Health Square: Barrier Contraceptives, Making Your Choice

omen have been using barrier contraceptives for more than 3,000 years. Ancient Egyptians, Greeks, and Romans inserted a mixture of herbs, tree resins, and honey or oil into their vaginas. Some African women used hollowed­out okra pods as a vaginal pouch, somewhat like the modern female condom. Roman women used goat bladders in a similar manner while their partners used various forms of animal membrane as sheaths for the penis.

Today, millions of women and men rely on modern forms of barrier contraception both to prevent pregnancy and—more and more—to protect themselves against sexually transmitted diseases such as gonorrhea and especially HIV. Many women also choose barrier contraceptives to avoid the potential side effects and risks associated with the Pill, the IUD, and other forms of birth control.

Most barrier contraceptives are simple to use and are available without a prescription. This chapter outlines the advantages and drawbacks of each of your options, from the familiar condom and diaphragm to new alternatives like the vaginal sponge and female condom.

Ensuring Success

Barrier contraceptives won't prevent pregnancy unless you and your partner remember to use them every time you have sex. That means planning ahead. Unlike methods such as the IUD or the Pill, barrier contraceptives need to be applied within a specific time before intercourse occurs. In addition, the barrier method you choose must be used correctly and consistently. Carelessness significantly increases the failure (pregnancy) rates for each method.

Failure rates for contraceptive methods are usually given as a percentage: the number of pregnancies expected to occur in a group of 100 women using the method for one year. The official rates vary. A “perfect” or ideal rate assumes that the couple uses the method absolutely correctly and without fail every time they have sex. In the real world, however, few couples manage to maintain a “perfect” record. Mistakes do happen: women forget the sponge or cap, insert the diaphragm incorrectly, or run out of spermicide.

The failure rates given in this chapter (see nearby table) are based on typical use—that is, allowing for a certain margin of error on the user's part. The effectiveness of a particular method may be higher when it is invariably used correctly and consistently.

Your Options

Couples today no longer have to rely on okra pods, herbs, tree resins, and goat bladders to prevent unwanted pregnancy. Now they can choose from a wide variety of devices and chemical formulations. Some work well alone. Others are even more effective when used in combination. For example, more unplanned pregnancies occur when couples rely solely on the male condom than when the woman also uses a barrier. But no matter which type you select, or combination you choose, remember that you must follow the guidelines given below for maximum protection.

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