246节默克诊疗学第十八章妇科与产科对照版本精编版.docVIP

……………………………………………………………最新资料推荐………………………………………………… PAGE PAGE 1 [General] One or both members of a couple can use contraception to prevent pregnancy temporarily or sterilization to prevent pregnancy permanently. Induced abortion (elective termination of pregnancy) can be used when contraception fails. The couples decision to begin, prevent, or interrupt a pregnancy may be influenced by prenatal diagnosis or genetic counseling (see Chs. 247 and 286). Infertility is discussed in Ch. 245. Contraception The contraceptive methods most commonly used in the USA are (in order of popularity) oral contraceptives (hormones), condoms, withdrawal (coitus interruptus), periodic abstinence, progestin injections, spermicides, diaphragms, progestin subdermal implants, and intrauterine devices (IUDs). Each method has advantages and disadvantages, and each method, other than complete abstinence, can fail. Diaphragms, condoms, spermicides, and withdrawal are much more likely to fail, especially with inexperienced users, than are methods unrelated to coitus (eg, oral contraceptives, IUDs). Over several years, pregnancy rates are 1%/yr with oral contraceptives, IUDs, progestin injections, and subdermal progestin implants and about 5%/yr with coitus-related methods. However, condoms have the added advantage of protecting against sexually transmitted diseases. Emergency contraception, taken after fertilization occurs, should not be used as a regular method of contraception. Barrier Contraceptives Condom use is the only reversible effective male method other than withdrawal. If used properly, the condom provides considerable protection against sexually transmitted diseases (only latex condoms can protect against HIV) and may prevent premalignant changes in the cervix. The condom should be applied before penetration and should not fit too tightly (the tip should extend about 1/2 in beyond the penis to collect the ejaculate); it must be removed carefully so that none of the content