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Insertion of an IUD can be done by a clinician within five to seven days of unprotected intercourse.

The Copper T-380 A IUD (ParaGard) is used for emergency contraception. It can be left in place for up to 10 years to provide very effective contraception. Or, if you prefer, the IUD can be removed after your next menstrual period, when it is certain that you are not pregnant.

IUD insertion for emergency contraception is not recommended for women who are at risk for sexually transmitted infections:

• women with more than one sex partner or whose partners have more than one partner

• women with new partners

• women who have been raped

The side effects, advantages, and disadvantages of using IUDs for emergency contraception are the same as those associated with using IUDs for ongoing contraception.

Effectiveness of Emergency Contraception

Of 1,000 women who use emergency IUD insertion, only one will become pregnant.

Of 100 women who use emergency hormonal contraception, up to two will become pregnant.

The closer a woman is to ovulation at the time of unprotectected intercourse, the less likely the method will succeed. If 100 women have vaginal intercourse without contraception during the second î third weeks of their cycle when they are most fertile, eight will become pregnant. Using emergency contraception reduces a woman’s chance by about 75 percent—two out of 100 during her most fertile days.

Emergency contraception is meant for emergencies only. It is not as effective as the regular use of reversible contraception—Norplant, Depo-Provera, the IUD, or the Pill.

Morning-after pills only help prevent pregnancy from one act îf unprotected intercourse. They do not continue to prevent pregnancy during the rest of the cycle. Other methods of birth control must be used.

Emergency contraception offers no protection against sexually transmitted infections.

Where to Get Emergency Contraception

Emergency contraception is available at Planned Parenthood health centers, public clinics and women’s health centers, private doctors and hospital emergency rooms—unless they are affiliated with religions that oppose the use of birth control.

You can get the name, address, and phone number of three emergency contraception providers nearest you by calling, toll-free, the emergency contraception hot line—800-584-9911.

Take-home packs

Packs of morning-after pills are available from some women’s health centers for women whose medical histories are well known to their clinicians. Take-home kits allow women to use the medication u emergency situations without having to wait to see their clinicians.

What Emergency Contraception Costs

Costs vary. Costs depend on which of the following services are needed. Here are some estimates:

Morning-after pills

Morning-after pills kit $8 to $15

One pack of combination pills $20

Two packs of progestin-only pills $50

Visit with health care provider $35 to $150

Pregnancy test $10 to $20

Total cost $75 to $245

Fees may be less at family planning clinics and health centers.

IUD

The ParaGard IUD costs about $450 for exam, IUD, and insertion. It lasts for 10 years, however, which works out to only $45 a year if left in place.

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After you take the pills

• Your next period may be earlier or later than usual.

• Your flow may be heavier, lighter, or more spotty than usual.

• If you see other health care providers before you get your period, remember to tell them that you have taken morning-after pills.

• Schedule a follow-up visit with your clinician if you do not menstruate in three weeks or if you have symptoms of pregnancy.

• Be sure to use another method of contraception if you have vaginal intercourse before your period.

Side effects

Side effects associated with the use of morning-after pills usually taper off one or two days after the second dose has been taken.

• Nausea, usually mild, is experienced by 50 percent of women who use morning-after pills.

• Up to one out of three women experience vomiting.

• Breast tenderness, irregular bleeding, fluid retention, and headaches may occur.

If you use emergency contraception frequently, your periods may become quite irregular and unpredictable. Repeated use is not advised.

Emergency contraception may not prevent ectopic pregnancy. Ectopic pregnancies develop outside the uterus. They must be treated or they will cause complications that may cause death.

If you think you may have an ectopic pregnancy, get medical attention immediately. Signs of ectopic pregnancy include:

• severe pain on one or both sides of the lower abdomen

• abdominal pain and spotting, especially after a missed menstrual period or a very light one

• feeling faint or dizzy

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Emergency hormonal contraception is a sequence of two doses of certain oral contraceptives. The most common “morning-after” pills are “combination” pills that contain estrogen and progestin—synthetic hormones like the ones produced by a woman’s body. Progestin-only pills—mini-pills—may be used by women who cannot take estrogen.

Women who request morning-after pills should review their medical histories with their clinicians before receiving the medication.

You should not use morning-after pills if:

• you are pregnant from a previous act of intercourse

• you have missed your period or it is late

• you are allergic to the medication

How to Use Morning-After Pills

There are several kinds of pills that can be used. Your clinician will designate the brand and dose for you. The pills are taken in two doses, 12 hours apart. You must use only one type of pill and use it for all doses.

