The tutorials listed below are interactive health education resources from the Patient Education Institute. Using animated graphics each tutorial explains a procedure or condition in easy-to-read language. You can also listen to the tutorial.

NOTE: These tutorials require a special Flash plug-in, version 8 or above. If you do not have Flash, you will be prompted to obtain a free download of the software before you start the tutorial.

Diseases and Conditions

• Abdominal Aortic Aneurysm
• Acne
• Allergies to Dust Mites
• Alopecia
• Amyotrophic Lateral Sclerosis (ALS)
• Angina
• Anthrax
• Arrhythmias
• Arthritis
• Asthma
• Atrial Fibrillation
• Avian Influenza (Bird Flu)
• Back Pain – How to Prevent
• Bell’s Palsy
• Brain Cancer
• Breast Cancer
• Burns
• Cataracts
• Cerebral Palsy
• Cold Sores (Herpes)
• Colon Cancer
• Congestive Heart Failure
• COPD (Chronic Obstructive Pulmonary Disease)
• Crohn’s Disease
• Cystic Fibrosis
• Depression
• Diabetes – Eye Complications
• Diabetes – Foot Care
• Diabetes – Introduction
• Diabetes – Meal Planning
• Diverticulosis
• Endometriosis
• Epstein-Barr Virus (Mononucleosis)
• Erectile Dysfunction
• Fibromyalgia
• Flashes and Floaters
• Fractures and Sprains
• Ganglion Cysts
• Gastroesophageal Reflux Disease (GERD)
• Glaucoma
• Gout
• H1N1 Flu (Swine Flu)
• Hearing Loss
• Heart Attack
• Hepatitis B
• Hepatitis C
• HIV and AIDS
• Hypertension (High Blood Pressure)
• Hypoglycemia
• Incisional Hernia
• Influenza
• Inguinal Hernia
• Irritable Bowel Syndrome
• Kidney Failure
• Kidney Stones
• Leishmaniasis
• Leukemia
• Low Testosterone
• Lung Cancer
• Lupus
• Lyme Disease
• Macular Degeneration
• Malaria
• Melanoma
• Meningitis
• Menopause
• Migraine Headache
• Mitral Valve Prolapse
• Multiple Myeloma
• Multiple Sclerosis
• Myasthenia Gravis
• Osteoarthritis
• Osteoporosis
• Otitis Media
• Ovarian Cancer
• Ovarian Cysts
• Pancreatitis
• Parkinson’s Disease
• Pneumonia
• Post-Traumatic Stress Disorder (PTSD)
• Prostate Cancer – What Is It?
• Psoriasis
• Retinal Tear and Detachment
• Rheumatoid Arthritis
• Rotator Cuff Injuries
• Sarcoidosis
• Scabies
• Seizures and Epilepsy
• Sexually Transmitted Diseases
• Shingles
• Skin Cancer Non-Melanoma
• Sleep Disorders
• Smallpox
• Spinal Cord Injury
• Strokes
• Temporomandibular Joint Disorders (TMJ)
• Tennis Elbow
• Tinnitus
• Traumatic Brain Injury
• Tuberculosis
• Ulcerative Colitis
• Umbilical Hernia
• Uterine Fibroids
• Varicose Veins
• Vasculitis
• Warts

Spermicides contain a chemical called nonoxynol-9. It comes in the form of cream (only for use with diaphragms), gel, foam, film, or suppository. By inserting spermicide in the vagina, in front of the cervix, it destroys sperm on contact. By themselves, spermicides are not a very effective method of birth control. For this reason, they should be used with another form of contraception like condoms.

Benefits

Along with protecting against pregnancy, spermicide also can protect you from bacterial infections and pelvic inflammatory disease. You can also use it as an emergency contraception, by inserting it into the vagina immediately after unprotected sex or an accident with other contraception (i.e. a condom breaks, cap or diaphragm moves or forgotten, etc..).

Disadvantages

Spermicide can be messy. It’s only effective for about an hour, so you have to insert it right before sex. Sometimes, it can also irritate the entrance of the vagina or the tip of the penis. One big disadvantage is that using a spermicide alone will increase your risk of HIV transmission. The failure rate of spermicides used alone is between 6% (perfect use) and 21% (typical use). You may also be allergic to some of the ingredients in spermicides.

The popular spermicide called nonoxynol-9 does not protect people from sexually transmitted infections as previously thought.  Contraceptive products that contain this spermicide, such as condoms, vaginal gels, inserts, and contraceptive film, are now required by the Food and Drug Administration (FDA) in the United States to carry a label indicating nonoxynol-9 does not protect against STIs. It may actually increase the risk of getting HIV from an infected person, because of the irritation it can cause to the lining of the vagina or rectum. The SOGC recommends that spermicide only be used by women who are at low risk for STIs and HIV, for example, women in monogamous relationships where STIs have been ruled out. It’s best to use uncoated condoms instead of nonoxynol-9 coated condoms.

Where to find it

At any drugstore.

Troubleshooting

Some spermicides have a bad odour or taste. When buying spermicide, make sure that it’s nonoxynol-9. There are lots of other hygiene-type products that look very similar, and are pretty easy to confuse with spermicide.

Reference

Natural birth control methods teach women to determine the fertile phase (typically 7 to 10 days long) of their menstrual cycle. To avoid pregnancy, women avoid intercourse on fertile days.

