Barrier Methods

Male Condoms
o Latex, synthe,c or natural membrane sheath o With or without lubricant or spermicide o Typical failure rate 15%

Timothy Takemoto/Crea/ve Commons

Male Condoms
o Inconsistent use is common
51% use it every ,me 28% use most of the ,me 21% use < half the ,me

o Reasons for inconsistent use:

Not having it available Not expec,ng to have sex Not using during safe ,me of the month

Male Condoms: Patient Instr uctions

o Air out of ,p; space for semen o Withdraw before erec,on disappears o Hold on to base when withdrawing o Check for leak, tear o Keep in cool, dark place o Check expira,on dates o No oil based lubricant or vaginal medica,on

Female Condom
o FC and FC2 o Polyurethane or nitrile sheath with silicone based lubricant o Typical failure rate 21%

Hatzell T. Sex Transm Dis. 2001. Trussel J. Fam Plann Perspect 1994. Trussel J. Contracep/ve Technology. 2007. Image: Associa/on of Reproduc/ve Health Professionals

Female Condom
o Female can control this method o One ,me use only o Stronger than latex o Can be inserted up to 8 hours before intercourse o Cannot use with male condom o Some pa,ents say its noisy, awkward

Male and Female Condoms

o For Whom?
Those who have sex intermiVently Want to decrease risk of STIs Dont want a hormonal method Men with premature ejacula,on Desire a method with low side eect prole

Condoms: Patient Counseling

o Review how to use eec,vely o How to nego,ate condom use o Use for all sexual ac,vi,es that can transmit STIs o New condom for each act of intercourse o Encourage dual method use o Provide emergency contracep,on

Vaginal Bar riers and Sper micides

o Used in combina,on or alone o Prevent fer,liza,on
Mechanically blocking transport to upper genital tract Killing sperm spermicidal agent

Diaphragm
o Used with a spermicide o Only about 0.4% of women between the ages of 15 to 44 use diaphragms o 16% failure rate in typical use

Fihn SD. JAMA. 1985. DOro LC. Genitourin Med. 1994. Trussel J. Contracep/ve Technology. 2007. Image: Associa/on of Reproduc/ve Health Professionals

Diaphragm
o Can be inserted up to 6 hours prior to intercourse o Should be led in place for at least six hours post intercourse o Can remain in place for up to 24 hours o Requires prescrip,on and fng

Cer vical Cap (FemCap )

o Silicone o Can be led in for 48 hours o Strap to help with removal o Need prescrip,on, comes in 3 sizes

Associa/on of Reproduc/ve Health Professionals

Diaphragm and Cer vical Caps

o Risks
Increased risk UTI Allergy to latex or spermicide

o Direc,ons
Must be t correctly by a provider Teach and have pa,ent place and remove in exam room Must use spermicide!

Sponge
o Wet with water before inser,on o Use for up to 24 hours o Each sponge can only be used once o Should be led in place for at least 6 hours
Associa/on of Reproduc/ve Health Professionals

Sper micide
o Available as creams, gels, lm, foam, and suppositories containing nonoxynol-9 o Used alone or with a barrier method

Roddy RE. N Engl J Med. 1998. Trussel J. Contracep/ve Technology. 2007. Image: Associa/on of Reproduc/ve Health Professionals

Vaginal Bar riers & Sper micides

o Advantages
Non hormonal User controlled Immediately eec,ve Decreased risk of cervical dysplasia (HPV)

o Disadvantages
Local irrita,on Urinary tract and vaginal infec,ons Toxic Shock Syndrome