Introduction

contraception hormonal teenager

The topic of the course work “contraceptives” was chosen because it is interesting and very relevant at the present time.

Contraception is not only protection against unwanted pregnancy. This is the preservation of health and the path to the birth of a healthy child.

Choosing a contraceptive is a relatively difficult task. The method used must be suitable to the lifestyle, take into account the partner’s opinion, not have a harmful effect on the body, have maximum efficiency, be accessible, not expensive and satisfy with full awareness of oneself. Oral hormonal drugs, intrauterine devices, modern surgical and chemical methods of contraception - we owe all these effective methods to the 20th century.

Contraception has been used since ancient times. Currently, contraceptives have become safe and more convenient to use.

Modern contraception makes it possible to reliably avoid unwanted pregnancy completely, but has a number of side effects.

All this determined the relevance of this work.

The purpose of my course work is to study methods of modern contraception.

To reveal the purpose of the work, the following tasks were set:

1. study the history of the development of contraception,

2. identify and characterize the main methods and means of modern contraception,

3. reveal the features of each contraceptive method,

4. identify the positive and negative aspects of modern methods of contraception,

Research methods:

Theoretical (study of methodological literature on this topic).

Structure of the work: introduction, three chapters, conclusion and bibliography

History of the Development of Contraception

The history of female and male contraception goes back to ancient times. The beginnings of almost all modern methods and techniques for preventing pregnancy and terminating an existing pregnancy took place many centuries ago.

The African Nandi peoples and the Indians of South America, many centuries BC, used abstinence from sexual intercourse on certain days of the menstrual cycle to prevent pregnancy. This method of contraception in our time is called calendar.

In ancient times, a chemical method was used to prevent unwanted pregnancy. For this purpose, before sexual intercourse, women injected substances into the vagina that killed sperm. Thus, an Egyptian papyrus describes a recipe for preparing a vaginal tampon consisting of cotton, crocodile feces and honey. Crocodile feces have an acidic reaction, in which sperm die, and honey, having a sticky consistency, makes it difficult for sperm to penetrate from the vagina into the cervix.

In ancient Egypt, women used tampons soaked in acacia decoction and honey for contraception. Women of ancient India used vaginal tampons made from acacia leaves and elephant feces to prevent pregnancy. When these components are fermented, lactic acid is formed, which causes the death of sperm. Arab women prevented conception by inserting tampons with feces of ungulates, cabbage, earwax and some other substances into the vagina. Ancient Egyptians used sea sponges soaked in vinegar as tampons.

In the Middle Ages, European women used cotton wool and paper tampons soaked in acetic acid for the same purpose. In ancient China, a mixture of vegetable oil and mercury, which was injected into the vagina, was used as a contraceptive and abortifacient. Chinese women injected mixtures of cedar resin, alum and pomegranate apple into the vagina for contraception. The famous Casanova (1725-1798) in his biography described various methods of preventing pregnancy, including inserting a slice of lemon into a woman’s vagina immediately after intercourse. At the beginning of the 19th century, R. Gunther published a number of articles in which he described the results of studies of the influence of 101 names of various chemical substances (acids, alkalis, alkaloids and others) on sperm survival. These were the first scientific works on chemical methods of female contraception. Such substances are now called spermicides. Nowadays, these methods of contraception, in modified form, are classified as chemical methods of preventing pregnancy.

In America, Indian women, even before the advent of Spanish colonizers and other immigrants from Europe, used a decoction of mahogany and lemon to wash the vagina after sexual intercourse for the purpose of contraception. In ancient times, in many countries, pregnancy prevention was achieved by washing the vagina after sexual intercourse with an extract or decoction of willow leaf, juniper, aloe, lavender, parsley, marjoram, pineapple and other plants. Aristotle and Hippocrates recommended that women douche with their own urine to remove sperm from the vagina. Prevention of pregnancy by washing the vagina with decoctions and infusions of plants and solutions of various chemicals is now classified as mechanical methods of contraception.

Many years before our era, methods of contraception were known by taking juices, decoctions and infusions of various herbs by mouth. Thus, in the ancient civilizations of the Incas, Mays and Aztecs, women prevented conception by using infusions and decoctions from the root of a plant called Dioscorea. In Ancient Greece and Ancient Rome, infusions and decoctions from the roots and herbs of various plants were drunk for contraception. At the same time, Greek women chewed wild carrot seeds, and Indian women still do this today. It has been proven that wild carrot seeds inhibit the synthesis of the pregnancy hormone progesterone.

In Malaysia, women drank unripe pineapple juice for several days after menstruation as a contraceptive, while women in the Pacific Islands and Java drank unripe coconut juice. In North America, women prevented unwanted pregnancy by drinking a decoction of crushed ginger root or burdock tea. In Western Europe, many years ago, juniper decoction or oil was drunk to prevent unwanted pregnancy. German and Hungarian women drank marjoram tea during their “critical days.” In Southern Europe, women drank asparagus infusion daily for the same purpose. In Northern Europe, crushed shepherd's purse or plantain powder was used. The latter not only has a contraceptive effect, but also suppresses a woman’s desire for sexual intimacy with a man. In the old days in Malaysia, North and South America, women drank juice, decoctions or powder from milkweed, mistletoe, peas, etc. as oral contraception. Surgical methods of contraception have also been known for a long time. The primitive tribes of the aborigines of Australia and Java performed surgical sterilization of women by amputating the cervix using a stone knife. Sterilization of men was achieved by cutting the vas deferens. In these same tribes, in order to avoid the birth of an unwanted child, abortion was performed in the late stages of pregnancy by rupture of the fetal membranes. The ancient Egyptians surgically sterilized women by destroying the ovary using a thin wooden stick.

The condom is also an invention of ancient times. Written information about him was found in Egyptian sources dating back to 1350 BC. It was a fish skin condom. The tomb of the Egyptian pharaoh Tutankhamun (circa 1400-1392 BC) contained a reusable condom, which is now kept in the Egyptian National Museum. The ancient Arabs used the prototype of the modern condom, made from the intestines of domestic animals. At the same time, the Japanese used a similar product, which was made from the finest leather, intestines or horn.

Intrauterine contraceptive methods are a thousand-year-old invention. Before a long journey, the ancient nomads of the Middle East inserted small round stones into the uterine cavity of a camel. In ancient China, women injected various substances into the uterine cavity to prevent pregnancy. In Japan, they used "kyotan", which was made from thin skin and inserted into the cervical canal.

The first medical description of a condom was the work of Gibriel Fallopius (the organs of the female reproductive system, which were first discovered by him, are named after him). Fallopius wrote about a cotton “sheath” for the male genital organ, used as a means of protection, but against syphilis, and not against pregnancy. That is, the first condoms known to medicine protected the health of men, not women.

Other written sources from around the same period (mid-16th century) indicate that these “cases” were also made from animal intestines, gall bladders and skin. These materials had excellent stretch and were much smoother than fabric.

