Taking it Back to the Future with Nexplanon

      Happy New Year from the Speculum Diaries team!       

To start the year off with a BANG... This week’s post is dedicated to a somewhat infamous method of birthcontrol, the subdermal implant! -aka Nexplanon

As always follow our links to more comprehensive and in-depth info about our chosen topics and helpful general info.

Nexplanon is the newest version of the subdermal contraceptive implant. It is a long-term yet reversible form of birth control that releases hormones (called progesterone) to prevent ovulation. This small device, about the size of matchstick, is implanted underneath your skin by your ObGyn physician in the office. There is no other maintenance required and it lasts for up to 3 years when it must be removed.
                                                                                       
                                                                                  
While we would love to portray this to you as a truly ‘next-generation’ product, these implants are really more of a re-vamp. The concept of subdermal contraceptive implants (SCIs) have been in research & development since the late 1960s and the first device, called Norplant, was licensed in the mid 1980s. Since that time Norplant and more recently developed SCIs have been in use throughout the world over the last 30 years.

That’s right… these types of devices have been wandering the world under your nose this whole time!

Norplant was introduced to the US and the UK in 1996 after being endorsed by the World Health Organization. Using a 6-rod system, Norplant quickly met with significant user dissatisfaction in these markets, specifically because of problems with insertion, expulsion and removal of the many rods.

While they say ‘there is no such thing as bad publicity,’ this may not hold true for bad drug publicity in the US. Still new to the market in the 90s, Norplant was doomed to obscurity after it became synonymous with ideas of federally funded sterilization. Thereafter American SCI manufacturers eliminated them from the US market; however, these devices continued to be widely used throughout the world. 

In 2002 a 2-implant product called Jadelle was introduced, by the same Norplant manufacturer. It was never made available in the US, and not unlike the Norplant, it is still widely used throughout the world.

Since Norplant, much has changed to get the Nexplanon we are presenting to you today. As we mentioned earlier, this device releases a hormone called etonogestrel (a type of progestin) from a single, non-latex rod to prevent ovulation. Its side effects are not unlike those of other hormonal methods of contraception. Currently Nexplanon is the only subdermal contraceptive implant marketed in the US.

Now for the take home info:

Why an Implant? Taking birth control requires some type of regimen. The Nexplanon is going to be a good choice for someone who has had problems maintaining a strict daily regimen in the past. As another type of Long Acting Reversible Contraceptive (LARC), we definitely would also recommend this method for new moms interested in planning their family by prolonging the birth of their next child. Studies showed that pregnancy occurred as soon as 7-14 days after removal. 

Effectiveness Over 99% ! This means that less then 1 pregnancy occurred per 100 women who used Nexplanon for 1 year. This level of effectiveness and its length may be compromised in women who are overweight or obese.

Side Effects Users of any type of hormonal birth control most often complain of: irregular bleeding, headache, weight gain, and vaginitis. The most common reason users stopped using the implant is irregular bleeding. Additionally, the implant&removal procedure can cause: pain, irritation, swelling, bruising, scarring, infection, injury to the nerves or blood vessels, and breaking of the implant. The implant may come out by itself, and pregnancy is possible if this happens. There is an increased risk that of a pregnancy that occurs while using Nexplanon while be an ectopic pregnancy which is a very serious condition.

Right or wrong, over the years this method of birth control hasn't been the most popular in the U.S. The post includes a kind of mini history lesson to try and give you ‘the rest of the story’ about contraceptive implants, as viable contraceptive options,  in an effort to keep you informed and assist you in making informed health choices for yourself.

Again, please click on the links for more in-depth info.
Please post questions or comments about this or any topic related to sexual and reproductive health.  

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Mechai Viravaidya: How Mr. Condom made Thailand a better place

How to Have a Hormone-Free Holiday and New Year

 CONDOMS, GELS, SPONGES and a partridge in a pear tree!


If you are looking to plan a holiday and New Year with hormone-free methods of birth control.. stuff your stockings with barrier contraceptives!

This week's post covers non-hormonal contraceptive options and all but one are available over the counter at any local drugstore. 

THE DIAPHRAM
 
Maybe you remember this as Carrie's chosen method of birth control in Sex and the City? Well it actually exists and is available to you! 