There are many variations of natural birth control. The most effective methods teach women to chart the signs of fertility that ebb and flow with the natural hormonal changes of each menstrual cycle. There are two main approaches 1) the sympto-thermal approach where waking temperature and cervical mucus are charted, and 2) the mucus approach where only cervical mucus is charted.

It is helpful for women and their partners to know about the two most common methods:

1. Fertility Awareness Method (FAM) refers to a natural birth control method outside of a religious framework that supports the use of barrier methods (condom, diaphragm, and spermicide), emergency contraception, and abortion. Justisse is a Canadian developed variant of FAM that teaches both the mucus only and the sympto-thermal approaches.

2. Natural Family Planning (NFP) typically refers to natural birth control that is taught and practised within a religious framework, most commonly Catholic centred organizations. It does not support the use of barrier methods, emergency contraception, or abortion. Billings Ovulation Method teaches only mucus observations. Serena and Couple to Couple League methods are sympto-thermal NFP variants. The Creighton Model will teach both mucus only and sympto-thermal approaches. 

How natural birth control works

The FAM/NFP sympto-thermal method is explained below.  It is considered the most effective of all the natural birth control methods.

Sympto-thermal teaches a woman how to observe, chart and interpret her waking temperature (basal body temperature or BBT) and cervical mucus to understand what days she is fertile and what days she is not fertile. She then knows when she is likely and when she is less likely to become pregnant from intercourse.

A woman who has a regular menstrual cycle will usually experience the following sequence of events:

• 3 to 7 days of menstruation
• several days where she does not feel or see mucus in her vagina or on her vulva
• several days of a ‘wet’ or ‘slippery’ sensation at her vulva or in the vagina where she sees and/or feels mucus, which becomes progressively more slippery, stretchy, and clear as ovulation approaches
• after ovulation her waking temperature rises, mucus disappears from the vulva, and the vulva and vagina feel “drier

Fertile days begin with the first sensation of mucus at the vulva and continue until both the mucus has dried up and the waking temperature has been high for 3 days in a row.  With days of higher fertility and lower fertility determined, a woman can time intercourse to avoid or achieve pregnancy.

If a woman’s cycle does not follow a typical pattern, using natural birth control will be more difficult.  However, she can still use natural birth control but she is advised to seek consultation with a trained FAM/NFP instructor in order to use the method most effectively.  In general, FAM/NFP are not recommended for women with the following difficulties:  irregular cycles, inability to interpret the fertility signs correctly, or persistent infections that affect the signs of fertility.

Cervical changes are a third fertility sign that a woman may find useful in determining her fertility. She checks for variations in the position, firmness and openness of the cervix that relate to fertile and infertile days.

Effectiveness

In order to effectively use FAM/NFP a woman needs to accept responsibility for charting and interpreting her fertility on a day-to-day basis. The possibility of an unplanned pregnancy should not represent a devastating occurrence in order to use this method of family planning.  As with all forms of birth control, motivation, intention, and cooperation between partners are the key to effective, successful use.

Successful use of FAM/NFP methods depends on the accuracy of the method in identifying the woman’s actual fertile window, a woman’s/couple’s ability to correctly identify the fertile time, and  the couple’s ability to follow the instructions of the method they are using.  The effectiveness of FAM/NFP(Strauss and Barbieri 2004, Hatcher 2004.) varies depending on the method:

1. 95-98% effective with perfect use (user strictly follows rules to avoid pregnancy)
2. 75-88% for typical use (user may not always follow rules)

Benefits of FAM/NFP

1. Effective method of birth control
2. Has no negative health side effects
3. An alternative for women who cannot or do not want to use hormonal methods
4. Promotes positive body awareness
5. Consistent with many religious beliefs and lifestyles
6. Alerts women to reproductive health and fertility concerns
7. Fosters communication between partners
8. Encourages partners to enjoy a variety of romantic or sexual activities as alternatives to vaginal intercourse during fertile periods
9. Encourages male involvement

Disadvantages OF FAM/NFP

1. Provides no protection from sexually transmitted infections
2. Often difficult to find trained FAM/NFP instructors
3. Requires time to learn (usually 3 to 6 cycles)
4. Requires discipline and commitment to chart fertility signs and follow the rules to avoid pregnancy
5. Times of abstinence from intercourse may be a challenge for some couples

Other Natural birth control methods

Lactational Amenorrhea Method (LAM) is used by a woman who has just given birth and is exclusively breastfeeding. This method is highly effective for the first six months after childbirth, provided the woman breastfeeds the baby at least every four hours during the day and every six hours through the night, and that her menstrual period has not yet returned. After six months fertility may return at any time.

In the Temperature Method a woman takes her waking temperature to identify a rise in temperature indicating ovulation has passed. Elevated waking temperature for three days in a row is considered confirmation of the post-ovulatory less fertile phase.

Rhythm (Calendar) Method is a much less effective natural birth control method. It predicts a woman’s fertile days using calculations based on the length of past cycles and not daily observations of fertility signs as used by FAM/NFP. The Standard Days Method/Cycle Bead Systemis a variation of the Rhythm Method. These are the least effective natural birth control methods and are not generally recommended.

Resources in Canada

For more information about Natural Family Planning instruction and follow-up visit either Serena Canada (www.serena.ca) or Billings Ovulation Method (http://www.woomb.ca/billings_method/)

For more information about Fertility Awareness Methods and a listing of certified instructors throughout North America please visit Justisse (www.justisse.ca).

References

Strauss, J., & Barbieri, R. (Eds.). (2004). Jen and Jaffe’s reproductive endocrinology (5 ed.). Boston, Massachusetts: Elsevier Saunders.

