Encyclopedia of Family Medicine

Chapter 34 Sexual knowledge and eugenics (6)
3.Women's "Three Periods"

Women's physique is relatively weak during menstruation, pregnancy and puerperium, and their disease resistance declines, so sex life should be prohibited or restrained.

(1) Menstrual period: During menstrual cramps, due to the exfoliation and bleeding of the endometrium, a wound surface that is susceptible to infection is formed. At the same time, the cervix is ​​slightly opened, and the local resistance decreases.If you have sexual intercourse at this time, it is easy to bring germs from the vagina into the uterus, causing inflammation of the uterus, vagina or pelvic cavity.In addition, sexual intercourse will aggravate pelvic congestion, increase menstrual flow, prolong menstrual periods, and seriously affect women's health. Therefore, sexual intercourse should be prohibited during women's menstrual cramps.

(2) Pregnancy: Pregnancy is a relatively long period of time, and it is difficult for most couples to have sex during this period.Therefore, sex life should be controlled according to the characteristics of each stage of pregnancy.It is generally believed that sexual life should be avoided in the first three months of pregnancy.The reason is that uterine contractions are caused by sexual arousal and mechanical stimulation.At the same time, prostaglandins in semen can promote uterine contraction and relax the cervix, which can easily lead to miscarriage.Sexual life should also be abstained during the last trimester of pregnancy.The reason is that the cervix descends and the penis penetrates during intercourse, contaminating the birth canal.Moreover, the uterus is in a hypersensitive state during this period, and the orgasm stimulates the uterus to contract, which can easily cause premature delivery.Although sexual life is not prohibited at other times, it is also necessary to restrain sexual life, and violent sexual life should be avoided.At the same time, attention should be paid to the posture of sexual intercourse to avoid pressure on the woman's abdomen.Usually choose the female-lying male kneeling front-entry style, the female kneeling-lying rear-entry style, and the double-standing rear-entry style. In short, the principle is to make the woman comfortable without oppressing the abdomen.

(3) Puerperium: During childbirth, the uterus and vagina are traumatized, and the perineum often needs to be incised.It takes a long time for the healing of perineal wounds and the recovery of uterine wounds.Coupled with heavy bleeding during childbirth, physical exertion during labor, and the fatigue of feeding the baby, etc., the body is extremely weak and the ability to resist diseases is reduced. It takes a long time (about 6-8 weeks) of recuperation and rest to recover.During this period, especially the first 4 to 6 weeks, sex life should be absolutely prohibited.Premature sex life can easily cause cervicitis, endometritis, adnexitis, pelvic inflammatory disease and uterine bleeding, and also hinder the healing of vaginal and perineal birth injuries.At the same time, premature sexual life makes women worry about infection and pain, which can easily cause psychological pressure and even lead to psychological disorders.Therefore, both men and women should restrain their sexual desire after giving birth, and start sex life after the woman's body has fully recovered.

4.other taboos

(1) After drunkenness: it is not suitable to have sex. "The Yellow Emperor's Canon of Internal Medicine" has a saying: "Using wine as syrup, taking delusions as constant, getting drunk to enter the house, using desire to exhaust the essence, and dissipating the truth, not knowing how to hold full, controlling the spirit from time to time, being quicker than the heart, and contrary to life Happiness, life without restraint, so half a hundred will decline.” After being drunk, he loses control, and his sexual behavior is often rough. He only cares about his own venting and ignores the other party’s emotions.In addition, pregnancy after drinking and having sex can also affect the growth and development of the fetus, which can lead to fetal deformities, and may cause mental retardation when they grow up.

(2) It is not suitable to have sex if you are too full or hungry. Being too full during sex can easily cause food reflux, affect digestion and absorption, and even cause nausea and vomiting.When hungry, the energy metabolism in the body is significantly reduced, coupled with a large amount of sexual life consumption, prone to collapse.

