First, tubal ligation

The inside of the fallopian tube is connected with the uterus, and the outer end is free, but it is similar to the ovary, and the egg runs from the fallopian tube to the uterine cavity.

Tubal ligation is an operation to ligate the fallopian tube and block the passage of eggs into the uterus, so as to achieve the purpose of permanent sterilization of women. This operation is suitable for adult women who expect permanent sterilization and have no surgical contraindications. Women who only want temporary or reversible contraception are not suitable for this operation.

* General anesthesia;

* make a transverse solitary incision with a length of 1~ 1.5cm at the lower edge of the umbilical foramen and extend it into the laparoscope;

* Double ligation and removal of fallopian tubes;

* Suture the skin incision. The patient can go home a few hours after the operation. Surgery can also be performed immediately after a woman gives birth.

Second, the intrauterine device

What is an intrauterine device?

IUD is generally made of antiseptic plastic or metal, and some drugs (such as releasing estrogen or indomethacin) are added. Intrauterine devices have many shapes, such as round, uterine cavity, T-shaped and so on. Doctors can choose the appropriate intrauterine device according to each person's uterus.

2. Why can I use contraception after placing IUD?

After the intrauterine device is put into the uterine cavity, it changes the intrauterine environment, which is not conducive to the implantation of fertilized eggs, affects the motility of sperm and the moving speed of eggs in the fallopian tube, and achieves the purpose of contraception. The contraceptive efficiency of IUD is about 94-99%.

What are the advantages of using intrauterine devices?

It is a long-acting contraceptive method, and its validity period ranges from one year to several years. You can get pregnant again after the IUD is taken out by the doctor. After wearing the ring, you don't need to make any preparations before sexual intercourse. Women who wear rings will not feel the existence of intrauterine devices, which is suitable for women who need regular contraception.

4. Who should not use IUD?

Genital malformation or tumor, dysmenorrhea or menorrhagia, pelvic inflammatory disease, gonorrhea, women with multiple sexual partners, severe anemia, heart disease and people with a history of ectopic pregnancy should not place intrauterine devices. It is generally up to the doctor to decide whether it is appropriate or not.

5. When can I bring an IUD?

Basically, as long as it is determined that there is no possibility of pregnancy, doctors can place intrauterine devices. It is usually best to wear a ring within two or three days after menstruation is clean. Have a postpartum check-up six to eight weeks after delivery. If the doctor thinks it's appropriate, he can wear a ring.

6. Is it complicated and painful to place and remove the IUD?

Placement and removal of IUD is very simple. First, the doctor disinfected the IUD, and then sent her to the uterus with a "ring feeder". She was placed after quitting the "ring feeder" and cutting off the nylon thread tied with the intrauterine device. When taking the ring, just gently pull the nylon thread at the tail of the pull ring or use the "ring remover" to pull the ring out of the uterus. When placing and removing IUD, there is usually only slight pain in the lower abdomen.

7. Can I use contraception immediately after placing an intrauterine device?

When the IUD is first placed, some women are prone to get pregnant when wearing the IUD, so doctors will instruct them to use external contraceptive methods 1 to 2 months after wearing the IUD to ensure safe contraception.

8. Do you want to check regularly after wearing the IUD?

Routine examination should be carried out after the first menstrual cramp after wearing. Then check it once a year without special problems.

9. What should I pay attention to after placing an intrauterine device?

The first menstrual period of women after wearing a ring can be extended by two to three days, and the menstrual flow may be slightly more. Some women will feel abdominal discomfort or menstrual abdominal pain. This is the initial maladjustment reaction. However, individual women will have a significant increase in menstrual flow, a small amount of menstrual bleeding, and obvious abdominal pain. If these conditions persist, you should go back to the hospital for examination.

10. What should I do if I get pregnant unexpectedly during wearing IUD?

There is still a 3% chance of unintended pregnancy when using IUD for contraception, so if menstruation is delayed or pregnancy is suspected, please consult a doctor.

1 1. When should the IUD be taken out?

The service life of different intrauterine devices is different, ranging from three to eight years. It usually takes about five years. When you go to Sheung Wan, you should keep the medical records of Sheung Wan. Take or change the ring according to the doctor's instructions. It is the easiest to get pregnant by taking and changing the ring, and other contraceptive methods should be used at the same time.

Third, oral contraceptives.

