Module 04: Human Sexuality, Contraception, and Reproduction


Content

This Module contains 4 Lessons:
  • Lesson 1: Behavioral presentation of human sexuality
  • Lesson 2: Sexual bias and misconceptions
  • Lesson 3: Contraception
  • Lesson 4: Reproduction

Lesson 1: Behavioral Presentation of Human Sexuality


Behavioral Presentation of Human Sexuality

Sexual Health

Source: Sexual Health, CDC, http://www.cdc.gov/sexualhealth/

Sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.

Sexuality

Source: Sexuality, NLM, NIH, http://www.nlm.nih.gov/medlineplus/sexualhealth.html
Sexuality is a big part of being human. Love, affection and sexual intimacy all play a role in healthy relationships. They also contribute to your sense of well-being. A number of disorders can affect the ability to have or enjoy sex in both men and women. Concerns about infertility or fear of unplanned pregnancy can also come into play.In addition, a number of diseases and disorders affect sexual health. These include sexually transmitted diseases and cancer. In men, treatment of prostate cancer can cause erectile dysfunction. In women, cervical, uterine, vaginal, vulvar or ovarian cancer may have sexual effects.

Public Health Approach to Sexual Health

Source: Public Health Approaches to Sexual Health, Centers for Disease Control and Prevention. A Public Health Approach for Advancing Sexual Health in the United States: Rationale and Options for Implementation, Meeting Report of an External Consultation. Atlanta, Georgia: Centers for Disease Control and Prevention; December, 2010. http://www.cdc.gov/sexualhealth/docs/SexualHealthReport-2011-508.pdf

Sexuality affects individuals and society across a broad spectrum of activities: through health, but also through factors at multiple levels, such as gender relations, reproduction, and economics. Physiologic, behavioral, and affective measurement of sexuality and sexual behavior is complicated by cultural values and norms, but is essential to individual health (including happiness) as well as public health.

Stigma


Cultural or structural norms that stigmatize aspects of sexuality, such as sexual orientation, have adverse effects on individuals across their lifespan, with homophobia being a prominent example of such. In addition, survey data reveal several individual and relationship factors that are important to sexual health at all levels, with overall health noted as the greatest predictor of sexual satisfaction.

Infidelity


Sexuality is important to society not only because of health implications; it also affects gender and property relations, reproduction potential, and economics. Physical, mental, social, and cultural factors affect health, especially sexual health. For instance, infidelity between couples often leads to hurt and divorce, and in Western countries, between 25% and 50% of divorcees cite a spouse’s infidelity as the primary cause of divorce.

Sexual Dysfunction


Sexual dysfunction can pose public health problems, as it is related to public health issues and affects people’s happiness and general well-being.

According to the National Health and Social Life Survey,

  • The prevalence of sexual dysfunction was found to be higher among women than men.
  • Lack of sexual desire is the most common problem among women
  • For men, the most common sexual problem is premature ejaculation, not erectile dysfunction.
  • Sexual problems increase with age, but sex-related personal distress decreases.

Sexual Frequency


Sexual frequency is important for sexual relationship satisfaction. Sexual intercourse frequency is noted as being the most important factor when predicting sexual satisfaction. Satisfaction declines with age but not as steeply as sexual frequency declines. However, although satisfaction is lower in women, satisfaction levels do not change over time among women, compared with men.


Learning Activity 1.1: Human Sexuality in Relationships

Watch this video - Intricacies of Human Sexuality in Relationships (03:08 minutes).
  • What characterizes healthy human sexuality?

Sex and Health


Duration and age matter, but health matters most of all. Health proves to be a critical predictor of sexual satisfaction. Among those indicating their health is at least “very good,” more than half say they are satisfied with their sex lives. The majority of older Americans do not practice safe sex, even if they have multiple partners. It was reported that only 1 in 5 sexually active, dating singles use condoms regularly. Many older Americans report dating more than one person at a time and being sexually active with more than one sex partner (6% of men and 1% of women).

There are cultural differences that affect sexual and romantic happiness. Despite having a lower overall reported health rating, Hispanics report being happier with their sex lives compared with the general population. Sexuality was found to be a higher priority for older Hispanics, who report higher levels of sexual activity and satisfaction. Having a partner matters.

Sexual Happiness


The most important indicator of the sexual happiness of older Americans is having a steady sex partner. That indicator is less important than the frequency of sexual intercourse, good health, low levels of stress, and the absence of financial worries. There are still behavioral differences between older men and women, and older men and women continue to rank the importance of sex and the enjoyment of sex differently—even as they age. Older men continue to have more sex and think about sex more than older women; they see it as more important to their quality of life. Older men report having more frequent orgasms than women (2 out of 3 men, compared with 1 in 3 women), but their frequency of orgasm drops with age. Older men are twice as likely (21% compared with 11%) to admit sexual activity outside their relationship than women.

Sex Trafficking

Source: Sex Trafficking Fact Sheet, Administration for Children and Families, USDHHS, http://www.acf.hhs.gov/trafficking/about/fact_sex.html

Sex trafficking is a modern-day form of slavery in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such an act is under the age of 18 years. Enactment of the Trafficking Victims Protection Act of 2000 (TVPA) made sex trafficking a serious violation of Federal law. The TVPA also recognizes labor trafficking, which is discussed in a separate fact sheet.
As defined by the TVPA, the term ‘commercial sex act’ means any sex act on account of which anything of value is given to or received by any person.
The TVPA recognizes that traffickers use psychological and well as physical coercion and bondage, and it defines coercion to include: threats of serious harm to or physical restraint against any person; any scheme, plan, or pattern intended to cause a person to believe that failure to perform an act would result in serious harm to or physical restraint against any person; or the abuse or threatened abuse of the legal process.

Victims of Sex Trafficking and What They Face

Victims of sex trafficking can be women or men, girls or boys, but the majority are women and girls. There are a number of common patterns for luring victims into situations of sex trafficking, including:
  • A promise of a good job in another country
  • A false marriage proposal turned into a bondage situation
  • Being sold into the sex trade by parents, husbands, boyfriends
  • Being kidnapped by traffickers
Sex traffickers frequently subject their victims to debt-bondage, an illegal practice in which the traffickers tell their victims that they owe money (often relating to the victims’ living expenses and transport into the country) and that they must pledge their personal services to repay the debt.
Sex traffickers use a variety of methods to “condition” their victims including starvation, confinement, beatings, physical abuse, rape, gang rape, threats of violence to the victims and the victims’ families, forced drug use and the threat of shaming their victims by revealing their activities to their family and their families’ friends.
Victims face numerous health risks. Physical risks include drug and alcohol addiction; physical injuries (broken bones, concussions, burns, vaginal/anal tearings); traumatic brain injury (TBI) resulting in memory loss, dizziness, headaches, numbness; sexually transmitted diseases (e.g., HIV/AIDS, gonorrhea, syphilis, UTIs, pubic lice); sterility, miscarriages, menstrual problems; other diseases (e.g., TB, hepatitis, malaria, pneumonia); and forced or coerced abortions.
Psychological harms include mind/body separation/disassociated ego states, shame, grief, fear, distrust, hatred of men, self-hatred, suicide, and suicidal thoughts. Victims are at risk for Posttraumatic Stress Disorder (PTSD) – acute anxiety, depression, insomnia, physical hyper-alertness, self-loathing that is long-lasting and resistant to change (complex-PTSD).
Victims may also suffer from traumatic bonding – a form of coercive control in which the perpetrator instills in the victim fear as well as gratitude for being allowed to live.

Types of Sex Trafficking

Victims of trafficking are forced into various forms of commercial sexual exploitation including prostitution, pornography, stripping, live-sex shows, mail-order brides, military prostitution and sex tourism.Victims trafficked into prostitution and pornography are usually involved in the most exploitive forms of commercial sex operations. Sex trafficking operations can be found in highly-visible venues such as street prostitution, as well as more underground systems such as closed-brothels that operate out of residential homes. Sex trafficking also takes place in a variety of public and private locations such as massage parlors, spas, strip clubs and other fronts for prostitution. Victims may start off dancing or stripping in clubs and then be coerced into situations of prostitution and pornography.

Learning Activity 1.2: Identifying and Interacting With Victims of Human Trafficking

Find out about how to identify and interact with victims of human trafficking.
  • What would you do if you think you identified someone who might be a victim of human trafficking?

Lesson 2: Sexual Bias and Misconceptions


Sexual Bias and Misconceptions

Lesbian, Gay, Bisexual, and Transgender Health

Source: Lesbian, Gay, Bisexual, and Transgendered Health, CDC, http://www.cdc.gov/lgbthealth/about.htm

People who are lesbian, gay, bisexual, or transgender (LGBT) are members of every community. They are diverse, come from all walks of life, and include people of all races and ethnicities, all ages, all socioeconomic statuses, and from all parts of the country. The perspectives and needs of LGBT people should be routinely considered in public health efforts to improve the overall health of every person and eliminate health disparities.
In addition to considering the needs of LGBT people in programs designed to improve the health of entire communities, there is also a need for culturally competent medical care and prevention services that are specific to this population. Social inequality is often associated with poorer health status, and sexual orientation has been associated with multiple health threats. Members of the LGBT community are at increased risk for a number of health threats when compared to their heterosexual peers. Differences in sexual behavior account for some of these disparities, but others are associated with social and structural inequities, such as the stigma and discrimination that LGBT populations experience.

Learning Activity 2.1: Embrace Diversity in School

Watch this 4-minute video, Embrace diversity in school: say no to HIV-related stigma and other forms of discrimination.

