Obstetrics and Gynecology - A.M. Gromova 2000

Modern family planning methods
Traditional contraception methods
Barrier methods of contraception

Barrier Methods (BM) of Contraception include diaphragms, cervical caps, Sponges, and condoms.

The MECHANISM OF ACTION of BMs is based on creating a mechanical barrier that prevents sperm from entering the cervical canal. The contraceptive efficacy of BMs is relatively low. Specifically, the Pearl index is 4.0–19.0 for diaphragms, 17.4–16.7 for cervical caps, 13.9–24.5 for sponges, and 12.5–20.0 for condoms. BMs can be used independently or in combination with Spermicides.

Diaphragms were first made of rubber in Germany in 1883 by the scientist C. Hasse. Modern diaphragms are dome-shaped rubber or latex caps with a flexible rim. A Diaphragm is inserted immediately before intercourse and left in the Vagina for 8 hours.

Cervical caps were first developed around the same time as diaphragms and have a cup-like shape. Originally, caps were made of silver or copper, later of rubber, aluminum, heavy-duty rubber, or plastic, and nowadays they are made of soft rubber.

The Prentif cervical cap is fitted onto the cervix by a gynecologist three days after the end of menstruation and removed three days before the expected period, while other types are worn for 36–48 hours.

The contraceptive sponge combines the effects of both BMs and spermicides. There are two forms of contraceptive sponge: a natural sea sponge soaked in a spermicide, and a polyurethane sponge containing 1 g of nonoxynol-9. The contraceptive sponge is a round, pillow-like device with a indentation on the cervical side. It is inserted immediately before intercourse and left in the vagina for 6–8 hours.

Indications for using diaphragms, cervical caps, and contraceptive sponges are quite limited: first, these methods are recommended for patients with a low risk of Pregnancy, i.e., those with infrequent sexual intercourse or in the late reproductive period; second, they are indicated in combination with rhythm methods of contraception; third, these BMs can be offered as a temporary contraceptive method during breaks in The Use of COMBINED ORAL CONTRACEPTIVES (COCs) or intrauterine devices (IUDs).

The described mechanical methods of contraception have A number of contraindications:

- high risk of unwanted pregnancy;

- allergic reactions to rubber, latex, or spermicides;

- cervical erosion, suspected or confirmed malignant transformation of the cervix;

- colpitis, Endocervicitis;

- history of toxic Shock syndrome;

- vaginal developmental anomalies.

Patients advised to use barrier methods of contraception should be warned about the potential risk of allergic reactions, urinary retention, discomfort for either the woman or her sexual partner, and toxic shock syndrome. In such cases, an alternative method of pregnancy Prevention should be offered.

The limitations of BMs are due to their relatively low contraceptive efficacy, The Need for simultaneous use of spermicides, and vaginal manipulation immediately prior to intercourse. The advantages of the method include simplicity, accessibility, and the prevention of Sexually Transmitted Infections.

The male barrier method of contraception is the condom. This contraceptive was already known during the Roman Empire, when fish and animal bladders were used to prevent unwanted pregnancy and venereal diseases. Later, condoms were made from leather, linen, silk, and animal intestines.

The term "condom" only appeared in the 19th century. Nowadays, they are made from thin rubber less than 1 mm thick or from animal intestines, such as lamb cecum. Condoms vary in size, shape, thickness, external texture, and color. They are available with or without spermicides and lubricants. This method of contraception is quite widespread; for example, in the early 1990s, more than 45 million men used condoms as a form of family planning.

This barrier contraceptive method can be recommended when a woman lacks a steady partner or has multiple partners, for the prevention of sexually transmitted infections in cases of low pregnancy risk, and as a temporary contraceptive method during breaks in the use of COCs or IUDs.

Contraindications to condom use may include allergies to spermicides or rubber, decreased sensitivity, erectile dysfunction, and a partner's unwillingness to participate in family planning. The limitations of this method are associated with lower contraceptive efficacy and reduced sensation during intercourse.

The advantages of the method include accessibility, ease of use, prevention of premature ejaculation, and protection against sexually transmitted infections.