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The choice of contraception at various diseases
Contraception is the prevention of undesirable pregnancy reached in various ways.
There are several types of contraception, and the most ancient are barrier methods of contraception. At the beginning of the 20th century it were the only means for prevention of undesirable pregnancy, however in the modern world their popularity considerably decreased that is connected with emergence of more effective contraceptive remedies. However barrier methods of contraception continue to develop and be improved since they have much less undesirable complications and contraindications, and also with growth of quantity of diseases, sexually transmitted.
Diseases which are transmitted sexually a huge number and their prevalence, unfortunately, grows. Such diseases are: candidiasis, bacterial vaginosis, gonorrhea, trichomoniasis, genital herpes, vulvovaginitis, mucopurulent cervicitis, AIDS, cystitis and not gonococcal urethritis, and also pubic louse, genital condylomas, hepatitis B, various inflammatory diseases of bodies of a small pelvis and intestinal infections, and others. To prevent infection with similar diseases of the sexual sphere, it is necessary to support sexual bonds only with one healthy partners, or to reduce the number of such partners, to pass inspection on STD to you and your partner, to exclude sexual contacts with those who have a large number of sexual partners, and also to lead a healthy lifestyle.
There are several types of barrier contraceptives: man's and female which happen medicamentous and barrier non-drug. Anyway barrier contraceptives block penetration of semen into cervical slime. The general advantages of barrier methods of contraception are the small quantity of side effects, protection from venereal diseases, they act only locally and do not cause system changes in an organism, and have practically no contraindications. Shortcomings of barrier methods of contraception are emergence of allergic reactions to materials of which these contraceptives are made (rubber, latex, polyurethane), and then it is impossible to use them, possess smaller efficiency in comparison with other methods of contraception, for their use it is necessary to carry out some manipulations on genitalias and to watch their arrangement during sexual intercourse. Similar methods of contraception apply in cases when it is impossible to use other contraceptives — intrauterine means and oral contraceptives, during a lactation, at reception of the medicines which are not combined with oral contraceptives.
The most popular barrier contraceptive is the condom. The condom is the only contraceptive in the world which is used by men. They are made of the elastic rubber having thickness about 1 mm. Usually condoms have 10 cm in length and can increase depending on the sizes of a generative organ. Condoms protect from the diseases of the sexual sphere caused by viruses and bacteria. Besides, use of condoms protects from infections all departments of a sexual path, as well as from an extrauterine pregnancy. The twisted condom is put on a penis in a condition of an erection. Prevalence of this method of barrier contraception makes about 30%. Advantages of use of a condom: simplicity in the use, protection against diseases, sexually transmitted. Also condoms protect from infection with AIDS. Shortcomings of condoms are: decrease in pleasant feelings at sexual intercourse, a possibility of use of this method of contraception only at a certain stage of sexual intercourse, and also emergence of an allergy to material of which it is made.
Use of condoms has also contraindications: use of condoms from the natural materials passable for viruses if there is an opportunity to catch a sexual disease, and also inability to keep an erection when using a condom.
The vulval diaphragm is a barrier method of contraception, and represents a dome-shaped cap which is entered into a vagina before sexual intercourse so that its dome closed a neck of uterus. Usually diaphragms have the sizes from 50 to 150 mm, and are selected individually to each woman depending on whether she gave birth, her builds, etc. It is from the first correct to establish a diaphragm difficult, the doctor can help with it. At a diaphragm there are a lot of advantages, it protects from sexually transmitted infections which can be caught from the sick person, from an extrauterine pregnancy, and also simplicity of use and the fact that it can be used several times. Side effects of use of a cap are possible infection of urinogenital putsches because of the diaphragm pressure upon an urethra, and also an inflammation of walls of a vagina in places of contact with a diaphragm.
The vulval diaphragm has also contraindications to use, it is an allergy to rubber, and also various diseases of generative organs — a colpitis, an erosion of a neck of uterus, omission of walls of a uterus and vagina, an endocervicitis, and also anomalies of development of generative organs.
One more method of barrier contraception are cervical caps (cervical caps) which are made of latex rubber. Distinguish 3 types of caps: Prentif's cap, Vimul and Dumas's cap which differ among themselves with a form and the sizes. The doctor will help to pick up suitable option to you. It is necessary to notice that correctly established cap closes upper part of a vagina and a neck of uterus.
