Encyclopedia of Family Medicine

Chapter 35 Sexual knowledge and eugenics (7)
other contraceptive methods

1.contraceptive film

Put a piece of medicine film on the penis, or push it into the deep part of the vagina at the cervix with your fingers, stay for 5 minutes, and you can have sex after the medicine film dissolves.If ejaculation occurs 5 minutes before the film is inserted into the vagina.Contraceptive failure may still occur.

2. In vitro ejaculation contraceptive method

When a man feels ejaculation, he immediately withdraws his penis from the vagina, allowing the semen to drain onto a prepared towel or cloth pad.The advantage of this method is that it does not require any tools and can achieve the purpose of contraception if used properly.However, the failure rate of this method is relatively high, because a small amount of semen may have entered the vagina before ejaculation, or the action of withdrawing the penis is slightly slower, and part of the semen has been ejaculated.In addition, this contraceptive method interrupts sexual intercourse when it is about to enter the orgasm period, which has a certain impact on the sexual pleasure of both parties.Therefore, this method can only be used as an expedient measure without contraceptives.

3. Rhythm contraceptive method
Eggs generally survive for 1 to 3 days after being discharged from the ovary, and sperm can survive for about two days when they enter the female reproductive tract.The average menstrual cycle is 28 to 30 days, and the length of the cycle varies from person to person, but it should be regular.It is normal to advance or delay within 7 days.Ovulation date is 14 days before menstruation.5 days before and 4 days after ovulation are the most fertile days, called the fertile period.The time other than the fertile period is called the safe period.Using safe period sex life to achieve the purpose of contraception is called rhythm contraceptive method.This method is only applicable to people who have normal menstrual cycle, couples often live together, and can master and strictly abide by the safety period.Newly married couples, couples who do not often live together, women after childbirth or abortion, women with significant changes in mental, emotional, living environment and health conditions, and women who cannot grasp the rhythm period are not suitable for using rhythm contraception.

Choice of contraceptive method
There are many contraceptive methods, and each person can choose the appropriate contraceptive method according to his specific situation.The following principles are available for reference:
① Newlyweds who do not want children and require contraception for the time being, prefer condoms or female external contraceptives.A vaginal diaphragm can also be considered after a period of sex.Long-acting oral contraceptives and intrauterine devices are generally not used.

② Condoms are the first choice for breastfeeding women.IUDs can also be used after menstrual cramps, and oral contraceptives are not selected during lactation.

③After caesarean section, condom is the first choice, and vaginal diaphragm can be considered.If the IUD is selected, it should be half a year later.

④ For women who have one child, IUDs, oral contraceptives, condoms, etc. can all be used.

⑤ Couples with two or more children.Sterilization is preferred, such as female sterilization or male sterilization, and other contraceptive methods may also be considered.

⑥ Patients with various chronic diseases can choose the following methods in turn: condoms, vaginal diaphragms, external contraceptives, intrauterine devices, and sterilization.

⑦Safe period contraception, extracorporeal ejaculation, prolonged lactation, single-use external medication, diaphragm, and contraceptive ointment have proven to have a high failure rate and unreliable contraception, so they must be chosen with caution.

Abortion
There are three methods of induced abortion: negative pressure suction, curettage and medical abortion.

1.negative pressure suction
It is suitable for those who are within 10 weeks of pregnancy and have no contraindications for surgery.This method is relatively simple, less pain for the recipient, less bleeding, shorter operation time, and better results.

Pregnant women preparing for surgery should be aware of the following:
① Do not have sex 3 days before the induced abortion to avoid postoperative infection. If there is vaginitis, it should be cured before surgery.

② Do a good job of personal hygiene the day before the operation.Preoperative body temperature and blood pressure should be normal, urinating and emptying the bladder.

③ When performing abortion, you should cooperate with the doctor, and you don’t need to be nervous mentally. Do not move your body or use abdominal pressure to hold your breath.When you feel uncomfortable during the operation, you can open your mouth to breathe properly.

