What is a barrier method of contraception? Barrier contraception

From time to time I hear from patients about the following question about contraception:

- I’m afraid of the IUD, I’m tired of the condom, I don’t want hormonal contraceptives. Anything non-hormonal?

Of course, there are non-hormonal ones. Besides the well-known male condom, there are several barrier contraceptive options that women can use.

Spermicides are merciless sperm killers

Spermicides are substances that destroy sperm. Pharmacies sell vaginal tablets, suppositories and vaginal creams with spermicides. The most popular spermicides in the Russian Federation are benzalkonium chloride (Pharmatex, Benatex, Ginekotex) and nonoxynol-9 (Patentex Oval and Sterilin). Preparations based on benzalkonium chloride form a film in the vagina, and nonoxynol-9 forms foam.

In laboratory conditions, benzalkonium chloride is active against the pathogens of gonorrhea, chlamydia, trichomonas and herpes simplex virus. But it has no effect on mycoplasma, gardnerella and the causative agent of syphilis. Nonoxynol-9 also does not protect against all infections. In general, humanity’s hopes for a worthy alternative to condoms have not come true.

Scientific research shows that regular use of spermicides can increase the risk of urinary tract infections and significantly increases the risk of HIV transmission. The fact is that spermicides cause irritation of the mucous membrane, as a result it becomes looser, which increases the risk of infection. By the way, it is precisely because of irritation of the mucous membrane that such a frequent side effect of the use of spermicides occurs, such as burning and itching in the vagina.

It is necessary to administer a suppository, tablet or cream before each sexual intercourse. It is very important to wait until contact begins so that the substance is completely dissolved and “starts working.” For capsules and tablets, the contraceptive effect will occur 8–10 minutes after administration, the suppository will take effect after 5 minutes, and the cream will take effect after 3 minutes. Of course, spermicide can be administered in advance. However, if the onset of sexual intercourse is delayed, you will have to administer another dose of the drug.

Nonoxynol-9 should be renewed every hour, drugs with benzalkonium chloride are more humane in this regard: a new vaginal tablet should be administered if contact is delayed for 3 hours, a capsule or suppository - after 4 hours, a new dose of cream is administered if a romantic date is postponed for 8– 10 hours. At the same time, there is no need to try to somehow “wash out” the previous portion of spermicide.

You cannot insert one suppository and, hoping for a 4-hour contraceptive effect, perform 8 sexual acts! Before each new intercourse, a new dose of contraception must be administered!

The main problem of spermicides is their low contraceptive effectiveness. With ideal application, the efficiency is even more or less (82%), but with user errors everything becomes much sadder.

Preparations based on benzalkonium chloride are easily destroyed by almost any chemical compounds, including soap and shower gels. The instructions strictly instruct to avoid washing or irrigating the vagina with soapy water 2 hours before and 2 hours after sexual intercourse; external toilet of the genital organs is possible only with clean water.

Contraceptive sponges

Contraceptive sponges are made of polyurethane and impregnated with a spermicidal substance. On the Russian market, this contraceptive option is represented in a single form - Pharmatex vaginal tampons (spermicide - benzalkonium chloride). There are usually 2 or 6 tampons in a package.

The main difference between a “sponge” and “just spermicides” is that the tampon begins to work immediately after insertion and maintains a contraceptive effect for 24 hours for any number of sexual acts. After 24 hours, the tampon must be removed. It is advisable that at least 2 hours have passed since the last sexual intercourse before removal.

You should not take baths, swim in the sea, pool or other bodies of water with a contraceptive sponge - this may reduce the protective properties of the tampon. The effectiveness of this type of contraception is higher in women who have not given birth - 88-91%, in women who have given birth - only 76-80%.

Female condoms - femidoms

The femidom is a polyurethane cylinder 15–18 cm long and 7–8 cm in diameter. One end of the femidom is closed and contains a fixing ring, which is inserted deep into the vagina, near the cervix. The outer end remains at the entrance to the vagina.