The following method of contraception is use of chemical ways of contraception, namely, spermitsid. Spermitsida inactivate sperm and interfere with its penetration into a uterus, and also neutralize almost all viruses and bacteria. Drugs are issued in the form of foam aerosols, tablets, the jellies concealing and the foaming candles, creams which are applied locally and protect from some diseases of the sexual sphere caused by infections and viruses and from an extrauterine pregnancy. Modern spermitsida consist of the carrier and substance killing sperm which both are important for ensuring contraceptive effect. Function of the carrier — implementation of dispersion of chemical in a vagina, by conformal coating of a neck of uterus. And spermoubivayushchy active ingredient are strong surfactants which destroy a membrane of spermatozoa (menfegol, oktooktinol, chloride benzalkonium). Spermitsida are used as independently, and together with barrier contraceptives. In the first case they are entered into a vagina in 7-15 min. prior to sexual intercourse.
Advantages of spermitsid are: simplicity of use, protection against some infections which can catch sexually. Shortcomings of this type of contraception: need of manipulations on generative organs, the limited period of action, and at frequent use can be broken natural microflora of a vagina, and local dysbacteriosis can develop. Also they cannot be used at pregnancy, and also at inflammations of external genitals.
By the way, for increase of contraceptive effect it is possible to use spermitsida along with use of a condom, efficiency of this method to 98% of protection against pregnancy and sexually transmitted infections.
The contraceptive sponge is widespread in some countries — the USA, England and the Netherlands. The polyurethane sponge with a nylon loop is established over a neck of uterus, contains in a sponge spermitsid. The sponge needs to be entered one day before the sexual intercourse and to leave in a vagina. The contraceptive sponge protects from gonorrhea and clamidiosis.
Special distribution intrauterine contraception which foundation was laid at the very beginning of the 20th century received now. Initially this type of contraception represented several silk threads twisted in a ring and entered into a uterus. A little later instead of silk threads began to use silver or copper threads, however the design was firm and caused pains and difficulties at introduction and extraction. Were made of flexible plastic of a spiral only in 1960. Today more than 50 types of Naval Forces are known, and they differ on rigidity, the sizes, a form, and on generations. Inert Naval Forces, for example, polyethylene Naval Forces in the form of a letter S (Lipps's loop) treat intrauterine means of the first generation. Today inert Naval Forces are prohibited in the majority of civilized countries because of their low performance in comparison with Naval Forces of the next generations. The second generation of this type of contraceptives are cupriferous Naval Forces which main advantage is rather high contraceptive performance, and also usability. Initially these Naval Forces were made of copper, and validity period they had 2-3 years. To increase the term of their service began to include a silver core in a copper wire, the most popular Naval Forces of this generation are the Poppet of T of Ku 380 A, Multiload Ku-150 and Funkoyd. Gormonosoderzhashchy Naval Forces treat the third generation. They were created as the combined means, having connected advantages of Naval Forces and oral contraceptives. This type of an intrauterine kontatseption includes Naval Forces of LNG-20 and Progestasert which leg of a spiral is filled with progesterone or levonorgestrel. Use of these Naval Forces reduces the frequency of inflammatory diseases, but at the same time emergence of allocations between periods is possible.
Naval Forces have contraindications, they are absolutely contraindicated to those who have acute and subacute inflammatory diseases of genitalias, various malignant processes in generative organs, and also pregnancy including expected. Naval Forces have also relative contraindications, these are anomalies of generative organs, a hysteromyoma, anemia and some other diseases of blood.
Naval Forces are usually entered by the doctor for 4-6 day of a menstrual cycle (at this time the woman can be already sure that she is not pregnant) into the cervical canal that facilitates carrying out manipulation. Naval Forces can be also entered in several weeks after the delivery or into more remote puerperal period. It is taken by Naval Forces also in hospital conditions by means of a packer or a uterine hook, depending on a type of a spiral.
In several days after establishment of a spiral inspection then the doctor grants permission for sex life without other type of protection except Naval Forces is performed. Advantages of intrauterine spirals are: they can be used during feeding by a breast, Naval Forces can apply women of advanced age and those who are not recommended to use other types of contraception. Naval Forces can apply several years that is economic. Besides, after establishment of a spiral only periodic supervision at the doctor is necessary. It should be noted that according to researches, against use of spirals generative function at women is not broken, and pregnancy comes almost at 90% of women within a year after removal of Naval Forces.
