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Contraception Continued: The Coil, Condoms and the Snip

Following on from my previous blog on the female contraceptive pill I received a lot of requests to detail other contraceptive options and any potential health implications or side effects. In this blog I’ll discuss the coil and barrier methods including condoms and the diaphragm. I’ve also had some blokes ask if I can cover vasectomies just in case they need to prepare themselves for the responsibly 😉 My biggest dilemma with this blog was what to use as the featured image lol!

The Intra- Uterine Device (Coil)

IUD_thumbnailThe Intra- Uterine Device (IUD) is a T-shaped piece of plastic.  A specially trained GP will insert the coil into a women’s uterus so that it may act as a mechanical contraception inhibiting the implantation of a fertilised egg. An important  point raised by Francesca Naish in Natural Fertility is that if intercouse takes place during fertile times of the month and the egg is fertilised then the IUD may act as an abortifacient. Some IUD’s contain copper which acts as a spermicide and some emit a low dose of progesterone to act as a contraception.

Copper IUD

This IUD has copper wires inside which allow it to act as a spermicide, killing off the sperm as they enter the womb. It may also be used as an emergency contraceptive (inserted after intercourse) and fertility usually returns much quicker than when the contraceptive pill is used. Most women’s regular cycle resumes within three months of the coil being removed. The copper ions in the IUD also increase the release of pro-inflammatory chemicals known as prostaglandins.  Therefore it may increase inflammatory symptoms including menstrual cramps, heavy bleeding and clotting.

Progesterone IUD’s (Mirena)

This IUD emits a low dose of  synthetic progesterone, around 20 micrograms daily which gradually decreases after 5 years (to around 14 micrograms) This is significantly lower than the contraceptive pill. The hormones are released locally so there are less circulating in the blood stream. In a similar manner to the progesterone only pill, the supplemental hormones will thickens the cervical mucus and thins the lining of the uterus to prevent conception. It may also halt ovulation although some individuals will still ovulate whilst with an IUD device.

Side effects

Women with a history of painful and heavy periods might wish to refrain from having an IUD. It is also not advised for the women with any of the following:

  • Abnormalities in the shape of the uterus
  • Fibroids
  • Autoimmune diseases
  • High risk of sexually transmitted disease/ multiple sexual partners
  • Previous ectopic pregnancy
  • Cervical/Uterine cancer
  • Anaemia
  • Blood clotting defects

Important health implications to be aware of:

Uterine Perforation: Although incredibly rare the IUD can become lodged in the uterus or even perforate it, causing intestinal obstruction and bleeding. In worst cases this may involve surgery to remove it.

Expulsion: There is a risk of the IUD becoming dislodged and causing discharge, bleeding or pain.

Inflammation and Infection: There is a increased risk of pelvic inflammatory disease with an IUD, increased even more so if the IUD is copper and you are exposed to sexually transmitted diseases. The copper can increase inflammatory mechanisms in the body and lower innate immune defences.

Irregular Bleeding: In the initial months the IUD may cause irregular bleeding patterns and menstrual irregularities.

Diabetic Implications: Diabetic individuals are not advised to use an IUD as the metabolic complications that accompany the condition impact upon the efficacy of the IUD.

Unplanned or Problem Pregnancies: Again this situation is rare, however, pregnancy can still occur, more specifically there’s a greater risk of ectopic pregnancy and miscarriage.

Copper toxicity: The copper contained in the IUD can create nutrient imbalances in the body, specifically with zinc as the two minerals compete for absorption. 

Source: Natural Fertility: Francesca Naish

Barrier Methods

There are few sides affects in using the barrier methods which include condoms, the diaphragm (cap) and spermicides. A condom will also protect against sexually transmitted diseases. Some of these products are chemical based and therefore it’s worth exploring more natural, organic options where possible. The main side effects and disadvantages include:

