Jonathan Soriano

Human Sexual Behavior

April 1, 2010

Cottonseed Oil
- Has a component that inhibits spermatogenesis (gussipoyl)
- Was a problem with fertility in China

Other male contraceptives?

- Research on various possible hormonal/chemical contraceptives
o Inhibiting sperm production without lowering sex drive and/or erection
o Reversibility
- Maybe not as much male contraceptives because:
o It is a lot easier to interfere with female infertility vs. male fertility
o Ovulation is a point event – only occurs approximately once every four weeks
 If you prevent that one occurance, you have prevented fertility
o Spermatogenesis goes on all the time

Emergency Contraception
- Contraceptive methods used AFTER intercourse
- These have also been around for a very long time
o Very potent estrogen that interferes with sperm transport and implantation
o Also made women very nauseous
o Decades ago
- Somewhat more recently:
o A different version is used that is to apply high dosages of oral contraceptive pills
o A lot of estrogen and progestin in the system
o Being replaced by what is marketed as Plan B
- Regimen of synthetic estrogen and/or progestin taken within 5 days unprotected sexual
intercourse or rape (It will not terminate pregnancy)
- 99-75% reduction in the risk of pregnancy depending on timing and formulation (more
effective if within 24 hours than 72)
- In 2006, FDA approved Plan B OTC availability at licensed pharmacies for women 17 or
older, younger women must have a prescription
- Interfere with ovulation, sperm transport, and implantation
o Used without knowledge of whether fertilization is known is taken place or not
o Would cause ovulation not to occur and interferes with implantation
- It is a lot of hormone  side effects go up as dosage goes up
o Do not use routinely, but instead under emergency situations
o Ex: a condom breaking during intercourse
- Medical insertion of an IUD within 5 days of the unprotected sexual intercourse is highly
effective as well
- At 5-7 days implantation will occur  not really effective after this

The Options for Unintended Pregnancy

- About 50% of the pregnancies in the US are unintended
- You have two options: either allow it to progress or terminate it
Abortions
- Abortion is a term that means pregnancy termination
- Three kinds of abortions
o 1. Spontaneous abortions
 Pregnancy terminates all by itself
 Also called a Miscarriage
 Most of the research suggests that somewhere between 10 and 50% of all
implantations fail spontaneously
 Of those, the vast majority occur very early in the pregnancy, not too long
after implantation, and the woman is never aware of it
 If the failure occurs within 2 weeks of fertilization, there may not even be a
disruption in the menstrual cycle
- The other two are Induced abortions
o 2. Elective abortions
 The woman, with unintended pregnancy or whatever, decides that her best
option is to terminate the pregnancy
o 3. Therapeutic abortions
 Advised to have an abortion because of health-related reasons
 Medical advice is “you should strongly consider having an abortion because
this could be dangerous”
- Induced Abortions
o Number of US abortions per 1000 women aged 15-44 by year (both elective and
therapeutic) – graph
o Research suggests that the rate of abortion slowly declined beginning in the early
1980s and is now relatively stable at around 20/1000 women
- The earliest forms of abortion in terms of pregnancy:
o Can be done pharmacologically using drugs (recently)
o Doing this, however, is something that’s known of almost all cultures going back
cultures
o Abortifacient
 A medical (non-surgical such as herbs) that induces abortion
 The distinction that is made between a physician’s supervision with drugs is
calling it a Medical abortion as opposed to a surgical abortion
- Mifeprex
o The most successful current abortifacient (medical abortion) is with Mifepristone
(RU-486)
 Discovered in 1980 in a French pharmaceutical firm and every drug
company, when they first start experiment, gives it a code name – RU-486
 They decided not to market it
 They licensed it to someone else because of the uproar of it in France, even
after it had been approved by the French government in 1988
 The company they licensed it to referred to the drug as Mifeprex
o No one had been able to develop an anti-progestin (which would block the
progestin receptor) instead of the anti-estrogen
 Even though these herb-type of medicines were around for a while
 This drug is a progestin-protagonist
  The cells of the uterus act as if no progestin is present 
endometrium breaks down
 Receptors are now blocked temporarily by this drug
o Was illegal in the US while it was approved in France and China
 After a while, the US approved its anti-progestin use in 2000
 Still remains highly controversial
 There are people who object to it based on the fact that it could be seen as
making abortion easier
 Highly regulated
 Not available at drug stores, or even by prescription
 Only way to get it legally in the US is by going to a physician and
having that physician monitor its use
o The treatment is to take the compound (which causes the endometrium to begin to
fail which causes problems with implantation) and then a second drug which
induces uterine contractions which expels the contents of the uterus
 Used in some countries also as emergency contraception
 Not used this way in the US
 It is useful typically within the first few weeks of pregnancy
o Also been controversial because some people still worry about long-term effects
because it is something that is relatively new
o 95% effective up to 35 days