(3) Bad mood, harsh environment, hot weather, are not suitable for sexual life.

contraceptive method

1.condom
The condom is made of soft and thin latex. It is put on the penis before sex, and the semen is discharged into the small sac at the front of the condom during ejaculation, so that the sperm has no chance to enter the female reproductive tract.Its usage and precautions are as follows:
There are four types of condoms: large, medium, small, and special. They can be selected according to the thickness of the penis after erection. Generally, the medium size is used.Condoms that are too large are easy to slip off, and condoms that are too small are easy to break and cause discomfort during intercourse.

Air should be blown before use to check whether the condom has any cracks. If there is air leakage, it cannot be used.

After ejaculation, pinch the mouth of the penis before the penis is completely soft, pull out the penis and the condom together, and use a condom every time you have sex.No need to save after use.

The following factors may lead to contraceptive failure: ① Failure to carefully check whether the condom has leaks before use, so that semen flows into the vagina; ② Failure to squeeze out the air in the sac before use, the pressure in the condom increases after ejaculation, and the semen overflows; ③ Failure to withdraw the penis and condom in time after ejaculation.The penis shrinks, and semen can flow into the vagina from between the penis and the condom; ④The condom slips off and falls into the vagina.

Other precautions are: People who are allergic to latex or silicone oil should not use condoms.If the condom is found to be broken during intercourse, any of the following remedial measures can be taken: ①Take 53 tablet of No. 1 contraceptive pill as soon as possible, and then take 1 tablet a day for 4 consecutive days, and then take 1 tablet the next day, a total of 4 times, before and after Take a total of 8 tablets; ②Installation of intrauterine devices within 5 days.About 7 to 8 days after fertilization, the egg implants on the wall of the uterus. Before that, placing intrauterine contraceptives can play an anti-implantation role.It can not only remedy this contraceptive mistake, but also prevent pregnancy for many years; ③Put the external contraceptive suppository or film into the vagina immediately to kill the sperm leaking in the vagina.

The reliability of the above methods is in order: the second type > the first type > the third type.

2. Vaginal diaphragm (cervix cap)

Contraceptives for women.It is made of latex, flat and round in shape, and a steel wire spring is embedded in the surrounding rubber membrane.Before sexual intercourse, the vaginal diaphragm is placed on the top of the vagina to cover the cervix so that sperm cannot enter the uterine cavity.The placement method is:

Inspect the vaginal septum for damage before use.Urinate, wash your hands, take a squat or half-lying position on the bed, separate your legs, and then separate the labia with your left hand, and put the diaphragm into the vagina with your right hand. The direction of insertion is downward and backward along the back wall of the vagina. Push the back of the diaphragm against the cervix.After putting it away, you can have sex.

The diaphragm can only be removed 8 to 12 hours after sexual intercourse. If the diaphragm is removed too early, the sperm has not been inactivated, and pregnancy is still possible.However, the vaginal diaphragm should not be placed in the vagina for more than 24 hours.

Wash your hands, insert your right finger into the vagina, hook the front edge of the diaphragm, take out the diaphragm upwards and outwards, and wash it for later use.

Before using the vaginal diaphragm, it should be checked by the medical staff to select the appropriate number.

If it is used in combination with contraceptive ointment, the contraceptive effect can be improved. When in use, the contraceptive ointment can be applied to the protruding surface of the diaphragm and around the spring ring.

Women with vaginitis, severe cervical erosion, prolapsed uterus, loose or bulging vaginal walls are not suitable for vaginal diaphragms.

3.IUD
The IUD, commonly known as the contraceptive ring, is a contraceptive tool placed in the uterus.Usually made of materials such as stainless steel, plastic or silicone rubber.

There are many kinds of intrauterine devices used at home and abroad. Most of them are plastic products abroad, and metal products are mostly used in China, such as stainless steel rings, stainless steel palace rings, twist rings and double rings.

