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Sex Ed 102: Implants/Transcervical Sterilization


What are Implants / Transcervical Sterilization?

When the word “transcervical” (meaning “through the cervix“) sterilization is used, it’s meant to encompass any method of Permanent Contraception where a health care provider reaches the fallopian tubes through the cervical opening of the uterus to block the tubes, preventing an unintended pregnancy.

In 2002 the U.S. Food and Drug Admisitration (FDA) approved a small metallic implant called Essure as safe form of Permanent Contraception. The implant itself is a small, soft, flexible metal and fiber coil that is placed into the fallopian tubes to prevent pregnancy.

How does a the Essure Implant work?

Once the Essure Implants are in place it works by making scar tissue form over the implant, blocking the fallopian tube and preventing fertilization of the egg by the sperm.

Essure Benefits 2How is a Transcervical Sterilization performed?

The procedure does not require cutting into the body or the use of radio frequency energy to burn the fallopian tubes. Instead, a health care professional inserts the soft, flexible implants through the body’s natural pathways (vagina, cervix, and uterus) and places one into the opening of each of the 2 fallopian tubes. The very tip of the device remains outside the fallopian tube, which provides immediate visual confirmation that it is in place.

What can a patient expect after the procedure?

During the 3 months following the procedure, the patients body forms scar tissue over the inserts to form a natural barrier that prevents sperm from reaching the egg. During this period, the patient must continue using another form of birth control like a condom.

After three months, it’s time to get a confirmation test to verify that the patient is protected from the possibility of an unplanned pregnancy. The test uses a dye and special type of x-ray to ensure both that the inserts are in place and that the fallopian tubes are completely blocked.

What are the advantages?

  • No surgery, burning or anesthesia
  • No hormones
  • No slowing down to recover
  • Can be performed in less than 30 minutes
  • Allows sexual spontaneity and requires no daily attention.
  • It is a permanent form of birth control.
  • There are no changes in sexual desire, menstrual cycle, or ability to breastfeed
  • May be covered by Heath Insurance

What are the disadvantages?

  • May not be reversible.
  • It is meant to be a permanent form of birth control, and some women may regret the decision later.
  • The two most common factors associated with regret are young age and unpredictable life events, such as change in marital status or death of a child.
  • It can be expensive, usually around $2,000 with insurance covering a portion
  • Allergic reaction to the materials
  • Perforation, expulsion, or other unsatisfactory location of the micro-insert
  • Symptoms during or immediately after the procedure may include mild to moderate cramping, nausea/vomiting, dizziness/light-headedness, and bleeding/spotting
  • Not all women will achieve successful placement of both inserts

How effective is the Essure Implant/Transcervical Sterilization?

During clinical trials the Essure procedure was found to be 99.74% effective.


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Sex Ed 102: Tubal Ligation

If you’ve watched my videos on YouTube over the years you’re likely well versed with my support of safe sex practices.  You know, the kind that leave you free of worries about an unintended pregnancy or possible transmission of an STD. As such, I hope this page gives you the insight you need to help find a method of protection that’s right for you.

tuballigation1What is a Tubal Ligation?

For those who have decided that they do not want more (or any) children, tubal Ligation, commonly referred to as “getting your tubes tied,” is a surgical sterilization technique that can be done at any time.

Before we go over what tubal ligation is, it’s important to understand how pregnancy occurs; every month the fallopian tubes carry an egg from one of your ovaries to the uterus. By blocking or removing the path egg takes through the fallopian tubes, the egg cannot travel to the uterus and be fertilized. If the egg doesn’t become fertilized by sperm, a pregnancy cannot occur.

In a tubal ligation, the fallopian tubes are cut, burned, or blocked with rings, bands, or clips (pictured right) with the intention of permanently blocking or removing the path the egg takes therefor stopping any chance of a pregnancy occuring.

How is a Tubal Ligation Performed?

The procedure is an out-patient surgery done in a clinic, doctor’s office, or hospital which can be performed under local or general anesthesia.