Side reactions of use of Naval Forces are back pains, bloody allocations within several weeks after establishment filched. Uterine bleedings can sometimes disturb, there can be allocations between periods, and blood volumes at periods can increase. For reduction of blood loss at periods prostaglandinsintetaza inhibitors are appointed. The risk of inflammatory diseases when using Naval Forces is especially big in the first 3 weeks after introduction of an intrauterine spiral. However if the woman has chaotic sex, then risk to pick up an inflammation increases. The most rare, but also the most dangerous type of complication is perforation of a uterus. At perforation of the first degree when Naval Forces partially is located in the muscle of a uterus, it is deleted in the vaginal way, however at the second and third extent of perforation when the spiral is in a muscle of a uterus or even leaves in an abdominal cavity, then the abdominal way of removal of a spiral is appointed.
It is considered that Naval Forces is the best contraceptive for the giving birth women who have one constant partner and do not suffer from inflammatory diseases of genitalias.
Intrauterine contraception also has contraindications. By Naval Forces it is not entered to women with diseases of bodies of a small pelvis, with acute gonorrhoeas, clamidiosis, a purulent cervicitis, a puerperal endometritis for the last several months, with an erosion of a neck of uterus, at uterus tumors. Also the spiral is not established to pregnant women, and suspecting pregnancy. Besides, Naval Forces are not recommended to introduction at pathological vaginal bleedings and at suspicions on a uterus cancer. However Naval Forces is a post-coital contraceptive which can be used within 5 days after sexual intercourse without protection.
Relative contraindications for establishment of a spiral is: existence in the past of extrauterine pregnancies, existence of recurrent vaginal infections, leukorrheas, at the diseases causing weakness of immune system at a stenosis of a neck of uterus, and also at heavy anemia, at painful periods.
The most widespread contraceptive method is use of hormonal contraceptives. They are divided into several types. The most widespread type of hormonal contraceptives are the combined oestrogenic drugs. They are hopes, are rather inexpensive and are usually well transferred, and divided into 3 types:
- monophase which contain a constant dosage of estrogen and a gestagen;
- two-phase as a part of which one part of tablets contains estrogen and the others — and it is oestrogenic and gestagen;
- three-phase oral contraceptives contain the changing dose of estrogen and gradually increasing dose of gestagen.
Further there are mini-drank which contain to 500 mkg of a gestagenny component in 1 tablet. They are accepted every day, since first day of a cycle. Post-coital drugs as a part of which high doses of a gestagen or it is oestrogenic also belong to hormonal contraceptives. Doses of active agent are 50 times higher here, than in the combined oestrogenic drugs. Post-coital drugs are used within 24 hours after not protected sexual intercourse. It is impossible to accept often them. Besides, it should be noted the vaginal rings containing gestagen which enter into time 1 or 3 days of a cycle, and hypodermic implants (norplant) in the form of the capsules emitting levonorgestrel. They provide contraception on 5 flyings. Also not really long ago there was intrauterine means — Rogestasert as a part of which levonorgestrel which is emitted during the whole year contains.
As it was already noted, the most widespread type of contraception of modern women, reception of the combined oral contraceptives is. The modern combined oral contraceptives contain much less steroids and gestagenny elements, their dosage decreased more than by 5 times. Modern drugs contain up to 1 mg of Norethisteronum and 125 mg of levonorgestrel. Development of oral contraceptives took place 3 stages, depending on a type of a gestagen. The first generation OK contained a noretynodrel acetate, in the second generation instead of a noretynodrel more effective levonorgestrel began to be used. Oral contraceptives as a part of which contains belong to the third generation dezogestret, gestoden. Oral contraceptives of the third generation do not break process of a metabolism of lipids, and do not increase risks of development of heart diseases and vessels.
Contraceptives block an ovulation, change transport of a gamete and break functions of a yellow body.
