Barrier Methods: condoms (both male and female), diaphragms and cervical caps. Generally speaking all of these methods work by preventing sperm from passing through the cervix into the uterus and thus prevent fertilization. Hence the term “barrier methods” as they literally create a barrier to fertilization. The most well known barrier method, is of course, the male condom. However, as we will discuss this is not the only weapon in this particular arsenal.
Another important topic to consider when choosing a contraceptive method is potential side effects. One of the nice things about barrier methods is that the potential side effects are relatively limited. Here are some general benefits and risks of barrier methods:
- Benefits: no affect on future fertility, can be female driven (diaphragm, internal condom), only used during intercourse, offers protection against Sexually Transmitted Infections of STI’s, safe while lactating, safe with potential co-morbidities such as high blood pressure or migraine headaches. Not associated with increased weight gain, acne, headaches, blood clots, mood swings or menstrual changes.
- Risks: allergies to latex or spermicide, potentially embarrassing, must have cooperation of partner, must use every time you have intercourse, potential for toxic shock syndrome (although very rare) with diaphragms or cervical caps.
The Male Condom
But since the male condom is the most well known of these methods, we might as well start out here. The male condom has been called many things; a cock sock, rubber, jimmy hat, night cap, love glove, cum catcher, rain coat, french letter, dinger, prophylactic and many, many more through the ages. Our first known reference to a prototype of the modern condom is found in relation to the 1st King Minos of Crete around 3,000BC. It was rumored that his seed contained “scorpions and serpents” so it was necessary to protect his wife from them. To do this, the bladder of a goat was used to catch the semen before it could attack her. This sounds like a relationship issue to complex to be fixed with a condom if you ask me, but I digress. Descriptions of early condoms then pop up all over the world. In China silk was used to sheath the penis. In Japan, they had Kabuta-Gata which was made using tortoise shell (???I have so many questions???) or leather. Linen was also a popular material used to try to offer protection both from pregnancy and of course venereal diseases. In Ancient Egypt the linen condom was died in different colors to denote social status. So prior to the advent of rubber and later latex, humans used all kinds of materials from fabrics to animal intestines and everything in between to keep that darn semen from getting through the cervix.
Then, in 1839 but patented in 1844, Charles Goodyear invented vulcanized rubber and a condom revolution began! Condoms could be made with this new rubber that was more pliable, however, it was not without issue. This vulcanized rubber was still relatively thick and definitely did not smell great. These early condoms were also incredibly time consuming to create, the factories were prone to catching fire and the condoms had a pretty short shelf life. Then two (really three) things happened to help condoms become what they are today. In 1918, doctors were allowed to prescribe condoms to help prevent disease. And in 1920, we had the invention of latex, which made condoms more practical for large scale use. But the big boom for our friend the condom was actually World War II. With the troops out and about in the world, the need for prophylactics to prevent disease become even more necessary, the prescription requirement was lifted and mass production began.
Enough of the history lesson though, lets get to the brass tacks. Male condoms are widely available, easy to use and are relatively inexpensive. All of this makes them a wonderful choice for contraception. And there is the very important added bonus of protection from Sexually Transmitted Infections or STI’s. In this way condoms are a great companion with other types of contraception, like those discussed in my article on LARC’s. There is a catch of course, and that is that you actually have to put the condom on properly before any penetration and keep it on throughout intercourse until completion. As I often say in appointments with clients, “they do not work on the nightstand”.
When we, providers, talk about the effectiveness of a contraceptive method we typically talk about two categories. First is “perfect use”, this describes the method being used in a perfect world with perfect humans who never make mistakes, don’t get carried away in the heat of the moment and always follow directions. (As you may imagine this rarely happens in the real world we all actually live in!) Then there is “actual use” which refers to how we live and function in the actual reality of the world. So what are the numbers for male condoms you ask?
Perfect Use = 98% effective at preventing pregnancy
Actual Use = 87% effective at preventing pregnancy
Those are pretty good numbers, especially considering all the points discussed above, including the hormonal side effects. There is the potential for a latex allergy and this should be considering when using this method.
Internal (Female) Condom
Continuing on the path of Covering Contraception: Barrier methods lets take a moment to discuss the female, or internal condom. These devices actually look more like a pouch and are made to be inserted in the vagina. They are made of nitrile, which is another type of rubber. There are advantages to having the internal condom made of nitrile, first it does not have the potential for allergies like latex does and so may be good choice for folks with latex allergies. Secondly, nitrile is stronger than latex and is less permeable as well. One nice thing about this method is that the control is in the hands of the woman, but due to its size it is not something that could easily be used without the knowledge of the partner. So how effective are they?
Perfect Use = 95% effective at preventing pregnancy
Actual Use = 79% effective at preventing pregnancy
Similar to all barrier methods, this choice will not interfere with the hormonal processes which is important for many users. So, where can you find an internal condom? In the US there is only 1 manufacturer, FC2 and it is mostly only available through their website. This of course, is a huge issue, makes access pretty limited and is partially why internal condoms are not more widely used.
Diaphragms and Cervical Caps
This is another Barrier Method that has been around for quite a while. For centuries, women have been very creative with the use of internal items to help prevent pregnancy and disease. There are reports of lemon halves, oiled pieces of paper, beeswax, pepper, seeds, roots, rock salt, seaweed or even balls of opium (that one could have other effects??) being used. The closest relation to the modern day diaphragm was invented in 1842 by a German Gynecologist, Friedrich Wilde and was brought to the US in the early 1900’s by Margaret Sanger.
***Any mention of Margaret Sanger requires an acknowledgement of the racist views she brought with her to the work she did towards contraceptive access in the US***
Diaphragms and cervical caps are worn internally and essentially cover the cervix and thus prevent sperm from entering the uterus. Both should be used in conjunction with spermicidal gel or foam to be most effective. In general, diaphragms are slightly larger and more flexible that cervical caps. Diaphragms are also more effective. The most prevalent, currently available diaphragm in the US is the Caya and does require a prescription. I have prescribed, fitted (I know the website says “one size fits most” but I like to do a fitting to make sure each individual does fall into the “most” category) and dispensed these diaphragms for years and find them to be well liked my my clients who choose them. And again, spermicidal gel or foam is required for best results.
Diaphragms, Perfect use = 94% effective at preventing pregnancy
Diaphragms, Actual Use = 88% effective at preventing pregnancy
As far as cervical caps, there is also only one available in the US. It is the FemCap and does require a prescription. However, you can complete an online evaluation through their website to get the prescription. Cervical caps do come in different sizes and whether or not you have given birth vaginally plays into the mix as well. These generally work the best for folks who have not given birth vaginally. They should also be used with a spermicidal product for the highest effectiveness.
Cervical Cap, for folks who have never given birth = 86% effective at preventing pregnancy
Cervical Cap, for folks who have given birth = 71% effective at preventing pregnancy
P.S. Have I mentioned that Diaphragms and cervical caps must be used with spermicidal gel or foam to be the most effective???
So there ya go! The basics of Barrier Methods for Covering Contraception. As always, please keep in mind this series is meant as informational only and is simply a place to get started. Please visit you health care provider for more detailed information, specific to your individual health history and situation.
And there is also one of my favorite online sources for more information at Bedsider. I really like this website, it is a wealth of easy to understand and access information about ALL forms of contraception and sexual health.