BARRIER CONTRACEPTION &

IUCD
 Contraception
• Method or system
• Allows intercourse
• Yet prevents conception
• DIFFERENT METHODS- natural family
planning, barrier, IUCDs and hormonal
BARRIER CONTRACEPTION
 Condoms
• Erectile penis completely covered by very thin
rubber
• Used with water based spermicidal agent to
improve efficacy of method.
• Used only once
• Made up of latex , polyurethane(non latex),
silicone
 Male condoms
• Only contraceptive
method preventing STDs
including HIV.
• Max efficacy when used
with hormonal
contraceptive
• India- supplied free of
cost by Govt.-family
welfare clinics-NIRODH
• Lubricated , nonoxynol-9
containing
Advantages
 The condom is the best method for reducing the risk of
STIs.
 ↓transmission of STD like HIV, Chlamydia and
Gonorrhea
 Can be easilyobtained.

Disadvantages
 Some people are allergic to latex. Polyurethane
condoms can be used as an alternative.
 Loss of sensation or pleasure
 Slippage/breakage
 Female condoms
• Femidom
• 17 cm long vaginal pouch
made of polyurethane
• 2 rings
• Inner- smaller- inside to apex
of vagina-insertion and
anchoring device
• Outer- covers ext. genitalia
• Inserted upto 8 hours prior
to intercourse
• Protection against preg.,
STDs, CMV
ADVANTAGES DISADVANTAGES

• FEMALE CONTROLLED • Requires pre planning

METHOD • Not aesthetic
• No side effects/ latex
allergy • Harder to dispose
• Breakage less common • Requires practice
• Protection from HPV, • Expensive
Herpes
• Inserted any time before • May get displaced
intercourse
• Does not need erection
before use
 Vaginal spermicides
• Chemical contraceptive method
• Kill sperms before accessing to cervical canal.
• Surfactants- nonoxynol-9
• Foam tablets, soluble pessaries, creams, jellies,
films along with occlusive diaphragms
• Effective for 1-2 hr after application high in
vagina
 Nonoxynol-9
• Available in india
• Incorporated in polyurethane disposable sponge- TODAY
• mushroom shaped-Provided with loop for easy removal
• Moistened with water & placed firmly against cervix
• Concave side covers the cervix
• Release spermicide during coitus, absorbs ejaculates,
blocks entrance to cervical canal
• Sponge not removed for 6 hrs after intercourse
 Vaginal barriers
• Barrier in vagina against direct insemination
• Effective- used with spermicidal jellies/
sufficient time for complete destruction of
sperms before removal
1. Dutch cap/ diaphragm
2. Cervical cap
3. Dumas cap/ vault cap
 Diaphragm
• Circular spring covered with latex rubber
• First effective contraception under female control
• Pushed into vagina- leading edge behind cervix, front
edge behind pubic symphysis
• ADVANTAGES: low cost, durability, reduce STD
 Cervical cap
• Thimble or dome shaped
• Placed over cervix
• Left in place for longer-48hrs
• Not used with spermicide
• For women with vaginal wall relaxation
• Reduce STD transmission
 Vault cap
• Cup shaped rubber cap
• Thickened rim
• Fits to vault of vagina-enclosed cervix
INTRAUTERINE DEVICES
 IUDs
• Very important contraceptive method
• Effective, safe&convenient
• IUDs can be of Inert IUDs ,Cu Releasing
IUDs,Hormone releasing IUDs
 Copper T 380A

• Presently most widely using IUD

• A long vertical arm (314 sq. mm of Cu), two
transvere arms (33 sq. mm of Cu)
• Lifespan is of 10 years
• Available as free of cost
• High effectiveness
• Method of insertion of Cu T380A •
• No touch technique is recommended to prevent
infection
• Speculum and bimanual examination to rule out
any STD or Pelvic inflammatory disease
• Assess the size and direction of uterus
• Vagina cleaned with antiseptic solution and
speculum inserted.
• Anterior lip of cervix hold with a volsellum or
Allis forceps
• A uterine sound is introduced to note the size
and position of uterus.
• CuT is then taken and the arms are folded and
introduced into the top of inserter
• (without taking the device out of sterile pack)
• Adjust the adjustable collar so that the part of
inserter above it corresponds to the size of
uterine cavity.
• Solid plunger introduced into the inserter tube
up to the lower end of vertical arm
• The inserter loaded with the device is
negotiated into the uterine cavity till it
touches the fundus and collar touches the
external os
• The plunger is held with the left hand& the
outer inserter tube is withdrawn over the
plunger with the right hand for about 2 cm.
• The plunger is then withdrawn completely
followed by removal of inserter tube and the
thread is cut.
• This is the withdrawal method
• Minimizes chance of perforation.
• Placement can be checked by sonography.
• If the position is not correct, remove the
device, and do not re insert the same
 Instructions
• Women should be aware of the following
• She should check her pad for expulsion of device for the
first few periods.
• Should be instructed to feel the thread for the first few
months.
• Should be told that menstrual periods may be heavier
and may lasts for longer for initial few cycles.
• Should be asked to report if there is heavy bleeding,
severe pain, abnormal discharge or if she can't feel the
thread .
• Once the lifespan over it should be replaced.
• If necessary, can be continued for 2yr after menopause.
 LNG-IUS or Mirena

• Levonorgestrel releasing device

• Contains 52 mg of Levonorgestrel
• Release at a rate of 20 micro gram
per day
• Hormonal action & the intrauterine
inflammatory response by other
device
• In some it inhibits ovulation
• In all it causes endometrial atrophy
• Hence cause reduction in menstrual blood loss
followed by amenorrhoea
• Used as first line for menorrhagia
• Provide progestogenic component of
hormone replacement therapy after
menopause
 Problems of IUDs
• Expulsion
• Increased Menstrual blood flow
• Intermenstrual bleeding
• Amenorrhoea& irregular bleeding
• Perforation
• Infection
• Ectopic pregnancy
• Pregnancy with IUD
THANK YOU