Your guide to barrier methods of contraception

Condoms

What are condoms?

Condoms are one the most traditional methods of birth control. They are usually made from a very thin latex (rubber) or a synthetic equivalent (polyisoprene or polyurethane). Whilst traditionally used for men, they are also available for women, meaning quick contraception is available for everyone.

How do condoms work?

They are designed to act as a physical barrier for semen, so it stops it coming into contact with your sexual partner.

Condoms are primarily used by women to prevent pregnancy. In fact, a study found that three-quarters of women in the UK use condoms just for pregnancy prevention, compared to 1 in 10 who use it just for STI protection. By stopping semen entering the vagina, condoms inhibit the sperm cells in semen from being able to enter the vagina and reach an egg.

They also significantly reduces the risk of contracting STIs and STDs that are spread through sexual fluids (e.g. chlamydia, syphilis and human immunodeficiency virus or HIV). This includes any type of sexual intercourse, including anal, oral, and intravaginal sex. However, you should be mindful of any STI symptoms that appear in areas not covered by a condom, as these can still be transmitted (e.g. genital herpes and genital warts).

Condoms can also reduce the risk of spreading bacteria from certain infections, such as urinary tract infections (UTIs), bacterial vaginosis or thrush.

How do I use a condom?

Male condoms and female condoms are similar but obviously need to use them differently. Male condoms are applied over the penis, whilst a female condom needs to be inserted inside the vagina. They are sometimes referred to as external and internal condoms for that reason.

Some general instructions on how to use both are as follows.

How to use a male condom:
Take the condom carefully out of the packaging - be mindful not to tear it.	Squeeze the air out of the tip of the condom.	Place the condom on the tip of an erect penis.
Gently roll the condom down the base of the penis. If it doesn’t roll down, it may be the wrong way round.	Once you have finished, remove the penis while still erect (hold the condom at the base of the penis whilst you do so).	Carefully remove the condom and dispose of the bin.

How to use a female condom:
Carefully remove the condom out of the packaging.	The thick inner ring with the closed end is placed into the vagina whilst the outer ring remains outside of the body.	Find a comfortable position. While holding the closed end, squeeze sides of the inner ring together with your thumb and forefinger.	Using your finger, push the inner ring as far up as it goes until it rests against the cervix. It will expand naturally.
Guide partner’s penis into the opening of the condom.	Stop intercourse if you feel it slip between the condom and the walls of the vagina.	To remove, gently twist the outer ring and pull the condom out.	Dispose of the condom in a bin, do not reuse.

How effective is a condom?

Condoms are 98% effective at preventing pregnancy and contracting STIs, meaning roughly 2 in every 100 people will get pregnant or contract an STI when using a condom.

However, using them improperly can increase failure rate, such as by:

• tearing them - such as from friction or whilst opening the packaging
• putting them on incorrectly - not squeezing out the air in condom before use
• putting them on mid intercourse or taking it off early
• it slipping off during sex - by not buying the correct size
• using oil-based lubricants - these can damage latex condoms and cause them to tear
• using an expired condom

In the rare event that a condom breaks or it slips off, you may need emergency contraception if you are at risk of getting pregnant.

What are the advantages of using a condom?

Diaphragms and cervical caps

Other popular methods of barrier contraception include the cervical diaphragm and cervical cap. They are slightly different in shape, but they work identically.

A cervical cap, also known as a FemCap, is a soft silicone cap that is shaped like a sailor’s hat. A diaphragm is also a small silicone device but it is cone shaped, similar to a menstrual cup. You insert them into your vagina and they cover the cervix, preventing sperm from being able to enter the cervix and fertilise an egg.

They are different to condoms in several ways:

• they should be used with a spermicide - a cream or gel that kills sperm
• they do not reliably protect against STIs - you must use a condom in addition to a cervical cap to be fully protected
• they can be reused each time you have sex

They are not suitable for everyone, and should be avoided if you are prone to vaginal or sexually transmitted infections, have an unusually positioned cervix or your vaginal muscles cannot hold a device in place (e.g. from giving birth).

