Contraception for People with Disabilities
Methods of Contraception
|THE COMBINED PILL
Obtained only on prescription from a GP or family planning clinic. There are many different pills available, the one most appropriate to each individual can be prescribed. Contains two substances, oestrogen and progesterone, the newer pills have less hormones but are just as efficient if taken properly.
|Very effective when properly used. Requires only a small amount of manual dexterity. Controls and reduces menstrual bleeding, and period pains.||Not to be taken in combination with some other drugs eg, drugs used to control Epilepsy , so the doctor should be told of all drug treatments. Dependent on intelligence and motivation. Possibility of increased thrombosis risk in physically inactive women such as wheel-chair users.|
|THE MINI PILL
Contains one substance: progesterone
|Contains no oestrogen, so side effects due to oestrogen are eliminated. Requires only a small amount of manual dexterity.||Not quite as effective as the combined pill. Irregular periods, for some women. Must be taken regularly at about the same time each day, ie, within 3 hours. If later, continue pill and use condom for 2 days.|
|THE CAP OR DIAPHRAGM
A small rubber or plastic dome shaped device placed in the vagina before intercourse. Acts as a barrier to prevent sperm reaching the egg. Must be fitted by a doctor, and used with 3 contraceptive cream, or jelly.
|Effective when properly used. No side effects, no drug interference.||Some manual dexterity required by one or other partner to insert and remove. Dependent on motivation and intelligence. There is a possibility that emptying the bladder by pressure on the abdomen (Crede • method) could cause the cap to be dislodged. Should be checked regularly to ensure right size.|
|INTRAUTERINE DEVICE (IUD)
A small usually plastic and copper device put into the womb by a doctor. It must be periodically checked and changed every 3-5 years.
|Once put in, no further contraceptive precautions are required.||May cause abdominal discomfort and heavy periods (where toileting is difficult this can be a disadvantage). Inadvisable for a woman who takes anticoagulants. Care must be taken if the woman has no abdominal sensation, to check that the IUD is still in place, and to look for signs of pelvic infection.|
|BARRIER CREAMS AND FOAMS
Are rarely effective when used alone — should only be used under exceptional circumstances, unless with the condom or cap.
|One of the ingredients can reduce the risk of infection.||May cause irritations.|
| NATURAL METHODS OF BIRTH CONTROL (THE RHYTHM METHOD)
Based on predicting when the egg will be present and avoiding intercourse at that time. Involves daily temperature recording and abstinence from sexual intercourse for about 10 days each month. Unreliable. Now
used very rarely and usually in conjunction with the temperature method or Billings method.
|No side effects, no drug interference. No effect on periods.||Requires motivation and intelligence. Some manual dexterity required for temperature recording. Requires abstinence from sexual intercourse at specific times.|
| DEPO FROVERA
A drug given by injection. Regular injections needed every 12 weeks.
|Very effective, no further contraceptive precautions necessary. Helpful if user is forgetful or not suitable for IUD.||Irregular periods at first, then no periods. May be side effects such as weight gain. Return of fertility may take 6-10 months approx.|
| THE CONDOM
Made of thin rubber, and placed on the erect penis before intercourse. Acts as a barrier preventing sperm reaching the egg. Contraceptive pessaries/ cream should be used with the condom. The penis must be withdrawn from the vagina immediately after the male orgasm as the penis gets smaller after ejaculation, when the condom could slip off.
| Very effective when used properly. Easily obtained from chemists
or by mail order (free on NHS from family planning clinics).
No side effects or drug interference. Protection against sexually transmitted infections.
|Manual dexterity required by one or other partner to put it on. Dependent on motivation and intelligence. If condom bursts or slips off, post-coital (morning-after pill) treatment should be sought without delay from GP or family planning clinic.|
| COITUS INTERRUPTUS (WITHDRAWAL METHOD)
Man withdraws penis from vagina before he ejaculates — extremely unreliable.
|None||Can reduce both partners' satisfaction.|
PHYSICALLY HANDICAPPED PEOPLE AND CONTRACEPTION
Disability does not usually affect fertility. Where contraception is required, the method chosen must be within the physical and mental capabilities of the disabled person, or their partner and appropriate to their state of health, life style and personal preferences. There are extra considerations in the choice of contraception for a disabled person which are outlined overleaf.
STERILISATION — A permanent method of contraception which is generally irreversible. No additional contraceptive precautions are required. Sterilisation in women is carried out by either cutting or tying the fallopian tubes. This is usually done through a small incision in the abdomen and requires a one or two day stay in hospital. It may be performed after other procedures, such as a Caesarean section. It does not usually affect periods.
A HYSTERECTOMY is usually carried out for disease of the utereus but results in permanent sterilisation. Sterlisation in men (VASECTOMY) is a surgical procedure carried out under local anaesthetic. The tubes carrying sperm from the testes to the penis are cut and tied.
None of these methods of Sterlisation should adversely affect sexual performance and enjoyment, but they should be looked on as irreversible.
POST-COITAL TREATMENT — if there is unprotected intercourse, or if the condom bursts or slips off, emergency contraception or 'morning-after' pill should be sought without delay and definitely within 72 hours.
Any questions on personal issues like these can be asked on our Sex and Disability Helpline:
Post: Tuppy Owens, BCM Box Lovely, London WC1N 3XX
Email: Email Helpline
Phone: 07770 884 985 : The Helpline is open weekdays 11am to 7pm