This great female happiness is placed in the depths of the body before sexual intercourse and mercilessly thrown away after use. Femidoms make a woman independent of a man’s desire or unwillingness to use contraception. However, you should not use male and female condoms at the same time; this is precisely the case when more is not better.

In our country, femidoms are still not very popular and are not sold on every corner, but it is quite possible to get them. This method of barrier contraception has moderate contraceptive effectiveness (without spermicidal treatment with ideal use - 95%, with typical use - 79%) and provides sufficient protection against STIs. Let me remind you that the effectiveness of male condoms with ideal use is 98%, with typical use - 82%.

Vaginal diaphragms and cervical caps

Diaphragms and caps are experiencing a certain renaissance associated with the discovery of new safe materials, primarily medical silicone. These are individual, reusable products that should be selected according to size with your doctor.

The vaginal diaphragm is a dome-shaped hemisphere with a diameter of 50 to 105 mm with a springy rim. The cervical cap is shaped like a thimble and is placed directly on the cervix.

Both diaphragms and cervical caps should only be used in combination with spermicides. In this case, contraceptive effectiveness is 88–94% for the diaphragm and 74–91% for the cap. These methods do not guarantee protection against STIs, so they can only be used in monogamous relationships.

The diaphragm can be inserted 6 hours before sexual intercourse; if this time has passed or the couple has multiple intercourse, an additional dose of spermicide will be required. After sexual intercourse, it is necessary to leave the diaphragm in the vagina for at least another 6 hours, but the total time the device remains in the woman’s genital tract should not exceed 24 hours. The cervical cap can remain on the cervix for 36–48 hours (at least 6–8 hours after completion of sexual intercourse).

You can get acquainted with modern Caya diaphragms and FemCap cervical caps on specialized websites. They are sold in kits with modern spermicides and are FDA approved.

Oksana Bogdashevskaya

Photo depositphotos.com

Barrier methods of contraception (BMC) are a group of methods to prevent the development of unwanted pregnancy, which prevent sperm from entering the uterus using a mechanical barrier.

Types, advantages and disadvantages of barrier methods

There are 2 types of means:

mechanical;
spermicides.

There is a combined method, when mechanical means are combined with medications. This method improves the reliability of both methods.

Mechanical contraceptives prevent sperm from entering the cervix. Their main advantage is that they do not have any harmful effects on women, unlike hormone-containing medications, and protect against contracting sexually transmitted diseases. The efficiency is about 85%.

You can use barrier-type products without first consulting a doctor.

Barrier methods of contraception are quite cheap, accessible and most often have no contraindications. They can also be used in the following cases:

during breastfeeding, since they will not affect either the volume of synthesized milk or its quality;
if taking oral contraceptives is contraindicated;
if you need to take medications that are not combined with oral contraception;
after an abortion, before the onset of a favorable period for conception;
during the use of oral contraceptives, during a period when ovarian activity is not completely suppressed;
as a temporary means of preventing conception before sterilization.

The disadvantages of mechanical contraceptives include their lower degree of effectiveness compared to oral hormone-containing drugs, and the possibility of an allergic reaction to certain materials (latex, rubber). The products must be used before each sexual intercourse.

In most cases, the use of barrier contraceptives will not have a negative effect, but there are contraindications for use: with inflammatory diseases, deformation of the cervix, a history of toxic shock syndrome, etc.

Contraceptives of both types can be for women or men.

Female barrier contraceptives

Barrier contraceptives for women are a more preferable option for many, as they do not require consultation with a doctor, the involvement of specialists for administration (unlike spirals) and systemic changes. These devices include the diaphragm and cervical cap.

The diaphragm is a small cap made of special rubber that must be inserted before sexual intercourse. The size of the diaphragm can be different (50-100 mm), and is selected individually at a doctor’s appointment. For nulliparous women, a diaphragm of 60-65 mm is usually prescribed. After childbirth - up to 75 mm. After the birth of a child or weight changes (weight loss, weight gain), you need to re-size. The effectiveness of this product is quite high.

