The document provides comprehensive information on barrier methods of contraception, including male and female condoms, diaphragms, cervical caps, and spermicides. It outlines their definitions, types, mechanisms of action, effectiveness, advantages, disadvantages, and usage instructions. The effectiveness of these methods largely depends on user adherence and proper techniques, with varying failure rates reported across different barrier methods.

1. BARRIER METHODS OF
CONTRACEPTION
1
BY:- Gizaw K.(BSc Mw,MScinMidwiferyEducation)
Lecturer, Department of Midwifery
@Harar Health Sciences College

2. Learning outcome
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 At the end this session the student will be able to:-
Define barrier contraceptive methods.
 Describe the types of barrier contraceptives.
Describe the mechanism of action, use, effectiveness, advantages
and disadvantages of the male and femalecondom.
Discuss the use, advantages and disadvantages of using
diaphragms.
Describe the mechanism of action, effectiveness and advantages of
spermicidal..

3. Barrier Contraceptive
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 Barrier methods are one of the family planning methods used
for prevention of pregnancy as well as sexually transmitteddisease.
 The success of such methods depends on the quality of the
barriers and the motivation & willingness of the couple to use the
method.
 The Male condom is the only male barrier known, while a number of
different female barriers exist, such as the diaphragm, female
condomand cervical cap all of which are widely available.

4. Types of barriers
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 Barrier contraceptives are broadly classified into two main types:
mechanical barriers and chemical barriers.
1. Mechanical barriers
 Are devices that provide a physical barrier between the sperm and
the egg.
 Example: Male condom, Female condom, Diaphragm, Cervical cap andsponge.
 The condom is the only contraceptive method that helps prevent
sexuallytransmittedinfections (STIs).

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2. Chemical barriers
 Are sperm-killing substances, available as foams, creams,
gels, films or suppositories, which are often used in female
contraception in conjunction with mechanical barriers and
other devices.
 Spermicides are usually available without a prescription or
medical examination.

6. Male Condom
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What Are Male Condoms?
 Sheaths, or coverings, that fit over a man’s erect penis.
 Also called rubbers, “raincoats,” “umbrellas,” skins, prophylactics
and preservativos; known by many different brand names.
 Most are made of thin latex rubber.
 Male condoms also are made from other materials, including
polyurethane, polyisoprene, lambskin and nitrile.

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 Made of natural, latex rubber and plasticmaterials
 Natural condoms
 Intestines and skins
 Barrier against sperm and bacteria
 Not effective against virus
 Allow transfer of body heat
 Rubber condoms
 Since the 19th Century
 Less permeable than natural condoms
 Reduce heat transfer
 Effective barrier even against HIV
 Plastic condoms
 Under development
 Good heat transfer
 The male condom is one of the most widely used barrier
methodsin the world.

8. Male Condom Cont. …
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Mechanismof action
 A male condom is a covering made to fit over a man’s erect
penis.
 It works by providing a barrier between partners during sexual
intercourse, so that bodily fluids, such as semen and blood are
not shared.
 As a result, pregnancy and reproductive tract infections (RTIs),
including human immune deficiency virus (HIV) and acquired immune
deficiencysyndrome (AIDS), can be prevented.

9. Male Condom Cont. …
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Effectiveness
 Its effectiveness depends on the users
 Protection Against Pregnancy:
 As commonly used, about 15 pregnancies per 100 women whose
partners use male condoms over the first year.
 When used correctly with every sex act, about 2 pregnancies per 100 women
whosepartners use male condomsover the first year
 Protection Against HIV and Other STIs:
 When used consistently and correctly, it prevents 80 – 95% of HIV transmission that
wouldhaveoccurred withoutcondoms

10. Male Condom Cont. …
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5 Basic Steps of Using a Male Condom
1. Check the condom package.
 Do not use if torn or damaged; or if it shows obvious signs of
deterioration, such as brittleness, stickiness or discoloration, regardless of
their expiration date.
 Avoid using a condom past the expiration date
 Tear open the package carefully.
 Don’t use fingernails, teeth, or anything that could damage the condom.

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5 Basic Steps of Using a Male Condom cont. …
2. Before any physical contact, place the condom on the tip of the
erect penis with the rolled side out and Leave emptyspace at the tip
of the condom.
3. Unroll the condom all the way to the base of the erect
penis. If extra lubrication is needed use water, KY Jelly or
contraceptive foam, gel or cream.
Note: Do not use petroleumjelly or oil.
4. Immediately after ejaculation, hold the rim in place
and withdrawthe penis whileit is still erect.
5. Dispose of the used condom safely
3
4
5
Male Condom Cont. …

12. Male Condom Cont. …
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Condom failure
 The most common causes of condom failure are breakage and slipping.
 To prevent a condom from breaking due to dryness, the user has to make
sure there is enough lubrication from natural secretions, or use a water
basedlubricant.
 A water-based lubricant is a jelly-like lubricant made of water, e.g. KY jelly.
 Oil-based lubricants can cause condoms to break.