However, such a remedy was very expensive and rare, so condoms came into use only several centuries later. Even after Charles Goodyear invented the process of vulcanizing rubber and began mass production of condoms in the late 1860s, many governments banned all advertising of such products.

As a result, it was extremely difficult to buy condoms, and those who did choose them as a means of contraception had to use one product several times.

This is what the first condom looked like

Man has used contraception methods, preventing the development of pregnancy, from the very beginning of his existence. The need for birth control led to the creation of a variety of contraceptive methods that were used in primitive society and exist today.

Already in ancient Africa, various substances of plant origin were known in the form of a cocoon, which was inserted deep into the vagina. Coitus interruptus (coitus interruptus) was also described in ancient Africa.

In America, the Indians, even before the arrival of immigrants from Europe, used a decoction of mahogany bark and lemon to wash the vagina after sexual intercourse. They also knew that after chewing parsley, a woman would bleed for 4 days.

Similar methods have been used all over the world. In Australia, for example, contraceptive mixtures were prepared from pond and fucus extract. In Sumatra and neighboring islands, opium was also used.

In Ancient Egypt, they used a vaginal tampon soaked in acacia decoction and honey (Ebers papiras). According to information from the Berlin papirus, steam heating was very effective in preventing pregnancy. According to oral traditions, women used the introduction of crocodile droppings into the vagina for contraceptive purposes.

The third section of the book of Genesis indicates that in ancient Palestine “interrupted copulation” was considered a natural way to prevent pregnancy. Around the same time, Diascorides recommended the use of mandrake. Information about the use of mandrake decoction to prevent pregnancy is found many times in the works of Ancient authors.

It should be especially noted that in the territory of ancient Palestine, to prevent pregnancy, there were the following recommendations of Rabbi Yochanan: “...Take Egyptian thorn wood glue, alum and garden saffron...”.

At that time, a variety of tampons and sponges had already become widespread, which, after being soaked in various substances, were inserted into the vagina and prevented the development of pregnancy or caused its premature termination.

Later, Soranus noted the significance of introducing into the vagina a mixture of cedar, resin, alum and pomegranate. During the Roman Empire, it was believed that inserting elephant dung into the vagina would prevent pregnancy.

The attitude towards these methods, for example, to the droppings of an elephant or a crocodile, must take into account the conditions and level of development of a given era. However, there is no doubt that elephant and crocodile droppings can change the acidity of the vaginal contents and thus have a contraceptive effect.
Contraception has been the focus of attention in the Far East since ancient times. In China, for example, various substances placed in the uterine cavity were used to prevent pregnancy; mercury was mainly used by introducing it into the vagina. In Japan, they used the so-called “ki-otai”, made of thin skin, which, when located in the area of ​​the external os of the cervix, prevented the penetration of sperm into it. Oil-soaked bamboo sheets, which were used in a similar way, were also well known in Japan.

In Europe, written instructions on contraceptive methods dating back to the 12th-18th centuries have been preserved. According to Spalazani, a vinegar solution makes sperm immobile, unable to enter the uterine cavity and fertilize the egg. First of all, cotton wool and paper swabs soaked in acetic acid were used.

The great conqueror of women of that time, Casanova, said that lemon peel placed in the vagina perfectly prevents pregnancy. Although this makes us smile today, the recommendation is not without common sense, given that an acidic environment has an adverse effect on sperm motility.

According to the Pray Code, pregnancy can be prevented by washing the vagina with juniper decoction if it is used immediately after intercourse. In Hungary, vaginal douching was used with extracts and decoctions of aloe, juniper, lavender, parsley and marjoram.

In the 20th century, methods and methods of contraception developed progressively. In 1933, Knocke’s book was published, in which 180 different spermicidal substances were described. Subsequent controlled studies led to the development of certain spermicidal contraceptives that could be used as powders, tablets, or vaginal pellets.

Male condoms made from animal skin were used in the ancient world, but became widespread mainly in the first half of the 20th century. Somewhat later, rubber condoms appeared, the improvement of their reliability continued until the end of our century. Condoms, having a contraceptive effect (unfortunately, not one hundred percent), are important for the prevention of AIDS. Of particular note is an important date in the first half of the 20th century - 1908, when the cervical cap was invented.

Information about extracts from plants that were used for contraceptive and abortifacient purposes is given in Table 1.1.

Table 1.1 Herbal contraceptives and abortifacients of traditional medicine (SheregeyD, 1973)

Name of plant Place of application (country and region) Method and purpose of application
Pineapple (Ananas fruc-tus) Malaya Women drank the juice of the unripe fruit for several days, causing infertility.
Juniper (Juniperus sabina) Central Europe To prevent conception, women drank a decoction or oil.
Ginger root (Gei urbani radix) North America The root of the plant was crushed, boiled and drunk daily to prevent conception.
Euphorbia (Taraxacum officinale) - dandelion North America To prevent conception, women drank a decoction of the plant weekly.
Asparagus Southern Europe To prevent conception, it was boiled for a long time and drunk daily.
Arum maculatum South America The Indians drank a decoction of the plant to suppress sperm production.
Shepherd's purse (Capsella bursa pas-toris) Northern Europe To prevent conception, powder was quietly added to women's food.
Burdock (Arctium lappa) North America To prevent conception, Indian women drank a decoction of the plant as tea.
Green coconut Pacific Islands and Java To reduce fertility, women drank milk from unripe coconuts.
Lanceolate plantain (Plantago lanceolata) Central Europe Added plant powder to food to reduce libido and prevent conception.
Mistletoe (Viscu album) North America Indian women drank tea from the leaves of the plant daily to prevent conception.
Marjoram (Majoraima hortensis) Germany, Hungary Women drank tea during menstruation to ensure infertility for a month (plant powder was also mixed with honey and inserted into the vagina using a woolen tampon).
Peas (Plsum sativum) England, Europe Women used the oil as a contraceptive.
Asa foetisa + banan Malaya Women ate this mixture three times a month to prevent conception.

