Dean Cruikshank

Contraception

Sex is a delicate subject that is often difficult to speak about with healthcare professionals. Sex is an essential part of life, regardless of age, sex, health, or physical activity and is considered by many a wonderful way to express love to one another. CF does not diminish sexual desire or the need to be intimate with your partner.

Although most men with CF are infertile, they are not immune to sexually transmitted infections or STIs. Women must use contraceptives if they do not wish to become pregnant and they must have protected sex since they are also at risk for contracting STIs.

There are several different types of contraceptives, including:

Male Condom: when used correctly, it is a highly effective means of means of birth control and provides protection against STIs almost 100% of the time. Perfect use, i.e. correct use every single time, can still result in a 2% per-year pregnancy rate. Typical use is not necessarily using it correctly or at every sexual contact, meaning the pregnancy rate can go up to 15% or higher. Accidental breakage can also happen even with perfect use. It is an excellent method of protection from STIs and transmission or organisms that cause AIDS, genital herpes, genital warts, syphilis, and gonorrhea.

Female condom: similar to the traditional male condom, but inserted into the vagina, it also offers highly effective birth control and STI protection; the female condom is suitable for people who are allergic to latex.

Birth control pill: if used properly, is very effective in preventing pregnancies, but does not offer any protection against STIs; its effectiveness may be decreased when certain antibiotics are taken. Recent pharmacokinetic data has shown that plasma levels of oral contraceptive steroids (birth control pill) remained unchanged whilst using antibiotics commonly prescribed in CF with the exception or rifampicin which does alter plasma hormone levels, leading to contraceptive failure. Some complementary medicines such as St. John's Wort can also effect liver enzymes and reduce the effectiveness of oral contraception.

Depo-ProveraTM: delivered by an intramuscular injection every three months. It is NOT recommended for women with CF because it increases the risk of osteoporosis (having to do with bone mineral density), a condition to which individuals with CF are already predisposed

• "The Patch" (EvraTM): is an effective once-a-week birth control patch that works on the same principles as the pill. Like the pill it does not offer protection against STIs, and its effectiveness may be decreased when certain antibiotics are taken.

Intrauterine Device (IUD): a highly effective device that is inserted into the uterus by your gynecologist or family doctor, and can remain there for several years. It does not protect against STIs.

The diaphragm: a device that prevents sperm from entering the uterus; it should be used in combination with spermicidal cream or jelly and offers no protection against STIs.

Spermicide: a contraceptive substance that eradicates sperms. It is inserted into the vagina prior to intercourse to prevent pregnancy. It is NOT an effective method when used alone. Usually, Spermicides are combined with contraceptive barrier methods (i.e. diaphragm, condom, cervical caps and sponges. When combines use can result in lower pregnancy rate.
Important to note that Spermicide is NOT recommended by CDC. Spermicides can cause irritation, increased risk of contracting HIV, urinary tract infections, yeast infections, and bacterial vaginosis in women, and itching and burning sensation in genital area of either partner.

Vaginal Ring (NuvaRing): delivers estrogen to the source and is inserted into the vagina for 3 weeks and removed for the 4th week. It has the same efficacy as the pill.

Contraceptive Sponge: is a sponge placed inside the vagina that contains spermicide. You add water and place it inside up to 24 hours before intercourse and you take it out no sooner than 6 hours after intercourse. Toxic Shock Syndrome can occur if it is left inside longer than 30 hours total. Similar to spermicide, it has been reported to cause irritation in the genital area. It has 64 to 82% effectiveness if used correctly and at every intercourse.

The following are not-so-effective methods but have been used by people due to religious regions or fear of side-effects from the above methods.

Rhythm method/natural family planning: This method has been known for thousands of years. It works by focusing on a woman's most fertile period during her menstrual cycle and then restricting sexual intercourse during that time. As mentioned earlier in the section re: menstrual cycle, the egg is ready for fertilization after ovulation. This matured egg will survive for 24 to 48 hours at the most. So, if a woman who is using the rhythm method to avoid pregnancy, she should not have sex during this period of time. Unfortunately, it time that takes to ovulation within a menstrual cycle varies slightly from woman to woman. In CF, many girls have irregular periods. Therefore, it would be quite difficult to do the calculation and pinpoint the exact day of fertility. Unplanned pregnancy can bring in significant physical and psychological stress to a woman and her family. Therefore, this method is not recommended.

Withdraw/coitus interruptus: this method involves the male partner pulling his penis out of the vagina before ejaculation. It is not an effective method because it is not easy to withdraw early enough and sperm containing in the first squirt may have already reached into the woman before his complete withdrawal. Also, it is believed that the "dew drop" of fluid man produces when he becomes excited contains sperm. So sperm may have already deposited before actual ejaculation. With all the modern reliable methods and knowing the possible physical and psychological stresses that can result from unwanted and unplanned pregnancy especially in women with CF, this method is not recommended.

Please note that both the rhythm method and the withdrawal method are NOT effective methods of contraception and should be avoided. Because of the risk of side effects and potential interactions with your CF medications, it is important to talk to your doctor to find the best contraceptive for you. You may also seek advice from a family doctor; however, it is important that the CF team is aware of all treatment.