Barrier contraception

Condoms

  • Male (external) condom — 88% effective, cheap and available over the counter
  • Female (internal) condom — 79% effective, more expensive and available over the counter

What

  • Male (external) condom — latex or non-latex sheath pulled onto erect penis
  • Female (internal) condom — loose-fitting polyurethane (non-latex) sheath inside vagina or anus

How it works

  • Prevents contact between eggs, sperm and some STIs
  • Correct use
    • In date and stored in cool place
    • Worn and removed carefully so contents don't spill

    • Disposed of carefully after use and out of reach of children — bury or burn used condom or put in can and flatten. Don't flush down the toilet

Timing — Single use only. New one needed each time they have sex

Who benefits — men and women who want

  • STI protection
  • Cheap and  non-hormonal contraception

Promoting condoms

  • Important that condoms are easy to get without shame
  • Offer condoms and talk about where they can get more
  • Talk with ATSIHPs, appropriate local staff and community members about good places to supply condoms (eg shop, clinic, garage, council, club, toilets)

Special issues

Type of male (external) condoms

  • Latex
  • Non-latex (eg polyurethane, polyisoprene)
    • May transmit body-heat and sensation better
    • Useful if latex allergy

Lubricants

  • Do not use oil-based lubricants — water-based or silicone-based lubricants are safe with all condoms
  • Medicines used inside the vagina (eg thrush cream) are oil-based and may weaken latex or polyisoprene (rubber) condoms if used 

Negotiating use

  • Men and women may feel shame to suggest or use condoms
  • Women or transgender people may have little power to negotiate — try to talk about this

Condom uncomfortable 

  • Could be too dry — use water-based or silicone-based lubricant (only on the outside of the male condom)
  • Could be latex allergy — try non-latex condoms
  • Less sensitivity — try polyurethane condoms
  • Check for thrush (candida) or STI

Breakage/slippage

  • Check they know how to use condoms properly — see male condom demonstration 
  • Check use-by date and that packet is intact
  • Use lubricant
  • Beware of sharp fingernails/teeth
  • Check size of condom
  • Offer woman ECP
  • Offer both partners STI check — man, woman, young person

Male (external) condom demonstration

Offer to demonstrate how to use condom

  • Check use-by date — Figure 7.2. Feel condom packet — should be 'squashy'. Open carefully

Figure 7.2   

Figure 7.3   

Figure 7.4   

Figure 7.5   
  • Use water-based lubricant for anal sex or if extra lubrication needed for vaginal sex
    • Do not use oils or Vaseline — they weaken the rubber
  • After man has ejaculated ('cum', passed sperm) while penis still hard, hold condom on penis and take penis out of vagina or anus slowly
  • When penis soft, remove condom — Figure 7.6
  • Tie knot in condom — Figure 7.7, dispose of carefully
  • Wipe excess sperm from penis

Figure 7.6   

Figure 7.7   

Diaphragms

82% effective

  • Not commonly used by women in remote areas
  • If woman would like to try a diaphragm — get help. Woman needs informed discussion with knowledgeable practitioner

What

  • Dome-shaped silicone cap inserted in vagina to cover cervix (base of womb)
  • One size fits about 80% of women
  • Non-hormonal

How it works — prevents contact between egg and sperm if used correctly. Does not provide STI protection

Timing — inserted before sex, left in for 6 hours. Do not leave in for more than 24 hours

Figure 7.8