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INTRODUCTION — There are a number of methods available to help prevent pregnancy. Deciding which method is right for you involves considering a number of issues, including convenience, cost, potential side effects, and your future pregnancy plans. (See "Patient education: Birth control; which method is right for me? (Beyond the Basics)".)
Health care providers use the term "pericoital contraception" to refer to birth control methods that you use at the time of sex. These include condoms (both external and internal) as well as the diaphragm, cervical cap, sponge, and vaginal spermicides.
Condoms are also known as "barrier" methods of birth control; they physically block or otherwise prevent sperm from entering the uterus and reaching the egg for fertilization. The diaphragm, cervical cap, and sponge are used along with spermicide (a chemical substance that destroys sperm) to prevent pregnancy.
●Have no hormonal side effects (since they do not contain hormones).
●In the case of internal and external condoms, protect against certain sexually transmitted infections.
●Are available without a prescription (in the case of condoms, contraceptive sponges, and spermicides).
This topic discusses several methods of birth control including condoms, the diaphragm, the cervical cap, the contraceptive sponge, and spermicides. A discussion of hormonal and long-term birth control methods is available separately. (See "Patient education: Hormonal methods of birth control (Beyond the Basics)" and "Patient education: Long-acting methods of birth control (Beyond the Basics)".)
CHOOSING A BIRTH CONTROL METHOD — It can be difficult to decide which birth control method is best due to the variety of options available. The best method is one that will be used consistently and does not cause bothersome side effects. Other factors to consider include:
●Efficacy (how well it works to prevent pregnancy)
●How long the drug or device works
●Whether and how it affects your monthly period
●Type and frequency of side effects
●Whether or not it also protects against sexually transmitted diseases
●How quickly your fertility will return if you stop taking it
No birth control is perfect; you must balance the advantages and disadvantages of the different options and decide which method is best for you.
EFFICACY OF BARRIER AND PERICOITAL METHODS — The efficacy rates (that is, how well they work) depend on which birth control method you choose. Average pregnancy rates for people using each method are listed in the table (table 1). The risk of pregnancy may be slightly lower if you use your birth control perfectly, that is, you use it every time you have sex and follow all instructions carefully.
In general, barrier and pericoital methods do not prevent pregnancy as effectively as some of the other available methods (such as the intrauterine device [IUD], implant, or birth control pills). (See "Patient education: Hormonal methods of birth control (Beyond the Basics)" and "Patient education: Long-acting methods of birth control (Beyond the Basics)".)
EMERGENCY CONTRACEPTION — If you have unprotected sex (eg, you did not use birth control or the method did not work), there are still ways to lower the risk of pregnancy. You can have an IUD inserted (this is the most effective emergency contraceptive) or take a "morning after" pill to reduce your risk of pregnancy. This should be taken as soon as possible after sex, ideally within 120 hours.
Since barrier and pericoital methods can fail (for example, condoms can break, or you might forget to insert your diaphragm, cervical cap, or contraceptive sponge), it is a good idea to keep a supply of emergency contraceptive pills available at home to use if you need it. Emergency contraception is discussed in detail separately. (See "Patient education: Emergency contraception (Beyond the Basics)".)
CONDOMS — There are two types of condoms: external (which go over the penis) and internal (which go inside the vagina).
External condom — External (male) condoms are a thin, flexible sheath or cover that is placed over the erect penis to prevent semen from entering the partner's body during sexual intercourse. To help ensure optimal effectiveness and protection, anyone who uses condoms must carefully follow instructions for their use.
Spermicidal condoms (those that are packaged with spermicide applied to the condom) are no more effective and expire faster than condoms without spermicide and therefore are not recommended. It is better to use a separate spermicide instead. (See 'Spermicide' below.)
When used properly, condoms can also reduce the risk of sexually transmitted infections such as HIV. Studies have found the following:
●There is a decreased risk of gonorrhea, chlamydia, trichomonas, syphilis, HIV, and HPV (human papillomavirus, which can cause genital warts and cervical cancer) in women whose male partner consistently uses condoms. (See "Patient education: Genital warts in women (Beyond the Basics)" and "Patient education: Cervical cancer screening (Beyond the Basics)" and "Patient education: Testing for HIV (Beyond the Basics)".)