There are 3 ways in which a Tubal Ligation may be performed

1.) As an outpatient procedure; a needle is inserted through the navel and the abdomen is inflated with gas (carbon dioxide or nitrous oxide). Then a laparoscope (a thin tube equipped with a camera lens and light, pictured left) is inserted into the abdominal cavity to help them see the pelvic organs. Using instruments passed through the abdominal wall, the doctor will seal the fallopian tubes by destroying segments of the tubes or blocking them with plastic rings or clips. If the laparoscope doesn’t contain a channel for passing instruments, the doctor may make a second incision above the pubic bone to insert special grasping forceps. After the procedure has been completed the gas will be withdrawn from the abdomen and the small incision will be sewn up. Patients may be allowed to go home several hours after the procedure or required to spend the night in the hospital depending on the health of the patient and any previously made arrangements.

2.) After child birth; If having a tubal ligation after vaginal childbirth is a more fitting option, the doctor will likely make a small incision under the navel, providing easy access to the still enlarged uterus and fallopian tubes. The health care provider then cuts and ties the fallopian tubes.

3.) During a C-section: with easy access to the area, the health care provider will cut and tie the fallopian tubes after the baby is delivered.

Generally the procedure takes about 30 minutes. In some cases, it is done immediately after a woman gives birth. If the procedure was done in combination with childbirth, the tubal ligation isn’t likely to prolong the patients hospital stay.

What can a patient expect after the procedure?

Whether or not the tubal ligation was performed in combination with childbirth, patients usually need to rest for at least a day after the procedure.

Common side effects may include:

  • Abdominal pain or cramping
  • Fatigue
  • Dizziness
  • Gassiness or bloating
  • Shoulder pain
  • Sore throat

It has been advised that patients avoid using aspirin for pain relief, since it may promote bleeding. Bathe 48 hours after the procedure is usually okay, , but avoid straining or rubbing the incision for one week. Carefully dry the incision after bathing making sure that it is clean and there is no discharge which could be a sign of infection. Also avoid strenuous lifting and sex for one week. Patients are advised to resume normal activities gradually as they begin to feel better. More often the health care provider will use stitches that will dissolve and won’t require removal. It’s also important to make an appointment to see your doctor a week after the procedure to make sure the body is healing properly.

What are the advantages?

  • Female sterilization does not involve hormones.
  • It is a permanent form of birth control.
  • There are no changes in sexual desire, menstrual cycle, or ability to breastfeed.
  • The procedure is usually a same-day procedure done in a surgical outpatient clinic.
  • Immediately effective.
  • Allows sexual spontaneity and requires no daily attention.
  • Cost-effective in the long run.

What are the disadvantages?

  • The procedure involves general or regional anesthesia.
  • May not be reversible.
  • It is meant to be a permanent form of birth control, and some women may regret the decision later.
    • The two most common factors associated with regret are young age and unpredictable life events, such as change in marital status or death of a child.
  • It can be expensive, ranging between $1,500 and $6,000
  • Does not offer protection against STD’s, so a secondary method may need to be used.

How effective is Tubal Ligation?

A study taken from the The United States Collaborative Review of Sterilization has shown the cumulative 10-year failure rate with each method of tubal ligation as follows:

  • spring clip method is 3.7%,
  • electrocoagulation is 2.5%,
  • interval partial salpingectomy (partial removal of tubes) is 2%,
  • silicone rubber bands is 2%,
  • postpartum salpingectomy (tubes cut after delivery) is 0.8%.

To learn more about each of the above methods of tubal ligation please speak with your health care provider.


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Beginners Guide: Condoms

As you all know I’m a big supporter of safe sex, the kind that leaves you free of worries about an unwanted pregnancy or possible transmission of an STI.  As such, I hope this “beginners guide: condoms” post will give you further insight to the options available when it comes to safer sex practices and help you find a method of protection that’s right for you.

condomsWhat are Condoms?

Condoms are a flexible sleeve made of latex, lambskin, polyisoprene, or polyurethane, and are meant to be worn over the erect penis as means of a prevention against unintended pregnancies and/or to help stop the transmission of STI’s.

Readily available in different colors, textures, and flavours, condoms have come a long way since the days when they were made of sheeps intestines.