Surgical Abortions
- Abortions manually by a health professional
- The most common of these methods is known as Vacuum Aspiration Abortion
o Vacuum aspiration is a health professional inserting a very small suction tube into
the uterus and through suction, removing the contents of the uterus
o Early in pregnancy, this can be done without anesthesia and the tube is small
enough that it can be inserted into the cervical canal without altering the cervical
canal
o It can also be done as a kind of emergency contraception (in other words whether
you know if a pregnancy has occurred or not)
 Menstrual extraction
 Sometimes an MVA (manual vacuum aspiration)
o As the pregnancy progresses, the embryo is larger (at 8 weeks it is now a fetus –
larger and more difficult to pull out)
o After 6 weeks, the size of the suction tube you need is larger than the cervical canal
 Thus need to dilate the cervix – increase the diameter of the cervical canal
 One method is to insert, over time, larger and larger probes or tubes to
slowly expand it
 OR you can use a dried seaweed stick that’s inserted into the cervix (a sterile
stick) and it absorbs moisture from the surrounding tissues and as it does
this it slowly expands, dilating the cervix over the course of 24 hours
 This can then be removed and then a tube can be inserted
 At this point, you need some anesthesia as well
 When you start dilating the cervix  “Dilation and Evacuation”
 - This CAN be a vacuum and suction procedure, but as the pregnancy progresses, suction
alone may not be enough
o Insert forceps and tweezers to break up the fetus if it gets too big
- Typically done only in the first trimester
o This method accounts for 80-90% of the abortions in the US

Other surgical methods besides Vacuum

- Dilation & Curettage (D&C)
o For pregnancies of 15 weeks or less
o Once common but only 2.4% of US abortions in 2002
o Not specific to induced abortions
o Women have this D&C for a lot of reasons
o Basically just used to scrape the contents of the endometrium off  maybe if
there’s an abnormality
o Much less commonly used for abortions nowadays, and is no longer approved by
the world health
- Second Trimester (until 24 weeks)
o At this point, if the fetus is born then it has about a 50% chance of survival with
provisions to ensure health of baby
o Want to shut down the developing fetus and cause labor to start
o Induced Labor
 Only for pregnancies beyond 16 weeks, saline injected into the amniotic sac,
and prostaglandins to induce labor within 12-36 hours
 You basically have ejection of the fetus (saline kills developing fetus)
o Intact Dilation & Extraction (IDX or D&X)
 Used in late-term abortions generally when the mother’s life/health is
endangered by the pregnancy (banned as “partial birth” abortion)
 Surgical procedure
 Involves surgical dilation and extracting the contents
 The size of the fetal head is too big to go through the dilated cervix  it is
punctured and deflated first
 No longer legal in the united states
o Hysterectomy
 Similar to a Caesarean section
 Make an incision and remove the developing fetus
 Many physicians argue that this is a really serious and dangerous operation
in comparison to the IDX  that’s why medical people fought the ban on
IDX
- Partial-Birth Abortion Ban Act
o The act defines partial-birth abortions as: An abortion in which the person
performing the abortion partially vaginally delivers a living fetus before killing the
fetus and completing the delivery

Abortion rates
- About 800,000 abortions per year
- 61% of abortions were performed at <8 weeks, and 88% at <13 weeks
- These are only induced abortions – both elective and therapeutic
- In terms of number of abortions per 1000 live births
o For every 1000 live births, we have on the order of 200-250 abortions taking place
- Abortions tend to be safer than pregnancy
o There are more deaths by pregnancy than deaths by abortions
- Abortion and when the abortion is done is not constant over age
o Teenagers account for 17.4% of abortions, women 20-24 account for about 33.5%
o Most abortions are done in women between 15 - 24
o Teenagers also tend to wait longer  more second trimester abortions
 These are less safe than first trimester abortions
