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Birth Control Overview (cont.)

What is the effectiveness, and what are the side effects of other barrier methods of birth control?

Diaphragm: The diaphragm is a shallow latex cup with a spring mechanism in its rim to hold it in place in the vagina. Diaphragms are manufactured in various sizes. A pelvic examination with measurement of the vaginal length of your vaginal canal must be performed by your health-care professional so that the correct size of the diaphragm can be determined. Instructions as to how to prepare and insert the diaphragm will be provided by the physician.

The diaphragm prevents pregnancy by providing a barrier to the passage of semen into the cervix. Once in position, the diaphragm provides effective contraception for 6 hours. After that time, if the diaphragm has not been removed, fresh spermicide must be added with an applicator. The diaphragm must be left in place for at least 6 hours after sex but not more than 24 hours.

  • Effectiveness: Effectiveness of the diaphragm depends on the age and experience of the user, the continuity of its usage, and the concomitant use of a spermicide. The typical failure rate within the first year of use is estimated to be 20%.
  • Pros: The diaphragm does not use hormones. The woman is in control of her contraceptive method. The diaphragm may be placed by the woman in anticipation of intercourse.
  • Cons: Prolonged use during multiple acts of intercourse may increase the risk of urinary tract infection. Use for longer than 24 hours is not recommended due to the possible risk of vaginal erosion and (much less commonly) toxic shock syndrome. The diaphragm requires professional fitting. The diaphragm has a high failure rate, and its usage requires brief formal training. The diaphragm must be cleansed regularly to prevent vaginal odor.
  • STDs and the diaphragm: This method does not protect against STDs.

Cervical cap: The cervical cap is a soft cup-shaped latex device that fits over the base of a woman's cervix. It is smaller than a diaphragm and may be more difficult to insert. It too must be fitted by a trained provider, as it comes in different sizes. Spermicide is needed to fill the cap one third full prior to its insertion. It may be inserted as long as 8 hours before sexual activity, and it can be left in place for as long as 48 hours. The cervical cap acts as both a mechanical barrier to sperm migration into the cervical canal and as a chemical agent with the use of spermicide.

  • Effectiveness: The effectiveness depends on whether a woman has had previous vaginal childbirth, because this affects the shape of her cervix. With perfect use during the first year, a woman with no previous vaginal deliveries has a theoretical failure rate of 9% (use failure rate approximately 20%), as opposed to a theoretical failure rate of 20% in a woman who has delivered vaginally (use failure rate of 40%).
  • Pros: It provides continuous protection as long as it is in place regardless of the number of episodes of intercourse. Unlike the diaphragm, repeat applications of spermicide are not necessary if intercourse is repeated. The cervical cap does not involve ongoing use of hormones.
  • Cons: Cervical erosion may lead to vaginal spotting. A theoretical risk of toxic shock syndrome exists if the cervical cap is left in place longer than the prescribed interval period. The cervical cap requires professional fitting and instruction in its use. Severe obesity may make placement difficult. A relatively high failure rate exists. Women must have a history of normal results on Pap smears.
  • STDs and the cervical cap: This method does not protect against STDs.

Sponge: The vaginal sponge, introduced in 1983, and taken off the market shortly thereafter, is enjoying a resurgence in its popularity. The sponge is a soft circular polyurethane device that contains a spermicide (nonoxynol-9). It is disposable, and should be discarded after use. It is OTC, and may be appealing to women who wish to avoid using hormonal contraception. It offers an immediate and continuous presence of spermicide throughout a 24-hour period.

  • Effectiveness: The FDA lists the failure rate for the previously marketed sponge to be 14-28 pregnancies per 100 women per year.
  • Cons: Serious medical risks are rare, but they include irritation and allergic reactions, as well as difficulty with removal. Toxic shock syndrome is a rare but serious infection that can occur if a sponge is left in place longer than recommended. Nonoxynol-9 provides some protection against pregnancy.
  • STDs and the sponge: The sponge does not protect against STDs.
Medically Reviewed by a Doctor on 8/26/2016
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