For those in need of a condom more specific to size, they also come in a small variety of options, from Snugger fit to Magnum. On average condoms are 7.5 inches long, 2 inches wide at the shaft and a little more than 2 inches wide at the head

Types of Condoms

Generic Latex CondomLatex: Latex condoms can only be used with water based lubricants, anything oil based like Vaseline, natural oils (almond, coconut etc), lubricants, or cold cream, will break down the latex causing it to tear or fall apart completely. If you find latex condoms leave you feeling sore, raw, red and rashy, itchy, or swollen, it may be due to an allergic reaction to latex (some people have them), in that case I’d suggest using polyurethane or sheepskin condoms instead.

Trojan Bareskin Non-Latex CondomPolyurethane: Compared to latex condoms, polyurethane condoms are often the go-to material for those with latex allergies. They’re often thinner and stronger than latex, and have been found to be a little less constricting size wise. Polyurethane condoms also transfer heat much better than latex, which for some may make the experience more pleasurable.

Skyn Polyisprene condomPolyisoprene: If latex and polyurethane condoms don’t work for you, polyisoprene may be the way to go. They tend have a softer, more natural feel, and will conform to skin in a similar way to latex. Since they’re the newest material on the market there aren’t too many manufacturers making them, with LifeStyles (SKYN) and Durex (Avanti Bare) brands being your only options.

natural lamb condomsLambskin: Lambskin condoms are made from the intestinal membrane of a lamb. Yes, you read that right, the intestinal membrane of a lamb. Due to small pores within the membrane, lambskin condoms are ineffective when it comes to protecting against viruses that cause STIs. Fortunately they do protect against pregnancy, since the pores are too small for sperm to pass through. It’s been said that they have a more “natural” feel (when compared to latex and polyurethane), in the case of polyisoprene they’re fairly similar.

There’s also the female/internal condom; a sheath placed inside the vagina up to 8 hours before intercourse, designed to protect against STI’s and unintended pregnancies.

Lubrication on condoms also varies; some are not lubricated at all, some are lubricated with a silicone base, others have a water-based lubricant. The lubrication on condoms aims to make the condom easier to put on and more comfortable to use and can also help prevent condom breakage.

Ultimately, it’s up to you which type of condom you choose. Just remember, it’s important to always use either a male condom or female condom to avoid the possibility of transmitting and STI, as other methods of protection only offer protection against unintended pregnancies.

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Sex Ed 102: Reversible Contraception Methods

“Birth Control” by definition relates to the use of any practices, methods, or devices that are employed to prevent pregnancy from occurring. The main goal of any birth control method is to either prevent fertilization of an egg, or implantation of a fertilized egg in the uterus.

When I speak of Reversible Birth Control Methods I am referring to any practice of birth control that protects a person from pregnancy at any point in their life, while still preserving the option to have children at another time.In most cases the ability to become pregnant, returns shortly after the reversible method is discontinued. The rate at which fertility returns will vary with each method.
Technically there are 4 methods of Reversible Birth Control; barrier, behavioral, hormonal and emergency.This page will specifically cover the Barrier and Hormonal methods. If you would like to learn about the others please go back to the Contraception and STI page and select the corresponding category.


Safer Sex Practices

Barrier Methods of Protection

Beginners Guide: Condoms

Condoms: What is the right type of material for your needs?

Beginners Guide: Condom Sizing

Condoms Sizing: Are you wearing the proper size? Let's make sure.

Beginners Sex Guide: How To Put On A Condom

How To Put On A Condom: Stay safe, practice makes perfect. (*v)

Beginners Guide: The Female Condom

The 'Female' Condom: The internal condom has you covered. (*v)

Beginners Sex Guide: Spermicide

Spermicide: Even though it works, it's not the best option. Find out why here.

Getting Ready For Your First Time

Diaphragm: Everything you need to know about diaphragms.

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Sex E 102 Q&A: Are Spermicides Safe?


My partner has been saying that we dont need to use condoms if we use spermicide since it kills the sperm, is this true? if so what kind of spermicide do you suggest?


