BARRIER METHODS.

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 BARRIER METHODS
• Different barrier methods.
• 1. Condoms {Male and Female}
• 2. The Diaphragm
• 3. The Cervical Cap
• 4. The Contraceptive Sponge {Vaginal}.
• 5. Spermicides.

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 TYPES
• Broadly classified into two main types: Mechanical
barriers and Chemical barriers.
• Mechanical barriers.
– Provide a physical barrier between the sperm and the egg.
include the male condom, female condom, diaphragm,
cervical cap, and sponge.
• Chemical barriers/ spermicides.
– Are sperm-killing substances, available as foams, creams,
gels, films or suppositories, which are often used in female
contraception in conjunction with mechanical barriers and
other devices.
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General xstics of barrier methods

Advantages
• Preventing pregnancy and some stop STDs
when used consistently and correctly.
• Easy to initiate or discontinue.
• Immediate return to fertility.
• Most do not require clinic visit.
• No systemic effects.
• Safe.
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Disadvantages
• Not as effective as other methods
• Maybe difficult to use consistently and
correctly for some.
• May interrupt sexual activity.
• Cultural barriers may inhibit use.
• Need for proper storage and resupply.
• Expensive in some settings.
• May require partner participation.

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• Various contraceptive methods are
based on three general strategies:
• (1) Prevention of ovulation,
• (2) Prevention of fertilization or
• (3) Prevention of implantation.

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 1. THE MALE CONDOM
• A male condom is a thin sheath made of latex or other
materials.
• The man puts the condom on his erected penis, while the
condom holds the semen.
• After having sexual intercourse, the man must carefully take
off the condom so that it does not leak.
• Each condom can be used only once.
• These are coverings, that fit over a man’s erect penis.
• Different sizes, shapes, colours and textures are common.

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 Mechanism of action

• Preventing pregnancy that keeps sperm out of

the vagina,
• keep infections in bodily fluids (semen and
blood), on the penis.

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 Effectiveness
• Protection against pregnancy:
– As commonly used, about 13 pregnancies per 100 women whose partners use
male condoms over the first year. This means that 87 of every 100 women
whose partners use male condoms will not become pregnant.
• Protection against HIV and other STIs.
– When used consistently and correctly, condom use prevents 80%
to 95% of HIV transmission that would have occurred without
condoms.
– Protect best against STIs spread by discharge, such as
HIV, gonorrhea, and chlamydia.
– Also protect against STIs spread by skin-to-skin contact,
such as herpes and human papillomavirus.
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 Medical eligibility criteria
• All men and women can safely use latex male
condoms except those with:
– Severe allergic reaction to latex rubber.
– Or those or partner cannot avoid risk of STIs.
• suggest they use female condoms or plastic male
condoms, if available.
• When to start using male condom: Any time,
whenever a man or a couple wants protection
from pregnancy or STIs
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 Side effects, health benefits and
health risks
• Side effects: None
• Know health risk:
• Known health benefits Extremely rare:
• Help protect against: – Severe allergic
– Risks of pregnancy reaction (among
– STIs, including HIV people with latex
• May help protect against: allergy)
– Conditions caused by STIs:
• Recurring PID and chronic pelvic pain
• Cervical cancer
• Infertility (male and female)

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 Basic steps of using the male condom

• Five basic steps when using a male condom.

(A Global Handbook for Providers, WHO, 2007)
1. Use a new condom for each act of sex.
2. Before any physical contact, place the condom on the tip
of the erect penis with the rolled side out.
3. Unroll the condom all the way to the base of the erect
penis
4. Immediately after ejaculation, hold the rim of the
condom in place and withdraw the penis while it is still
erect
5. Dispose of the used condom
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 THINGS TO PAY ATTENTION TO
IN CONDOM USE

• Expiry date
• Use in all kinds of sexual intercourse.
• Use New condom in each intercourse.
• Do not carry the condom in a tight pocket.
• Do not use dry, dirty and damaged condoms that have lost their
flexibility
• Do not use teeth or perforating tools (scissors, nails, etc)
• Use the condom at the beginning of intercourse before the
exchange of fluids and for male condoms, when the penis is in full
erection.
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• If condom damaged immediately change
 FEMALE CONDOM.
•Female condom comprises of strong, soft, transparent
polyurethane sheath, which is inserted in the vagina
before sexual intercourse.
•It is approximately 15 cm in length and 7 cm in
diameter.
•It has inner and outer rings
•A soft ring at the closed end of the tube covers the
cervix during intercourse and holds it inside the vagina.

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 MECHANISM OF ACTION

• The female condom helps protect partners

from pregnancy and STIs, including
HIV/AIDS.
• It is the only female-controlled device
offering this protection.
• To prevent the sharing of bodily fluids, like
semen and blood.
• Pregnancy does not occur, and STIs are not
transmitted.
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 Steps of insertion
1. Squeeze the ring at the closed end of the tube. use other
hand to spread the outer lips.
2. The inner ring should be pushed just past the
pubic bone and over the cervix.
3. After insertion, make sure the condom is not twisted.
4. About one inch of the open end will stay outside the body.
The outer ring of the female condom needs to be held in
place during intercourse.
5. After intercourse, squeeze and twist the outer ring to keep
all fluids, including sperm, inside the condom, and gently
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 ADVANTAGES

• Unlike the male condom, erection is not

necessary to keep the condom in place.
• Female condoms do not reduce a male
partner’s stimulation.
• Female condoms can be used by people who
are known to be sensitive to latex.

