BARRIER METHODS OF CONTRACEPTION

CONTENT

-INTRODUCTION

-CONDOMS

--MALE CONDOMS

--FEMALE CONDOMS

-SPERMICIDES

-DIAPHRAGMS

-CERVICAL CAPS

 

INTRODCUTION

These are among the commonest and the most easily available contraceptives around. They are a group of short acting contraceptives that act by forming a barrier between the sperms and the ovum (egg). They include the male and female condoms, the spermicides, the diaphragms and the cervical caps. Typically between 80% to 90% effective (i.e. 10 to 20 women out of 100 women who used them everyday for a year will get pregnant) when used by most people, barrier methods of contraception require consitent and correct use before they can be very effective. Unfortunately, because they may interefere with the spontaneous nature of sex, failure of barrier methods of contraception can largely be asociated with their inconsistent and or improper use, rather than their inherent deficiencies when used. It is therefore important that these methods are used correctly and consistently as explained in this article.

Despite this, barrier methods of contraception have the following advantages over most other modern methods of contraception:

1.  They may offer protection against some sexually transmitted diseases (STDs) including HIV.

2.  They do not affect a woman's or man's current or future fertility whenever they are discontinued.

3.  They are only required at the time of sexual intercourse and thus do not affect any part of the woman’s body.

4.  They are often safe for breast feeding women. 

5.  They are safe irrespective of a woman’s health conditions, such as high blood pressure or diabetes.

6.  They are often cheaper and more readily available than hormonal methods of birth control and many do not require prescription or a hospital before administartion.

CONDOMS

These are thin sheaths worn over the penis or inside the female vagina that acts to keep the sperm away from the vagina. They are broadly divided into the male and female condoms.

MALE CONDOM

This is a thin sheath worn over the erect penis during sex in other to keep the ejaculated semen and the sperms away from the vagina. Generally produced in different sizes, shapes, thickness, colors, scents and flavors, some condoms may be ribbed while others may not and some may be dry while others may be lubricated. Based on the types of materials used, condom can be divided into latex condoms, polyurethane plastic condoms, rubber condoms and condoms made from animal tissues such as the gut of animals.

HOW TO USE THE MALE CONDOM

Select an appropriate sized condom and wear it only on an erect penis and never on a flaccid penis.  By holding the tip with two fingers, place the condom on the penile tip and unroll the condom backward unto the erect penis until the whole length of the condom is fitted snugly unto the penile shaft. Ensure that this is done in the right direction. An appropriate sized condom is one that when unrolled, it reaches the base of the penis and fits snuggly unto the penis. A smaller sized condom is more likely to slip off the penis into the vagina or break during intercourse while a bigger sized condom is also more likely to slip into the vagina both increasing the chances of contraceptive failure and or the chances of acquiring an STD. After wearing the condom, ensure there is enough space at the tip of the condom for the collection of the semen after ejaculation. This is important to prevent the condom from bursting at its tip during sex. A lubricant if required must be water based and not oil based as oil based lotions such as vaseline or petroleum jelly are known to damage the latex condoms and increase the chances of breakage. Another alternative to water based lotions is the use of spermicides, which apart from having the ability to serve as lubricants, also have the additional advantage of being able to kill the sperms and increase the contraceptive activity of the male condom. Immediately after ejaculation, withdraw the penis while holding the base of the condom with your hands to prevent trapping of the condom in the vagina and subsequent spillage of the semen into the vagina. After withdrawal, the condom and the semen must be disposed and must not be reused. To store an unused condom, please keep it in a cool and dry place and not in your waIlet because the condom can easily be damaged by heat. The male condoms, if consistently and correctly used is 97% effective in preventing pregnancies.

ADVANTAGES

1. It is easily and readily available.

2. It doesn’t require a prescription and can be bought over the counter.

3. It is cheap and can last after being bought; it should be stored in a cool dry place where it can last up to 5 years or more without losing its quality. Although, as part of its advantages, it is very easy to transport and conceal, the wallet is not the right place to keep it as it can be damaged easily.