●In a study of HIV-negative women whose only risk for infection was a stable relationship with an HIV-infected man, none of the women who consistently used condoms became infected.
●Regular use of latex condoms appears to decrease the risk of HIV infection by approximately 69 percent.
Oil-based lubricants (eg, suntan oil, petroleum jelly, or food items such as whipped cream) should not be used with latex condoms because they can cause the condom to weaken and break. Water-based lubricants (sample brand names: K-Y liquid lubricant, Astroglide) are safe.
Most condoms are made of latex, which can be a problem for people who have an allergy or sensitivity to latex. Polyurethane condoms are an alternative to latex. Animal skin condoms (eg, lambskin) are not recommended when there is a risk of HIV infection because they do not effectively prevent transmission of HIV.
With use of condoms, approximately 13 out of 100 women will get pregnant during the first year. Efficacy is higher with perfect use (ie, using a condom correctly and every time you have sex).
Internal condom — The internal (female) condom is worn inside the vagina to prevent semen from entering. It is a sheath made of nitrile and is prelubricated with a silicone-based lubricant. There is a soft, flexible ring at each end (picture 1). The edges of the ring at the closed end of the sheath are squeezed together and then inserted as far as possible into the vagina; upon release, the ring will open to hold the condom in place. The ring at the open end of the sheath remains outside the vulva, resting against the labia.
With use of internal condoms, approximately 21 out of 100 women will get pregnant during the first year.
DIAPHRAGM/CERVICAL CAP — The diaphragm or cervical cap is placed over the cervix before sex. It prevents pregnancy by killing sperm with spermicide (see 'Spermicide' below). Both devices require fitting by a trained clinician, and the fit should be rechecked after you give birth or if you lose or gain more than 10 pounds (4.5 kilograms). One diaphragm (brand name: Caya) does not need to be fitted because it comes in a single size anyone can use.
Both the diaphragm and the cervical cap can decrease the risk of certain sexually transmitted diseases and infections, including gonorrhea, chlamydia, and pelvic inflammatory disease. However, they do not prevent the spread of HIV infection. Women with known HIV infection or those who are at risk of becoming infected with HIV are advised to use external condoms (if their partners have a penis) in addition to the diaphragm or cervical cap.
In most studies, the failure rate (number of pregnancies) was higher for users of the diaphragm or cervical cap compared with those using hormonal methods of birth control (eg, the birth control pill). (See "Patient education: Hormonal methods of birth control (Beyond the Basics)".)
Approximately 17 out of 100 women using the diaphragm will become pregnant during the first year. With the cervical cap, 16 to 32 out of 100 women will get pregnant in the first year; the cervical cap is less effective for women who have given birth. (See 'Cervical cap' below.)
Diaphragm — The diaphragm is a soft, dome-shaped cup made of silicone with a flexible rim. Before sex, the hollow of the dome is partially filled with a spermicidal cream or jelly and then the diaphragm is inserted deep into the vagina and positioned so that it fits over the cervix (picture 2). It must be left in place for six to eight hours after sexual intercourse and should then be removed. If you have sex more than once during this time, you do not need to remove the diaphragm, but an additional dose of spermicide should be inserted into the vagina.
Precautions — Most women can use the diaphragm; however; it is not a good method for those who have an allergy/sensitivity to silicone or spermicides; problems with the pelvic floor muscles (uterine prolapse, cystocele, rectocele, or poor vaginal tone); difficulty with the insertion process; or frequent urinary tract infections. As discussed above, women who have a sexually transmitted infection (or are at high risk for acquiring one) should use an external condom during sex (if their partners have a penis) in addition to the diaphragm. Women with a history of toxic shock syndrome should not use a diaphragm. In some women, using a diaphragm increases risk of urinary tract infections.
Cervical cap — The cervical cap is available in silicone rubber (brand name: FemCap) in multiple sizes. Similar to the diaphragm, it is partially filled with spermicide and placed over the cervix. It can remain in place for up to 48 hours.
The cervical cap may not be a good choice if you have given birth before because it is less effective in preventing pregnancy in this situation. This is because childbirth changes the size of the cervix, so the cap may not fit as well.