It is considered that oral contraceptives prevent pregnancy with probability of 100%, they are simple and convenient in use. It is necessary to remember that the combined oral contraceptives are medicines, and it is necessary to apply them only with the permission of your doctor. Anyway, such smallest dose of steroids providing the necessary level of protection is appointed to each woman. Usually, reception of the contraceptives containing no more than 35 mkg of ethinylestradiol and 150 mkg of levonorgestrel is recommended to women. And the doctor can define to what women hormonal contraception is contraindicated. So reception of oral contraceptives is categorically contraindicated to the women suffering, or transferred in the past, various diseases of cardiovascular system, and other vitals. It is thrombophlebitis, a thrombembolia, varicosity, diseases of a liver and kidneys, epilepsy, a diabetes mellitus. Here also malignant tumors of generative organs, tumors of mammary glands, brain vessels, anemia, severe headaches, migraines, various diseases of a gall bladder belong, and also they are contraindicated to those who have an excess weight who suffers from the increased arterial pressure, and also smokers, are especially aged more senior than 40 years.
Usually combined oral contraceptives do not suppress pharmacological effect of other medical supplies, however some drugs can influence efficiency of action of contraceptives, for example, barbiturates and cyclophosphamide. Today interaction researches the COOK and other medicinal substances therefore it is better to use along with oral contraceptives and spermitsida continue.
Interaction of oral contraceptives with other drugs and drugs:
Alcohol — the COOK are capable to strengthen the intoxicating effect of alcohol therefore it is at the same time necessary to apply with care.
Antibiotics — Antibiotics are capable to weaken efficiency the COOK, especially with the low content of ethinylestradiol. It is better to choose other way of contraception.
Analgetics — the COOK can weaken action of analgetics.
Antidepressants — the COOK promote strengthening of antidepressive effect.
Barbiturates — Barbiturates cause decrease in contraceptive effect therefore at their reception it is better to choose other type of contraception.
Vitamin C — At vitamin C reception more than 100 mg/days is observed strengthening of by-effects of estrogen therefore at reception the COOK reduce a vitamin C dose to 100 mg/days.
Hypoglycemic drugs — the COOK can reduce hypoglycemic effect therefore it is necessary to watch glucose level in blood.
Corticosteroids (cortisol) — the COOK increase toxicity of corticosteroid drugs, in this case it is better to choose other way of contraception.
Anticoagulants — At reception of anticoagulants it is better not to use oral contraceptives since they promote decrease in medical effect.
Beta adrenoblockers — the COOK strengthens effect of the medicine, at a concomitant use it is necessary to control a condition of cardiovascular system.
Reception of oral contraceptives can exert adverse impact on cardiovascular diseases since estrogen stimulating affects a myocardium and causes a hypervolemia that leads to reduction of hemoglobin in blood. Besides, the COOK can make an adverse effect on diseases of a liver and exchange processes in an organism. Most often complications at reception of such contraceptives appear at the smoking women, 35 years and with an excess weight are more senior than women. The most dangerous complication of reception of such type of contraceptives is development of a thromboembolism, especially it is dangerous to the smoking women.
Modern oral contraceptives do not exert impact on a lipidic exchange as it was in early the SHOUTING, containing a large number of a progestinovy component.
Under supervision of the doctor and in the absence of contraindications, the woman can use oral contraceptives many years in a row.
Emergence of a headache, increased fatigue, nausea, increase in body weight, emergence of an acne, spasms in legs, an acrimony, a hypertension, thrombophlebitis, abdominal distention, etc. belong to side effects at reception of oral contraceptives which are usually observed in the first two months after the beginning of their reception.
Unlike the COOK which suppress an ovulation and do a neck of uterus impassable for spermatozoa, that mini-saw make impact on cervical slime and change mucous a uterus so the oospore cannot be fixed in it. In structure mini-saw microdoses of gestagen (levonorgestrel, Norgestrelum) enter, and there is no estrogen. This type of contraception is applied every day, since first day of a cycle. The main side effect from reception mini-saw emergence of intermenstrual bloody allocations is. Mini-saw can be appointed to the women with liver diseases, hypertensia and also having obesity at a diabetes mellitus, a varicosity.
Contraceptives of the last generation, or the low-dosed oral contraceptives, call the norplant representing 6 capsules which are entered into a forearm of the left hand and provide a protective effect during 5 flyings. Also here also the Depot-Provera in the form of water suspension of a medroksiprogesteron of acetate which is entered into an organism in the form of 4 injections belongs. The low-dosed oral contraceptives are categorically contraindicated: that who has heart diseases and vessels, a diabetes mellitus, thrombosis, heart diseases, heart ischemia, a cancer of mammary glands, a viral hepatitis, cirrhosis, liver tumors, during pregnancy and in the period of a lactation. Low-dosed OK can be applied without restrictions at a hysteromyoma, endometriosis, venereal diseases, HIV infection, at tuberculosis, epilepsy, an iron deficiency anemia.