1. Why can birth control pills be used for contraception?

Contraceptives are divided into two categories: oral and external use. The main components of oral contraceptives are synthetic estrogen and progesterone, which can be divided into three types according to the duration of contraception: long-acting, short-acting and quick-acting (visiting relatives). Oral contraceptives play a role by inhibiting ovarian ovulation, thickening cervical mucus, interfering with endometrial development, changing tubal peristalsis, inhibiting sperm capacitation, and inhibiting or killing sperm.

2, the types of contraceptives, contraceptives and which drugs should not be taken at the same time.

Long-acting contraceptive needle

It is compound progesterone caproate and compound megestrol acetate containing estrogen and progesterone. Inject once on the 5th day and 10- 12 days of the menstrual cycle for the first time, and then once on the 10 day of each menstrual cycle. A simple progesterone contraceptive needle, mainly medroxyprogesterone acetate (DMPA), is injected on the fifth day of menstrual cramps, and then every three months. About 2/3 women have irregular bleeding after using pregnancy needle alone. It is suitable for lactating women.

Short-acting contraceptive

Simple administration, reliable contraceptive effect, no harm to human body, and no influence on later fertility.

How to take it: generally take it after dinner and before going to bed on the fifth day of menstrual cramps. Take one tablet a day for 22 days. Take the medicine for one month, and you can use contraception for one month.

Contraceptive pill for visiting relatives

It is suitable for visiting relatives who have lived continuously for 10 days or more, and can be taken after the same room, regardless of menstrual cycle. Visiting relatives for more than two weeks can be changed to taking birth control pills.

Long acting oral contraceptives

Take one tablet after lunch on the fifth day of the first menstrual cramp, twice every 20 days, and then take one tablet every second day of every month.

3. What should I pay attention to when taking birth control pills?

Before choosing birth control pills, you should go to the hospital for a physical examination to find out if you are suitable for using birth control pills. No matter what kind of contraceptive, you should take it in strict accordance with the instructions, and you can't change the method and dosage at will, otherwise it will affect the contraceptive effect. Birth control pills should be kept in a cool and dry place. If there are children at home, they should be put out of children's reach.

A few women will have nausea, vomiting, dizziness and other reactions after taking birth control pills. Short-acting contraceptives can be taken after meals or before going to bed, and long-acting contraceptives can be taken after lunch, which can alleviate the reaction.

If you have vaginal bleeding or no menstruation for 3 months during medication, you should go to the hospital to check the reasons. Long-acting contraceptives should not be stopped suddenly, and short-acting contraceptives should be taken for 2-3 menstrual cycles as a transition to avoid irregular vaginal bleeding. Women who take birth control pills for a long time should go to the hospital regularly for health check-ups. If you want to have children, you should stop taking drugs for half a year before getting pregnant. It is best to use condoms for contraception after stopping taking drugs for half a year.

4. Which women should not use birth control pills?

① Women with acute and chronic hepatitis and nephritis are excreted by the kidneys because contraceptives are metabolized in the liver.

(2) Women suffering from heart disease and cardiac insufficiency, because contraceptives keep water and sodium in the body, which increases the burden on the heart.

③ Women with hypertension should not use it.

④ People with diabetes and family history of diabetes should not use it.

⑤ Hyperthyroid women should not be used before they are cured.

⑥ Not suitable for patients with breast benign tumor, hysteromyoma and various malignant tumors.

⑦ Patients with past or present thromboembolic diseases, such as cerebral thrombosis, myocardial infarction and vasculitis. , should not be used, so as not to aggravate the condition.

8 Not suitable for women with chronic headache, especially migraine and vascular headache.

Pet-name ruby long-term use of contraceptives will shrink the endometrium, so it is best not to use it for those who have had too little menstruation in the past.

Attending contraceptives can reduce milk secretion and reduce milk quality; Contraceptive pills can also enter the breast milk, which has adverse effects on newborns, so it is not suitable for lactating women. Another point is that people over 40 or women who smoke should not use it over 35.

5. Contraceptive pills should not be taken at the same time with which drugs.

Women who are taking birth control pills, if they take some other drugs due to illness, will accelerate the metabolism of birth control pills, interfere with the role of birth control pills and lead to contraceptive failure. So far, there are several drugs known to affect the effectiveness of contraceptives: antibiotics include ampicillin, tetracycline, chloramphenicol, neomycin and erythromycin. Rifampicin and other anti-tuberculosis drugs. Antirheumatic drugs. Antiepileptic drugs and sedatives include phenytoin sodium, butanone, hypnotics, hypnotics and metoclopramide. Other drugs that affect the efficacy of contraceptives include sulfonamides, clotrimazole, insulin and furandine. Therefore, when women who are taking birth control pills need to use the above drugs, it is best to temporarily stop using birth control pills and switch to contraceptive methods such as condoms, vaginal contraceptives and intrauterine devices.

