Abstract

PIP: The prevention of pregnancy in ileostomy patients presents a special problem because of the delicacy of the choice of contraceptive methods. They include chemical methods, such as suppositories, gels, salves, or foams which contain spermicidal substances, but these can be used only as long as there is no injury to the vagina. These methods are relatively safe, provided the time required for action of the preparation is observed. Mechanical means of contraception include the diaphragm and other cervical caps placed on the cervix, possibly in combination with a chemical agent, except when the cervix is injure,d which is not always the case with Crohn's disease. The IUD is very reliable; however, it should be contraindicated in case of vaginal or rectal fistulas. It is not known, if IUD use would contribute to the formation of fistulas; however, IUDs have been implicated in increased monthly menstrual flow and resultant anemia. Ovulation inhibitors containing hormonal components, such as oral contraceptive are absorbed in the small and large intestines; however, as ileostomy suffers have increased passage of stool, the effectiveness of these preparations is not fully reached, and reliable protection is uncertain. When no childbirth is desired, an alternative is the 1 or 3 month injectable contraceptive, although its side effects (sterility, amenorrhea, and dysmenorrhea) are frequent. The advice and counselling of a gynecologist is recommended to assess individual physical and psychological needs.