Family Planning:

Barrier Methods
Family Planning Project
NURS-320
Presented by: Lisa Chee, Grace Kim, Chelsey Miyake,
Amber Suzuki

OVERVIEW
Definition
Types
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o
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Male/ female condoms

Diaphragm
Cervical Cap
Spermicides
Sponge
IUD

DEFINITION
Barrier methods of contraception prevent
pregnancy by placing a physical or chemical
wall between sperm and the cervix.

Male Condom

Description
A thin sheath made of latex or plastic
Prevents sperm from entering the cervix
May be coated with spermicide

Instructions for Use

1.
2.
3.
4.
5.
6.
7.
8.

Check expiration date. Open individual packaging

If uncircumcised, pull back foreskin before applying
Place rolled condom over the tip of erect penis
Pinch the tip of condom while placing it on penis
Unroll the condom over the penis to the base
Smooth out any air bubbles
Lubricate the outside of the condom
Pull out before penis softens

Instructions for
for Use (cont.)

Advantages

Safe
Readily available
Non-surgical contraception
Helps prevent STIs and HIV
Disposable
May help a man stay erect longer
Inexpensive

Disadvantage

May dull sensation

Lovemaking must be interrupted
Must be applied correctly to prevent pregnancy
One time use
May tear

Side Effects, Danger Signs,

Effectiveness

Latex allergies (6 out of 100 people)

Oil-based lubricants and vegetable oils damage latex
98% effectiveness when used correctly
82% effectiveness if not always used correctly

Costs
Individually condoms cost one dollar or more
Packs of three cost from $2 to $6
Free at certain clinics
Example: Health Services at UHM

Female Condom

Description

Lubricated vaginal sheath, made of polyurethane

Flexible rings at both ends
Inserted deep into the vagina
May be used for both vaginal and anal intercourse

Instructions for Use

Check expiration date
Put spermicide or lubricant on the outside of the closed
end
Squeeze together the sides of the ring at the closed end
Insert into vagina, push up as far as it can go
Pull out your finger and let outer ring hang 1 inch
outside the vagina

Advantages

Allows women to share responsibility

Easy to get
Can be used for people with latex allergies
Can be used with both oil- and water-based lubricants
Does not require prescription
May enhance sex play
Stays in place whether or not a man maintains his
erection
Reduce the risk of STIs

Disadvantages
May cause irritation
May slip into vagina during intercourse
Reduce feeling during intercourse

Side Effects, Danger Signs,

Effectiveness
95% effective when used correctly
79% effective if not always used correctly

Costs
On average, costs $2-4.

Diaphragm

Description
A shallow, dome-shaped latex or silicone device with a
flexible rim that covers the cervix
Types: coil spring, arcing spring, flat spring, wide seal
rim

Types of Diaphragms

Instructions for Use

Hold diaphragm between thumb & fingers
Dome can be either up or down
Place index finger on outer rim of compressed
diaphragm
Use fingers of the other hand to spread labia
Insert diaphragm into vagina

Instructions for Use (cont.)

Direct it inward & downward as far as it will go to space
behind & below cervix
Tuck front of rim of diaphragm behind pubic bone so
that rubber hugs front wall of vagina
Feel for cervix through diaphragm to be sure it is
properly placed & securely covered by rubber dome
Leave in for at least 6 hours after intercourse

Instructions for Use (cont.)

Advantages
Can be inserted up to 6 hours before intercourse
No effect on womans natural hormones
Can be used during breastfeeding

Disadvantages
Annual gynecologic exam to assess fit of diaphragm
Needs to be refitted if 20% weight change, after
abdominal or pelvic surgery, & after every term
pregnancy & miscarriage or abortion that occurs after 14
weeks of gestation
May be difficult to insert
Must add more spermicide for each act of intercourse

Side Effects, Danger Signs, & Effectiveness

Irritation of tissues related to contact with spermicide
Toxic shock syndrome (TSS)
sunburn type rash, diarrhea, dizziness, faintness, weakness, sore
throat, aching muscles & joints, sudden high fever, & vomiting

Avg failure rate of diaphragm combined with spermicide

is 16% in first year of use
Less effective when used without spermicide

Cost
$15-75
Free with medicaid

Cervical Cap

Description
Soft, rubber or latex-free silicone dome with firm brim that
fits snugly around the base of the cervix.

