0521779407-C03 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:54
402 Contraception for the Internist
Overall protective effect on risk of ectopic pregnancies
➣Complications
Perforation, infection, and expulsion
Increased rates of 2nd trimester abortion, premature delivery,
low birth weight and stillbirth when IUD not removed in 1st
trimester
➣Prognosis
First year failure rate:
Copper, 0.5%
Progestin, 0.1%
■Barrier methods:
➣Diaphragm: circular metal ring covered with latex; fitted by
provider; used with spermicides; left in 6 h after intercourse
➣Cervical caps: latex rubber, covers only cervix, harder to fit
➣Condoms: latex sheath to cover penis (latex-free condoms avail-
able)
➣Female condom: also requires spermicide
➣Sponge: in place up to 24 h
➣Side Effects
Allergy to latex or to spermicides
Increased incidence of UTIs with diaphragm
Increased risk of toxic shock syndrome with diaphragm and
sponge
➣Special Situations
Condom breakage uncommon
Petroleum-based products markedly reduce strength of con-
doms
Both male and female condoms decrease risk of STDs
➣Prognosis
First-year failure rate:
Diaphragm, 18%
Cervical cap, 18%
Condoms without spermicides, 12%
Female condoms with spermicides, 15%
■Female sterilization:
➣Postpartum sterilization: partial salpingectomy
➣Uni/bipolar coagulation
➣Silicone band application (Falope ring)
➣Hulka or Filshie clips
■Side Effects
➣Concern regarding menstrual irregularities not supported