13. Male Condom Cont. …
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Condom failure Cont. …
 The five most commonmistakes are:
1. Not having a condomwhen needed.
2. Starting intercourse without a condom on the penis, then interrupting
intercourse to put on the condom (or deciding not to use the condomat all).
3. Tearing the condomwith a fingernail.
4. Not holding the rim of the condom when withdrawing the penis from the
vagina, causing condom slippage and leakage.
5. Forgetting to use the condomaltogether.

14. Male Condom Cont. …
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Condom Breakage and Slippage
 Breakage= Condom develop hole or tear
 Slippage= Condom comes off the penis while it is still in the vagina
 Causes for condombreakage or slippage
 Opening package with teethor sharpobjects
 Unrolling condombefore putting it on
 Having intercoursefor more than20 min
 Having intense sexual intercourse

15. Male Condom Cont. …
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Important messages
 Clients need to be informed that:
 They shouldnot use two condoms at once.
Placingtwo male condoms on a penis can raise the chance of tearing.
 Used condoms should be thrown away after each sex act.
 Male condoms and female condoms should not be used at the same
time.
 The condom must be used from ‘start to finish’ with every act of
intercourse.

16. Male Condom Cont. …
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Advantages of male condom
 Prevent pregnancy and STDs, including HIV/ AIDS
 Safe and have no hormonal side-effects.
 Can be stopped at any time
 Fertility returns shortly after each use.
 Very easy to find and use without seeing a healthcare provider first.
 Men of any age can use.

17. Male Condom Cont. …
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Advantages of male condom Cont. …
 Enables a man to take responsibility
 No medical contraindication.
 Does not require medical screening
 Used as back up method.
 Easy to use and relatively inexpensive.
 Widely available (pharmacies and community shops)

18. Male Condom Cont. …
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Disadvantages and side-effects
 Women have to rely on the man’s cooperation to protect
them selves from pregnancy and disease.
 Some people connect condoms with immoral sex, sex outside
marriage,or sex withprostitutes and do not want to use them.
 Some people are too embarrassed to buy, ask a partner to use, put
on, take off, or throwaway condoms.

19. Male Condom Cont. …
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Disadvantages and side-effects Cont. …
 Latex condoms may cause itching for a few people who are
allergic to latex and/or lubricants.
 There is a small possibility that a condom will slip off during sex.
 Condoms can weaken and may break during use
 if stored for too long or in too muchheat, sunlightor humidity or
 if usedwith oil-basedlubricants, suchas Vaseline or edible oils.

20. Female Condom
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 Is a thin, loose-fitting and flexible plastic tube
worn inside the vagina.
 It has inner and outer rings.
 A soft ring at the closed end of the tube covers the
cervix during intercourseand holds it inside thevagina.
 Another ring at the open end of the tube stays
outside the vagina and partly covers the lip area.
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21. Female Condom cont. …
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 The female condom helps protect partners from pregnancy and
STIs, including HIV/AIDS.
 It is the only female-controlled device offering this protection.
 Like the male condom, the Female Condom provides a barrier
between partners during sexual intercourse.
 This ensures that pregnancy does not occur and STIs are not
transmitted

22. Female Condom cont. …
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5 Basic Steps of Using a Female Condom
1. Check the condom package. If possible, wash your
hands with mild soap and clean water.
2. Before any physical contact, insert the condom.
 Can be inserted up to 8 hours before sex.
 Choose a comfortable position —squat, raise one leg, sit, or lie
down.
 About 2 to 3 centimeters of the condom and the outer ring
remain outside the vagina.
3. Ensure that the penis enters the condomand stays inside.
 The man or woman should carefully guide the tip of penis inside the
condom.

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5 Basic Steps of Using a Female Condomcont.….
4.After the man withdraws his penis, hold the outer ring
of the condom, twist to seal in fluids and gently pull it out
of the vagina.
5. Dispose of the used condom safely.
Female Condom cont. …

24. Female Condom cont. …
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25. Female Condom cont. …
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Advantages
 Female controlled
 Dual protection
 Can be inserted before
intercourse
 No need to withdraw immediately
 Easy removal
 Lubrication is possible
 No side effects of allergy
 Stronger & stores better than
latex
Disadvantages
 Difficult to insert
 Noise
 Too large- only one size
available
 Discomfort caused by rings
 Reduced pleasure
 Penile misrouting
 Uncomfortable in some
sexual positions
 Relatively expensive

26. Diaphragm
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 The diaphragm is a small dome-shaped latex cup
with a flexible rim that fits over the cervix.
 Covers the vaginal fornices & the cervix
 The cup acts as a physical barrier against the
entry of sperm into the uterus.
 This barrier method is not common in Ethiopia.
 A diaphragm is usually used along with spermicide.
Effectiveness
 The diaphragm has a relatively high failure rate,
about 16%.