Fourth, emergency contraception.

Emergency contraception is a remedial measure to worry about pregnancy when you don't want to get pregnant because of various reasons (such as condom rupture or falling off). The specific use method is as follows:

No.53 anti-pregnancy tablet

This is a remedy within 24 hours. Take one tablet orally immediately after sexual intercourse (no later than 12 hours), and then take one tablet in the morning and one tablet in the evening. After taking one tablet for three days, the effective rate can reach 95%.

Short-acting oral contraceptives

Take 2-4 tablets orally immediately after sexual intercourse and 2-4 tablets orally after 12 hours.

18 norethindrone

This is a 48-hour remedial contraceptive. Specific usage: Take one tablet orally 48 hours after sexual intercourse, and one tablet after 12 hours.

Mifepristone

It is a contraceptive pill taken within 72 hours after sexual intercourse, but it can only be taken under the guidance of a doctor and can only be obtained in hospitals and family planning services.

Yuting (levonorgestrel tablets)

It is a relatively new emergency contraceptive, which can avoid pregnancy by inhibiting follicular development, inhibiting or delaying ovulation, affecting endometrial development and interfering with implantation. The usage is to take the first tablet (0.75mg) within 72 hours after sexual intercourse and the second tablet (0.75mg) after 12 hours, a total of two tablets. This product is an emergency contraceptive and cannot be taken as a conventional contraceptive.

intrauterine device (IUD)

Go to the hospital to get IUD12 48 hours after sexual intercourse-its main mechanism is to interfere with fertilization and implantation of fertilized eggs.

Suggestion:

We should reserve some emergency contraceptives at ordinary times, just in case.

Reminder:

Don't use expired contraceptives.

It is worth noting that:

In addition to placing intrauterine contraceptive ring as a long-term protection measure, hormone drugs protect women once and should not be reused. If used repeatedly for a long time, it may cause menstrual disorder and even cause systemic side effects, such as nausea, vomiting, breast pain, irregular vaginal bleeding and so on.

Therefore, emergency contraceptives are only used in emergencies and should not be abused. At present, no emergency contraceptive measures that can be used routinely after each sexual life have been found, so conventional contraceptive methods are still very important. If there is an unexpected pregnancy, other methods should be used to terminate the pregnancy.

Five, subcutaneous implantation contraceptive method

1. What is subcutaneous implant contraception?

Subcutaneous implantation contraception is a new contraceptive method, which has been widely used all over the world.

This contraceptive method is to put a certain dose of progesterone into a silicon capsule tube, and then bury this tube under the skin and slowly release a small amount of progesterone, thus playing a contraceptive role. This contraceptive was introduced to China on 1984, and was first used in Beijing, Shanghai, Tianjin, Shenyang and other cities. At present, 15 provinces and cities in China have established clinical experimental centers for subcutaneous implants to perform this operation. According to statistics, the pregnancy rate is only 0. 1% in two years and 0.24% in three years.

The implant used in the subcutaneous implant contraceptive method consists of six silicon capsule tubes the size of matchsticks, and each capsule tube contains 34 mg of levorotatory 18 nail implant (also known as Nopula). After the capsule tube is implanted in subcutaneous tissue, the contraceptive begins to release slowly immediately, and it can play a contraceptive role after 24 hours. The effective contraceptive time is 5 years.

Subcutaneous implantation of contraceptives prevents sperm from entering the uterine cavity by changing the viscosity of cervical mucus; Inhibition of endometrial growth is not conducive to implantation of fertilized eggs; Inhibition of ovarian ovulation and other aspects to achieve contraceptive purposes.

2. Who is suitable for using subcutaneous implant contraception?

Women under the age of 40 who need long-term contraception can use this method as long as they are healthy, which is especially suitable for women who are prone to failure in using intrauterine devices, women who cannot take contraceptives on time and women who are worried about sterilization.

3. Who is not suitable for using subcutaneous implant contraception?

Suffering from severe anemia, hypertension, recurrent headache, hyperthyroidism, breast cancer, diabetes, hysteromyoma, ovarian tumor, serious skin diseases, hepatitis, nephritis and other diseases, as well as women with ectopic pregnancy history, lactating women, women weighing more than 70 kg or taking antiepileptic drugs and anti-tuberculosis drugs, this contraceptive method is not suitable.