Using Progestin-Only Pills

Progestin-only pills may be more appropriate for women who cannot take estrogen. Take 20 tablets of Ovrette within 48 hours of unprotected intercourse and then take another 20 tablets 12 hours later.

Using Combination Pills

Combination pills that are currently used for emergency contraception include Ovral, Lo/Ovral, Nordette, and Levlen. If ó take your pills from a regular 28-pill pack of combination pills, ó can use any of the first 21 pills for emergency contraception.

You can also use Triphasil or Tri-Levlen. The first 21 pills these pills are in three different colors—you must use only the yellow ones.

If you are using Ovral, each dose is two pills. If you are using any other kind of combination pill, each dose is four pills. The dose repeated in 12 hours.

Don’t use the last seven pills in a 28-day pack. They are only reminder pills that contain no hormones.

First dose: Swallow the pills in the first dose as soon as possible a no later than 72 hours—three days—after having unprotected intercourse.

Nausea is a possible side effect when combination pills are used. You may want to eat a snack of saltines or soda crackers or drink a glass of milk 30 minutes before taking each dose to avoid vomiting. Your clinician may prescribe an antinausea medication or suggest ó use an over-the-counter product such as Dramamine.

The side effects of antinausea medication may include light headedness, dizziness, or feeling spacey. Please follow the precautions on the package insert.

Second dose: Swallow the second dose 12 hours after taking the first dose. If vomiting occurred after the first dose, be sure to use an antinausea medication 30 minutes before taking the second dose. Or ó may want to take the second dose as a vaginal suppository.

If you vomit the second dose, do not take any extra pills—it unlikely that they will reduce the risks of pregnancy any further. It is likely that they will increase your risk of nausea.

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Emergency contraception is designed to prevent pregnancy after unprotected vaginal intercourse takes place. It is also called postcoital or “morning-after” contraception.

At some time in their lives, most women are faced with the fear that they might have an unintended and unwanted pregnancy. In fact, the average woman spends 75 to 80 percent of her fertile years trying to avoid pregnancy. During that time, she may forget to use a contraceptive, her contraceptive may fail, or she may be coerced into having unprotected vaginal intercourse.

You may want emergency contraception if:

• his condom broke or slipped off, and he ejaculated inside your vagina

• he forced you to have unprotected vaginal intercourse

• your diaphragm or cervical cap slipped out of place, and he ejaculated inside your vagina

• you miscalculated your “safe” days for periodic abstinence or fertility awareness methods

• you forgot to take your birth control pills

• you weren’t using any birth control

• he didn’t pull out in time

Contact your health care provider immediately if you have unprotected intercourse when you think you might become pregnant.

Emergency contraception is available from health care providers, Planned Parenthood health centers, and other women’s health and family planning centers. It is for use only if a woman is sure she is not already pregnant. It prevents pregnancy by preventing fertilization or implantation. It will not cause an abortion.

Emergency contraception is provided in two ways:

• emergency hormonal contraception—doses of birth control pills

• insertion of an IUD

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Diaphragms and cervical caps are reversible barrier methods of birth control that are available only by prescription. Both are soft rubber barriers that are intended to fit securely over the cervix. Both are used with a contraceptive cream or jelly.

The diaphragm is a shallow, dome-shaped cup with a flexible rim that fits securely in the vagina to cover the cervix.

The cervical cap is thimble-shaped, smaller than the diaphragm, and fits snugly over the cervix itself.

How Diaphragms and Cervical Caps Work

If you choose the diaphragm or cervical cap, you must coat it with spermicide and insert it deep into the vagina before intercourse. Each blocks the entrance to the uterus, and the jelly or cream immobilizes sperm, preventing it from joining the egg.

The diaphragm can be inserted up to six hours before intercourse and may be left in place for 24 hours. Each time sex is repeated, more jelly or cream must be inserted in the vagina (without removing the diaphragm).The cervical cap may be left in place for up to 48 hours. Using additional spermicide with the cap is optional.

Effectiveness of Diaphragms and Cervical Caps

Of 100 women who use diaphragms, 18 will become pregnant during the first year of typical use. Six will become pregnant with perfect use. Of 100 women who have not given birth and who use the cervical cap, 18 will become pregnant during the first year of typical use. Nine will become pregnant with perfect use. Of 100 women who have given birth and who use the cervical cap, 36 will become pregnant during the first year of typical use. Twenty-six will become pregnant with perfect use. You may increase protection by checking that the cervix is covered every time you have intercourse.