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 DISADVANTAGES

• Female condoms make a noticeable

sound during sexual intercourse.
• It is sometimes difficult to insert or use,
• It can break or leak.
• It is much more expensive than a male
condom.

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2. Diaphragm
• The diaphragm is a small dome-shaped latex cup
with a flexible ring that fits over the cervix.
• It is an intravaginal device made of latex with
flexible metal or spring ring at the margin.
• Its diameter varies from 5–10 cm.
• The distance between the tip of the middle finger
placed in the posterior fornix and the point over
the finger.
• The device is introduced up to 3 hours before
intercourse and is to be kept for at least 6 hours
after the last coital act.
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Mechanism of action
• The cup acts as a physical barrier against the
entry of sperm into the uterus.
• A diaphragm is usually used along with
spermicide.

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 HOW TO INSERT

• During the fitting process, a fitting ring is inserted

into the vagina.
• The largest ring that fits comfortably is usually
the size chosen.
• Diaphragms can be inserted up to two hours
before sex, because spermicide is only effective
for two hours.
• As a general rule, diaphragms should be
replaced every one to two years.
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 GUIDELINES FOR INSERTION

• Before or after each use, the woman should hold

the diaphragm up to the light, or fill it with water,
• A small amount of spermicide (about one
tablespoon) is usually placed inside the cup, and
some is smeared around the lip of the cup.
• The device is then folded in half and inserted into
the vagina by hand, or with the assistance of a
plastic inserter.
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• The diaphragm should fit over the cervix,
blocking entry to the uterus.
• If more than six hours pass before repeat
intercourse occurs,
• The diaphragm must remain in the vagina
for six to eight hours
• The diaphragm should be washed with soap
and warm water after each use, and then
dried and stored in its original container.
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 Advantages

• Cheap.
• Can be used repeatedly for a long time.
• Reduces PID/STIs to some extent
• Protects against cervical precancer and
cancer.
• It also does not interfere with a woman’s
hormones.
• Few side effects.
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 Disadvantages

• Requires help of a doctor or paramedical person to

measure the size required
• Risk of vaginal irritation, and abrasion.
• Risk of urinary tract infection.
• Not suitable for women with uterine prolapse.
• Need to keep in place for at least 6 hours after
intercourse to ensure that no motile sperm are left in the
vagina
• Need to replace spermicide with each act of intercourse
• Associated with an increased risk of urinary tract
infections
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• Need to be fit by a clinician
 3. Cervical Cap.
A Cervical cap is a soft, deep rubber cup with a firm, round
rim that fits snugly over the cervix.
The cap provides effective contraception for 48 hours.
The cervical cap acts as a physical barrier between the
sperm and egg by fitting snugly over the cervix.
It must be inserted at least 15 minutes prior to intercourse
and must be kept in place for a minimum of 6−8 hours but
can be left in place for up to 48 hours, following which, it
should be removed.
Pregnancy rate have been found to vary between 11% and
32%.
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• Advantages
• Ability to leave in place up to 48 hours (compared
to 6 hours with the diaphragm), regardless of
number of acts of intercourse.
• Effectiveness without the addition of a spermicidal
agent.
• Disadvantages
• Need to keep in place for at least 6 hours after
intercourse (same as the diaphragm)
• Few physicians are trained in the placement and
use of the cervical cap
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 4. Contraceptive Sponge
• The Today contraceptive sponge is an over-the-counter,
one size-fits-all device.
• The nonoxynol-9–impregnated polyurethane disc is 2.5
cm thick and 5.5 cm wide and has a dimple on one side
and satin loop on the other .
• The sponge can be inserted up to 24 hours prior to
intercourse, and while in place, it provides contraception
regardless of coital frequency.
• It should remain in place for 6 hours after intercourse.

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 5. SPERMICIDES
• Spermicides are available as vaginal foams, gels,
creams, tablets and suppositories.
• Usually, they contain surfactants like nonoxynol–9,
octoxynol or benzalkonium chloride.
• These agents mostly cause sperm immobilization.
• The cream or jelly is introduced high in the vagina
with the help of the applicator soon before coitus.
• Foam tablets (1–2) are to be introduced high in
the vagina at least 5 minutes prior to intercourse.

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 Mechanism Of Use

• They work by causing the membrane of the sperm

cells to break, killing them or slowing their
movement.
• This keeps the sperm from meeting the egg.
• Effectiveness
• One of the least effective family planning methods,
with a 29% chance of pregnancy, and as with other
methods effectiveness depends on the user.
• Risk of pregnancy is greatest when spermicides are
not used with every act of sex.
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• Advantages.
• Increase the efficacy of vaginal sponges, diaphragms, and
cervical caps.
• Available over the counter.
• No need for medical consultation.
• Few side effects
• Disadvantages.
• Need for insertion with each act of intercourse.
• Limited duration of effectiveness
• Possible increase in the risk of HIV transmission caused by
disruption of vaginal epithelium.
• This increased risk appears to be dose dependent:
• People who use these products multiple times per day should
be wary of this effect
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