4. How to use subcutaneous implantation for contraception?

Subcutaneous implantation contraception is generally carried out within 7 days of menstrual cramps, or at the same time as induced abortion. Simple operation. Make a small incision on the inner side of the upper arm of the contraceptive, and push 6 silicone capsule tubes under the skin (fan-shaped arrangement) from the incision with a special trocar. After the operation, the incision does not need to be sutured. The whole operation can be completed in a few minutes.

Within a few days after operation, there may be cyanosis and swelling locally. This kind of situation will disappear without treatment for a few days. If the wound has bleeding, infection or prolapse of silicone capsule tube, you should seek medical attention immediately. You can't have sex until 24 hours after the operation.

A set of silicone capsule tubes can be used for contraception for 5 years, and then taken out. If you need to continue using this method for contraception, you can rebury a group of silicon capsule tubes; If family planning, take out the silicone capsule tube half a year before planned pregnancy. In the meantime, condoms and vaginal contraceptives can be used for contraception.

If amenorrhea, irregular vaginal bleeding and lower abdominal pain occur during subcutaneous implantation of contraception, you should see a doctor immediately to check whether you are pregnant.

5. Advantages of subcutaneous implant contraception.

Subcutaneous implant contraception has the following advantages:

(1) The contraceptive effect is good, and the contraceptive effective rate is over 99%.

(2) The contraceptive effect is long, and it can be used for 5 years once implanted.

(3) The drug reaction is small. This contraceptive only contains progesterone, not estrogen, so the side effects are less than oral contraceptives.

(4) It is reversible, and the fertility can be quickly restored after taking out the silicon capsule tube.

6. Subcutaneous implantation of contraception also has some disadvantages:

About 20% women have menstrual disorders such as inaccurate menstruation, prolonged menstruation and increased menstrual flow at the initial stage of use; Some women also have amenorrhea. Most of these phenomena can be gradually improved after half a year.

Six, vaginal contraceptive and vaginal contraceptives.

1. What is vaginal contraceptive?

Vaginal contraceptive is a kind of chemical preparation, which is placed deep in the vagina, near the cervix, so that sperm can't move here, and can't reach the fallopian tube through the uterus to combine with eggs, so vaginal contraceptives are also called spermicide.

Vaginal contraceptives include external contraceptive suppository (couples' contraceptive suppository, wife's friend), contraceptive membrane (Lele ether external contraceptive membrane), contraceptive tablet (Le 'an ether external contraceptive tablet) and Lele ether jelly.

2. How to use vaginal contraceptives

Vaginal contraceptives are mainly placed in the depths of women's vagina, close to the cervix. It is about 10- 12 cm deep from the vaginal opening. If you use ointment, you should inject it into the pump according to the dosage in the instructions, and then inject it into the position near the cervix through the vagina with the pump, so that you can have sexual intercourse. After use, clean the pump with soap and water and dry it. Save it for next time. If suppositories, tablets or pellicles are used, the drugs should be sent to the depth of vagina 10- 12 cm by hand, and sexual intercourse can only be carried out after the drugs are dissolved 10- 15 minutes. Ointment should not be used as contraception alone.

3. What are the advantages of using vaginal contraceptive?

It is more flexible to use external contraceptives before each sexual intercourse without doctor's prescription or surgery. Drugs are not absorbed by the body, so they have no effect on the body. The rate of sexually transmitted diseases among women who use vaginal contraceptive is low. Adding these drugs to the choice of condoms can improve the contraceptive effect. Women who use intrauterine devices, oral contraceptives and contraceptive needles can also add these drugs within one month after starting to use them to improve the contraceptive effect.

4. What should I pay attention to when using vaginal contraceptive?

The use of vaginal contraceptive must be used correctly before each sexual intercourse. Inadvertent or incorrect use of human factors may lead to contraceptive failure. When using suppositories, tablets and films, you must wait until the drugs are dissolved before having sex. It should be placed before each sexual intercourse, and it should be placed again if it has not ejaculated for more than an hour or has sexual intercourse again. During sexual intercourse, the woman should lie in the supine position (when the woman is in the upper or upright position, the medicine will flow out of the vagina, reducing the contraceptive effect). The woman should lie on her back 15-30 minutes after sexual intercourse. It is not advisable to wash the vagina within six hours after sexual intercourse.