HISTORY OF THE DEVELOPMENT OF INTRAUTERINE CONTRACEPTION

There is no sufficiently complete and reliable historical information about when, where and under what circumstances intrauterine contraception began to be used. It is only known that even in ancient times, in some African tribes, nomads introduced small pebbles into the uterine cavity of camels in order to prevent pregnancy during long and difficult caravan journeys (Speroff L., 1996). Similar remedies were used by doctors of Ancient Greece. In particular, Hippocrates worked with a hollow lead tube - a probe, with the help of which he may have carried out examinations or installed some kind of contraceptives.
The forerunner of modern intrauterine devices is a small plant that has served as a contraceptive since the early 19th century. Its flower was used to cover the internal pharynx, and the stem was placed in the cervical canal.
By the end of the 19th century, special buttons or cervical caps in the shape of an onion with side branches began to be used, which were sometimes inserted into the uterine cavity. They were also used to secure the uterus in case of prolapse (Southern, 1975). Such contraceptives were made from ivory, regular and ebony wood, glass, tin alloys, gold and platinum with diamonds (Tatum H.J. et al., 1975).
In 1902, Karl Hollweg from Germany invented a cervico-intrauterine pessary in the form of a metal spring (Speroff L., 1996; Thiery M., 1997). Karl Pust in 1923 made a pessary from silk twisted into a ring (introduced into the uterine cavity), which was attached to a glass stem. The leg at the other end was connected to a glass plate located outside the external os of the cervix. Contraceptives of this design served as a bridge between the external genitalia, vagina and upper genital tract and created favorable conditions for the occurrence of pelvic inflammatory diseases (PID). Since gonorrhea was widespread and poorly treated at that time, doctors reacted negatively to such IUDs.
It is believed that intrauterine contraception has been thoroughly explored since 1909, when Dr. Richter from Waldenburg published the article “A New Method for Preventing Pregnancy” in a popular German medical journal. The author proposed using a contraceptive made of two silk threads and a bronze thread connecting them, twisted into a ring, which was inserted into the uterine cavity through a metal catheter (Richter R., 1909). However, Richter's invention was not widely used.
The next gynecologist who made a major contribution to the creation and improvement of the IUD is considered to be Grafenberg, known as the author of the first study on determining the time of ovulation (Thiery M., 1997). Since 1920, he began working on the creation of a new intrauterine device. At first he experimented with various structures made from silkworm threads (1924), but they had to be abandoned due to frequent expulsions, menorrhagia and pain. As a result of subsequent creative searches, the famous Grafenberg ring appeared, made of silk threads braided with German silver wire (an alloy of copper, nickel and zinc). Publications 1928-1930 made the invention famous outside of Germany. In 1929, the London Commission for the Safety of Medicines found the Grafenberg silver ring acceptable for contraception in women with psychosexual disorders. After the introduction of such a contraceptive, stress due to fear of pregnancy was relieved.

Rice. 1.1. Grafenberg and Otha rings.
As such IUDs spread, the number of concomitant inflammatory diseases of the pelvic organs increased. For this reason, in 1931, at the Congress of Obstetricians and Gynecologists in Frankfurt, IUDs were declared dangerous to women's health. After the establishment of the Nazi regime and the repression of Jewish doctors, intrauterine contraception was banned as “a threat to the mental and mental health of Aryan women.” Grafenberg, persecuted by the authorities, was forced to emigrate to the United States in 1940, where he died without receiving during his lifetime the recognition that he undoubtedly deserved.
A serious drawback of the Grafenberg ring - a high percentage of expulsions - was eliminated by the Japanese Ota in 1934. He improved the Grafenberg design (added a central disk and called the new device the Rhecea ring, which means pressure ring in Japanese), which became famous and was continued in secret use (Fig. 1.1). Few people know that it was Ota who first used plastic in the manufacture of the IUD, but it was still of very low quality and was not used in production.
The Grafenberg and Otha rings were forgotten during the Second World War. However, in the first decade after it, the population in many countries grew rapidly, and this provided an impetus for continued scientific developments in the field of contraception.
In 1959, Dr. Ogatenheimer from Jerusalem published data on the successful use of Grafenberg rings by 1500 women (Oppenheimer W., 1959), and the Japanese gynecologist Ishihama published the results of a study involving 20,000 patients with Ota rings (Ishihama A., 1959).
In 1962, Christopher Tietze, a medical statistician and admirer of Grafenberg, organized the first International Symposium on Intrauterine Contraception in New York, where Margulis and Lipps demonstrated their IUDs and the results of their clinical use.
Dr. Margulis is the author of the first device made of thermoplastic and known as the “Perma-spiral”, or Margulis spiral. It was he who introduced barium sulfate into the plastic IUD to impart radiopaque properties. Subsequently, the author added a rod with seven small thickenings to the spiral to facilitate its removal from the uterine cavity (Tatum H.J., 1983).
In 1961, after numerous experiments, Lipps created an IUD with a serpentine configuration in the form of a double letter S. The contraceptive is usually called the Lipps loop, although it looks more like a zigzag. It is made from a copolymer of ethylene with vinyl acetate, which is inert to body tissues, non-toxic, quite elastic and resilient, retains its shape at a temperature of 35-40°C, does not cause reactive inflammation and can remain in the body for a fairly long period of time. Thanks to its elasticity and flexibility, the Lipps loop was easily inserted into the syringe guide and then into the uterine cavity without dilating the cervical canal. Lipps believed that his design was more consistent with the uterine cavity than a spiral or ring. It was the first device to have a nylon thread attached to the bottom of the device to make it easier to remove the IUD and also make it easier to monitor its presence in the uterine cavity. The rounded and thickened top tip of the loop reduced the risk of perforation (Fig. 1.2).

Rice. 1.2. Lipps loop.
Based on studies of the comparative effectiveness and acceptability of various IUDs carried out in 1962-1970, it was approved to use Lipps loops and some other similar devices, called inert, or non-medicinal, to prevent unwanted pregnancy in healthy women of reproductive age.
In subsequent years, several more IUDs were invented, differing in size, shape, material, etc. One of them - Dalkon Shield (author - Davis X.J., 1970) - turned out to be unsuccessful and to some extent compromised intrauterine contraception as a whole. Thus, with its use, the incidence of tubal infertility increased by 2 times, and inflammatory diseases of the pelvic organs by 5 times compared to the use of other types of IUDs. The cause of the complications was believed to be rubberized threads through which microorganisms penetrated from the vagina into the uterine cavity (Tatum H.J., 1983). Non-medicated plastic IUDs are classified as the first generation. Their effectiveness is estimated at 5.3 pregnancies per year per 100 women.
The second generation of IUDs - copper-containing intrauterine devices - appeared in 1969 (authors: Zipper J. and Tatum N.). The first discovered the anti-nidation effect of copper in experiments on rabbits, and the second added copper to plastic IUDs.
Currently, there are a large number of different copper-containing IUDs, and the development of new ones continues. In order to increase the efficiency and duration of use, reduce complications and adverse reactions, a search is underway for optimal shapes, sizes and surface areas of copper. The most common contraceptives are: T Cu-200, Cu-200 V, T Cu-200 C, T Cu-200 Ag. The numbers indicate the copper surface area in mm2.
Copper-containing products can be divided into two groups:
1) With relatively low copper content: Si-7
Gravigard (USA) - rice. 1.3, Copper T-200 (Finland), T Si-200, T Si-200 V, T Si-220 C (USA), Multiload-250 (Netherlands), Nova-T (Finland), etc.
2) With a large amount of copper: T Si-380 A (Germany),
Multiload-375 (Netherlands), etc.
Below are the main characteristics of the listed IUDs.
T Cu-200, T Cu-200 V, T Cu-220 C and T Cu-200 Ag are made of polyethylene with the addition of barium sulfate and have a T-shape. The contraceptive leg is wrapped with copper wire with a total area of ​​200 mm2. The size of horizontal branches is 32 mm, vertical - 36 mm. Conductor diameter - 4.4 mm. T Cu-200 Ag has copper wire with a silver core. T Cu-200 V has a ball at the end of the rod to exclude retrograde perforation of the uterus. T Cu-200 C has copper “collars” instead of copper threads. This design slows down the loss of copper, and, accordingly, increases the efficiency and service life of the IUD.
The developers of these tools are Howard Tatum (USA), Jaime Zipper (Chile). Contraceptives have been on the world market since 1972. Their standard service life in the USA is 4 years, in European countries - 3 years.

