Forms of barrier contraception include condoms, femedoms, diaphragm, and caps.
Condom
A condom is a rubber sheath that fits over the end of the penis during intercourse.
How it works
A condom works by creating a barrier to sperm preventing it from reaching the cervix.
Types
There are a number of different types of condom. These include different shapes, sizes and even flavours. Some contain the spermicide nonoxynol-9.
Risks
Some people get an allergy to the rubber.
Advantages
Protects against some sexually transmitted diseases. Those containing the spermicide nonoxynol-9 have a higher transmission rate of HIV in high risk populations. There is no evidence that nonoxynol-9 impregnanted condoms are more effective.
Disadvantages
Some people feel that it interferes with the spontaneity of sexual intercourse.
Some people find that it interferes with sensation.
Requires the man to participate in contraception.
Contraindications
The following women should not use condoms;
- Women (or partners) with an allergy to the condom
- Women receiving vaginal treatment for thrush
- HIV positive men or women should not use a condom containing nonoxynol-9
Effectiveness of condoms
The failure rate for condoms is about 5 per 100 woman years. In teenagers this may be as high as 15 per 100 women years.
How to use a condom
- Apply prior to intercourse.
- Squeeze tip and roll over the full shaft of the penis.
- Remove once male ejaculation has occured.
Femedom
A femedon (female condom) is a plastic device that sits in the woman's vagina.
How it works
A femedom works by creating a barrier to sperm preventing it from reaching the cervix.
Risks
Some people get an allergy to the plastic.
Advantages
Protects against some sexually transmitted diseases.
Disadvantages
Some people feel that it interferes with the spontaneity of sexual intercourse.
Some people find that it interferes with sensation.
Contraindications
The following women should not use a femedom;
- Women (or partners) with an allergy tot he condom
- Women receiving vaginal treatment for thrush
Effectiveness of femedoms
The failure rate for a femedom is about 5 per 100 woman years.
How to use a femedom
- Apply prior to intercourse.
- insert the end with the small ring into the vagina. The outer ring should sit outside the vulva.
- Remove once male ejaculation has occured.
Diaphragm
A diaphragm is a rubber dome with a flexible spring on the outside. It is normally used with a spermicidal gel or cream (although it should be noted that the most common spermicide may increase the risk of HIV transmission). The diaphragm keeps the spermicide next to the cervix.
How it works
A diaphragm works by creating a barrier to sperm preventing it from reaching the cervix.
Types
There are a numbr of different sizes of diaphragm. Furthermore, there ar a number of different rims. These include the standard spring rim and one that creates an angle when bent to assist placement behind the cervix.
Risks
Some women get urinary tract infections with the diaphragm. It is possible to get vaginal infections from it's use and very rarely pressure sores can form in the vagina. Some people also have an allergy to the rubber. Toxic shock synrome had been reported also but this is extremely rare.
Advantages
Protects against some sexually transmitted diseases. Does not rely on man for contraception.
Disadvantages
Requires forward planning.
Some people feel that it interferes with the spontaneity of sexual intercourse.
Some people find that it interferes with sensation.
Contraindications
The following women should not use the diaphragm;
- Women with vaginal sores
- Women with recurrent urinary tract infections
- Women taking vaginal treatments for thrush
- Women who cannot feel their cervix
Effectiveness of the diaphragm
The failure rate for the diaphragm is 1.5 - 10 per 100 woman years.
How to use a diaphragm
- Apply spermicide: Hold the diaphragm with the dome down. Squeeze the spermicide onto the dome (use about one tablespoon). Spread a little bit around the rim of the diaphragm with your finger.
- Insert the diaphragm: Insert the diaphragm no more than two hours before intercourse. With one hand hold the diaphragm dome down (spermicide in the dome) and press opposite so that the diaphragm folds. Spread the lips of the vagina with the other hand, and insert. This can be done standing with one foot propped up (on the edge of a bath or toilet), squatting, or lying on your back. Push the diaphragm downward and back along the back wall of the vagina as far as it will go. Then tuck the front rim up along the roof of the vagina behind the pubic bone. The back rim should be placed behind the cervix. If it is uncomfortable or can be felt, then most likely it is not in correct position; take it out and reinsert it.
If discomfort continues it may be the result of
- a pelvic condition causing irritation
- constipation
- incorrect size
- Check the placement of your diaphragm: Tthe back rim of the diaphragm should be below and behind the cervix. The front edge of the rim should be behind the pubic bone. Check to be sure that you can feel your cervix covered by the soft rubber dome of the diaphragm and that the front rim is in place behind the pubic bone. The spermicidal cream (inside the dome of the diaphragm) should be next to your cervix.
- After sex: Leave the diaphragm in place for at least 6-8 hours, then remove it when convenient. If you have intercourse more than once within the 6-8 hour period, use an additional application of spermicide but do not remove the diaphragm. Instead use the plastic applicator to insert a fresh amount or insert another pessary. If possible, remove the diaphragm and wash it at least once every 24 hours.
- Remove the diaphragm: Place your index finger behind the front rim of the diaphragm and pull down and out. If you find it hard to hook your finger behind the diaphragm, try a squatting position and push downward with your abdominal muscles. Some women find it easier to remove the diaphragm by inserting a finger between the diaphragm and the pubic bone to break the suction created by the diaphragm. A woman should practice inserting and removing a diaphragm repeatedly during the first weeks until she is confident.
- When removed: Wash it with mild soap and water, rinse and dry with a towel. Store in its plastic container. Do not use talcum powder or perfume powder; they may damage the diaphragm or may be harmful to your vagina or cervix.
The diaphragm may also be damaged by many common treatments for thrush.
Additional information
- A diaphragm shouldl last for 2-3 years with proper care. Check the diaphragm for tears with each use. Hold it to the light and stretch the dome to look for defects.
- Have the diaphragm size checked when;
- If you are just beginning to have intercourse.
- After a pregnancy.
- If you change weight by more than a stone.
- If you have pelvic surgery.
- The diaphragm should not interfere with normal activities. Urination and bowel movement should not affect its position. It is fine to bath or shower with the diaphragm in place.
- Use the diaphragm whenever you have intercourse, even during your period. If your flow is heavy and cramping occurs remove diaphragm 3-4 hours after intercourse (instead of 6-8 hours).
- WARNING: If you begin to have bladder infections, check with your health care provider. You may need a different birth control method.
Cap
A cervical cap (along with a vault cap and vimule) sits over the cervix and is suitable for women who are contraindicted to the daiphragm.
