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BARRIER CONTRACEPTION

SHELDON FERRON

objectives
Define barrier contraception
Compare and contrast with hormonal contraceptives List types of barrier contraception

Describe the use of each method


Advantages and disadvantages of each method Efficacy of each method

DEFINITION
A contraceptive method which creates a physical barrier between the spermatozoa and the ovum/ova thereby preventing fertilization.

How do barrier methods compare with hormonal methods?


Advantages Disadvantages

Fewer side effects


Effective protection against some sexually transmitted infections and diseases

Not as effective at preventing pregnancy


Reduces spontaneity

Available without a prescription

Persons may find some methods hard to use

Cheaper
Immediately effective and reversible Can be used during breastfeeding

types
Condom/Femidom
Diaphragm Cervical Cap

Vaginal Sponge
Spermicide

Condom/femidom

condom
A thin, flexible cover that is placed over the penis to prevent semen from entering the vagina during sexual intercourse

May be made out of latex, polyurethane, animal skin

Most common barrier method

effectiveness
Perfect effectiveness rate = 97%

Typical effectiveness rate = 88%

Combining condoms with spermicides raises effectiveness levels to 99%

Advantages Cheap Readily available

Disadvantages Uncomfortable/decreased sensation Condom may break/slip causing leakage of seminal fluid

Protects against sexually transmitted diseases

Oil based lubricants cause increased incidence of breakage/slippage Erection necessary before putting on condom

Available in different flavours, textures, patterns

Female condom/femidom
It is a sheath made of nitrile and is pre-lubricated with a silicone-based lubricant.

Not very popular

effectiveness
Perfect effectiveness rate = 95%

Typical effectiveness rate = 79%

Advantages/disadvantages similar to male condom


Advantages Erection not necessary to keep in place Disadvantages Make a noticeable sound during intercourse

Does not reduce male partners stimulation

Some women find insertion difficult

Made of nitrile which rarely causes allergic reactions Less likely to break than male condom

More expensive than male condom Not aesthetically pleasing

Diaphragm/cervical cap

A soft dome-shaped cup made of latex, rubber or silicone with a flexible rim placed over the cervix before intercourse.

No longer very popular methods because of the introduction of newer methods of contraception

Pregnancy is prevented by blocking sperm from entering the uterus and killing sperm with the spermicide.

Both require fitting by a trained clinician, and the fit should be checked after childbirth and weight loss or gain of more than 10 pounds.

Generally used in conjunction with spermicides

Diaphragm Vs. Cap


Diaphragms are wider than cervical caps

Diaphragm does not rest directly over cervix while the cap does

Caps less popular than diaphragms. Mainly for women who find it difficult to keep a diaphragm in place because of the shape of their vagina

effectiveness
Perfect Effectiveness Rate = 94%

Typical Effectiveness Rate = 80%

Advantages Provides some amount of protection against some sexually transmitted infections

Disadvantages Less effective than condoms in preventing spread of HIV

Generally cannot be felt by female or her partner Can be inserted up to six hours before intercourse

Latex/silicone/spermicide may trigger allergic reactions Must be left in place for six to eight hours after intercourse Some women find insertion difficult Increased incidence of urinary tract infections

Vaginal sponge

The circular sponge disk attached to a loop that is used for removal. It contains a spermicide, and is moistened with tap water before insertion deep in the vagina

Provides a barrier as well as spermicide to prevent pregnancy

Effectiveness
Perfect Effectiveness Rate = 90%

Typical Effectiveness Rate = 85%

Advantages/disadvantages similar to that of the diaphragm and cap

Spermicide

A chemical is that is used to destroy spermatozoa

The most common agent is Nonoxynol-9. Other agents include benzalkonium chloride and sodium cholate

Available as a gel, foam, cream, suppository or tablet

May be used alone or in conjunction with the other

Effectiveness
Perfect effectiveness rate = 94%

Typical effectiveness rate = 74%

Advantages Readily available No fitting necessary Easy to apply

Disadvantages May leak/ messy May cause irritation of genitals Does not protect against sexually transmitted infections

References
Edmunds, K. et al. Gynaecology by Ten Teachers. 18th ed. London: Hodder Education. 66-67
Bassaw, B. Fletcher, H. Gynaecology review. 175176 Stoppler, M. (2011). Barrier Methods of Birth Control. Available: http://www.medicinenet.com/barrier_methods_of_bir th_control/article.htm. Last accessed 4th Feb 2014.

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