Reference

Withdrawal

In this method, a man withdraws his penis from a woman’s vagina before ejaculation.

Benefits

Put simply, withdrawal is better than nothing.

Disadvantages

Withdrawal really isn’t that effective because there may be sperm in the pre-ejaculate (pre-cum), the tiny bit of fluid that escapes a man’s penis before he reaches an orgasm. Remember, it only takes one sperm to get a girl pregnant. Withdrawal also requires a lot of self-control and practice, and it can be difficult to get the timing right. It has a failure rate of about 19%. This means that if 100 couples were to use withdrawal as their only method of birth control for one year, 19 women would likely get pregnant. Withdrawal also does not protect a person from sexually transmitted infections.

What to know

Talk to your partner about it first. Withdrawal requires practice, so you may want to use a condom and/or spermicide first until you’re REALLY sure you have the hang of it.

Troubleshooting

The most common problem with withdrawal is that the guy pulls out too late. If this happens, contact your doctor or head to the nearest family planning clinic within 72 hours to get emergency contraception.

Reference

Vasectomy

The surgery blocks a guy’s sperm duct and prevents sperm from entering the ejaculate. The guy can still ejaculate during sex, but the fluid doesn’t contain any sperm. You could never tell from the amount of ejaculate that a guy has had a vasectomy. A vasectomy is considered permanent, because the surgery is difficult and costly to reverse. The pregnancy rate following vasectomy is 0-2.2%.

Benefits

It’s the most effective method of contraception controlled by a guy. It’s easy, permanent, and relieves women of contraceptive burdens.

Disadvantages

There might be some swelling after the surgery, but the most common problem is that a man will come to regret his decision…and reversal doesn’t always work.

Where to find it

There might be some swelling after the surgery, but the most common problem is that a man will come to regret his decision…and reversal doesn’t always work.

Troubleshooting

A man can still have sperm in his ejaculate up to 3 months after the surgery, so he should use another method of contraception until his check-up. A vasectomy also does not protect against STIs, so a man may still want to use a condom for protection.

Reference

Tubal Ligation

In tubal ligation (often known as getting your “tubes tied”), the two fallopian tubes which transport the eggs from the ovaries to the uterus are disconnected. This means that the egg can never meet the sperm, so pregnancy is impossible. The process can be reversed, but because it is costly, difficult and not always possible, a tubal ligation is generally considered permanent. In very rare cases, a woman may still get pregnant up to 10 years later, because sometimes the tubes will try to “heal” themselves and will reconnect to the uterus.

Benefits

It’s the most effective method of contraception that is controlled by women. It is ideal for women who don’t want to have any more kids.

Disadvantages

A woman may be in pain and have bleeding or nausea after her surgery. Because it’s permanent, some women may eventually regret their choice. Tubal ligation provides no protection against STIs.

Where to find it

After having a consent form signed and a full medical exam, a gynecologist will perform the surgery. There are two popular types of tubal ligation surgery. In a laparoscopy surgery, a doctor disconnects the tubes through a cut made in a woman’s bellybutton. In the other surgery, called a laparotomy, a larger cut is made in the belly. This surgery is less common, but is often used when tubal ligation is requested shortly after a woman delivers a baby.

Troubleshooting

A dangerous condition called an ectopic pregnancy – in which a pregnancy develops inside of a woman’s fallopian tube – is more likely in women who have had a tubal ligation. If you’ve had a tubal ligation and start showing signs of pregnancy, you should contact your doc as soon as possible. You may want to continue to use condoms, because a tubal ligation does not protect against STIs.

Reference

Lea Contraceptive

This soft silicone device is inserted inside the vagina in front of the cervix, to prevent sperm from entering. When used with a spermicide, failure rates are about 8.7%, which means that if 100 women were to use it correctly for one year, 8 or 9 of them would likely get pregnant. If used alone, without a spermicide, the failure rate rises up to 12.9%.

Benefits

The re-usable Lea offers 8-hour protection, and you can insert it hours before sex, so it offers you a degree of privacy.

Disadvantages

It doesn’t protect against STIs, and unless it is used with a spermicide, it isn’t very effective at preventing pregnancy. Also, you may find it hard to insert at first.

Where to find it

At a drugstore or family planning clinic for about $50.

Troubleshooting

If the male partner feels the Lea during sex, it means that it’s not inserted properly.take it out and try again.

Note: Use with a condom for increased prevention of pregnancy and STIs.

Reference

Cervical Cap

A deep silicone cap that fits inside the vagina against the cervix and prevents sperm and bacteria from entering. The cap must be used with a spermicide, which destroys sperm.

Effectiveness

There is a difference in effectiveness when used by women who have already given birth and women who have not. If used perfectly (meaning if it fits you well and you insert the cap correctly every time you have sex), the failure rate is of 9% in women who have never given birth. This means that if 100 women use the cap perfectly for a year, nine will likely become pregnant. However, the typical-use failure rate is 20%.

For women who have had children before, the failure rates are much higher: 26% for women who use the method perfectly every time, and 40% for the typical user.

Benefits

It provides a woman with privacy and control, because she can insert it before sex.

Disadvantages

It doesn’t protect against STIs, and the cap itself isn’t protective. It must be used with spermicide, which kills sperm. Wrong fit will prevent some women from using the Cap.

Where to find it

Your doctor can fit you for a cap, and then you can purchase it online or from certain family planning clinics for about $40.

