Contraceptive Jungle Part II: Which Contraception should I Use?

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There are many methods of contraception to chose from, some may be suitable for some women but not for others. On the other hand some may be used at a certain stage of woman’s life but not at other times. There are many products available on the market which may cause a great confusion to the couple seeking contraception.

This article will address some methods of contraception, their indications, advantages, disadvantage and their contraindications. 

Natural Methods


Though research has proved that breastfeeding suppresses fertility, many women have experienced either themselves or other women becoming pregnant while breastfeeding. Lactational amenorrhoea which is absence of periods due to breast feeding is a temporary contraception. Therefore, a woman must also use some other method of contraception while breastfeeding. Contraceptive devices that can be used while breastfeeding are: Barrier methods, intrauterine devices, injectables and  mini pills It is recommended to avoid using oral contraception containing both estrogen and progesterone as the combination decreases breast milk production. However, it is important to note that 3-15 % of women conceive before the first post delivery menstruation. Therefore don’t depend entirely on breastfeeding if you want to avoid pregnancy.

Withdrawal Method

This method is known also as coitus interruptus. The couple proceeds with intercourse in the usual way until the moment of ejaculation and the male withdraws his organ and discharges outside the vagina or the external genitalia. This method may make one or both partners not completely satisfied by the sexual experience. The female partner may develop sexual neurosis as female satisfaction/orgasm may not be achieved. On the other hand the pre-ejaculate (fluid that is secreted for lubrication, in males) may contain few sperms which may lead to unwanted pregnancy thus 5 to 25% may conceive in spite of using this method. Obviously this method cannot be used by males suffering from premature ejaculation.

Safe Period

The safe period is no longer safe. It has been proven that sperms can live up to five days in the female genital tract. Some reports have mentioned even up to seven days. This means that the couple will have to avoid having intercourse for a long period of time during the cycle to reduce the chances of pregnancy. This may not be accepted by many couples. There are many methods to detect the time of ovulation thus to avoid having sex. These methods depend either on checking the basal body temperature or the quality of the cervical mucus. The other way is calculating the time ovulation, which is 14 days before the next expected period, then avoiding intercourse 3-4 days before after that day.

Barrier Methods


Condoms are contraceptive sheaths meant to cover the penis during coitus to prevent pregnancy. A condom is a narrow tube usually made of natural rubber latex, which is closed at one end. Most condoms have a teat at the end, which holds semen once the man has ejaculated. Male condoms are available in a variety of types: plain, colored, ribbed, flavored, and shaped.

The condom should be put on by unrolling it on to the erect penis before there is any contact between the male and female organs. The teat should be emptied by squeezing the tip by holding up before unrolling for better full collection of semen after ejaculation. A pre-lubricated condom is preferable. It is advisable not to use lubricants like creams, oils, Vaseline or skin lotion. The failure rate of condoms is dependant on the couple using it. If the condom is using correctly, they can be 98% reliable at protecting from unwanted pregnancies. However, with some couples this can fall to 85%. To reduce the pregnancy rate the condom should be unrolled on erect penis before there is any contact between male and female organs. Spermicidal cream, jelly or foam tablet may be used at the same time as this may increase its efficiency. Soon after ejaculation, the male should withdraw the penis holding the condom firmly against his body. Making sure the condom is thrown away and the penis dried before further contact with the female’s genital area.

There are many advantages for using condoms, they are easily available and don’t require any special training. They offer protection against sexually transmitted diseases and AIDS (HIV infection). They are non hormonal thus avoiding side effects encountered with pills. Condoms are most suitable for couples having infrequent coitus, during breastfeeding and holidays.

However, there are some problems with the use of condoms. They should be avoided if there is allergy to latex material. They can split or have a tiny hole which may allow semen to escape. Some couples are uncomfortable with the use of condoms are they feel it interferes with sexual pleasure and may cause pain.


Female Sheath

The female sheath is a tube of very thin rubber or polyurethane plastic, which is pre-lubricated with a silicone base. It is closed at one end and has two flexible rings. The loose inner ring fits inside the vagina and the fixed outer ring stays flat on the outside of the vagina. It works by gently lining the inside of the vagina and the area just outside and stops sperms from entering the vagina. To remove after intercourse, simply twist the outer ring to hold the semen and gently pull the female condom out. The sheath has many advantages as it protects from sexually transmitted diseases (STD’s) and HIV and may protect against cervical cancer. It can be used with oil based lubricants, such as body oils, lotions and petroleum jelly, unlike male condoms should not be used with an oil based lubricant. They are 95% reliable if used according to manufacturer’s instructions.

However, the sheath may be tricky to use at first but usually gets better with practice. Some women are unhappy inserting the sheath into the vagina, as the inner ring can slide down if not fit properly, which can be uncomfortable


Vaginal Diaphragm

It consists of thin, nearly hemispherical dome made of rubber or latex material, with a circular, covered metal spring at the periphery. These are available under the names of ortho diaphragm or komex diaphragm.

The doctor chooses the appropriate size after internal examination. The cap should be introduced two hours before the sexual act. An applicator full of spermicidal cream or jelly should be introduced vaginally or a foam pessary introduced at least 15 minutes earlier as it takes time to dissolve. Like condoms, diaphragms can prevent spread of sexually transmitted diseases, although less effectively, they don’t have major side effects and don’t interfere with sexual pleasure. However, the use of spermicides with occlusive caps is found to be messy and unacceptable for some women. If forgotten inside may cause infection, the vaginal diaphragm shouldn’t be removed 6 – 8 hours of the last act and shouldn’t be kept for more than 24 hours. After removal, vaginal diaphragm should be cleaned with soap and water, dried thoroughly and kept in a well fitting container. It can be re-used for average 50 times or up to 6 months. They can only be used correctly by intelligent and highly motivated women. The failure rate is less than 2%, when used as per manufacturer’s instructions.

Cervical Cap 
Cervical caps are small thimble or dome shaped rubber appliances designed to cover the cervix, which is the neck of the womb. They remain in place by suction. The degree of suction depends on the tightness of the fit.  They are not very popular thus not much used in practice.


Spermicides are chemical agents capable of destroying sperms. Spermicides alone are not very effective in preventing pregnancy and are not recommended alone. Their main role is to improve the contraceptive effect of other barrier methods. They are mostly used along with diaphragms, cervical caps and condoms. If used alone the failure rate can be as high as 30%.

I hope this article has clarified some facts in respect to natural and barrier methods of contraception. Next month’s issue will try to cover other contraceptives available.

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