Hesperian Health Guides

Barrier methods of family planning

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HealthWiki > A Health Handbook for Women with Disabilities > Chapter 9: Family planning > Barrier methods of family planning


Barrier methods include the condom for men, condom for women, diaphragm, cervical cap, sponge and spermicide.

a man holding a condom from a package.

Condom for men (rubber, prophylactic)

A condom is a narrow bag of thin rubber that the man wears on his penis while having sex. The bag traps the man’s sperm so it cannot get into the woman’s vagina or womb.

Unfortunately, some men do not like to wear a condom during sex because they say it reduces their sexual pleasure. This is too bad, because condoms work well to prevent both pregnancy and sexually transmitted infections (STIs).

Lubricant can make sex feel better for both the woman and the man. It can also keep the condom from breaking. Use a water-based lubricant like saliva (spit), K-Y Jelly, or spermicide. Do not use oils, petroleum jelly (Vaseline), skin lotions, or butter as they can make the condom leak or break. A drop of lubricant inside the tip of the condom makes it more comfortable on the penis.
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A little lubricant can also be rubbed on the outside of the condom after the man puts it on. This can make sexual intercourse more comfortable for the man’s partner.


The most effective condoms are made from latex or polyurethane—not sheepskin.

A new condom must be used each time a couple has sex.

Condoms can be used alone or along with any other family planning method, except the condom for women. They can be bought at many pharmacies and markets, and are often available at health posts and through HIV/AIDS prevention programs.

If you have good movement in your hands, you can put a man's condom onto his penis. It helps to know how to do this before you are about to have sex. You can practice by:

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putting the condom on a banana...
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...or a corn cob.

For women who are blind or who cannot see well, practicing how to put a condom on a man is an especially good idea. Then, when you have sex with a partner, you can use your hands to feel if the condom is on correctly, and you can make sure the tip of the condom is not broken or cut.

How to use a male condom:

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A new condom should come rolled up inside a small packet that has not been opened. Be careful not to tear the condom as you open the packet. The condom should feel smooth and slippery. If it feels stiff, hard or sticky, throw it away. It will not work.

1.
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A condom should be put on the man's penis when the penis is hard, and before it touches the woman's genitals. An uncircumcised man should pull his foreskin back. The man should squeeze the tip of the condom and put it on the end of the penis.
2.
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Unroll the condom until it covers all of the penis. Keep squeezing the
tip of the condom while unrolling. Without this extra space at the tip for the semen, the condom may break.
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3. Right after the
man ejaculates (comes) and before his penis gets soft, he should hold onto the rim of the condom while he pulls his penis out of the vagina. Then he should carefully take the condom off.

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4. Tie the condom shut. Then throw it in the garbage or a latrine, out of reach of children and animals.

Condom for women

(Female condom)

Condoms for women also prevent HIV and other STIs from passing from one person to another.
a woman who uses a hearing aid holding a female condom.


The condom for women fits into the vagina and covers the outer lips of the genitals (vulva). It protects against both pregnancy and sexually transmitted infections, and against HIV/AIDS. Unfortunately, the female condom is more expensive and harder to get than the male condom. The female condom should not be used with the condom for men. It works best when the man is on top and the woman is on the bottom during sex.

How to use the female condom:

1. Carefully open the packet without tearing the condom.
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2. Find the inner ring, which is at the closed end of the condom.

Outer ring

3. Squeeze the inner ring together.
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4. Put the inner ring in the vagina.
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5. Push the inner ring up into your vagina with your finger.

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The outer ring stays outside the vagina.
6. When you have sex, guide the penis through the outer ring.
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7. Remove the female condom immediately after the man's penis leaves your body, before you stand up. Squeeze and twist the outer ring to keep the man’s semen inside the pouch. Pull the pouch out gently, and then dispose of it out of reach of children and animals. Either put it into a pit latrine, or bury it.

If you really want to use the female condom, but your disability makes it difficult, try sitting or lying down in different positions, or ask your partner or another person to help you.

It is best to use a new female condom every time you have sex. But, if you cannot get a new one, you can clean and reuse a female condom up to 7 times.


How to clean a condom for women


Before having sex, prepare a large cup of bleach (Cloro, Clorox, etc.) mixed with water (1 part powder or liquid bleach to 20 parts clean water). Bleach kills HIV.

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After sex, take the condom out of your vagina. Be careful not to spill any of the man’s semen. Right away, pour half the bleach solution into the condom, and then put the filled condom into the remaining bleach solution.

Let the condom soak for 5 minutes only. Do not try to clean the condom in any way before putting it into the bleach.

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Wash your hands with mild soap, and use the soap bubbles on your hands to gently wash off the bleach and any remaining body fluids or lubrication, both outside and inside the condom, including the inner ring (do not rub a bar of soap directly on to the condom or it may break).

Use clean water to rinse off the soap bubbles from the ring and from both the inside and outside of the condom.

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Dry gently the inside and outside of the condom with a clean cloth, or leave it to dry in the air.

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Check the condom for holes by holding it up to the light. If there is even a tiny hole, throw the condom away and get a new one. Some change in color is OK. If there are no holes, store in a clean, dry place until next use.

