New_Head(1, ' Birth Control Has a Long History, pp. 365–368'); New_Question('Although many contraceptive mechanisms and behaviors have been experimented with over the millennia, reliable contraception first emerged in the form of the ', 0, 'condom', ' popularly associated with Casanova and originally made from ', 0, 'intestines_intestine_animal intestines_animal intestine', '. A later development introduced in the ', 4, 3, 'seventeenth', 'eighteenth', 'nineteenth', 'twentieth', ' century was the cervical ', 0, 'diaphragm', '. Twentieth-century developments included the ', 0, 'intrauterine', ' device (IUD), which interferes with sperm ', 0, 'transport', ', and perhaps the most revolutionary approach to contraception—', 0, 'hormone_sex steroid', '-based contraceptive pills.') New_Question('Contraception has long been the subject of legal restriction because of ', 0, 'religious_philosophical', ' convictions of some people that it is ', 0, 'morally', ' wrong as it subverts the ', 2, 2, 'recreational', 'procreative', ' function of sex. In the United States, the distribution of contraception ', 3, 3, 'devices', 'research', 'information', ' was banned by the ', 0, 'Comstock', ' law. It was not until the ', 4, 4, '1930s', '1940s', '1950s', '1960s', ' that state regulation of contraception finally ended, having been judged to be an infringement on the constitutional right of ', 0, 'privacy', '. The social acceptability of the use of condoms for contraception has been particularly spurred on by the ', 0, 'AIDS', ' epidemic.') New_Question('Margaret Sanger was repeatedly ', 0, 'arrested_imprisoned', ' for distributing contraceptive information in the ', 4, 4, 'early eighteenth', 'early nineteenth', 'late nineteenth', 'early twentieth', ' century. She opened the first ', 0, 'birth control clinic', ' in the United States, founded the American Birth Control League, and helped found the ', 0, 'Planned Parenthood', ' Federation for which she served as president during the 1950s. She also helped fund research into ', 0, 'hormone', '-based contraception.') New_Question('It is estimated that among U.S. women aged 15–45, about ', 4, 4, '60', '70', '80', '90', '% of those who are sexually active and do not wish to become pregnant do use some contraceptive technique. Even so, less than ', 3, 2, 'three-quarters', 'half', 'one-quarter', ' of all pregnancies in the United States are wanted or planned. The remainder is split among unwanted births, spontaneous abortions, and ', 0, 'induced', ' abortions.') New_Question('For many individuals there is a ', 3, 2, 'motivational', 'financial', 'social', ' impediment to obtaining contraceptive services and supplies because many U.S. ', 3, 2, 'medical clinics', 'health insurance plans', 'state funding agencies', ' provide little coverage for contraceptive drugs or devices. It is estimated that providing full ', 0, 'contraceptive_contraception', ' coverage on employment-based insurance plans would increase their cost by ', 4, 1, '21', '71', '121', '141', ' dollars per employee per year.') New_Question('Federal legislation to mandate equal coverage of contraceptive and noncontraceptive prescription drugs and services has been introduced in Congress on more than one occasion (most recently in 2001) ', 3, 1, 'but has not yet been enacted', 'and is currently law', 'has not passed', '.') New_Question('When using a contraceptive technique, one must consider the following:
  1. Reliability is important if an unplanned pregnancy would be disastrous. It is important to distinguish between ', 0, 'perfect-use_perfect use', ' reliability, which is the reliability of the method if there are no slip-ups; and ', 0, 'typical-use_typical use', ' reliability, which is more realistic as it accounts for human infallability. The difference between these two types of use—when considering the pill—is approximately ', 5, 3, '2', '4', '6', '8', '10', '%.
  2. ', 0, 'Reversibility', ' is important if one plans to ', 0, 'have children', ' at a later date; some methods produce long but finite terms of sterility.
  3. STDs—', 0, 'condoms_a condom', ' provide(s) the best protection and when used in combination with other techniques increase(s) overall reliability.
') New_Question('When choosing a contraceptive, one must also consider the following:
  1. ', 0, 'Ease of use', ' is a factor for methods that require rituals such as taking a pill every day or significant forethought such as getting a prescription.
  2. Some techniques are quite ', 0, 'costly_expensive', ' but may be cheaper compared to the cumulative costs of other methods such as condoms or the costs of an unwanted ', 0, 'pregnancy', '.
  3. ', 0, 'Safety', '—some contraceptive techniques can involve health risks.
  4. ', 0, 'Control', '—for some users it is important to control the contraception rather than leaving the responsibility to their sex partner.
') New_Question('The two most popular methods of contraception are ', 4, 1, 'condoms and the pill', 'the pill and withdrawal', 'condoms and sterilization', 'the rhythm method and condoms', '. The same survey indicates that the most reliable contraceptive in typical usage is ', 4, 4, 'condoms', 'the pill', 'sterilization', 'the hormone implant', '.') New_Head(1, ' Physical Methods Block Sperm Transport, pp. 368–378'); New_Question('Condoms are a ', 0, 'barrier', ' method of contraception. They block the entry of semen into the vagina and also may kill the sperm if treated with ', 0, 'nonoxynol-9', ', which is a spermicide. The addition of spermicide to a condom ', 2, 2, 'does', 'does not', ' provide added protection in the event of a condom breaking. Frequent use of condoms treated with ', 0, 'nonoxynol-9', ' can result in ', 4, 4, 'STDs and pregnancy', 'vaginal discharge and pregnancy', 'vaginal irritation and pain during coitus', 'health problems for women', '.') New_Question('Most condoms are made of latex but some may be made of ', 0, 'polyurethane', ' or animal ', 4, 2, 'skin', 'intestinal tissue', 'protein', 'veins', '. Polyurethane condoms may be useful in the case that one partner has ', 0, 'latex allergy_allergy to latex_an allergy_allergies', ' or if latex condoms reduce ', 0, 'sensation_feeling_erotic sensation', ' too much.') New_Question('Polyurethane condoms are ', 0, 'thinner_slicker_thinner and slicker', ' than latex condoms, improve sensation, are tasteless and ', 0, 'odorless', ', and ', 2, 1, 'are', 'are not', ' believed to be effective barriers to STDs. They are also ', 4, 1, 'less stretchy', 'more transparent', 'more durable', 'less durable', '. Animal-tissue condoms are effective contraceptives and ', 2, 2, 'are', 'are not', ' effective barriers to STDs.') New_Question('With latex condoms, ', 3, 3, 'any', 'oil-based', 'water-based', ' lubricants can be used, and ', 3, 1, 'any', 'oil-based', 'water-based', ' lubricants can be used with polyurethane condoms. Condoms do break for a variety of reasons: a survey of condom usage in brothels in Nevada found that breakage rates were about 1 in ', 4, 4, '10', '100', '500', '1000', '. The efficacy of condoms in protecting against STDs was attested to by the finding in the same study that ', 4, 1, '0', '3', '5', '7', '% of 20,000 HIV tests of prostitutes were positive.') New_Question('According to a recent study, most or all latex condoms ', 4, 2, 'meet but do not exceed', 'meet or exceed', 'show great variability in', 'fail a small proportion of the time in', ' international standards for failure-resistance. The best-performing condom in the study were ', 4, 1, 'Durex Extra Sensitive Lubricated Latex', 'those distributed by Planned Parenthood', 'professional grade condoms', 'Magnum “most bang for your buck” super smooth', ' and the worst-performing (but still adequate) condom was one distributed by ', 4, 2, 'Durex', 'Planned Parenthood', 'Nevada Brothels', 'Magnum', '.') New_Question('The advantages of male condoms:
  1. In the case of Latex condoms, ', 3, 3, 'costly but reusable', 'moderately expensive', 'inexpensive', '.
  2. Easy to obtain.
  3. ', 0, 'Reliable', ' when properly used.
  4. Protect against STDs, so protect current and future ', 0, 'fertility', '.
  5. Free of significant ', 0, 'hormone_physiological', ' side effects.
  6. Immediately ', 0, 'reversible', ', meaning that they are a temporary means of birth control as opposed to sterilization.
') New_Question('The disadvantages of male condoms:
  1. Intrusive and can interfere with ', 0, 'spontaneity', '.
  2. Require an ', 0, 'erection', ' to keep in place.
  3. Require immediate ', 0, 'withdrawal', ' after ejaculation.
  4. Reduce ', 0, 'sexual_erotic', ' sensations.
  5. ', 2, 2, 'Are', 'Are not', ' perfectly reliable (but this increases when ', 3, 3, 'the male makes the condom use decision', 'when the female makes the condom use decision', 'when both partners make the condom use decision', ').
') New_Question('Female condoms are made of ', 3, 2, 'latex', 'polyurethane', 'animal tissue', ' and are ', 2, 2, 'stretchy', 'not stretchy', '. They consist of a closed tube with a ring at each end—the ring at the closed end encircles the ', 4, 3, 'clitoris', 'vulva', 'cervix', 'uterus', '. After use, the female condom should be removed ', 3, 1, 'before the woman stands up', 'after the woman stands up', 'over a bath or toilet', ' and ', 2, 2, 'must be discarded', 'can be reused if washed', '.') New_Question('The advantages of female condoms:
  1. The only female-controlled contraceptive that is protective against ', 0, 'STDs_sexually transmitted diseases_', '.
  2. Can be inserted in ', 0, 'advance', ', thus avoiding interruption of sex.
  3. Does not require a continuous ', 0, 'erection', ' by the man.
  4. ', 0, 'Reversible', ', meaning that they are a temporary means of birth control as opposed to sterilization.
  5. Can be used for ', 3, 1, 'anal', 'oral', 'anal and oral', ' sex if the inner ring is removed.
') New_Question('The disadvantages of female condoms:
  1. Generates ', 0, 'nonerotic_strange_unusual_weird', ' sensations and noises.
  2. Looks strange.
  3. May be ', 0, 'accidentally', ' circumvented.
  4. May sometimes be drawn entirely into the ', 0, 'vagina', '.
  5. ', 2, 2, 'Can', 'Cannot', ' be used with a male condom.
  6. Most couples prefer the ', 2, 1, 'male', 'female', ' condom to the ', 2, 2, 'male', 'female', ' condom.
') New_Question('The diaphragm is the contraceptive choice of about ', 4, 3, '1 in 10', '1 in 25', '1 in 50', '1 in 150', ' women and consists of a rubber dome that covers the ', 0, 'cervix', '. It is always used in conjunction with ', 0, 'spermicidal', ' jelly or cream and must be inserted within about six hours before coitus. After coitus it must be left in place for at least ', 4, 2, '2', '6', '12', '24', ' hours and should be removed within ', 4, 3, '6', '12', '24', '72', ' hours to reduce the risk of ', 0, 'toxic shock', ' syndrome. Diaphragms like latex condoms ', 2, 1, 'are', 'are not', ' damaged by oil-based lubricants.') New_Question('The ', 0, 'Lea’s_Lea', ' Shield is a recently approved (2002) silicon rubber device with a ', 0, 'valve', ' that allows fluids to move only from the ', 4, 1, 'cervix to the vagina', 'vagina to the cervix', 'oviducts to the abdomen', 'vagina to the outside', '. It ', 2, 1, 'comes in one size fits all', 'must be fitted by a medical professional', '. It has a ', 2, 1, 'shorter', 'longer', ' usable life than a regular diaphragm.') New_Question('A ', 0, 'cervical cap', ' is a small rubber dome that adheres to the cervix only via ', 4, 2, 'friction', 'suction', 'involunatary muscular contractions', 'a non-toxic spermicial glue', '. Compared with the diaphragm, it is ', 3, 2, 'more', 'less', 'equivalently', ' effective and is suitable for women with unusual vaginal anatomy; it ', 2, 2, 'is', 'is not', ' a good choice for women who have given birth previously, and is ', 2, 1, 'more', 'less', ' difficult to insert properly than the diaphragm. Even if properly inserted it can ', 3, 3, 'be easily perforated', 'cause discomfort for the male partner', 'become dislodged during coitus', '.') New_Question('A variant of the traditional cervical cap is the ', 0, 'FemCap', '. It is a silicone rubber device shaped like a ', 4, 3, 'policeman’s hat', 'fireman’s helmet', 'sailor’s cap', 'soldier’s helmet', ' with a dome and a raised brim which lies snugly against the walls of the vagina, thus deflecting sperm toward the spermicide. Typical-use failure rates range from ', 4, 3, '5–14', '12–19', '14–29', '19–34', '%, with the higher numbers applying to women who ', 4, 2, 'do not insert it properly', 'have previously delivered a baby', 'have never had a baby', 'have multiple sex partners', '.') New_Question('Spermicides are chemical agents such as the common ', 0, 'nonoxynol-9', ' that kill sperm. There are a wide variety of preparations of spermicides; typically the spermicide is placed in the vagina at least ', 4, 1, '10 minutes', '30 minutes', '1 hour', '2 hours', ' prior to coitus but not more than ', 4, 3, '30 minutes', '1 hour', '2 hours', '6 hours', ' ahead. The spermicide should be left in place for at least ', 4, 3, '1', '2', '6', '12', ' hour(s) after coitus. They ', 2, 2, 'are', 'are not', ' recommended as a sole method of contraception. The Today sponge is ', 3, 3, 'a spermicidal method', 'a barrier method', 'both a spermicidal and barrier method', ' and is effective for ', 4, 4, 'single coital episodes', 'multiple acts of intercourse over 6 hours', 'multiple acts of intercourse over 12 hours', 'multiple acts of intercourse over 24 hours', '.') New_Question('The advantages of spermicides are:
  1. Easy to obtain without ', 0, 'prescription', '.
  2. Fairly inexpensive.
  3. Have few ', 0, 'side effects', ', except in the case of allergic reactions and irritations caused by ', 4, 1, 'frequent use', 'very vigorous sex', 'reactions to barrier methods such as condoms', 'improper insertion of suppositories', '.
') New_Question('The disadvantages of spermicides are:
  1. They have a very high rate of ', 0, 'failure', '.
  2. They offer no protection against ', 0, 'STDs_sexually transmitted diseases', ' and in some cases they can increase the possibility of infection.
') New_Question('Two models of IUDs are currently available in the United States: the ', 4, 2, 'ParaGard and the Copper-T', 'Copper-T and the Mirena', 'ParaGard and the Dalkon Sheild', 'Mirena and the Dalkon Sheild', '.') New_Question('Less than ', 4, 1, '1', '5', '6', '8', '% of American women use IUDs; however, worldwide they are in use by about ', 4, 3, '5', '45', '85', '95', ' million women. They work by causing a slight ', 0, 'inflammation', ' of the ', 4, 1, 'uterus', 'oviducts', 'cervix', 'ovaries', ' that interferes with sperm transportation. An IUD is inserted by ', 4, 3, 'the user', 'a partner', 'a trained health care provider', 'a family physician', ' and, once in place, may remain there for up to ', 4, 4, '6 months', '2 years', '10 years', '12 years', ', depending on the brand. Some models release low levels of ', 4, 2, 'estrogens', 'progestins', 'androgens', 'glucocorticoids', '.') New_Question('The advantages of the IUD are:
  1. Is highly effective.
  2. Has few ', 0, 'hormonal_physiological', ' side effects.
  3. Is ', 0, 'convenient', ' and unobtrusive.
  4. May reduce ', 0, 'menstrual', ' symptoms such as cramps if it releases hormones.
  5. Is a ', 0, 'reversible', ' form of contraception when the device is removed.
  6. Provides significant protection against ', 4, 4, 'ovarian', 'uterine', 'cervical', 'endometrial', ' cancer.
') New_Question('The disadvantages of the IUD are:
  1. Involves fairly ', 0, 'high', ' (but one-time) costs.
  2. May cause temporary cramping and ', 0, 'bleeding', '.
  3. Offers no ', 0, 'STD_sexually transmitted disease', ' protection.
  4. Increases risk of ', 0, 'ectopic', ' pregnancy, and if a STD is contracted while an IUD is in place, the risk of ', 3, 2, 'cervical cancer', 'pelvic inflammatory disease', 'genital warts', ' is increased.
') New_Head(1, ' Hormone-Based Methods Are Easy to Use, pp. 378–382'); New_Question('Oral contraceptive pills are favored by 1 in ', 4, 2, '2', '4', '10', '20', ' contraceptive-using women. They contain either a combination of estrogen plus ', 4, 2, 'androgen', 'progestin', 'FSH', 'prolactin', ', or ', 4, 2, 'androgen', 'progestin', 'FSH', 'prolactin', ' alone. Synthetic versions of the natural hormones are used because they are ', 4, 3, 'broken down more quickly', 'absorbed more quickly', 'broken down more slowly', 'absorbed more slowly', '.') New_Question('A common formulation of combination pill is the ', 0, 'constant-dose', ' or monophasic combination pill in which the ratios of estrogens and progestins remains the same for 21 days, followed by 7 days of taking ', 4, 4, 'estrogen alone', 'progesterone alone', 'low doses of both hormones', 'no hormones', '. Some pills that contain very low doses of hormones shorten the drug-free period to as little as ', 4, 4, '5', '4', '3', '2', ' days.') New_Question('Depending on the contraceptive pill brand and formulation, the estrogen dose varies between ', 4, 1, '20 and 50 micrograms', '0.1 and 1.0 milligrams', '500 and 1000 micrograms', '20 and 50 milligrams', ' and the progestin dose varies between ', 4, 2, '20 and 50 micrograms', '0.1 and 1.0 milligrams', '500 and 1000 micrograms', '20 and 50 milligrams', '. A more recent variant is the ', 0, 'triphasic_multiphasic', ' combination pill in which these ratios are varied across the menstrual cycle in order to minimize ', 6, 5, 'conceptions', 'negative effects on sex drive', 'total dose', 'side effects', 'total dose and side effects', 'expense', '.') New_Question('Combination pills primarily act on the ', 3, 3, 'hypothalamus', 'pituitary', 'hypothalamus and pituitary', ' of the brain where the ', 0, 'progestin', ' component of the pill reduces ', 4, 3, 'GH', 'LH', 'FSH', 'ACTH', ' secretion. The ', 0, 'estrogen', ' component assists by increasing ', 0, 'progesterone_progestin', ' receptors. As a result of the reduction in ', 4, 3, 'GH', 'LH', 'FSH', 'ACTH', ', the maturation of ovarian ', 0, 'follicles', ' is suppressed and ', 0, 'ovulation', ' does not occur.') New_Question('The hormones of combination birth control pills also directly affect the ', 0, 'uterus', ', causing it to secrete a thick ', 0, 'mucus', ' that prevents sperm from entering the ', 0, 'uterus', '. During the 7-day hormone-free period, the ', 4, 2, 'myometrium', 'endometrium', 'introitus', 'mucosa', ' sloughs off, simulating a menstrual period. This is factored into the design of the pills ', 3, 3, 'because it is healthier for women', 'because it helps preserve future fertility', 'because it simulates normal menstrual cycling', '. Some physicians favor pills with low levels of ', 4, 1, 'estrogen', 'progestins', 'androgens', 'cortisol', ' in order to minimize certain health risks. These lower estrogen pills ', 2, 2, 'do', 'do not always', ' regulate a woman’s cycle as effectively.') New_Question('The advantages of combination pills are:
  1. Very ', 0, 'reliable', ', even when used less than perfectly (typical-use failure rates is about ', 4, 3, '4', '6', '8', '10', '%).
