Know Your Birth Control Options Part 1: Barrier Methods

A variety of factors will likely determine the right kind of birth control for you. Common considerations include effectiveness, cost, existing health issues, cycle length and severity, lifestyle habits and even acne concerns. Recently we spoke with Dr. Donald Brown, an OB/GYN at INTEGRIS, about the many different types of birth control available to help you choose the best option.

This is the first of a three-part series. Today's blog will focus on barrier methods. Check back to the blog soon for an in-depth discussion on hormonal contraception. The final blog will feature permanent contraceptive methods.

Barrier methods

Barrier methods block sperm from reaching an egg. Some barrier methods do protect against sexually transmitted infections (STIs), but others don’t. All barrier methods are safe for women who are breastfeeding, since there are no added hormones.

Because of user error, barrier methods are not the most effective option for preventing pregnancy. According to The American College of Obstetricians and Gynecologists, approximately 18 to 28 percent of women will become pregnant when using barrier methods. This number is high because barrier methods can be forgotten, used improperly or broken. “Any method that requires the patient do something prior to intercourse lowers its effectiveness,” Dr. Brown says.

Condoms

There are both male and female condoms. A male condom is a thin cover made of latex, polyurethane or animal membrane worn over the penis during intercourse. A female condom is a thin, plastic pouch that is placed inside the vagina between the opening and the cervix.

Although both male and female condoms provide protection from STIs, male latex and polyurethane condoms provide the most protection. However, women with latex or polyurethane allergies should be cautious when using these condoms. Instead, they should opt for natural or polyisoprene options.

There are numerous benefits in choosing condoms for birth control. Condoms are less expensive than other methods, are easy to find, and they are convenient and portable. They are also some of the more effective barrier methods of birth control. According to Planned Parenthood, and assuming "improper" usage by some (see above):

• For male condoms, 15 out of every 100 women who use them will get pregnant in a year.
• For female condoms, 21 out of every 100 women who use them will get pregnant in a year.

Spermicide

Spermicide is a chemical, often containing nonoxynol-9, which inactivates sperm. It can be used in various forms including creams, foams, gels, films and suppositories.

When used on its own, spermicide should be inserted into the vagina, close to the cervix. There are time-sensitive variables to know when using spermicide. Spermicide does not become effective until 10 to 15 minutes after insertion. These rates vary by brand, so it is always good practice to read the label prior to use. Spermicides are only effective for a maximum of one hour after insertion but cannot be removed until at least six hours after insertion.

The benefits of spermicide include ease of use, low cost and availability. However, using spermicide also comes with a number of drawbacks.

According to the World Health Organization (WHO), “Regarding the use of spermicides for contraception, when used alone, nonoxynol-9 is only moderately effective for pregnancy prevention.” Planned Parenthood says that for users of spermicides like nonoxynol-9, and assuming some improper usage, then 28 out of every 100 women who use spermicide will get pregnant in a year.

Also, in some cases spermicides have been found to cause vaginal burning and irritation.

In addition, spermicides containing nonoxynol-9 do not protect against STIs. And, according to WHO, “spermicides containing nonoxynol-9 do not protect against HIV infection and may even increase the risk of HIV infection in women using these products frequently.” WHO advises women who have multiple sexual partners against using nonoxynol-9 spermicides for contraception. Spermicides should only be used if you have only one sexual partner and both of you have a minimal risk of HIV.

Sponges

A sponge is a small round mass of soft foam containing spermicide that is inserted into the vagina to cover the cervix, acting as a barrier between sperm and the uterus. Unlike many spermicide options, the sponge can be inserted up to 24 hours before sexual intercourse. The sponge contains enough spermicide for multiple sexual acts during a 24-hour period, so you do not need to replace the sponge between sessions, but sponges should not be worn for more than 30 hours at a time.

Like condoms and spermicide options, sponges are inexpensive and widely available. They are simple to insert and easily disposable after intercourse.

As for effectiveness, sponges are more effective for those who have never given birth. According to Planned Parenthood, and assuming some improper usage:

• For users who have not given birth, 12 out of every 100 women will get pregnant in a year.
• For users who have given birth, 24 out of every 100 women will get pregnant in a year.

Sponges, like spermicide, can increase your risk of contracting HIV from an infected sexual partner and may cause vaginal burning or irritation. Don't wear a sponge during your menstrual cycle because toxic shock syndrome can occur. Also, don't wear a sponge if you have had toxic shock syndrome in the past.

New moms must wait at least six weeks after birth before inserting a sponge to give the uterus and cervix enough time to reach their normal size, and to make sure they do not develop toxic shock syndrome.

Diaphragms

A diaphragm is a small, flexible rubber cup that is inserted into the vagina to cover the cervix. It must be used in combination with spermicide. You will choose between an individually sized diaphragm (fitted by a health care professional) and a one-size diaphragm which fits most (but not all) women.

A diaphragm can be inserted hours before intercourse (for exact time ranges, read the device’s label) but must remain in place for six hours after sex. Diaphragms can be effective for multiple sexual acts within a 24-hour period, but before each act you must apply more spermicide without removing the diaphragm. Also, do not wear a diaphragm for more than 24 hours at a time.

Diaphragms have the same risks as sponges, including an increased risk of STIs, HIV infection, and burning, irritation and toxic shock syndrome. In addition, diaphragms may increase the risk of a urinary tract infection (UTI). Do not wear a diaphragm during your period.

As for effectiveness (and assuming some improper usage), Planned Parenthood says 12 users out of every 100 women will get pregnant in a year.

New moms must wait at least six weeks after birth before inserting a diaphragm to give the uterus and cervix enough time to reach their normal size, and to make sure they do not develop toxic shock syndrome.

Cervical caps

A cervical cap is a small bowl-shaped dome made of silicone or latex, used with spermicide, which suctions over the cervix. It must be prescribed and fitted by a health care professional. It is similar to a diaphragm but is smaller and can be worn for longer intervals. The cervical cap may be inserted up to 40 hours before intercourse but should not be worn longer than 48 hours at a time.

Unlike the diaphragm, if you have sex more than once during this period, you do not need to reapply spermicide. The cervical cap must stay inserted for six hours after sex to remain effective.

Do not use a cervical cap during your menstrual cycle as it can increase your risk for infection or toxic shock syndrome. The cap may also cause vaginal irritation or odor in some cases. Cervical caps have the same risks as diaphragms, including an increased risk of STIs and HIV infection.

Cervical caps are much more effective for those who have never given birth. According to Planned Parenthood (and assuming some improper usage):

• For users who have not given birth, 14 out of every 100 women will get pregnant in a year.
• For users who have given birth, 29 out of every 100 women will get pregnant in a year.

New moms must wait at least six weeks after birth before inserting a cervical cap to give the uterus and cervix enough time to reach their normal size, and to make sure they do not develop toxic shock syndrome. 

From fertility, labor and delivery to pediatrics, specialized breast care, heart health, gynecological care and everything in between, INTEGRIS brings exceptional care every woman deserves. For more information visit the INTEGRIS Women’s Health Network of Oklahoma.