Abstract

PIP: Barrier methods keep sperm from entering the cervical canal. Spermicides, most of which are nonoxynol based, are used with diaphragms and caps and in the lubrication of some male condoms. One dose of spermicide for each act of intercourse suffices. The efficacy rate of barrier methods is good when used before any genital contact and used correctly. Nurses should discuss with potential users of barrier methods the possibility of failure and inform them about postcoital contraception. Nurses or family planning-trained physicians must do an accurate fitting of diaphragms and caps. They need to also do a good job of teaching clients how to use them. The failure rate of diaphragms and caps is 4-18%, depending on the degree of consistent and correct use. Diaphragms and caps protect against some sexually transmitted diseases (STDs) (but not HIV) and may protect against cervical cancer and pelvic inflammatory disease (PID). Diaphragms lie across the cervix. Suction holds the cap over the cervix. The type and size of cap depends on the shape of the cervix. Contraindications to the diaphragm or cap range from allergy to rubber or spermicides to current vaginal, cervical, or pelvic infection. Diaphragms and caps must be left in position for 6 hours after intercourse but no longer than 24 hours. They can be inserted 3 hours before intercourse and, if it is longer than 3 hours, an extra dose of spermicide should be inserted. The UK has had the single-use female condom since 1992. It comes in 1 size. It protects against STDs, including HIV; cervical cancer; and PID. Acceptability of the female condom is rather low, however. Spermicides protect against some STDs. The contraceptive sponge is a carrier for the spermicide and is not a barrier method. Its efficacy is relatively low (75-90%). Male condom efficacy varies from 85-98%. Male condoms protect against STDs and HIV. Nurses should advise both male and female clients about correct use of male condoms.