Birth Control Barrier Methods

The condom (also called a rubber) is a thin sheath placed over an erect penis. A man would put a condom over his penis before he places the penis in a womans vagina. A condom worn by a man prevents pregnancy by acting as a barrier to the passage of semen into the vagina. A condom can be worn only once. It is one of the most popular forms of barrier methods for birth control. Condoms may be purchased at most drugstores and grocery stores, and dispensers can be found in many public restrooms.

Condoms made from latex are the most effective at preventing pregnancy. They also protect against sexually transmitted diseases such as AIDS and gonorrhea. Condoms should not be used with petroleum jelly (e.g. Vaseline), lotions, or oils. They can decrease the effectiveness of the condom and increase the chance of pregnancy, as well as sexually transmitted disease. Condoms can be used with lubricants which do not contain oil, such as K-Y Jelly.

Many women prefer the male condom because it prevents the contraction of HIV (the virus that leads to AIDS) and other STDs.

• How effective: The failure rate of condoms in couples which use them consistently and correctly is estimated to be about 3% during the first year of use. However, the true failure rate during that time period is estimated to be about 14%. This marked difference of failure rates reflects usage error. Some couples fail to use condoms with each sexual encounter. Condoms may fail (break or come off) if you use the wrong type of lubricant. Using an oil-based lubricant with a latex condom will cause it to fall apart. The condom may not be placed properly on the penis. Also, the man may not use care when withdrawing.
• Advantages: Condoms are readily available and inexpensive. A prescription is not necessary. This method involves the male partner in the choice in contraception. Besides abstinence, latex condoms provide the best protection against STDs. They are the only method of birth control that is highly effective in preventing AIDS.
• Disadvantages: Condoms possibly decrease enjoyment of sex. Some users may have a latex allergy. Condom breakage and slippage can make them less effective. Oil-based lubricants may damage the condom.

The female condom (brand name: Reality) is a polyurethane sheath intended for a single use, it is similar to the male condom. It contains two flexible rings and measures 7.8 cm in diameter and 17 cm in length. They may be purchased at a pharmacy without a prescription. The ring at the closed end of the sheath serves as an insertion mechanism and internal anchor that is placed inside a woman's vagina just before sex. The other ring forms the external edge of the device and remains outside of the canal after insertion. The female condom prevents pregnancy by acting as a barrier to the passage of semen into the vagina. A male condom should not be used simultaneously because of the possibility of adherence leading to slippage or displacement of one or both of the devices. When choosing between the male and female condom, it should be noted that the male condom has a lower failure rate.

• How effective: Early tests show a pregnancy rate of 15% at the end of 6 months. In August, 2002, however, the U.S. Food and Drug Administration (FDA) listed a higher failure rate of 21 pregnancies per 100 women per year. The proportion of women using this method of contraception in the United States is less than 1%.
• Advantages: The female condom provides some protection to the labia and the base of the penis during intercourse. Although it may provide some protection, it is not as effective as a latex male condom in preventing STDs. The sheath is coated on the inside with a silicone-based lubricant. It does not deteriorate with oil-based lubricants. It can be inserted as long as 8 hours before intercourse.
• Disadvantages: The lubricant does not contain spermicide (a substance that kills sperm). The device is difficult to place in the vagina. The inner ring may cause discomfort. Some users consider the female condom awkward. If left in the vagina for a long period of time, the female condom may facilitate a urinary tract infection (UTI).

The diaphragm is a shallow latex cup with a spring mechanism in its rim to hold it in place in the vagina. Diaphragms are manufactured in various sizes. You need a pelvic examination and measurement of the diagonal length of your vaginal canal so your health care provider can determine the correct diaphragm size. You insert the diaphragm with spermicide before sex. The spermicidal cream or jelly is applied to the inside of the dome, which then covers your cervix. Your doctor will show you how to insert it and how to know it is in place. It prevents pregnancy by acting as a barrier to the passage of semen into the cervix. Once in position, the diaphragm provides effective contraception for 6 hours. After that time, if you have not removed the diaphragm, you will add fresh spermicide with an applicator. After intercourse, the diaphragm must be left in place for at least 6 hours after sex but not more than 24 hours.

