BARRIER

CONTRACEPTION

TERRUMUN Z. SWENDE MBBS, MHM,FMCOG, FWACS

PROFESSOR & FORMER DEAN
FACULTY OF CLINICAL SCIENCES BSU MAKURDI NIGERIA
 OUTLINE
 Introduction

 Classification
 Male condom
 Female condom
 Diaphragm
 Cervical cap
 Contraceptive sponge
 Spermicides
 INTRODUCTION
 The desire to control fertility dates back ancient times.
However, the 20th century has witnessed the adoption
of family planning by all segments of the population.
 The National Population and Housing Census for
Nigeria for the year 2006 is 140,003,543.
 71,709,859 Males
 68,293,683 Females
 63% increase over the population recorded in 1991 (16 years
ago) of 88.99 million.
 With an annual growth rate of 3.2%, Nigeria population is
expected to double in less than 24years…..
 INTRODUCTION cont’d
 Only 15 % of currently married women (Up
from 6% in 1990 & 13% in 2003)
 Of these, !0 % are modern methods
 Most common methods among currently
married women – Injectables 3%, Male
condom & Pill 2% each
 (NDHS 2013)
 INTRODUCTION cont’d
 Pearl Index:
Refers to the no. of failures per 100 women using
a particular contraceptive method for a year
 CLASSIFICATION
 MECHANICAL BARRIERS
1. Male condom
2. Female condom
3. Diaphrams
4. Cervical caps
5. Contraceptive sponge
 CHEMICAL BARRIERS
1. Spermicides
 MALE CONDOM
 Mechanical barriers covering the penis have been used for
centuries
 For protection against pregnancy, infection,
decoration and to produce penile or vaginal
stimulation
 Egyptian men wore decorative covers as early as 1350
BC
 Gabriel Fallopio described the use of linen sheaths in
1564
 In 18th century the term ‘CONDOM’ was used to
refer to penile sheaths & popularized by the libertines
as a means of protection from venereal disease &
numerous bastard offspring
 MALE CONDOM
 They are sheaths or devices made up of natural membrane
(lamb membrane), latex (natural or synthetic) and
polyurethane (plastics). May be coated with lubricant or
spermicides.
 Renewed interest because of HIV/AIDS pandemic

Mechanism of Action
 It prevents the release of semen directly into the vagina,
thereby preventing the fusion of the male and female
gametes. Not only do they prevent pregnancy, they also
prevent transmission of sexually transmitted diseases such
as Gonorrhea, Syphilis, and HIV.
 MALE CONDOM cont’d
CONTRACEPTIVE EFFECTIVENESS
 3 per 100 woman years

ADVANTAGES
 Easy to use ,safe ,cheap and readily available
 Offers protection against HIV/STDs in 80-95% (Dual
protection effective)
 Encourages male involvement
 Condom dulls sensation thereby prolonging erection
and delaying ejaculation
 Makes sex less messy
 No hormonal side effects
 Good option during lactation
 Can be used without health care provider
 MALE CONDOM cont’d
DISADVANTAGES
 Interrupts spontaneity of sex
 Some cannot maintain erection when a condom is on
 Allergy

 Decreases sexual enjoyment for some couples

 A new condom must be used with each act of
intercourse
 May burst or slide off a flaccid penis
 MALE CONDOM cont’d
HOW THE PRODUCT IS USED
 One condom must be used per sexual act. Condom
must be put on erect penis before any contact with the
vagina.
 Place the condom at the tip of the penis with the rolled
side out. Create a space for the semen by holding the
tip, then place over the glans penis and unroll it to
cover the penis up to the base.
 After ejaculation, before the loss of erection the male
partner holds the base of condom, so that the condom
does not slip off and gently withdraws the penis out of
the vagina.
 THE FEMALE CONDOM
 Thin sheath of poly
urethane plastic wit
h polyurethane ring
s at either end
 Inserted into the va
gina before intercou
rse

12
 FEMALE CONDOMS: MECHANISMS OF
ACTION

Dual protection
 Prevent sperm from gaining access to female rep
roductive tract

 Prevent microorganisms (STDs) from passin

g from one partner to another

13
FEMALE CONDOMS: MECHANISMS OF ACTION

Prevent sperm from

gaining access to
female reproductive
tract

Prevent
microorganisms
(STDs) from passing
from one partner to
another

14
 FEMALE CONDOMS: LIMITATIONS

 Moderately effective (5!21 pregnancies per 10

0 women during the first year)
 Effectiveness as contraceptives depends on
willingness to follow instructions
 User-dependent (requires continued motivat
ion and use with each act of intercourse)