④Observe for 2 hours after the operation, and go home if there is no abnormality. Avoid heavy physical labor for 2 weeks.Keep the vulva clean, use sterile menstrual pads and change menstrual belts frequently.Prohibit bathing and sexual intercourse within one month to avoid bacterial infection and pay attention to prevent colds.At the same time, nutrition should be increased.Those who release the ring at the same time during abortion should recheck the ring position after the next menstruation is clean.There is a small amount of vaginal bleeding after the operation, which usually clears up in about a week.If there is a lot of vaginal bleeding or the bleeding lasts for more than half a month, or if you have lower abdominal pain or fever, you should go to the hospital for diagnosis and treatment in time.

⑤Multiple miscarriages will damage the health, so appropriate contraceptive measures should be actively taken after abortion to prevent re-pregnancy.

⑧Abortion surgery must be done by a doctor at the hospital. Unauthorized abortion is harmful to women's health, and in severe cases, it can even cause life-threatening.

2.Abortion forceps curettage
It is suitable for those who require termination of pregnancy within 11 to 14 weeks of pregnancy without contraindications.Precautions are the same as negative pressure aspiration.

3.medical abortion

It is a method of terminating early pregnancy without surgery and only with oral medication.After years of scientific research and clinical trials by researchers, a new type of anti-early pregnancy drug - Mifepristone (Ru 486) has been developed.This medicine is a very effective medicine for urging menstruation, stopping pregnancy and anti-fertility. According to statistics, the complete abortion rate can reach more than 92%.

(1) Indications: ① healthy women aged 18-35; ② normal intrauterine pregnancy within 49 days of menopause; ③ normal menstrual cycle (3-25 days) in the past 35 months, without steroid hormones Medications, no IUDs.Not breast-feeding; ④ no acute or chronic organic disease.No cardiovascular diseases, blood and endocrine system diseases; ⑤ no liver and kidney diseases, pregnancy pruritus, ⑥ no hormone-related tumors; ⑦ no smoking and alcohol addiction; will be exacerbated by medication).

(2) Contraindications: ① Patients with heart, liver, and kidney diseases, adrenal insufficiency, and hypertension; ② Past or current contraindications to the use of mifepristone (such as adrenal gland diseases, tumors related to steroid hormones) And diseases that contraindicate the use of prostaglandin drugs such as glaucoma, asthma and allergies; ③ Pregnancy with an intrauterine device and suspected ectopic pregnancy.

（3）服药方法：空腹或进食后2小时口服米非司酮片（25mg／片），每日2次，每次1片，共3天。第4天早晨于阴道后穹窿放置卡波前列甲酯栓1枚（1mg）。卧床休息2小时，门诊观察6小时。

(4) Precautions: ①Physical examination must be carried out before taking the medicine, including blood pressure, pulse, cardiopulmonary and gynecological examination.Liver function needs to be normal, hemoglobin should be >95g/L; platelets should be over 90×109/L and blood type should be checked; ②Must be in a medical unit with conditions for emergency curettage, infusion, and blood transfusion under the guidance of a trained doctor use below.Take the first medicine in the hospital, and take the remaining tablets (5 tablets) home. Follow the doctor's advice and take the medicine according to the taking method, and don't miss a dose.Come to the hospital on the fourth day to add prostaglandins; ③Do not take salicylate, indomethacin and other sedatives at the same time; If the blood pressure exceeds 2 times, you should seek medical attention immediately, and the obstetrician and gynecologist will handle it as appropriate; ⑤ Before and after the use of prostaglandins, measure blood pressure every 1 hour.If there is a lot of bleeding, 20 units of oxytocin can be injected intramuscularly.

male sterilization
Using methods such as surgery to make men no longer have children is called male sterilization, and its methods include vasectomy and vas deferens sticking and blocking.

1. Vasectomy
Vasectomy is a minor operation, simple and relatively safe, with few side effects.The vas deferens is the channel for transporting sperm. After it is cut and ligated, the sperm cannot be excreted, so as to achieve the purpose of permanent contraception.Vasectomy does not affect sex life, and ejaculate as usual, but there is no sperm in the semen.The secretion and delivery of testosterone are not affected after ligation, so various physiological functions of the body will not be damaged.It will not affect the ability to work.