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Guidelines for diaphragm insertion
 Before or after each use, the woman should hold the
diaphragm up to the light, or fill it with water, to check for holes,
tearsor leaks.
 A small amount of spermicide (about one tablespoon) is usually
placed inside the cup, and some is smeared around the lip of
the cup.
 The device is then folded in half and inserted into the vagina
by hand, or with the assistance of a plastic inserter.
Diaphragm cont. …
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Guidelines for diaphragminsertion cont. …
 The diaphragm should fit over the cervix, blocking entry to the
uterus.
 If more than six hours pass before repeat intercourse occurs, the
diaphragm can be left in place and extra spermicide inserted into
the vagina using an applicator.
Diaphragm cont. …
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Guidelines for diaphragm insertion cont. …
 The diaphragm must remain in the vagina for six to eight hours
after the final act of intercourse and can safely stay there up to 24
hours after insertion.
 The diaphragm should be washed with soap and warm water
after each use, and then dried and stored in its original
container, which should be kept in a cool dry place.
Diaphragm cont. …
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30. Diaphragm cont. …
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Advantages
 Can be carried in a purse &
inserted up to two hours
before intercourse begins
 Usually cannot be felt by
either partner.
 It also does not interfere with
a woman’s hormones.
Disadvantages
 Dislike having to insert the
device every time they have
intercourse.
 Dislodged during sex and the
failure rate is high.
 Does not protect against STIs.
 Frequent UTIs and vaginal
infections can be a problem for
some women when using a
diaphragm.

31. Cervical cap
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 This devices, also made of soft rubber
are an alternative to the diaphragm.
 The cap is much smaller thanthe
diaphragm, does not contain a ring in the rim
and covers onlythe cervix.
Mechanismof action:
 Act in a similar way to the diaphragm
Effectiveness
 The failure rate of cervical cap varies
from 18% for nullipara to 36% for
multipara.

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Advantage
 Safe, women controlled.
 Offer contraception when
needed.
 No side effects from hormones.
 No effect on breast milk.
 Can be stopped at any time.
 Easy to use with little practice.
Disadvantage
 High failure rate.
 Less effective in parous
women.
 Not widely available.
 Requires fitting by family
planning provider.
 Sometimes may be difficult to
remove.
 Cap should be washed after
each use.

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Inserting
 Fill one-third of the cap with spermicidal cream, jelly, or foam.
 Press the rim of the cap around the cervix until it is completely covered
 Insert the cervical cap any time up to 42 hours before havingsex.
Removing
 Leave the cervical cap in for at least 6 hours after her partner’s last
ejaculation, but not more than 48 hours from the time it was put in.
 Tip the cap rim sideways to break the seal against the cervix, and then gently pull the cap
down and out of the vagina.

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 Spermicides are sperm-killing chemicals
inserted deep into the vagina, near
the cervix, before sex.
 They are available in tablets, melting or
foaming suppositories, melting film, jelly,
foaming and cream.
 Jellies, creams and foam from are
can be used on their own, with a diaphragm,
or withcondoms.
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 Foaming tablets or foaming suppositories can be used on
their own or with condoms.
 Nonoxynol-9 is most widely used.
 Others include Benzalkonium Chloride, Chlorhexidine,
Menfegol, Octoxynol-9, And Sodium Docusate.
 Work by causing the membrane of sperm cells to break,
killing them or slowing their movement.
 This keeps sperm from meeting an egg.

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When to insert spermicide
 Foamor cream: Any time less than one hour before sex.
 Tablets, suppositories, jellies, film: Between 10 minutes and
one hour before sex, depending on type.
 Do not wash the vagina (douche) after sex b/c it’ll wash away the spermicide
and also increase the riskof sexually transmitted infections.
 If you mustdouche, wait for at least 6 hours aftersex before doing so.

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Effectiveness of spermicides
 Spermicides are one of the least effective family planning
methods, with a 29% chance of pregnancy.
 spermicides may be an appropriate choice for women who
need back-up protection against pregnancy (for instance, if they
forget to take their birth control pills).
 Spermicides should not be used alone as the primary method
of birth control.
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Advantages and disadvantages of spermicides
 Spermicides are safe to use.
 They are a female-controlled method that almost every woman
can use without the need to consult a healthcare provider.
 They can increase vaginal lubrication, so that vaginal dryness and friction
will be minimized.
 Easier to use and can be stopped at any time.
 No hormonal side effects.
 Unfortunately they are one of the least effective methods on their
own.

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