Natural and Barrier Methods of Contraception

Definition


Natural contraception is a method of preventing pregnancy without the use of medications or physical devices.

What are the natural methods?

 

Natural methods rely on the observations of a woman' body and menstrual cycle based on Fertility Awareness Methods (FAMs). Women can reduce the risk of pregnancy by avoiding sexual intercourse during the fertile window (i.e. during ovulation).

Effectiveness?


The contraception efficacy of natural methods is approximately 75% as the estimation of fertile window can be difficult.

Natural Methods


Advantages

  • No side effects.

  • Acceptable to all faiths and cultures.

  • Most women can use natural family planning if properly trained by a teacher in fertility awareness, and keep accurate records. 

  • Once educated, there is no further need for input from HCPs.

  • Non-reliance on chemicals or physical products.

  • The practice involves both partners, which could enhance feelings of closeness and trust. 

Disadvantages

  • Does not protect against sexually transmitted infections.

  • Must avoid sex during the fertile window or use other methods of contraception such as condoms to prevent unplanned pregnancy

  • May need to avoid sex for a long duration of time (up to 16 days), depending on individual's menstrual cycle

  • May not be as effective as other methods of contraception

  • Need continuing commitment and co-operation from both.

  • Can take several menstrual cycles before the patient becomes confident in identifying her fertile time.

  • Need to keep a daily record of your fertility signs.

  • Not suitable for patients that have persistent irregular periods.

  • Many other factors such as stress, illness, travel, lifestyle and use of hormonal treatments can disrupt patient's fertility signs.

How to detect fertile period?


3 methods that can be used  in combination to identify the fertile window:

  1. Recording and calculating menstrual cycle on a calendar

  2. Measuring body temperature daily in the morning (temperature drops 0.5 degree C during ovulation period)

  3. Monitoring the changes in cervical mucus

Conclusion


Although it has advantages, natural methods need commitment and diligence and detecting the fertile period can be difficult – therefore in reality this method may not be very effective.

Barrier Methods of Contraception

 

Barrier methods of contraception prevent pregnancy by blocking the s[perm from coming into contact with an ovum.

Types of Barrier Methods
Male condom
Cervical cap
Diaphragm
Female condom
Spermicides

Male Condom


How does it work?

  • Put the condom on the penis before any genital contact.

  • Avoid usage of oil-based lubricants such as vaseline and baby oil, which may cause chemical damage. Use KY jelly, or a spermicidal product.


How effective is it?
Typical effectiveness rate = 88%

Common problems

  • Genital contact – condom put on just before ejaculation – not in time to catch the first fraction of sperm.

  • Loss of erection – condom slips off before ejaculation.

  • Leakage on withdrawal, when the penis is flaccid.

  • Damage to the sheath – manufacturing defects, chemical damage or by sharp fingernails.

Disadvantages

  • Decreased ‘sensitivity’, especially for the male.

  • May slip off or rupture.

  • Even very small leaks of semen may cause a pregnancy. Hence extremely meticulous use is required.

  • Side effects – very few but includes allergy to rubber.

Cervical Cap & Diaphragm

How does it work? How effective?

  • Use together with spermicides to achieve better results.

  • Do not remove for six hours after intercourse

  • Typical effectiveness rate = 80%

Advantages

  • Protection against sexually transmitted infections

  • Aesthetically useful for intercourse during uterine bleeding

  • No proven systemic effects

 

Disadvantages

  • Local adverse effects such as vaginal irritation or abrasion

  • Allergy to the rubber, or spermicide

Female Condom


Effectiveness

  • Typical effectiveness rate = 80%

Advantages

  • Over-the-counter method.

  • Complete barrier against sexually transmitted infections including viruses.

  • Less likely than male condom to rupture in use.

  • Not damaged by any common chemicals.

Disadvantages

  • Prominence during foreplay.

  • Potential for penis to wrongly position between sac and vaginal wall.

  • Rather noisy.

Spermicides


Should be used in combination with another method for example male condom, since it is not effective enough to use alone.

Advantages

  • No major health risks

  • Protect against some sexually transmitted infections.

Disadvantages

  • Waiting period of 10 minutes before it is effective.

  • Not effective if inserted more than 60 minutes ahead.

References

  1. Shagaf H Bakour, Archana Hatti, Susan Whalen. Contraceptive methods and issues around the menopause: an evidence update. The Obstetrician & Gynaecologist 2017;19:289-297.

  2. www.plannedparenthood.org/bc Hatcher, Robert, MD. Contraceptive Technology. 17th edition, 2001.

  3. Arulkumaran S, Sivanesartnam V, Chatterjee A, Kumar P. Essential of Gynaecology. Second Edition. Jaypee Brothes Medical Publishers (P) Ltd; 2011

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