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
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.
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.
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.
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
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
A comparison of the failure rates of the various contraceptive methods is presented in Table 99.1.
Effectiveness of contraceptive methods
|Favorite Table|Download (.pdf) Table 99.1
Effectiveness of contraceptive methods
| ||Failure rate (%) during first year of use |
|Contraceptive method ||Typical use ||Perfect use (consistent and correct) |
|No method ||85 ||85 |
|Fertility awareness-based methods ||24 ||0.4–5 |
|Withdrawal ||22 ||4 |
|Barrier || || |
|• Female: || || |
| • diaphragm with spermicide ||12 ||6...|
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
Murtagh Collection Full Site: One-Year Subscription
Connect to a suite of general practice resources from one of the most influential authors in the field. Learn the breadth of general practice, including up-to-date information on diagnosis and treatment, as well as key clinical skills like communication.
Pay Per View: Timed Access to all of Murtagh Collection
48 Hour Subscription $34.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.