Spotters in "Family Planning: Barrier Contraceptive Methods" for CFM & MPH students

 Physical methods:

1. Male Condom:

Important points:

• It is a thin sheath made up of latex or other material
• Most widely known & used barrier method by males
• An effective, simple spacing method without side effects
• Mechanism of action: Acts as a physical barrier & prevents the semen from being deposited in female genital tract
• Pearl index/ Failure rate: 2-3 to 14 per 100 women years
• Advantages:  Easily available, safe & inexpensive, easy to use & do not require medical supervision, no side effects, light compact and disposable, provides protection not only against pregnancy but also against STDs
• Disadvantages: It may tear or slip off during coitus due to incorrect use, interferes with sex sensation locally, 
• Manufactured in India by Hindustan Latex in Trivandrum, London Rubber industries Chennai 

2. Female Condom:

Important points:

• It is a pouch made of thin plastic, polyurethane, which lines the vagina
• Has two rings,a thick inner ring with closed end, which is placed in the vagina & thin outer ring that remains outside the body covering the opening
• Mechanism of action: It is an effective barrier method & prevents the semen from being deposited in female genital tract
• Pearl index/ Failure rate:  5-21 per 100 women years
• Advantages:  It prevents pregnancy as well as STDs, controlled by women & can be used even during menstruation
• Disadvantages: Relatively expensive & not very popular choice among women

3. Diaphragm/ Dutch cap:

Important points:

• It is a shallow cup made up of synthetic rubber or plastic material
• Diameter 5-10 cm (2-4 inches)
• Has a flexible ring made up of spring or metal
• Spermicide jelly is always used along with the diaphragm
• Mechanism of action: Acts as barrier & inserted before sexual intercourse
• Pearl index/ Failure rate:  6-12 per 100 women years
• Advantages: Prevents pregnancy but not STDs. Almost total absence of risks & medical contraindications, safely used during breastfeeding, protects against PID & HPV
• Disadvantages: initial training by physician is needed, if left in vagina for long period there is possibility of toxic shock syndrome, best avoided in urinary tract and bladder infections or if allergy to rubber/latex
• Not recommended by National family welfare programme

4. Vaginal sponge:

Important points:

• It is shaped like a mushroom cap & made of polyurethane
• Contains 1 gm of nanoxynol-9
• Measures 5 cm * 2.5 cm
• It should be moistened with water (not saliva) just before saliva & placed over cervix
• Mechanism of action: Acts  as a barrier & can be used for 24 hours, it should not be removed for 6 hours after intercourse
• Pearl index/ Failure rate:  20-40 per 100 women years in parous women and 9-20 in nulliparous women
• Advantages: Prevents pregnancy but not STDs 
• Disadvantages: Sometimes it may cause allergic reactions, toxic shock syndrome, vaginal irritation & fungal infection

Chemical methods:

1. Foams:

Important points:

• It is a spermicide
• Mechanism of action: They are surface active agents which attach themselves to spermatozoa & inhibit oxygen uptake and kill sperms
• Pearl index/ Failure rate:  per 100 women years
• Advantages:  Prevents pregnancy but not STDs
• Disadvantages: High failure rate, must be used immediately before intercourse, repeated before each act, may cause burning or irritation besides messiness, may be carcinogenic to fetuses

2. Cream, jellies & pastes:

 

Important points:

• It is a spermicide
• Mechanism of action: They are surface active agents which attach themselves to spermatozoa & inhibit oxygen uptake and kill sperms
• Pearl index/ Failure rate:  per 100 women years
• Advantages:  Prevents pregnancy but not STDs
• Disadvantages: High failure rate, must be used immediately before intercourse, repeated before each act, may cause burning or irritation besides messiness, may be carcinogenic to fetuses

3. Suppositories:

Important points:

• It is a spermicide
• Mechanism of action: They are surface active agents which attach themselves to spermatozoa & inhibit oxygen uptake and kill sperms
• Pearl index/ Failure rate:  per 100 women years
• Advantages:  Prevents pregnancy but not STDs
• Disadvantages: High failure rate, must be used immediately before intercourse, repeated before each act, may cause burning or irritation besides messiness, may be carcinogenic to fetuses

4. Soluble films:

Important points:

• It is a spermicide
• Mechanism of action: They are surface active agents which attach themselves to spermatozoa & inhibit oxygen uptake and kill sperms
• Pearl index/ Failure rate:  per 100 women years
• Advantages:  Prevents pregnancy but not STDs
• Disadvantages: High failure rate, must be used immediately before intercourse, repeated before each act, may cause burning or irritation besides messiness, may be carcinogenic to fetuses

References:

1. Park, K. (2019). Park's textbook of preventive and social medicine. 25th. Jabalpur, India: M/S Banarsidas Bhanot.
2. Kadri AM. (2019). IAPSM's Textbook of Community Medicine. 1st. New Delhi, India: Jaypee Brothers Medical Publishers (P) Ltd.
3. https://humdo.nhp.gov.in/choice_for_planning/nirodh/ photo credit
4. https://commons.wikimedia.org/wiki/File:Male_Condom.png photo credit
5. https://www.saintlukeskc.org/health-library/birth-control-condoms photo credit
6. https://www.thecut.com/2016/09/why-is-it-so-hard-to-get-a-diaphragm-these-days.html photo credit
7. https://online.pharmacy/product/product-576/ photo credit
8. https://www.ssplprints.com/image/99354/delfen-contraceptive-foam-2000 photo credit
9. https://www.amazon.in/ContraGel-Green-Contraceptive-Gel-60ml/dp/B00ZMWSGOS photo credit
10. https://yaoota.com/en-eg/product/contra-seed-12-vag-supp-2-price-from-seif-egypt photo credit
11. https://www.amazon.com/VCF-Vaginal-Contraceptive-Single-Sealed/dp/B000GGT8X8 photo credit