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| |    Barriers and Spermicides for Birth Control by Marjorie Greenfield, M.D. reviewed and revised by Marjorie Greenfield, M.D. Barriers and spermicides are excellent methods of birth control, but they require that the couple take a lot of responsibility around the time of intercourse. Some find that this takes some of the spontaneity and pleasure out of sex, while others appreciate the protection from sexually transmitted infections that barrier methods afford. For the woman who cannot or will not use oral contraceptives, but who plans to have children some day, these forms of birth control often are the best options for her and her partner. Couples who use barrier methods should familiarize themselves with emergency contraception, an option if the barrier method is dislodged or breaks--or if the next day, you regret not using your method consistently. The effectiveness rates stated here are for typical use on the lower end and perfect use on the upper end. Pregnancy rates in a year would be 100 minus the effectiveness rate--so, for instance, the risk of pregnancy for condom use is 3-12 percent in a year of regular use. Condoms--88-97 percent effective Condoms are sheaths made of latex or animal intestine that cover the man's penis and prevent his semen from entering the woman's body. Latex condoms also provide some protection against sexually transmitted infection. In order to be effective, the condom must be put on before intercourse is begun. For the best fit, the man should already have an erection. The best latex condoms have a reservoir tip, a narrower area at the end to catch the semen. When putting on the condom, pinch the condom tip so that it is collapsed, making a place for the semen to go after ejaculation; otherwise the condom may break if too much pressure builds up inside. Just as important: The man should be sure to hold the condom at the base of the penis as he withdraws to prevent the condom from slipping off. Condom breakage happens most commonly to men who are unfamiliar with its use. Knowing how to properly put on the condom decreases its chance of breaking. In theory, condoms have about a 3 percent failure rate. In reality, about 12 percent of women will become pregnant within one year of use. If you and your partner have condoms around for birth control, don't forget to use them. They won't do you any good sitting in your purse or buried in the back of a nightstand drawer; in such cases, the failure rate in one year jumps to nearly 80 percent. Disadvantages:
The female condom is a thin plastic (polyurethane) sheath with a flexible ring at each end that can be bought off the shelf at the drugstore--one size fits all. The woman places the inner ring into her vagina, fitting it between her pelvic bones similarly to a diaphragm. The other ring remains outside the body, partially covering the lips of the vagina. It can be inserted anywhere from a few minutes to a few hours before intercourse. Disadvantages:
Spermicides are chemical agents that kill the sperm before it reaches the uterus. They come in the form of suppositories, foam, absorbable film, sponge, or jelly and are placed in the vagina before intercourse. Spermicides alone are not particularly good contraceptives, running the risk of up to a 20 percent failure rate in a year. They do work well, however, when combined with another method of birth control, such as condoms, diaphragm, or breastfeeding, since the effectiveness rate increases when two methods are used. Disadvantages:
The diaphragm is a dome-shaped rubber barrier that the woman places in her vagina prior to intercourse. Before insertion, the woman puts spermicidal jelly into the cup of the dome. The diaphragm holds the jelly over the cervix so that if sperm get past the barrier of the rubber, they have to swim through the spermicide in order to reach the cervix. The diaphragm must be fitted by a healthcare professional, and a specific size is then prescribed for purchase at a pharmacy. To use the diaphragm properly, the woman must be taught and must practice the insertion technique. Disadvantages:
The cervical cap, which looks like a small diaphragm, functions as a true barrier to sperm and does not require spermicide. The woman inserts it into her vagina and fits it onto her cervix, where natural suction keeps it in place. However, while the diaphragm is difficult to learn how to use, the cervical cap is even more so, and practitioners have a tougher time learning how to fit a woman with one. It's most effective in women who have not had children. If your practitioner doesn't offer this method, check with a local family-planning clinic.
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