Unit 4-Study Notes on Barrier Methods of Contraception

Barrier Methods

Overview

  • Presentation by Kelly Hamade, DNP, RN-CNM

Chemical Barriers

Definition

  • Spermicides include various forms such as creams, films, foams, gels, and suppositories.

Effectiveness

  • Ranges from 79% to 93%

  • Mechanism: Work by interfering with sperm motility and blocking the cervix.

  • Most products are available over the counter, with the exception of Phexxi (prescription only), which is a gel that alters vaginal pH.

Benefits of Chemical Barriers

  1. Can be combined with another barrier method to increase effectiveness.

  2. Hormone-free, thus minimizing hormonal side effects.

  3. Cost-effective, approximately $1 per dose.

  4. Does not affect future fertility.

  5. Most are available without a prescription.

  6. Safe to use while breastfeeding.

Downsides of Chemical Barriers

Not highly effective when used on its own.

  • Potential for irritation or urinary tract infections.

  • Does not provide protection against sexually transmitted infections (STIs).

  • Must be used at every instance of intercourse.

  • Considered messy and smelly by some users.

  • Requires effort and planning for use.

  • Difficult to conceal from partners.

Important Teaching Points for Chemical Barriers

  1. Not advisable for individuals at risk for HIV transmission.

  2. May increase risk of STIs.

  3. Follow placement instructions: generally 10–15 minutes before sexual activity.

  4. Efficacy typically lasts about an hour post-application.

  5. Wash and dry hands thoroughly before insertion to maintain hygiene.

External Condoms

Definition

  • A latex, lambskin, polyurethane, or polyisoprene sheath that fits snugly around the penis to block sperm during intercourse.

Effectiveness

  • Effectiveness ranges from 87% to 98%.

  • May include a lubricant or spermicide pre-applied to the condom.

  • Cost is around $1 each.

Benefits of External Condoms

  1. Hormone-free alternative for contraception.

  2. Most varieties offer protection against STIs.

  3. Do not require a prescription, enhancing accessibility.

  4. Available in a variety of sizes, colors, textures, and novelty options.

  5. Generally easy to use and apply.

Downsides to External Condoms

  1. Potential for allergic reactions and sensitivities (e.g., latex allergies).

  2. May reduce sensation during intercourse.

  3. Requires planning to ensure availability.

  4. Compliance from partner is necessary for effective use.

  5. Sensitive to environmental factors (heat, moisture).

  6. Not all condom types are compatible with all lubricants.

Internal Condoms

Definition

  • A nitrile pouch worn inside the vagina, secured by flexible rings at each end.

Effectiveness

  • Effectiveness ranges from 79% to 95%.

  • Cost is between $2 and $3 each.

  • Requires a prescription.

Benefits of Internal Condoms

  1. Hormone-free, making them suitable for various users.

  2. Offer protection against STIs.

  3. May be covered by health insurance plans.

  4. Hypoallergenic properties reduce the chance of allergic reactions.

  5. Compatible with any kind of lubricant, making them versatile.

Downsides to Internal Condoms

  1. Considered harder to use compared to external condoms.

  2. Prescription requirement may limit access for some users.

  3. Only one FDA-approved manufacturer, limiting market options.

  4. Cannot be used simultaneously with external condoms.

  5. Compatibility issues may arise with specific applications and styles.

Diaphragms & Cervical Caps

Definition

  • Silicone cup or shield inserted into the vagina that covers the cervix to prevent sperm from entering the uterus.

Effectiveness

  • Effectiveness ranges from 71% to 86%.

  • Cost can vary widely from $0 to $300 plus the cost of spermicide.

Benefits of Diaphragms & Cervical Caps

  1. Hormone-free contraceptive option.

  2. Reusable, promoting environmental sustainability.

  3. Increased effectiveness when used with spermicide.

  4. Allows for immediate return to fertility following discontinuation.

  5. Can be placed hours before intercourse, offering flexibility.

Downsides to Diaphragms & Cervical Caps

  1. No protection against STIs.

  2. Requires education and practice for effective use.

  3. Fitting by a healthcare provider is mandatory.

  4. Diaphragms may require refitting after significant weight changes or pregnancy.

  5. Proper maintenance and storage are necessary between uses to ensure effectiveness and hygiene.