The diaphragm works as both a barrier to the opening of your uterus (the cervix) and it holds the spermicide in place to keep sperm from getting inside your uterus to an awaiting egg. In perfect use, meaning if this is the method of birth control you use every time you have sex, it has a failure rate of 6%. This means 6 of 100 women who use it correctly every time they have sex will get pregnant using the diaphragm. If this is a method that isn't used correctly or every time, the failure rate can increase up to 12%.

As previously mentioned this is a non-hormonal method and it also requires the addition of some type of spermicide, either foam, cream or jelly. The spermicide is applied inside of the diaphragm and the user most place it inside her vagina to fit over the cervix.

As you can see here, the diaphragm has to be inserted into the vagina (after spermicide has been applied) prior to any starting of sexual intercourse. In order to make sure the diaphragm fits properly this is something that you will have to get from a doctor. There are different sizes so this is the only barrier method that we will require a visit to your ObGyn. 

If it seems like the diaphragm has a higher rate of failure compared to the pill, it does. However you can increase the effectiveness of this method by using it correctly, consistently and in conjunction with latex condoms and/or incorporating the withdrawl method e.g. having your partner pull out prior to ejaculation. 

If you've had trouble remembering the pill, or have had consistently troublesome side effects from other hormonal methods.. the diaphragm might be right for you. If considering the diaphragm, its a good idea to take note of some disadvantages.
DONT FORGET The diaphragm has to be inserted with spermicide prior to sexual activity and must stay in place for 6 hours after last vaginal intercourse. It should not be left in place for more then 24hrs.
GOOD FIT REQUIRED As stated above, the diaphragm has to stay in place after intercourse to be effective so its important for the fit to be comfortable. Its important to be mindful if certain sexual positions cause it to become dislodged. Its even possible that initially re-fitting maybe needed, so that could mean another visit to your ObGyn.
IRRITATION MAY OCCUR Whether a sensitivity to the silicone of the diaphragm or the active agent in the spermicide (called nonoxynol-9). Women using diaphragms can experience frequent urinary tract infections, increase in vaginal discharge or vaginal irritation. 

SPERMICIDES

 
These are just some pictures of the different brands of spermicides you might encounter.

USE As mentioned above, spermicides can come in different forms: foam, cream or gel. These can be used with a diaphragm or alone. 
How it is used depends on the form it comes in, which can also include suppositories, films and sponges. All of these work in a similar manner to provide both a barrier to the uterus by covering the cervix (opening to the uterus) so that sperm cannot reach the egg and keeping the sperm moving so that they cant join the egg.

EFFECTIVENESS 15 out of every 100 women who use spermicides correctly every time they have sexual intercourse will still get pregnant. This rate of failure can go up to 29% (29 pregnancies out of 100 women) with inconsistent and incorrect use. As mentioned above, spermicides can be more effective if they are used in along with latex condoms and/or the penis is removed from the vagina prior to ejaculation. 

DOWNSIDES So we know that inserting any type of gel/foam/cream into your vagina sounds like it could be messy especially when you couple that with having sexual intercourse. One of the major downsides of spermicides are that they can be messy. Depending on the form, some can even leak from the vagina. Another issue that was previously mentioned and that was vaginal irritation, and depending on the partner, irritation of the penis can occur as well.

 CONDOMS: HIS&HERS

   

MALE CONDOMS A tried and true method of birth control dating back to Ancient Egypt, the condom has been used to varying degrees of effectiveness to prevent pregnancy. It serves as a barrier between the sperm and their intended target, the egg. Today most condoms also contain a spermicide but continue to function in the same basic way.Currently male condoms have an effectiveness rate in preventing pregnancy of up to 98% with perfect use and a typical-use failure rate of 18%.  

So we just described condoms having an effectiveness rating of 82-98%... Confused? Again we go back to perfect use vs typical use. As we mentioned with the spermicides, "perfect" use would describe consistent (use with every occurence of sexual intercourse) and correct use. Situations that would not be considered "correct" include the following:
-using condoms that are either old (past their expiration date) or stored impropperly (in places either too hot or too cold)
-putting the condom on a penis that was not fully erect 
-use with the incorrect lubricant, such as those that ARE NOT water based
-failure to put on a new condom after climax has occured and a new session has begun

All of these situations could contribute to decreased effectiveness. 

