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Natural Family Planning Methods

The most fertile period of a woman is from the 10th (rarely 9th) to the 18th day, provided the cycle is of 28 days.


Natural family planning (NFP) methods are based on the premise that Coitus should be avoided during this fertile period of the woman, as determined by timing or calculating the time of ovulation.

  1. Rhythm Method
    In a woman having a regular 28-day cycle, the unsafe period is from day 7 to day 2L The chance of pregnancy is at its minimum (10 per 100 women-year) when coitus is avoided between day 7 and day 21, whereas the failure rate rises to 25-35 per 100 women-year if coitus is avoided only between day 8 and day 18.
  2. Basal Body Temperature Method
    This method is based on the fact that after ovulation, the progesterone level in the blood rises, increasing the basal metabolic rate and causing rise of temperature by 0.5-0.8°For 0.2-O.4°Cin the luteal phase, Sometimes there is a slight drop of 0,2°F just before the rise.
  3. Cervical Mucus Method
    The cervical mucus method is also called "ovulation method" or more commonly "Billings' ovulation method. This method is based on recognizing the changes that occur in cervical mucus due to the effect of estrogen and progester one at different times of the menstrual cycle.

    Just before that, at the time of ovulation, the mucus becomes more copious, clear, and slippery, resembling the white of a raw egg, and can be stretched slowly between two fingers. The vagina and vulva feel moist or wet. This persists for about 3 days. These are called "wet days"; the last day of wet mucus is called the "peak day." These days mark the peak of fertility.
  4. Symptothermal Method
    The symptothermal method pinpoints the fertile period with greater precision and reliability. It is based on observation of basal body thermal change (by basal body temperature-BBT -method), cervical mucus change (by Billings method), and other manifestations of the fertile period such as mid-cycle pain, mid-cycle light spotting, or bleeding and breast tenderness.

    Typical failure rates of NFP methods as commonly used is 20% (20 per 100 women) in the first year of use. However, it can be reduced to 1-9% in the first year of use, when used consistently and correctly.



NFP methods are not suitable for women:

  1. With irregular cycles, cycles shorter than 21 days
  2. During adolescence, lactation, and premenopause
  3. Who have had cervical surgery (cautery and conization)
  4. With vaginal infection (until cure)
  5. Who have sexually transmitted disease (STD) or pelvic inflammatory disease (PID) in the last 3 months
  6. Who had abortion recently
  7. Non cooperative husbands and couples who have casual sex.

Withdrawal Method

  1. Withdrawal method or coitus interruptus means discharge of semen outside the female genitalia at the end of intercourse.
  2. Typical average failure rate per 100 users in the first year is 18.



Premature ejaculation is the only contraindication.




The advantages of the withdrawal method are that it (a) involves no expense, (b) needs no medical supervision, (c) requires no prior preparation, and (d) causes no definite harm. The main drawbacks are the lack of full sexual satisfaction and the relatively higher failure rate.


Persona: It is a device that detects urinary estrone-3-glucuronide, which indicates the beginning of fertile period, and LH, which indicates ovulation.

Lactational Amenorrhea Method

Excessive secretion of prolactin, which controls lactation, inhibits the pituitary. Prolactin inhibits LH but has no effect on FSH. However, it partially inhibits ovarian response to both of these gonadotropins. As a result, while the prolactin level remains high, the ovary produces little estrogen and no progesterone. Hence, ovulation and menstruation are affected.


Failure rate of lactational amenorrhea method (LAM) (for 6 months only) is less than 2% when correctly and consistently used, but it is more otherwise.


The breast-feeding practices required by LAM have other health benefits for mother and baby:

  1. It provides the healthiest food for the baby.
  2. It protects the baby from life-threatening diarrhea.
  3. It protects the baby from diseases such as measles and pneumonia by passing on the mother's immunities to the baby.
  4. It helps to develop a close relationship between mother and baby.
  5. It protects the mother from diseases such as subinvolution, fibroadenosis, and fibroadenoma of the uterus.
  6. Breast feeding reduces risks of breast cancer and epithelial ovarian cancer.

Barrier Contraceptives

  1. Condoms
    1. Condoms are contraceptive sheaths meant to cover the penis during coitus to prevent pregnancy. They are also known as French letters.
    2. The condom is the oldest and most widely used birth control device in the world. In the folklore of contraception, its invention is attributed to a physician named Dr Condom, who recommended it to Charles II.
    3. Condoms are mostly made of fine latex rubber and are available in various shapes and colors. They are circular cylinders, 15-20 cm in length, 3-3.5 cm in diameter and 0.003-0.007 cm in thickness; they are closed at one end and open at the other with an integral rim.
    4. Nonlatex forms of male condoms are now commercially made of polyurethane. Polyurethane condoms have a longer shelf life and can be used with oil-based lubricants, which can damage latex condoms.
    5. It is most harmless method of contraception.
    6. When used properly, the condoms give very good protection against STDs. These include not only traditional syphilis and gonorrhea but also trichomoniasis, moniliasis, nongonococcal urethritis, and infection with chlamydia and herpes virus.
    7. The condom seems to give best protection against sexually transmitted AIDS. Condoms also give protection against sexually transmitted hepatitis B virus. Protection against STD benefits male and female partners as well as their children.
    8. When used for more than 5 years, barrier methods, particularly the condom, reduce the chance of developing severe cervical dysplasia and cervical cancer as compared to the use of oral pills or to nonuse of contraceptives.
    9. Storage and disposal problems affect village people and reduce use of condoms. They should be wrapped in a piece of paper and thrown in dustbins or buried underneath the soil but should never be left in commodes or flushing-type latrine pans.
    10. Typical average failure rate of condom as commonly used is 12%.
    11. Total condom failure rates (breakage and slippage rate combined) range from 4% to 13%.

