Barrier methods of birth control

Barrier methods of birth control block sperm from entering the uterus. Using a spermicide with a barrier method gives you the best possible barrier method protection. In fact, without a spermicide, a diaphragm, cervical cap, or Lea's Shield is not effective.

• The spermicide kills most of the sperm that enter the vagina.
• The barrier method then blocks any remaining sperm from passing through the cervix to fertilize an egg.

Barrier methods include the diaphragm, cervical cap, Lea's Shield, male condom, and female condom and spermicidal foam, sponges, and film. Unlike other methods of birth control, barrier methods are used only when you have sexual intercourse. Be sure to read the instructions before using a barrier method. It is very important that you use a barrier method correctly every time you have sex.

For more information, see how to use a condom and how to use a female condom.

Sexually transmitted disease protection

Male or female condoms are the only birth control methods that protect against sexually transmitted diseases (STDs), including infection with the human immunodeficiency virus (HIV). To protect yourself and your partner from STD infection, be sure to use a condom every time you have sex.

Follow the directions for your choice of barrier method. After sexual intercourse:

• A male or female condom is removed promptly and thrown away.
• A contraceptive sponge has to be left in for 6 or more hours, then removed and thrown away.
• A diaphragm or cervical cap has to be left in for 6 or more hours, then washed and stored for reuse.
• A Lea's Shield is left in for 8 or more hours, then washed and stored for reuse.

Condoms are necessary when you need to protect yourself or your partner from sexually transmitted disease (STD) or when you do not know that you are both infection-free. Latex or polyurethane male condoms give you and your partner the most effective possible protection from STDs, including infection with HIV. Natural membrane (sheepskin) condoms do not protect you against all STDs.

Barrier methods of birth control, such as a diaphragm, cervical cap, Lea's Shield, or condom, are a good choice if:

• You want an option that does not require hormones or insertion of an intrauterine device.
• You want an option that does not restrict when you have sexual intercourse, such as natural family planning.
• You are planning to become pregnant soon and prefer a method you can stop using anytime you want.
• You are breast-feeding.
• You have heavy menstrual periods and don't want to use hormonal methods. A diaphragm may be used for birth control during a menstrual period and can contain the menstrual blood as long as it is not left in for longer than 6 hours at a time.
• You and your partner find it easy to use the method every time you have sex.

Barrier methods of birth control vary in how effective they are in preventing pregnancy.^{1, 2} They also vary in how effective they are at preventing STDs.

A diaphragm-type device called Lea's Shield is now available. It is reportedly as effective as other female barrier contraceptives (the cervical cap, diaphragm, and sponge), although only limited studies have been done so far. Lea's Shield is made of silicone, so latex allergy is not a problem. The device comes in one size only, simplifying the fitting process. The shield currently requires a prescription.

Condoms

A condom can tear when it is too tight or fall off when it is too loose. If this should happen while you are having intercourse, use emergency contraception. If you are worried about exposure to a sexually transmitted disease (STD), get tested.

Diaphragm or cervical cap

Using a diaphragm with spermicide may increase your risk of urinary tract infections.

Leaving a diaphragm or cervical cap in for longer than 24 hours increases your chances of getting toxic shock syndrome.

Spermicide

Some people are allergic to nonoxynol-9, which is the active ingredient in most spermicides. They can develop sores in the vagina or on the penis, which make it more likely that HIV can be transmitted from an infected partner during sex. Frequent use of spermicides that contain nonoxynol-9 may cause vaginal irritation and increase the risk of transmitting HIV.

If you have a possible risk of giving or getting a sexually transmitted disease (STD) and you want to effectively prevent pregnancy, combine condoms with a more reliable method of birth control, such as the hormone pills, ring, patch, or shot or an intrauterine device (IUD).

If you think that your barrier method has failed or has been used incorrectly, you can use emergency contraception to help prevent pregnancy. Vaginal douching is not a birth control method even if done with spermicides. Douching after intercourse does not prevent sperm from reaching the fallopian tubes, where fertilization takes place. It may also increase your chance of getting a pelvic infection.

Advantages of all barrier methods

Barrier methods of birth control:

• Do not affect a woman's or man's future fertility.
• Are only used at the time of sexual intercourse.
• Are safe for a woman to use while she is breast-feeding.
• Do not affect other health conditions, such as high blood pressure or diabetes.
• Are less expensive than hormonal methods of birth control, and some are available without a prescription.

Condoms and diaphragms may reduce the risk of cervical cancer, which is caused by a sexually transmitted human papillomavirus. Condoms also are the best method for reducing the risk of sexually transmitted diseases, including HIV.

Disadvantages of all barrier methods

Failure rates for barrier methods are higher than for most other methods of birth control. If you are considering using a barrier method for birth control, think through what the emotional and financial costs of an unintended pregnancy would be if the method fails.

To prevent pregnancy with a barrier method, you and your partner must be comfortable with using it and be prepared to use it every time you have sex. For some couples, barrier methods are not a good choice because one or both partners:

• Find it embarrassing to use.
• Do not want a barrier method to interrupt foreplay or intercourse.

Some people develop allergies to spermicides. This makes it impossible to use a diaphragm, cervical cap, or Lea's Shield.

For people who have an allergy to latex, polyurethane condoms are available. Latex condoms are slightly more dependable than polyurethane condoms.

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Citations

1. Trussell J (2004). The essentials of contraception: Efficacy, safety, and personal considerations. In RA Hatcher et al., eds., Contraceptive Technology, 18th ed., pp. 221–252. New York: Ardent Media.

2. U.S. Food and Drug Administration (2002). Birth Control Guide. Available online: http://www.fda.gov/fdac/features/1997/babyguide.pdf.