Before using the diaphragm, you must ensure that there are no cracks or other damage. After intercourse you need to leave it for 7 hours. Immediately after removal, rinse and dry. You can store it in a dry, dark, cool place, but without using talc. When used correctly, the diaphragm efficiency can reach 85%.

Its advantages are:

harmlessness;
protection from STDs;
ease of use;
possibility of repeated use.

The use of this remedy is contraindicated in case of allergies to rubber and certain diseases, such as erosion or prolapse of the cervical walls, colpitis, and developmental anomalies.

Cervical (cervical) caps are made of soft rubber. Available in 3 types depending on the shape. The cap is held in place by the vaginal walls and covers the cervix. It is not recommended to set it for longer than 4 hours. Efficiency ranges from 73 to 90%. The type and optimal size are determined by a gynecologist during examination, depending on the size and shape of the cervix. Used in combination with spermicide: it is applied to the surface of the cap.

Barrier type contraceptives for men

The release of barrier contraceptives for men is carried out in only one version - condoms. They allow you to protect yourself from infections with a high degree of probability. Produced from elastic thin rubber in the form of a bag-like formation. This method is considered quite common today, despite the emergence of more effective means of such contraception.

This barrier method has the following advantages of use:

simplicity - used immediately before sexual intercourse;
protects against STDs, including HIV, which is currently of great importance;
can be purchased at any pharmacy and many stores;
There is no need to consult a doctor before use.

There are also disadvantages to this method of contraception: the need to use it at a certain stage, a possible decrease in sensations and the appearance of an individual allergic reaction. The possibility of a break remains. Low efficiency requires the use of additional chemical protection agents (spermicides).

Condoms can be used as an “insurance” for couples who have irregular sexual relations, as well as in the presence of more than one partner. It is not recommended to use this method of protection during regular sexual intercourse. It should not be used if you are allergic to the materials used in the manufacturing process of the condom and if pregnancy may pose a danger to the woman (due to age, health problems, etc.).

Chemical methods of protection

Chemical methods are represented by spermicides - agents that reduce the activity of sperm or destroy them. The composition includes active substances (nonoxylon, benzolkonium chloride), which reduce sperm motility and reduce their ability to fertilize. They may also protect against certain types of sexually transmitted diseases.

Spermicides are produced in the form of aerosol foam, suppositories, gels, and tablets. Aerosol foam requires strict adherence to the instructions, otherwise the effect will inevitably decrease. For example, the effectiveness will decrease if the foam canister is not shaken well or if too little foam is applied before administration.

Creams and gels are intended for use by women before sexual intercourse. Creams are not recommended for use as a stand-alone product due to their low effectiveness. Therefore, they are recommended to be used only as an addition to mechanical means.

Tablets and suppositories can guarantee reliable protection, but are not convenient enough to use, since they must be administered approximately 15 minutes before intimacy. The protection lasts for about an hour, so if it occurs again, you will have to reintroduce the suppository.

The effectiveness of most chemical products cannot be called high: from 5 to 25 pregnancies out of 100 are observed per year (depending on the type of spermicide used). Therefore, you should not use them as the main means. Before using chemical barrier contraceptives, you should consult your doctor.

Barrier protection is rightfully considered one of the most ancient and reliable methods of preventing unwanted pregnancy. After pharmaceutical companies began producing hormonal drugs that prevent conception, these methods faded into the background. Today, condoms, caps and spermicidal contraceptives have regained popularity. To make the right choice of barrier means of protection against unwanted pregnancy, you need to know about all their disadvantages and advantages.

What are barrier contraceptives

Today, women have at their disposal a variety of contraceptives, differing in different properties, methods of use, and having preventive and even therapeutic effects. A barrier method of contraception prevents sperm from entering the cervical canal and vagina by creating a chemical or mechanical barrier. Indications for the use of such methods are:

reluctance or prohibition on the use of hormonal contraceptives (for example, women who smoke or women over 35 years old);
contraindications or refusal to use intrauterine contraception;
the need to have protection against STDs (sexually transmitted diseases);
the need to use temporary means of protection (for example, during recovery after childbirth, when feeding a child, or skipping a hormonal dose);
irregular sex;
having multiple sexual partners;
prevention of premature ejaculation (ejaculation) in men;
prevention of allergic reactions to sperm, if this condition has been diagnosed.

