Barrier methods

• Faculty of Sexual & Reproductive Healthcare •

Male and female condoms

Pregnancy prevention

• Used consistently and correctly, male condoms are up to 98% effective at preventing pregnancy and female condoms are up to 95% effective

Reducing the risk of sexually transmitted infection

• In general, evidence supports the use of condoms to reduce the risk of sexually transmitted infection (STI) transmission; however, even with correct and consistent use, transmission may occur

Key points

• Men and women with latex sensitivity or allergy can use polyurethane or deproteinised latex condoms
• Condoms lubricated with non-spermicidal lubricant are recommended for use
• Additional lubricant should be recommended for use with condoms for anal sex to reduce the risk of breakage
• Non-oil-based lubricants are recommended as they can be used safely with latex and non-latex condoms
• Advance provision of emergency contraception should be offered to women using condoms as their sole method of contraception
• Condom users should be made aware of the risk of pregnancy and STIs should a condom fail
• STI testing should be offered after a condom has burst. Although STI testing can be done at the time of presentation, it is recommended at 2 and 12 weeks after a condom failure
• Post-exposure prophylaxis for HIV should be considered if the person presents within 72 hours of a condom failure. The risks may outweigh the benefits and a risk assessment is required before initiating treatment
• The fpa leaflet on male and female condoms should be given to back up the oral information given about condom use
• Men and women should be given advice on condoms, including: correct use, appropriate use of lubricant, STI screening, and when emergency contraception is required

Female barrier methods

Efficacy

• When used consistently and correctly and with spermicide, diaphragms and cervical caps are estimated to be between 92% and 96% effective at preventing pregnancy
• When used consistently and correctly, female condoms are 95% effective at preventing pregnancy, and the contraceptive sponge is estimated to be between 80% and 90% effective at preventing pregnancy

Reducing the risk of sexually transmitted infections

• There is limited evidence on the use of diaphragms, cervical caps, or the contraceptive sponge in reducing the risk of STIs. There may be some protection against cervical intra-epithelial neoplasia (CIN) with diaphragms
• In general, evidence supports the use of female condoms to reduce the risk of STIs. However, even with consistent and correct use, transmission may occur. Evidence on use of male condoms suggests they offer better protection against STIs than female barrier methods

Eligibility for use

• Women with sensitivity to latex proteins can use a silicone diaphragm or cervical cap, or a polyurethane female condom
• The use of a diaphragm, cervical cap, or contraceptive sponge by women who have or are at high risk of HIV or AIDS is not generally recommended
• For women with a history of toxic shock syndrome the use of diaphragms, cervical caps, and the contraceptive sponge is not generally recommended

Instructions for use

• Initial assessment of diaphragm and cervical caps should be done by a competent healthcare professional
• All methods can be inserted any time before intercourse
• The use of spermicide is recommended when using diaphragms and cervical caps
• If intercourse is repeated or occurs ≥3 hours after insertion more spermicide is required and should be inserted with an applicator or as a pessary without removing the diaphragm or cervical cap
• The diaphragm or cervical cap must be left in situ for at least 6 hours after the last episode of intercourse. Sperm in the lower reproductive tract are unlikely to be alive after 6 hours
• Oil-based lubricants can damage latex and women should be advised to avoid their use when using latex diaphragms or cervical caps
• Women should be advised to check their diaphragm or cervical cap regularly for tears, holes, or cracks
• There is no evidence that a colour change or change in shape of the outer ring of a diaphragm reduces efficacy
• Women should be advised on the use of emergency contraception should female barrier methods be used incorrectly

Follow-up

• Women should be advised to attend for a review of contraception if they have:
• any problems with the method
• lost or gained more than 3 kg (7 lb) in weight
• had a pregnancy

Emergency hormonal contraception

• An advance provision of emergency hormonal contraception can be offered to women relying on female barrier methods for contraception

full guidelines available from…
Faculty of Sexual & Reproductive Healthcare
http://www.fsrh.org

FFPRHC Guidance (January 2007): Male and female condoms. January 2007
FFPRHC Guidance (June 2007): Female barrier methods. June 2007
Updated May 2009