL METHODS
Although it has its, fans the IUD is less satisfactory than the Pill, especially in young women who have not yet had a baby. The method probably works by dislodging an embryo which arrives in the uterus. Because of this it is really a type of early abortion – not a method of preventing conception.
Before an IUD is fitted the woman should have sufficient information about other methods in order to make an informed choice. She also needs to know the advantages and disadvantages of an IUD.
The advantages include the fact that nothing contraceptive needs to be done at the time of intercourse. Secondly, except at the time of insertion, it requires no motivation. Thirdly, if she is symptom-free and does not object to its presence, as some women do, it is an acceptable method; and finally, it does not disturb the hormones in the body as does the Pill.
The disadvantages are that the device is expelled in 2-10 per cent of women perhaps unknown to the woman herself. Although recent designs minimise this risk, the IUD has a failure rate which is about the same as the progestogen-only Pill. An IUD can produce menstrual disorders with resultant anaemia and also inflammation of the fallopian tubes, with the risk of subsequent infertility, if an infection with organisms such as chlamydia is present. This eventuality, and pregnancy, occur most commonly in the early months after the device is fitted but manufacturers recommend removal and the fitting of a new one every z or 3 years. If the woman is allergic to copper then devices containing copper should not be used and neither should the IUD be used in women with valvular heart disease or those on corticosteroid drugs. Furthermore, at the time of insertion or later, the device may pass into or through the wall of the uterus.
IUDs do not increase the chances of cancer of the cervix or uterus but deaths do occur from it at the rate of 3 to 5 per million users per year. Overall it is as safe from this point of view as other methods and safer than using no contraception.
There used to be a variety of IUDs but choice is now more limited because of manufacturers withdrawing products from the market as a result of litigation, especially in the US. The Multiload Cu 375 gained a favourable report from the World Health Organisation. High hopes also exist for the Novagard/Nova-T which releases progesterone and can be left in position for 5 years. A failure rate of 1 per hundred woman years is claimed and it is associated with less menstrual pain and less blood loss.
For a variety of reasons the success of an IUD is associated with the fitting of the device by a doctor who has some enthusiasm, but not too much, for the method and who has a lot of experience in fitting them and caring for the patient afterwards. This factor appears to influence success more than the actual device fitted.
Chemical methods-Various substances kill sperms and, if put into the vagina before intercourse, reduce the chances of conception. Vaginal foams and pessaries are probably the most effective but any of the chemical methods can cause irritation. A possible advantage of these methods is that as well as killing sperms they may kill gonococci and cither organisms.
The effectiveness of such chemical methods is increased by using them along with a barrier method, such as a condom (sheath, rubber, protective) or a cervical cap (diaphragm) all of which are intended to prevent the sperms reaching the cervix.
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Categories: Men's Health-Erectile Dysfunction | Tags: Men’s Health