4. It protects strongly against HIV and many other STDS that can be transmitted via contact with genital fluids.

5. It offers some but not full protection against HPV

6. It may help to delay ejaculation in some men with premature ejaculation.

DISADVANTAGES

1. A new one must be worn each time you want to have sex as it cannot be reused.

2. It may reduce the spontaneity of sexual intercourse and requires a lot of discipline in order to consistently utilize it. The temptation to skip its use is very common when there are no condoms and both partners are in the mood. Its inconsistent use accounts for its high pregnancy rate and whenever an unprotcted intercourse occurs, an emergency contraception must be used as a back up.

3. In some people a reduced sexual stimulation is attributed to the use of condoms, making compliance and its consistent use difficult. Polyurethane condoms and animal tissue condoms are more sensitive than latex condoms but are less protective of STDs as latex condoms. This is especially true of condoms made from animal tissues which confer no protection whatsoever against HIV and STDs unlike polyurethane condoms which although confer some protections against STDs, they remain less effective compared to latex condoms in protecting against STDs. Finally, polyurethane condoms are more likely to break compared to latex condoms.

4. Although most condoms are latex, 1 to 2% of men and women will react to it.

5. Once a condom breaks, there is a significant lack of barrier contraception and a risk of getting pregnant. Factors that may increase the chances of condom breakage include:

A) Poor storage,

B) Use of wrongly sized condom,

C) Not leaving enough space at the tip of the condom to collect the semen after ejaculation

D) Use of low quality condoms

E) Contact with jewelries and long finger nails of partners.

F) Dry sex with inadequate lubrication

6. Although latex condoms reduces the chances of having HPV infection and genital warts, it doesn’t totally protect against the transmission of HPV and genital warts. Condoms from animal tissues on the other hands have pores that freely allow HIV, STDs and HPV to pass through it and are thus not ideal for the protection of STDs. 

                           The male condom

FEMALE CONDOMS

Unlike the male condom, which is a tube rolled over the penis before vaginal penetration, the female condom is a cylindrical pouch with two rings at each end, one opened and the other closed, that is inserted into the vagina before sex, with the open end placed outside the vagina to receive the penis during sex. It is made of a thin, soft polyurethane plastic

HOW TO USE THE FEMALE CONDOM

Push the closed end of the condom into your vagina as high as possible until the cervix is reached and the whole length of the condom is placed in the vagina and leave the opened end of the condom outside the vagina to collect the penis. During sex, the condom collects the semen and prevents contact with the female vagina. After sex, the semen collected within the female condom is  then discarded along with the female condom. The female condom must never be used with the male condom as both condoms may stick, tear or pull out each other. during intercourse. A variant of the female condom is the “condom pant” which is a pant that covers the perineum while containing a rolled up sheath which can be pushed into the vagina during intercourse.

ADVANTAGES

1. It is very effective (95%).

2. It requires no prescription and can be bought over the counter.

3. It is thinner than the male latex condoms and may offer more sensitivity

4. Unlike the male condom, it can be worn up to 8 hours before sex thus allow spontaneity of intercourse.

5. Also unlike the male latex condom, it is resistant to damage by oil based lubricant. 

DISADVANTAGES

1. It is more expensive and not easily available as the male condom

2. It is not as effective in protecting against pregnancy and STDs as the male latex condoms.

3. It is cumbersome and difficult to wear and requires some practice.

4. It is usually not attractive and may not stay in place during sex.

5. If not well lubricated, it may make some annoying sounds during sex.

    

The female condom

 SPERMICIDES

As the name implies, these are substances used to kill sperms in the vagina during and after sex. Unlike the others which act primarily by imposing a physical barrier against the sperms, spermicides are chemical barriers that prevent sperms from reaching the womb by killing them off within the vagina. They may be used alone or in combination with any of the other barrier methods of contraception. Although, they come in different preparations and forms, the active ingredient in almost all spermicides is Nonoxynol-9. Examples of spermicidal preparations include tablets, gels, creams, suppositories and films. Sponges or foams are preparations that act both as a physical and a chemical barrier against sperms.