Diaphragms and cervical caps may provide some protection against certain sexually transmitted infections, including chlamydia and gonorrhea.

Advantages of the Diaphragm and Cervical Cap

• Once learned, insertion is easy. Insertion can be part of bedtime routine, or it can be shared by both partners during sex play.

• If properly placed, the devices are generally not felt by either partner during intercourse.

• These barrier methods may reduce the risk of developing cervical cancer.

Who Can Use Diaphragms and Cervical Caps

Diaphragms can be worn by most women when they are not menstruating. They are not recommended for women who have:

• poor muscle tone of the vagina or a sagging uterus

• a history of toxic shock syndrome

• recurrent urinary tract infections

Cervical caps can be worn by most women when they are not menstruating. They can be used by women whose pelvic muscles are too relaxed to hold a diaphragm in place. Some women cannot be fitted with existing sizes.

Compared to the diaphragm, the cervical cap may be more difficult and time-consuming for a professional to fit and for a woman to learn to insert and remove.

Women who are not comfortable touching their genitals will probably not like the diaphragm or cervical cap.

It is not wise to use a diaphragm or cervical cap during any kind of vaginal bleeding, including menstruation. Infection may result.

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Breasts are important. They serve many functions during different times of our lives. They are the warm, soft milk bottles we drink from as babies. They are the first sign of our physical maturation from little girls to women during puberty. They are a signal of our sex, which distinguishes us from, and therefore attracts, men. They are the warm, soft milk bottles with which we feed our own babies.

No wonder we may feel rather sensitive about them if they are threatened by disease.

There are many conditions which can affect breasts, and cause women to go to their doctor. The problem may involve the skin of the breast, as in the case of a rash, or a boil. Many women suffer from breast pain, which is rarely associated with cancer, but which still requires diagnosis and management. Breast lumps, however, are always treated with suspicion, and should be investigated thoroughly.

A breast problem may be found by the woman herself, by her sexual partner, or by a doctor performing a routine breast examination. Once an abnormality is identified, it should be investigated until a diagnosis is made.

Certain information can be obtained from the history and examination, but the definitive investigation of breast problems usually involves having some tests performed. Most women can expect to undergo some, or all of the following:

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Physical reasons. If there is something affecting die lining of the uterus, making it more difficult for the conceptus to implant, it is more likely to miscarry. Physical barriers to a pregnancy continuing include an abnormally shaped uterus, or trauma, such as pelvic procedures, operations or infections.

Psychological factors. There is thought to be a relationship between stress and anxiety, and hormones, the nervous system, blood vessels, muscles, etc. This may play a part in some miscarriages, but it would be difficult to prove or quantify. Some researchers have shown a relationship between anxiety and recurrent abortion.

Diseases. Some specific infections are associated with an increased risk of miscarriage, but any severe illness (acute or chronic), may affect a pregnancy.

Medications. There has been some suggestion that some drugs, like anti-cancer treatment, and possibly anaesthetic gases, may increase the risk of miscarriage.

Maternal age. Older women (in medical terms, those over 35) have a higher chance of miscarriage than younger women, perhaps because some developmental problems in the conceptus are more common with age.

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Coming to terms with a difficult decision, like how to cope with an unplanned, unwanted pregnancy is an intensely personal experience. No one can tell you how to do it. Ultimately a person has to make a decision that is right for her. She should not be having an abortion because she feels that someone else would prefer it that way; she is the person who should be uppermost in her concerns.

She does not have to make the decision on her own. Many women find that talking things through makes it easier, but choosing a person to share those thoughts with is the difficult part, particularly if you do not want anyone to know. A friend or relative may be helpful, but there are also trained counsellors at many centres who are available to help women in this situation.

If a woman does decide to have an abortion she may experience emotional reactions.

Dealing with your emotions about having an abortion can sometimes be difficult. It may be that the abortion coincides with a difficult time in a relationship, or increases tensions within a family. If a woman does not want anyone to know about it this can place greater stress on her. She may be worried about what effect an abortion may have on her relationship with her partner, or her family. Any number of added factors can compound her feelings.

Sometimes the partners of women who have had abortions find it useful to discuss their feelings, and some abortion clinics and counsellors provide this help if it is needed.

