Barrier Contraception

Types of Barrier Contraception

Principally, there are four physical barrier contraceptive types:

• 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.
• 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.
• 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, and are often combined with spermicide to increase their efficiency.
• 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 cervical caps have the same advantages and disadvantages as diaphragms, they shall be considered together in this article.

Advantages

Male Condom

• Not contraindicated by any condition except latex allergy, in which case other materials (such as polyurethane) can be used, with a similar efficacy rate.
• It is the only contraceptive method mentioned that is controlled by the male, which may be desirable to the couple.
• Widely available and simple to use, and only needs to be used immediately before intercourse.
• Protective against many STIs.

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.¹

Diaphragm/Cap

• Can be inserted up to 3 hours before intercourse.¹

Disadvantages

Male Condom

• Perfect use is rarely achieved – may tear or the couple may lack motivation to use them every time.
• Can reduce sensitivity and/or arousal.

Female Condom

• Perfect use is rarely achieved – may become dislodged or the couple may lack motivation to use them every time.
• The penis may be inserted between the condom and vaginal wall.
• Can be noisy and/or uncomfortable during intercourse.

Diaphragm/Cap

• Perfect use is rarely achieved – may tear or the 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,¹ 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.

Failure rates for barrier contraception are much higher than those of long-acting reversible contraception. These methods require thought at the point of intercourse, hence their typical and perfect use failure rates vary greatly. All values are expressed as the percentage of people who will get pregnant in one year using this method.

Table 1: Failure Rates for Perfect and Typical Use of Barrier Contraceptives²

Complications

Latex Allergy

A latex allergy is when the body detects latex as harmful and produces IgE antibodies in an immune response.¹ These antibodies produce pro-inflammatory stimuli, such as histamine, which induce allergy symptoms, for example:

• Itching
• Rash
• Shortness of breath

This can be treated with oral antihistamine.

In very rare cases, patients can have a life-threatening anaphylactic reaction. The symptoms of this include:

• Swelling of throat and tongue
• Difficulty breathing and/or swallowing
• Feeling faint

This can be treated with an adrenaline pen.²

Prevention involves use of non-latex condoms or other forms of contraception.³

Reaction to Spermicide

• Spermicide containing nonoxynol-9 has been associated with an increased risk of genital lesions and thus risk of HIV.
• Use of spermicide by individuals who are at high risk of HIV or are living with HIV is therefore UKMEC category 3.² This means the risks of using spermicide in this context generally outweigh the advantages.

Equity, Safety and Professionalism

Barrier contraceptives can commonly be accessed in sexual health clinics and pharmacies for free, or purchased in shops in the UK. However, 164 million women worldwide have unmet needs for contraception.³ This unmet need occurs commonly in developing countries.

Even in countries where access is not limited, stigma around use of contraceptives can deter patients and reduce contraceptive uptake, for example:

• Embarrassment around purchasing contraception
• Condoms can be perceived as interrupting intimacy
• Cultural and religious factors

A lack of use of contraceptives, or incorrect use, can result in STI transmission. If a patient is diagnosed with an STI, healthcare professionals can:

• Support patients to notify their sexual partner(s), even if they are asymptomatic
• Discuss how the patient can conduct partner notification depending on the circumstance
• Inform the patient of the risk of reinfection

This should be carried out in line with the British Association for Sexual Health and HIV statement on partner notification for STIs.⁴

Recent Changes and Controversies

Updates have been made to guidance around the use of contraception when taking GLP-1 receptor agonists. These medicines can reduce the effectiveness of oral contraception, and it is unknown whether taking this medication when pregnant or breastfeeding could harm the baby. Due to this, use of oral and non-oral contraceptives together is advised.⁵ This could include use of barrier contraceptives.

Assessment

Medical Eligibility

According to NICE guidance, assessment for suitability of method of contraception should be carried out.¹ Part of this assessment should include use of the Medical Eligibility Criteria.

Table 2: MEC Category Definitions²

For barrier contraceptives, MEC category 1 is allocated in the majority of cases, meaning there is no restriction for use of this method.

MEC category 2 conditions:²

• Parous – there is a higher risk of cervical cap failure
• Complicated history (pulmonary hypertension, risk of atrial fibrillation, history of subacute bacterial endocarditis)
• Patient is awaiting treatment for cervical cancer, where it is recommended the cervical cap should not be used
• Urinary tract infection

MEC category 3 or 4 conditions:² for these circumstances, this method of contraception is generally not used, but a shared decision-making process between the healthcare professional and patient is still required.

• Asymptomatic or mild HIV WHO clinical disease (stage 1 or 2)
• Severe or advanced HIV WHO clinical disease (stage 3 or 4)
• High risk of HIV
• History of toxic shock syndrome
• Antiretroviral therapy
• HIV pre-exposure prophylaxis (PrEP)
• Allergy to latex

These conditions are MEC category 3 or 4 due to an interaction with spermicide, except for the allergy to latex, which also involves a reaction to latex condoms.

Consent, Capacity and Competence

Information should be given to the patient verbally and in written format describing the following: how the contraceptive works, its efficacy, advantages, disadvantages, adverse effects, how to use the method correctly, and other forms of contraception that can be used. For consent to treatment for contraception to be valid, it must fulfil the following criteria:

• Voluntary
• Informed
• The patient must have capacity – this is assumed for patients aged 16 years or older under the Mental Capacity Act.⁶

If the patient is under 16 in England and Wales, the Fraser criteria must be considered:⁷

• The young person understands the practitioner’s advice
• The young person cannot be persuaded to inform their parents, or will not allow the practitioner to inform the parents, that contraceptive advice has been sought
• The young person is likely to begin or continue having intercourse with or without contraceptive treatment
• Unless they receive contraceptive advice or treatment, the young person’s physical or mental health (or both) are likely to suffer
• The young person’s best interest requires the practitioner to give contraceptive advice or treatment (or both) without parental consent

This is not used in Scotland; the Age of Legal Capacity Act is used instead to determine competence:⁷

• Understand the treatment, its purpose and nature, and why it is being proposed
• Understand its benefits, risks, and alternatives
• Understand in broader terms what the consequences of the treatment will be
• Retain the information for long enough to use it and weigh it up to arrive at a decision

Assessment pathway for barrier contraception, from initial consultation to method selection

References

1. NICE. Contraception – barrier methods and spermicides. CKS. 2021. Available from: https://cks.nice.org.uk/topics/contraception-barrier-methods-spermicides/ [Accessed June 2026].

2. FSRH. Barrier Methods for Contraception and STI Prevention. 2012 (amended 2015). Available from: https://www.cosrh.org/Common/Uploaded%20files/documents/ceuguidancebarriermethodscontraceptionsdi.pdf [Accessed June 2026].

3. WHO. Family planning/contraception methods. 2025. Available from: https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception [Accessed June 2026].

4. BASHH. Statement on partner notification for sexually transmitted infections. Available from: https://www.bashh.org [Accessed June 2026].

5. FSRH. Statement on GLP-1 receptor agonists and contraception. February 2025. Available from: https://www.fsrh.org [Accessed June 2026].

6. Gov.UK. Mental Capacity Act 2005. Available from: https://www.legislation.gov.uk/ukpga/2005/9/contents [Accessed June 2026].

7. NICE. Contraception – assessment. CKS. 2024. Available from: https://cks.nice.org.uk/topics/contraception-assessment/ [Accessed June 2026].

Recommended Reading

FSRH – UK Medical Eligibility Criteria for Contraceptive Use (2006, updated 2025)

NICE – Contraception: barrier methods and spermicides (2021)

NICE – Scenario: Assessment for contraception (2024)