Instructions for Use

Coat inside of cap with spermicide

Push the cap up into the vagina until it covers the cervix
Press the rim against the cervix to create a seal
Leave in for at least 6 hours after intercourse

Instructions for Use (cont.)

Advantages

No effect on womans natural hormones

Can be used during breastfeeding
Able to leave in for an extended period of time
May be inserted hours before sexual intercourse without
a need to add more spermicide later

Disadvantages
May be difficult to insert
Must check the caps position before & after sexual
intercourse
Annual gynecologic exam to assess fit
Should be refitted after any gynecologic surgery or birth
& after a major change in weight

Side Effects, Danger Signs, & Effectiveness

Irritation of tissues related to contact with spermicide
Toxic shock syndrome (TSS)
sunburn type rash, diarrhea, dizziness, faintness, weakness, sore
throat, aching muscles & joints, sudden high fever, & vomiting

Avg failure rate for women who have never been

pregnant or given birth vaginally is 14%; for women who
have given birth vaginally is 29%

Cost
$60-75
Usually free with Medicaid

Spermicides

Description
Spermicide is a birth control method that contains
chemicals that stop sperm from moving. Spermicides are
available in different forms, including creams, film, foams,
gels, and suppositories.
Spermicide can be used alone, or it can be used with other
birth control methods to make them more effective. It is
always used with the diaphragm and cervical cap.

Instructions for Use

Lie down or squat, then gently insert the spermicide deep
into your vagina using your fingers or an applicator.

Instructions for Use (cont.)

For most spermicides, you need to wait at least 15 minutes after
you insert it before you can have intercourse. These methods
typically remain effective for only one hour after insertion.
You need to insert more spermicide each time you have
intercourse.
Women should not douche, unless they are told to by a health
care provider. If you do, wait until 6-8 hours after intercourse.

Advantages

It can be carried in your pocket or purse.

It can be inserted by a partner as part of sex play.
It does not have an effect on a woman's
natural hormones.
It is very easy to get in drugstores and
some supermarkets.
It does not require a prescription.
It can be used during breastfeeding.

Disadvantages

If not used exactly as directed, spermicides may not

form a good barrier over the cervix. This may make the
spermicide less effective.
Some women complain that spermicides are messy or
that they leak from their vaginas.
Spermicide may irritate the penis or vagina (switching
brands may solve this problem).

Nonoxynol-9
The most commonly used spermicide in the U.S. is
called nonoxynol-9. Nonoxynol-9 has certain risks.
If it is used many times a day, or if it is used by
people at risk for HIV, it may irritate tissue and
increase the risk of HIV and other sexually
transmitted infections.

Side Effects, Danger Signs, & Effectiveness

Side effects: irritation, itching, sensation of burning of sex
organs. In women: UTI, yeast infection, bacterial
vagninosis
Effectivness: If women always use spermicide as directed,
15 out of 100 will become pregnant each year. If women
don't always use spermicide as directed, 29 out of 100
will become pregnant each year. When used alone,
spermicide is not very effective.

Costs

Applicator kits of foam and

gel cost about $8.
Refills cost $4-$8.
Large cans of foam contain
between 20 and 40
applications.
Film and suppositories are
also about $8.

Sponge

Description
The sponge is made of plastic foam and contains
spermicide. It is soft, round, and about two inches in
diameter. It has a nylon loop attached to the bottom for
removal. It is inserted deep into the vagina before
intercourse. The Today Sponge is the only brand of
contraceptive sponge available in the United States today.

Instructions for Use

Wash your hands with soap and water.

Before inserting the sponge, wet it with at
least two tablespoons of clean water.
Gently squeeze the sponge. The
spermicide will become active when the
sponge is completely wet.
Fold the sides of the sponge upward and
away from the loop on the bottom to make
it look long and narrow.

Instructions for Use (cont.)

Slide the sponge as far back into your vagina as your

fingers will reach. The sponge will unfold and cover the
cervix when you let go of it.
To make sure the cervix is covered,
slide your finger around the edge of the
sponge and check its position. You also
should be able to feel the nylon loop on
the bottom of the sponge.