Before using it again, lubricate the condom with a water-based lubricant. For the female condom you can also use vegetable oil or vegetable shortening. Because the female condom is not made from latex, it is OK to use some oils. But do not use peanut or groundnut oil, or lotions that contain lanolin or perfume, as these can all cause an allergic skin reaction.

The diaphragm and the cervical cap

The diaphragm and cervical cap are both shallow cups made of soft rubber that are worn in the vagina during sex. Either one must be left in your vagina for at least 6 hours after sexual intercourse, and you can leave it in for as long as 24 hours (but no longer).

Both the diaphragm and the cap are good methods to prevent pregnancy if they are used with a contraceptive cream or jelly (spermicide) every time you have sex. Diaphragms and cervical caps come in different sizes. An experienced health worker can fit you with the correct size for your body. The diaphragm is larger than the cap, and some small women say the cap fits them better. After childbirth, or if you have gained or lost a lot of weight, you may need to change the size of your diaphragm.

The diaphragm and the cap usually last a year or longer. Both must be checked regularly for holes and cracks by holding them up to the light. If there is even a tiny hole, get a new one because the man’s sperm is even tinier and can get through the hole. After use, wash in warm soapy water, rinse, and dry. Keep the diaphragm or cap in a clean, dry place.

These methods are not available everywhere. But if enough women demand them,
more programs and
clinics will make them
available.
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cervical cap
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diaphragm


The Sponge

The contraceptive sponge

The contraceptive sponge is made of soft plastic and is filled with a spermicide (nonoxynol-9). You put the sponge deep inside your vagina before having sex. Once it is in place, you can have sexual intercourse as often as you like, without having to add more spermicide. It must stay in your vagina for 6 hours after having sex, and you can leave it in for as long as 24 hours (but no longer). In many countries the sponge is not available.

The homemade sponge

You can also use a sponge soaked in vinegar or lemon. This method is not as effective as the contraceptive sponge, but it may prevent some pregnancies. You may wish to try it when no other method is available.


How to make a homemade sponge

  1. Mix:
  2. 2 tablespoons of vinegar with 1 cup of clean boiled water or
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    1 teaspoon of lemon juice with 1 cup of clean boiled water
    or
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    1 spoon of salt with 4 spoons of clean boiled water.
  3. Wet a boiled piece of sponge about the size of an egg with one of these liquids.
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  5. Push the sponge deep into the vagina no more than 1 hour before having sex.
  6. Leave the sponge in for at least 6 hours after having sex. Then take it out.


The sponge can be difficult to take out, but it cannot get lost in the vagina. It may be easier to take out if you squat and push down as if you are passing stool, while you reach into your vagina. If you have trouble taking it out, you can tie a clean ribbon or string around it for the next time.

The sponge can be washed, boiled, and used again many times. Keep it in a clean, dry place. The liquid can be made ahead of time and kept in a bottle.

The spermicide or the liquid in either sponge method may irritate the skin inside the vagina, which can make it easier for a woman to get STIs. Stop using these methods if they make your vagina dry, sore, or itchy.

Spermicides

a can of foam with an applicator; a tube of spermicide; a tablet from a package.

Spermicides are foam, tablets, cream, or jelly that are put into the vagina before having sexual intercourse. Spermicide kills the man’s sperm before it can get into the womb. It does not protect against STIs or HIV/AIDS. Tablets should be put into the vagina 10 to 15 minutes before having sex. Foam, jelly, or cream work best if they are put into the vagina just before having sex. Add spermicide each time you have sex. After sex, do not douche or wash out the spermicide for at least 6 hours. Some spermicides can cause itching or irritation to the skin inside the vagina. The foam is the one most likely to cause an irritation. If you are sensitive to the foam, try using contraceptive jelly or cream instead.

IUD (IntraUterine Devices: IUCD, Copper T, the Loop)

2 kinds of IUD.

The Intra-Uterine Device (IUD) is a small object made of plastic, or of plastic and copper, that has 2 small strings attached.

The IUD does not protect against HIV/AIDS or other STIs. A trained health worker or midwife can insert an IUD inside the womb, and the strings hang down into the vagina. The IUD prevents the man’s sperm from fertilizing the woman’s egg. To use an IUD safely, you need to be able to check the strings inside your vagina regularly. It is best to do this just after your monthly bleeding has stopped. If you cannot check the strings yourself, ask your partner or someone you trust to help you.

The IUD can be left in for up to 10 years. Women with IUDs should get regular pelvic exams to make sure it is still in correctly.

Common side effects

You may have some light bleeding during the first week you have an IUD. Some women also have longer, heavier, and more painful monthly bleeding, but this usually stops after the first 3 months. If you want to use an IUD, talk with an experienced health worker to see if this method will work well for you.

IUS (IntraUterine System: An IUD with hormones)

One type of IUD called the Intrauterine System (IUS) contains the progestin hormone, levonorgestrel. The 2 most common brand names are Mirena and Levonova. The IUS reduces the amount of blood lost during monthly bleeding and is also very effective in preventing pregnancy for 5 years. Unfortunately, it is more expensive than other IUDs and is not available in as many countries. Talk with a health worker to see if it is available in your community.