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Dr Miriam: In control of your sex life.

Byline: Miriam Stoppard

IF you're a woman who wants 100 per cent effective contraception without resorting to sterilisation, you have two choices.

You can use the combined contraceptive pill or the progesterone intrauterine device.

The next most effective method is the mini-Pill and the IUD, then methods which place a mechanical barrier between sperm and egg.

This week Doctor Miriam guides you through the forms of contraception.YOUR choice of birth control will probably change during your fertile years.

No one method is ideal for such a long time, punctuated, as it may be, by planned pregnancies and changes in sexual partners.

You need to match forms of contraception to your personality, sexual practice and stage of your life.

Barrier methods

THESE physically block sperm from reaching the ovum or they chemically inactivate sperm.

Male condom

THE condom is a latex rubber or plastic sheath placed over the erect penis before penetration.

It should be lubricated and freed from air so it doesn't burst inside the vagina. It works by preventing sperm from entering the vagina.

The condom is widely used, even with another form of contraception because of the danger of sexually-transmitted diseases, especially HIV. I'd therefore advise all women who haven't been in a monogamous relationship for more than five years to insist on using male or female condoms whenever they have a new sexual partner.

Female condom

THE female condom is designed to line the inside of the vagina. It consists of a lubricated plastic sheath with an anchoring ring to keep it in place inside, and an outer ring that holds the sheath open to allow insertion of the penis.

As effective as the male condom in preventing pregnancy, it means a woman can control contraception as well as protecting herself against sexually-transmitted diseases.

Diaphragm and cervical cap

THE diaphragm, a dome of rubber with a coiled metal spring in its rim, is made in different sizes, depending on a woman's internal shape and size. It fits diagonally across the vagina and is used with a spermicidal agent; it must be left in place for six hours after intercourse.

The cervical cap is smaller and more rigid and fits over the cervix, where it's held in place by suction. Like the diaphragm, it must be fitted to size and used in conjunction with a spermicide.

The diaphragm and cap work by preventing sperm reaching the cervix. They must be refitted regularly, because of childbirth or weight gain or loss.

Contraceptive sponge

THIS is an old form of contraception now updated. These days it's usually made of polyurethane foam impregnated with spermicide. The sponge is moistened with water to activate the spermicide and left in place for six hours after intercourse.

Spermicides

SPERMICIDES are essential with these barrier methods to ensure their effectiveness. They aren't effective on their own.

They come in many forms, including aerosols, pessaries, foams, film and creams.

Some need to be inserted 15 minutes before intercourse, and none should be washed away for at least six hours afterwards.

Spermicides seem to be an added protection against sexually-transmitted diseases.

Intrauterine device

THE IUD probably works by slowing sperm passing through the womb or by preventing the fertilised egg from implanting in the uterine lining, and it's immediately effective.

THE progesterone IUD stops the uterine lining from thickening and makes cervical mucus impermeable to sperm. It's a physical barrier to conception and may suppress ovulation for three years.

IUDs aren't suitable for young women who haven't had children.

IUDs have been implicated in cases of perforation of the uterus, septic abortion, pelvic inflammatory disease and ectopic pregnancy.

They aren't suitable for women with heavy periods as they may increase bleeding and pain during menstruation.

Advantages

No need to remember pills.

Don't interfere with ovulation or breastfeeding.

Disadvantages

Can be expelled without your being aware of it.

May increase pain and bleeding during menstruation.

Risk of ovarian cysts

Emergency methods

THERE are two means of preventing conception after unprotected sex, and they must be started within one to five days after intercourse. They aren't recommended as a routine form of birth control.

The hormonal method involves a short high-dose course of the combined Pill.

For women who can't take the high-dose Pill, a copper-bearing intrauterine device (IUD) can be inserted within five days of unprotected intercourse; this prevents a possible pregnancy.

A PILL containing oestrogen may not be suitable for you if you're overweight; if you smoke, are over 35; suffer from diabetes, high blood pressure, a heart condition or migraine and have a deep vein thrombosis.FOR further reading, Family Health Guide, by Dr Miriam Stoppard is available from Mirror Direct on 0870 07 03 200, price pounds 22.50 including postage and packing.

Miriam Stoppard

HORMONAL METHODS

Advantages

Most effective method.

Regulates menstruation and reduces pain and bleeding.

Brings some relief of PMT.

Reduces the probability of ovarian cysts and ovarian cancers.

Protects against brittle bones (osteoporosis).Disadvantages

Slightly increased risk of thrombosis in women using this method.

Occasional break through bleeding with some forms.

Need to take the mini-pill at the same time every day.

CAPTION(S):

YOUR CHOICE: It's wise to use a condom as well as taking the Pill
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Title Annotation:Features
Publication:The Mirror (London, England)
Date:Apr 1, 2004
Words:868
Previous Article:Dr Miriam: Hormones keep the sperm at bay.
Next Article:SHELLEY on THE TELLY: Wild about this bunch.


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