(1) Stainless steel single ring
一般统称为金属单环，圆形，是国内应用最普遍的一种宫内节育器。按环的外径分为18、19、20、21、22、23、24等型号。最常用为18、20、21、22号。此种环放置和取出都较方便，一般不须扩张宫颈，随访复查容易。环在X线下显影。

(2) Stainless steel palace type
A spring womb-shaped ring that is a stainless steel wire wound into a helix.Generally divided into three types: large, medium and small.It is convenient to place and take out, without dilating the cervix, and the ring can be visualized under X-ray.The off-ring rate and pregnancy with ring are higher than those with single ring.But there are certain side effects, such as increased menstrual flow, bleeding and so on.This ring is mostly used for women with a history of ring removal.

(3) stainless steel twist ring, double ring

Due to certain side effects, the cervical dilation is required when the ring is inserted and removed at the same time, so it is rarely used clinically.

After the intrauterine device is placed in the uterine cavity, the natural environment in the uterine cavity and the biological and physical characteristics of the endometrial surface are changed through the action of mechanical foreign bodies, thereby affecting the implantation of fertilized eggs and achieving the purpose of contraception.Its contraindications are as follows:
① Severe systemic diseases, such as heart failure, severe anemia, bleeding disorders or acute stages of various diseases;
②Reproductive organ inflammation, such as acute and chronic pelvic inflammatory disease, vaginitis, severe cervical erosion;
⑧A history of excessive menstrual blood or irregular bleeding;
④ The cervix is ​​too loose, severe old cervical laceration or severe uterine prolapse;
⑤ The uterine cavity is too large or too small: the diameter of the uterine cavity is >9 cm or <5 cm;

⑥ Reproductive organ tumors, such as uterine and ovarian tumors;

⑦ reproductive tract deformities.Placement of an IUD before a deformed uterus is diagnosed is likely to cause surgical injury, and the IUD is not easy to place in the correct position, so the ring should not be inserted.For the double uterus, after a definite diagnosis, those with better development will place IUDs in the two uterine cavities respectively.

The time to place the IUD is generally 3 to 7 days after menstruation is clean.After abortion (artificial or natural) or full-term delivery, it is best to place it after one menstruation; cesarean section should wait half a year and after one menstruation; lactating amenorrhea requires placement without contraindications, it should be placed first Consider placement after excluding pregnancy.

Precautions for placing the contraceptive ring are:
Not all married women can place an IUD, so seek medical advice.

After placing the IUD, you can rest for 3 days, avoid heavy physical labor for one week, prohibit sexual life and bathing within two weeks, and keep the vulva clean to avoid pelvic infection.

After placing the IUD, please consult a doctor if you experience irregular vaginal bleeding, increased leucorrhea, back pain, etc.

定期复查。术后1个月、3个月、半年、1年各复查1次，以后每年复查1次，以及时发现宫内节育器有无脱落或异位。

IUD placement time: The stainless steel metal ring can be placed in the uterine cavity for about 20 years, the plastic ring or silicone rubber IUD can be placed for 3 to 5 years, and the progesterone-releasing IUD can be placed for 1 year .

The IUD can be taken out in the following situations: ①The period of insertion has expired, ②The menopause has been over half a year, ③Planning for another child or switching to other contraceptive measures, ④Severe side effects (such as heavy bleeding, long duration, etc.) , low back pain, menstrual cycle disorder, increased menstrual flow, etc.) who are ineffective after treatment, ⑤ who have ectopic or incarcerated IUDs.

The ring removal conditions are the same as the ring release conditions, and the appropriate time is 3 to 7 days after menstruation is clean.In case of special circumstances such as uterine bleeding or infection due to the insertion of the birth control ring, it can be taken out at any time.The birth control ring is taken out at the same time as the abortion.

