Hesperian Health Guides
Barrier methods of family planning
In this chapter:
Barrier methods prevent pregnancy by blocking the sperm from reaching the egg. They do not change the way the woman’s or man’s body works, and they cause very few side effects. Barrier methods are safe if a woman is breastfeeding. Most of these methods also protect against STIs, including HIV. When a woman wants to become pregnant, she simply stops using the barrier method.
The most common barrier methods are the condom, condoms for women, the diaphragm, and spermicides.
If a condom breaks or comes off the penis, the woman should put spermicide in her vagina immediately. If possible, use emergency family planning.
The condom is a narrow bag of thin rubber that the man wears on his penis during sex. Because the man’s semen stays in the bag, the sperm cannot enter the woman’s body.
Condoms are the best protection against STIs and HIV. They can be used alone or along with any other family planning method. Condoms can be bought at many pharmacies and markets, and are often available at health posts and through AIDS prevention programs.
Be careful not to tear the condom as you open the package. Do not use a new condom if the package is torn or dried out, or if the condom is stiff or sticky. The condom will not work.
The condom must be put on the man’s penis when it is hard, but before it touches the woman’s genitals. If he rubs his penis on the woman’s genitals or goes into her vagina, he can make the woman pregnant or can give her an STI, even if he does not spill his sperm (ejaculate).
How to use a condom:
1. If the man is not circumcised, pull the foreskin back. Squeeze the tip of the condom and put it on the end of the hard penis.
|2. Keep squeezing the tip while unrolling the condom, until it covers all of the penis. The loose part at the end will hold the man’s sperm. If you do not leave space for the sperm when it comes out, the condom is more likely to break.|
|3. After the man ejaculates, he should hold on to the rim of the condom and withdraw from the vagina while his penis is still hard.
||4. Take off the condom. Do not let sperm spill or leak.
||5. Tie the condom shut and dispose of it away from children and animals.|
A woman who is using another family planning method should also use condoms if she needs STI protection.
- Use a condom every time you have sex.
- If possible, always use condoms made of latex. They give the best protection against HIV. Condoms made of sheepskin or lambskin may not protect against HIV.
- Keep condoms in a cool, dry place away from sunlight. Condoms from old or torn packages are more likely to break.
- Use a condom only once. A condom that has been used before is more likely to break.
- Keep condoms within reach. You are less likely to use them if you have to stop what you are doing to look for them.
More Informationencouraging your partner to use condoms
At first, many couples do not like to use condoms. But once they get used to it, they may even recognize benefits besides protecting against unwanted pregnancies and STIs. For example, condoms can help some men last longer before they come.
The condom for women (female condoms)
Female condoms are larger than condoms made for men and are less likely to break. They work best when the man is on top and the woman is on the bottom during sex.
A female condom, which fits into the vagina and covers the outer lips of the vulva, can be put in the vagina any time before sex. It should be used only once, because it may break if it is reused. But if you do not have any other condoms, you can clean it and reuse it up to 5 times. The female condom should not be used with a male condom.
The female condom is the most effective of the methods controlled by women in protecting against both pregnancy and STIs, including HIV. There are now 3 types of female condom available. The newest are less expensive. The VA female condom fits more closely to the woman’s body, so it is more comfortable and makes less noise during sex.
Female condoms are available only in a few places now. But if enough people demand this method, more programs will make them available.
How to use the female condom:
|1. Carefully open
|2. Find the inner ring, which is at the closed end of the condom.||
|3. Squeeze the inner
|4. Put the inner ring
in the vagina.
|5. Push the inner ring up into your vagina with your finger. The outer ring stays outside the vagina.|
|6. When you have sex, guide the penis through the outer ring.||7. Remove the female condom immediately after sex, before you stand up. Squeeze and twist the outer ring to keep the man’s sperm inside the pouch. Pull the pouch out gently, and then dispose of it out of reach of children and animals.|
When a diaphragm is used correctly, it prevents pregnancy most of the time and may also give some protection against STIs.
The diaphragm is a shallow cup made of soft rubber or thin silicone that a woman wears in her vagina during sex. The diaphragm covers the cervix so that the man’s sperm cannot get into her womb. The diaphragm should be used with spermicide. If you do not have spermicide, you can still use the diaphragm, but it may not work as well to prevent pregnancy.
Diaphragms come in different sizes, and are available at some health posts and family planning clinics. A health worker who has been trained to do pelvic exams can examine you and find the right size diaphragm.
Diaphragms can get holes, particularly after being used for more than a year. It is a good idea to check your diaphragm often. Replace it when the rubber gets dry or hard, or when there is a hole in it.
You can put the diaphragm in just before you have sex or up to 6 hours before. If you have sex more than one time after you put the diaphragm in, put more spermicide in your vagina each time before you have sex, without removing the diaphragm.
How to use a diaphragm:
|1. If you have spermicide, squeeze it into the center. Then spread a little bit around the edge with your finger.||2. Squeeze the diaphragm in half.||3. Open the lips of your vagina with your other hand. Push the diaphragm into your vagina. It works best if you push it toward your back.|
|4. Check the position of your diaphragm by putting one of your fingers inside your vagina and feeling for your cervix through the rubber of the diaphragm. The cervix feels firm, like the end of your nose. The diaphragm must cover your cervix.|
|5. If the diaphragm is in the right place, you will not be able to feel it inside you.||6. Leave the diaphragm in place for at least 6 hours after sex.|
You can leave the diaphragm in for up to 24 hours. It is OK to use the diaphragm during monthly bleeding, but you will need to remove it and clean it as often as you would change a cloth or pad.
To remove the diaphragm:
Put your finger inside your vagina. Reach behind the front rim of the diaphragm and pull it down and out. Wash your diaphragm with soap and water, and dry it. Check the diaphragm for holes by holding it up to the light. If there is even a tiny hole, get a new one. Store the diaphragm in a clean, dry place.
|Cream or Jelly|
(contraceptive foam, tablets, jelly, or cream)
Spermicide comes in many forms—foam, tablets, and cream or jelly—and is put into the vagina just before having sex. Spermicide kills the man’s sperm before it can get into the womb.
If used alone, spermicide is less effective than some other methods. But it is helpful when used as extra protection along with another method, like the diaphragm or condom.
Spermicides can be bought in many pharmacies and markets. Some women find that some types of spermicides cause itching or irritation inside the vagina.
Spermicides do not provide protection against any STI. Because spermicides can irritate the walls of the vagina, they may cause small cuts that allow HIV to pass more easily into the blood.
When to insert spermicide:
Tablets or suppositories should be put in the vagina 10 to 15 minutes before having sex. Foam, jelly, or cream work best if they are put in the vagina just before having sex.
If more than one hour passes before having sex, add more spermicide. Add a new tablet, suppository, or applicator of foam, jelly, or cream each time you have sex.
How to insert spermicide:
- Wash your hands with soap and water.
To use foam, shake the foam container rapidly, about 20 times. Then press the nozzle to fill the applicator.
To use jelly or cream, screw the spermicide tube onto the applicator. Fill the applicator by squeezing the spermicide tube.
To use vaginal tablets, remove the wrapping and
wet them with water or spit on them. (DO NOT put the tablet in your mouth.)
- Gently put the applicator or vaginal tablet into your vagina, as far back as it will go.
- If you are using an applicator, press in the plunger all the way and then take out the empty applicator.
- Rinse the applicator with clean water and soap.
- Leave the spermicide in place for at least 6 hours after sex. Do not douche or wash the spermicide out. If cream drips out of your vagina, wear a pad, cotton or clean cloth to protect your clothes.
- Rinse the applicator with clean water and soap.