Operating principle

Mechanical methods of barrier contraception are objects made of materials that do not allow air and water to pass through: latex, polyurethane, lambskin, polyisoprene. They should be placed on the erect penis or inserted into the vagina a few minutes before sexual intercourse. The most popular representative of mechanical protection is the condom. The principle of operation of such contraceptives is to block the penetration of ejaculate (sperm) into the cervical secretion of the vagina.

A condom not only prevents unwanted conception, but also protects against infection with sexually transmitted diseases: HIV infection, AIDS, human papillomavirus, gonorrhea, trichomoniasis, hepatitis. All mechanical devices are used and act only locally, without affecting internal processes or the functioning of body systems.

Another type of barrier contraception is spermicides. They are available in the form of lubricants (lubricants that ease friction), suppositories, and intravaginal tablets. Spermicides contain special contraceptive or bactericidal substances: benzalkonium chloride, nonoxynol-9, metronidazole, miconazole nitrate. They destroy the outer membrane of the sperm, reducing its motility and ability to fertilize. Spermicides are introduced into the vagina 20–40 minutes before sexual intercourse, often combined with mechanical barrier protection.

Advantages and disadvantages

The number of fans of barrier contraception is increasing every year. This is due to the many advantages of these protective agents compared to similar hormonal drugs:

Barrier methods not only reduce the chance of unplanned conception, but also help in the prevention of STDs, some of which can cause cancer of the uterus, ovaries, and fallopian tubes.
They have a short-term effect and do not require a long recovery period of reproductive function when the desire to conceive a child arises.
Many contraceptives can be used independently, without prior consultation with a gynecologist.
They are widely available and sold at reasonable prices.
They do not have a large list of side effects, with the exception of allergies.
Unlike interrupted coitus and some oral contraceptives do not lead to the development of frigidity, congestion in the pelvis, impaired fertility, or ovarian dysfunction.
They can be prescribed immediately after childbirth, abortion, or during breastfeeding.

Barrier contraceptives have virtually no effect on the partner's body, but are less effective compared to hormonal drugs. Other disadvantages of protective devices include:

the chance of allergic reactions in both partners;
decreased sensitivity during sexual intercourse (this only applies to condoms);
inconvenience of use (some contraceptives can become dislodged during active sex, others must be inserted into the vagina 20–40 minutes before sexual intercourse, which is not always possible to plan).

Kinds

Barrier-type contraceptives are divided into two types: male and female. If we take into account the mechanism of action, the classification of protective agents will look like this:

Mechanical barrier methods of protection against unwanted pregnancy are the most popular contraceptives. These include: male and female condoms, caps, diaphragms. They may differ in form and method of use.
Barrier contraception with a chemical composition or spermicides are not as popular as mechanical ones; they are rarely used as an independent means. They are often produced in the form of gels, aerosols, foam, but can have a solid form: suppositories, intravaginal tablets, tampons, vaginal sponges.

Barrier contraceptives for women

The largest selection of products to protect against unwanted pregnancy and sexually transmitted diseases is for women. They can use only mechanical means, spermicides, or a combination of both. All barrier contraceptives have their advantages and disadvantages and differ in composition or method of application. To make the right choice, you need to study all the options in detail.

This is a relatively new and not so popular method of barrier contraception. Female condoms are not made from latex, but from flexible and smooth polyurethane materials. Outwardly, they resemble a cylinder up to 170 mm long and about 70–80 mm in diameter, at the ends of which there are two rings. The smaller diameter one is covered with a film on top and must be inserted into the vagina. The procedure is absolutely painless and resembles inserting a tampon. The larger diameter ring remains on the outside.