  2. Convenient and do not diminish the sensations associated with ', 0, 'sex_coitus', '.
  3. ', 0, 'Reversible', '— fertility returns to normal about ', 0, '3', ' months after stopping the pill.
  4. May lessen undesirable ', 0, 'menstrual', ' symptoms such as cramping.
  5. May reduce the likelihood of a number of ', 0, 'disorders_diseases', ' (including endometrial and ', 0, 'ovarian', ' cancer, anemia, ovarian ', 0, 'cysts', ', endometriosis, acne and ', 0, 'hirsutism', '—excessive facial and body hair).
') New_Question('The disadvantages of combination pills are:
  1. Do not protect against ', 0, 'STDs_sexually transmitted diseases', '.
  2. Are not ', 0, 'evident', ' in use unless the partner sees her taking her pill every day.
  3. Must be taken ', 0, 'daily_reliably', '—every day.
  4. May cause a decreased or increased interest in ', 0, 'sex', '.
  5. Can cause several undesirable ', 0, 'side', ' effects (including nausea, breast pain, emotional disturbances, blood clotting disorders, and stroke), especially in women over 35 who ', 0, 'smoke', '.
  6. Reliability is decreased with low dose pills in ', 2, 2, 'lighter', 'heavier', ' women.
  7. May slightly increase the risk of ', 4, 4, 'ovarian', 'uterine', 'colon', 'breast cancer', ' for women ', 2, 2, 'over', 'under', ' 35 when using combination pills.
  8. Can be passed on to nursing babies via ', 0, 'breast milk', '.
') New_Question('Combination pills can be prescribed in such a way to allow menstruation to occur once every two or three months, or never in some cases. Seasonale is a new pill that is taken continuously for ', 0, '12', ' weeks, followed by a ', 0, '7', '-day drug-free period. ', 0, 'Seasonique', ' contains the same drugs as Seasonale, except the pills taken during the 7-day interval contain a low dose of ', 4, 2, 'vitamins', 'estrogen', 'progestins', 'androgens', '. Lybrel ', 4, 4, 'contains the same drugs but at lower doses', 'has no drug-free interval', 'is not yet approved for use', 'contains the same drugs but at lower doses and has no drug-free interval', '. The main advantage of these ', 0, 'extended-use', ' regimens is a reduction in the total number of menstrual ', 0, 'periods', '. Disadvantages of combination pills include: cost, possible ', 0, 'irregular', ' bleeding, and ingestion of greater quantities of the hormone(s) ', 3, 2, 'progestin', 'estrogen', 'progestin and estrogen', '.') New_Question('Progestin-only pills, which are sometimes called “', 0, 'mini-pills_mini pills_the mini-pill', ',” release ', 3, 1, 'low', 'moderate', 'high', ' doses of synthetic progestins. These act primarily on the ', 3, 2, 'brain', 'cervical mucus', 'ovaries', ' and ', 2, 2, 'do', 'do not necessarily', ' involve a cessation of ovulation. The ', 0, 'mucus_cervical mucus', ' becomes thick and prevents sperm transport, and the ', 0, 'endometrium', ' may become hostile to implantation. The effects of these pills last for ', 4, 1, '24 hours', '48 hours', 'several days', 'a week or more', '. Typical-use failure rates with the progestin-only pill are believed to be ', 2, 1, 'higher', 'lower', ' than with combination pills. This effect ', 2, 2, 'has', 'has not', ' been supported with clinical trials.') New_Question('Progestin-only pills share most of the advantages of the combination pill but lack estrogenic ', 0, 'side', ' effects and can be taken by ', 0, 'nursing_breast-feeding', ' mothers.') New_Question('The disadvantage of progestin-only pill: Compared with the combination pill, it can disrupt the ', 0, 'regularity', ' of menstrual cycles; this is the main reason why some women ', 2, 2, 'take more', 'discontinue use', ' of this contraceptive.') New_Head(1, ' Hormones Can Be Administered by Non-Oral Routes, pp. 383–386'); New_Question('Non-oral hormone-based contraceptives have the distinct advantage over oral hormone-based contraceptives of ', 4, 3, 'having a lower drug dose', 'having a long and well researched history', 'not requiring a pill to be taken every day', 'having a lower disease and disorder risk', ' and this makes them ', 2, 2, 'less', 'more', ' reliable in typical use.') New_Question('A slow-release injection of hormones is called a ', 0, 'depot', '; one such preparation for contraceptive use is ', 0, 'medroxyprogesterone', ' acetate (Depo-Provera) which is injected ', 4, 3, 'under the skin', 'into fat', 'into muscle', 'into the uterus', ' and lasts for about ', 4, 2, '1 month', '3 months', '1 year', '2 years', '. Depo-SubQ Provera is the same contraceptive, but this one is administered ', 4, 1, 'under the skin', 'into fat', 'into muscle', 'into the uterus', '. One noticeable side effect of Depo-Provera is that after a ', 0, 'year', ' of use, about half of women using it experience ', 4, 1, 'cessation of menstrual cycles', 'acceleration of menstrual cycles', 'very heavy menstrual periods', 'increased sex drive', ', but there seem to be few harmful side effects.') New_Question('The advantages of Depo-Provera are:
  1. ', 0, 'Reliability', '—Depo-Provera is more reliable than contraceptive pills, with a typical-use failure rate of ', 4, 3, '1', '2', '3', '4', '%.