Rice. 1.3. Cu-7 Gravigard (Searl, USA). Rice. 1.4. Multiload Cu-375.

Made in the form of a number 7, contains 89 mg of copper with a total surface of 200 mm2. It was produced in two sizes: Gravigard standard (with horizontal dimensions - 26 mm, vertical - 36 mm) and Mini-Gravigard (22x28 mm).
Nova-TCuAg (Finland). On the market since 1979. Service life in European countries - 5 years. It is made of polyethylene with the addition of barium sulfate and contains silver, which slows down the corrosion of copper wire, thereby increasing the duration of use of the contraceptive. The diameter of the copper wire is 0.2 mm, the copper surface area is 200 mm2. There is a loop at the lower end of the stem to prevent possible retrograde perforation of the cervix. Maximum dimensions of Nova-T: 32x32 mm. Conductor diameter - 3.6 mm.
Multiload Si-250 (Netherlands). On the market - since 1979. Service life in European countries - 5 years. Copper surface - 250 mm2. The horizontal size is smaller than that of other IUDs, has increased flexibility, and does not irritate the uterine angles. Subulate protrusions reduce the percentage of expulsions, fix the contraceptive in the highest possible position, resting against the fundus of the uterus and without stretching it. Multiload Cu-250 is available in three types: standard - for the uterus with a probe length of 6-9 cm; short - for a uterus 5-7 cm long; mini-type - for a uterus less than 5 cm long. The vertical size of these products is 35, 29 and 24 mm, respectively. The diameter of the pistonless conductor is 12 mm (the shoulders remain outside the tube).
The third generation of copper-containing IUDs are contraceptives with a copper surface area of ​​more than 300 mm2 and a service life of 5 to 8 years. These include Multiload Cu-375 (Netherlands), T Cu-380 A (Germany), T Cu-380 Ag (Finland), T Cu-380 S and Multiload Cu-375 (see Fig. 1.4). Available in two types: standard - for a uterus with a probe length of 6-9 cm and mini-type - for a uterus with a length of 5-8 cm. The length of the first IUD is 35 mm, the second - 29 mm.
T Cu-380 A (USA, Germany), T Cu-380 Ag (Finland), TCu-380 S (Canada). On the market - since 1982. Service life: T Si-380 A in the USA and Europe - 10 years, in Russia and the CIS - 6 years; T Si-380 Ag in FINLAND - 5 years; T C-380 S in Canada - 2.5 years, in Europe - 5 years.
These IUDs are T-shaped contraceptives (36x32 mm) with a high copper content, made of polyethylene with the addition of barium sulfate. A 0.4 mm thick copper wire with a surface area of ​​314 mm2 is mounted on a vertical rod, and two additional copper braids (with an area of ​​2x33 mm2) are mounted on horizontal arms. T Cu-380 Ag wire has a silver core. In the 380 S model, the copper plates are thinner, attached to the outside of each shoulder of the IUD and recessed into the plastic. This design makes it easier to install the product into the conductor and introduce it into the uterine cavity using a conductor with a diameter of 4.4 mm.
T Cu-380 A is the “gold standard” against which all existing IUDs are compared when assessing their effectiveness and acceptability (see Fig. 1.5). According to published data, the probability of pregnancy when using T Cu-380 A is less than one case per 100 women in the first year and only 1.8 after 8 years.
The next stage in the development of intrauterine contraceptives is the creation of hormone-releasing devices - the third generation IUD. They appeared as a result of attempts to combine the advantages of hormonal and intrauterine contraception.

Rice. 1.5. C T 380 A. FIG. 1.6. Progestasert.
In 1970, Dr. Antonio Scommegna (Michael Reese Hospital, Chicago) reported the results of observation of 34 women with a Lipps loop containing a silastic capsule with progesterone (30 mg), gradually released (300 mcg per day) into the uterine cavity. Ovulation was not suppressed, the nature of menstruation did not change, but endometrial changes were noted that prevented implantation. The effect on the endometrium was noted after 18 hours. When a similar drug was introduced into one of the horns of the rabbit’s uterus, not a single implantation site was found in it at autopsy.
Later, Pandya and Scommegna replaced the Lipps loop with a Tatum T-shaped design. Seemmegna, in the manufacture of a new contraceptive, excluded copper, and placed a reservoir (an ethylene-vinyl acetate copolymer housing) with 38 mg of a mixture of progesterone and barium sulfate in the vertical rod. As a result, Progestasert entered the market in 1976 (Alza Corporation, USA). The service life is at least a year at a hormone release rate of 65 mcg per day. IUD length - 36 mm, width - 32 mm. Conductor diameter - 8 mm (Fig. 1.6). Its advantage is that after insertion of the IUD, blood loss during menstruation was much less than when using other types of IUDs. However, Progestasert did not become popular due to the short duration of action of the hormone. The approved service life in the USA is 1 year, in France - 18 months. (Speroff L. et al, 1996).
Subsequently, scientific research and improvement of various IUDs actively continued. Among them, the most promising hormone-releasing IUDs such as Mirena and copper-containing Gine-frx should be highlighted.
Dr. T. Luukkainen - the author of NOVA-T - removed the copper from it and attached a reservoir with levonorges-trel to a vertical rod. As a result of long-term testing and modifications, the levonorgestrel-releasing intrauterine system (LNG-IUD) Mirena (Leiras - Schering) was created. Mirena has been on the market since 1990, its standard service life is 5 years. Dimensions - 32x32 mm. The length of the hormone-containing cylinder is 19 mm, the outer diameter is 2.8 mm, the inner diameter is 1.2 mm, the diameter of the conductor is 4.75 mm. Levonorgestrel, which is part of Mirena, has the same effect on a woman’s body as levonorgestrel in tablets. This gestagen acts on the endometrium and thickens cervical mucus, making it difficult for sperm to penetrate from the vagina into the uterine cavity.
The hormone-releasing drug Mirena (another name for Levonov) is currently recognized as one of the best contraceptives and is therefore discussed in detail in a separate chapter.