Things to keep in mind after vasectomy are:
① Rest for a week after surgery, do not do heavy physical labor and strenuous exercise, such as long-distance walking, cycling, playing ball, bearing weight, etc.;

② Intercourse is prohibited within two weeks.Pay attention to clean the incision, and do not bathe in the water until the incision is healed to avoid infection;
③ If there is bleeding from the wound, swelling of the scrotum or fever, you must go to the hospital in time;

④ There may still be a small amount of sperm in the vas deferens and seminal vesicles near the end of the penis after ligation, so other methods of contraception should still be used within 2 to 3 months after the operation.It is best to check the semen, and then stop contraceptive measures after confirming that there is no sperm.

2.Vasectomy

Using a syringe, inject the blocking agent into the vas deferens to block the tube that transports sperm.Its purpose, effect and precautions are the same as those of vasectomy.

female sterilization
The use of surgery to permanently stop a woman from having children is called female sterilization.Methods generally include tubal ligation and tubal sticking, the former is the most widely used.

1.tubal ligation

The fallopian tubes are the passages through which eggs are delivered from the ovaries to the uterus.The fallopian tubes are cut and ligated so that the egg cannot meet the sperm.After tubal ligation, the ovary ovulates as usual, and the ovum dies, dissolves, and is absorbed by the body within a few days because it is not fertilized.Ligation of the fallopian tubes does not damage the pituitary gland and ovaries that are in charge of menstruation, nor does it damage the uterus that produces menstruation, so it will not affect women's health and menstruation.

Things to pay attention to after tubal ligation:

①The postoperative diet can be semi-liquid juice or ordinary diet;
② Get out of bed as soon as possible after surgery;
③The sutures were removed 5 days after the operation.During this period, care should be taken to keep the incision clean and dry to prevent infection.If you find blood oozing or swelling from the incision, fever and abdominal pain, you should see a doctor in time;

④ Intercourse is prohibited within one month after the operation.

2. Sterilization for fallopian tube blockage
Drugs are injected into the fallopian tubes to block the fallopian tubes and sterilize them.The method is simple and safe.But the reliability is not as good as tubal ligation, and it will be very difficult to recanalize the fallopian tubes in the future.

复孕
After tubal or vas deferens ligation, if for some reason it is necessary to restore fertility, the recanalization of fallopian tubes and vas deferens can be performed, which is the so-called re-pregnancy operation.Due to infertility caused by tubal occlusion, the couple insisted on surgery.And those who have the conditions for surgery can also perform re-pregnancy surgery.

Both couples need to consider the following factors before undergoing re-fertility surgery:
① The best age of the woman is under 35 years old, there is no obvious pathological change in the reproductive tract, and the menstruation is normal.

②The general condition is good, there is no tumor in the uterus and appendages in gynecological examination, there is no obvious inflammation and adhesion, and the ovarian function is good.

③ In the case of infertility surgery, the genitals must be normal, the ovaries should contain eggs, the uterine cavity should be well developed by hysterography, there should be no trichomonas and mold in the vaginal secretions, and the man's sperm count and function should be normal.

④ There is no guarantee of successful re-pregnancy surgery, and there should be some mental preparation in advance.

Pregnancy care
1.pregnancy signs

For married women, the following symptoms suggest that you may be pregnant:
Menstruation stops.Women of healthy reproductive age with a normal menstrual cycle, and those who are still fertile after 1 to 2 weeks of menstrual expiration after marriage, should first consider whether they are pregnant.

Nausea or accompanied by vomiting.After pregnancy, due to changes in hormones in the body, dysfunction of the gastrointestinal system often occurs, and most pregnant women have nausea or vomiting.It's more noticeable when you wake up in the morning.This phenomenon generally occurs after 6 weeks of menopause and disappears naturally at 12 weeks of pregnancy.

frequent urination.In early pregnancy, due to the enlargement of the uterus and the compression of the bladder in the pelvic cavity, symptoms of frequent urination may occur, especially at night.This symptom disappears until the uterus gradually increases and rises into the abdominal cavity.