  • What are the challenges an HIV positive student, gay or lesbian student faces at school?


Public Health Approach for Advancing Sexual Health


Source: Public health Approach for Advancing Sexual Health,Centers for Disease Control and Prevention. A Public Health Approach for Advancing Sexual Health in the United States: Rationale and Options for Implementation, Meeting Report of an External Consultation. Atlanta, Georgia: Centers for Disease Control and Prevention; December, 2010. http://www.cdc.gov/sexualhealth/docs/SexualHealthReport-2011-508.pdf

Lesbian, Gay, Bisexual, and Transgender (LGBT) sexual health and well-being is affected by numerous social and cultural challenges across the life course, contributing to negative health outcomes and posing barriers to attain such protective health indicators as marriage and family formation, community support, and inclusion in faith communities.

Key Points: It is critical to ask the right questions. The fundamental issue we face in this field is not “What is wrong with LGBT people,” but rather “What is right with them?”Homophobia has proven to be a structural norm in the United States.

The incidence of hate crimes, continued discrimination promulgated though denial of marriage rights, and policies such as, “don’t ask, don’t tell,” in the armed forces contribute to the continuation of homophobia as a structural norm. Psychological, interpersonal, and cultural scripts perpetuate attitudes that homophobia is normal, that discrimination is okay, and that high levels of society approve of homophobia. As a result of cultural and societal discriminations, LGBT people suffer an added burden of stress and experience health disparities.

U.S. culture has historically disapproved of LGBT people as evidenced by “sodomy” laws and institutional recognition that homosexuality was a psychiatric disorder. In addition, the LGBT population experiences health disparities and minority-related stress based on their marginalized social status. Sexual attraction is established early, and LGBT youth are susceptible to the added burden of emotional and physical trauma.Some research suggests that sexual attraction is established by the ages of 9–10 years in humans. Around the ages of 13–14 years, young LGBT persons typically have their first sexual experience (13.5 for males, 15.5 for females). However, some studies have indicated that many young LGBT persons aspire to save themselves for love or more committed relationships when they are older. Societal values and norms may preclude sexual expression, as LGBT youth are stigmatized early. Young gay men experience disproportionate rates of sexual victimization and pre-pubertal LGBT youth are often marginalized or victimized in schools. Violence and harassment against LGBT students is widespread.

Knowledge of young adult sexual behavior and related negative health outcomes proves to be critical when implementing interventions to ensure the health of this population. The majority of new HIV diagnoses are made in young MSM, with the bulk occurring in black and Latino MSM. The Internet is used as a source of sexual health information, pornography, and as a main source for “hooking up” in the MSM population. Also, recent research indicates that women are more sexually fluid, changing lesbian identification and indicating a higher degree of bisexuality. LGBT seniors face many barriers to successful aging. Unlike heterosexuals, LGBT seniors can’t count on legal and biological families, which poses a tremendous challenge when assessing basic needs as they age. Further, along with incurring past and present stigmas, elderly LGBT are more likely to be more single and to have less good health care, and thus, must come to rely upon their friends or “families of choice” as a primary source of social support.

Gay and Bisexual Men's Health

Source: Gay and Bisexual Men's Health, Centers for Disease Control and Prevention, http://www.cdc.gov/msmhealth/

Gay and bisexual men and other men who have sex with men (MSM) represent an incredibly diverse community. Gay and bisexual men have both shared and unique experiences and circumstances that affect their physical health and mental health needs as well as their ability to receive high-quality health services.

Stigma and Discrimination

Source: Gay and Bisexual Men's Health, CDC, http://www.cdc.gov/msmhealth/stigma-and-discrimination.htm

Homophobia, stigma, and discrimination persist in the United States and negatively affect the health and well-being of gay, bisexual, other men who have sex with men (MSM), and other members of the LGBT community. Homophobia, stigma, and discrimination are social determinants of health that can affect physical and mental health, whether MSM seek and are able to obtain health services, and the quality of the services they receive. Such barriers to health need to be addressed at different levels of society, such as health care settings, work places, and schools in order to increase opportunities for improving the health of MSM.
Homophobia and stigma persist in the United States even though acceptance of same-sex relationships has been steadily increasing. For example, a Gallup poll conducted in May 2010 found that more than half (52%) of Americans believed that gay and lesbian relationships were acceptable. Forty-three percent of Americans believed that gay and lesbian relationships are not morally acceptable.

The Effects of Negative Attitudes About Homosexuality

Negative attitudes about homosexuality can lead to rejection by friends and family, discriminatory acts and violence that harm specific individuals, and laws and policies that adversely affect the lives of many people; this can have damaging effects on the health of MSM and other sexual minorities. Homophobia, stigma and discrimination can:
  • Limit MSM's ability to access high quality health care that is responsive to health issues of MSM
  • Affect income, employment status, and the ability to get and keep health insurance
  • Contribute to poor mental health and unhealthy behaviors, such as substance abuse, risky sexual behaviors, and suicide attempts
  • Affect MSM's ability to establish and maintain long-term same-sex relationships that reduce HIV & STD risk
  • Make it difficult for some MSM to be open about same-sex behaviors with others, which can increase stress, limit social support, and negatively affect health
The effects of homophobia, stigma and discrimination can be especially hard on adolescents and young adults. Young MSM and other sexual minorities are at increased risk of being bullied in school. They are also at risk of being rejected by their families and, as a result, are at increased risk of homelessness. A study published in 2009 compared gay, lesbian, and bisexual young adults who experienced strong rejection from their families with their peers who had more supportive families. The researchers found that those who experienced stronger rejection were:
  • 8.4 times more likely to have tried to commit suicide
  • 5.9 times more likely to report high levels of depression
  • 3.4 times more likely to use illegal drugs
  • 3.4 times more likely to have risky sex

Reducing the Effects of Stigma and Discrimination

MSM and their family and friends can take steps to reduce the effects of homophobia, stigma and discrimination and protect their physical and mental health. One way to cope with the stress from stigma and discrimination is social support. Some studies show that gay men who have good social support—from family, friends, and the wider gay community—have:
  • higher self-esteem
  • a more positive group identity


Learning Activity 2.2: Bullying of Gay and Lesbian Youth

Find out about the It Gets Better Project.
  • Do you think that this campaign is effective in showing gay and lesbian youth that they are not alone and that they can get past bullying?
  • Will this campaign help reduce suicide and attempted suicide among gay and lesbian youth caused by harassment?

Lesbian and Bisexual Women's Health

Source: Lesbian and Bisexual Women's Health, NIH, http://womenshealth.gov/publications/our-publications/fact-sheet/lesbian-bisexual-health.cfm

What challenges do lesbian and bisexual women face in the health care system?

Lesbians and bisexual women face unique problems within the health care system that an hurt their health. Many health care professionals have not had enough training to know the specific health issues that lesbians and bisexuals face. They may not ask about sexual orientation when taking personal health histories. Health care professionals may not think that a lesbian or bisexual woman, like any woman, can be a healthy, normal female.
Things that can stop lesbians and bisexual women from getting good health care include:
  • Being scared to tell your doctor about your sexuality or your sexual history
  • Having a doctor who does not know your disease risks or the issues that affect lesbians and bisexual women
  • Not having health insurance. Many lesbians and bisexuals don't have domestic partner benefits. This means that one person does not qualify to get health insurance through the plan that the partner has (a benefit usually available to married couples).
  • Not knowing that lesbians are at risk for STIs and cancer
For these reasons, lesbian and bisexual women often avoid routine health exams. They sometimes even delay seeking health care when feeling sick. It is important to be proactive about your health, even if you have to try different doctors before you find the right one. Early detection — such as finding cancer early before it spreads — gives you the best chance to do something about it. That’s one example of why it’s important to find a doctor who will work with you to identify your health concerns and make a plan to address them.


Lesson 3: Contraception


According to the Guttmacher Institute: " In 2008, there were 6.4 million pregnancies to the 62 million women of reproductive age (15–44) in the United States. Sixty-six percent of these pregnancies resulted in live births and 19% in induced abortions.And, nearly half of pregnancies among American women—more than three million each year—are unintended."

Unintended Pregnancy

Source: Unintended Pregnancy, CDC, http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/index.htm

An unintended pregnancy is a pregnancy that is either mistimed or unwanted at the time of conception. It is a core concept in understanding the fertility of populations and the unmet need for contraception. Unintended pregnancy is associated with an increased risk of morbidity for women, and with health behaviors during pregnancy that are associated with adverse effects. For example, women with an unintended pregnancy may delay prenatal care, which may affect the health of the infant. Women of all ages may have unintended pregnancies, but some groups, such as teens, are at a higher risk.
Efforts to decrease unintended pregnancy include finding better forms of contraception, and increasing contraceptive use and adherence.

What is contraception?

Source: What is Contraception? NLM, NIH, http://www.nlm.nih.gov/medlineplus/birthcontrol.html

Contraception, also known as birth control, is designed to prevent pregnancy. Some types of birth control include (but are not limited to):
  • Barrier methods, such as condoms, the diaphragm, and the cervical cap, are designed to prevent the sperm from reaching the egg for fertilization.Intrauterine device, or IUD, is a small device that is inserted into the uterus by a health care provider. The IUD prevents a fertilized egg from implanting in the uterus. An IUD can stay in the uterus for up to 10 years until it is removed by a health care provider.
  • Hormonal birth control, such as birth control pills, injections, skin patches, and vaginal rings, release hormones into a woman’s body that interfere with fertility by preventing ovulation, fertilization, or implantation.
  • Sterilization is a method that permanently prevents a woman from getting pregnant or a man from being able to get a woman pregnant. Sterilization involves surgical procedures that must be done by a health care provider and usually cannot be reversed.
The choice of birth control depends on factors such as a person's overall health, age, frequency of sexual activity, number of sexual partners, desire to have children in the future, and family history of certain diseases. A woman should talk to her health care provider about her choice of birth control method.
It is important to remember that even though birth control methods can prevent pregnancy, they do not all protect against sexually transmitted diseases or HIV.