  2. Easily concealed.
  3. As it is a progestin-only contraceptive, it may make it safer for some women.
  4. Menses cessation can be beneficial to some women who are plagued with ', 4, 1, 'menstrual problems', 'low sex drive', 'depression', 'painful breasts', '.
') New_Question('The disadvantages of Depo-Provera are:
  1. Repeated ', 0, 'medical_doctors', ' visits to get the injections.
  2. No protection against ', 0, 'STDs_sexually transmitted diseases', '.
  3. Irregular bleeding, especially ', 4, 3, 'with long-term use', 'among teenage girls', 'in the early months of use', 'among women who have previously delivered babies', '.
  4. ', 0, 'Side effects', ' such as depression, liver damage, loss of sex drive, and others.
  5. Any problematic ', 0, 'side', ' effects are present for the duration of each ', 2, 2, 'menstrual cycle', 'injection cycle', '.
  6. ', 0, 'Bone density', ' loss while using Depo-Provera that may not be fully recovered.
  7. Length of reversibility— up to ', 4, 3, 'six months', 'nine months', 'one year', 'two years', ' for some women to return to full fertility.
') New_Question('Transdermal contraceptive patches are similar in their hormonal constituents and usage to ', 4, 2, 'the mini pill', 'the combination pill', 'Depo-Provera', 'spermicides', '. The one type of patch currently available in the U.S., ', 0, 'Ortho Evra', ', contains a combination of an estrogen and a ', 2, 1, 'progestin', 'androgen', '. Each patch lasts one week and can be placed anywhere on the body except the ', 4, 4, 'face', 'inner thighs', 'buttocks', 'breasts', '. During the one week of ', 4, 2, 'three', 'four', 'five', 'six', ' that the woman does not wear the patch, her ', 0, 'menses_period', ' will occur.') New_Question('The advantages of Ortho Evra are:
  1. When compared to combination pills, the Ortho Evra patch requires ', 2, 1, 'fewer', 'more', ' actions to use and this may increase compliance rates.
  2. Unlike combination pills, it is ', 0, 'evident_obvious', ' to partners that contraception is being used.
') New_Question('The disadvantages of Ortho Evra are:
  1. Local skin ', 0, 'inflammations_reactions', '.
  2. The patch may loosen or ', 0, 'fall_come', ' off.
  3. It is not advised for women ', 4, 3, 'over 35', 'over 40', 'over 35 who smoke', 'over 40 who smoke', '.
  4. It is ', 3, 2, 'a little more expensive than', 'twice as expensive as generic', 'more than three times as expensive as', ' combination pills.
  5. Its reliability may be jeopardized in women over ', 4, 1, '200', '250', '300', '350', ' lbs.
  6. Risk of ', 0, 'heart attack', ' may be higher with the patch than with combination pills.
') New_Question('The NuvaRing is a flexible ', 0, 'ring', ' that ', 3, 2, 'fits around the cervix', 'is placed deep in the vagina', 'adheres to the vulva', ' and releases an estrogen and a ', 0, 'progestin', '. The ring is left in place ', 4, 4, 'during coitus', 'for 24 hours', 'for 2 weeks', 'for 3 weeks', '. The advantages, disadvantages, and cost are similar to the ', 4, 2, 'combination pill', 'Ortho Evra patch', 'mini pill', 'diaphragm', '. However, the NuvaRing is more discrete, requires less effort, has no skin reactions, and the cumulative estrogen exposure is lower than ', 0, 'Ortho Evra', '. A new vaginal ring is in final clinical trials and, if approved, a single ring is usable for ', 3, 1, 'one year', 'two years', 'five years', ' on a 3-weeks-on, 1-week-off basis.') New_Question('When compared to Ortho Evra, the NuvaRing has some disadvantages:
  1. Can ', 4, 3, 'wear out', 'get lost in the vagina', 'fall out', 'break into pieces', '.
  2. Can cause vaginal irritation or ', 0, 'discharge', '.
  3. Some women and their partners report they can feel the NuvaRing during ', 0, 'intercourse_coitus', '.
  4. ', 3, 3, 'Moisture', 'Pressure', 'Heat', '-sensitive.
') New_Question('Contraceptive implants are rods implanted under the skin that contain contractive hormones. ', 0, 'Implanon', ' is the only implant currently available in the United States. It consists of a flexible matchstick-sized rod which releases a(n) ', 3, 2, 'estrogen', 'progestin', 'estrogen and a progestin', '. The implant provides effective contraception for ', 5, 3, '1', '2', '3', '4', '5', ' years.') New_Question('The advantage of Implanon: When compared to Ortho Evra and NuvaRing, Implanon requires no routine action by the user (other than insertion and removal every ', 0, '3', ' years) and for this reason it is probably extremely ', 0, 'reliable', '.') New_Question('The disadvantages of Implanon are:
  1. When compared to Ortho Evra and NuvaRing, beginning and ', 0, 'terminating_ending_finishing_stopping', ' Implanon is more complex.