Non-contraceptive uses of condom include.

  1. Prevention of STDs
  2. Condom catheter in males
  3. To cover the TVS probe
  4. After vaginoplasty
  5. Shivkars pack (condom tamponade) for atonic PPH.
  6. In cases of antisperm antibodies present in cervical mucus.
  1. Occlusive Caps (Vaginal Diaphragm and Cervical Cap)
    1. Occlusive caps do not act as sperm-proof mechanical barriers like condoms but are used as a means to retain spermicides in contact with the cervical os.
    2. Spermicides must be used along with these devices.
    3. After intercourse, the vaginal diaphragm and vault cap should not be removed before 6-8 h of the last act and should not be kept for more than 24 h. The best time to introduce it is from a few minutes to 2 h before the sexual act, mostly at bedtime, and it should be removed next morning.
    4. Like condoms, diaphragms and cervical caps prevent spread of STDs, although less effectively.
    5. However, AIDS is not prevented by these contraceptives.


  1. Infection may set in if caps are not removed for a long time.
  2. The chance of erosion may increase.
  3. Diaphragms increase the chance of urinary infection.
  4. Occlusive caps do not prevent spread of AIDS.
  5. Very rarely, diaphragms and occlusive caps may produce toxic shock syndrome (TSS).


  1. Prolapse uterus, cystocele
  2. Badly lacerated or eroded cervix
  3. WF (vesico vaginal fistula)
  4. RVF (rectovaginal fistula)

Failure Rate


Vaginal diaphragms and cervical caps have typical average failure rates, as commonly used, of 18-28%. Diaphragms should be replaced anytime between 6 months and 2 years (depending on its care), for the rubber may perish. Caps need less frequent replacement.

  1. Vaginal Sponge
    1. "Today" is a soft, disposable foam sponge made of polyurethane. It is round shaped, with a depression at the center of the upper surface designed to fit over the cervix, and is saturated with nonoxynol-9, the most powerful spermicide: it has an attached nylon loop that helps in its removal. It is moistened with water, squeezed gently to remove excess water and inserted high up in the vagina to cover the cervix.
    2. It acts for 24 h, and intercourse may be repeated as often as desired during this period. Like the cervical cap, it can be introduced long before the sex act. The failure rate varies between 9 and 27 per 100 users in the first year.
    3. It must be removed and thrown away after 8-24 h but not before 6 h of the last act. The real danger of the sponge is development of TSS, although it happens very rarely.
  2. Spermicides
    1. Spermicides are contraceptive chemical agents. They comprise a chemical capable of destroying sperms incorporated into an inert base. The commonly used spermicidal agents contain nonionic surfactants that alter sperm surface membrane permeability, causing osmotic changes resulting in the killing of sperms. Most spermicides contain nonoxynol-9, which is best for the purpose.
    2. Their main role is to improve the contraceptive effect of other barrier methods. They are mostly used along with diaphragms, cervical caps, and condoms.
    3. Spermicidal agents nowadays contain nonoxynol-9. A few products contain octoxynol-9 and menfegol.
    4. There is no evidence that spermicides including nonoxynol-9 offer any protection against HIV and other STIs. Furthermore, there is some evidence that frequent use of nonoxynol-9 (twice a day or more) increases rather than reduces, the chance of HIV transmission, perhaps by irritating the vaginal and cervical mucosa.
    5. Typical average failure rate, as commonly used, is 21%.
  3. Female Condom
    1. A female condom, by the trade names of "Femidom" or "Reality," is a new disposable barrier contraceptive for women. It consists of soft, loose-fitting polyurethane sac about 15 cm long and 7 cm in diameter.
    2. Sexual intercourse takes place within the cavity of the device.
    3. It is a women-controlled method and can even be used without the partner's cooperation.
    4. It prevents STDs including HIV / AIDS.


  1. Intercourse is noisy, and slippage occurs in about one in 5-10 uses; however, female condom rarely breaks.
  2. Occasionally the penis is introduced, by mistake, outside the female condom, which may lead to pregnancy and STDs including HIV.
  3. It is an expensive method.

Use effectiveness is similar to that of a diaphragm with spermicide.

Typical failure rate, as commonly used, is 21 %.


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