Mission locale du bassin chambérien

Mission locale jeunes
du bassin chamberien
Contraception et IVG Imprimer Envoyer
Mardi, 03 Février 2009 15:00

Qu’est-ce-qu’une contraception ?

mn_evenm008.jpgC’est l’ensemble des moyens employés pour provoquer une infécondité temporaire chez la femme ou chez l’homme, c’est à dire les différentes méthodes qui ont pour but d’éviter une grossesse. Qu’elles agissent en bloquant l’ovulation, en empêchant la fécondation ou empêchant l’implantation d’un œuf, les méthodes contraceptives, à une exception près (méthode de stérilisation chirurgicale) sont réversibles et temporaires. La contraception est très répandue en France : 60% des femmes utilisent la pilule, 23% un stérilet et 16% une autre méthode. Une contraception de «rattrapage», la contraception d'urgence (appelée également la pilule du lendemain), est disponible depuis 1999.

Malgré le nombre important de femmes et de couples utilisant un moyen de contraception, le nombre de grossesses non désirées reste élevé comme le montrent les résultats d'enquêtes épidémiologiques.

 

 

Principe et mécanisme d’action des contraceptions

 

Seuls les préservatifs masculins et féminins protègent
contre les infections sexuellement transmissibles et contre le VIH.

La méthode la plus utilisée en France est la pilule, contraception orale qui agit par différents mécanismes, notamment en bloquant l’ovulation. Prise très régulièrement, la pilule est très efficace. Elle est délivrée sur prescription médicale, dans les pharmacies et les centres de planification. Trois autres méthodes font appel à des substances hormonales. Le timbre (patch) contraceptif, où l’association oestro-progestative est active par voie transdermique ; il est appliqué sur la peau et délivre les hormones pendant 7 jours, 3 semaines sur quatre. L’anneau vaginal, qui se pose dans le vagin, contient une association oestro-progestative qu’il diffuse pendant trois semaines ; à la fin de la troisième semaine, il est retiré. Un nouvel anneau est mis en place sept jours plus tard. L’implant progestatif, petit bâtonnet qui est posé sous la peau du bras par un médecin, délivre progressivement un progestatif ; il reste actif pendant 3 ans.

Le stérilet, également appelé dispositif intra-utérin (DIU), constitue une contraception mécanique et agit en empêchant l’implantation de l’œuf dans l’utérus. C’est un petit objet d’environ 3 cm, en plastique souple, qui est placé par un médecin dans l’utérus. Il existe plusieurs types de stérilets ; le choix est fait par le médecin en fonction des situations individuelles. Le stérilet est délivré en pharmacie sur prescription médicale. Son efficacité est importante.

Des méthodes agissent aussi en empêchant la rencontre entre ovule et spermatozoïdes. C’est le cas des préservatifs masculin et féminin, seuls moyens contraceptifs qui assurent une protection contre les infections sexuellement transmissibles et le VIH. Le préservatif masculin se présente sous la forme d’une gaine en latex (ou en polyuréthane) qui se déroule sur le pénis en érection. Son efficacité, lorsqu’il est utilisé correctement, est de 95%. Il est disponible sans prescription en pharmacie, dans les grandes surfaces ou encore dans des distributeurs situés sur la voie publique. Il est également possible de s’en procurer dans les centres de planification ou d’éducation familiale. Le préservatif féminin se présente sous la forme d’une gaine en polyuréthane (ou en nitrile) qui se place dans le vagin avant un rapport sexuel. Il s’achète dans certaines pharmacies et dans de rares distributeurs automatiques de préservatifs féminins, notamment dans la région parisienne. Il est possible de s’en procurer dans les centres de planification ou d’éducation familiale. D’autres méthodes agissent comme une «barrière». La cape cervicale et le diaphragme sont des coupelles en latex ou en silicone qui se placent avant les rapports sexuels sur le col de l’utérus. Ils sont délivrés sur ordonnance en pharmacie, après explication de la méthode par un médecin ou une sage-femme. Ils sont utilisés avec des spermicides. Les spermicides sont des produits chimiques dont l’action contraceptive altère localement les spermatozoïdes ; vendus en pharmacie, ils sont utilisés seuls ou en complément d’une autre méthode contraceptive.

Les méthodes d’observation naturelles ont en commun d’identifier le moment où, dans un cycle, se produit l’ovulation et de déterminer une période pendant laquelle les rapports sexuels sont déconseillés lorsqu’une grossesse n’est pas désirée. Elles ne nécessitent ni médicament ni dispositif médical. L’identification de cette période est basée soit sur des méthodes d’abstinence périodique, soit sur des méthodes d’auto-observation (de la température, de la glaire cervicale), soit sur des calculs (méthode Ogino, méthode du calendrier). Ces méthodes ne sont pas des méthodes contraceptives fiables. Il existe aussi des tests qui servent à détecter d’ovulation par un dosage urinaire d’hormones ; ils sont vendus en pharmacie.

Deux types de contraception doivent être distingués pour leur place particulière.
La contraception d’urgence est une méthode de «rattrapage» hormonale (progestatif) utilisée par voie orale lorsqu’un rapport sexuel a eu lieu sans contraception régulière ou à la suite d’un incident, tel qu’une déchirure d’un préservatif ou un oubli de pilule. Elle ne nécessite pas de prescription médicale et est délivré dans les pharmacies. Deux cas de figure peuvent se présenter : sans prescription, cette contraception d’urgence est délivrée mais non remboursée ; avec une prescription, elle est remboursée.
Pour les mineures, la contraception d’urgence est délivrée gratuitement par les pharmaciens, sans prescription, et de façon anonyme sans que la mineure ait à justifier de son identité. Elle peut être délivrée, dans certaines situations par les infirmières scolaires.

Un dispositif intra utérin au cuivre peut également être posé comme contraception d’urgence après un rapport non ou mal protégé. Il doit être posé dans les 5 jours qui suivent l’ovulation.

La stérilisation à visée contraceptive : il s’agit de la stérilisation tubaire (appelée communément ligature des trompes) pour les femmes et de la ligature des canaux déférents (encore appelée vasectomie) pour les hommes. Ces actes chirurgicaux, considérés comme irréversibles, sont réalisés par un médecin dans un établissement de santé public ou privé (hôpital ou clinique). Seules les personnes majeures peuvent demander une stérilisation.

 
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La Mission Locale Jeunes du Bassin Chambérien est une association
loi de 1901 labellisée par l'Etat et financée par l'Europe, l'Etat,
le Conseil Régional Rhône Alpes, le Conseil Général de la Savoie,
la Communauté d'Agglomération Chambéry Métropole,
les communautés de Communes et les Communes de l'Avant
Pays Savoyard et de la Combe de Savoie.

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