  2. More expensive initially.
  3. Irregular bleeding is not uncommon (because it is a ', 0, 'progestin', '-only contraceptive).
  4. Reliability is uncertain in women over ', 4, 2, '200', '220', '240', '260', ' lbs.
') New_Head(1, ' Behavioral Methods Can Be Demanding, pp. 386–390'); New_Question('Fertility awareness methods of contraception rely on sexual ', 0, 'abstinence', ' during the most fertile times of a woman’s cycle. This is the ', 5, 5, '2', '3', '4', '5', '6', '-day period ending with the day of ', 3, 3, 'menses onset', 'menses cessation', 'ovulation', '. It is for this reason they are often also known as ', 0, 'periodic abstinence methods', ', or “rhythm methods.” For women with highly regular 28-day cycles, ovulation will generally occur ', 0, '14', ' days after the beginning of the previous menstrual period; this precludes coitus on days 8 through ', 5, 1, '17', '18', '19', '20', '21', ' of the cycle. If the woman’s cycle is at all ', 0, 'irregular_variable', ', this period ', 2, 1, 'is generally', 'is not generally', ' longer.') New_Question('The standard days method can be used by women who have regular cycles between 26 and ', 3, 3, '28', '30', '32', ' days long. Between days 8 and ', 0, '19', ' of the cycle, the woman abstains from sex. Memory devises such as ', 0, 'CycleBeads', ' have been specifically designed to help women keep track of the days of their cycle but has the major disadvantage of human error; a woman might simply forget one day to move the ring to the next ', 0, 'bead', '.') New_Question('In the ', 0, 'calendar', ' rhythm method, the woman notes the length of her longest and shortest cycle over the past 6 to ', 0, '12', ' cycles. She then simply subtracts ', 0, '18', ' from the number of days in her ', 2, 1, 'shortest', 'longest', ' cycle to identify the first no-sex day in her cycle, and she subtracts ', 0, '11', ' from the number of days in her longest cycle to identify the last no-sex day in her cycle. Although this method is good for women with ', 2, 2, 'regular', 'irregular', ' cycles, it is very demanding and also rules out a large number of days.') New_Question('In the ', 0, 'TwoDay_Two Day_two day', ' method, the woman simply notes every day whether she has any ', 0, 'cervical', ' secretions. She asks herself two questions: “Do I have any secretions today?” and “Did I have any secretions yesterday?” If the answer to both questions is ', 2, 2, 'yes', 'no', ', the chances of becoming pregnant are low. If the answer to either question is ', 2, 1, 'yes', 'no', ', the chances of becoming pregnant are high. This method has been validated in research and, used correctly, less than ', 5, 2, '2', '4', '6', '8', '10', ' out of 100 women become pregnant per year. Typical-use failure rates are ', 2, 2, 'lower', 'higher', '. If combined with measurements of basal temperature for improved reliability in detecting the fertile window, it is called the ', 0, 'sympto-thermal_symptothermal_sympto thermal', ' method.') New_Question('The advantages of fertility awareness methods are:
  1. Inexpensive or ', 0, 'free', '.
  2. Available to those who have no other choices (usually for ', 0, 'moral', ' reasons).
  3. Have none of the ', 0, 'side effects', ' seen with other forms of contraception.
  4. Are completely and immediately ', 0, 'reversible', '.
') New_Question('The disadvantages of fertility awareness methods are:
  1. Reliability is ', 2, 2, 'average', 'poor', ' compared to other methods.
  2. May result in too many unplanned pregnancies that couples may be unwilling to ', 0, 'abort_terminate_end', '.
  3. May involve too-long periods of ', 0, 'abstinence', '.
  4. Tend to be demanding of ', 0, 'time', ' and attention to track cycles.
  5. Require a long lead-in time of record keeping of ', 0, 'ovulations_ovulation_cycle_menstrual cycle', '.
  6. Offer no ', 0, 'STD_sexually transmitted diseases', ' protection.
') New_Question('With typical use, the withdrawal method of contraception has a ', 4, 4, '6', '12', '18', '27', '% failure rate. Failure of this method is occasionally due to the presence of sperm in ', 0, 'pre-ejaculatory fluid_preejaculatory fluid_pre-cum_pre_come', ' but usually is due to a failure to pull out in time.') New_Question('The advantages of withdrawal method are:
  1. Requires no ', 0, 'preparation', ' or expense (except for the roughly $200,000 cost of raising a baby to age 18, according to the U.S.D.A.).
  2. Has no medical ', 0, 'side', ' effects.
  3. Can be combined with a ', 0, 'condom', ' for extra protection.
') New_Question('The disadvantages of withdrawal method are:
  1. Has a ', 4, 4, 'low to moderate', 'moderate', 'moderate to high', 'high', ' rate of failure.
  2. ', 4, 3, 'Painful', 'Technical', 'Stressful', 'Uncomfortable', ', which may remove the enjoyment of coitus for both partners.
  3. Provides ', 2, 2, 'some', 'little or no', ' protection from STDs.
') New_Question('Although not recommended given the availability of better contraceptives, the withdrawal method had been instrumental in ', 0, 'demographic transition', ' in countries such as Turkey.') New_Question('As a means of contraception, noncoital sex ', 0, 'or outercourse', ' is completely ', 0, 'reliable', ' if adhered to. It is free, requires no preparation, lacks medical ', 0, 'side', ' effects, preserves ', 0, 'vaginal', ' virginity, and offers at least some ', 0, 'STD_sexually transmitted disease', ' protection. But noncoital sex precludes one of the better things about sex (', 0, 'coitus', ') and may end up provoking coitus anyway.') New_Head(1, ' There Are Contraceptive Options after Unprotected Coitus, pp. 390–391'); New_Question('Emergency contraception, or the “', 0, 'morning-after pill_morning after pill', ',” involves taking 1.5 mg of the ', 0, 'progestin', ' levonorgestrel (this is the dosage contained in ', 0, 'Plan B', ') within ', 5, 5, '1', '2', '3', '4', '5', ' days of the “accident,” spaced 12 hours apart—sooner is better than later, however. This regimen will reduce the likelihood of pregnancy by 60% to ', 0, '90', '%. Combination pills are also available as emergency contraception but pills that contain ', 0, 'estrogen', ' may induce nausea, so an anti-nausea medication is recommended. Another reliable postcoital contraceptive technique is the insertion of a(n) ', 4, 3, 'Today sponge', 'shot of Coca Cola', 'IUD', 'diaphragm', '. This is nearly ', 3, 3, '80', '90', '100', '% reliable with only ', 5, 5, '2', '5', '6', '8', '10', ' failures ever being reported.') New_Head(1, ' Sterilization Is Highly Reliable, pp. 391–394'); New_Question('The