Breast tenderness.In early pregnancy, due to the action of various hormones in the body on both breasts, the increase in mammary ducts and mammary alveoli, breast enlargement and firmness.Areola coloring.Some pregnant women feel that their breasts are full, and the pain is obvious when they rub against each other.

other.After pregnancy, some pregnant women will experience lethargy, fatigue, and changes in food preferences.

2.Maternal changes during pregnancy

During pregnancy, due to the continuous growth and development of the fetus and the changes of hormones in the body, a series of changes occur in various systems of the mother.

(1) Reproductive system.The changes that pregnant women can perceive are mainly seen in the following aspects:

Uterus.Because the fetus grows and develops in the uterine cavity, the uterus changes the most after pregnancy.The volume of the uterine cavity can be increased many times compared to before pregnancy, and the weight of the uterus is also greatly increased.By 12 weeks of gestation, the enlarged uterus is palpable in the lower abdomen beyond the pelvis.Commonly known as "out of pregnancy".From the 12th to 14th week of pregnancy, the uterus can experience painless contractions, and pregnant women feel that the uterus is hard, but such contractions only occur occasionally and generally do not cause cervical dilation, which is not a sign of premature birth.

cervix.After pregnancy, the blood vessels of the cervix increase and become thicker, the lymphatic vessels expand, and the tissue edema.Therefore, the appearance is hypertrophy and purple-blue, which is one of the references for judging early pregnancy.

vaginal.The vaginal mucosa is purple-blue, with increased folds, soft connective tissue, and increased extensibility.

vulva.The epidermis of the vulva is thickened, and the size of the labia is hyperpigmented.

(2) Breast changes.During the first trimester, the breasts begin to enlarge and become congested.Pregnant women perceive breast swelling and tingling.The nipple is enlarged and colored, and the areola is colored.Multiple raised and enlarged sebaceous glands can be seen on the areola.These changes in the nipple and areola are a feature of pregnancy.Later in pregnancy, a little thin yellow fluid often comes out when you squeeze your breasts.

(3) Circulatory system.Due to various physiological changes and the needs of fetal growth and development during pregnancy, the mother's demand for oxygen increases and the amount of blood circulation increases.Correspondingly increases the burden on the heart.During the 32-36 weeks of pregnancy, the period of childbirth and the first 3 days of the puerperium are the periods when the systemic circulatory system changes the most and the heart bears the heaviest.The circulatory system of healthy pregnant women can bear these burdens, but pregnant women with organic heart disease often develop heart failure due to the overload of the heart during this period.

(4) Urinary system.The amount of renal blood increases in the late pregnancy, and the burden on the kidneys increases due to the increase in metabolites of pregnant women and fetuses.About 20% to 30% of pregnant women can detect a small amount of urine sugar or protein in urine routine, and a small number of pregnant women even have renal function damage.In addition, under the influence of progesterone, the tension of smooth muscle in the urinary system decreases, and the enlarged uterus compresses the ureter or renal pelvis, which can cause hydroureter, so pregnant women are prone to urinary system infections.

(5) Respiratory system.The thoracic cage changes in early pregnancy, with increased diaphragmatic activity during breathing.In the third trimester of pregnancy, the uterus increases, the diaphragm activity decreases, and the thoracic activity increases, changing from the usual abdominal breathing to thoracic breathing to compensate for the lack of gas exchange.The number of breaths changed little during pregnancy, not more than 20 breaths per minute, but the breathing was deeper.However, during pregnancy, the upper respiratory tract mucosa is hyperemia and edema, and the local resistance is weakened, which is prone to upper respiratory tract infection.