Troubleshooting

If your cap moves out of place during sex, apply more spermicide with an applicator right away, and call your doctor for emergency contraception. For increased protection against pregnancy and STIs, use with a condom.

Reference

Diaphragm

A latex cap that covers the cervix and prevents sperm from swimming inside. Spermicide should always be used inside of a diaphragm to help prevent pregnancy.

Benefits

It offers a girl privacy and control, because she can insert it before sex. If used perfectly, the failure rate is 4-8%. In other words, if 100 women use it correctly for one year, 4-8 of them will become pregnant.

Disadvantages

Some girls find it difficult to insert at first, and others say that it doesn’t fit them right. There is also a chance of developing a urinary tract infection while using it.

Where to find it

You can make an appointment with your doctor to have a diaphragm fitted properly to your body.

Troubleshooting

If you’re having difficulty inserting the diaphragm correctly, practice, practice, practice – before having sex. If you use too much spermicide, it makes it difficult to handle when you try to fold the diaphragm during insertion. Use only 1-2 teaspoons of spermicide. For increased protection against pregnancy and STIs, use with a condom.

Reference

Contraceptive Sponge

This disposable sponge containing spermicide is placed at the cervix and kills sperm before they can enter. When used in combination with the male condom, the failure rate is only 2%.

Benefits

It’s a barrier method and spermicide in one. It provides 12-hour protection, and you don’t have to change the sponge if sex is repeated during this time.

Disadvantages

Some girls find it difficult to remove the sponge, or forget to take it out all together. The contraceptive sponge really has to be used with condoms; on it’s own, it’s not overly effective as contraception, and does not prevent STIs.

Where to find it

You can pick up a package of 4 sponges in a drugstore for around $10, or for less at a birth control clinic.

Troubleshooting

Some girls who use the sponge report recurrent yeast infections. If this is the case, talk to your doc about finding a different method of contraception that works best for you.

Reference

Female Condom

The female condom is a polyurethane sheath in the shape of a round, upside-down baggie inserted into the vagina before sex. The baggie holds in the sperm, preventing it from entering the vagina.

Benefits

It’s the only contraceptive controlled by girls that protects them against pregnancy and STIs. Used perfectly, the female condom has a failure rate of 5%.

Disadvantages

Some girls may have trouble inserting it correctly, and it may make a “rustling” sound during sex. They can also be expensive.around $3 each.

Where to find it

You can pick one up at a drugstore or at a family planning clinic.

Troubleshooting

If the female condom makes a rustling sound during sex, try changing your position. Otherwise, add some lubricant inside, which may calm the sound and stop it from disturbing you.

Putting on a Female Condom

Female condoms can be inserted up to 8 hours before sex. You can insert it either standing with a foot on a chair, or sitting or lying with your legs apart.

Carefully remove the condom from its package.	One end of the condom will have an opening for the penis to enter. This end will remain outside the vagina.	Squeeze the flexible inner ring at the closed end of the condom.
Some women find it comfortable to insert the condom while standing with one leg raised,	or you may find it more comfortable to insert the female condom while squatting or lying down.	While squeezing the ring, insert the closed end of the condom into your vagina.
Placing your index finger inside of the condom, gently push the inner ring into your vagina as far as it will go. Be careful not to twist the condom.	The outer ring of the condom should remain outside of the vagina. Placing lubrication inside of the condom may help keep it in place during sex.	Make sure his penis enters inside the female condom, not to one side. The female condom should not be used with a male condom.
When removing the condom after sex, twist the outer ring so that no semen leaks out during removal.	Throw the used female condom into the garbage. Do not flush it down the toilet. Do not reuse the condom.

Reference

The male condom is a latex sheath that is rolled over the penis to prevent secretions including semen from entering the vagina. A condom should be used in combination with spermicide.

Benefits

Condoms are 97% effective, and they protect against most STIs if used consistently and correctly. Condoms are the only contraception that can prevent STIs.

Disadvantages

Some guys complain about lack of sensitivity. The condom may slip off during sex. Rough handling may cause the condom to break. Some guys (and girls) may be allergic to latex. Tip: To increase sensitivity put some water-soluble lubricant (saliva, KY jelly) inside the tip of the condom before putting it on.

Where to find them

You can pick up a pack of condoms at the drugstore for about 50 cents per condom, or you can grab one in a washroom, supermarket, convenience store, or free at a family planning centre.

Troubleshooting

If a condom breaks or slips off during sex, contact your doctor or a clinic for emergency contraception as soon as possible.

Condoms in Depth

Condoms are your best protection against sexually transmitted infections (STIs). They stop bacteria and viruses that may be present in your partner’s genital fluid from infecting your own genitals, anal area, or mouth. They also protect against unwanted pregnancy. For a lot of sexually active people, they’re about as good as contraception gets.

Condoms work! When used as directed, they offer better protection against AIDS and other STIs than any other birth control method.

To give yourself added protection, team up a condom with a spermicidal jelly, foam, cream, suppository, or film. These products can stop sperm from moving up the female reproductive tract in case the condom breaks. Just be sure not to use spermicides on their own, as they can make HIV spread easier.

The only situation in which it’s safe not to use a condom is in a long-term, monogamous relationship with a partner who’s tested negative for STIs and has proven himself worthy of your trust.

Condoms, HPV and Hepatitis B

Condoms offer protection against most STIs, but do not protect against two of the most common: human papillomavirus (HPV) and Hepatitis B.