Contraception Methods

Source: Contraception Methods, NIH, http://womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.cfm

There is no "best" method of birth control. Each method has its pros and cons.
All women and men can have control over when, and if, they become parents. Making choices about birth control, or contraception, isn't easy. There are many things to think about. To get started, learn about birth control methods you or your partner can use to prevent pregnancy. You can also talk with your doctor about the choices.
Before choosing a birth control method, think about:
  • Your overall health
  • How often you have sex
  • The number of sex partners you have
  • If you want to have children someday
  • How well each method works to prevent pregnancy
  • Possible side effects
  • Your comfort level with using the method

What are the different types of birth control?

You can choose from many methods of birth control. They are grouped by how they work:

Continuous abstinence

This means not having sex (vaginal, anal, or oral) at any time. It is the only sure way to prevent pregnancy and protect against sexually transmitted infections (STIs), including HIV.

Natural family planning/rhythm method


This method is when you do not have sex or use a barrier method on the days you are most fertile (most likely to become pregnant). You can read about barrier methods in the following chart.
A woman who has a regular menstrual cycle has about 9 or more days each month when she is able to get pregnant. These fertile days are about 5 days before and 3 days after ovulation, as well as the day of ovulation.
To have success with this method, you need to learn about your menstrual cycle. Then you can learn to predict which days you are fertile or "unsafe." To learn about your cycle, keep a written record of:
  • When you get your period
  • What it is like (heavy or light blood flow)
  • How you feel (sore breasts, cramps)
This method also involves checking your cervical mucus and recording your body temperature each day. Cervical mucus is the discharge from your vagina. You are most fertile when it is clear and slippery like raw egg whites. Use a basal thermometer to take your temperature and record it in a chart. Your temperature will rise 0.4 to 0.8° F on the first day of ovulation. You can talk with your doctor or a natural family planning instructor to learn how to record and understand this information.

Barrier methods - put up a block, or barrier, to keep sperm from reaching the egg

Contraceptive Sponge

Before having sex, you wet the sponge and place it, loop side down, inside your vagina to cover the cervix. The sponge is effective for more than one act of intercourse for up to 24 hours. It needs to be left in for at least 6 hours after having sex to prevent pregnancy. It must then be taken out within 30 hours after it is inserted.
Only one kind of contraceptive sponge is sold in the United States. It is called the Today Sponge. Women who are sensitive to the spermicide nonoxynol-9 should not use the sponge.

Diaphragm, cervical cap, and cervical shield


These barrier methods block the sperm from entering the cervix (the opening to your womb) and reaching the egg.
  • The diaphragm is a shallow latex cup.
  • The cervical cap is a thimble-shaped latex cup. It often is called by its brand name, FemCap.
  • The cervical shield is a silicone cup that has a one-way valve that creates suction and helps it fit against the cervix. It often is called by its brand name, Lea's Shield.
The diaphragm and cervical cap come in different sizes, and you need a doctor to "fit" you for one. The cervical shield comes in one size, and you will not need a fitting.
Before having sex, add spermicide (to block or kill sperm) to the devices. Then place them inside your vagina to cover your cervix. You can buy spermicide gel or foam at a drug store.
All three of these barrier methods must be left in place for 6 to 8 hours after having sex to prevent pregnancy. The diaphragm should be taken out within 24 hours. The cap and shield should be taken out within 48 hours.

Female condom


This condom is worn by the woman inside her vagina. It keeps sperm from getting into her body. It is made of thin, flexible, manmade rubber and is packaged with a lubricant. It can be inserted up to 8 hours before having sex. Use a new condom each time you have intercourse. And don't use it and a male condom at the same time.

Male condom

Male condoms are a thin sheath placed over an erect penis to keep sperm from entering a woman's body. Condoms can be made of latex, polyurethane, or "natural/lambskin". The natural kind do not protect against STIs. Condoms work best when used with a vaginal spermicide, which kills the sperm. And you need to use a new condom with each sex act.

Condoms are either:
  • Lubricated, which can make sexual intercourse more comfortable
  • Non-lubricated, which can also be used for oral sex. It is best to add lubrication to non-lubricated condoms if you use them for vaginal or anal sex. You can use a water-based lubricant, such as K-Y jelly. You can buy them at the drug store. Oil-based lubricants like massage oils, baby oil, lotions, or petroleum jelly will weaken the condom, causing it to tear or break.
Keep condoms in a cool, dry place. If you keep them in a hot place (like a wallet or glove compartment), the latex breaks down. Then the condom can tear or break.

Optional Learning Activity: Watch How to Use a Condom.

Hormonal methods - Prevent pregnancy by interfering with ovulation, fertilization, and/or implantation of the fertilized egg

Oral contraceptives — combined pill ("The pill")


The pill contains the hormones estrogen and progestin. It is taken daily to keep the ovaries from releasing an egg. The pill also causes changes in the lining of the uterus and the cervical mucus to keep the sperm from joining the egg.

Some women prefer the "extended cycle" pills. These have 12 weeks of pills that contain hormones (active) and 1 week of pills that don't contain hormones (inactive). While taking extended cycle pills, women only have their period three to four times a year.

Many types of oral contraceptives are available. Talk with your doctor about which is best for you.
Your doctor may advise you not to take the pill if you:
  • Are older than 35 and smoke
  • Have a history of blood clots
  • Have a history of breast, liver, or endometrial cancer

Antibiotics may reduce how well the pill works in some women. Talk to your doctor about a backup method of birth control if you need to take antibiotics.
Women should wait three weeks after giving birth to begin using birth control that contains both estrogen and progestin. These methods increase the risk of dangerous blood clots that could form after giving birth. Women who delivered by cesarean section or have other risk factors for blood clots, such as obesity, history of blood clots, smoking, or preeclampsia, should wait six weeks.

The patch

Also called by its brand name, Ortho Evra, this skin patch is worn on the lower abdomen, buttocks, outer arm, or upper body. It releases the hormones progestin and estrogen into the bloodstream to stop the ovaries from releasing eggs in most women. It also thickens the cervical mucus, which keeps the sperm from joining with the egg. You put on a new patch once a week for 3 weeks. You don't use a patch the fourth week in order to have a period.
Women should wait three weeks after giving birth to begin using birth control that contains both estrogen and progestin. These methods increase the risk of dangerous blood clots that could form after giving birth. Women who delivered by cesarean section or have other risk factors for blood clots, such as obesity, history of blood clots, smoking, or preeclampsia, should wait six weeks.

Shot/injection

The birth control shot often is called by its brand name Depo-Provera. With this method you get injections, or shots, of the hormone progestin in the buttocks or arm every 3 months. A new type is injected under the skin. The birth control shot stops the ovaries from releasing an egg in most women. It also causes changes in the cervix that keep the sperm from joining with the egg.

Vaginal ring

This is a thin, flexible ring that releases the hormones progestin and estrogen. It works by stopping the ovaries from releasing eggs. It also thickens the cervical mucus, which keeps the sperm from joining the egg.
It is commonly called NuvaRing, its brand name. You squeeze the ring between your thumb and index finger and insert it into your vagina. You wear the ring for 3 weeks, take it out for the week that you have your period, and then put in a new ring.
Women should wait three weeks after giving birth to begin using birth control that contains both estrogen and progestin. These methods increase the risk of dangerous blood clots that could form after giving birth. Women who delivered by cesarean section or have other risk factors for blood clots, such as obesity, history of blood clots, smoking, or preeclampsia, should wait six weeks.

Implantable devices — Devices that are inserted into the body and left in place for a few years.

Implantable rod

This is a matchstick-size, flexible rod that is put under the skin of the upper arm. It is often called by its brand name, Implanon. The rod releases a progestin, which causes changes in the lining of the uterus and the cervical mucus to keep the sperm from joining an egg. Less often, it stops the ovaries from releasing eggs. It is effective for up to 3 years.

Intrauterine devices or IUDs

An IUD is a small device shaped like a "T" that goes in your uterus. There are two types:
||* Copper IUD The copper IUD goes by the brand name ParaGard. It releases a small amount of copper into the uterus, which prevents the sperm from reaching and fertilizing the egg. It fertilization does occur, the IUD keeps the fertilized egg from implanting in the lining of the uterus. A doctor needs to put in your copper IUD. It can stay in your uterus for 5 to 10 years.
  • Hormonal IUD The hormonal IUD goes by the brand name Mirena. It is sometimes called an intrauterine system, or IUS. It releases progestin into the uterus, which keeps the ovaries from releasing an egg and causes the cervical mucus to thicken so sperm can't reach the egg. It also affects the ability of a fertilized egg to successfully implant in the uterus. A doctor needs to put in a hormonal IUD. It can stay in your uterus for up to 5 years.

Sterilization implant (essure)

Essure is the first non-surgical method of sterilizing women. A thin tube is used to thread a tiny spring-like device through the vagina and uterus into each fallopian tube. The device works by causing scar tissue to form around the coil. This blocks the fallopian tubes and stops the egg and sperm from joining.
It can take about 3 months for the scar tissue to grow, so it's important to use another form of birth control during this time. Then you will have to return to your doctor for a test to see if scar tissue has fully blocked your tubes.

