Spotlights on Health and Rights

Key topics in the Heilbrunn Department of Population and Family Health

Reproductive Health

Non-Hormonal Methods

The diaphragm, cervical cap, male condom, female condom and sponge prevent pregnancy by creating a "barrier" between the sperm and the ovum.

Diaphragm

The diaphragm is a dome-shaped rubber cup that is inserted into the vagina before sexual intercourse

Method Use

  • Spermicidal (sperm-killing) jelly is applied inside of the diaphragm before it is inserted.
  • The diaphragm is inserted up to six hours before intercourse, and must be left in place for six hours following intercourse.
  • If intercourse is repeated, additional spermicide should be inserted into the vagina with an applicator without removing the diaphragm.
  • For more detailed information about how to insert a diaphragm, go to: http://www.webmd.com/sex/birth-control/tc/diaphragm-use-and-care-topic-overview

Effectiveness

Diaphragm effectiveness with perfect use is 94%. With typical use, it is 80%.

Benefits/Advantages

There are few medical risks associated with the diaphragm

Disadvantages/Risks

  • In rare instances, users report irritation or allergy from the spermicide.
  • The only major side effect of using the diaphragm is toxic shock syndrome (TSS), a rare but serious disorder caused by the staphylococcus aureus bacterium. The risk of TSS is very low among barrier method users (three cases of per year can be expected for every 100,000 women using vaginal barrier methods, resulting in one death for every 100,000 users).

Cervical Cap

The cervical cap is a small rubber cup that fits snugly onto the cervix.

Method Use

Prior to insertion, spermicide is placed inside the cap. Additional spermicide is not needed for repeated intercourse. The cap can be left in place for up to 48 hours. Cap use longer than 48 hours is not recommended (increased risk of TSS).

Effectiveness

Effectiveness of the cap is 74% with perfect use and 60% with typical use.

Disadvantages/Risks

Limited sizes of cervical caps are available in the U.S. which means that some women will not be able to be fitted for the cap. Additional sizes are available in other developed countries.

STI Protection: Although the latex male condom is the best method of preventing the transmission of STIs and HIV, other barrier methods such as the diaphragm and cervical cap may provide some STI/HIV protection as well. Studies in both the United States and developing countries are investigating the use of barrier methods and newly formulated microbicides (microbe killing creams or jellies) in the reduction of STI/HIV transmission risk.

Sponge

The sponge is a small, soft, and round piece of polyurethane foam that contains spermicide and is inserted into the vagina before sexual intercourse.

Method Use

  • Before inserting it into the vagina, the sponge should be wet with a small amount of water to activate the spermicide.
  • The sponge is inserted so that it covers the cervix and positioned with the nylon loop at the bottom for easy removal.
  • The sponge protects for up to 24 hours, even with repeated intercourse, and must be left in place for at least six hours after intercourse. It should not be worn for more than 30 hours due to increased risk of TSS.
  • The sponge can be used only once and should be discarded in a waste receptacle and not the toilet. Effectiveness
  • Sponge effectiveness with perfect use for women who have never given birth is 91%. With typical use, it is 84%.
  • Sponge effectiveness with perfect use for women who have previously given birth is 80%. With typical use, it is 68%.

Benefits/Advantages

The sponge is available without a prescription and can be inserted up to 24 hours before sex.

Disadvantages/Risks

  • The sponge contains nonoxynol-9, a spermicide that can cause irritation to the vaginal tissue, increasing susceptibility to STIs including HIV.
  • There is also a small risk of toxic shock syndrome (TSS), a rare but serious disorder caused by the staphylococcus aureus bacterium. The risk of TSS is very low among barrier method users (three cases of per year can be expected for every 100,000 women using vaginal barrier methods, resulting in one death for every 100,000 users).

Condoms

Male and female condoms will be described below. Because both prevent pregnancy by blocking the passage of semen into the vagina, they also prevent STIs and HIV.

Male Condom

Male condoms are available in latex, lambskin, and/or polyurethane. All three materials effectively prevent pregnancy. Lambskin contains small pores that may permit the passage of bacteria and viruses, and are thus not recommended for infection prevention.


Method Use

  • New condoms must be used with each act of intercourse.
  • Check expiration date of the condom.
  • If penis is uncircumcised, pull back foreskin before placing the condom, if possible.
  • Gently pinch the tip of the condom to squeeze out air to allow room for the semen.
  • Place condom on erect penis before intercourse by carefully unrolling it all the way down to the base of the penis.
  • Make sure condom is being unrolled in the right direction (if condom does not unroll, it is probably in-side out).
  • Use adequate lubrication (only water-based lubricants should be used with latex condoms, because oil based lubricants - creams, oils, petroleum jelly, etc. - may cause latex to tear).
  • After ejaculation, withdraw the penis from the vagina before the penis becomes flaccid, and hold the rim of the condom against the base of the penis to prevent the semen from spilling.
  • Do not flush condoms in toilets as they will clog plumbing.

Effectiveness

Male condom effectiveness is 98% with perfect use, and 85% with typical use.

Advantages/Benefits

  • Provides protection against both pregnancy and STI/HIV.
  • Widely accessible without a prescription.
  • Causes almost no medical side effects.

Disadvantages/Risks

  • Coitus dependent.
  • Reduced sensitivity for men however, this may be an advantage for preventing premature ejaculation..
  • Some men have difficulty maintaining erections, especially when they are inexperienced condom users.
  • Challenge to use in relationships where there is weak partner cooperation and/or intimate partner violence or coercion.
  • Latex allergy.

STI Protection: When used consistently and correctly, condoms prevent the transmission of HIV and other sexually transmitted infections. Despite prior evidence that using a spermicide containing nonoxynol-9 along with condoms decreases the risk of STIs and HIV, this is no more effective than using a condom with non-spermicidal lubricants (water based only). In fact, recent studies have indicated that nonoxynol-9 may actually increase the risk of HIV transmission during vaginal sex.

When used consistently and correctly, condoms prevent the transmission of HIV and other sexually transmitted infections. Despite prior evidence that using a spermicide containing nonoxynol-9 along with condoms decreases the risk of STIs and HIV, this is no more effective than using a condom with non-spermicidal lubricants (water based only). In fact, recent studies have indicated that nonoxynol-9 may actually increase the risk of HIV transmission during vaginal sex.

Female Condom

The female condom is a polyurethane sheath - one end is inserted into the vagina while the other remains outside of the vagina and provides some protection to the external genitalia. It contains a silicone lubricant. Additional lubricant is provided with each condom.


Female Condom Use

  • Inserted up to eight hours before intercourse.
  • With the thumb and middle finger of one hand, squeeze the inner ring (at the closed end of the pouch) into a narrow oval. With other hand, spread the vaginal lips and insert the inner ring and the pouch into the vagina and push it gently high up into the vagina. An outer ring rests on the outer lips of the vagina. During intercourse, the penis should be guided into the pouch through the outer ring.
  • Following ejaculation, the penis should be removed from the vagina, while holding onto the female condom.
  • To remove condom, first twist the outer ring, and pull the condom out gently.
  • Use a new condom with each act of intercourse.

Effectiveness

Female condom effectiveness is 95% with perfect use, and 80% with typical use.

Advantages/Benefits

  • Dual protection against pregnancy, and STI/HIV.
  • Accessible without prescription
  • Causes few medical side effects
  • Some people find female condoms to be more comfortable and less constricting than male condoms, as they are wider.

Disadvantages/Risks

  • Coitus dependent
  • More expensive than male condoms
  • Challenge to use in relationships with weak partner cooperation and/or intimate partner violence.