Chapter 13: Family Planning and Nonhormonal Contraception

LEARNING OBJECTIVES

1. Assess the short- and long-term effectiveness and safety for patient-directed and health care provider-directed nonhormonal contraceptive methods, and apply this to an individual’s contraceptive planning.

2. Identify individuals who would be ideal candidates for nonhormonal contraceptive methods.

3. Develop counseling information to optimize patient compliance with nonhormonal contraceptive methods.

4. Describe proper instructions for the handling, storage, use, and need to resupply for each type of barrier or spermicidal method.

5. Compare the duration of effect and return to fertility for each type of nonhormonal contraceptive method.

INTRODUCTION

Pregnancy prevention by a variety of means has been practiced by almost every culture. Historical evidence of contraceptive use dates back thousands of years and includes behavioral methods (eg, coitus interruptus) as well as mechanical methods (eg, vaginal sponges and recipes for vaginal inserts that were believed to form an impenetrable barrier to the cervix).

Of significance is the fact that the natural methods involving the recognition of signs and symptoms of fertility are used by women to plan as well as prevent conception. For this reason, knowledge of the “natural” or physiologic signs of female fertility may involve a much broader audience than those interested in contraceptive methods.

The majority of birth control methods in this section are under the control of the woman, which may make them more desirable. With the exception of the nonhormonal intrauterine contraceptive (IUC) and sterilization by surgery or microinserts, women can decide to stop using any of these methods and can expect an almost immediate return to fertility because there is no disruption of normal hormonal function and no structural or organic change.

With the advent of newer hormonal and nonhormonal methods of contraception (see Chapter 14: Hormonal and Emergency Contraception), many of the reversible nonhormonal options are now practiced infrequently in the United States. For instance, despite resurgence of male condom use in the 1980s subsequent to concern with transmission of the human immunodeficiency virus (HIV), the use of the male condom is only used by approximately 15% of total contraceptive users in the United States.¹ Contraceptive choices differ greatly by patient age, but since 1982, the pill and sterilization have been the most frequently used methods of contraception in the United States, with 25% of women using tubal sterilization and 25% of women using the pill.^1,2 Interestingly, from 2008 to 2014, there was a slight decrease in sterilization as a contraceptive method (37%-28%) and a slight increase in the use of the long-acting reversible contraceptive (LARC) methods, including intrauterine devices (IUDs) and transdermal implants (6%-14%).¹