Barrier Contraception

iStock 000005843641SmallBarriers methods include condoms and diaphragms, as well as sponges (not available in the USA) and spermicides. They are an important part of Practicing Safer Sex and preventing STDs.

We encourage you to read as well the American College of Obstetricians and Gynecologist’s Patient Information:

  • Preventing STDs
  • Barrier Contraception
  • Birth Control (note that this particular brochure has not yet been updated to include information on In-Office Tubals)

Barriers methods include condoms and diaphragms, as well as sponges (not available in the USA) and spermicides.

What are the advantages of barrier contraceptives?

Barrier contraceptives are the only method that protects against sexually transmitted diseases (STDs) and PID (pelvic inflammatory disease). This includes protection against chlamydia, gonorrhea, genital herpes, cytomegalovius, human papillomavirus, and HIV infection.

They are also fairly convenient, and the only current reversible way for males to be sure that they are not going to cause a pregnancy.

How effective are barriers?

With typical use, male condoms are 86% effective, and female condoms are 79% effective. The sponge is 72% effective for women who've had a baby, and 82% effective for those who haven't. Spermicides, by themselves, are about 74% effective with typical use. Diaphragms are about 80% effective.

With ideal use, they are all more effective, but still not as much as the pill, by themselves. Using more than one barrier (such as condoms and spermicide) increases the effectiveness. It is still less effective than the pill.

So ideally barriers should be combined with a hormonally based contraception for ideal protection against both pregnancy and STDs.

What is a diaphragm and how does it work?

Diaphragms are a sheet of plastic on a flat metal spring that is placed in the vagina and covers the cervix. It is fitted by the gynecologist who assesses whether the pelvic floor has adequate tone to hold it and the size and shape of the vagina, and writes a prescription for the appropriate size. The diaphragm is very safe and easy to use. Less than 1% of people discontinue because of difficulty using it or irritation. It slightly increases risk of urinary tract infections after intercourse. It has a 15% to 20% failure rate used by itself, without spermicides, about a 5% failure rate when used with them. It should be placed no longer than 6 hours prior to sexual intercourse and a tablespoon of spermicidal cream or jelly should be placed in the dome of the diaphragm prior to insertion and some should be spread around the rim with a finger. It should be left in placed for approximately 6 hours after intercourse, but not more than 24 hours afterwards, then removed, washed with soap and water, rinsed and dried. Do not apply powder of any kind to it. Periodically check for leaks. Reassess if you gain or lose weight or have a baby - you may need a different size.

Unfortunately the diaphragm is no longer available in North America

What are spermicides and how are they used?

Spermicides come as jellies, creams, foams, melting suppositories, foaming tablets, foaming suppositories and soluble films. Usually they are used with other barriers, such as condoms or diaphragms, but even alone, they provide some contraceptive effect and some protection against STDs.

What are some examples of spermicides:

  • Films: Vaginal contraceptive film (VCF), Allendale-N9
  • Foams - Delfen, Emko, Koromex
  • Jellies and Creams: Contraceptrol, Delfen, Ortho Gynol, Ramses, Koromex Jelly
  • Gels: Advantage 24
  • Suppositories: Encare, Koromex Inserts, Semicid

How do you use them?

Spermicides require application 10 to 30 minutes prior to sexual intercourse and remain effective for about 8 hours. Used alone, without condoms or the pill, they have up to a 20% failure rate (compared to using nothing, which has an 85% failure rate, ie "pregnancy rate").

What are the advantages?

They are relatively inexpensive, widely available without prescription and simple to use. They provide protection against STDs (not 100%, but some), in addition to a contraceptive effect.

What are the disadvantages of spermicides?

Allergic reactions (1-5%) and increased risk of urinary tract infections (2-3%) seem to be the main side effects.

How should condoms be used?

A condom must be placed over the penis before it touches the partner. Uncircumcised men should roll the foreskin back. Prior to unrolling the condom to the base of the penis, air should be squeezed out of the reservoir tip with a thumb and forefinger. The tip of the condom should extend beyond the end of the penis to provide a reservoir to collect the ejaculate (a half inch of pinched tip). Any lubricants should be water based (Vaseline weakens condoms). Click here to watch a demonstration.

The penis must be withdrawn while still erect, and the condom should be held at the base while withdrawing. It must not be allowed to spill or leak and must be handled gently. Fingernails and rings can penetrate the latex and cause leakage. For more information, please read ACOG's Brochure on Barrier Contraception.

What do I do if a condom breaks?

If you use condoms, ideally you are using them with a spermicide, or and you have spermicide immediately available. If you do, immediately place spermicidal agents into the vagina. A woman should contact a clinician within 72 hours of a condom breakage and emergency contraception considered.

The Female Condom

To use the female condom, squeeze the inner ring between your fingers and insert it into the vagina. Push the inner ring up until it is just behind the pubic bone. About an inch of the open end should be outside your body.

Right after ejaculation, squeeze and twist the outer ring and pull the pouch out gently. Like the male condom, it should be thrown away—it should never be reused.

Debra Ravasia, updated 2017