Surgical sterilization

For women, surgical sterilization closes the fallopian tubes by being cut, tied, or sealed. This stops the eggs from going down to the uterus where they can be fertilized. The surgery can be done a number of ways. Sometimes, a woman having cesarean birth has the procedure done at the same time, so as to avoid having additional surgery later.
For men, having a vasectomy (vuh-SEK-tuh-mee) keeps sperm from going to his penis, so his ejaculate never has any sperm in it. Sperm stays in the system after surgery for about 3 months. During that time, use a backup form of birth control to prevent pregnancy. A simple test can be done to check if all the sperm is gone; it is called a semen analysis.

Emergency contraception


Used if a woman's primary method of birth control fails. It should not be used as a regular method of birth control. Emergency contraception (Plan B One-Step or Next Step. It is also called the "morning after pill.")
Emergency contraception keeps a woman from getting pregnant when she has had unprotected vaginal intercourse. "Unprotected" can mean that no method of birth control was used. It can also mean that a birth control method was used but it was used incorrectly, or did not work (like a condom breaking). Or, a woman may have forgotten to take her birth control pills. She also may have been abused or forced to have sex. These are just some of the reasons women may need emergency contraception.
Emergency contraception can be taken as a single pill treatment or in two doses. A single dose treatment works as well as two doses and does not have more side effects. It works by stopping the ovaries from releasing an egg or keeping the sperm from joining with the egg. For the best chances for it to work, take the pill as soon as possible after unprotected sex. It should be taken within 72 hours after having unprotected sex.
A single-pill dose or two-pill dose of emergency contraception is available over-the-counter (OTC) for women ages 17 and older.

Can all types of birth control prevent sexually transmitted infections (STIs)?

No. The male latex condom is the only birth control method proven to help protect you from STIs, including HIV. Research is being done to find out how effective the female condom is at preventing STIs and HIV. For more information, see Will birth control pills protect me from sexually transmitted infections (STIs), including HIV/AIDS?

How well do different kinds of birth control work? Do they have side effects?

All birth control methods work the best if used correctly and every time you have sex. Be sure you know the right way to use them. Sometimes doctors don't explain how to use a method because they assume you already know. Talk with your doctor if you have questions. They are used to talking about birth control. So don't feel embarrassed about talking to him or her.
Some birth control methods can take time and practice to learn. For example, some people don't know you can put on a male condom "inside out." Also, not everyone knows you need to leave a little space at the tip of the condom for the sperm and fluid when a man ejaculates, or has an orgasm.

Where to Get Birth Control

Where you get birth control depends on what method you choose.
You can buy these forms over the counter:
  • Male condoms
  • Female condoms
  • Sponges
  • Spermicides
  • Emergency contraception pills (girls younger than 17 need a prescription)
You need a prescription for these forms:
  • Oral contraceptives: the pill, the mini-pill
  • Skin patch
  • Vaginal ring
  • Diaphragm (your doctor needs to fit one to your shape)
  • Cervical cap
  • Cervical shield
  • Shot/injection (you get the shot at your doctor's office)
  • IUD (inserted by a doctor)
  • Implantable rod (inserted by a doctor)
You will need surgery or a medical procedure for:
  • Sterilization, female and male

Spermacides

You can buy spermicides over the counter. They work by killing sperm. They come in many forms:
  • Foam
  • Gel
  • Cream
  • Film
  • Suppository
  • Tablet
Spermicides are put in the vagina no more than 1 hour before having sex. If you use a film, suppository, or tablet, wait at least 15 minutes before having sex so the spermicide can dissolve. Do not douche or rinse out your vagina for at least 6 to 8 hours after having sex. You will need to use more spermicide each time you have sex.
Spermicides work best if used along with a barrier method, such as a condom, diaphragm, or cervical cap. Some spermicides are made just for use with the diaphragm and cervical cap. Check the package to make sure you are buying what you need.
All spermicides contain sperm-killing chemicals. Some contain nonoxynol-9, which may raise your risk of HIV if you use it a lot. It irritates the tissue in the vagina and anus, so it can cause the HIV virus to enter the body more freely. Some women are sensitive to nonoxynol-9 and need to use spermicides without it. Medications for vaginal yeast infections may lower the effectiveness of spermicides. Also, spermicides do not protect against sexually transmitted infections.

Withdrawal

Withdrawal is when a man takes his penis out of a woman's vagina (or "pulls out") before he ejaculates, or has an orgasm. This stops the sperm from going to the egg. "Pulling out" can be hard for a man to do. It takes a lot of self-control.
Even if you use withdrawal, sperm can be released before the man pulls out. When a man's penis first becomes erect, pre-ejaculate fluid may be on the tip of the penis. This fluid has sperm in it. So you could still get pregnant.
Withdrawal does not protect you from STIs or HIV.

Dental Dams

The dental dam is a square piece of rubber that is used by dentists during oral surgery and other procedures. It is not a method of birth control. But it can be used to help protect people from STIs, including HIV, during oral-vaginal or oral-anal sex. It is placed over the opening to the vagina or the anus before having oral sex. You can buy dental dams at surgical supply stores.

Learning Activity 3.1:

For a handy summary of birth control information, see this Frequently Asked Questions Fact Sheet.

Source: Frequently Asked Questions Fact Sheet, Office of Women's Health, NIH, http://www.womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.pdf

Learning Activity 3.2:

Find out the Real Cost of Contraceptives: "Choosing the most money-smart method isn’t as easy as crunching numbers because costs depend on a variety of factors, including how long you want the birth control to last, how often you need it, and how generous your insurance policy is."

Lesson 4: Reproduction


Reproductive Health

Source: Reproductive Health, Medline Plus, NLM, NIH, http://www.nlm.nih.gov/medlineplus/reproductivehealth.html

Both the male and female reproductive systems play a role in pregnancy. Problems with these systems can affect fertility and the ability to have children. There are many such problems in men and women. Reproductive health problems can also be harmful to overall health and impair a person's ability to enjoy a sexual relationship.
Your reproductive health is influenced by many factors. These include your age, lifestyle, habits, genetics, use of medicines and exposure to chemicals in the environment. Many problems of the reproductive system can be corrected.

What is reproductive health?
Reproductive health includes a variety of topics, such as:
  • Menstruation and menopause
  • Pregnancy and preconception care
  • Fertility/Infertility
  • Contraception
More information on some of these issues is provided below.

Menstrual Cycle

The menstrual cycle is the process by which a woman’s body gets ready for the chance of a pregnancy each month. The average menstrual cycle is 28 days from the start of one to the start of the next, but it can range from 21 days to 35 days.
Most menstrual periods last from three to five days. In the United States, most girls start menstruating at age 12, but girls can start menstruating between the ages of 8 and 16.

Menstruation and the menstrual cycle fact sheet

Source: Menstruation, Office of Women's Health, NIH, http://womenshealth.gov/publications/our-publications/fact-sheet/menstruation.cfm

Menstruation is a woman's monthly bleeding. When you menstruate, your body sheds the lining of the uterus (womb). Menstrual blood flows from the uterus through the small opening in the cervix and passes out of the body through the vagina (see how the menstrual cycle works below). Most menstrual periods last from 3 to 5 days.

What is the menstrual cycle?

When periods (menstruations) come regularly, this is called the menstrual cycle. Having regular menstrual cycles is a sign that important parts of your body are working normally. The menstrual cycle provides important body chemicals, called hormones, to keep you healthy. It also prepares your body for pregnancy each month. A cycle is counted from the first day of 1 period to the first day of the next period. The average menstrual cycle is 28 days long. Cycles can range anywhere from 21 to 35 days in adults and from 21 to 45 days in young teens.

What happens during the menstrual cycle?

In the first half of the cycle, levels of estrogen (the female hormone) start to rise. Estrogen plays an important role in keeping you healthy, especially by helping you to build strong bones and to help keep them strong as you get older. Estrogen also makes the lining of the uterus (womb) grow and thicken. This lining of the womb is a place that will nourish the embryo if a pregnancy occurs. At the same time the lining of the womb is growing, an egg, or ovum, in one of the ovaries starts to mature. At about day 14 of an average 28-day cycle, the egg leaves the ovary. This is called ovulation.
After the egg has left the ovary, it travels through the fallopian tube to the uterus. Hormone levels rise and help prepare the uterine lining for pregnancy. A woman is most likely to get pregnant during the 3 days before or on the day of ovulation. Keep in mind, women with cycles that are shorter or longer than average may ovulate before or after day 14.
A woman becomes pregnant if the egg is fertilized by a man’s sperm cell and attaches to the uterine wall. If the egg is not fertilized, it will break apart. Then, hormone levels drop, and the thickened lining of the uterus is shed during the menstrual period.

The menstrual cycle

Source: The Menstrual Cycle, Office of Women's Health, NIH, http://womenshealth.gov/pregnancy/before-you-get-pregnant/menstrual-cycle.cfm

  • Day 1 starts with the first day of your period. This occurs after hormone levels drop at the end of the previous cycle, signaling blood and tissues lining the uterus (womb) to break down and shed from the body. Bleeding lasts about 5 days.
  • Usually by Day 7, bleeding has stopped. Leading up to this time, hormones cause fluid-filled pockets called follicles to develop on the ovaries. Each follicle contains an egg.
  • Between Day 7 and 14, one follicle will continue to develop and reach maturity. The lining of the uterus starts to thicken, waiting for a fertilized egg to implant there. The lining is rich in blood and nutrients.
  • Around Day 14 (in a 28-day cycle), hormones cause the mature follicle to burst and release an egg from the ovary, a process called ovulation.
  • Over the next few days, the egg travels down the fallopian tube towards the uterus. If a sperm unites with the egg here, the fertilized egg will continue down the fallopian tube and attach to the lining of the uterus.
  • If the egg is not fertilized, hormone levels will drop around Day 25. This signals the next menstrual cycle to begin. The egg will break apart and be shed with the next period.

