Barrier contraceptive devices physically block the access of sperms to a woman's uterus and fallopian tubes. They include the diaphragm and cervical cap, the male and female condom, and the spermicides ("sperm killers") in form of foams, creams and gels.

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Diaphragms and cervical caps
Diaphragms and cervical caps are not commonly used in South Africa because they are not always easily available. The use of these devices requires an initial assessment by a medical practitioner/gynaecologist, whereby a gynaecological examination is performed to choose the correct size. The doctor will instruct the woman how to insert the device correctly and how to remove it again. Effectiveness: If 100 women use the diaphragm or cap together with a spermicide, 5 to 20 users will become pregnant within one year.

The diaphragm

• Consists of a soft, dome-shaped rubber or silicone at the centre and a firm outer ring. It is positioned over the cervix to prevent sperms from entering the uterus.
• Should be used with a spermicide which is applied to both sides of the diaphragm before being placed over the cervix a few minutes to six hours before intercourse. It should be left in place for at least six hours after intercourse. For intercourse after the six-hour period, or repeated intercourse within this period, fresh spermicide should be administered in the vagina with the diaphragm still in place. The diaphragm should not be left in the vagina longer than 24 hours.
• Can be fairly effective if used correctly with a spermicidal cream, and if a doctor is consulted regularly to assess the correct size and fitting (especially after childbirth).

Cervical cap (not available in South Africa)

• Works similarly to the diaphragm, and is initially also fitted by a health professional.
• Smaller and firmer than the diaphragm, cup-shaped with a round rim, made of slightly thicker rubber or plastic.
• Thirty minutes to 40 hours before intercourse, the cap is filled with spermicide and inserted over the cervix. It protects for 48 hours and for multiple acts of intercourse within this time. Should be kept in place for at least eight hours after intercourse, but not longer than 48 hours.
• Advantage: Does not affect a woman's hormones like the pill or injection. Does not interfere with intercourse if inserted ahead of time.

Disadvantages of diaphragms and cervical caps:

• The devices are not as effective as other contraceptive methods.
• Some women find it difficult to insert the devices properly.
• The use of the devices requires regular re-assessment for size and fitting, particularly after pregnancy or change in body weight.

Male condom

• The male condom is a very thin synthetic rubber or latex sheath which is drawn over the penis to prevent sperms from entering the vagina.
• Prevents direct contact with disease-causing organisms during intercourse.
• Can be used only once. If intercourse is repeated, the penis should be dried and a new condom applied.
• Some are prelubricated. Lubricants do not provide more contraception or STI protection. Oil-based lubricants, such as petroleum jelly (Vaseline), lotions, or massage or baby oil, can weaken the material and should be avoided. Other lubricants (water-based or K-Y jelly) can be used with latex condoms. Lubricated condoms that include a spermicide, such as nonoxynol-9, may decrease the possibility of pregnancy and transmission of certain STI-organisms (for example trichomonas but probably not gonorrhoea, chlamydia or HIV). Because condoms can break, their effectiveness can be increased by using an additional spermicide.
• The condom should be applied before any genital contact to prevent pregnancy and STI.
  
• Advantages:
  • It is easy to use and fairly effective if handled properly.
  • Does not require a prescription, is inexpensive and easily available - can be obtained at pharmacies, family planning clinics and from vending machines.
  • Has no systemic side-effects.
  • After abstinence and mutual monogamy, condoms are the next most effective method of reducing risk of infection from STIs.
  • Has slight tourniquet effect on outer veins of the penis, which may benefit men who have difficulty maintaining erection.
    
• Disadvantages:
  • The condom may break or slip off during intercourse.
  • Interrupts lovemaking. Since the condom must be put on when the penis is erect and before contact is made between the penis and vagina, there is usually a brief interruption during foreplay.
  • Some pre-planning is needed to have a condom available for intercourse.
  • May cause loss of sensation - no direct contact between the penis and vagina. Some men are unable to maintain an erection when wearing a condom.
  • If there is insufficient lubrication, the condom may cause friction making intercourse uncomfortable. (Lubricated condoms may alleviate this).
  • Rarely, allergic reactions to latex condoms can occur.
    