HISTORY OF THE DEVELOPMENT OF HORMONAL CONTRACEPTION

The creation of hormonal contraception was a new milestone in pregnancy prevention. Back in the second half of the last century, it was noted that during pregnancy the maturation of follicles stops, that is, during this period a second pregnancy becomes impossible. Based on this, Ludwig Haberbladt, in the first years of this century, proved in an experiment that the corpus luteum extract contains progesterone, which blocks ovulation, and recommended the use of ovarian extract as a method of “hormonal sterilization.” He found that implantation of ovarian and placental tissue from pregnant animals leads to infertility. Schmidt in 1929, using an extract of the corpus luteum, was able to prevent ovulation in rats, thereby confirming that in the presence of the corpus luteum, ovulation does not occur.
The discovery of sex hormones (in 1929 - estrogen, and then - progesterone, synthesized in 1934 by Gutenacht) was a new stage in the development of contraception. Gutenacht proved the blocking effect of progesterone on follicular rupture. Following this, a large number of reports appeared on the physiological actions of these hormones. In 1944, Bikenbach and Pavlovich experimentally induced anovulatory cycles in humans by parenteral administration of progesterone. The results of these experimental studies were used in clinical practice after Pincus showed in 1955 that pregnancy could be prevented by daily administration of 300 mg of progesterone to healthy women. However, this type of contraception did not become widespread at that time due to the need to prescribe large doses of progesterone due to the high rate of metabolism and clearance of the drug.
Subsequent efforts of scientists were aimed at the synthesis of gestagens, which would have the ability to undergo metabolic transformations more slowly, compared to natural steroids, and surpass the latter in biological action, which would make it possible to prescribe them orally in small doses and with good effect. They began to use an extract of Mexican licorice root as the main substance for the synthesis of sex steroids. Djerassi was the first to produce a semi-synthetic derivative of progesterone - norethisterone. Simultaneously with Djerassi, but independently of him, Colton synthesized norethinode-rel. These two drugs, which have a progesterone-like effect, are called “gestagen” (gestagen, progestin). In the mid-50s, a series of animal experiments were carried out, the results of which made it possible to establish the biological properties of progestins.
In 1956, the first clinical studies of norsteroids began in Puerto Rico. They confirmed the antiovulatory effect of progestins. The results were reported by Rock et al. Pincus and co-workers have proven that norethynod-rel and mestranol have a 100% effect in preventing pregnancy.
The first drug proposed for everyday medical practice in the form of tablets was Enovid (1960). It contained 15 mg of norethinodrel and 0.15 mg of mestranol. From this time on, the history of the development of combined contraceptives began, which can be divided into several stages. At the first stage, the so-called first generation drugs with a high content of hormones were created.

1st GENERATION DRUGS

The first generation combined contraceptive pills were characterized by a low Pearl index, a high content of hormones (the drugs Enovid and Infecundin), as well as often life-threatening complications such as thromboembolism. The development of thrombosis and thromboembolism was associated with high estrogen levels. This is explained by the fact that estrogens, depending on the dose, increase the concentration and activity of blood coagulation factors I, II, VII, X and XII. At the same time, they lower the level of antithrombin III. Estrogens in large doses stimulate the synthesis of angiotensinogen, which can cause an increase in blood pressure. Other serious side effects include fluid retention, swelling, nausea, breast tenderness and chloasma.
The goal of improving combined oral contraceptive drugs at the first stage was to minimize the incidence of these serious complications. Then drugs with low estrogen content were developed. These drugs contained gestagens in the same amount, but the estrogen content in them decreased by 5 times and amounted to 30-35 mcg/day. As a result, the risk of thrombosis decreased by 4 times. It should be noted that in women who smoke, the thrombogenic effect of estrogens is enhanced due to increased release of thromboxane. Therefore, smoking, especially in women over 35 years of age, was a contraindication to taking any contraceptive drug.
Although the side effects caused by estrogens with these drugs have become less frequent, less severe and, as a rule, reversible, it was considered advisable to further improve oral hormonal contraceptives in order to further reduce their side effects. For this purpose, it was necessary to create second-generation drugs containing estrogens and gestagens in even smaller quantities.
Currently, there are two main groups of progestins used in oral contraceptives: estrans (for example, norethinodrel, norethindrone, ethynodiol diacetate) and gonans (for example, levonorgestrel, desogestrel, norgestimate and gestodene). The main side effects of gestagens are the following: decreased glucose tolerance (which is of particular importance when using these drugs in patients with diabetes), increased blood pressure, increased body weight, undesirable changes in lipid composition, increased hair growth and depression. The occurrence of some of these side effects is also explained by the androgenic and mineralocorticoid effects of progestins.

II GENERATION DRUGS

The group of second generation drugs includes contraceptives containing levonorgestrel (LNG).

Levonorgestrel was the first progestogen created synthetically. It, unlike the so-called pro-hormones, does not require additional metabolic transformations to manifest its effect. The biological availability of levonorgestrel (the portion of the oral dose that reaches the systemic circulation) is 100%. Levonorgestrel has the most powerful androgenic, mineralocorticoid and glucocorticoid effects when used in large doses. Small doses do not have the above effects.
Levonorgestrel in the minimum effective dose was included in phase contraceptive drugs, developed for the first time in the USA in the early 80s in order to bring the composition of these drugs closer to the level of hormones during the physiological menstrual cycle.
These drugs, containing the smallest dose of levonorges-trel, have no effect on blood pressure and glucose tolerance, and do not cause changes in the lipid spectrum.

III GENERATION DRUGS

III generation drugs include drugs containing new types of progestogens (gestagens), synthesized in order to reduce the side effects inherent to these hormones. Their tests were carried out in Switzerland, Holland and the USA. These drugs are called gestagens of the 111th generation.
Norgestimate contained in silest. In the intestines and liver, it is quickly and completely converted into levonorgestrel and its derivatives. Compared to levonorgestrel, norgestimate has a less pronounced gestagenic effect, and therefore its effect on the lipid spectrum of the blood is less significant.
Desogestrel, contained in Mercilon, Marvelon, Regulon, Novinet, Tri-Mercy, as well as norgestimate, is a prohormone. In the liver and gastrointestinal tract, desogestrel is quickly and completely converted into an active derivative - 3-keto-desogestrel. The bioavailability of deso-gestrel is 76%. The advantages of oral hormonal contraceptives containing desogestrel are a weak androgenic effect and the lack of the ability to change glucose tolerance.
Finally, the third generation gestagenic drug is gestodene, which contains an active gestagen. Its bioavailability is almost 100%. The amount of hormones in contraceptive drugs containing this gestagen is the lowest. K| These drugs include Femoden, Logest, Lindinet. The androgenic effect of these drugs is slightly expressed.
Recently, combined hormonal contraceptives containing dienogest (Zhanine) and | drospirenone (Yarina), which has an antiandrogenic effect. In addition, Yarina, possessing an antimineralocorticoid! effect, has found application in the treatment of premenstrual syndrome-1.
In addition, hormonal contraceptives with an alternative route of administration have appeared, which suggests that steroids do not pass through the liver first. These include the NuvaRing vaginal ring, the Otto Evra skin patch, and the Mirena intrauterine hormonal releasing system.

