Hormonal Contraceptives vs Barrier Contraceptives – Pros and Cons of Each

Hormonal Contraceptives vs Barrier Contraceptives – Pros and Cons of Each

Hormonal Contraceptives vs Barrier Contraceptives – Pros and Cons of Each

 

Until a few decades ago, contraception focused almost exclusively on the prevention of unintended pregnancy. Changes in sexual behaviour and the increase in sexually transmitted infections (STIs), including HIV/AIDS, have led to a shift in the focus towards the sexual and reproductive health of women.

 

Hence, contraception approaches today seek to address both unintended pregnancy and prevention of STIs, i.e. - dual protection.

Barrier contraceptives prevent the sperm from meeting an egg, and provide some protection from STIs, including HIV/AIDS. This is of particular importance for those who have more than one sexual partner, or whose partner has more than one partner, both of which increases the likelihood of getting STIs.

 

The cervix in young girls, teenagers and pregnant women is especially vulnerable to infection. Adult women are more than 10 to 20 times more likely than men to get STIs.

 

As such, barrier contraceptives (i.e. male and female condoms, caps or diaphragms) in particular, condoms, should be used with other contraceptives, whenever there is a risk of getting STIs.

 

Types of Barrier Contraception

Principally, there are four physical barrier contraceptive types:

1)      Male condoms – typically made of latex, male condoms are rolled down from the tip of the penis to the base. Semen collects in a reservoir at the tip end of the condom. They are proven to reduce transmission of many STIs such as chlamydia and gonorrhoea.

2)      Female condoms – made of polyurethane, these are tubular shaped, where an inner ring sits deep in the vagina, with an open outer ring sitting just outside the vulva. The male inserts their penis into the female condom, preventing contact with the vagina. They are proven to reduce transmission of many STIs, such as chlamydia and gonorrhoea.

3)      Diaphragms – these are typically rubber structures with a metal inner frame that spans the posterior fornix to the anteroinferior wall of the vagina, covering the cervix and therefore preventing entry of semen. They are held in place by a combination of vaginal tone, the rigid metal inner frame and the pubic symphysis. Often combined with spermicide to increase their efficiency.

4)      Cervical caps – these sit directly over the cervix, and are held in place by suction and vaginal tone. They are often combined with spermicide to increase their efficiency.

 

As these have the same advantages and disadvantages as diaphragms they shall be considered together in this article.

 

What are the advantages and disadvantages of barrier contraception?

1)      Male condom

-          Not contraindicated by any condition exception latex allergy, in which other materials (such as polyurethane) can be used, with similar efficiency rate.

-          It is the only contraceptive method mentioned that is controlled by the male, which may be desirable by the couple.

-          Widely available and simple to use, and only need to be used immediately before intercourse.

-          Are protective against many STIs.

2)      Female condom

-          No contraindications.

-          Less likely to tear than the male condom.

-          May protect against some STIs.

-          Can be inserted up to 8 hours before intercourse.

3)      Diaphragm/cap

-          Can be inserted up to 3 hours before intercourse.

 

Disadvantages

1)      Male condom

-          Perfect use is rarely achieved – may tear or couple may lack motivation to use them every time.

-          Can reduce sensitivity and/or arousal.

2)      Female condom

-          Perfect use is rarely achieved – may become dislodged or couple may lack motivation to use them every time.

-          Penis may be inserted between condom and vaginal wall.

-          Can be noisy and/or uncomfortable for the woman during intercourse.

3)      Diaphragm/cap

-          Perfect use is rarely achieved – may tear or couple may lack motivation to use them every time.

-          They require prior planning and careful insertion.

-          They require measuring and fitting to find the correct size – any weight gain or pregnancy mandates a refitting.

-          They are associated with a higher risk of urinary tract infections.

-          Most likely due to the position of the diaphragm/cap putting pressure on the urethra.

-          STI transmission is not reduced –  in fact spermicide may irritate vaginal mucosa, possibly increasing the rate of transmission.

 

Non-Barrier Contraceptives (Hormonal and Non-Hormonal)

Whether administered as a pill, patch, shot, ring or implant, hormone medications contain manufactured forms of the hormones oestrogen and/or progesterone.  The only non-hormonal for of non-barrier contraceptive methods are the copper IUD.

Hormonal contraceptives do NOT protect against the transmission of sexually transmitted diseases.

 

Hormonal methods work in one of three ways:

1) preventing a woman’s ovaries from releasing an egg each month;

2) causing the cervical mucus to thicken, making it harder for sperm to reach and penetrate the egg;

3) thinning the lining of the uterus, which reduces the likelihood that a fertilized egg will implant in the uterus wall. This third method presents an ethical concern to consider.

 

Birth Control Pills:

Birth control pills are taken daily as prescribed by your healthcare provider.

 

Depo-Provera:

Depo-Provera is an injection given by your doctor that prevents pregnancy for three months.

 

Ortho Evra Patch/Birth Control Patch:

The birth control patch is placed directly on the skin, with the hormones built into the sticky side of the patch. Each week for the first three weeks a new patch is placed on the hip, buttocks, or upper arm.

 

The patch is removed during the fourth week, allowing for a menstrual period.

 

Intrauterine Device (IUD) or IUB:

The IUD is a small plastic device containing copper or hormones and is inserted into the uterus by a medical professional.

The IUD does not stop the sperm from entering into the uterus, but rather it changes cervical mucus decreasing the probability of fertilization. It also changes the lining of the uterus preventing implantation should fertilization occur. The IUB is made of copper – which is the best spermicide around. The way this method works is by preventing mobile sperm from reaching the uterus.

 

While it’s clear that barrier methods are the cheapest form of birth control, and are the only contraceptive means to prevent the transmission of STI’s – the downfalls sometimes do outweigh their benefits.

 

Non-barrier methods can be dangerous if not used properly, especially the hormonal type, while non-hormonal IUD’s offer the set-and-forget convenience many women seek, but do not prevent against STI’s.

 

 

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Cover Image Credit: The Hello Doctor Medical Blog