(6) Digestive system.The gums are affected by a large amount of estrogen in the body and become hypertrophic, congested, edematous, sometimes painful, and prone to gingivitis and dental bleeding.During pregnancy.Due to the relaxation of the gastric cardia sphincter, gastric contents flow back into the lower esophagus, causing "heartburn"-like discomfort.In addition, the tone of smooth muscle in the gastrointestinal tract is reduced, and the secretion of gastric acid is reduced.Gastric peristalsis is weakened, gastric emptying time is prolonged, and epigastric fullness is prone to occur.Intestinal peristalsis is weakened and the enlarged uterus compresses the intestinal tract, and abdominal distension and constipation often occur.

(7) SKIN.During pregnancy, the secretion of melanocyte-stimulating hormone by the pituitary gland increases, and estrogen increases significantly, which causes pigmentation in the nipples, areola, abdominal alba linea, and vulva of pregnant women.Butterfly-shaped brown spots appear on the cheeks.It can gradually subside after delivery.

(8) Metabolism.In order to meet the needs of fetal growth and development, supplement the loss of the mother during childbirth and postpartum lactation, pregnant women have more nutritional needs than ordinary adults, and they should be satisfied in diet.

3.Hygiene during pregnancy

(1) During pregnancy, the metabolic rate of the mother increases, and she sweats more. She should take a bath frequently, change her underwear frequently, and keep her skin clean.Sitz baths should be avoided during pregnancy, especially in the late stage, to prevent sewage from entering the vagina and causing ascending infections.Vaginal secretions are more during pregnancy, and the vulva should be washed with water every day.

(2) Pay attention to nipple hygiene and prepare for postpartum breastfeeding.Since the 7th month of pregnancy, often wipe the nipples with a warm towel, and then apply oil to prevent chapped.If you have sunken nipples, you can pull the nipples away by hand, or suck them out with a breast pump, 2 times a day, 5-10 minutes each time.Don't constrict your chest, but wear a loose-fitting cotton bra or loose-fitting underwear.

(3) Keep the stool smooth and eat appropriate amount of vegetables, fruits and whole grains every day.If you have constipation, you can use laxatives under the guidance of your doctor.

(4) The spirit should be happy.Emotions should be relaxed, and there should be adequate sleep and rest.Avoid going to crowded places with dull air.Pregnancy, especially in the third trimester, should avoid heavy physical labor and strenuous exercise, and should not make long-distance bumpy travel.It is best to take a rest 2 weeks before your due date.In short, the activities of pregnant women should be moderate, such as walking, simple housework, etc., so as not to feel fatigued.

4.maternity clothes
The body shape of pregnant women changes greatly during pregnancy.Such as abdominal distension, breast fullness, and lower limbs have different degrees of edema in the third trimester of pregnancy.Therefore, the clothes for pregnant women should be loose, soft, simple in style, clean and hygienic, heatstroke-proof and warm-keeping.Do not bandage the abdomen blindly, this will affect the normal growth and development of the fetus, pregnant women will also feel uncomfortable, and affect the blood circulation of the lower limbs.Cause varicose veins and lower extremity edema, corset will affect breast development, not conducive to future breastfeeding.Pregnant women should also choose appropriate footwear, and should wear soft sandals.The heel should be short and wide, because pregnant women’s abdomen swells and the center of gravity moves forward, and the high heel will aggravate backache and abdominal drop.The socks are also not easy to be too tight, so as not to affect the peripheral circulation and aggravate the swelling of the feet.

5. Meals during pregnancy
During pregnancy, in addition to doing prenatal examinations, paying attention to hygiene, taking proper rest, etc., it is also necessary to strengthen nutrition.Because the growth and development of the fetus and the storage of nutrients by pregnant women for childbirth and breastfeeding require a certain supply of nutrients, and these nutrients must be taken from food.Pregnant women need 25% more calories than non-pregnant women.Do not control your diet because you are afraid that the fetus will grow too large, which is not good for the fetus or the pregnant woman itself.It has been proven that lack of nutrition during pregnancy can lead to miscarriage, premature birth, intrauterine growth retardation or complications during pregnancy, delivery and postpartum.

(End of this chapter)