HISTORY OF INJECTION CONTRACEPTION

Medroxyprogesterone acetate (DMPA) depot was initially used in medicine as a treatment for cancer, threatened miscarriage, and endometriosis. The first clinical trials of the drug as a contraceptive began in 1963.
The first report on contraceptive effectiveness was published in 1966. Based on the results of the study, scientists came to the conclusion that the suppression of reproductive function for several months by progesterone derivatives is quite reasonable. Initially, 3 progesterone steroids were used for injection contraception, the effectiveness of which remained for 3 months: DMPA at a dose of 150 mg, norethisterone enanthate - 200 mg and chlormadinone acetate - 250 mg.
It was subsequently found that, in contrast to other long-acting drugs, Depo-Provera 150 (medroxyprogesterone acetate) has received the most widespread use in clinical practice; A standard contraceptive regimen was established: 150 mg DMPA every 3 months.
Subsequently, injectable contraceptives caused a lot of controversy. Despite the proven high contraceptive effectiveness of DMPA, the FDA's decision to introduce the drug was delayed due to cases of mammary cancer in experimental beagle dogs.
WHO experts later reviewed the data from the dog trial and concluded that progestogen-induced mammary tumors do not provide any basis for predicting possible changes in the mammary glands of women using steroid contraceptives. In 1981, after a repeated meeting of WHO experts, it was confirmed that in an effective dose (150 mg) DMPA does not have teratogenic properties in humans.
The history of the development of contraception shows that oral contraceptive hormonal drugs, created over the past four decades, have made it possible to abandon most other means and methods of preventing pregnancy. These drugs have become widespread throughout the world. Today, more than 150 million women worldwide take oral contraceptives. The composition of these drugs has changed, resulting in increased acceptability and safety. With the creation of hormonal contraceptives, gynecologists have at their disposal contraceptives that provide effective pregnancy prevention.

Since ancient times, people have tried to control childbirth. Women tried to save themselves from some troubles or prevent the birth of a child from the “wrong” man. Men did not always want children to appear every time after he “accidentally” dropped his seed. The appearance of an unplanned, completely legitimate heir or bastard was often completely inappropriate for rulers. And economically, it was not easy to feed and raise numerous offspring. From time immemorial they have racked their brains and followed a thorny empirical path to prevent conception.



Today, out of a hundred women, 64 are protected. WHO statistics claim that it is thanks to modern contraception that it has been possible to reduce maternal mortality by half and infant mortality by three times.

All currently existing methods of contraception were known in the Ancient world. Let's try to follow the development of each of them from time immemorial to the present day.

Natural contraception

It refers to methods that do not require the use of special equipment. Success is guaranteed only by knowledge and some skills.



Coitus interruptus

This method today, according to statistics, is used by about 7% of the stronger sex.

The Latin phrase coitus interruptus - “interrupted sexual intercourse” - gives its name to probably the oldest method of preventing conception, which a man always has at his disposal. It was used by ancient Africans.

The third book of Genesis tells of the popularity of this method in Ancient Palestine.

He is described in detail in the Biblical story about Onan, who was forced by his own father to have intercourse with his brother’s wife. Then the unfortunate man was noticed in sin - he spewed his seed onto the ground. As often happens, the story, passed from mouth to mouth, acquired other details, and as a result, poor Onan began to be mentioned in completely different circumstances.



Yogi way

An interesting physiological contraception was developed in India. Men mastered the special yoga technique “Vairoli Mudra”, which made it possible to block the sperm channel.

With the help of a special abdominal massage, the woman’s uterus was moved forward or backward. Later, European women who ended up in the Dutch part of the colony were also taught this method of contraception.



Prolongation of lactation

The poorest African tribes still practice this barbaric method of contraception. A nursing mother, prolonging lactation for several years, simply exhausts her body, and conception becomes impossible due to uterine dystrophy and infertility.



Ogino method

A simple biological method was developed by a Japanese doctor, after whom it was named. This attentive and experienced gynecologist suggested abstaining from sexual intercourse for 8 days a month. Only 2% of women in the world use the calendar method, perhaps because in a year there are as many as 96 days without sex.

Some, in order to reduce the time frame of the ban, use the method of daily measurement of basal temperature, which gives a more accurate idea of ​​the onset of ovulation, and therefore “dangerous” days.



Samurai Egg

The ancient Japanese method of male contraception required only desire and self-discipline: one had to patiently hold the “manhood” for just a few minutes in a vessel with water at a temperature of at least 40 degrees for a couple of months. This protected against surprises after communicating with the opposite sex, at least for several months.

By the way, modern men inadvertently have the same “greenhouse effect”, heating what belongs to their primary sexual characteristics in traffic jams, sitting behind the wheel for several hours a day.



Barrier contraception

In an effort to take control of childbirth into their own hands, the progressive thought of mankind took another path, inventing special means that stood as a barrier between a man and a woman.



Chastity belt

Probably the most insurmountable barrier was the “chastity belt,” which was invented long before the Middle Ages. Even in ancient times, such “haberdashery” was quite popular among the powers that be, although such means of protection are often associated with the Arab World. They became widespread in the Middle Ages, when they were called “Bergamon castle” or “Venetian lattice”. Skilled craftsmen tried to come up with a “lock” with a special secret. Some were equipped with a small guillotine, which cut off everything that tried to open the belt, at the same time collecting “evidence” that could tell about attempts at female infidelity.



Male barrier contraceptives

In the era of Lucretius and Ovid, the “forefather” of the modern male condom was widespread - a bag made of oil-soaked fabric or papyrus, fish bladders, and the cecum of sheep. In Ancient China, silk condoms were sewn, and in Ancient Japan, “kyotai” were made from horns or thin leather.



The new era of the condom was opened with America, bringing syphilis to Europe and the urgent need to somehow protect against sexually transmitted diseases. And in the 17th century, the personal physician of Charles II, the Englishman Condom, in the second circle, following the ancient people, guessed that linen bags serve not only to prevent sexually transmitted infections, in particular syphilis imported from overseas, but also against unwanted pregnancy.

At the turn of the 18th-19th centuries, the first rubber condom appeared; it resembled a “cap” that fit over the top of a man’s “dignity”, and was immediately anathema to moralists. However, the natural need for contraception outweighed hypocrisy, and sales of rubber condoms broke records.



The competitors were not asleep, and therefore, after just about ten years, a seamless condom appeared, and a couple of decades later, a latex condom.

Folklore in the USSR dubbed condoms “rubber product No. 2,” giving primacy to gas masks. Everyone knows that there was no sex in the Union, so Soviet pharmacies were often decorated with chaste advertisements “there are no products No. 2!” In the early 70s, it was great luck to buy tights, toilet paper and a paper bag of condoms, which were prudently packaged in twos.