HOW TO USE THE SPERMICIDES

Please read the instructions on the leaflet of the exact product prior to use. In general, insert the spermicide into the vagina as high and close to the cervix as possible using an applicator some minutes prior to the intercourse. For tablets and suppositories, in order to to allow them enough time to melt, you must insert them about 15 to 30 minutes prior to intercourse. After an initial intercourse, you must insert a new spermicide into the vagina, before having another interourse in order to maintain the effectiveness of the spermicide. Finally, after each intercourse, avoid douching immediately after sex so as to allow the spermicide enough time to kill the sperms.

Sponges or foams are ball-like rings of polyurethane foams embedded with the spermicides that act as both a physical and a chemical barrier against sperms. They are inserted high up in the vagina, just below the cervix where they absorb the semen and kill them during and after sex. They can be used for a whole day and do not require a reapplication of spermicides. They must not be removed until after 6 hours of intercourse to maintain effectiveness but should never be left longer than 30 hours due to the risk of toxic shock syndrome, a severe infection caused by bacteria toxins released by infected sponge in the vagina. Once used it must be discarded.

ADVANTAGES

1. They are cheap and available over the counter

2. Their effectiveness increases when used with other barrier methods where they can serve a double function of being a lubricant and a contraceptive.

3. In case of any pregnancy, they do not cause any abnormality to the baby.

4. They may provide some protection against Chlamydia and gonorrhea infections.

DISADVANTAGES

1. They are often cumbersome to put and to remove. Some have a small thread with which you can use to pull them out.

2. They may cause vaginal irritation, burning and allergic reactions.

3. They are only about 65% to 80% effective and not as effective as male or female  condoms.They are more effective when used with other barrier methods of contraception than when used alone.

4. The frequent irritation of the vagina wall increases the risk of vaginal infection as well as the risk of transmission of HIV and other STDs.

5. They may also increase the risk of urinary transmitted infection (UTI).

6. Sponges are likely to cause toxic shock synfrome if forgotten or left inside the vagina for more than 30 hours.

 

         Spermicides suppositories with the applicator

DIAPHRAGM

A diaphragm is a small, round, rubber or latex cup surrounded by a firm, flexible rim of metal spring that fits into the vagina and covers the cervix. For it to be effective, It must be used with a spermicide to form a tight seal with the vaginal wall and prevent the passage of sperms into the cervix.

HOW TO USE THE DIAPHRAGM

Insert the diaphragm into your vagina not earlier than 4 to 6 hours before having sex after applying generously a spermicidal cream unto the dome and the rim of the diaphragm. Although the cream may be applied unto both sides of the diaphragm, the side facing up is the side required to be lubricated most with the spermicide. To insert, fold its rim between your fingers and insert it into your vagina as high as possible ensuring that the front part of the rim is placed behind your pubic bone and your cervix is covered fully with the diaphragm. The cervix is the firm structure that points downward into your vagina and feels like the tip of your nose when touched. Following each intercourse, check that the diaphragm is still in place covering the cervix and not mechanically dislodged. Each time after having sex, reapply the spermicidal gel or cream before you have another intercourse or anytime it is more than 2 hours after the insertion of the diaphragm. After sex, the diaphragm must be left in place for at least 6-8 hours to ensure that all the sperms are killed and to maintain the effectiveness of the device. It should however not be left for more than 24 hours after insertion to prevent the risk of a vaginal or pelvic infection. After use, rinse the diaphragm well with water and mild soap making sure no soap is left on it. Once dry keep it in its case. If you notice any hole in it, replace the diaphragm immediately to prevent a contraceptive failure.

To check for holes, run the diaphragm under water or stretch the diaphragm gently and observe directly for holes under a bright light. Possible causes of holes are direct damage to the rubber of the diaphragm following the use of oil based lubricant during sex. Therefore, to avoid damage to the rubber, use only use water based lubricants during intercourse.

ADVANTAGE

1. Because it can be applied 4 to 6 hours before sex it doesn’t interefere with the initial process of intercourse. However, remember that once inserted more than 2 hours, you must reapply the spermicides before sex.

DISADVANTAGES

1. It must be prescribed and can’t be bought over the counter.

2. It is not readily available in many parts of the World including Nigeria.

3. It must be fitted by a doctor or a nurse to select the appropriate size as it comes in various sizes. As a principle, the largest and the most comfortable size must be picked because the diaphragm is held in place by vaginal wall. If the vaginal wall is laxed or if a small sized diaphragm is used, the diaphragm will keep falling off.

