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Barrier methods for contraception and STI prevention

How to use barrier methods

  • Men and women requesting a barrier method should be informed of the efficacy of the method, including the failure rate relative to other methods such as long-acting reversible contraception. Information should be provided on correct use, factors affecting efficacy, and when sexually transmitted infection (STI) testing, emergency contraception (EC) and post-exposure prophylaxis after sexual exposure to HIV (PEPSE) may be required
  • A diaphragm or cervical cap can be inserted with spermicide any time before intercourse
  • Spermicide should be reapplied if sex is to take place and the diaphragm or cap has been in situ for ≥3 hours or if sex is repeated with the method in place
  • A diaphragm or cervical cap should not be removed until at least 6 hours after the last episode of intercourse

Efficacy of barrier methods: pregnancy prevention

  • Male condoms are 98% effective and female condoms are 95% effective at preventing pregnancy but only when used consistently and correctly
  • Pregnancy rates are similar for latex and non-latex condoms
  • When used consistently, correctly and with spermicide, diaphragms and cervical caps are estimated to be between 92% and 96% effective at preventing pregnancy

Efficacy of barrier methods: STI prevention

  • Sexually active men and women can be informed that the consistent and correct use of condoms (including with sex toys) is the most efficient means of protecting against HIV and other STIs
  • Women using a diaphragm or cervical cap should be aware that there is little evidence that these methods reduce the risk of HIV/STI transmission or development of cervical intraepithelial neoplasia
  • Individuals should be informed that dams are available as a means of reducing risk of exposure to STIs and blood-borne viruses during cunnilingus and/or oro-anal contact

Factors affecting efficacy

  • Women using a diaphragm or cap should be advised to use the method with spermicide
  • The use of condoms lubricated with nonoxinol-9 is not recommended
  • When using lubricant with latex condoms, diaphragms and caps a water- or silicone-based preparation is recommended
  • The use of lubricant is recommended for anal sex to reduce the risk of condom breakage
  • In terms of condom safety, there is insufficient evidence to routinely advise additional lubricant for vaginal sex, but its use can be considered for those experiencing condom breakage
  • Men and women should be informed that adding lubricant to the inside of condoms or to the outside of the penis before using condoms is associated with an increased risk of slippage
  • Ill-fitting condoms can be associated with breakage and incomplete use. Individuals should be informed that different shapes and sizes of condoms are available
  • Condom breakage rates are similar for standard and thicker condoms and therefore there is no requirement to recommend thicker condoms for anal sex
  • Advice on condoms should be supported by demonstration of correct use

HIV/STI transmission and the law

  • Health professionals should keep up to date with the important legal issues regarding HIV/STI transmission and advise patients appropriately as regards partner notification, disclosure and condom use

Other considerations

  • Men and women can be made aware of post-exposure prophylaxis after sexual exposure to HIV (PEPSE). The decision to initiate PEPSE can only be made after consideration of the risks of exposure and likelihood of side effects and compliance with treatment
  • Health professionals should utilise opportunities such as presentation for EC, PEPSE or STI testing to discuss pregnancy and STI risk reduction strategies
  • Health professionals should inform women about the availability of EC and when it can be used. Advance supply may be considered but there is no evidence to support routine provision

Medical eligibility

  • For women living with HIV or at high risk of HIV infection the use of either a diaphragm or cervical cap is a UK Medical Eligibility Criteria (UKMEC) Category 3
  • Women with sensitivity to latex proteins should avoid the use of latex barrier contraceptives and may use a silicone diaphragm, cervical cap, non-latex male or female condoms, or deproteinised latex male condoms
  • For women with a history of toxic shock syndrome (TSS) the use of the diaphragm, cervical cap or contraceptive sponge is UKMEC Category 3
  • Women with a history of TSS may use male or female condoms
  • Caps and diaphragms should not be left in situ for longer than recommended by the manufacturer or used during menstruation

full guidelines available from…
Faculty of Sexual & Reproductive Healthcare
www.fsrh.org/standards-and-guidance

Faculty of Sexual & Reproductive Healthcare Clinical Guidance: Barrier methods for contraception and STI prevention. August 2012
First included: February 2008.