Placement of the IUD does not affect sexual life, and fertility can be restored after removal.Inserting or removing an IUD takes minutes and is painless.The material of the IUD is very good, stable in nature, will not rust and deteriorate, and will not be embedded or grow into the uterine wall, so there is no need to worry about it.

drug contraception

Oral contraceptives were first used clinically in 1956.It has been used since 1963 in our country.The steroid female contraceptives currently used at home and abroad are artificially synthesized estrogen, progesterone and their compound preparations.They inhibit ovulation, change the viscosity of cervical mucus, prevent sperm from passing through, or change the tissue shape of the endometrium, affect the implantation of fertilized eggs in the endometrium, or change the peristalsis speed of the fallopian tubes, so that the fertilized eggs are separated from the uterus. Membrane development is not synchronized to achieve the purpose of contraception.

1. Classification of contraceptives
There are five types of contraceptives: long-acting, short-acting, visiting relatives, contraceptive injections, and sustained-release systems.

(1) Long-acting oral contraceptives
It is composed of one or two synthetic progestogens plus a long-acting estrogen.Take the medicine once for contraception for 1 month.The effective rate of contraception is above 98%.Commonly used drugs are as follows:
Compound 18 methyl norethisterone.Take one tablet on the 5th day and the 25th day from the day of menstruation.Remember the date of the second dose, and then take the drug on this date every month, 1 tablet each time.To enhance the contraceptive effect, the dose may be doubled during the first three or four doses.

Compound ethinyl estradiol.The method of administration is the same as above, but it is not necessary to double the dosage for the first three or four times.

Compound 16 methyl chlormadinone.On the 5th day from the day of menstruation, start taking the first medicine, take the second medicine after 20 days, take the third medicine after another 20 days, and then take it once every other month, each time is 1 tablet .

You only need to choose one of the above three drugs.

(2) Short-acting oral contraceptives
有口服避孕片0号、1号、2号和复方甲基炔诺酮短效片四种。剂型有片剂、纸式薄型片和滴丸三个类型。使用时可选任一种避孕药，从月经当天算起的第5天开始服药，每天服1片。连服22天不能间断，下个月即往后以此类推。短效避孕片的避孕效果为99．95%。

(3) Birth control pills for family visits
Also known as fast-acting contraceptives.Applicable to couples who live apart in the West for temporary short-term visits to relatives.While taking medicine, it is not restricted by menstrual period, and the contraceptive effect can reach 99%.Commonly used drugs and usage are as follows.

Megestrol tablets (visiting relatives contraceptive tablet No. 1).Take 1 tablet at noon on the day of visiting relatives or wedding, take 1 tablet in the evening, and then take 1 tablet every night until the end of visiting relatives, and then take 1 tablet the next day.If you are visiting relatives and stay together for less than 14 days, you should also take 14 tablets to ensure the contraceptive effect.

炔诺酮。于探亲当天晚上开始服用1片，以后每晚1片。同居1~10天，必须连服10丸，同居11~14天连服14丸，探亲1月者，服完14丸后接着服短效避孕片1号或2号至探亲结束。服药期间不来月经，一般停药1周即月经来潮。

18-甲基炔诺酮。同居前1~2天开始服用，一日1片连服10~15天。如同居超过半月者，从第16天起可接服短效口服避孕片1号或2号，一直到假期结束停止服药。

醋炔醴探亲避孕药。于探亲前一天或当日服药。一次1片，可避孕2周左右。如同居时间超过2周，可从服药的第15天起接服短效避孕片1号或2号。

53号探亲避孕片。短期探亲每次性生活后即服1片，每天最多服1片，但探亲的第一次性生活后次晨须加服1片。1个月经周期内（28~30天内）服药总量不得少于10片，以保证避孕效果。

23号探亲片。探亲当日服2片（上午1片，晚上1片，或当晚服2片）。以后每3天服1片或每周服2次，每次1片。探亲结束后第2天再加服1片。服药期间遇月经来潮即停药。月经后第一次房事起按同法服药。1个月经周期内至少服足5片以保证效果。

Methyl ether anti-pregnancy tablets.Take 1 pill at noon on the day of visiting relatives, and then take 1 pill after each sex life.

(4) contraceptive injection
Can be used for intramuscular injection, generally not commonly used, you can consult a doctor when necessary.Not introduced in detail here.