4. It takes some time to get used to and it may be uncomfortable.

5. It must be checked, changed and refitted by a health worker as you may require a new size:

A) Every one or two years

B) After you gain or lose some significant amount of weight.

C) After you have a pelvic surgery.

D) After you recently gave birth or have an abortion.

E) If you keep having repeated urinary tract infections.

F) If you or your partner feel pain or pressure during sex

6. It cannot be used immdiately after giving birth

7. Because new spermicides must be reaplied after each intercourse before another one can be had, this process may interfere with the process of sexual intercourse and may make it difficult for the couple to comply, increasing the chances of failure.

8. Although, it may provide a partial protection against gonorrhea and chlamydiae because of the use of spermisides, it may predispose the woman to vaginal and urinary tract infections.

9. It can causes vaginal irritation and allergic reaction in some women

10. It doesn’t protect against STDs and it may increase the risk of some STDs such as HIV. For optimal protection, diaphragms are better used with condoms.

          Diaphragm and spermicides

CERVICAL CAP

This is a latex or rubber dome shaped cap that fits directly on top of the cervix. Although in many ways it is similar to the diaphragm, it is however a bit smaller. Unlike the diaphragm, it doesn’t require the vaginal wall to hold it in place as it is held in place by negative pressure of the cervix on the cap. Also, it requires a much smaller amount of spermicides compared to diaphragms.

HOW TO USE THE CERVICAL CAPS

Similar to the diaphragm, apply some spermicides unto the part of the cap facing the cervix and place the cap directly on the cervix. Avoid using it with oil-based lubricants, such as petroleum jelly as they can damage the latex. They must also be checked for holes similar to diaphragms and must be assessed every one or two years for changes in the size of the cervical cap required.

ADVANTAGES

1. Unlike the diaphragm that is held by the vaginal wall, cervical caps are held on to the cervix by negative pressure.

2. It can be applied up to 8 hours before sex and can be left in the vagina up to 48 hours after insertion with no need to re apply spermicides after sex hence reducing the interference of applying spermicides with sex.

3. It causes less irritation and less risk of UTI compared to diaphragms.

DISADVANTAGES

1. The efficacy rate of contraception just like the diaphragm is about 80 to 89% in women who have never had a child. This decreases further to about 60 to 80% in women who have had a vaginal delivery in the past, confirming that the efficacy of the cervical cap decreases with child birth due to increased patency of the cervical os.

2. It has about 4 different sizes and must be prescribed, inserted and fitted by a health worker before being use.

3. It requires some learning and can be difficult to insert.

4. Just like diaphragms, although it reduces the risk of some STDs, it doesn’t protect against many others STDs such as HIV and HPV.

5. Because it must be used with spermicides, it may also cause vaginal irritation which may increase the risk of UTI and some STDs such as HIV. These risks are however lesser than the risks involved with the use of diaphragms. For better protection against STDs, it should be used in combination with the male condom.

6. It cannot be worn immediately after giving birth as the presence of lochia may increase the risk of infections.

7. It must also be refitted after giving birth, after having an abortion, or after a significant weight gain or weight loss.

8. When left in the vagina for more than 48 hours, it may cause an offensive vaginal discharge.

9. Just like diaphragms, it must be inspected regulalry for holes.

               The Cervical cap

From the above, it is quite obvious that barrier methods of contraception are a diverse group of short acting contraceptives that are cheap and easily available. Often times, they do not require a doctor or a nurse to prescribe or to fix each time they are required. This is especially true of all the types of barrier contraceptives except for cervical caps and diaphragms. Also combined with its ease of accessability, condoms have been shown to possess a very high effective contraceptive property along with a good protection against sexually transmitted diseases when used consistently and correctly. Hence all sexually active young adults are advised to consistently and correctly use condoms, in order to prevent the occurence of both or either an unwanted pregnancy and a sexually transmitted infection. Having said this, HPV and hence cervical cancer, as well as genital warts cannot be totally prevented by the use of condoms. Therefore all women who are sexually active, requires regular cervical cancer screening to prevent cervical cancer despite the regular use of condoms.

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