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.
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.
- 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
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)
Disadvantages of diaphragms and cervical
- 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
- Advantage: Does not affect a woman's hormones
like the pill or injection. Does not interfere with intercourse if inserted
ahead of time.
- The devices are not as effective as other
- Some women find it difficult to insert the
- The use of the devices requires regular
re-assessment for size and fitting, particularly after pregnancy or change in
- The male condom is a very thin synthetic rubber or
latex sheath which is drawn over the penis to prevent sperms
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.
- It is easy to use and fairly effective if handled
- 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
- Has slight tourniquet effect on outer veins of
the penis, which may benefit men who have difficulty maintaining erection.
- The condom may break or slip off during
- 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
- 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
Effectiveness: Condom use has a Pearl Index of 3-15. This variation is
- 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).
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
- 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
teat (or plain end) should be held together to expel
- 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
- 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
These are probably old.
- If the package of a condom is damaged, so may be
- 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
- Remember that pregnancy or transmission of
STD-organisms can also occur without ejaculation.
- Store condoms in a cool, dry place away from sunlight.
- 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
- 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
- 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
- Can be inserted up to eight hours before intercourse but should be
removed immediately after ejaculation.
- Has a minimally higher failure rate than the
male condom (Pearl Index: 5–15).
- Requires some practice to be used
- May be uncomfortable.
- 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
- 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
- Contain a substance
which either immobilises or kills sperms to prevent them from fertilising an
- 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.
Shockingly low condom sales
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