And for the “Olympics-80”, the “light” industry prepared a surprise for the “builders of socialism” - a kind of sign of quality. Now the packaging with the condom was proudly decorated with the inscription: “Electronically tested.”

Every year, about 2.5 billion condoms are produced worldwide, although only 4% of men use them.

There are 3 sizes:

regular - 16 in length and 3.5 cm in diameter;

“king size” - for specimens up to 20 cm;

"Ptit Thai" - 15 cm in length, popular in Southeast Asia.

Female barrier contraceptives

It is not known for certain where the “promate” of female diaphragm rings was first used - half a lemon, which was inserted into the vagina - in Ancient Africa or China.



Around the 15th century BC, according to mythology, the king of Crete Minos was famous for the fact that his sperm was swarming with scorpions and snakes. Then one of his cunning wives figured out how to protect herself from misfortune with the help of a goat's bladder.

By the time of Casanova’s adventures in Europe, “advanced users” were already “packed” with this gadget.

In 1908, cervical caps were invented to protect the female uterus from sperm interference.



Modern caps have a diameter of 5.5 cm and fit tightly to the cervix, leaving almost no chance for sperm to penetrate inside.

Spermicides

This type of contraception has never given a 100% guarantee; according to statistics, most often women have an unwanted pregnancy using it. Out of 100 women who use spermicides, about 20 become pregnant per year. Nevertheless, the method has a rich history and has been very popular at all times.

Hungry for love pleasures, the ancient Arab tribes widely used tampons soaked in special balms to prevent conception.



In ancient India, ladies practiced mixtures of sacred elephant dung, honey and cotton.

In Ancient Egypt, crocodiles were more revered, so their excrement was the main ingredient. The recipe has come to us thanks to the Petri papyrus, dated 1850 BC.



Egyptian women were the first to soak vaginal tampons in vinegar, which inhibited zealous sperm.

Avicenna described a recipe for spermicide with pomegranate pulp and narcotic substances.

A decoction of lemon and mahogany was used for contraception by the Indians long before the arrival of Europeans.

In Australia, a mixture of fucus and pond extracts was used for this.

In Sumatra, women relied entirely on opium tincture for this purpose.



The most terrible method was common in China, where mercury was injected into the vagina to prevent conception.

Published in 1933, Knocke's book contained 180 substances that were used in spermicidal recipes, including juniper, asparagus, ginger root, mistletoe, burdock, shepherd's purse and many others.

Modern spermicides have little in common with the ancient ones, but are also introduced into the vagina before sexual intercourse and have a destructive effect on sperm. They are available in the form of tablets, suppositories, foam aerosols and creams.

Intrauterine contraception

Today it is chosen by 17% of women.

The first attempts to apply it go back to ancient times. Camel drivers, preparing to cross the desert, in order to protect the females from pregnancy, burdensome on the way, placed pebbles in the uterine cavity of the animals.

Even 3 thousand years ago in Japan, geishas and quite respectable young ladies placed silver balls in the uterus in order to protect themselves from conception.



At the beginning of the 20th century, loops made of catgut, and then strings of gold, silver and copper, began to be inserted into the uterus for contraception.

The invention of plastic, the Margulis spiral and the Lipps loop revolutionized contraception.



In 1952, parallel to each other, two scientists at once, Oppenheimer in Israel and Ishihama in Japan, conducted successful clinical studies of plastic uterine rings.



The 60s of the last century saw a real boom in the Navy.

Male spiral

Quite recently, a method of male contraception that was highly effective and harmless to health was invented, but did not find a wide audience. The male IUD is a complex structure equipped with a gel that has a spermicidal effect. The structure is inserted into the seminal canal and then into the scrotum, where it opens like an umbrella.

Hormonal contraceptives



It’s hard to imagine, because sex hormones were discovered by science relatively recently, in 1929, but even Dioscorides in the 1st century AD testified that mandrake or Dioscorea, as he called the plant, was used to prepare a decoction that guaranteed protection against conception.

The American Indians, not without reason, believed that diligent eating of parsley would protect against pregnancy. The Jewish women chewed resin for the same purpose. In ancient India, they took a decoction of carrot seeds, the recipe for which was described by Hippocrates.

In China, a contraceptive based on cottonseed oil was invented and widely used until it became clear that it caused infertility in more than a third of men.

Modern pharmacology uses Mexican licorice root extract, which has long served faithfully in alternative medicine, for the synthesis of the sex hormone, progestogen, which is then used in the production of hormonal contraceptives.

In the middle of the last century, Georges Pincus announced the effectiveness of progesterone against unwanted conception, and in 1960, WHO already approved the use of the first contraceptive pills, which are used by 60% of women today.

Since then, hormonal contraceptives have undergone significant evolutionary growth, along with a decrease in the concentration of steroids, unwanted side symptoms have decreased and new valuable properties have appeared, for example, beneficial effects on skin, hair, etc.

Modern complex oral contraceptives (COCs) provide one hundred percent protection against unwanted pregnancy under the only condition - constant use.

For ladies with “girlish memories,” other hormonal contraceptives have been invented that lead to temporary sterility due to the presence of hormones:

Injections;

Patch;

Subcutaneous implants;

Postcoital contraception



This method involves the use of certain substances to prevent pregnancy, even if the egg has been fertilized by a sperm. Today this method is considered emergency and is used relatively rarely. Typically, such “first aid” is recommended if a woman was raped, for some reason could not use another method, the integrity of the condom was damaged during intimacy, etc.

Among the drugs used for postcoital contraception:

mifepristone,

difuston,

postinor,

Surgical methods of contraception



They are the most drastic, and involve sterilization of individuals of both sexes. They provide 100% protection against conception, as they lead to artificial infertility.

Female sterilization is carried out with ligation or dissection of the fallopian tubes, or a combination of two techniques.

Male sterilization or vasectomy takes only a quarter of an hour. During the operation, the seminal ducts are cut or ligated.

Considering that a man may want to “take back” his voluntary decision about infertility, a technique was developed for blocking the seminal ducts with rubber valves, which can always be removed through simple manipulation.

Moreover, reverse vasectomy is practiced, which allows you to return the possibility of conception to 90%.

The topic of contraception has been one of the most important for humanity since time immemorial. These days, with the massive increase in the popularity of abortion and the spread of HIV, AIDS and other dangerous diseases, especially. Even the popular adult film actress Elena Berkova, who supported the #DayWithout social marathon, called for safe sex. Take care of your health and the health of your partner, friends!

At all times, people have sought and tried various methods of protection against pregnancy. It's funny that almost all methods of protection today have been used for many centuries. Of course, thanks to progress, ancient contraception has been significantly improved, but the essence remains the same.