At selection of a type of hormonal contraception, the woman usually takes a blood test on biochemical analysis, does a gemostaziogramma, ultrasonography of bodies of a small pelvis, and also gets advice of the mammologist and therapist.
One of the most well-tried remedies from undesirable pregnancy and various venereal diseases is the condom combination from latex and spermitsid. In this case protection against the HIV infections, various diseases caused by viruses and bacteria is guaranteed. For example, farmateks protects from herpes, chlamydias, a trichomonad, gonorrhea and many other diseases.
Many practice syringing after sexual intercourse, however it can only increase probability of infection since in this case the chance to injure mucous membranes of a vagina, and also washings off of its protective slime is big.
The ideal contraceptive does not exist. If we prevent physiological feature of the woman — pregnancy, then surely there will be by-effects. To minimize them, select contraceptives together with the good doctor.
Right choice of contraception influences the course of any other disease, and efficiency of methods of protection in this case different therefore at purpose of contraception it is necessary to conduct complex examination of an organism of the woman.
If the woman has various genital diseases, then contraception is necessary for avoidance of risk of deterioration in health if suddenly there comes pregnancy. The best method of protection from undesirable pregnancy at diseases of generative organs is use of a condom and spermitsid. These methods of contraception are available, simple in use, do not exert a negative impact on generative organs of the woman, and also their action is reversible after the end of their use.
At heart diseases and vessels it is recommended to use female diaphragms in connection with spermitsida, at their correct use this method is rather effective. The interrupted sexual intercourse or sexual abstinence will hardly improve quality of your intimate life. The best method of contraception at cardiovascular diseases is continuous reception of small doses of gestagen. In the minimum quantities they do not influence coagulability of blood, however can cause increase in body weight. Besides this method can promote disturbance of a menstrual cycle.
At arterial hypertension, heart failure, in the presence in the past of thromboses, a thromboembolism, at inborn heart diseases, rheumatic diseases, and also existence at someone from relatives of an idiopathic hypertensia, the combined oral contraceptives are strictly forbidden to be applied. Are also unacceptable for use at heart diseases and vessels drugs which contain more than 50 mkg of estrogen. At the use of oral contraceptives, for reduction of probability of development of thrombosis, it is not necessary to apply anticoagulants since at the same time there are changes in coagulability of blood. Action of a norplant on having cardiovascular diseases is not studied. Besides, use of hormonal contraceptive tablets can lead to giperplaziya, and also to decrease in comprehensibility of carbohydrates that is especially dangerous to diabetics.
Intrauterine contraception has to be used by the women having cardiac diseases and pathologies of vessels, carefully. Naval Forces should not be applied at arterial hypertension, at heart diseases and vessels which can be complicated by a bacterial infection, and also at diseases in which treatment anticoagulants are applied.
At cardiovascular diseases voluntary surgical sterilization, especially for women with heavy heart diseases can be also used or at malignant arterial hypertension. It can be seen off at once after Cesarean section. Best of all at the same time bipolar electrocoagulation.
If the woman has a high risk of tromboembolic episodes, then it is necessary to make very responsibly the contraception choice since the wrong choice can lead to dangerous effects. Women are especially subject to tromboembolic episodes 40 years, and also smokers are more senior. In a usage time of the combined oral contraceptives the risk of a hematencephalon increases by 1,5 times. And the women who are constantly applying means of hormonal contraception are subject to formation of thromboses 5-7 times more often, and myocardial infarctions come twice more often. High doses of estrogen influence coagulability of blood, coagulant potential increases and fibrinolitic activity decreases. It should be noted that the use of oral contraceptives of the third generation reduces quantity of possible thromboses, by 4 times in comparison with reception of contraceptives of the first generation. The risk of similar complications in the first several months of reception of hormonal contraceptives is especially high. The risk of developing of thromboses is especially big with the increased arterial pressure, and emergence of migraines, falling of sight, weakness in extremities can become harbingers of complications. In this case, the COOK cancel, and the woman is surveyed.