What is a typical menstrual period like?

During your period, you shed the thickened uterine lining and extra blood through the vagina. Your period may not be the same every month. It may also be different than other women's periods. Periods can be light, moderate, or heavy in terms of how much blood comes out of the vagina. This is called menstrual flow. The length of the period also varies. Most periods last from 3 to 5 days. But, anywhere from 2 to 7 days is normal.
For the first few years after menstruation begins, longer cycles are common. A woman's cycle tends to shorten and become more regular with age. Most of the time, periods will be in the range of 21 to 35 days apart.

What kinds of problems do women have with their periods?

Women can have a range of problems with their periods, including pain, heavy bleeding, and skipped periods.
Amenorrhea (ay-men-uh-REE-uh) the lack of a menstrual period. This term is used to describe the absence of a period in:
  • Young women who haven't started menstruating by age 15
  • Women and girls who haven't had a period for 90 days, even if they haven't been menstruating for long
Causes can include:
  • Pregnancy
  • Breastfeeding
  • Extreme weight loss
  • Eating disorders
  • Excessive exercising
  • Stress
  • Serious medical conditions in need of treatment
As above, when your menstrual cycles come regularly, this means that important parts of your body are working normally. In some cases, not having menstrual periods can mean that your ovaries have stopped producing normal amounts of estrogen. Missing these hormones can have important effects on your overall health. Hormonal problems, such as those caused by polycystic ovary syndrome (PCOS) or serious problems with the reproductive organs, may be involved. It’s important to talk to a doctor if you have this problem.
Dysmenorrhea (dis-men-uh-REE-uh) painful periods, including severe cramps. Menstrual cramps in teens are caused by too much of a chemical called prostaglandin (pros-tuh-GLAN-duhn). Most teens with dysmenorrhea do not have a serious disease, even though the cramps can be severe. In older women, the pain is sometimes caused by a disease or condition such as uterine fibroids or endometriosis.
For some women, using a heating pad or taking a warm bath helps ease their cramps. Some over-the-counter pain medicines can also help with these symptoms. They include:
  • Ibuprofen (eye-byu-PROH-fuhn) (for instance, Advil, Motrin, Midol Cramp>
  • Ketoprofen (key-toh-PROH-fuhn) (for instance, Orudis KT)
  • Naproxen (nuh-PROK-suhn) (for instance, Aleve)
If these medicines don’t relieve your pain or the pain interferes with work or school, you should see a doctor. Treatment depends on what’s causing the problem and how severe it is. Report vaginal bleeding that’s different from normal menstrual periods. It includes:
  • Bleeding between periods
  • Bleeding after sex
  • Spotting anytime in the menstrual cycle
  • Bleeding heavier or for more days than normal
  • Bleeding after menopause
Abnormal bleeding can have many causes. Your doctor may start by checking for problems that are most common in your age group. Some of them are not serious and are easy to treat. Others can be more serious. Treatment for abnormal bleeding depends on the cause.

In both teens and women nearing menopause, hormonal changes can cause long periods along with irregular cycles. Even if the cause is hormonal changes, you may be able to get treatment. You should keep in mind that these changes can occur with other serious health problems, such as uterine fibroids, polyps, or even cancer. See your doctor if you have any abnormal bleeding.

When does a girl usually get her first period?

In the United States, the average age for a girl to get her first period is 12. This does not mean that all girls start at the same age. A girl can start her period anytime between the ages of 8 and 15. Most of the time, the first period starts about 2 years after breasts first start to develop. If a girl has not had her first period by age 15, or if it has been more than 2 to 3 years since breast growth started, she should see a doctor.

Menopause

Women usually have periods until menopause. Menopause occurs between the ages of 45 and 55, usually around age 50. Menopause means that a woman is no longer ovulating (producing eggs) or having periods and can no longer get pregnant. Like menstruation, menopause can vary from woman to woman and these changes may occur over several years.
The time when your body begins its move into menopause is called the menopausal transition. This can last anywhere from 2 to 8 years. Some women have early menopause because of surgery or other treatment, illness, or other reasons. If you don’t have a period for 90 days, you should see your doctor. He or she will check for pregnancy, early menopause, or other health problems that can cause periods to stop or become irregular.

When to Consult a Doctor about Your Period


See your doctor about your period if:
  • You have not started menstruating by the age of 15.
  • You have not started menstruating within 3 years after breast growth began, or if breasts haven't started to grow by age 13.
  • Your period suddenly stops for more than 90 days.
  • Your periods become very irregular after having had regular, monthly cycles.
  • Your period occurs more often than every 21 days or less often than every 35 days.
  • You are bleeding for more than 7 days.
  • You are bleeding more heavily than usual or using more than 1 pad or tampon every 1 to 2 hours.
  • You bleed between periods.
  • You have severe pain during your period.
  • You suddenly get a fever and feel sick after using tampons.
You should change a pad before it becomes soaked with blood. Each woman decides for herself what works best. You should change a tampon at least every 4 to 8 hours. Make sure to use the lowest absorbency tampon needed for your flow. For example, use junior or regular tampons on the lightest day of your period. Using a super absorbency tampon on your lightest days increases your risk for toxic shock syndrome (TSS). TSS is a rare but sometimes deadly disease. TSS is caused by bacteria that can produce toxins. If your body can’t fight the toxins, your immune (body defense) system reacts and causes the symptoms of TSS (see below).
Young women may be more likely to get TSS. Using any kind of tampon puts you at greater risk for TSS than using pads. The Food and Drug Administration (FDA) recommends the following tips to help avoid tampon problems:
  • Follow package directions for insertion.
  • Choose the lowest absorbency for your flow.
  • Change your tampon at least every 4 to 8 hours.
  • Consider switching between pads and tampons.
  • Know the warning signs of TSS (see below).
  • Don't use tampons between periods.
If you have any of these symptoms of TSS while using tampons, take the tampon out, and contact your doctor right away:
  • Sudden high fever (over 102 degrees)
  • Muscle aches
  • Diarrhea
  • Vomiting
  • Dizziness and/or fainting
  • Sunburn-like rash
  • Sore throat
  • Bloodshot eyes

Preconception Care

Source: Preconception Care, Office of Women's Health, NIH, USDHHS, http://womenshealth.gov/pregnancy/before-you-get-pregnant/preconception-health.cfm

Why preconception health matters

Preconception health is a woman's health before she becomes pregnant. It means knowing how health conditions and risk factors could affect a woman or her unborn baby if she becomes pregnant. For example, some foods, habits, and medicines can harm your baby — even before he or she is conceived. Some health problems, such as diabetes, also can affect pregnancy.
Every woman should be thinking about her health whether or not she is planning pregnancy. One reason is that about half of all pregnancies are not planned. Unplanned pregnancies are at greater risk of preterm birth and low birth weight babies. Another reason is that, despite important advances in medicine and prenatal care, about 1 in 8 babies is born too early. Researchers are trying to find out why and how to prevent preterm birth. But experts agree that women need to be healthier before becoming pregnant. By taking action on health issues and risks before pregnancy, you can prevent problems that might affect you or your baby later.

Five most important things to boost your preconception health

Women and men should prepare for pregnancy before becoming sexually active — or at least three months before getting pregnant. Some actions, such as quitting smoking, reaching a healthy weight, or adjusting medicines you are using, should start even earlier.

The five most important things a woman can do for preconception health are:
  1. Take 400 to 800 micrograms (400 to 800 mcg or 0.4 to 0.8 mg) of folic acid every day if you are planning or capable of pregnancy to lower your risk of some birth defects of the brain and spine, including spina bifida. All women need folic acid every day. Talk to your doctor about your folic acid needs. Some doctors prescribe prenatal vitamins that contain higher amounts of folic acid.
  2. Stop smoking and drinking alcohol.
  3. If you have a medical condition, be sure it is under control. Some conditions that can affect pregnancy or be affected by it include asthma, diabetes, oral health, obesity, or epilepsy.
  4. Talk to your doctor about any over-the-counter and prescription medicines you are using. These include dietary or herbal supplements. Be sure your vaccinations are up to date.
  5. Avoid contact with toxic substances or materials that could cause infection at work and at home. Stay away from chemicals and cat or rodent feces.

Talk to your doctor before you become pregnant

Did you know?

It's best to be at a healthy weight when you become pregnant. Being overweight or underweight puts you at increased risk for problems during pregnancy. Learn how healthy food choices and physical fitness, together, can help you reach or maintain a healthy weight.
Preconception care can improve your chances of getting pregnant, having a healthy pregnancy, and having a healthy baby. If you are sexually active, talk to your doctor about your preconception health now. Preconception care should begin at least three months before you get pregnant. But some women need more time to get their bodies ready for pregnancy. Be sure to discuss your partner's health too. Ask your doctor about:
  • Family planning and birth control.
  • Taking folic acid.
  • Vaccines and screenings you may need, such as a Pap test and screenings for sexually transmitted infections (STIs), including HIV.
  • Managing health problems, such as diabetes, high blood pressure, thyroid disease, obesity, depression, eating disorders, and asthma. Find out how pregnancy may affect, or be affected by, health problems you have.
  • Medicines you use, including over-the-counter, herbal, and prescription drugs and supplements.
  • Ways to improve your overall health, such as reaching a healthy weight, making healthy food choices, being physically active, caring for your teeth and gums, reducing stress, quitting smoking, and avoiding alcohol.
  • How to avoid illness.
  • Hazards in your workplace or home that could harm you or your baby.
  • Health problems that run in your or your partner's family.
  • Problems you have had with prior pregnancies, including preterm birth.
  • Family concerns that could affect your health, such as domestic violence or lack of support.
Bring
PDF - Requires Adobe Acrobat Reader
PDF - Requires Adobe Acrobat Reader
a list of talking points (PDF, 182 KB) to be sure you don't forget anything. If you run out of time at your visit, schedule a follow-up visit to make sure everything is covered.

