Choosing a Contraceptive
Choosing a method of birth control is a highly personal decision, based on individual preferences, medical history, lifestyle, and other factors. Each method carries with it a number of risks and benefits of which the user should be aware.
Each method of birth control has a failure rate–an inability to prevent pregnancy over a 1-year period. Sometimes the failure rate is due to the method and sometimes it is due to human error, such as incorrect use or not using it at all. Each method has possible side effects, some minor and some serious. Some methods require lifestyle modifications, such as remembering to use the method with each and every sexual intercourse. Some cannot be used by individuals with certain medical problems.
Spermicides Used Alone
Spermicides, which come in many forms–foams, jellies, gels, and suppositories–work by forming a physical and chemical barrier to sperm. They should be inserted into the vagina within an hour before intercourse. If intercourse is repeated, more spermicide should be inserted. The active ingredient in most spermicides is the chemical nonoxynol-9. The failure rate for spermicides in preventing pregnancy when used alone is from 20% to 30%.
Spermicides are available without a prescription. People who experience burning or irritation with these products should not use them.
Periodic abstinence entails not having sexual intercourse during the woman’s fertile period. Sometimes this method is called natural family planning (NFP) or “rhythm.” Using periodic abstinence is dependent on the ability to identify the approximately 10 days in each menstrual cycle that a woman is fertile. Methods to help determine this include:
- The basal body temperature method is based on the knowledge that just before ovulation a woman’s basal body temperature drops several tenths of a degree and after ovulation it returns to normal. The method requires that the woman take her temperature each morning before she gets out of bed. There are now electronic thermometers with memories and electrical resistance meters that can more accurately pinpoint a woman’s fertile period.
- The cervical mucus method, also called the Billings method, depends on a woman recognizing the changes in cervical mucus that indicate ovulation is occurring or has occurred.
Periodic abstinence has a failure rate of 14% to 47%. It has none of the side effects of artificial methods of contraception.
In-Office Procedure for Permanent Sterilization
What is Essure?
Essure is a safe, effective in-office procedure for permanent sterilization.
During the procedure, a small camera called a hysteroscope will be inserted into the uterus to visualize the fallopian tube openings called ostia. A thin introducer will place a small coil within the fallopian tube during a quick ten minute procedure in the office. There is minimal cramping when the coil is placed. There are small fibers within the coil that will induce scar tissue to form causing blockage of the fallopian tubes.
How long has Essure been available and how long has Dr. Martinez been doing Essure?
Essure has been available for over 15 years. Dr. Martinez started performing Essure in 2007 and now does several procedures weekly. Dr. Martinez’ patients are extremely happy with Essure and their experience with the procedure.
What kind of follow up do I need to do for Essure?
Since it takes about 3 months for the body to form the scar tissue that will block the fallopian tube, you would need to use a back-up method of contraception for three months until you have an x-ray called a hysterosalpingogram or HSG. During the HSG, dye is injected into the uterus and an x-ray is taken to confirm that no fluid goes past the Essure implants to confirm that the tube is blocked. After the HSG confirms tubal occlusion, you will not need additional contraception.
How much time do I have to take off for Essure?
We perform the procedure in our office most mornings. You would need someone to drive you to and from the appointment due to the pain medications you are given. We usually have you arrive at about 8AM and you can resume all normal activity including work and exercise later that day.
How much discomfort is associated with the Essure procedure?
There is minimal cramping during the procedure. We do premedicate you with oral pain medication about 30 minutes prior to the procedure. Ten minutes prior to the procedure we perform a local anesthetic block around the cervix. The procedure itself takes about 10 minutes and postoperative discomfort is minimal.
How do I know if I am a candidate for Essure?
You must be 100% certain that you don’t want more children as Essure is irreversible.
“The (Essure) procedure was not uncomfortable at all. Everyone made me feel comfortable and relaxed. I would most definitely recommend Dr. Martinez and this procedure to friends and family.” – Joann
Surgical Laparoscopic Tubal Ligation
Surgical sterilization must be considered permanent and irreversible. Laparoscopic Tubal Ligation is performed in the operating room under general anesthesia. A small incision (5mm) is made in the umbilicus and another small incision is made above the pubic bone. Gas is insufflated into the abdomen and small plastic tubes, or trochars, are introduced into the abdominal cavity. A small camera, or laparoscope, is introduced into the abdomen. Through the lower port, a device called a Kleppinger Cautery device, is used to grasp and burn the middle portion of the fallopian tubes. After the tubes are cauterized, laparoscopic scissors are used to transect the fallopian tubes so that recanalization of the fallopian tubes is less likely. There is a 1/500 risk of failure of a laparoscopic tubal ligation.
Major complications, which are rare in female sterilization, include: infection, hemorrhage, and problems associated with the use of general anesthesia. It is estimated that major complications occur in 1.7 percent of the cases, while the overall complication rate has been reported to be between 0.1% and 15.3%.
Although there has been some success in reopening the fallopian tubes, the success rate is low, and sterilization should be considered irreversible.