BIRTH CONTROL

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2 ARTIFICIAL METHODS

Condoms

Condoms are rubber sheaths that fit closely over the entire erect penis. They protect against pregnancy by collecting all the semen a man ejaculates and preventing any of it from getting into the vagina. When condoms are used properly their effectiveness is about 97 percent, a rate similar to those of the IUD or diaphragm. When a condom is used together with a contraceptive foam or jelly their combined effectiveness is about 99 percent. A condom should not be used twice. There are no medical risks in using condoms and no medical reasons why they cannot be used. Some people's skin is allergic to latex, but they can change to condoms made of sheep's intestines. Some women have found that latex condoms irritate the vagina, but the irritation usually disappears when a lubricant for intercourse is placed in the vagina or on the condom.

Condoms are inexpensive, convenient to use, require no medical examination or prescription, give some protection against sexually transmitted diseases and can be included in lovemaking without interfering much with the flow and feelings of the moment.

The picture shows a condom incorrectly placed on penis with inflated tip - this should be squeezed to expel air before the condom is placed over the shaft of the penis.

How to Use a Condom Correctly

Before sexual intercourse the man, or his partner, places the rolled up condom (they come ready rolled) on the tip of his erect penis and unrolls it down the penis's entire length. Condoms unroll in one direction only. Only use condoms with a reservoir tip to receive the semen, preventing the rush of semen at ejaculation from bursting the tip of the condom. (If you happen to use a condom without a reservoir tip, do not roll or stretch the condom tightly against the head of the penis; leave a small amount of space - about half an inch - to allow for semen to be collected.) After ejaculation, as you begin to lose your erection hold the back of the condom and withdraw the penis from the vagina. This will prevent the stretched condom from slipping off and allowing semen to enter the vagina. After ejaculation, any thrusting may cause the condom to slip off; the penis should be withdrawn from the vagina before the erection is lost.

Condom correctly placed on erect penis.

After ejaculation

 

Condom correctly withdrawn from vagina before erection lost after ejaculation.

Condoms must be stored away from heat as high temperatures break down the rubber and cause tearing. Even keeping a condom or two in a wallet, although it may be convenient, is a bad idea - body heat over an extended period is enough to cause the rubber to deteriorate.

Q. "If condoms are so effective and don't cause any medical problems, how come everyone doesn't use them?"

A: "Because good as they are they can interfere with sexual pleasure. The most common reasons given for discontinuing their use are:

Q. "What are skin condoms?"

A: "Skin condoms are made from sheep's intestines. They look much the same and are used in exactly the same way as rubber ones, though most people use rubber condoms because they cost less. Some people prefer skin condoms because they say they can feel more during intercourse - this is probably because skin condoms conduct heat better than rubber."

Q: "What about condoms with lubrication for intercourse - are they better than unlubricated ones?"

A: ""Yes, they break less often and they cause less irritation to the vagina. Some people, however, have an allergic reaction to the lubricant."

Q: "Can you lubricate your own condoms?"

A: "Yes, as long as you use a safe lubricant like Astroglide. Don't use Vaseline or oil based products, as they weaken the rubber. (Vaseline is anyway a poor lubricant since it takes the natural lubrication out of the vagina.) Contraceptive foam or jelly used by the woman for added protection also works as a lubricant."

Q. "Is it true that you can't catch STIs or HIV if you use a condom?"

A: "No, though a condom will help to reduce the risk. If you have sex with someone who has a sexually transmitted disease and doesn't know it, a condom may prevent your being infected, but there is no guarantee of this. If you know that you have a sexually transmitted disease or if your partner has, there is only one rule: no sex at all until the disease is cured."

Q: "What should I do if my condom bursts while I am having sexual intercourse?"

A: "The best remedy for a burst condom is to have your partner fill her vagina immediately with a contraceptive foam, jelly or cream and leave it in place until it dissolves. Don't attempt to carry on without a new condom, however frustrating it may be to stop when you are both excited. Your partner must check with her doctor if her next period is at all late. It is most important that she should not douche - that can drive sperm further up. You can now see how important it is to keep contraceptive foam, jelly or cream instantly available in case of an emergency."

Q. "Do condoms prevent coming quickly?"

A: "'Quickly' is a matter of opinion. Condoms will not cure premature ejaculation, if that is what you mean. They do, however, sometimes make intercourse last longer in bed because they reduce sensitivity and may slow up the approach to ejaculation."