(5) Slow-release contraceptives
It is a special dosage form, which can continuously release a constant small dose of contraceptive pills to achieve long-acting contraceptive effect.There are silicone rubber subcutaneous implants and silicone rubber vaginal contraceptive rings.After one insertion, the former can prevent pregnancy for 1 to 5 years, and the latter can prevent pregnancy for 1 year.Their disadvantage is that they have more side effects, and subcutaneous implantation requires minor surgery.

2.Use of oral contraceptives

Precautions when using birth control pills:

Contraceptives have certain side effects. People with the following conditions should consult a doctor before using contraceptives: heart failure, liver and kidney dysfunction, high blood pressure, diabetes, malignant tumors, breast lumps, tuberculosis, uterine fibroids, thyroid function hyperactive.

The following patients are generally not allowed to use contraceptives: acute and chronic hepatitis has not been cured, thrombotic vascular disease, blood disease, acute and chronic nephritis has not been cured, lactating women (contraceptives inhibit milk secretion), postpartum menstruation has not returned to normal.

To take the medicine on time, the time of taking the medicine is generally chosen about half an hour after lunch.For those who take short-acting contraceptives, if they forget to take the pills on the same day, they can take another pill the next morning, and take the pills as usual in the evening, otherwise the contraceptive effect will be affected.

Do not change the type of contraceptive pill without the consent of your doctor.

Store medicines properly.If the tablet is found to be damp, the sugar coating layer is worn, or cracked, it should not be used again.

A small number of people will experience nausea, dizziness, fatigue, drowsiness, loss of appetite and other similar early pregnancy reactions after taking the medicine.Mild cases do not need to be dealt with, and the drug reaction can be reduced or disappeared after taking the medicine for a few days.Severe cases can adopt: ① diet therapy.Such as eating something, drinking some strong tea, chewing some pickles and ginger; ②Drug treatment.Vitamin B6, diazepam, etc. can be used as appropriate.

Some people may experience changes in menstrual cycle and menstrual volume after taking the medicine. The treatment methods are as follows: ① Amenorrhea.It usually recovers naturally after stopping the drug.If menstruation does not come after stopping the drug, you should start taking the next cycle of tablets on the seventh day.Don't wait too long to avoid pregnancy; if you don't have menstruation for two consecutive months, you can see a doctor;

Individuals have breast swelling or pain, facial pigmentation, and weight gain after taking the medicine. Generally, there is no need to deal with it, and most of them can return to normal after stopping the medicine.

Increased leucorrhea is a common reaction after taking the medicine. It usually occurs after 2-3 cycles of taking the medicine. Generally, no treatment is required. If it is serious, you should see a doctor.

During the use of oral contraceptives, if the following drugs are used at the same time, the incidence of irregular vaginal bleeding will be significantly increased, menstrual disorders, the effect of contraceptives will be reduced, and even contraceptive failure: ①Antibiotics: erythromycin, rifampicin; ②Central nervous system drugs : phenytoin sodium, meproton, chlordiazepoxide, paratonin, carbamazepine, carbamazepine; ③ antipyretic analgesics: phenacetin, phenylbutazone.

During the use of the following drugs, oral contraceptives may reduce their efficacy or increase their side effects: ① Paracetamol.Oral contraceptives accelerate the excretion of paracetamol from the body; ② Antihypertensive drugs.After several months of oral contraceptives, it can cause high blood pressure and edema, thus reducing the efficacy of antihypertensive drugs; ③ insulin, D-860, Jiangtangling.Oral contraceptives accelerate the excretion or failure of these drugs, weakening the hypoglycemic effect; ④ iron.Oral contraceptives are not conducive to the absorption of iron; ⑤ imimida howl, amitriptyline, doxepin.Oral contraceptives slow down the metabolism of these drugs, increasing their side effects.

Smoking and drinking can weaken the effectiveness of oral contraceptives.

(End of this chapter)