Patient information from BMJ

Contraception: barrier methods

Last published:Apr 25, 2022

There are many types of contraception, all designed to help you plan when you do and don't want to try to have children. You can use our information to talk to your doctor about the type that's best for you.

This leaflet is about barrier contraception. That means using a physical barrier (such as a condom) or spermicide to stop the man's sperm from reaching the woman's egg.

The right contraception for you

There are many types of contraception to choose from. But they are not all suitable for everyone.

For example, women with heart conditions might not be able to take the contraceptive pill. And people allergic to latex won't be able to use latex condoms.

The type of contraception that suits you best will depend on several things including:

• your medical history, including things like allergies and any health conditions that you have

• your lifestyle

• whether you need to think about preventing sexually transmitted infections (STIs), including HIV. For example, this applies to you if you have multiple partners, or if you change partners, and

• your own preferences: for example, you might not want to use some types of contraception because you're concerned about side effects. Or maybe you don't want to use condoms because you want something that you don't want to have to think about 'in the moment'.

What is barrier contraception?

There are several types of barrier contraception. They are called that because they use a physical barrier, such as a condom, or chemicals called spermicide, to stop the man's sperm from reaching the woman's egg.

What is barrier contraception?

Although barrier contraception is less effective at preventing pregnancy than some other methods, it is popular with many people for other reasons. For example:

• condoms and spermicide are available without a prescription

• most types of condom protect against HIV and other STIs

• all barrier methods are safe to use while breastfeeding

• some women don't want to take the contraceptive pill because of worries about side effects

• some women who use another contraceptive method, such as the pill, also use barrier methods to prevent STIs.

However, in order to work as well as possible, barrier methods need to be used properly and carefully.

Different barrier contraception methods

The diaphragm and cervical cap

The diaphragm and the cervical cap are circular domes made of soft, stretchy silicone. The cap is slightly smaller than the diaphragm, but they both do the same job, which is to stop sperm from getting from the vagina into the cervix.

You will need to see your doctor before starting to use this type of contraception. A doctor or nurse will explain how to use it.

Before having sex, you coat and fill the cap or diaphragm with spermicide foam or gel, then insert it into your vagina. If you have sex again within six hours, you will need to use more spermicide using a special applicator.

When used properly, the cap and diaphragm prevent pregnancy about 85 times in 100. So you can see that they're not perfect. But this figure is just an average: it's not possible to say how successful these methods are for individual women.

Possible side effects and disadvantages of the diaphragm and cap include:

• skin irritation in some women

• a greater chance of bladder infection (cystitis) with the diaphragm (but not with the cap), and

• possibly a greater chance of HIV infection. The diaphragm and cap do not protect against HIV. And it's possible that frequent use of spermicide can actually make HIV infection more likely.

The female condom

The female condom is a lubricated pouch made of a soft material a bit like the latex that male condoms are made of. You insert it into your vagina before sex. Like male condoms, you use a new one each time you have sex.

When used properly, the female condom is effective in preventing pregnancy up to 95 times in 100, and it can prevent HIV and other STIs.

Possible side effects and disadvantages include:

• rubbing (friction) and noise during sex

• some loss of sexual feeling (sensation)

• more chance of slipping or breaking compared with the male condom.

The male condom

When used properly, the male condom can prevent pregnancy up to 98 times in 100. You need to use a new condom each time you have sex.

Most condoms are made of either latex or polyurethane. Both types can prevent HIV and other STIs. Male condoms can also help prevent early ejaculation, because they cause some loss of sexual feeling.

There are some side effects and disadvantages of male condoms:

• People with a latex allergy cannot use this type of condom. Check the packaging to see what that type of condom is made of.

• Condoms cause some loss of sexual feeling for the man.

• Male condoms can sometimes slip off or break during sex.

• Oil-based lubricants such as vaseline can weaken latex condoms and cause them to break.

Spermicide

Spermicide is a chemical that kills sperm and stops a woman becoming pregnant. The woman applies it inside her vagina before having sex.

You need to insert more spermicide each time you have sex. When used properly, spermicide can prevent pregnancy up to about 88 times in 100.

Possible disadvantages and side effects include:

• skin irritation, and

• a possibly increased chance of HIV.

Why contraception matters

The number of unplanned pregnancies tells us how important it is for sexually active people to think about contraception. For example:

• in the UK about 30 in 100 pregnancies are unplanned, and

• in the US about 50 in 100 pregnancies are unplanned.

This is not always bad news, of course: just because a pregnancy is unplanned doesn't mean it's not wanted.

But many unplanned pregnancies end in abortions, which can cause emotional distress, and which carry physical health risks, such as infections.

Barrier methods of contraception are not always the most effective. But many of them can protect against HIV and other STIs.

Whatever method you choose, planning and taking responsibility for contraception is vital if:

• you are a sexually active girl or woman who could become pregnant, and you do not wish to become pregnant

• you are a sexually active male having sex with females of childbearing age, and you wish to play your part in avoiding an unwanted pregnancy

• you think that you might be at risk of HIV or other STIs (for example, if you have multiple sexual partners) and you want to use a method of contraception that protects against infection.

Very few methods of contraception are totally effective. But planning gives you the best chance of being in control of when and if you become pregnant.

Your doctor or practice nurse will be very happy to discuss contraception and family planning methods that best suit you.