Its important to note that out of ANY of birth control methods currently available, latex male and female condoms are the only form of birth control that also protect from STIs like chlamydia, gonorrhea and HIV.
 
 FEMALE CONDOM Certainly the less popular of the two, the female condom was approved by the FDA in 2009. It looks very similar to the male condom.
  It is inserted prior to intercourse and can be used in both anal and vaginal intercourse, as with the male condom. 
Its rates of failure are between 5 and 21%, so like the other methods we've discussed in this post, consistent and correct use can increase effectiveness. 
DOWNSIDES Reasons why someone might not like the female condom aren't unlike those reasons associated with male condoms like irritation, decreased sensation and some women might not feel comfortable inserting it. 

Again its important to mention that condoms also decrease the rate of transmission of sexually transmitted infections in addition to preventing pregnancy.   

We hope that this post has served to fill your holiday with some information about barrier methods of contraception. While all of these (with the exception of the diaphragm) can be found at a local drugstore Target or Walmart its a good idea to talk to your ObGyn about any changes in your method of birth control. 

We look forward to your comments and questions. Follow any of our links for more information on these topics from trustworthy and informative sources. 

Have a safe and happy Holiday Season! 

What does your birth control say about you?

You chose your method of contraception, but what does that birth control method really say about you?  Selecting the perfect birth control is not just any ordinary feat.  It can even be more frustrating that finding that perfect pair of jeans.  It must fit with your personality, your lifestyle, your daily activities, and even your mood.  See if these popular birth control methods are right for you!

www.babble.com

IUD: You like long-term commitment.  You're a no-fuss kinda gal, who can't be bothered with daily alarms to take your pill.  Maybe you're a busy mom, who doesn't have time for baby #5.  You're spontaneous, care-free, and responsible to check your strings monthly. 

 






Implant: You're hip, you're cool, you're down with the times.  You're always up to try something new, and also enjoy long-term commitments.  You like discrete and hassle-free.  You are one busy lady.  Ain't nobody got time for that. 

birthcontroltab.com

The Pill: You are responsible, disciplined, and predictable in a good way.  Nobody better mess with Monday night meatloaf or Tuesday night tacos. You are organized and have a list for everything.  Reminder alarms are your best friend.  Your friends characterize you as reliable and dependable.   

www.theguardian.com

Condom:  "Tried and true" that is your motto.  You won't eat a restaurant unless it has 4 stars and at least 100+ reviews on Yelp.  You love a good deal.  Lazy does not define you, and you put 100% effort  into everything you do.  Variety is the spice of life.

www.womenshealthspecialists.org

The Shot: Good things come in 3!  Being the social butterfly that you are, you enjoy seeing your doctor and the office staff every 3 months.  They are even looking forward to your holiday cookies at your upcoming visit.  You enjoy your privacy and spontaneity.   You are one brave lady, shots don't bother this tough woman! 

www.allbirthcontrol.com

Withdrawal: You love tradition.  You make the same side dish at Thanksgiving, you enjoy visits to Santa at the mall, and you always seek out the oldest bar on vacation.  You are very trustworthy and appreciate convenience.  Who doesn't enjoy gratis?

www.jillstanek.com

Abstinence: You are disciplined and demonstrate much self-control.  You have great communication skills and a good support system to back you up.  You are focused on your goals.  Things still get interesting since you are one creative lady.     

www.millerandzois.com

The Ring: You are comfortable in your own skin.  You like to be in control.  Easy, convenient, and relatively little effort is your mantra.  You have dibs on the plates and cups at your company's potluck lunches. 

familytreeclinic.org

Fertility Awareness:  Channeling your inner hippie, you don't want any hormonal side effects.  Your body is your temple, and you want only natural.  You have total self-discipline.  You are detail oriented.  Math was you favorite subject in school as you thrive on calculations.

www.oops-planb.com

Emergency Contraception:  You like options, and you like to be prepared.  You're a passionate person.  You like dancing in the rain and midnight strolls along the beach.  Accidents do happen, and sometimes you just get caught in the moment.

www.essuredr.com

Sterilization: You like certainty and leave little room for error.  You are a planner.  Your thinking is straightforward and to the point.