• How effective: Efficacy of the diaphragm depends on the age of the user, experience with its use, continuity of use, and the use of spermicide. The typical failure rate during the first year of use is estimated to be 20%.
• Advantages: The diaphragm does not use hormones. The woman is in control of her birth control. The diaphragm may be placed by the woman in anticipation of intercourse.
• Disadvantages: Prolonged usage during multiple acts of intercourse may increase the risk of UTI. Retention of the diphragm for more than 24 hours is not recommended because of the possible risk of toxic shock syndrome. The diaphragm requires professional fitting. Poorly fitted diaphragms may cause vaginal erosions. Diaphragms have a high failure rate. Use of a diaphragm requires brief formal training. The diaphragm must be washed and dried properly following removal from the vagina. This method does not consistently protect against STDs.

The cervical cap is a soft cup-shaped latex device that fits over a woman’s cervix. It is smaller than a diaphragm and may more difficult to insert. It must be fitted by a physician because it comes in different sizes. Its use is derived from the eighteenth- to twentieth-century European practice of placing the rind of a lemon or small orange against the cervix prior to intercourse. The groove which is found along the inner circumference of the rim of the cap provides a seal between the rim and the base of the cervix. Spermicide is needed to fill the cap one third full prior to its insertion. It may be inserted as long as 8 hours prior to intercourse, and it can be left in place for as long as 48 hours. A cervical cap acts as both a mechanical barrier to sperm migration into the cervical canal and as a chemical agent because it is used with of spermicide.

• How effective: The effectiveness depends on whether a woman has had children before, as prior vaginal childbirth influences the shape of her cervix. With perfect use during the first year, a woman who has not had children has a theoretical failure rate of 9% (use failure rate is more typically 20%), as opposed to 20% in a woman who has delivered vaginally (40% use failure rate).
• Advantages: It provides continuous contraceptive protection as long as it is in place regardless of the number of sex acts. Additional spermicide, unlike for the diaphragm, is not necessary for repeated intercourse. The cervical cap does not involve the usage of hormones.
• Disadvantages: Cervical erosions may lead to vaginal spotting. The theoretical risk of toxic shock syndrome increases if the cervical cap is left in place longer than the recommended period. The cervical cap requires professional fitting and training for its use. Severe obesity may make placement difficult. A relatively high failure rate exists. Women must have a history of normal results on Pap smears prior to initiation of its usage. This method does not protect against STDs.

• The vaginal sponge was first introduced in 1983 and was taken off the market shortly thereafter because of concerns about infection.  It was reintroduced in the U.S. 2009, and has been gaining in popularity. 
• The sponge is a soft circular polyurethane device that contains nonoxynol-9, the most commonly used spermicide. It is disposable and should be discarded after a single usage. It requires no prescription, and it may be appealing to women who wish to avoid using hormonal methods of contraception.
• The sponge is inserted into the vagina and placed over the cervix. The polyurethane foam is designed to trap and absorb semen after it is deposited in the vagina, and the spermicide then kills or immobilizes sperm. The sponge has a polyester loop for removal.
• It offers an immediate and continuous presence of the spermicide for a period of 24 hours. It continues to be effective if sexual intercourse is repeated during this time frame. The sponge should be left in place for at least 6 hours after sex. It should be removed no more than 30 hours after insertion because of a low, but finite, risk of toxic shock syndrome.
• The FDA lists the failure rate for the previously marketed sponge to be 14-28 pregnancies per 100 women per year.
• Serious medical risks are rare with the sponge.  These include vaginal irritation, allergic reactions, and difficulty with removal. Toxic shock syndrome is a rare but serious infection that can occur if the sponge is left in place longer than recommended.
• Nonoxynol-9 provides protection against pregnancy, but neither the sponge nor the spermicide protects against STDs.