What Are the Barrier Methods of Contraception?

Contraception refers to any measures you take to prevent sexual intercourse from resulting in pregnancy. The barrier method of contraception prevents the fertilization of the egg (ovum) by blocking the passage of the sperm into the cervix with a physical device, or by destroying the sperm cell membrane with spermicide.

The definition of ‘best’ contraceptive is different for every individual and is also likely to change for a person from time to time. Some techniques may need a combination of contraceptive methods to be effective.

An individual’s choice of contraception may depend on factors that include:

• Efficacy
• Safety
• Costs
• Noncontraceptive benefits
• Personal considerations

The American Academy of Pediatrics recommends that condoms should be freely available to adolescents, along with sexual counseling. While sexual abstinence may be desirable until adulthood, educating adolescents on the necessity and correct use of condoms has shown in many circumstances to reduce incidence of unwanted pregnancies and STIs in given populations.

Following are the barrier methods of contraception:

Male condom

The male condom is a sheath placed over the penis before vaginal insertion. The condom contains the semen, preventing the sperm’s entry into the vaginal canal.

Efficacy: The approximate failure rate of male condoms in the first year of correct and consistent use is 3%, which rises to 14% in typical use. The primary reason for failure is incorrect condom usage such as:

• Incorrect placement
• Failure to use with every intercourse.
• Failure to use throughout intercourse duration
• Improper lubricant use with latex condoms
• Poor withdrawal technique

Advantages:

• Male condoms may prevent pregnancy as well as protect against transmission of STDs.
• They are readily available and usually not expensive.

Disadvantages:

• Condoms may possibly reduce sexual pleasure.
• People allergic to latex products cannot use latex condoms, though other condom materials like vinyl are available for people with this allergy.
• Condoms can break or slip during intercourse.
• Oil-based lubricants can damage the condom.

Female condom

The female condom is a new technique. Fewer than one percent of American women use it. FC2 is a female condom that is made of synthetic nitrile, which consists of two flexible rings placed on either end of a lubricated nitrile sheath. The ring at the closed end is placed inside the vaginal canal while the other ring remains outside.

Efficacy: Initial trials show a 15% pregnancy rate in 6 months.

Advantages:

• Female condoms provide some protection to the labia and penis base.
• Do not get damaged by oil-based lubricants.
• Can be inserted up to eight hours before intercourse.

Disadvantages:

• Female condom is difficult to place and may cause discomfort.
• Does not have a spermicidal lubricant.
• May cause urinary infection if left in place for long periods.

Diaphragm

The diaphragm is a shallow silicone cup that is inserted inside the vaginal canal to cover the cervix. Diaphragms are custom-made to fit each woman who uses them. The diaphragm’s dome is coated with a spermicidal jelly, which is effective for up to six hours and can be reapplied.

The diaphragm should remain in place for six hours after intercourse to be effective, but should be taken out within 24 hours and cleansed thoroughly before reuse. Diaphragms should be replaced every two years.

Efficacy: Efficacy of the diaphragm depends on the user’s experience and proper use of spermicide. The approximate typical-use failure rate within the first year is 20%.

Advantages: Contraception can be controlled by the woman and the diaphragm can be placed well ahead of time, when intercourse is anticipated.

Disadvantages: 

• Requirement of proper fitting and training for use.
• Risk of urinary infection with prolonged use during multiple acts of intercourse.
• Risk of toxic shock syndrome if left in longer than 24 hours.
• Poorly fitted diaphragm may cause vaginal erosion.
• May develop an odor if not properly cleansed.

Cervical cap

The cervical cap is a cap-shaped latex device that fits over the base of the cervix. The cap is partly filled with a spermicide for best results. It can be inserted up to eight hours before intercourse, and can be left in place for 48 hours.

Efficacy: Efficacy depends on the shape of the cervix, which can change in a woman who has given birth (parous). With perfect use in the first year, the failure rate is 9% in women who have not given birth (nulliparous) and 20% in parous women. With typical use, the failure rate is 20% in nulliparous women and 40% in parous women.

Advantages: Provides continuous protection up to 48 hours for multiple instances of sexual intercourse, without re-application of spermicide.

Disadvantages:

• High failure rate.
• Requirement of proper fitting and training for use.
• Cervical erosion leading to vaginal spotting.
• Risk of toxic shock syndrome if left in longer than 48 hours.
• Cannot use if Pap test results or not normal.

Spermicidal agents

Spermicides contain octoxynol or nonoxynol-9, which are chemicals that destroy the sperm cell’s membrane. They are used with a base such as:

• Vaginal foams
• Suppositories
• Jellies
• Films
• Foaming tablets
• Creams

Spermicides must be inserted into the vagina before every intercourse.

Efficacy: The approximate failure rate with perfect use within the first year is 6%, which increases to 26% for typical use.

Advantages:

• Ease of application and availability at low cost.
• The lubrication from spermicides may heighten pleasure.
• Increased efficacy with diaphragms and cervical caps.

Disadvantages: 

• Toxic to lactobacilli, the normal bacteria that keeps the vagina healthy. This increases the risk of STDs and harmful bacterial infections such as Escherichia coli.
• Usually needs to be placed vaginally 10 to 15 minutes before intercourse.
• Insertion may be uncomfortable and a mood-spoiler.
• Some people may have irritation, or allergic reaction to spermicides.
• Spermicide’s effects last less than an hour.