Allergies

Condom_thumbnailSome individuals are sensitive to the rubber material, lubricants or the spermicides. More natural and sensitive skin versions now exist. YES have a range of organic lubricants and there are condom brands that are free from glycerin, parabens, spermicides and petrochemicals. Popular brands include Trojan Lamb Skin made from sheep cecum (part of the intestine) before you screw your face up it’s simply a natural animal product that is also eaten in some countries. There are other brands which are also vegan, ethical sourced and not tested on animals including  Sir Richards (I chuckled at the name too) and Clyde vegan condoms. It’s worth noting some condoms contain casein, a milk protein. More ethical, organic brands are discussed here. Women can also explore FemCap which can be inserted prior to having intercourse and used with a natural spermicide like Yes or Contragel

Embarrassment & Lack of Spontaneity 

There is an element of embarrassment attached to the process of purchasing and the application of barrier methods. Popping on a love glove mid session can of course interrupt the moment and mood. Some men also complain that it compromises the sensual element for them, however, the latest design and technology seems to be working round this, maybe it’s a case of sticking a bit of lamb’s intestine on it instead 😉

Spermicide Related Congenital Abnormalities

There is some concern that if it a spermicide is unsuccessful, a damaged sperm may fertilise the egg increasing the risk of congenital abnormalities. However, the chances of this are incredibly slim as a damaged sperm are unlikely succeed in fertilising the egg and spermicides should ALWAYS be used in conjunction with a condom or diaphragm. Again natural options exist including ContraGel.

Contraceptive Injection, Implants and Vaginal Ring

Injection_thumbnailA more recent option is the Deep Provera injection. An injection of synthetic progesterone administered every 3 months which works in a similar way to the progesterone only pill and Mirena coil by preventing the growth of the lining of the uterus. It’s believed the administration of the hormones also interrupts the signalling between the hypothalamus gland in the brain and the ovaries which regulate ovulation and the menstrual cycle. Many women experience noticeably lighter or totally absent menstrual cycles whilst taking the injections.

A potential side effect of the injection is an imbalance in all the reproductive hormones and for some women it may have an androgenising effect (elevated male hormones in relation to estrogen and progesterone) which can cause weight gain and other undesirable side effects including acne and hair loss. Studies suggest it may take longer to conceive after Deep Provera, for some women it could be as long as 12 months after stopping the injections.

Another means of administering progesterone is a small implant, inserted under the skin of the arm. It slowly releases progesterone in controlled doses.  The side effects can be similar to other progesterone therapies and include weight gain, mood changes, breast tenderness, acne, hair loss, migraines and delays in fertility returning upon cessation.

Another option is the vaginal ring, a plastic ring inserted into the vagina each month and left for for 21 days before disposing. Seven days later you insert a new ring for a further 21 days.  The ring releases synthetic estrogen and progesterone to prevent ovulation, thicken the cervical mucus and thin the lining of the womb. It contains less estrogen than the combination pill so may be preferable to women who experience an increase in estrogenic side effects whilst taking the pill including breast tenderness, nausea and PMS.

Hormone Administration

Pill_thumbnailIt occurred to me that I should just briefly cover why the medical world has suddenly established alternative forms of hormone administration. Most hormones therapies in the past have been via oral tablets, they are absorbed in the intestines and then pass straight to the liver which is required to break down the dose before it can enter general circulation and reach the cells in the body. Larger doses are often given because our liver function influences the amount of the hormone released into the blood stream. As many of these hormones are taken daily it places an increased burden on liver function, most people already have their liver working overtime given the increased number of toxins in our food, water and environment and let’s not even mention caffeine, alcohol, medications and excess sugar.

Some hormones are now administered through the skin (with patches and creams), sublingually (under the tongue where it can diffuse straight into the blood) and via IUD’s and injections because the dose is easier to control and therefore allows for more flexibility and personalised hormone therapy. They still need to be broken down by the liver for detoxification eventually but it’s a significantly smaller amount.

Natural, bio-identical topical hormones are also becoming a more preferred option for individuals who feel they benefit from hormone therapy. It is always worth checking in with a nutritional therapist or Functional Medicine Practitioner as lifestyle and nutrition also play a significant role in balancing hormones. We have covered this a little here and here and will be discussing further in the menopause blog.

