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Introduction

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The Membranous Envelope (condom) is prepared from the bladder of a fish caught in the Rhine. Its extreme thinness does not in the least interfere with the pleasure of the act … [its use] is of the greatest utility because, while it is a sure preventive of conception, it also prevents either party from contracting disease.

EDWARD BLISS FOOTE, MEDICAL COMMON SENSE, 1864

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The classic family planning consultation is the presentation of a young woman for contraceptive advice. It is a very critical visit and provides an excellent opportunity to develop a good rapport with the patient and provide education and counselling about important health concerns, such as health promotion, menses regulation, sexual activity, planned parenthood, fertility and infertility, pregnancy prevention, STI prevention, immunisation and cervical screening.

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In counselling and treating patients, especially teenagers, confidentiality is of paramount importance. Keep in mind the Gillick test of competency for females aged under 16 (see CHAPTER 97). The issues and contraceptive methods can be confusing so careful education using charts and other aids is recommended to enhance the therapeutic relationship and facilitate better compliance. It is worth discussing the patient’s attitude to pregnancy, including the fear of pregnancy and the possible reaction to contraceptive failure.

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Fertility control

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The choice of contraceptive methodology will be determined not only by individual needs, personal preference and resources but also by its effectiveness, safety and incidence of side effects.

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In developed countries of the Western world, the most widely used methods in order of preference are the male condom, combined oral contraceptive pill, intra-uterine device (IUD), female sterilisation and withdrawal.1

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The past decade has seen a wider availability of long-acting reversible contraception (LARC). LARC methods are defined as non-permanent contraception administered less frequently than once a month. They include implants, IUDs and injectables. LARC methods are the most effective reversible contraceptives, with failure rates for typical use virtually the same as for perfect use. For this reason, LARC plays an important public health role in reducing unintended pregnancies.2 Approximately half the pregnancies in the US are unintended and occur because of non-use of contraception, failure of a specific method or discontinuation of contraception.3 While many women are satisfied with oral contraceptives or barrier methods, it is important to check their awareness of LARC proactively.4

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A comparison of the failure rates of the various contraceptive methods is presented in Table 99.1.

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Table 99.1

Effectiveness of contraceptive methods

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