Guest Author - Denise Howard,M.D., M.P.H.

Barrier contraception works by blocking the passage of sperm thereby preventing fertilization. There are two types. The condom catches semen while the diaphragm and cervical cap covers the cervix so that sperm can not pass into the uterus. They were the primary contraceptive methods before the development of hormonal contraception. The condom is still widely used due its effectiveness in preventing sexually transmitted infections.

There are many different manufacturers of the male condom. They are made from either natural material or man made material. The natural material comes from lamb intestine and is attractive because of the improved sensation compared to the rubber condom. Since they have small pores the passage of infectious agents are possible. Most condoms are made of latex and are effective in the prevention of both pregnancy and transmission of infectious agents including HIV. Many people are allergic to latex and would not be able to use these condoms. In response there has been an increased production of nonlatex synthetic condoms that provide the same protection as the latex condom without the risk. In addition, these condoms are more durable and less constricting.

There is a female condom available. It is called Reality and is made of polyurethane. It is a sheath with rings on either side that allows placement deep in the vagina covering the cervix internally and the labia externally. It can be worn for up to 8 hours and is effective as contraception and in the prevention of sexually transmitted infections including HIV.

The diaphragm and the cervical cap are made of rubber and fit over the cervix. They must be used in conjunction with a spermicidal jelly or cream. The diaphragm is larger, more flexible and easier to insert than the cap. The cap is smaller, must be placed directly over the cervix. The diaphragm is effective for up to 6 hours after initial insertion, must be worn for at least 6 hours after intercourse but should not be worn for more than 24 hours. The cap provides effective contraception for up to 48 hours after insertion.

The contraceptive sponge is a barrier device as well. It contains a spermicide and is placed intravaginally covering the cervix. It is effective for up to 24 hours and must be left in place for at least 6 hours after intercourse.

The intravaginal barrier contraceptive devices are effective if used correctly. There are however many drawbacks. It takes some dexterity and skill to insert them. The risk of failure is high if one isn’t compliant with the instructions. They are all used in conjunction with spermicide. Spermicide can cause local irritation and can be associated with urinary tract infections and vaginal infections.

The safety and ease of use of hormonal contraception and the safety and ease of performing permanent sterilization has made the use of intravaginal contraception almost obsolete. Condoms are still widely used, primarily because of its proven effectiveness in the prevention of sexually transmitted infections. The advent of AIDS/HIV has had a dramatic impact on the use of condoms for this reason. I highly recommend the consistent use of condoms in conjunction with hormonal contraception in young sexually active women. The condom protects against the usual sexually transmitted infections including HIV but also prevents the transmission of the Human Papilloma virus which can cause cervical cancer and the transmission of the Herpes virus.