• HPV can be passed along by sex or close skin-to-skin genital contact. Some forms of HPV cause only harmless skin warts, others can lead to genital warts, and still others can cause cervical cancer. A medical test called a PAP smear can test for the early signs of this cancer, which can be treated. If you’re a sexually active female, be sure to have your doctor perform this simple test on a regular basis.
• The Hepatitis B virus can be passed along through semen or blood, and more rarely from saliva or vaginal secretions. The virus has to enter your bloodstream to cause disease. Hepatitis B can be detected through a blood test, and often heals spontaneously, but may cause serious liver damage in some people. An effective vaccine now exists to protect against Hepatitis B. If you’re sexually active, you might want to talk to a doctor about getting the Hep B vaccine.

Putting on a Condom

Interactive Demo
Try our interactive Demo: How to put on a condom

Male condoms usually come rolled up in a sealed packet, and most are pre-lubricated on the outside (the preferred choice). If the condom is brittle, stiff or sticky, discard it and use another. Begin the procedure when your penis is hard.

• Put a drop or two of lubricant or saliva inside the tip of the condom (optional)
• If you’re not circumcised, pull back your foreskin
• Place the rolled-up condom over the tip of your penis, leaving a half-inch space for semen collection
• Pinch the air out of the tip of the condom
• Unroll the condom all the way to the base of the penis
• If you’re not using a pre-lubricated condom, lubricate the outside of the condom with a water-based lubricant

When you’ve finished having sex (vaginal, anal or oral), hold the condom against the base of your penis while you pull out.

Reference

The IUD is a small, T-shaped device with a copper wire. Inserted into the uterus, the copper wire changes the chemistry in the uterus and destroys sperm.

Benefits

The copper IUD provides up to 5 years of contraception, and has no negative impact on future fertility once removed. It fails in only 1 of 100 users per year. The IUD should not alter the timing of your periods. Women who use an IUD have a lower rate of ectopic pregnancy (pregnancy that develops in the fallopian tube) than women who do not use any birth control. However, if pregnancy should occur, it is important to see your health care provider immediately, because there is a significant chance the pregnancy is in the fallopian tube, which is a dangerous medical condition.

The copper IUD may be a good choice for you if:

• You are at low risk for contracting a sexually transmitted infection (STI)
• You are looking for a long-term, reliable method of contraception
• You have had failure with other methods in the past (can not remember to take the pill)
• You are breastfeeding (it has no effect on breast milk)
• You have completed your family but do not want a tubal ligation
• You have problems with hormonal methods of contraception

Disadvantages

The copper IUD does not protect against sexually transmitted infections (STIs) or HIV. Condoms should be used to protect against STIs or HIV.

Women who use the copper IUD, may find that their periods get heavier or more crampy. Complications associated with the IUD are rare but may occur. Possible complications of inserting an IUD include irregular bleeding or spotting, perforating the uterus (making a small hole in the uterus), infection, or expulsion (the IUD falls out).

Where to find it

You will need a prescription to get a copper IUD. A health care provider must insert the IUD, usually in the office or family planning clinic. During your first visit, you will have a physical exam, take a sexually transmitted infection test and discuss your medical history. You may need to book a second visit to have the IUD inserted. Your health care provider will insert the IUD into the uterus through the cervix (opening of the uterus). The copper IUD costs from $60-$100.

Troubleshooting

You should contact your health care provider if any of the following occur:

• You cannot feel the IUD threads
• You or your partner can feel the lower end of the IUD
• You think that you are pregnant
• You experience persistent abdominal pain, fever, or unusual vaginal discharge
• You or your partner feel pain or discomfort during intercourse
• You experience a sudden change in your menstrual periods
• You wish to have the device removed or you want to get pregnant.

Reference

The intra-uterine system (IUS) provides reliable, reversible contraception for up to five years. This hormonal method of contraception is more than 99% effective in preventing pregnancy.

How does it work?

The IUS is made up of a small T-shaped frame with a small cylinder containing the hormone levonorgestrel. It does not contain estrogen. This cylinder slowly releases the hormone that acts on the lining of the uterus. The lining of the uterus becomes thinner and the cervical mucus becomes thicker which makes it harder for sperm to enter the uterus.

Benefits

The IUS does not contain estrogen so it can be used in women who cannot take or have a sensitivity to estrogen. The IUS is effective for up to five years. Unlike the copper intra-uterine device (IUD), the IUS decreases the amount of menstrual bleeding and may decrease menstrual cramping.

Disadvantages

The hormonal IUS does not protect against sexually transmitted infections (STIs) or HIV. Condoms should be used to protect against STIs or HIV.

Complications associated with the IUS are rare but may occur. Possible complications of inserting an IUS include irregular bleeding or spotting, perforating the uterus (making a small hole in the uterus), infection, or expulsion (the IUS falls out).

Side-Effects

• Irregular bleeding or spotting
  This is most common within the first 3 months following insertion. It usually improves with time.
• No periods (amenorrhea)
  Most women that use the IUS notice that their periods are less heavy. Of women that are using the IUS, 20-30% of women will stop having periods (amenorrhea). Not having a period does not necessarily mean that you are pregnant but it may just be a side-effect of the IUS.