  Effectiveness: Condom use has a Pearl Index of 3-15. This variation is due to:

  • Occasional rupture of a condom during intercourse.
  • Spillage of semen during withdrawal.
  • Delayed placement of a condom on the penis (penis comes into contact with vagina before condom is applied).
  • Failure to use a condom during each act of intercourse.
  • Manufacture fault of condom, although this risk is very small.

How to use a condom

• Remove the condom from its package, being careful not to tear or poke a hole in it while pulling it out. Unroll the condom slightly before putting it on the penis. This leaves enough space for semen collection and prevents the condom from being stretched too tightly over the glans (tip) of the penis.
• If the condom has a receptacle at the tip (to collect semen), place the condom against the glans of the penis and carefully roll it down over the shaft of the penis. If there is no receptacle at the end, leave a small space between the condom and the tip of the penis - otherwise semen may move up between the penis and the condom and come out at the base. Be sure there is no air between the penis and the condom: this can cause the condom to break. While applying the condom, the walls of the teat (or plain end) should be held together to expel air.
• Immediately after ejaculation, carefully withdraw the penis from the vagina so that semen cannot leak out of the condom as the erection is lost. Hold the condom at the base of the penis while it is withdrawn.
• Make sure to have condoms available and conveniently located at the time of a sexual encounter.
• Don't carry condoms in your wallet or pocket for long periods. Friction can cause tiny holes in the condom.
• Don't use condoms that are brittle, sticky or discoloured. These are probably old.
• If the package of a condom is damaged, so may be the condom.
• If you feel the condom is breaking during intercourse, stop immediately and put on a new one. If ejaculation occurs with a broken condom, insert a nonoxynol-9 spermicide, if available, to reduce risk of pregnancy and consider emergency contraception.
• Remember that pregnancy or transmission of STD-organisms can also occur without ejaculation.
• Store condoms in a cool, dry place away from sunlight.

Female condom (Femidom)

• Is a lubricated, thin polyurethane sac with two soft rings at each end. The larger open ring stays outside the vagina, covering part of the perineum and labia during intercourse, while the smaller ring, covered with polyurethane, fits loosely over the cervix.
• Resembles a male condom but is larger.
• Available without prescription, but only in a few clinics and some pharmacies.
• Less effective protection than the male condom against some STIs, including AIDS
• Intended for one-time use.
• Not for use with a male condom because both may not stay in place.
• The female condom should be used together with a spermicidal agent.
• Advantages:
  • It is less likely to rupture than the male condom and is more resistant to chemicals.
  • Allows the woman to take responsibility for pregnancy and disease prevention.
  • Can be inserted up to eight hours before intercourse but should be removed immediately after ejaculation.
• Disadvantages
  • Has a minimally higher failure rate than the male condom (Pearl Index: 5–15).
  • Requires some practice to be used correctly.
  • May be uncomfortable.

Spermicides

• Sperm-killing chemicals available as gel, foam, jelly, foaming tablets, vaginal suppositories or cream.
• Are designed to be used in conjunction with diaphragms, caps or condoms. If used on their own, they carry a higher failure rate.
• Are inserted into the vagina, close to the cervix.
• Some products require a waiting period before becoming active inside the vagina. Others must be inserted immediately before intercourse.
• Contain a substance which either immobilises or kills sperms to prevent them from fertilising an egg.
• One dose of spermicide is usually effective for one hour. For repeated intercourse, additional spermicide should be applied. After intercourse, the spermicide should remain in place for at least six to eight hours to ensure it's effect on all sperms. During this time, tampons and vaginal douches or rinsing of the vagina must be avoided.
• No prescription needed; easily obtainable from most pharmacies.
• Spermicidal creams and jellies provide added lubrication, often needed with a condom.

Read more:
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