SPONGE — The contraceptive sponge blocks sperm from entering the uterus and contains a spermicide to kill sperm. It can be purchased without a prescription (brand name: Today).
The sponge is a two-inch wide circular disk that is 3/4 of an inch thick and attached to a loop that is used for removal. It contains a spermicide, and is moistened with tap water before insertion deep in the vagina.
The sponge can be left in place and used repeatedly for up to 24 hours.
With sponge use, approximately 14 women out of 100 will become pregnant during the first year. The failure rate is higher in women who have previously given birth (approximately 27 percent).
VAGINAL SPERMICIDE AND pH REGULATOR GEL
Spermicide — Spermicides are chemical substances that destroy sperm. They are available in most pharmacies without a prescription. Spermicides are available in a variety of forms including gel, foam, cream, film, suppository, and tablet.
Spermicides may be used alone, but are more effective when used in combination with a condom, diaphragm, or cervical cap. Effectiveness is reduced if a couple does not wait long enough for the spermicide to disperse before having sex, if sex is delayed for more than one hour after application, or if a repeat dose is not applied before having sex again.
Local irritation of the vagina is not uncommon with spermicide use, and use of spermicide-coated condoms are associated with an increased risk of urinary tract infection in the female partner. In the United States, the only spermicide available is nonoxynol-9; use of this spermicide alone is not effective in preventing transmission of sexually transmitted infections, including HIV.
Approximately 21 out of 100 women using spermicides will become pregnant during the first year. When a spermicide is used with another contraceptive method, such as a condom or diaphragm, the number of women who become pregnant is much lower.
Vaginal pH regulator gel — In 2020, another vaginal gel became available. This product (brand name: Phexxi) changes acidity levels in the vagina, which reduces sperm mobility. This makes sperm less likely to reach and fertilize an egg (causing pregnancy). The gel is inserted into the vagina one hour or sooner before sex.
Vaginal contraceptive gel appears to be approximately as effective as spermicide in preventing pregnancy but may have fewer side effects, such as irritation of the vagina or the partner's penis. It can be used along with other birth control methods, although people who use the hormonal vaginal ring should not use the gel. (See "Patient education: Hormonal methods of birth control (Beyond the Basics)", section on 'Vaginal rings'.)
WHERE TO GET MORE INFORMATION — Your health care provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Patient education: Barrier methods of birth control (The Basics)
Patient education: Choosing birth control (The Basics)
Patient education: Vasectomy (The Basics)
Patient education: Screening for sexually transmitted infections (The Basics)
Patient education: Syphilis (The Basics)
Patient education: Urethritis (The Basics)
Patient education: Hormonal birth control (The Basics)
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Patient education: Hormonal methods of birth control (Beyond the Basics)
Patient education: Long-acting methods of birth control (Beyond the Basics)
Patient education: Birth control; which method is right for me? (Beyond the Basics)
Patient education: Emergency contraception (Beyond the Basics)
Patient education: Genital warts in women (Beyond the Basics)
Patient education: Cervical cancer screening (Beyond the Basics)
Patient education: Testing for HIV (Beyond the Basics)
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
Intrauterine contraception: Candidates and device selection
Contraception: Issues specific to adolescents
Depot medroxyprogesterone acetate (DMPA): Formulations, patient selection and drug administration
Internal (formerly female) condoms
Fertility awareness-based methods of pregnancy prevention
Hormonal contraception for suppression of menstruation
Pericoital (on demand) contraception: Diaphragm, cervical cap, spermicides, and sponge
External (formerly male) condoms
Contraception: Counseling and selection
Combined estrogen-progestin oral contraceptives: Patient selection, counseling, and use
Progestin-only pills (POPs) for contraception
Combined estrogen-progestin contraception: Side effects and health concerns
The following organizations also provide reliable health information.
●National Library of Medicine
●National Institute of Child Health and Human Development (NICHD)
Toll-free: (800) 370-2943
●National Women's Health Resource Center (NWHRC)
Toll-free: (877) 986-9472
●Planned Parenthood Federation of America
Phone: (212) 541-7800
●The Hormone Foundation