Barrier Methods of Birth Control (cont.)
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Introduction to birth control
- Barrier methods of contraception
- Male condom
- Female condom
- Contraceptive sponge
- Cervical cap
- Find a local Obstetrician-Gynecologist in your town
The contraceptive sponge is a doughnut shaped sponge. It is made of polyurethane foam and is impregnated with the spermicide Nonoxynol-9. This spermicide is essential to the contraceptive ability of the sponge.
Before intercourse, a woman pushes the sponge up into her vagina (as she would insert a tampon). The spermicidal sponge should then act as a barrier in order to prevent sperm from reaching the cervix. Once in place, the sponge provides protection for up to 24 hours without the need for additional spermicide.
The sponge must remain in the vagina for at least 6 hours after intercourse. However, the same sponge should never remain in the vagina for more than a total of 30 hours because of the risk of toxic shock syndrome. (Toxic shock syndrome is an uncommon and potentially very serious illness that is caused by a type of bacteria. This illness occurs when certain types of products, such as tampons,are left in place for excessive periods of time. This is why package instructions of these products are careful to specify how long they may be safely kept in place.) Each sponge is used only once and then thrown away.
The sponge is generally an effective birth control method. Some users of the contraceptive sponge may experience irritation and allergic reactions. The sponge can also be difficult to remove from the vagina. Removal has been made easier by the addition of a woven polyester loop.
The estimated effectiveness of the sponge as a contraceptive is 64% to 82%. As for protection from sexually transmitted infections, the spermicide may provide some protection against chlamydia and gonorrhea, but otherwise, the degree of protection is unknown.
The diaphragm is a soft flexible rubber cup shaped like a dome that is inserted into the vagina. The diaphragm blocks access to the cervix so that sperm cannot pass from the vagina into the uterus. The diaphragm must be covered on both sides and especially around its rim with spermicidal jelly, cream, or foam in order to form a tight seal around the diaphragm.
A woman inserts the diaphragm into her vagina no more than 4 hours prior to intercourse. After intercourse, she should check to be sure that the diaphragm has not been dislodged and is still in the correct position. The diaphragm must be left in place for at least 6-8 hours after intercourse; after this time it should be removed. Fresh spermicide jelly or foam must be inserted into the vagina each time intercourse is repeated.
Since diaphragms are only available with a prescription, a woman must see a health care practitioner to have a diaphragm properly fitted (they come in a range of sizes), and to learn proper insertion techniques. There are no known long-term health risks associated with using the diaphragm and spermicide method of birth control. Some women may find spermicides to be irritating, but changing brands of spermicides may help. There is also an increased risk of urinary tract infections with diaphragm use. One possible reason is that the diaphragm puts increased pressure on the urethra or the spermicide may contribute to irritation leading to infection. (The cervical cap is not associated with increases in urinary tract infections.)
The diaphragm may be appealing to women because it offers a safe temporary (not permanent) birth control that is under her control.
When the diaphragm and spermicide are used correctly, they are thought to have over an 82% success rate (18 pregnancies/100 women per year). To ensure protection, it is important that the diaphragm be checked after every use for rips or holes (this is best done by holding the diaphragm up to the light). Also, the fit of the diaphragm should be checked annually, after every pregnancy, and after significant weight loss.
Using a diaphragm does not protect a woman from sexually transmitted infections, although the spermicide does give partial protection against gonorrhea and chlamydia. It can, however, be used with condoms to offer some protection against sexually transmitted infections.
Next: Cervical cap
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