Contraceptive Practices

Male Condom

Used correctly, condoms rarely break or slip. Studies have found that only a small portion of condom users break them during use, and these people can be identified by good screening.

To use correctly:

  • open package carefully to avoid tearing condom, especially with sharp objects like fingernails, teeth or scissors
  • roll condom directly onto the erect penis all the way to the base of the shaft (do not unroll before putting it on)
  • pinch the end of the condom while unrolling it to leave room for the semen
  • after ejaculation, hold rim of condom and pull penis out of vagina before penis gets soft, to prevent condom from slipping off
  • slide condom off penis without spilling semen
  • dispose of properly after use

Other considerations:

  • avoid genital contact before condom is put on
  • use a separate condom for each act of intercourse, never reuse a condom
  • use only water based lubricants such as K-Y jelly, spermicidal gels or creams or saliva; oil-based lubricants such as hand lotions and mineral or vegetable oils weaken condoms in just a few minutes, making them more likely to break
  • if the package has been torn or damaged or if the condom feels brittle or dry or has changed color, do not use the condom

Female Condom

To avoid tearing the female condom, the package should be opened carefully, especially when using sharp objects like fingernails, teeth or scissors.

To use correctly:

  • insert inner ring high in the vagina, against the cervix
  • place the outer ring properly outside the vagina
  • during intercourse, be sure the penis is placed inside the female condom

Other considerations:

  • avoid genital contact before condom is put in and after it is removed
  • can be used by a woman who is pregnant or menstruating, but not by a woman who has a tampon inserted
  • is pre-lubricated with silicone, and a vial of lubricant is provided to allow adding more lubrication to meet a couple's preference; adding lubricant also reduces noise during use
  • dispose of properly after use

Spermicides

Spermicides should be placed high in the vagina near the cervix shortly before intercourse, and reinserted for each act of intercourse. Foams, jellies and creams are effective as soon as inserted. Suppositories, tablets and films require five to 15 minutes to dissolve before intercourse.

To use correctly:

  • use clean hands and a clean applicator when inserting
  • for foams, shake container vigorously just before insertion
  • for jelly or cream, fill applicator and insert far into vagina (near cervix); push applicator plunger to release spermicide; after each use, wash applicator with soap and water
  • film must be folded in half and inserted with dry fingers near the cervix, or the film will stick to the fingers and not the cervix

Other considerations:

  • once inserted, spermicides are effective for one to two hours
  • for maximum effectiveness, a spermicide should be used with another barrier method, such as a diaphragm or condom
  • after intercourse, wait at least six hours before douching

Diaphragm

A diaphragm must be fitted initially by a trained provider and is not recommended for women with cervical or vaginal abnormalities or during the first six weeks after childbirth.

To use correctly:

  • before inserting, check for holes or tears by holding it up to the light; if defective, use a backup method
  • spread spermicidal jelly or cream on the inside portion of the dome and rim with clean, washed hands
  • put the device all the way back against the cervix with the cavity containing the spermicide covering the cervical opening; feel around the edge to be sure the cervix is completely covered
  • if intercourse occurs more than an hour after inserting a diaphragm, or if multiple acts occur, spermicide should be added without removing the diaphragm
  • leave in place for at least six hours after the last act of intercourse, but no more than 24 hours
  • after use, wash with soap and water, dry it, and store it in a cool, dry, dark place

Other considerations:

  • after intercourse, wait at least six hours before douching
  • when removing, care should be taken not to damage it with fingernails
  • refitting may be necessary following weight change, full-term pregnancy or late-term abortion

Cervical Cap

Cervical caps are inserted before intercourse and can remain in place up to 48 hours. They are effective for multiple acts of intercourse.

They must be fitted initially by a trained provider and are not recommended for women with cervical or vaginal abnormalities or during the first six weeks after childbirth.

To use correctly:

  • before inserting, check for holes or tears by holding it up to the light; if defective, use a backup method
  • fill one-third to one-half of cap with spermicidal jelly or cream
  • insert by squeezing cap between thumb and index finger, sliding into vagina and pressing rim around cervix; feel around the edge to be sure the cervix is completely covered
  • to remove, press on rim until seal on cervix is broken, tilt cap, then hook fingers under rim and pull sideways out of vagina
  • after use, wash with mild soap and water, and dry thoroughly; store in a cool, dry, dark place

Other considerations:

  • although it can stay in place for up to 48 hours, this may lead to a bad odor
  • after intercourse, wait at least six hours before douching
  • when removing, care should be taken not to damage it with fingernails
  • refitting may be necessary following weight change, full-term pregnancy or late-term abortion

Sponge

A sponge is effective for multiple acts of intercourse and, depending upon brand, may be used up to 12 hours or up to 24 hours. It should be left in place for several hours after intercourse.

Specific instructions vary by product. The sponge is currently marketed only in France (benzalkonium product) and Canada (a product containing sodium cholate, benzalkonium chloride and nonoxynol-9). A U.S. nonoxynol-9 product, the Today sponge, is no longer manufactured.

To use correctly:

  • insert deep into the vagina so it rests against the cervix
  • check placement before and after intercourse
  • follow other brand-specific instructions provided in the labeling
  • dispose of properly after use

Other considerations:

  • use only once
  • no fitting needed
  • consider using with condom to increase effectiveness
 
Sources: Feldblum P, Joanis C. Modern Barrier Methods: Effective Contraception and Disease Prevention. Research Triangle Park: Family Health International, 1994; Hatcher RA, Trussell J, Stewart F, et al. Contraceptive Technology Sixteenth Revised Edition. New York: Irvington Publishers, Inc., 1994

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