main surgical approaches to sterilization are ', 0, 'vasectomy', ' in men and ', 0, 'tubal sterilization', ' in women. These procedures should be considered a ', 3, 1, 'permanent', 'semi-permanent', 'reversible', ' end to fertility. About ', 4, 4, '5', '10', '20', '40', '% of all users of contraception use sterilization of self or partner, with the majority of these sterilizations being performed on ', 2, 2, 'men', 'women', '.') New_Question('In vasectomy, a small incision is made in the ', 4, 2, 'abdomen', 'scrotum', 'penis', 'testicle', ' through which the ', 0, 'vas deferens', ' is cut, the ends are sealed, and the incision in the ', 0, 'scrotum', ' is stitched closed. In the “', 0, 'no scalpel', '” procedure, the incision is made by sharp-tipped forceps and no stitches are needed. After ', 3, 3, '2 or 3', '5–10', '15–20', ' ejaculations to clear out remaining sperm above the cut, the man’s sterility is confirmed microscopically. The semen now contains no sperm and ejaculate volume ', 2, 2, 'is decreased', 'remains the same', '.') New_Question('Surgery to attempt to reverse a vasectomy is called ', 0, 'vasovasotomy', '. This procedure has a success rate of about ', 4, 3, '10', '25', '50', '80', '%. In some cases, the man has started to produce ', 0, 'antibodies', ' that interfere with sperm production and getting a functional connection of the ', 0, 'vas deferens_vas', ' does not always occur.') New_Question('Vasectomy is almost 100% ', 0, 'reliable', ', it is ', 0, 'free', ' after the surgery cost, has few physiological ', 0, 'side', ' effects, and is cheaper and safer than ', 0, 'tubal sterilization', ' for the woman. But vasectomy is not reliably reversible, can be expensive at first, and offers no protection from ', 0, 'STDs_sexually transmitted diseases', '.') New_Question('In tubal sterilization, an incision is made in the ', 4, 4, 'uterus', 'cervix', 'vagina', 'abdomen', ' through which the ', 0, 'oviducts_oviduct', ' are cut and sealed. There are two main variations. In ', 3, 2, 'laparotomy', 'laparoscopy', 'mini-laparotomy', ', a viewing instrument is introduced through one small incision and a surgical instrument is inserted through another. In ', 3, 3, 'laparotomy', 'laparoscopy', 'mini-laparotomy', ', a tiny incision is made in the abdominal wall below the ', 0, 'navel', ' through which surgery takes place. Tubal sterilization is ', 2, 2, 'safer', 'less safe', ' than vasectomy.') New_Question('The advantages of tubal sterilization (compared with vasectomy) are:
  1. It might be ', 0, 'simplier_easier', ' for the woman to have this procedure rather than expend the energy convincing her partner to have a vasectomy.
  2. Risk of developing ovarian and endometrial cancer is significantly ', 0, 'reduced_decreased', '.
') New_Question('The disadvantages of tubal sterilization (compared with vasectomy) are:
  1. It is a more invasive procedure, so recovery is ', 0, 'longer', ' and riskier.
  2. It is more ', 0, 'expensive', '.
') New_Question('Essure is a new method of tubal sterilization in which the ', 0, 'oviducts', ' are blocked internally with small ', 3, 3, 'plastic', 'silicon', 'metal', ' coils. The coils cause a local tissue reaction which, after about ', 0, 'three', ' months, causes a complete blockage of the ', 0, 'oviducts', '. This procedure involves ', 3, 3, 'minor', 'moderate', 'no', ' surgical incisions and ', 2, 2, 'light', 'no', ' general anesthesia. It ', 2, 2, 'does', 'does not', ' require a hospital or clinic setting.') New_Head(1, ' Disabled Persons Have Special Contraceptive Needs, p. 395'); New_Question('For people with physical ', 0, 'disabilities', ', it is important to consider how the ', 0, 'disabilities', ' will interact with a particular contraceptive regimen—for example, hormonal contraceptives may be a ', 2, 2, 'good', 'poor', ' choice for women with restricted movement because of the ', 2, 1, 'increased', 'decreased', ' risk of blood ', 0, 'clots', '. For physical methods, the person must be capable of using the device such as a condom or diaphragm. These issues also pertain to individuals with intellectual ', 0, 'disabilities', ' but there is the added factor of compliance to consider—an intellectually ', 0, 'disabled', ' young person may not be able to adhere to the usual contraception regimes. A ', 0, 'depot injection_Depo-Provera injection', ' is often a good choice for such women. It also has the advantage of ', 0, 'stopping_reducing', ' menstruation.') New_Head(1, ' There Is Active Research into New Contraceptive Methods, p. 395'); New_Question('One new contraceptive research strategy is to interfere with the ', 3, 1, 'chemical', 'visual', 'tactile', ' signals involved in fertilization or ', 0, 'implantation', '. Another strategy focuses on blocking ', 0, 'sperm', ' production itself. This can be done by treating men with a combination of a long-acting androgen and a(n) ', 3, 2, 'estrogen', 'progestin', 'gonadotropin', ', delivered by ', 2, 2, 'pill', 'injection', ', which together block the secretion LH and ', 0, 'FSH', ' by the ', 0, 'pituitary gland', '. This causes sperm production to stop. The ', 0, 'dry orgasm', ' pill works by partially paralyzing the smooth muscles of the vas deferens and ', 0, 'urethra', ' to either eliminate ejaculation or prevent the ', 0, 'sperm', ' component from being added.') New_Head(1, ' Several Safe Abortion Procedures Are Available, pp. 396–400'); New_Question('Intentional termination of a pregnancy is called an ', 0, 'induced', ' abortion. ', 0, 'Induced', ' abortions may be performed either for reasons pertaining to the health of the mother, in which case it is called ', 0, 'therapeutic', ' abortion, or because the woman chooses not to remain pregnant, in which case it is classified as an ', 0, 'elective', ' abortion. ') New_Question('', 4, 2, '20', '22', '25', '28', '% of all established pregnancies in the United States are aborted, of which ', 4, 3, '10', '15', '17', '20', '% are performed on teenagers. Most abortions are done for ', 2, 2, 'medical', 'social', ' reasons. Abortion is most common in ', 0, 'minority', ' women and 89% occur in the first ', 4, 1, '12', '18', '21', '25', ' weeks of pregnancy. Abortion is legal in ', 4, 1, 'all', 'most', 'some', 'a few', ' U.S. states. Abortions can be performed either by physically removing the fetus from the uterus (', 0, 'surgical abortion', ') or by administering drugs that cause the death and expulsion of the fetus (', 0, 'medical abortion', '). Currently, ', 0, 'surgical abortions', ' are the most common.') New_Question('In vacuum ', 0, 'aspiration', ', which