History of contraception

The oldest methods of barrier protection against pregnancy include the use of spermicides (sperm-destroying agents). For example, in Australia, the history of contraceptives began with the production of balls from sea grape extract. The Indians used citrus and mahogany birch bark tea to rinse the vagina. The method of preparing a contraceptive vaginal tampon from cotton, crocodile excrement and bee products was described in 1850 BC. on Egyptian papyrus. In another scripture from 1300 BC. e. it is said that for protection before and after sexual contact it is necessary to douche with a “mimi” solution, the components of which are not known to this day.

In ancient times, Indian women made contraceptives from elephant dung and acacia leaves, and Chinese women used special Kong Fu tampons; they also often used mercury, placing it in the vagina. Avicena's notes say that in Muslim countries they made tampons from pomegranate and cotton pulp, additionally moistening them with narcotic drugs; in this case, men were advised to lubricate the penis with onion juice and oil. The Japanese used a bamboo sheet soaked in oil. Al-Razi (Arab doctor) recommended using cabbage, animal manure, earwax and other substances as spermicides.

The first contraceptives for the inhabitants of ancient Palestine were invented by Rabbi Yochanan; he recommended mixing garden saffron, Egyptian thorn tree glue and alum. And in the Greco-Roman Empire in the 1st century BC. Diascorides suggested douching with a decoction of willow leaves.

Somewhat later, Soranus said that before sexual contact the cervix should be narrowed to make it difficult for sperm to penetrate. This effect was achieved by first introducing a piece of cloth soaked in an astringent consisting of pomegranate apple, cedar resin and alum. Contraception in ancient times among the Romans consisted of injecting elephant dung into women. The contraceptive effect was achieved by changing the normal environment in the vagina.

An equally ancient method is protection with an intrauterine device. The first mention of the IUD dates back to 4000 BC.

The history of the development of contraception also includes many other methods that are very unusual for our time, such as douching with urine or tampons made from spiders.

Letters have reached our times about the use of spermicides in Europe in the 12th - 18th centuries: acidifying the vagina with vinegar or a slice of lemon.

Patentex was the first spermicidal drug patented in the 20th century. It consisted of lactic and boric acid, glycerin. By 1933, 180 different substances of the same effect had been invented. Subsequently, the history of contraceptives began to develop very rapidly; many tablets, synthetic and collagen sponges, powders and vaginal balls appeared.

A large number of scientists, describing the traditions of the tribes of Africa and Ancient India, pointed to the use of interrupted coitus. The third chapter of the book of Genesis talks about the contraceptive effect of interrupted copulation. The treatise “School for Girls” advises women to push away a man when ejaculation approaches.

Condoms were already used in contraception in the 19th century; the use of these barrier methods goes back to ancient times, the first mentions date back to 3000 BC. e. There is a myth that Queen Pasiphae (wife of King Minos) protected herself from pregnancy by using the bladder of the intestines of domestic animals. Later, in Africa, they began to use cervical caps and bags made of crocodile skin. Turtle shell and a silk condom were also later used, and in Europe there were many different fabric products to prevent pregnancy. In the 19th century in St. Petersburg, the Russian-American Rubber Manufactory Partnership was one of the first in Russia to produce rubber products.

Modern means of contraception: barrier, chemical, biological, hormonal, intrauterine contraception, surgical - there are a lot of them, but often a woman cannot decide what to choose. And she ends up unexpectedly pregnant. We will briefly describe different contraceptives for women, their advantages and disadvantages.

Intrauterine systems

These are those that are installed in the uterine cavity for a long time. Usually recommended exclusively for women who have given birth due to possible side effects. But we'll start with the advantages.

1. You don’t have to worry about an unwanted pregnancy for several years; it has a positive effect on sexual relationships.

2. High reliability. Just under 100%.

3. Availability. The most inexpensive intrauterine device costs about 200-300 rubles. Purchased once.

And these are disadvantages.

1. Unpleasant sensations during installation. Some women require local anesthesia.

2. The possibility of the IUD falling out and dislodging, which provokes a decrease or cessation of its contraceptive effect.

3. Inflammatory diseases. Installation of the system can provoke the penetration of pathogens into the uterine cavity, which sometimes causes endometritis, the occurrence of adhesions in the intestines and fallopian tubes. Accordingly, the risk of infertility in the future increases. Therefore, spirals are usually recommended specifically for women who have given birth.

4. The likelihood of an ectopic pregnancy. Due to the spiral, the fertilized egg cannot be fixed in the uterine cavity and can return back to the fallopian tube and be implanted there.

5. Increased likelihood of heavy menstruation. Therefore, non-hormonal intrauterine systems are not recommended for use in women who experience severe cyclic and acyclic uterine bleeding.

Condoms

Barrier contraceptives have a number of advantages and can be used without consulting a doctor. Always welcome.

1. Reliability. Almost 100% protection not only from unwanted pregnancy, but also from sexually transmitted infections.

2. Ease of use and accessibility. Can be purchased at any pharmacy or supermarket. The abundance of models allows any couple to choose the right contraceptive for themselves.

3. No contraindications. Only sometimes allergic reactions occur to them. More often it is a matter of lubricant, dye or flavoring that is used to cover the condom. In this case, you need to try another, regular one, without any bells and whistles.

But there are also disadvantages. They tend to be especially scary for couples who have previously used other forms of contraception.

1. Negative effect on erection, sensitivity. Usually, a condom with ultra-thin walls helps in this case.

2. The condom falls off during intercourse. Again due to poor erection. It happens when a condom is worn when there is insufficient sexual arousal.

3. Damage to the condom. This often happens if you try to apply various substances on it in the form of a lubricant that are not intended for this. But damage can also be the result of a defective product. If the condom breaks, emergency contraception is used to prevent pregnancy.

By the way, an intrauterine device can be used as emergency contraception. It should be installed a maximum of 5 days after unprotected sexual intercourse. Naturally, this method is suitable for those women who were already thinking about installing an intrauterine system.

Spermicides

They have no contraindications and can be used, if necessary, by women who are breastfeeding. The chemical method of contraception also has pros and cons.

Some advantages.

1. Availability. 10 vaginal tablets (or suppositories), for 10 sexual acts, cost about 300 rubles. Sold in all pharmacies.

2. They do not affect the body like hormonal contraceptives, that is, they only have a local effect.

3. They have some antimicrobial and antibacterial effects.

4. They have no contraindications and can be used in cases where no other contraception is suitable.

And these are the disadvantages.

1. Often cause irritation of the vaginal mucosa and glans penis.

2. With regular use, 2-3 times a week or more, the vaginal microflora is disrupted.

3. Efficiency is significantly lower than declared if sexual intercourse begins before the time specified in the instructions. After introducing the drug into the vagina, you need to wait a little for it to start working.

Hormonal agents

They are considered one of the most reliable and convenient, but at the same time they have many contraindications and side effects. We will talk about oral contraceptives. First, the good stuff.