Your partner's role in preparing for pregnancy

Your partner can do a lot to support and encourage you in every aspect of preparing for pregnancy. Here are some ways:
  • Make the decision about pregnancy together. When both partners intend for pregnancy, a woman is more likely to get early prenatal care and avoid risky behaviors such as smoking and drinking alcohol.
  • Screening for and treating sexually transmitted infections (STIs) can help make sure infections are not passed to female partners.
  • Male partners can improve their own reproductive health and overall health by limiting alcohol, quitting smoking or illegal drug use, making healthy food choices, and reducing stress. Studies show that men who drink a lot, smoke, or use drugs can have problems with their sperm. These might cause you to have problems getting pregnant. If your partner won't quit smoking, ask that he not smoke around you, to avoid harmful effects of secondhand smoke.
  • Your partner should also talk to his doctor about his own health, his family health history, and any medicines he uses.
  • People who work with chemicals or other toxins can be careful not to expose women to them. For example, people who work with fertilizers or pesticides should change out of dirty clothes before coming near women. They should handle and wash soiled clothes separately.

Genetic counseling

Did you know?

Some companies offer genetic tests that you can do yourself through the mail. These tests may not provide true or meaningful information. These tests might provide harmful information. Talk to your doctor before using this type of test.
The genes your baby is born with can affect your baby's health in these ways:
  • Single gene disorders are caused by a problem in a single gene. Genes contain the information your body's cells need to function. Single gene disorders run in families. Examples of single gene disorders are cystic fibrosis and sickle cell anemia.
  • Chromosome disorders occur when all or part of a chromosome is missing or extra, or if the structure of one or more chromosomes is not normal. Chromosomes are structures where genes are located. Most chromosome disorders that involve whole chromosomes do not run in families.
Talk to your doctor about your and your partner's family health histories before becoming pregnant. This information can help your doctor find out any genetic risks you might have.
Depending on your genetic risk factors, your doctor might suggest you meet with a genetic professional. Some reasons a person or couple might seek genetic counseling are:
  • A family history of a genetic condition, birth defect, chromosomal disorder, or cancer
  • Two or more pregnancy losses, a stillbirth, or a baby who died
  • A child with a known inherited disorder, birth defect, or intellectual disability
  • A woman who is pregnant or plans to become pregnant at 35 years or older
  • Test results that suggest a genetic condition is present
  • Increased risk of getting or passing on a genetic disorder because of one's ethnic background
  • People related by blood who want to have children together
During a consultation, the genetics professional meets with a person or couple to discuss genetic risks or to diagnose, confirm, or rule out a genetic condition. Sometimes, a couple chooses to have genetic testing. Some tests can help couples to know the chances that a person will get or pass on a genetic disorder. The genetics professional can help couples decide if genetic testing is the right choice for them.

Learning Activity 4.1: Find out about direct-to-consumer genetic testing kits.
  • Would you use a genetic test that you can do yourself through the mail? Why or why not?

What is pregnancy?

Pregnancy is the term used to describe when a woman has a growing fetus inside of her. In most cases, the fetus grows in the uterus.
Human pregnancy lasts about 40 weeks, or just more than 9 months, from the start of the last menstrual period to childbirth.
What are prenatal and preconception care and why are they important?
Prenatal care is the care woman gets during a pregnancy. Getting early and regular prenatal care is important for the health of both mother and the developing baby.
In addition, health care providers are now recommending a woman see a health care provider for preconception care, even before she considers becoming pregnant or in between pregnancies.

Knowing if you are pregnant

Source: Knowing If You Are Pregnant, Office of Women's Health, NIH, USDHHS, http://womenshealth.gov/pregnancy/before-you-get-pregnant/knowing-if-pregnant.cfm

A missed period is often the first clue that a woman might be pregnant. Sometimes, a woman might suspect she is pregnant even sooner. Symptoms such as headache, fatigue, and breast tenderness, can occur even before a missed period. The wait to know can be emotional. These days, many women first use home pregnancy tests (HPT) to find out. Your doctor also can test you.
All pregnancy tests work by detecting a special hormone in the urine or blood that is only there when a woman is pregnant. It is called human chorionic gonadotropin (kohr-ee-ON-ihk goh-NAD-uh-TROH-puhn), or hCG. hCG is made when a fertilized egg implants in the uterus. hCG rapidly builds up in your body with each passing day you are pregnant. Read on to learn when and how to test for pregnancy.

Home pregnancy tests

Reading a home pregnancy test

HPTs are inexpensive, private, and easy to use. Most drugstores sell HPTs over the counter. The cost depends on the brand and how many tests come in the box. They work by detecting hCG in your urine. HPTs are highly accurate. But their accuracy depends on many things. These include:
  • When you use them – The amount of hCG in your urine increases with time. So, the earlier after a missed period you take the test the harder it is to spot the hCG. Some HPTs claim that they can tell if you are pregnant one day after a missed period or even earlier. But a recent study shows that most HPTs don't give accurate results this early in pregnancy. Positive results are more likely to be true than negative results. Waiting one week after a missed period will usually give a more accurate result. You can take the test sooner. But just know that a lot of pregnant women will get negative test results during the first few days after the missed period. It's a good idea to repeat the test again after a week has passed. If you get two negative results but still think you're pregnant, call your doctor.
  • How you use them – Be sure to check the expiration date and follow the directions. Many involve holding a test stick in the urine stream. For some, you collect urine in a cup and then dip the test stick into it. Then, depending on the brand, you will wait a few minutes to get the results. Research suggests waiting 10 minutes will give the most accurate result. Also, testing your urine first thing in the morning may boost the accuracy. You will be looking for a plus sign, a change in color, or a line. A change, whether bold or faint, means the result is positive. New digital tests show the words "pregnant" or "not pregnant". Most tests also have a "control indicator" in the results window. This line or symbol shows whether or not the test is working. If the control indicator does not appear, the test is not working properly. You should not rely on any results from a HPT that may be faulty.
  • Who uses them – The amount of hCG in the urine is different for every pregnant woman. So, some women will have accurate results on the day of the missed period while others will need to wait longer. Also, some medicines affect HPTs. Discuss the medicines you use with your doctor before trying to become pregnant.
  • The brand of test – Some HPT tests are better than others at spotting hCG early on.
The most important part of using any HPT is to follow the directions exactly as written. Most tests also have toll-free phone numbers to call in case of questions about use or results.
If a HPT says you are pregnant, you should call your doctor right away. Your doctor can use a more sensitive test along with a pelvic exam to tell for sure if you're pregnant. Seeing your doctor early on in your pregnancy can help you and your baby stay healthy.

Unplanned Pregnancy

Source: Unplanned Pregnancy, Office of Woman's Health, NIH, http://www.womenshealth.gov/pregnancy/before-you-get-pregnant/unplanned-pregnancy.cfm

Unplanned pregnancy is common. About 1 in 2 pregnancies in America are unplanned. Ideally, a woman who is surprised by an unplanned pregnancy is in good preconception health and is ready and able to care for a new child. But this sometimes isn't the case.

If you have an unplanned pregnancy, you might not know what to do next. You might worry that the father won't welcome the news. You might not be sure you can afford to care for a baby. You might worry if past choices you have made, such as drinking or drug use, will affect your unborn baby's health. You might be concerned that having a baby will keep you from finishing school or pursuing a career.
If you are pregnant after being raped, you might feel ashamed, numb, or afraid. Unplanned pregnancy is common among abused women. Research has found that some abusers force their partners to have sex without birth control and/or sabotage the birth control their partners are using, leading to unplanned pregnancy.

You might wonder what options you have. Here are some next steps to help you move forward:
  • Start taking care of yourself right away. Take 400 to 800 micrograms (400 to 800 mcg or 0.4 to 0.8 mg) folic acid every. Stop alcohol, tobacco, and drug use.
  • Make a doctor's visit to confirm your pregnancy. Discuss your health and issues that could affect your pregnancy. Ask for help quitting smoking. Find out what you can do to take care of yourself and your unborn baby.
  • Ask your doctor to recommend a counselor who you can talk to about your situation.
  • Seek support in someone you trust and respect.

Trying to Get Pregnant

Source: Trying to Get Pregnant, Office of Women's Health, NIH, USDHHS, http://womenshealth.gov/pregnancy/before-you-get-pregnant/trying-to-conceive.cfm

How do you figure out when you're fertile and when you're not? Wondering if you or your partner is infertile? Read on to boost your chances of conception and get help for fertility problems.

Fertility awareness

The menstrual cycle

Being aware of your menstrual cycle and the changes in your body that happen during this time can help you know when you are most likely to get pregnant.
The average menstrual cycle lasts 28 days. But normal cycles can vary from 21 to 35 days. The amount of time before ovulation occurs is different in every woman and even can be different from month to month in the same woman, varying from 13 to 20 days long. Learning about this part of the cycle is important because it is when ovulation and pregnancy can occur. After ovulation, every woman (unless she has a health problem that affects her periods or becomes pregnant) will have a period within 14 to 16 days.