At chronic arterial hypertension it is better to use spirals with the content of progesterone, copper, to tablets with the content of progestin and to barrier methods of contraception. Oral contraceptives are forbidden to be accepted since their use leads to increase of arterial pressure.
Thus, for the women suffering from heart diseases of vessels, the best contraception are barrier methods of contraception and use of spermitsid.
The patients oral contraceptives and Naval Forces which contain progestogen suffering from an iron deficiency anemia since progestogen promotes reduction of menstrual bleedings can use. The COOK are absolutely contraindicated suffering a sickemia, it is possible to use only the contraceptives containing progestogen. Women with symptoms of anemia need to appoint very carefully spirals with the content of copper since they promote increase blood loss at periods.
At a diabetes mellitus the best means is intrauterine contraception, Naval Forces containing progesterone since they are not subject to an infection, and influence reduction of blood losses. Because of the raised susceptibility to infections, cupriferous Naval Forces have to be used with care. At their establishment it is necessary to follow strictly rules of an asepsis, and for prevention of infection antibacterial drugs are appointed. At vascular defeats oral contraceptives are not used since they can reduce sensitivity to insulin. In case of appointment the COOK, namely, a norplant, and also what contain only progestogen it is necessary to watch glucose level in blood.
Thus, the best means of a konratseption for women with a diabetes mellitus, is Naval Forces and surgical sterilization.
At chronic diseases of a liver and cirrhosis reception of hormonal contraceptives is categorically contraindicated, it is the best of all to use barrier contraceptives and Naval Forces. The COOK are capable to cause a nodular hyperplasia of a liver which can be transformed to a tumor.
At a system lupus erythematosus establishment of Naval Forces will be the best method, and also it is possible to use the COOK with progestins.
At treatment of tuberculosis rifampicin efficiency the COOK decreases therefore it is better to pick up other way of protection against undesirable pregnancy, taking into account contraindications.
Making the choice of contraception for women with mental disorders, it is necessary to consult on the psychiatrist, the sociologist, trustees and lawyers about an opportunity the patient it is correct to use methods of contraception or to give preference to sterilization. Reception of oral contraceptives can cause small mental deviations in the form of depressions, drowsiness and sharp differences of mood.
With a convulsive syndrome it is better for patients to choose non-hormonal methods of contraception.
At migraine the combined oral contraceptives since they are capable to strengthen disease symptomatology are contraindicated. In this case the preference is given to barrier methods of contraception, Naval Forces and drugs containing only progestogens.
For the women having epilepsy, the best security measure from pregnancy is establishment of Naval Forces. The drugs used at treatment of epilepsy, for example, phenobarbital promote decrease concentration of steroids in blood that can increase risks of pregnancy. In this case the dose of oral contraceptives should be increased twice that will cause increase in side effects.
With surplus of body weight use the COOK can be led to activation of side effect of gestagen which reason — in structural proximity of gestagen to testosterone. In this case increase in weight, emergence of an acne and excessive nervousness can be observed. In this case it is necessary to use the COOK with a low ratio gestagen / it is oestrogenic.
Categories of women for which were diagnosed a breast cancer malignant diseases of genitalias, are contraindicated to a liver the combined oral contraceptives since they can cause recurrence of hormonedependent cancer of neck of uterus or mammary glands. At all other types of oncological diseases it is possible to use any kinds of contraception.
According to some researches, at women till 36 flyings, it is long accepting the COOK, the risk of a breast cancer increases. Use of Naval Forces at breast cancer is also rather dangerous since can increase inflammatory diseases of genitalias which are followed by dysfunctions of ovaries and can lead to progressing of a mastopathy.
At a cancer of a neck of uterus use OK leads to an aggravation of symptoms, and also development of a ferruterous and planocellular carcinoma of a neck of uterus.
In the presence of HIV infection the best method of contraception is use of condoms and spermitsid, better at the same time. For prevention of HIV the condom can be used in combination with other types of contraception, for example, at sexual intercourses with addicts, women of easy virtue and those who treat STD risk group. Condoms should be used at all types of sexual contacts (vaginal, oral, proctal). Also condoms need to use even if one of partners had an operation on sterilization or is in a menopause.
When using Naval Forces risks of transfer of other diseases, sexually transmitted increase, besides, HIV-positive people cannot use it. There are researches that the prostitutes using oral contraceptives as protection are more susceptible to HIV infection.