Q. "Do condoms come in various sizes?"

A: "Yes. One size would never fit all, as you can see from the penis pictures below. Manufacturers offer smaller and larger sizes, discreetly packaged under names such as Snugger Fit or Magnum."

Q. "Where can I get condoms?"

A: "You can purchase condoms without a doctor's prescription from a pharmacy, family planning clinic, supermarket, vending machine, or you can order them by mail as advertised in many magazines and websites. In their original packaging, condoms last about two years before naturally breaking down, so be certain you check its date of manufacture before using a condom, especially if you bought it from a vending machine."

Q "Are the new textured and ribbed condoms better than the plain ones?"

A: "Yes and no. They are no safer - all condoms must meet the same government quality standards, but some people prefer them because, they feel, the texturing or ribbing increases sensation during intercourse. They are better if you find them so, but not more effective. Also, new ones like Inspiral, with shaped heads, can offer more comfort because the glans is free to move inside the condom."


Diaphragms

A diaphragm is a dome-shaped rubber device with a flexible rim that is placed in the vagina behind the pubic bone. It fits snugly and seals off the opening to the cervix completely. Properly placed, the diaphragm will block the cervix to the entry of sperm. Diaphragms should always be used with a spermicidal jelly or cream to kill any sperms that come in contact with the diaphragm.

It is reported that around the year 1750 a primitive diaphragm was devised by Casanova, who cut a lemon in two, scraped out the inside and inserted one half of the lemon skin in the vagina of his lover. Supposedly the barrier provided by the skin and the acid from the lemon combined to make an effective birth control device. The diaphragm used today  was designed in the 1880s by a German physician, Dr W. Mensinga.

If a woman wants a diaphragm, she must first be examined by her doctor or a nurse practitioner at a family planning clinic. This is to determine which size diaphragm she ought to have - diaphragms come in several sizes and must fit perfectly if they are to work. She will be given a prescription for the precise size of diaphragm to take to a pharmacy: it is essential to have precisely the right one if it is to be properly effective.

Spermicidal jelly or cream that is always used with the diaphragm can be purchased without a prescription at a pharmacy or supermarket. When a diaphragm fits perfectly and is properly used it usually provides 97 to 98 percent protection against pregnancy. The best diaphragm users are highly motivated, mature women in relationship with interested and responsible partners. When a pregnancy does occur, the cause is usually improper use by the woman. The common mistakes are failure to use spermicidal jelly or cream with the diaphragm, and removing it too soon after intercourse. Diaphragms can develop tiny holes or cracks, and they may also fail if they fit poorly.

How to Use a Diaphragm Correctly

After obtaining the correct size diaphragm, a woman will be instructed by her doctor or nurse practitioner on how to use it properly. The spermicidal jelly or cream should be spread in the center of the diaphragm and over and around the surface that will be facing the cervix. The diaphragm is then squeezed into an oval shape, perhaps using a lubricant for sexual intercourse, and placed in the vagina behind the pubic bone so when the woman's hand is removed it springs gently into place and covers the cervix. Each woman usually finds the way that suits her best to insert her diaphragm, but many find standing with one foot on a low stool makes it easy. For those women who have difficulty inserting their diaphragm properly by hand, special applicators called introducers are available from pharmacies. No prescription is needed. Inserting and removing the diaphragm should be practiced several times and checked by a doctor or family planning worker to be sure everything is in order. Until a woman gets the knack of inserting her diaphragm properly she should use a backup birth control method.

The diaphragm must be placed in the vagina not more than two hours before sexual intercourse, and left in place six to eight hours after. If it is put in or taken out too early, the jelly or cream will not have its full effect. When intercourse occurs several times in a short period more spermicidal jelly or cream must be placed in the vagina near the diaphragm each time and without disturbing the diaphragm. This is easily done with the special applicator that comes with the jelly or cream. Some men have learned how to insert a diaphragm and have made that a sensual part of lovemaking without interrupting the flow and feelings of the moment.

After the diaphragm has been removed, it should be washed with mild soap in warm water, dried, lightly dusted with cornstarch and returned to its container. When washing the diaphragm, check it for tiny holes or cracks by holding it up to the light. It is always wise to have a spare diaphragm of the proper size in case you discover a hole or crack in your regular one. If a diaphragm is properly cared for, it should last about two years.

Diaphragms have no side effects or medical risks. Once in a while a woman or her partner may complain about a minor skin irritation and blame it on the diaphragm. Frequently this is due to the jelly or cream, so change brands. If changing brands doesn't help, see your doctor. Unless there is a specific medical problem like an abnormally shaped or prolapsed uterus all women can use a diaphragm if they choose. Men will not feel a diaphragm at all if it is the correct size properly inserted.

