Contraception: Barrier methods

Uri Belkind, Susan M. Coupey

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Barrier contraceptive methods act by preventing spermatozoa from reaching the upper female genital tract or, in combination with spermicides, killing them. These methods include the male and female condom, diaphragm, contraceptive sponge, Lea's shield, and cervical cap. They have no systemic side effects and are safe to use in most instances, but are not as effective for pregnancy prevention as hormonal methods. Because of their mechanism of action, adequate efficacy is only achieved by consistent use with each act of sexual intercourse, so counseling is of the utmost importance. Barrier methods may not be the right choice for young women with altered vaginal anatomy. Combined hormonal oral contraception (pills that contain both estrogen and progestin), or COC, is one of the most popular birth control methods used by teenagers in the US. Because COCs are often considered synonymous with "birth control," this method may be appealing to adolescents in its familiarity. In addition to protecting a teen from unwanted pregnancy, COCs can be used to treat medical conditions commonly seen in adolescence, such as dysmenorrhea, menstrual abnormalities, and acne. Providers can assist patients' success with COC use by using "quick start" to initiate pills, rather than waiting until the next menstruation; prescribing sufficient COCs for a full year; and avoiding unnecessary exams and tests. COCs can also be prescribed using an extended or continuous regimen. Clinical "tips" regarding talking to parents, and helping teens with daily pill taking and managing common side effects are highlighted throughout the chapter. The transdermal patch, OrthoEvraR, and the transvaginal ring, NuvaRingR, are two forms of birth control aimed at simplifying the contraceptive regimen. Though both are similar to traditional oral contraceptive pills with regard to mechanism of action, side effects, and contraindications, there are unique differences that should be reviewed with adolescents prior to prescribing. In addition, counseling should be conducted with the adolescent and parent, if applicable, on options for method initiation, management, and follow-up. This chapter reviews these two contractive methods and provides additional tips, precautions, and a review of scientific evidence to facilitate optimal implementation by the prescriber. Intrauterine devices (IUDs) can be considered first-line contraception for adolescents. IUDs require minimal patient adherence. The levonorgestrel IUD results in less bleeding and is often preferred by adolescents. IUDs do not result in greater pelvic inflammatory disease or sexually-transmitted infections in adolescents. IUDs do not affect long-term fertility. Premedication will reduce patient complaints with insertion. Progestin-only contraceptive methods (pills, the injectable, and the implant) represent safe and effective methods for adolescent contraception. As progestin-only methods do not contain estrogen, there are few contraindications to their use. Consistent and correct use of contraceptive methods is often challenging for adolescents. When recommending and prescribing contraception for this age group, it is important to consider the most highly effective methods that require the lowest maintenance. Accordingly, nondaily methods (injectables and the implant) often represent preferred choices for adolescents. Injectable and implantable contraception is particularly important in the prevention of rapid repeat pregnancies in postpartum/postabortion adolescents. Emergency contraception is a safe and effective option for young women seeking to prevent pregnancy in the event of unprotected intercourse from lack of contraceptive use, contraceptive failure, or forced intercourse. There are several dedicated products currently available in the US. Providers have a unique role in educating adolescents about the method's availability and facilitating its use.

Original languageEnglish (US)
Title of host publicationPractical Pediatric and Adolescent Gynecology
PublisherBlackwell Publishing Ltd
Pages205-209
Number of pages5
ISBN (Print)9780470673874
DOIs
StatePublished - Apr 25 2013

Keywords

  • Adolescent
  • Adolescents
  • Barrier contraceptives
  • Birth control
  • Cervical cap
  • Condom
  • Contraception
  • Contraceptive option
  • Contraceptive sponge
  • Copper T380A
  • Diaphragm
  • Effective
  • Emergency contraception
  • Extended/continuous use
  • Hormonal
  • IUD
  • Intrauterine devices
  • LNG-IUS
  • Lea's shield
  • Levonorgestrel intrauterine system
  • Menorrhagia
  • Morning after pill
  • NuvaRingR
  • Oral contraception
  • OrthoEvraR
  • Patch
  • Postcoital contraception
  • Postpartum
  • Progestin-only
  • Quick start
  • Ring
  • Safe
  • Spermicide
  • Transdermal patch
  • Transvaginal ring
  • Treatment

ASJC Scopus subject areas

  • Medicine(all)

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  • Cite this

    Belkind, U., & Coupey, S. M. (2013). Contraception: Barrier methods. In Practical Pediatric and Adolescent Gynecology (pp. 205-209). Blackwell Publishing Ltd. https://doi.org/10.1002/9781118538555.ch34