15
 FEMALE CONDOM cont’d
ADVANTAGES
 No hormonal side effects
 Protects against sexually transmitted diseases
 Empowers women
 Safe, no allergy
 Compatible with oil based lubricants
 Makes sex less messy
 FEMALE CONDOM cont’d
DISADVANTAGES
1. May interrupt sex
2. Difficulty placing condom in the vagina
3. Decrease enjoyment
4. Rustling sound during intercourse
5. Inner ring may cause discomfort
6. Infection
7. Change in vagina flora
8. UTI may increase
9. Expensive ($3 each)
 FEMALE CONDOMS: WHO SHOULD
NOT USE (WHO CLASS 4)
Women:
 Whose age, parity or health problems make pregnancy
high-risk
 With physical disabilities or who find it unpleasant to tou
ch their genitals (vulva or vagina)
 With uterine prolapse (uterus protruding into the vagina)

 With severe cystocele or rectocele (bulging of the walls o

f the bladder or rectum into the vagina)
 With vaginal stenosis (narrowing of the vaginal canal)

 With genital anomalies (e.g., septated vaginal canal)

18
 FEMALE CONDOMS: CLIENT
INSTRUCTIONS
 Use a new condom every time you have intercourse.
 The female condom can be inserted up to 8 hours bef
ore intercourse.
 Wash hands with soap and water.
 Remove the condom from the package. Do not use tee
th, knife, scissors or other sharp utensils to open pack
age.
 Hold the condom with the open end down.
 Use the thumb and middle finger to squeeze the flexi
ble ring at the closed end into a narrow oval.
19
 FEMALE CONDOMS: CLIENT
INSTRUCTIONS CONTINUED

 Keep an extra supply of condoms available. Do n

ot store them in a warm place or they will deterio
rate and may leak during use
 Check date on condom package to ensure that it i
s not out of date
 Do not use a condom if the package is broken or
the condom appears damaged or brittle

20
21
RATIONALE FOR PROMOTING FEMALE
CONDOM

 Expansion of contraceptive choices

 Dual protection strategy
 Gender equity and female empowerment
 FC – only women initiated method prevent
ing HIV/STIs and unwanted pregnancy

22
 DIAPHRAGM
 It is a cervical dome shaped barrier type of birth
control. It is a soft latex or silicone dome with a spring
molded into the rim, with a diameter between 50-
105mm designed to fit into the vagina posterior fornix
and the space behind the pubic arch and covering the
cervix.
 5ml of spermicide may be placed in the dome of the
diaphragm before insertion.
 It can be in place for 24 hrs but not less than 6 hrs
after the last sexual intercourse.
 DIAPHRAGM cont’d
MECHANISM OF ACTION
 The spring in the rim of the diaphragm forms a seal
against the vaginal walls.
 The diaphragm covers the cervix, the entrance of the
uterus and blocks sperm from entering the female
reproductive track.
Types of diaphragms
1. Arcing spring e.g. ortho all flex, Milex wide seal
arcing
2. Coil spring e.g. ortho coil, semina diaphragm
3. Flat spring e.g. ortho - white
 DIAPHRAGM cont’d
Advantages
1. Non hormonal

2. Controlled by women

3. Can be used during lactation

4. Diaphragm lowers the risk for STI

 DIAPHRAGM cont’d
Disadvantage
1. Difficult in obese patient
2. Spontaneity may be interrupted
3. Not suitable in women with relaxation of pelvic support or
fixed uterine retroversion
4. Allergy
5. Odour may develop
6. May be messy with repeated act of intercourse
7. Not suitable in patient with recurrent cystitis
8. High failure rate
Complication
1. UTI
2. Vaginal erosion
3. Toxic shock syndrome (2.4cases/100,000)
 CERVICAL CAP
 It is a cervical barrier type of birth control. It
fits snugly over the cervix, the entrance of the
uterus.
 It is made of latex or silicone.
 It is inserted with spermicide and left in
place for 8 hrs after intercourse. May be left
in place for up to 48-72hrs.
 Should be replaced after 2 years.
 CERVICAL CAP cont’d
MECHANISM OF ACTION
As above
TYPES
1. Prentif (latex) sizes: 22, 25, 28, 31mm
2. Oves (silicone) sizes 26, 28, 30mm
3. Dumas (latex) sizes 50, 55, 60, 65, 75mm
4. Vimule or vault cap (latex) size 42, 48, 52mm
5. Femcap (silicone) sizes 22, 26, 30mm
6. Lea-shield made up of silicone, designed to be one
size fits all. It is a fitted also by suction and has a
loop to assist in removal.
 CERVICAL CAP cont’d
CONTRACEPTIVE EFFECTIVENESS
 Theoretical effectiveness: 9% nulliparous 26%
parous
 Use effectiveness: 20% nulliparous 40% parous