Charting your fertility pattern

Knowing when you're most fertile will help you plan pregnancy. There are three ways you can keep track of your fertile times. They are:
  • Basal body temperature method – Basal body temperature is your temperature at rest as soon as you awake in the morning. A woman's basal body temperature rises slightly with ovulation. So by recording this temperature daily for several months, you'll be able to predict your most fertile days.
    Basal body temperature differs slightly from woman to woman. Anywhere from 96 to 98 degrees Fahrenheit orally is average before ovulation. After ovulation most women have an oral temperature between 97 and 99 degrees Fahrenheit. The rise in temperature can be a sudden jump or a gradual climb over a few days.
    Usually a woman's basal body temperature rises by only 0.4 to 0.8 degrees Fahrenheit. To detect this tiny change, women must use a basal body thermometer. These thermometers are very sensitive. Most pharmacies sell them for about $10. You can then record your temperature on our special
    PDF - Requires Adobe Acrobat Reader
    PDF - Requires Adobe Acrobat Reader
    Basal Body Temperature Chart (PDF, 555 KB).
    The rise in temperature doesn't show exactly when the egg is released. But almost all women have ovulated within three days after their temperatures spike. Body temperature stays at the higher level until the woman's period starts.
    A woman is most fertile and most likely to get pregnant:
    • Two to three days before your temperature hits the highest point (ovulation)
      and
    • 12 to 24 hours after ovulation
    A man's sperm can live for up to three days in a woman's body. The sperm can fertilize an egg at any point during that time. So if you have unprotected sex a few days before ovulation, you could get pregnant.
    Many things can affect basal body temperature. For your chart to be useful, make sure to take your temperature every morning at about the same time. Things that can alter your temperature include:
    • Drinking alcohol the night before
    • Smoking cigarettes the night before
    • Getting a poor night's sleep
    • Having a fever
    • Doing anything in the morning before you take your temperature — including going to the bathroom and talking on the phone
  • Calendar method– This involves recording your menstrual cycle on a calendar for eight to 12 months. The first day of your period is Day 1. Circle Day 1 on the calendar. The length of your cycle may vary from month to month. So write down the total number of days it lasts each time. Using this record, you can find the days you are most fertile in the months ahead:
    1. To find out the first day when you are most fertile, subtract 18 from the total number of days in your shortest cycle. Take this new number and count ahead that many days from the first day of your next period. Draw an X through this date on your calendar. The X marks the first day you're likely to be fertile.
    2. To find out the last day when you are most fertile, subtract 11 from the total number of days in your longest cycle. Take this new number and count ahead that many days from the first day of your next period. Draw an X through this date on your calendar. The time between the two Xs is your most fertile window.
    This method always should be used along with other fertility awareness methods, especially if your cycles are not always the same length.

Optional: Use this Ovulation and due date calculator to find out when you (or a woman you know) are most likely to become pregnant and to estimate your due date should conception occur.

Did you know?

The cervical mucus method is less reliable for some women. Women who are breastfeeding, taking hormonal birth control (like the pill), using feminine hygiene products, have vaginitis\ or \sexually transmitted infections\ (STIs), or have had surgery on the cervix should not rely on this method.
  • Cervical mucus method (also known as the ovulation method) – This involves being aware of the changes in your cervical mucus throughout the month. The hormones that control the menstrual cycle also change the kind and amount of mucus you have before and during ovulation. Right after your period, there are usually a few days when there is no mucus present or "dry days." As the egg starts to mature, mucus increases in the \vagina\, appears at the vaginal opening, and is white or yellow and cloudy and sticky. The greatest amount of mucus appears just before ovulation. During these "wet days" it becomes clear and slippery, like raw egg whites. Sometimes it can be stretched apart. This is when you are most fertile. About four days after the wet days begin the mucus changes again. There will be much less and it becomes sticky and cloudy. You might have a few more dry days before your period returns. Describe changes in your mucus on a calendar. Label the days, "Sticky," "Dry," or "Wet." You are most fertile at the first sign of wetness after your period or a day or two before wetness begins.
    To most accurately track your fertility, use a combination of all three methods. This is called the \symptothermal (SIMP-toh-thur-muhl) method\. You can also purchase over-the-counter ovulation kits or fertility monitors to help find the best time to conceive. These kits work by detecting surges in a specific hormone called luteinizing hormone, which triggers ovulation.

Infertility

Some women want children but either cannot conceive or keep miscarrying. This is called infertility. Lots of couples have infertility problems. About one-third of the time, it is a female problem. In another one-third of cases, it is the man with the fertility problem. For the remaining one-third, both partners have fertility challenges or no cause is found.\

Causes of infertility

Some common reasons for infertility in women include:
Age – Women generally have some decrease in fertility starting in their early 30s. And while many women in their 30s and 40s have no problems getting pregnant, fertility especially declines after age 35. As a woman ages, normal changes that occur in her ovaries and eggs make it harder to become pregnant. Even though menstrual cycles continue to be regular in a woman's 30s and 40s, the eggs that ovulate each month are of poorer quality than those from her 20s. It is harder to get pregnant when the eggs are poorer in quality. As a woman nears menopause, the ovaries may not release an egg each month, which also can make it harder to get pregnant. Also, as a woman and her eggs age, she is more likely to miscarry, as well as have a baby with genetic problems, such as Down syndrome.
\Health problems – Some women have diseases or conditions that affect their hormone levels, which can cause infertility.\* Women with polycystic ovary syndrome (PCOS) rarely or never ovulate. Failure to ovulate is the most common cause of infertility in women.
  • With primary ovarian insufficiency (POI), a woman's ovaries stop working normally before she is 40. It is not the same as early menopause. Some women with POI get a period now and then. But getting pregnant is hard for women with POI.
  • A condition called luteal phase defect (LPD) is a failure of the uterine lining to be fully prepared for pregnancy. This can keep a fertilized egg from implanting or result in miscarriage.

Common problems with a woman's reproductive organs, like uterine fibroids, endometriosis, and pelvic inflammatory disease can worsen with age and also affect fertility. These conditions might cause the fallopian tubes to be blocked, so the egg can't travel through the tubes into the uterus.
Lifestyle factors – Certain lifestyle factors also can have a negative effect on a woman's fertility. Examples include smoking, alcohol use, weighing much more or much less than an ideal body weight, a lot of strenuous exercise, and having an eating disorder. Stress also can affect fertility.
Unlike women, some men remain fertile into their 60s and 70s. But as men age, they might begin to have problems with the shape and movement of their sperm. They also have a slightly higher risk of sperm gene defects. Or they might produce no sperm, or too few sperm. Lifestyle choices also can affect the number and quality of a man's sperm. Alcohol and drugs can temporarily reduce sperm quality. And researchers are looking at whether environmental toxins, such as pesticides and lead, also may be to blame for some cases of infertility. Men also can have health problems that affect their sexual and reproductive function. These can include sexually transmitted infections (STIs), diabetes\, surgery on the prostate gland\, or a severe testicle injury or problem.

When to see your doctor

You should talk to your doctor about your fertility if:
* You are younger than 35 and have not been able to conceive after one year of frequent sex without birth control.
  • You are age 35 or older and have not been able to conceive after six months of frequent sex without birth control.
  • You believe you or your partner might have fertility problems in the future (even before you begin trying to get pregnant).
  • You or your partner has a problem with sexual function or libido.

Happily, doctors are able to help many infertile couples go on to have babies.


If you are having fertility issues, your doctor can refer you to a fertility specialist, a doctor who treats infertility. The doctor will need to test both you and your partner to find out what the problem is. Depending on the problem, your doctor might recommend treatment. About 9 in 10 cases of infertility are treated with drugs or surgery. Don't delay seeing your doctor as age also affects the success rates of these treatments. For some couples, adoption or foster care offers a way to share their love with a child and to build a family.

Infertility treatment

Some treatments include:
* Drugs – Various fertility drugs may be used for women with ovulation problems. It is important to talk with your doctor about the drug to be used. You should understand the drug's benefits and side effects. Depending on the type of fertility drug and the dosage of the drug used, multiple births (such as twins) can occur.
  • Surgery – Surgery is done to repair damage to a woman's ovaries, fallopian tubes, or uterus. Sometimes a man has an infertility problem that can be corrected by surgery.
  • Intrauterine (in-truh-YOOT-uh-ruhn) insemination (IUI), also called artificial insemination – Male sperm is injected into part of the woman's reproductive tract, such as into the uterus or fallopian tube. IUI often is used along with drugs that cause a woman to ovulate.
  • Assisted reproductive technology (ART) – ART involves stimulating a woman's ovaries; removing eggs from her body; mixing them with sperm in the laboratory; and putting the embryos back into a woman's body. Success rates of ART vary and depend on many factors.
  • Third party assistance – Options include donor eggs (eggs from another woman are used), donor sperm (sperm from another man are used), or surrogacy (when another woman carries a baby for you).
Finding the cause of infertility is often a long, complex, and emotional process. And treatment can be expensive. Many health insurance companies do not provide coverage for infertility or provide only limited coverage. Check your health insurance contract carefully to learn about what is covered. Some states have laws that mandate health insurance policies to provide infertility coverage.