Female condoms, like male rubber products, protect not only from unwanted pregnancy, but also prevent the penetration of pathogenic microorganisms that carry diseases such as gonorrhea, chlamydia, vaginal herpes and others into the vagina. Other advantages of this type of contraception include:

the condom provides up to 95% effectiveness against unwanted pregnancy;
protects against various infections;
can be inserted into the vagina several hours before sexual intercourse;
does not create discomfort during sex for a man, since there is no rigid fixation of the penis;
does not reduce sensitivity for the partner;
a condom can lengthen the time of erection and ejaculation in men;
can be used during lactation;
has no side effects, except for a possible allergy to polyurethane;
You don't need a doctor's prescription to purchase.

Although female condoms are the most reliable barrier-type contraceptives, they still have a number of disadvantages. The disadvantages of such products include:

decrease in the severity of sensations in a woman;
a ban on re-using the same condom (such products are only disposable; before new sexual contact you should insert another condom);
high chance of deformation or displacement of the condom during active sex;
high price (compared to male counterparts).

Diaphragm

For a young woman who has only one partner and is regularly sexually active, a diaphragm, a mechanical barrier made of soft latex rubber, is suitable as reliable protection against pregnancy. In appearance, the contraceptive is similar to a dome with a diameter of 50 to 105 cm. On the narrow part of the diaphragm there is a hard edge - an elastic band, which ensures reliable fastening of the latex to the walls of the vagina.

The diaphragm creates a barrier to sperm directed towards the uterus, but does not protect against sexually transmitted diseases. The device is inserted directly into the uterine cavity in the following way:

Before inserting the diaphragm, empty your bladder and wash your hands thoroughly.
Check the integrity of the dome by turning it upside down and filling it with water.
Apply a small amount of any spermicide to the hard edges of the gum and into the bowl. This will not only make it easier to insert and then remove the diaphragm, but will also create additional protection.
Take one of the positions: lying on your back, legs bent, or squatting, one leg raised on a chair.
Squeeze the edges of the elastic and insert the diaphragm deep into the vagina (behind the pubic bone). Be sure to check how tightly the rim fits and whether the entrance to the uterus is closed.
The diaphragm is inserted no earlier than 6 hours before sexual intercourse. Then it remains in the vagina for the same period of time after sex (but no longer than 24 hours).
Before each new contact, it is necessary to introduce an additional portion of spermicidal intimate lubricant into the vagina.
The diaphragm is removed with your finger. To do this, insert it deep into the vagina, picking it up by the edge of the elastic band, and pull it towards you.
After removing it, it must be washed with soap, citric acid or potassium permanganate, and dried. The contraceptive must be stored in a tightly closed container.

The incidence of unwanted conception in women using a diaphragm is minimal and ranges from 2-5% per year. This method of protection does not affect breastfeeding and has virtually no side effects (except for a low likelihood of latex allergy). The disadvantages of this barrier method of contraception include:

the need for correct administration skills;
the need to use additional bactericidal agents and lubricants;
lack of protection against STDs;
the need for careful care of the diaphragm;
you should carefully monitor the time the diaphragm remains inside the vagina;
Before starting use, you must consult a doctor and undergo a medical examination.

Cervical cap

In appearance it resembles a diaphragm, but smaller in size. The cap is placed directly on the cervix and is fixed by creating negative pressure between the rim and the surface of the cervical canal. The principle of its installation, the pros and cons are similar to the insertion of a diaphragm, the only difference is that the cap can be inserted 20–30 minutes before the start of sexual intercourse. The effectiveness of such a barrier contraceptive varies from 60 to 80%.