Myths and Facts

1. MYTH: The IUS cannot be used by someone who hasn’t had a baby before.
   FACT: The IUS can be used by women who have not had a baby.
2. MYTH: The IUS increases the risk of infertility.
   FACT: IUSs do not increase the risk of infertility. Women who have their IUS taken out because they want to get pregnant will get pregnant at the same rate as women who have never used an IUS.
3. MYTH: IUSs increase the long-term risk of infection (pelvic inflammatory disease).
   FACT: After the first month of use, the risk of infection is not significantly higher than in women without IUSs.
4. MYTH: The IUS increases the risk of having an ectopic pregnancy (a pregnancy in the fallopian tubes)
   FACT: The IUS does not increase the risk of ectopic pregnancy.

How to use the IUS

You will need a prescription to get the IUS from the pharmacy. A health care provider must insert the IUS, usually in the office. Your health care provider will insert the IUS into the uterus through the cervix (opening of the uterus). The IUS can be inserted at any time during the menstrual cycle as long as pregnancy can be ruled out. If you have already an IUS inserted, it can be removed and a new one inserted on the same day. It takes only a few minutes to insert an IUS. You may feel some cramping pain when the IUS is being inserted. You may be given a local anesthetic or pain medicine to help control discomfort during insertion.

You should check for the IUS strings from time to time to make sure that the IUS is still in the uterus. You can do this by putting a finger inside the vagina and feeling for the strings near the cervix.

You should contact your health care provider if any of the following occur:

• You cannot feel the IUS threads
• You or your partner can feel the lower end of the IUS
• You think that you are pregnant
• You experience persistent abdominal pain, fever, or unusual vaginal discharge
• You or your partner feel pain or discomfort during intercourse
• You experience a sudden change in her menstrual periods
• You wish to have the device removed or you want to get pregnant.

Reference

What is it?

The vaginal ring (NuvaRingT) is a new birth control method that is now available in Canada. This soft, flexible, clear plastic ring measures 54mm in diameter and is inserted into a woman’s vagina where it slowly releases two female hormones (estrogen and a progestin) for three weeks.

How does it work?

These hormones enter into the woman’s bloodstream and prevent pregnancy mainly by stopping the ovaries from releasing an egg. They may also thicken the cervical mucous and make the uterine lining thin. The ring’s method of action is very similar to the combined oral contraceptive pill. The ring does not provide a physical barrier to sperm and it does not prevent sexually transmitted infections.

The ring comes in only one size, and does not need to be in a particular position in the vagina to be effective. It is held in place by the walls of the vagina and a woman usually cannot feel the ring once it is in. The woman inserts and removes the ring herself and most women find this easy to do. Remember, the vagina is a closed space and there is no way for the ring to get “lost” or go anywhere else.

The ring is worn inside the vagina for three weeks, followed by a one-week (seven day) ring-free interval. When the ring is removed, a woman usually has a period within a few days. At the end of the ring-free week, the woman inserts another ring to begin a new cycle.

The ring should be left in place during sex. Most men and women do not notice it during intercourse, and even for those who do, it is not usually bothersome.

Effectiveness

The ring is at least as effective as the birth control pill, and it may be more effective if a woman has trouble remembering to take her pill (remember, the pill won’t work if a woman forgets to take it!).

Benefits

In addition to preventing pregnancy, the ring has the added benefit of making a woman’s periods more regular, lighter, and possibly less crampy. It is thought to have similar benefits as the birth control pill, such as treating PMS, endometriosis and acne, and preventing ovarian and endometrial cancers but these haven’t been studied. It is completely reversible. When a woman stops using the ring, her body resumes its normal cycle and fertility returns quickly.

Side Effects

Side effects reported were uncommon but included headaches, vaginal irritation, discomfort or discharge, nausea, and breast tenderness.. Breakthrough bleeding (bleeding between periods) occurred in about 5% of women, especially in the first few months. The ring does NOT cause weight gain, nor does it increase vaginal infections.

Contraindications

Women who cannot take the birth control pill for medical reasons cannot use the ring either. This includes women who have had a blood clot, heart attack, stroke or breast cancer, as well as women with active liver disease or women over 35 years old who smoke. See your doctor to decide if the ring is right for you.

How to get it

You will need a prescription from your doctor and you pick it up at a pharmacy.

Troubleshooting

1. What to do if the ring falls out?

   If the ring falls out, it should be rinsed off and replaced as soon as possible. If it has been out for less than three hours, you should still be protected against pregnancy. If it has been out for more than 3 hours, a back-up method of birth control is needed for the next seven days. The ring must stay in for at least 7 more days after being out for longer than 3 hours; this may mean that you wear it for more than 21 days in total that month. Following this, a one-week ring-free interval can occur and the next ring inserted.

2. What to do if you forget to take the ring out?

   If it has been in for less than 28 days (that is, up to one week too long) remove it, have a seven-day ring-free interval, then insert the next ring. You are still protected against pregnancy. If the ring has been in for more than 28 days, immediately remove it, insert a new ring and use a back-up method of birth control for the next 7 days. You may have irregular bleeding, or no period that month.

3. What to do if you forget to insert the ring after the week off?

   Insert the ring as soon as you remember and use a back-up birth control method for 7 days. If you have unprotected sex after the ring has been out for more than one week, consider using emergency contraception. You should not have more than 7 days without wearing a ring or you risk getting pregnant. Talk to your doctor or pharmacist if in doubt. 

   Reference

Depo-Provera™ is a hormonal birth control method that contains a progestin. It does not contain estrogen. It is administered by a needle in the muscle of the arm or buttocks every 12-13 weeks. It is 99.7% effective in preventing pregnancy, but it can also weaken a woman’s bones. As a teenager, your bones are still hardening, so this is of particular concern for you. For this reason, it is generally only recommended for girls who cannot use other contraceptive methods. The injection should be used with condoms to prevent sexually transmitted infections (STIs).