Vasectomies – Let’s Ask Dr Tommy

Matt squirmed when I first started looking into this 🙂 My first thought upon being asked about the long term effects of a vasectomy was to investigate the impact on testosterone levels, I confessed to assuming there might be some negative impact. However, studies either showed no adverse effect or even the opposite with an elevation in testosterone

This is one of those examples where studies may not really offer much of an insight as a vasectomy may mean that couples can get down to business more frequently without worrying about implications or faffing around with barrier methods and more Barry White moments will always have a positive impact on hormone levels in both men and women. Furthermore a woman may feel happier not taking external hormones and we all know a happy lady = a happy man 😉

There are few other concerns regarding prostrate cancer and vasectomies although again no direct association have been established in the scientific literature and it seems more in-depth studies may be necessary.

I asked Dr Tommy to offer his professional opinion on the sensitive subject…

Tommy Wood Pic 1“In general, vasectomies are considered to be a relatively safe and cost-effective method of contraception, with a less than 2% failure rate (1). However, as with any surgical procedure there is a risk of complications (bleeding, infection, pain etc), with around 3% of men potentially needing medical attention or more surgery later on after the procedure (1). Over 50% of men will get pain after the procedure, with one small study showing that 2.2% had long-term pain that affected quality of life (2).

There have been some epidemiological and animal studies that suggested vasectomies might be associated with an increased risk of cardiovascular disease, and prostate and testicular cancers. However, this has yet to be proven, and recent meta-analyses and systematic reviews suggest no significant increase in these diseases after vasectomy, though research is ongoing (3,4).

As Keris says, there is also minimal evidence that vasectomies reduce testosterone levels, and though some people have suggested this might be the case, there is little evidence to support it (5). One reason that a significant effect on testosterone levels is unlikely is because of some of the common effects of vasectomies.

Firstly, one way in which a vasectomy reduces fertility is because the procedure disrupts the blood-testes barrier, which normally protects sperm from the immune system. After vasectomy, the majority of men produce anti-sperm antibodies, which makes the immune system more likely to kill off any sperm that are produced. This is worth considering if you plan to have your vasectomy reversed, because this autoimmune effect against your sperm will usually result in a decrease in fertility. However, production of anti-sperm antibodies relies on ongoing sperm production to stimulate the immune system (6). Similarly, at least 40% of men get an accumulation of sperm as part of a “sperm granuloma” next to a vasectomised testicle. As it doesn’t take large drops in testicular testosterone levels to halt sperm production, if testosterone production had dropped significantly, this sperm accumulation would be unlikely to happen. Similarly, erectile dysfunction after vasectomy is rare, and rather than being caused by low testosterone, seems to be more likely to be caused by a negative psychological response to the procedure. As you might expect, this is more likely to happen in those that were unsure about the procedure in the first place, or felt pressured to do it (7).

Therefore, the long-term effects will probably be minimised as long as you have a frank conversation with your partner before the procedure, and have taken all of the above into account and discussed it with your urologist before proceeding. As ever, better communication = more Barry White moments (with your partner, not your urologist) = better happiness and health all around!”

Up Next…

In next weeks blog I’ll be detailing natural methods of contraception, just in time for Valentines Day woo hoo!

P.S I haven’t forgotten the menopause club either and a blog detailing how to support hormonal balance throughout the experience is coming soon 🙂

Find out more about Fitter 16

Dr Tommy Wood References
1. Cook et al. Vasectomy occlusion techniques for male sterilization. Cochrane Database Syst Rev. 2014 Mar 30;3:CD003991.
2. Choe and Kirkemo. Questionnaire-based outcomes study of nononcological post-vasectomy complications. J Urol. 1996 Apr;155(4):1284-6.
3. Köhler et al. Putative health risks associated with vasectomy. Urol Clin North Am. 2009 Aug;36(3):337-45.
4. Zhang et al. Vasectomy and the risk of prostate cancer: a meta-analysis of cohort studies. Int J Clin Exp Med. 2015 Oct 15;8(10):17977-85. eCollection 2015.
5. McDonald. Is vasectomy harmful to health? Br J Gen Pract. 1997 Jun;47(419):381-6.

6. Pienkos. The use of testosterone in the treatment of chronic postvasectomy pain syndrome: case report and review of the literature. Mil Med. 2007 Jun;172(6):676-9.
7. Buchholz et al. Post-vasectomy erectile dysfunction. J Psychosom Res. 1994 Oct;38(7):759-62.