Spermicidal contraception

Chemical barrier contraceptives deprive sperm of activity and can partially or completely destroy their outer shell, reducing viability. Spermicides are used in combination with other means of contraception (condoms, diaphragm, caps). Depending on the form of release, chemical methods of barrier protection have their own application characteristics:

Aerosol and foam. Before use, the container with its contents is shaken vigorously for 10–30 seconds. An applicator is placed on the valve, which is moved to the side and remains in this position for several minutes to fill with foam. From a lying position, it is inserted into the vagina so that its tip is in contact with the cervix, after which the start button is pressed and a foam-like substance is released. The protective effect of using aerosols occurs instantly.
Vaginal suppositories, soluble film, jelly, tablets. Inserted deep into the vagina from a supine position. The bactericidal and protective effect occurs 10–20 minutes after administration.
Cream or gel. The contents of the bottle are squeezed out until the special applicator is completely filled. The tip is inserted into the vagina so that its end is in contact with the cervix. The button then opens the retaining latch and inserts the contents. As with using foam, the effect of a cream or gel occurs instantly.
Vaginal sponge. Before use, remove the sponge from the package and moisten it with 2 tbsp. l. warm water, squeeze until foam appears. The contraceptive is inserted from the lying position to the cervix. The effect occurs instantly and lasts up to 24 hours. After removal, the sponge is thrown away.

Many pharmaceutical companies produce spermicides. The following products are very popular among women:

Pharmatex vaginal tablets. They contain benzalkonium chloride, which is both a spermicide and an antiseptic. The drug destroys the flagellum and head of the sperm, reducing its ability to fertilize the egg. The tablet is inserted into the vagina 10 minutes before sexual intercourse. The duration of action of Pharmatex is 3 hours. Side effects may include itching, dermatitis (inflammatory skin disease), and burning.
Benatex vaginal suppositories. They contain benzalkonium chloride as an active component, and witepsol as a base. The drug has local spermicidal, antiseptic, and antifungal effects. One suppository is administered 5 minutes before the start of sexual intercourse. The duration of action is 4 hours. In rare cases, minor allergic reactions may occur during use.

Like other products, spermicides have their pros and cons. Disadvantages include low contraceptive activity (about 35% of pregnancies per year) and the need to re-introduce the substance before new sexual intercourse. It is worth considering that when taking certain medications, the effectiveness of spermicides may decrease, so a preliminary consultation with a gynecologist is necessary. The advantages of barrier chemical methods of protection are:

Today, mechanical contraception is one of the most popular and widespread methods of protection during sexual intercourse. Such pregnancy prevention products are divided into male and female. Male contraceptives include the well-known condoms. Women's ways of protecting themselves from unwanted pregnancy are the diaphragm, the female condom and the cervical cap.

Despite the fact that mechanical contraceptives are represented by several options, the undisputed leader is the male condom, which protects not only from unwanted pregnancy, but also protects against infection with sexually transmitted diseases. In addition, condoms are absolutely harmless to health and have a fairly affordable price. Another advantage of this method of protection is its ease of use and over-the-counter sale.

But mechanical contraceptives also have disadvantages. The main disadvantages of condoms include the likelihood of rupture, the possibility of allergies to lubricant or latex, as well as a low level of sensation during sexual intercourse.

Female mechanical contraceptives are used much less frequently, but recently condoms for women - femidons - have gained some popularity. These means of protection against unwanted conception are wider and longer than the male counterpart. Femidon is inserted into the vagina before sexual intercourse, which significantly reduces the risk of infection with sexually transmitted diseases. The effectiveness of female condoms is significantly higher than that of male condoms, however, due to the complex installation process, such a product is not widely used.

Also, female mechanical methods of contraception are represented by a diaphragm, which is a dome-shaped hemisphere made of latex. Typically, a woman independently inserts the diaphragm into the vagina before sexual intercourse. For this contraceptive to be effective, it is necessary that the dome tightly covers the cervix, and the rim is located in the vaginal vaults. The main advantage of this method is the possibility of reusable use of the diaphragm in the presence of a constant sexual partner.

The last mechanical contraceptive method is a cervical cap, which is fixed on the cervix due to a vacuum effect. Like other female mechanical methods of contraception, the woman herself installs a cervical cap, pre-filled with a spermicidal agent. Also, such a drug can be prescribed by a doctor.

Herpes urethra
Urethral herpes occurs as a result of damage to HSV type 2, which in most cases is transmitted through sexual contact....