Optional: Birth Control Methods


Birth Control Methods: Reversible and Permanent

Source: CDC, http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/Contraception.htm
In the United States, almost half of all pregnancies are unintended. Yet, several safe and highly effective methods of contraception (birth control) are available to prevent unintended pregnancy. Since 2000, several new methods of birth control have become available in the United States, including
  • the levonorgestrel-releasing intrauterine system,
  • the hormonal contraceptive patch,
  • the hormonal contraceptive ring,
  • the hormonal implant, a 91-day regimen of oral contraceptives, two new barrier methods, and
  • a new form of female sterilization.
Most women of reproductive age in the United States use birth control. Between 2006–2008, 99% of women who had ever had sexual intercourse had used at least one method of birth control; however, 7.3% of women who were currently at risk of unintended pregnancy were not using a contraceptive method. The most popular method of birth control was the oral contraceptive pill, used by 10.7 million women in the United States, followed by female sterilization, condoms, male sterilization, and other methods of birth control. Approximately 10% of women had ever used emergency contraception.

Types of Birth Control

The effectiveness of birth control methods is critically important for reducing the risk of unintended pregnancy. Intrauterine contraception and the contraceptive implant remain effective for years once correctly in place. The effectiveness of hormonal, barrier, and fertility awareness-based methods depends on correct and consistent use. For each of these methods, a range of effectiveness estimates is provided; lower estimates are based on typical use and higher estimates are based on perfect use.

Reversible Methods of Birth Control

Intrauterine Contraception* Copper T intrauterine device (IUD) —An IUD is a small device that is shaped in the form of a “T.” Your doctor places it inside the uterus to prevent pregnancy. It can stay in your uterus for up to 10 years. This IUD is more than 99% effective at preventing pregnancy.

  • Levonorgestrel intrauterine system (IUS)—The IUS is a small T-shaped device like the IUD. It is placed inside the uterus by a doctor. It releases a small amount of progestin each day to keep you from getting pregnant. The IUS stays in your uterus for up to 5 years. The IUS is more than 99% effective at preventing pregnancy.

Hormonal Methods

  • Implant—The implant is a single, thin rod that is inserted under the skin of a women’s upper arm. The rod contains a progestin that is released into the body over 3 years. It is 99% effective at preventing pregnancy.
  • Injection or "shot"—Women get shots of the hormone progestin in the buttocks or arm every three months from their doctor. It is 94–99% effective at preventing pregnancy.Combined oral contraceptives—Also called “the pill,”combined oral contraceptives contain the hormones estrogen and progestin. It is prescribed by a doctor. A pill is taken at the same time each day. If you are older than 35 years and smoke, have a history of blood clots or breast cancer, your doctor may advise you not to take the pill. The pill is 91–99% effective at preventing pregnancy.
  • Progestin only pill—Unlike the combined pill, the progestin-only pill (sometimes called the mini-pill) only has one hormone, progestin, instead of both estrogen and progestin. It is prescribed by a doctor. It is taken at the same time each day. It is a good option for women who can’t take estrogen. They are 91–99% effective at preventing pregnancy.Patch—This skin patch is worn on the lower abdomen, buttocks, or upper body (but not on the breasts). This method is prescribed by a doctor. It releases hormones progestin and estrogen into the bloodstream. You put on a new patch once a week for three weeks. During the fourth week, you do not wear a patch, so you can have a menstrual period. The patch is 91–99% effective at preventing pregnancy, but it appears to be less effective in women who weigh more than 198 pounds.
  • Hormonal vaginal contraceptive ring—The ring releases the hormones progestin and estrogen. You place the ring inside your vagina. You wear the ring for three weeks, take it out for the week you have your period, and then put in a new ring. It is 91–99% effective at preventing pregnancy.
  • Emergency contraception—Emergency contraception is NOT a regular method of birth control. Emergency contraception can be used after no birth control was used during sex, or if the birth control method failed, such as if a condom broke.
    • Women can take emergency contraceptive pills up to 5 days after unprotected sex, but the sooner the pills are taken, the better they will work. There are three different types of emergency contraceptive pills available in the United States. Some emergency contraceptive pills are available over the counter for women 17 years of age or older. If younger than 17 years, emergency contraceptive pills are available by prescription.
    • Another type of emergency contraception is having your doctor insert the Copper T IUD into your uterus within seven days of unprotected sex. This method is 99% effective at preventing pregnancy.

Barrier Methods

  • Male condom—Worn by the man, a male condom keeps sperm from getting into a woman’s body. Latex condoms, the most common type, help prevent pregnancy and HIV and other STDs as do the newer synthetic condoms. “Natural” or “lambskin” condoms also help prevent pregnancy, but may not provide protection against STDs, including HIV. Male condoms are 82–98% effective at preventing pregnancy. Condoms can only be used once. You can buy condoms, KY jelly, or water-based lubricants at a drug store. Do not use oil-based lubricants such as massage oils, baby oil, lotions, or petroleum jelly with latex condoms. They will weaken the condom, causing it to tear or break.
  • Female condom—Worn by the woman, the female condom helps keeps sperm from getting into her body. It is packaged with a lubricant and is available at drug stores. It can be inserted up to eight hours before sexual intercourse. Female condoms are 79–95% effective at preventing pregnancy, and also may help prevent STDs.
  • Diaphragm or cervical cap—Each of these barrier methods are placed inside the vagina to cover the cervix to block sperm. The diaphragm is shaped like a shallow cup. The cervical cap is a thimble-shaped cup.Before sexual intercourse, you insert them with spermicide to block or kill sperm. The diaphragm is 84–94% effective at preventing pregnancy. Visit your doctor for a proper fitting because diaphragms and cervical caps come in different sizes
  • Spermicides—These products work by killing sperm and come in several forms—foam, gel, cream, film, suppository, or tablet. They are placed in the vagina no more than one hour before intercourse. You leave them in place at least six to eight hours after intercourse. You can use a spermicide in addition to a male condom, diaphragm, or cervical cap. Spermicides alone are about 72–82% effective at preventing pregnancy. They can be purchased at drug stores.

Fertility Awareness-Based Methods

  • Natural family planning or fertility awareness—Understanding your monthly fertility pattern
    External Web Site Icon
    External Web Site Icon
    can help you plan to get pregnant or avoid getting pregnant. Your fertility pattern is the number of days in the month when you are fertile (able to get pregnant), days when you are infertile, and days when fertility is unlikely, but possible. If you have a regular menstrual cycle, you have about nine or more fertile days each month. If you do not want to get pregnant, you do not have sex on the days you are fertile, or you use a barrier method of birth control on those days. These fertility awareness-based methods are 75–96% effective at preventing pregnancy.

Permanent Methods of Birth Control

Contraceptive sterilization is a permanent, safe, and highly effective approach for birth control. These methods are meant for people who are sure that they do not desire a pregnancy in the future.

The following methods are more than 99% effective at preventing pregnancy.

  • Female SterilizationTubal ligation or “tying tubes”—A woman can have her fallopian tubes tied (or closed) so that sperm and eggs cannot meet for fertilization. The procedure can be done in a hospital or in an outpatient surgical center. You can go home the same day of the surgery and resume your normal activities within a few days. This method is effective immediately.
  • Transcervical Sterilization— A thin tube is used to thread a tiny device into each fallopian tube. It irritates the fallopian tubes and causes scar tissue to grow and permanently plug the tubes. It can take about three months for the scar tissue to grow, so use another form of birth control during this time. Return to your doctor for a test to see if scar tissue has fully blocked your fallopian tubes.
  • Male Sterilization–Vasectomy—This operation is done to keep a man’s sperm from going to his penis, so his ejaculate never has any sperm in it that can fertilize an egg. The procedure is done at an outpatient surgical center. The man can go home the same day. Recovery time is less than one week. After the operation, a man visits his doctor for tests to count his sperm and to make sure the sperm count has dropped to zero; this takes about 12 weeks. Another form of birth control should be used until the man’s sperm count has dropped to zero.
Although most women and men who undergo contraceptive sterilization do not regret having had the procedure, the permanence of the method is an important consideration, as regret has been documented in studies. For example, the U.S. Collaborative Review of Sterilization (CREST) study found that women who were younger at the time of the procedure were more likely to experience regret.
An additional issue addressed by the CREST study was the question of whether women who underwent contraceptive sterilization developed a “post-tubal ligation syndrome” of menstrual abnormalities, something that had been debated for years. Results indicated that menstrual abnormalities were no more common among women who had undergone tubal sterilization than among women who had not.
When considering a vasectomy, it’s important to understand that failures can occur. CDC research has estimated there is a probability of 11 failures per 1,000 procedures over 2 years; half of the failures occurred in the first three months after the vasectomy, and no failures occurred after 72 weeks. CDC research also examined regret among women whose partner underwent a vasectomy. In interviews with female partners of men who received vasectomies, CDC found that while most women did not regret their husband's vasectomies, the probability of regret over 5 years was about 6%. This is why it is important to know facts about this and other permanent forms of birth control before making a decision.

Sources:
Finer LB, Zolna MR.Unintended pregnancy in the United States: incidence and disparities, 2006
Adobe PDF file
Adobe PDF file
Contraception. 2011;84(5):478–485.

Mosher WD, Jones J. Use of Contraception in the United States, 1982–2008
Adobe PDF file
Adobe PDF file
National Center for Health Statistics. National Vital Health Stat. 2010;23(29).


Optional: Pregnancy


Instructions: Quick Guide to Healthy Living: Click on at least 5 topics to explore from this list of links. Be prepared to justify your selections and describe what you learned.
Pregnancy

Optional: Women's Health App


Instructions: “A Primer for Women’s Health: Learn about Your Body in 52 Weeks” The Office of Research on Women’s Health (ORWH) at the National Institutes of Health (NIH)
Women's Health Ap

Contemporary Health Issues

Open Courseware

This compilation is openly licensed under Creative Commons Attribution-ShareAlike by Judy Baker, September 2012.
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