is used during the first trimester, the ', 0, 'cervix', ' must first be dilated; this is accomplished by inserting a series of metal rods of increasing diameter. The fetus and ', 0, 'membranes', ' are then removed through an inserted cannula under ', 0, 'vacuum_suction', ' pressure. A metal ', 0, 'curette', ' may be used to clean the walls of the uterus and the abortion is confirmed by examining the ', 3, 1, 'extracted tissue', 'walls of the uterus', 'vagina and cervix', '. For abortions in the second trimester, the cervix is dilated more widely under ', 0, 'general', ' anesthesia (or with sedation in an ', 0, 'outpatient', ' setting) and the contents of the uterus removed using a combination of suction and surgical instruments. This type of procedure is called ', 4, 2, 'dilation and curettage', 'dilation and evacuation', 'vacuum aspiration', 'D and X', '.') New_Question('By late in the second trimester, an alternative to dilation and ', 2, 2, 'curettage', 'evacuation', ' is to induce premature labor either through a strong ', 0, 'salt_saline', ' injection into the amniotic sac or through treatments with ', 0, 'prostaglandins_prostaglandin', '. If induced labor is impossible, a surgical abortion called a ', 0, 'hysterotomy', ' may be performed to remove the fetus via an incision in the ', 0, 'abdomen', '.') New_Question('In medical abortion, mifeprestone and methotrexate terminate the pregnancy and misoprostol causes uterine contractions. Mifepristone is a ', 0, 'progesterone', ' receptor antagonist that causes the endometrium to deteriorate. Methotrexate selectively kills ', 0, 'rapidly dividing', ' cells and has a toxic effect on the fetus. In about ', 4, 2, '2', '5', '8', '10', '% of women the remains of the fetus and its membranes are expelled by ', 0, 'spontaneous', ' uterine contractions; however, in most cases a second treatment using misoprostol is needed. Misoprostol is a ', 0, 'prostaglandin', ' that induces uterine contractions and expulsion of the contents of the ', 0, 'uterus', '. Medical abortions may be performed up to ', 4, 2, '3–5', '7–9', '10–12', '16–18', ' weeks after the start of the last menstrual period. Mifepristone is reliable in ', 0, '96', '% of cases while methotrexate is reliable in ', 0, '90', '% of cases. If either procedure fails, the woman should have a ', 0, 'surgical abortion', '.') New_Question('The advantages of medical abortions compared with surgical abortions are:
  1. Do not require an invasive ', 0, 'surgical', ' procedure.
  2. Can be performed very ', 2, 1, 'early', 'late', ' in the ', 3, 1, 'first', 'second', 'third', ' trimester.
  3. Resembles a ', 0, 'miscarriage', '.
') New_Question('The disadvantages of medical abortions compared with surgical abortions are:
  1. Takes ', 2, 1, 'days or weeks', 'weeks or months', ' to complete.
  2. Can only be performed during the ', 2, 1, 'early', 'late', ' part of the ', 3, 1, 'first', 'second', 'third', ' trimester.
  3. Can be expensive.
  4. The expulsion of the uterine contents happens at home which could be ', 3, 2, 'very messy', 'more difficult to conceal and psychologically distressing', 'medically unwise', ' for some women.
') New_Question('Neither ', 0, 'medical', ' nor early surgical abortion impairs a woman’s fertility. Although a woman may feel sadness immediately after an abortion, the procedure does not cause any long-lasting ', 0, 'psychological', ' harm to most women. About ', 4, 1, '1', '2', '3', '4', '% of all women who obtain abortions do seem to experience lasting ', 0, 'depression', ' or stress. In general, these women ', 2, 1, 'were', 'were not', ' depressed before their abortion.') New_Head(1, ' Americans Are Divided on Abortion, but Most Favor Restricted Availability, pp. 400–403'); New_Question('If asked to declare a position, ', 4, 4, 'slightly more', 'slightly fewer', 'many more', 'about the same number of', ' Americans declare themselves to be “pro-choice” compared to “pro-life.” However, the opinions of Americans on the topic of abortion are less polarized than this suggests—more Americans believe that abortion should be legally allowed in ', 4, 2, 'all circumstances', 'the first trimester only', 'the first and second trimester only', 'only vary rare circumstances', '.') New_Question('Restrictive views on abortion are more common among those who hold religious beliefs and are ', 2, 2, 'Democrats', 'Republicans', ', whereas those with more permissive views tend to be ', 2, 2, 'less', 'more', ' educated, younger, and ', 2, 1, 'Democrat', 'Republican', '. There is ', 3, 1, 'no', 'a moderate', 'a strong', ' correlation between permissiveness or restrictiveness of abortion views between men and women.') New_Question('The six issues that have been the focus of the national abortion debate are:
  • Restriction of access to abortion by imposing conditions such as mandatory ', 0, 'waiting', ' periods and ', 0, 'parental', ' notification.
  • Restriction of abortions during certain ', 0, 'phases_periods_stages_trimesters', ' of pregnancy.
  • ', 0, 'Banning', ' of certain procedures like “intact D and X.”
  • Use of ', 0, 'public', ' funds for abortion services.
  • Restrictions on movement of ', 0, 'protesters_pro-lifers', ' around abortion patients and clinics.
  • Use of embryonic ', 0, 'stem', ' cells obtained from aborted fetuses for biomedical research.
    • ') New_Question('Abortion services are least available in the nonmetropolitan areas of the ', 4, 2, 'northern', 'southern', 'eastern', 'western', ' United States. ', 4, 2, 'One-quarter', 'One-third', 'One-half', 'Three-quarters', ' of all American women live in counties where there is not a single abortion provider. During the 1990s, at least ', 4, 4, '3', '5', '7', '11', ' abortion providers or supporters were murdered by anti-abortion activists. Pro-life and pro-choice activists both agree ', 3, 3, 'that abortion should be allowed early in pregnancy', 'that abortion numbers are acceptable', 'that contraception is preferable to abortion', '. Abortion rates in the Unites States ', 3, 2, 'are increasing', 'are decreasing', 'remain about the same', '.') New_Head(1, ' Some Countries Use Birth Control to Regulate Population Growth, p. 403'); New_Question('To control population in India there is a state-run ', 3, 2, 'program to abort all subsequent pregnancies after the first child is born', 'sterilization program', 'program whereby families pay less taxes the fewer children they have', '. Many Westernized countries such as Japan face a different issue—they have ', 0, 'decreasing_dropping_falling', ' birth rates.')