First, let my just say that it is ALWAYS safer to use more then one type of protection, and when it comes to sex, I ALWAYS suggest you use condoms to help prevent against not only pregnancy, but STD/STI's as well. As for spermicidal lubes, though they do kill sperm, I'm sad to say there isn't a brand that I would recommend.  Most spermicidal lubes contain a substance called "nonoxynol-9". For those of you who don't know what "nonoxynol-9" or N9 is;  N9 is a surfactant that's used as an ingredient in various cleaning and cosmetic products, it's also a form of birth control for its spermicidal properties. I'm sure most of you read that and went wtf is a 'nonoxynol surfactant'?
Nonoxynols are non-ionic surfactant mixtures varying in the number of repeating ethoxy groups. They're used as detergents, emulsifiers, wetting agents, de-foaming agents etc. -  taken from Wikipedia
Surfactants are wetting agents that lower the surface tension of a liquid, allowing easier spreading, and lower the interfacial tension between two liquids. Also, Surfactants are usually amphiphilic meaning they have "tails" and "heads"; think of what sperm or a tadpole looks like. If that isn't clear enough, the best way for me to describe it is to say that surfactants work by disturbing the cell membrane. **However due to the toxicity of these mixtures they are no longer allowed for anything that can be poured down the drain (think of chemical cleaners) or in laundry detergent. So I can't pour it down the drain, but I can put it in my vag? are you kidding me?! To put surfectants into perspective, think of the everyday products that they can be found in like;
  • Detergents
  • Fabric softener
  • Emulsifiers and Emulsions
  • Paints
  • Adhesives
  • Inks
  • Anti-fogging
  • Soil remediation
  • Wetting
  • Ski wax, snowboard wax
  • Deinking (particularly during the enzymatic deinking of used paper during the recycling and repulping process)
  • Foaming agents
  • Defoaming agents
  • Laxatives
  • Agrochemical formulations
  • Herbicides
  • Insecticides
  • Quantum dot coating
  • Biocides (sanitizers)
  • Hair conditioners (after shampoo)
  • Spermicide (nonoxynol-9)
  • Used as an additive in 2.5 gallon fire extinguishers
  • Pipeline, Liquid drag reducing agent
  • Alkali Surfactant Polymers (used to mobilize oil in oil wells)
Anti fogging? inks? snowboard wax? PAINTS? FABRIC SOFTENER? ...are you kidding me?! why would anyone want to put an ingredient that's found in paint or snowboard wax near their vagina!? As for N9 itself, it was originally thought that it could be used for the prevention of STD's/STI's however about 10 years ago it was discovered that spermicides actually INCREASE the chances of contracting infections like HIV by creating lesions on the layers of skin cells in the vagina or rectum walls, which can potentially facilitate infection. **remember what I said above, they "work by disturbing the cell membrane" Not only that but there are other downfalls or potential dangers to using N9:
  • Nonoxynol-9 offers no protection against sexually transmitted infections such as gonorrhea or chlamydia.
  • Nonoxynol-9 can damage the cells lining the rectum providing entry for HIV and other STD/STI's
  • If used regularily Nonoxynol-9 can increase a womans chances of contracting Bacterial Vaginosis
  • If used regularly there are increased chances of developing a yeast infection
  • There have been reports of vaginal bleeding after intercourse due to misuse of spermicides containing Nonoxynol-9
  • Increased chances of vaginal dryness or itching after use of spermicides.
The product is so bad for you that the FDA (Food and Drug Administration) issued a final rule in 2007 that requires manufacturers of spermicidal products containing nonoxynol 9 to post the following warnings to its products; "N9 can irritate the vagina and rectum, which may increase the risk of getting HIV/AIDS from an infected partner" The CDC (Center for Disease Control) conducted their own study to research the effects of N9 and found that it was ineffective in the prevention of STD's and in fact increased the risk of transmission by 50% *report can be found here: CDC N9 Aids research As you can see, with all of the above information there is no way that I could recommend such a product to any person at any time. hope that helped Kara_Sutra   Sit back, relax, let me come to you. Sign up through the form below and have my posts sent straight to your inbox. Don't worry, I promise not to spam you!
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