ADVANTAGES
1. Non hormonal
2. Can hold menses back during intercourse
3. Allow for spontaneity
4. May reduce risk of cervical infection
 CERVICAL CAP cont’d
DISADVANTAGES
1. Odour may follow if left for too long or during
bacterial vaginosis
2. High failure rate
3. Does not protect against HIV
4. May require repeat pap smear after 3 months.
Cervical dysplasia risk is increased for 1-3 months
COMPLICATION
 UTI
 Cervical erosion
 SPERMICIDE
 They are vaginal gel, foams, creams or suppositories, which
contain surfactants like octoxynol 9, nonoxynol-9,
menfegol, benzalkonium chloride, sodium docussate,
chlorhexide, alkyloxynol (Agent 741) imidazole RS -741 etc.

 A common urban legend suggest that coca cola can serve as

spermicide- this is false

 Lemon juice as found in krest bitter lemon drink can

immobilize sperm in laboratory investigation. But it’s use
as post coital douche is unlikely to be a contraceptive
 SPERMICIDE cont’d
MECHANISM OF ACTION
 They are able to kill or immobilize sperm. They
jeopardize nourishment by disrupting fructolytic
activity thereby preventing fertilization.
 It is inserted into the vagina not less than 10 mins and
no more than 1hr before sex. There should be no
douching for at least 6 hrs after the sexual act.
CONTRACEPTIVE EFFECTIVENESS
1. Theoretical effectiveness 6% /HWY
2. Use effectively 26%/HWY
 SPERMICIDE cont’d
ADVANTAGES
1. Non hormonal

2. Easy to use, cheap and available

3. May serve as lubrication

4. May be used without knowledge of the male

partner
5. May serve as immediate post coital
contraceptive in case of condom burst.
 SPERMICIDE cont’d
DISADVANTAGES
1. Allergy and dermatitis
2. Possible vaginal irritation and itching
3. UTI
4. Yeast infection
5. Bacterial vaginosis
6. No protection against HIV/AIDS. Infact frequent
use of spermicide containing nonoxynol – 9 may lead
to genital lesions that might increase risk of
transmission.
 SPERMICIDE cont’d
HEALTH CONCERNS
 Concerns have been raised over possible increased risk
of birth defects in children conceived despite
spermicide use, and also in children of women who,
not yet aware of their condition, continued spermicide
use during early pregnancy. A review in 1990 of large
studies on spermicide concluded “there appears to be
no increased risk of congenital anomalies, altered sex
ratio or early pregnancy loss among spermicide users”.
 CONTRACEPTIVE / VAGINAL SPONGE

 First used in 1983

 Combines both barrier and spermicide
 It is disposable. It contains polyurethane and
nonoxynol-9
 It is shaped like a mushroom cap to fit the upper
vagina while the concave side covers the cervix.
It can remain in the vagina for up to 24 hrs
but not less than 6 hrs after the last sexual
act.
 CONTRACEPTIVE / VAGINAL SPONGE
CONT’D
TYPES
 Protectaid which contains 5,000mg of ES gel, with
6.25mg nonoxymol, 6.25mg of benzalkonium chloride,
25mg of sodium cholate
 Pharmatex – contains 60ml of benzalkonium chloride.

 Today – contains 1,000mg of nonoxynol – 9

 Nonoxynol 9 and benzalkonium chloride are spermicidal and
microbicidal while sodium cholate is antiviral. Laboratory
studies indicated that the sponge (protectaid) inactivate HIV,
Chlamydia and Trichomonas.
 CONTRACEPTIVE / VAGINAL SPONGE
CONT’D
ADVANTAGES
• Easy to use
• No prescription
• Provide continuous release of spermicide over 24 hrs
• Does not require a waiting period after insertion before coitus.
Today must be wet before insertion
DISADVANTAGES
• Vaginal irritation, itching, yeast infection
• Poor retention
• Bad odour
• Difficult removal
• Allergy
• Cervical erosion/cervicitis
• Possible risk of toxic shock syndrome
 CONTRACEPTIVE / VAGINAL SPONGE
cont’d

CONTRACEPTIVE EFFECTIVENESS
 Theoretical effectiveness

Nulliparous 9% parous 26%

 Uses effectiveness

Nulliparous 16% parous 32%

 CONCLUSION
 In view of the unacceptable rate of use
effectiveness of most of the barrier method of
contraceptive, their acceptability as primary
birth control method is limited but when
prevention of sexually transmitted disease
including HIV is the issue, greater emphasis is
placed on barrier method (condoms).
Thank you
for
listening!!!