They should also not be used during a period, as this can increase the risk of developing toxic shock syndrome (TSS) which is a rare but potentially life-threatening condition.

How do I use a cervical cap or diaphragm?

Both devices can be put it any time before sex but any longer than 3 hours and spermicide should be reapplied. They also must be left in for at least 6 hours after sexual intercourse.

Here are some simple instructions on how to insert them.

How to use a cervical cap:
Wash your hands before use.	Fill one-third of the cap with spermicide and some on the groove between the dome and the rim.
Get into a comfortable position. Squeeze the sides of the cap together and hold it between your thumb and first two fingers.	Slide the cap into your vagina upwards.The cap must fit neatly over your cervix - it stays in place by suction

How to use a diaphragm:
Wash your hands before use	Put two 2cm strips of spermicide on the upper side of the diaphragm
Get into a comfortable position. Put your index finger on top of the diaphragm and squeeze it between your thumb and other fingers.	Slide the diaphragm into your vagina upwards. The diaphragm must fit neatly over your cervix.

Once you have used the device, leave it in for at least 6 hours. You can leave a diaphragm in for up to 30 hours and a cap for up 48 hours. To remove it, hook your finger under the rim of the device and gently pull downwards and out.

A diaphragm or cap should be washed after use using warm water and a mild soap. Rinse it thoroughly and allow it to dry in its container. Do not use any harsh soaps, disinfectants or boil it as this can damage the cap or cause irritation.

How effective are cervical caps and diaphragms?

Cervical caps and diaphragms have a higher failure rate than condoms. According to Planned Parenthood, cervical caps are 86% effective at preventing pregnancy in women who have never given birth. In women who have given birth, they are more like 71% effective.

Diaphragms are slightly more effective, with efficacy rates of 94% with perfect use every time. However, it’s unlikely they will be used perfectly every time, so the number is nearer 88%.

To ensure they are used as effectively as possible, you should ensure that

• it’s the right size - your doctor will help you find the correct size but it should be reevaluated if your weight changes by more than 7kg or after you have had a baby, abortion or miscarriage
• it’s not damaged each time you use it (e.g whether its torn or has holes)
• you use spermicide each time but do not overuse it
• it is kept in for at least 6 hours - do not remove it sooner
• you avoid using oil-based products such as lube or massage oil

In addition, not all spermicides protect you against HIV infection, such as spermicides containing nonoxynol-9.

If you have any doubt that it was used incorrectly, you may need to use emergency contraception.

What are the advantages of using a cervical cap or diaphragm?

What is a birth control sponge?

The contraceptive sponge is a small sponge-shaped device made from soft, squishy plastic. Similar to the cap and the diaphragm, it is inserted into the vagina so that the sponge covers your cervix. It has to be used with a spermicide, which kills the sperm whilst blocking the uterus to prevent any sperm from entering.

It also has similar efficacy rates to the cap and diaphragm. According to Planned Parenthood, In women who have not given birth and who use the sponge perfectly every time it is around 91% effective, whilst for women who have given birth rates are around 80%. However, perfect use every time is quite unlikely, so efficacy rates are closer to 88% and 76% respectively.

The sponge is no longer available in the UK, so if you’re looking for something similar, ask your healthcare provider about the cap or the diaphragm.

Main takeaways

Barrier methods of birth control are best suited for those who need instant and effective contraception. If you have multiple sexual partners, need protection from STIs or don’t want to use medicines, barrier contraception is probably the best option for you.

However, if you’re looking for effective contraception that is more long-term, you may want to consider getting the IUD (intrauterine device) or the implant. These are the most effective contraceptives available.

If you’re not sure, chat to a healthcare professional at a sexual health or family planning clinic. They’ll discuss your medical history, your lifestyle and your preferences to find what type of contraception will work for you.