How it works

It stops your ovaries from releasing an egg every month (ovulation). It also thins the lining of the uterus.

Benefits

With this method of birth control, you only have to think about it 4 times a year! You do not have to remember to take it every day. It is reversible.

Fifty percent of women will stop having periods all together (amenorrhea) within the first year of starting Depo-Provera™. This is not unhealthy though, and for women who have heavy or painful periods, it may be a positive side-effect.

Depo-Provera™ can be used by breastfeeding mothers. It has no effect on breast milk production. It also decreases the risk of endometrial cancer.

Disadvantages

Can cause bone density loss, so it is not recommended for some women.

It does not protect against sexually transmitted infections (STIs) or HIV. Condoms should still be used to protect against STIs or HIV. Women must return to their health care provider every 12-13 weeks to receive their next injection.

Side-effects

The most common side-effects are irregular bleeding and weight gain, although they do not happen to every user. Some other hormonal side-effects like headaches and mood changes have been reported but only occur in a small number of users.

Irregular bleeding

Irregular bleeding is common in the first few months of use. Some women have no bleeding, some women have spotting, and some women experience heavier bleeding. The bleeding usually decreases with time. By one year, 50% of women will stop having periods altogether.

Weight gain

The average weight gain in the first year of use is approximately 5 pounds. This may be due to increased appetite and an increased food intake.

Decreased bone density

There appears to be a decrease in bone density in women who use the injection. This has not been associated with an increase in broken bones (fractures). Bone density improves when the injections are stopped. Women using Depo-Provera™ should make sure that they get enough Calcium and Vitamin D, either in their diet or in vitamin supplements, in order to help protect their bones.

Return to fertility

A woman’s return to fertility with this method can be longer than with the oral contraceptive pill. It takes an average of 9 months after your last injection to return to your regular menstrual cycle pattern.

How to take it

The first injection should be given during the first 5 days of the menstrual cycle. It may be given immediately after childbirth or a pregnancy termination. It becomes fully effective 24 hours after the injection. Your next injection is given within 12-13 weeks of your last injection.

Your health care provider or nurse will administer the injection to you. A prescription is required. The cost is about $40.00 for each injection that lasts about 3 months.

Troubleshooting: What if you are late for your next injection?

It is important to get your next injection within 12-13 weeks of your last injection. Late for your next appointment? If you wait longer than 14 weeks, a pregnancy test should be done before you receive your next injection. A non-hormonal method of birth control (eg. condoms, diaphragm, cervical cap) should be used until you receive your injection and for 2 weeks after your injection.

Reference

The contraceptive patch (Evra®) is a new method of birth control that has been available in Canada since January 2004. It is a 4 cm x 4 cm beige patch that sticks to a woman’s skin and continuously releases the hormones estrogen and a progestin into the bloodstream.

How it works

The patch works very similarly to the Pill. They both use hormones to prevent pregnancy, and the only main difference is that you swallow the Pill and the Patch provides the hormones through your skin. The Patch prevents pregnancy by stopping the ovaries from releasing an egg, and it may also thicken the cervical mucus (making it harder for sperm to get into the uterus) and make the uterine lining thin.

How to use it

Unlike the Pill, which has to be taken every day, each patch is worn on the skin for seven days. One patch is worn each week for 3 weeks. The Patch should be changed on the same day each week (called the “Patch Change Day”). The fourth week is patch-free, and during this time you should get your period. The patch should never be off for more than seven days in a row. Following the seven patch-free days, a new cycle is started when you apply a new patch on your Patch Change Day.

Where to wear the patch

	The Stomach		The Upper Arms		The Buttocks		The Back

The patch can be worn on the buttocks, stomach, back or upper arms, but not on the breasts. It may help to change the location a bit each week. The patch should be applied to clean, dry skin. You should not use any creams or lotions near a patch you’re already wearing, or where you’ll be applying a new one. The patch is very “sticky”. You can exercise, shower, swim or go in a sauna or hot tub and it still sticks 98% of the time! (Read below for what to do if it comes off.)

How to start

You’ll need to visit your doctor or health clinic to see if this is a good choice for you, and to get a prescription. Ideally, you should apply the first patch on the first day of your period. If you apply the Patch more than 24 hours after the start of your period, you will not be protected from pregnancy for the first week. Women switching from a birth control pill should also start the Patch on their first day of bleeding (not when you would have started the next pack of pills).

Effectiveness

Like the Pill, the Patch is also more than 99% effective at preventing pregnancy when used perfectly, with about a 3% failure rate for typical users. For women who have trouble remembering to take a pill every day, the Patch may work better than the Pill, but it may be a bit less effective in women who weigh more than 90 kg (198 pounds).

Other Benefits

Other benefits to being on the Patch include a regular, lighter period, often with less PMS and cramping. It is believed to reduce the risk of endometrial and ovarian cancers and help prevent benign ovarian cysts like the birth control pill because it works in a similar way. It is completely reversible. Once you stop the Patch, your body resumes its natural cycle.

Disadvantages

The patch does not protect against sexually transmitted infections.

When starting the patch, you may notice side effects such as breakthrough bleeding (between periods), breast tenderness, headaches, or nausea as your body gets used to the hormones. These symptoms usually go away in the first three months. You may also notice some skin irritation.

