Barrier Methods

Condoms, the sponge, the diaphragm, the female condom, and the cervical cap are all examples of barrier methods. These need to be placed and then removed with each sexual encounter. They contain no hormones but have a higher chance of pregnancy then other birth control choices. The most common reason barrier methods fail is they tend not to be used every time or are not used correctly. Condoms can be used in combination with other barrier methods like the sponge or diaphragm to decrease the risk of pregnancy.

Condoms are placed over the penis prior to intercourse. They must be removed after each ejaculation. A new one can be placed if intercourse is to continue after the man ejaculates. Condoms decrease the risk of transmission of sexually transmitted diseases such as HIV, chlamydia, and gonorrhea. Most condoms are made out of latex but there are latex free condoms available for people with latex allergies. Condoms are considered 98% effective for the prevention of pregnancy if used perfectly. In actual use they are only about 82% effective, this is much lower then non-barrier birth control. Condoms should always be used with spermicide to increase effectiveness.

The contraceptive sponge is a device that is placed in the vagina against the cervix. It contains a spermicide in the sponge. The sponge needs to be activated by placing at least 2 tablespoons of water in the groove and squeezing the sponge. The sponge can be placed up to 24 hours before intercourse. It should not be removed for at least 6 hours after the last episode of intercourse and should not be left in the vagina for more then 30 hours. The sponge is not re-usable and must be discarded after it is removed. The sponge is more effective in women who have not had children, in this population it is about 88% effective in actual use. In women that have had children it is only about 76% effective. The sponge was off the market for a long time, not because there was a problem with the sponge, but rather there was a problem with the factory. The factory was closed due to worker safety issues. It was decided by the company that made the sponge that it was too expensive to fix the factory so they just stopped making the sponge. This led to the famous “sponge worthy” Seinfeld episode. Recently the manufacture of the sponge has re-started and it is available once again.

The diaphragm is a silicon ring that is filled with spermicide and placed in the vagina over the cervix before intercourse. The diaphragm must be left in for at least 6 hours after intercourse but not left in for more than 24 hours. If intercourse occurs more than once, spermicide must be placed in the vagina with each subsequent episode. The diaphragm is re-usable and should be washed and stored after use. The diaphragm is about 88% effective in actual use. The diaphragm comes in various sizes and must be fit by a doctor who then writes a prescription for the correct size. The diaphragm must be re-fit after pregnancy or pregnancy loss after 14 weeks, after pelvic or abdominal surgery, or after 20% change in weight.

Female condoms and cervical caps are very uncommonly used. The Female condoms are 79% effective in actual use and are more difficult to use than the traditional condoms. The cervical cap is similar to a diaphragm, it must be fit by a doctor. It is more difficult to place than the diaphragm and it is less effective.