Compared with other contraceptive methods, the risk of pregnancy is higher when using vaginal contraceptive, for example, the woman's menstruation has expired when using it, or the possibility of pregnancy must be considered when problems arise.

Some individuals may have local mild irritation due to drug allergy, and once it occurs, they should stop taking drugs.

Seven, the safe period of contraception

1. What is natural contraception?

The first half of the menstrual cycle is the development period of eggs in the ovary. Estrogen is mainly secreted in the ovary, which makes the inner layer of uterus (endometrium), cervix and vagina thicken and breasts swell. Followed by ovulation, mature eggs are released from follicles in the ovary, which is manifested by the increase of basal body temperature and the change of cervical mucus. At this time, the follicles mainly secrete progesterone; Ovulation is "pregnancy". If the egg is not fertilized, progesterone will decrease, the endometrium will fall off and menstrual cramps will occur. Natural contraception is also called safe period contraception or periodic abstinence; It refers to a means to avoid "pregnant" sex life in each menstrual cycle, thus preventing pregnancy.

2. How can I know that I am pregnant?

There are three detection methods.

Calendar rhythm method: women must record the menstrual cycle of 6- 12 months continuously, and take the first day of menstrual cramp as the starting day to calculate the longest and shortest cycle. Then calculate the growth period of abstinence. The calculation method is as follows:

First fertile day (first fertile day) = shortest period minus 20 days.

Date of final pregnancy (end of pregnancy) = maximum cycle minus 10 days;

For example, if the shortest period recorded by a woman is 26 days and the longest period is 3 1 day, then her ovulation period is 26-20 = 6 and 3 1- 10 = 2 1, and her ovulation period (or unsafe period) is the 6th-of the menstrual cycle. During this period, sexual life or other contraceptive methods should be prohibited.

Body temperature method: women measure their body temperature immediately after waking up every morning and before getting up, and record it on a special body temperature paper. Because after ovulation 1-2 days, the body temperature began to rise. Therefore, sexual intercourse should not be carried out from the first day of menstrual cramps to the third day after body temperature rises, and 3 days later to the next menstrual period 10 day is considered as a safe period for sexual intercourse.

Cervical mucus method (Billings method): Through learning, women learn to identify the dry, wet and wet feelings of the vaginal opening at various stages of the menstrual cycle. In the process of discharging mucus, different types of mucus should be distinguished; A small amount of viscous secretion means an increase in estrogen levels, while a large amount of lubricating mucus appears near ovulation. Before urinating, you can take out the mucus from the vaginal opening with your fingers, and check its appearance and stretch for confirmation. The third day after mucus and mucus peak is the fertile period. This method needs the guidance and study of professionals, and generally takes one to three months to learn to identify the types of mucus. Usually, calendar rhythm method, body temperature method and cervical mucus method should be integrated to calculate the pregnant time in menstrual cycle more accurately and the contraceptive effect will be better.

Who is suitable for using natural contraception?

This method is natural, and there is no need to use instruments, take hormones or perform surgery. It is suitable for women who are forbidden to use artificial contraception because of their religious beliefs. It is also used for women who have serious side effects and contraindications when using other contraceptive methods. Women who use this contraceptive method need a regular menstrual cycle and a stable frequency of sexual life. The relationship between sexual partners is more tacit, and both sides have the consciousness of not having sex for a long time.

4. Are there any taboos for natural contraception?

Natural contraception has no known medical side effects. However, women who cannot observe and record the symptoms and signs during pregnancy or ensure the cooperation of their sexual partners cannot use this method. Women with contraindications to pregnancy should not use this method.

5. Is natural contraception efficient?

Don't! At present, the three methods of natural contraception have many human factors in estimating pregnancy. Moreover, women's ovulation is often influenced by living environment, mood, health or sexual life, and sometimes even extra ovulation (ovulation during infertile pregnancy) occurs. So natural contraception is not very reliable.

5. How to preserve vaginal contraceptive?

Vaginal contraceptive's package is printed with the expiration date. Pay attention to whether it is expired and whether the packaging is complete when receiving and purchasing. It should be stored in a cool, dry place, out of the reach of children. The validity period of Anle ether tablets for external use in Guangzhou is one and a half years, and the suppository and film for external use produced in Tianjin are two years.

Eight, male condoms

Condoms are made of latex, polyurethane or lamb casings. One of the advantages of using condoms is that they can prevent sexually transmitted diseases.

Nine, vasectomy

The vas deferens are two thin muscle tubes that send sperm produced by two testicles to the urethra.