Q. "Once you have your diaphragm do you ever have to get measured again?"

A: "Yes. You should always have your diaphragm size checked at your yearly medical exam. It may change if you have gained or lost a significant amount of weight (say 10 lb), if you have had a child, miscarriage or an abortion. If you have done any of these things you may need a new diaphragm. If you are in any doubt - particularly about the effects of weight loss or gain - get checked at once, without waiting for your periodic medical examination."

Q. "My husband says he feels the diaphragm when we have intercourse. What should I do?"

A: "Your diaphragm may be improperly placed in your vagina, or you may be using an incorrect size. These are the two main reasons a penis contacts a diaphragm. Check with your doctor or clinic and take your husband along. If you have the right size diaphragm and you've put it in properly, your husband won't normally be able to feel it. Some men think they can feel it, using sex positions which provide deep penetration. Or maybe they just think they can feel it. What they may be doing is registering a protest against the use of a diaphragm, perhaps because they have a deep-seated reservation about contraception in general, or because they think a diaphragm is too 'mechanical' (the same protest is made against condoms on occasion), or because they want the woman to become pregnant. Get a medical check to be sure that the diaphragm is the correct size and that you are placing it properly, and then discuss the issue openly and honestly with your husband."

Q. "I know someone who used a diaphragm that didn't belong to her and didn't get pregnant."

A: "She was lucky."

Q- "My wife complains that her diaphragm hurts her. Is that all in her mind?"

A: "No. It may be irritating her vaginal wall for some reason, or it may be pressing against a full bladder or a full bowel. Together you should visit your doctor or family planning clinic immediately. Use another method of birth control until you have checked with your doctor."

Q. "Once in place, can my diaphragm move?"

A: "Sometimes even a properly placed diaphragm may shift during intercourse. This is unusual, but it can happen in the woman-on-top sex position. The thrusting of the penis during intercourse very rarely loosens the diaphragm."

Q. "What should a couple do if they like oral sex, but the taste and smell of the cream or jelly is a turn-off?"

A: "This is a real concern for some couples, but can be overcome if the diaphragm is inserted after having oral sex. Of course, this takes a great deal of motivation and control, as some couples are so involved in what they are feeling that they have trouble slowing down in order to insert a diaphragm. There are jellies and creams that some couples have found to have very little odor and no offensive taste or even a pleasant taste and odor. With these, oral sex is fine with the diaphragm in place. If you cannot find a jelly or cream that meets your needs, you will have to consider a new method of birth control."

A diaphragm in place, fitting closely against the cervix to block the passage of sperm through into the uterus.

Q: Some of my friends use their diaphragms during their periods. What is that all about?"

A: "They are being particularly careful. Although ovulation is most unlikely during menstruation it can happen, so some form of contraception is desirable. Diaphragms are particularly useful during menstruation for couples who dislike the presence of menstrual blood in intercourse. It is perfectly safe to use a diaphragm during menstruation."

Q: "Is it true that some women put their diaphragms in every night before going to bed?"

A: "Yes. If a couple usually have intercourse before going to sleep, routinely inserting the diaphragm each night means they are prepared and don't need to interrupt their lovemaking. Cervical caps work in a similar way to diaphragms, but are not as widely used, probably because some women find them more difficult to manage. Remember though, that the jelly or cream will not be effective after a couple of hours, if you want to have intercourse in the middle of the night or on waking."

Q: "Is a diaphragm another name for a cervical cap?"

A "No. Cervical caps are small, flexible and thimble like. They fit over rather than against the cervix. Like diaphragms, they come in several sizes. Capping the cervix (rather than blocking it off, as with the diaphragm) prevents sperm from passing through into the uterus and Fallopian tubes. The cervical cap can stay in place from the end of one menstrual flow to the beginning of the next, but doctors usually recommend that it be left in for a few days only. Women must be fitted with the proper size and instructed on how to place the cap securely. Cervical caps have been available for a century and appear to suit most - but not all - women. They are not officially approved for use in the United States, though unofficial tests show that they are as effective as diaphragms. Failures seem to be attributable to user-failure to insert the cap correctly more than to any deficiencies of the product - they are slightly more difficult to place than diaphragms." See www.femalesexualityfacts.com for more information.


General Issues Around Contraception

Artificial Methods of Birth Control

Birth Control Index