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This is the big one. ‘AIDS’ stands for ‘Acquired Immune Deficiency Syndrome’, and HIV is the name of the bug which causes the disease: ‘Human Immunodeficiency Virus’. If this book had been written fifteen years ago, AIDS would not have even rated a mention, because as far as we knew, it didn’t exist. It has, unfortunately, made its presence felt in no uncertain terms.

One reason that HIV has made such an impact on our lives is that it kills people. Infection may not cause symptoms initially, but there is, at the moment, a 100 per cent death rate among infected people, although the time between infection and death may be relatively long. In some studies in developed countries, only 50 to 60 per cent of infected people have become ill after ten years. Treatments have been found, and are still being developed to increase the length of time an infected person remains well. It is hoped that an effective treatment may one day change the course of this disease. Until then we can only hope to beat it by preventing its spread, relieving the suffering of the people it affects, and continuing to look for an effective cure.

The disease was first noticed in the early 1980s. In Australia and the United states it was initially predominantly found in homosexual and bisexual men (and they still account for the majority of infected people in Australia), intravenous drug users (the second biggest group here), and people who had been given infected blood and blood products. (This was before the Blood Bank knew about it. Now all blood is screened before being given, and the risk of getting infected blood is considered minuscule.) The disease has spread to varying degrees in different populations. In some developing nations, for example in parts of Africa and Asia, the rate of HIV infection among the general population is alarmingly high; men, women and children are infected in enormous numbers, and the proportion is increasing. This illustrates that the virus has the ability to be spread through heterosexual intercourse (the main route of transmission world-wide), and poses a great threat if we do not change our patterns of behaviour. The routes by which the virus is spread are:

• sex. It is in semen and vaginal secretions.

• blood and blood products. This includes sharing intravenous needles and syringes, as they are contaminated with blood.

• from a mother to a baby, either during pregnancy or childbirth.

Many people are concerned that traces of the virus have been reported in saliva (spit), but it appears that the amount is so small that it would take a bucketful, literally, to transmit the virus (and it is not often that one sees a bucketful of spit, fortunately). The possibility exists that it may also be found in breast milk. There is no evidence that it is spread though non-sexual social contact, like touching, kissing, sharing cups, etc.

The virus can be spread through oral, vaginal or anal intercourse. The skin can act as a weak barrier to transmission of the bugs, but microscopic breaks and small cuts in the skin can speed up transmission, and make it easiest for the bugs to get through. This is why more physically traumatic intercourse, like anal intercourse, is thought to spread the virus so well. Similarly, if there are other infections around which have helped to break down the skin’s barrier, like ulcers or sores in the genital region (like herpes or syphilis) or cervical infections (like chlamydia and gonorrhoea), the rate of transmission is probably higher. This may contribute to the very rapid transmission rate in developing countries and communities where heterosexual spread is more apparent than in developed societies to date. The rate of all sexually transmitted diseases is higher in underprivileged communities, and AIDS in particular is sweeping through parts of Africa with ferocity.

HIV causes damage by affecting the body’s immune (infection- and cancer-fighting) mechanisms. This means that the person who carries the virus will eventually lose the natural defence mechanisms which ward off disease. This leaves the person susceptible to other bacterial, fungal and viral infections and some cancers, one or more of which will eventually lead to death.

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The temperature method. A further guide to recognizing the riming of ovulation is to monitor the body temperature. Interestingly there is a tiny increase in a woman’s ‘basal’ (usual) temperature following ovulation. This is in the range of 0.2 to 0.6?C, and if a woman takes her temperature (via a thermometer in either her mouth or her vagina), she may be able to recognize this change, and know that ovulation has probably occurred. She should abstain, as outlined above, but as it is a ‘retrospective’ reading, she may find that the ovaries have fired off sooner than her calendar predicted, and in fact she is closing the gate after the sperm have bolted (so to speak).

The mucus method. The mucus (the dear sort of normal discharge in the vagina) changes under hormonal conrrol during the cycle. About ovulation time there is more clear, thin mucus. After ovulation it becomes stickier and tacky. Women may use this change as a further sign that ovulation has taken place. While it may be useful as an adjunct to other methods, it is not all that reliable as the mucus viscosity is also affected by such things as semen and infections.

Of course all these useful signs of ovulation can be helpful when trying to become pregnant, too. Simply try harder during the ‘fertile’ time. Some researchers have developed home ovulation detection kits, which may be useful to some women as another means of assessing if ovulation has taken place. These are probably more use to women trying to get pregnant rather than avoiding it.

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