Women who cannot take estrogen due to a medical condition cannot use the patch or the Pill. See your doctor to decide if the patch is a good choice for you.

It may not be covered by all drug plans.

Troubleshooting

Check each day to make sure the patch is still well applied. If the edges come loose try to smooth it back on by pressing with your hand for 10 seconds. If it does not stick back on, or comes off completely, apply a new patch. You would still change it on your same Patch Change Day and you are still protected against pregnancy.

If the patch falls off for more than 24 hours put a new patch right away, and start a new four-week cycle. You will need to use a back up method of birth control for the next week and you will have a new Patch Change Day.

If you forget to change your patch for 1 or 2 days, remove the patch when you remember and apply a new patch. You will still change it on your next Patch Change Day – you are still protected against pregnancy. If you are more than 2 days late changing the patch, you start a new four-week cycle with the new patch. You will need to use a back up method of birth control (like condoms) for the next week.

If you forget to take off your patch at the start of the Patch-free week, take it off when you remember and start the next cycle at the usual time. Your period may be shorter, or you may still be bleeding when you put on the next patch.

If you forget to put on your patch after your patch-free week (so you have had more than 7 days with no patch) put it on as soon as you remember. You need to use back up birth control for the first week of the new cycle, and your Patch Change Day will be different.

If you are not sure, talk to your doctor or pharmacist.

Reference

Oral Contraceptive Pill (a.k.a. the Pill)

The oral contraceptive pill (OC) is one of the most researched (and often most misunderstood) drugs in the world. It is also one of the world’s most prescribed medications – about 100 million women across the globe rely on it.

The Pill is a contraceptive suitable for most healthy women, regardless of age, and can be used long-term. Some women only want to take the Pill when they are in a stable relationship and stop taking it when the relationship ends. However, doing so can put people at risk of unintended pregnancy while adjusting back to a new contraceptive method. With proper use, the Pill is 99.9% effective, making it the most reliable contraception available. However, there is a 3% user failure rate.

Benefits

In addition to being the most effective form of contraception, the Pill regulates the menstrual cycle, reduces menstrual flow, can reduce the number of periods per year, reduces acne, protects against certain cancers, and is completely reversible (once a woman is off the Pill, the body resumes its normal cycle).

Disadvantages

The Pill doesn’t protect against STIs, and it may cause side-effects such as irregular bleeding, breast tenderness, weight gain, headaches and nausea. These side-effects generally disappear after a few months. In rare cases where these side-effects don’t go away, you should see your doctor.

How it works

Just take the Pill on a daily basis, and try to take it at the same time each day so that it becomes a habit. Some women find it helpful to set an alarm clock, pager or beeper as a reminder.

Myths

A common myth is that women who stop taking the Pill may not be able to get pregnant. Rest assured that taking the Pill will not cause you to be infertile. Most women who use a method of contraception, including the Pill, can later get pregnant if they wish. Another common myth is that the Pill causes cancer. Again, false.in fact, the Pill actually reduces the risk of getting certain cancers such as endometrial and ovarian. Note: The Pill should be used with condoms to prevent both pregnancy and STIs.

Where to find it

You can get a prescription by visiting your doctor or a clinic. The cost of the Pill varies from place to place; various health plans cover the cost. The Pill can be obtained at most public health clinics and Planned Parenthood Affiliates for free or at low cost.

Troubleshooting

If you miss one pill, you should take it as soon as you remember (this may mean taking two pills in one day). If you miss two pills in a row during week 1 or 2 of the pack, take two pills on the day you remember and two pills the next day. Remember to use a back-up method of birth control such as a condom if this happens. If you miss two pills in a row during week 3 of the pack, throw out the remainder of the pack and start a new pack on the day you remember. Use a back-up method of birth control. You may not have a period this month or your period may come early. If you ever miss 3 pills in a row, throw out the pack and start a new one the day you remember. Use a back-up method of birth control. You may not get your period this month or it may come early.

Reference

Asyndeton is a figure of speech where conjunctions are omitted from a series of related clauses.

Example

I came, I saw, I conquered. (Julius Caesar)

…we shall fight on the beaches, we shall fight on the landing grounds, we shall fight in the fields and in the streets, we shall fight in the hills; we shall never surrender… (Winston Churchill)

I will buy you a drink; you do not deserve it.

Discussion

Conjunctions join clauses into complete sentences and include words such as although, and, as, after, before, because, but, if, nor, since, that, until, unless, yet. They send signals about how the clauses work together. When then are omitted, they cause a certain amount of confusion, forcing the person to review what was just said. Asyndeton can thus be used as a form of light emphasis.

Where the conjunction is omitted there may well be a pause, which appears in written text as a comma or semicolon. This may act as a signal to the listener or reader to think again about the meaning.

You cannot just omit any conjunction. If you take the sentence ‘I’ll see you when you get home’, omitting ‘when’ leaves nonsense. The clauses must stand alone and the listener must be able to make sense of how they are connected.

One of the most common forms of asyndeton is the omission of the word ‘and’ in a list. This creates surprise as the word ‘and’ is usually a signal that the list is about to end.

In grammar, syndetic means ‘connected by conjunctions’. Related figures are syndeton (the use of a conjuction) and polysyndeton (the use of multiple conjunctions).

Asyndeton is popular in speeches, where the ‘and’ in a list is often missed out. It is also used in poetry and literature to add terseness.

Asyndeton is also known as brachylogia.

Classification: Omission

See also

Using Conjunctions, Confusion principle