Instructions for Use (cont.)

The sponge can be inserted up to 24 hours before
intercourse. It must be left in place for at least six
hours after the last time you have intercourse. It
should not be worn for more than 30 hours in a row.

Advantages

It can be carried in pocket or purse.

It generally cannot be felt by you or your partner.
It has no effect on a woman's natural hormones.
It does not interrupt sex play (can be inserted hours ahead
of time & worn for up to 30 hours after insertion).
You can have intercourse as many times as you like during
the first 24 hours without removing or reinserting.
It can be used during breastfeeding.

Disadvantages

It may be difficult for some women to insert or remove

the sponge.
It may cause vaginal irritation.
It may make sex too messy or too dry.

Side Effects, Danger Signs, & Effectiveness

Effectiveness: failure
rate is 16% in first year
of use in nulliparas
women and 32% in
multiparous women.

Cost
A package of three
sponges costs $9$15.

Intrauterine Devices (IUD)

Description
A chemically active T-shaped device that is inserted through a womans
cervix and placed in the uterus by the primary care provider.

Paraguard

Hormone free
Does not interfere with natural menstrual cycle
Continuous release of copper into the uterine cavity
Prevents sperm from reaching and fertilizing egg
Prevents egg from attaching to the uterus
Bleeding or spotting may increase at first, but should
decrease in 2-3 months

Instructions for Use

The device must be monitored
monthly by a client after
menstruation to assure the
presence of the small string that
hangs from the device into the
upper part of the vagina to rule
out migration or expulsion of the
device.

Advantages & Effectiveness

Effectiveness for 1 to 10 years
Contraception can be reversed, easily removed and
individual may be able to get pregnant right away
Does not interfere with spontaneity
No significant weight gain
May help shorten, lighten or even eliminate periods
Safe for mothers who are breastfeeding
It is 99% effective in preventing pregnancy

Disadvantages
An IUD can increase the risk of pelvic inflammatory
disease, uterine perforation, or ectopic pregnancy.
A client should report to the primary care provider late
or abnormal spotting or bleeding, abdominal pain or
pain with intercourse, abnormal or foul-smelling
vaginal discharge, fever chills, a change in string length,
or if IUD cannot be located.
An IUD does not protect from STDs

Nursing Process for IUD

Interview: Contraindications
o Contraindicated in women who have not had at least
one child
o Are not in a monogamous relationship.
Procedure
o Take pain meds prior to procedure
o Obtain consent
Follow up
o 1 month follow up w/ u/s to ensure positioning

Costs
Under the Affordable Care Act (ACA), Paraguard may be
available to insured women without a copay,
coinsurance costs or deductable.
Most other insurance plans cover 80% of device

Beliefs and Culture Against Barriers

Women must bear children to please their
husbands
Only promiscuous women use contraceptives
Contraception is a means to control the
African-American population
All sexual acts must be open to procreation

References
Association of Health Care Professionals. (2008). Breaking the contraceptive barrier. Retrieved from
http://www.arhp.org/Publications-and-Resources/Clinical-Proceedings/Breaking-the-Contraceptive-Barrier/Personal-Fac
tors
Lowdermilk, D. & Perry S. (2013). Maternity & Womens Health Care (8th ed.). St. Louis: Mosby.
Planned Parenthood. (n.d.) Cervical cap. Retrieved from
http://www.plannedparenthood.org/health-topics/birth-control/cervical-cap-20487.htm
Planned Parenthood. (n.d.) Condom. Retrieved from
http://www.plannedparenthood.org/health-topics/birth-control/condom-10187.htm
Planned Parenthood. (n.d.) Diaphragm. Retrieved from
http://www.plannedparenthood.org/health-topics/birth-control/diaphragm-4244.htm
Planned Parenthood. (n.d.) Female condoms. Retrieved from
http://www.plannedparenthood.org/health-topics/birth-control/female-condom-4223.htm
Planned Parenthood. (n.d.) Sponge. Retrieved from
http://www.plannedparenthood.org/health-topics/birth-control/birth-control-sponge-today-sponge-4224.htm
Planned Parenthood. (n.d.) Spermicide. Retrieved from
http://www.plannedparenthood.org/health-topics/birth-control/spermicide-4225.htm