Barriers and spermicides are being developed for the prevention of unwanted pregnancy and sexually transmitted infection. The inconvenience of current methods limits their acceptability and leads to higher user failure rates. New methods, such as female condoms, nonlatex male condoms, and new cervical caps are being developed: the Reality (Wisconsin Pharmacal, Jackson, WI) polyurethane vaginal pouch has already received conditional Food and Drug Administration approval for use in the United States. The material used in a Food and Drug Administration-approved nonallergenic glove is being tested for its effectiveness as a condom. In addition, the Fem Cap, a cervical cap that had a life table probability of failure within 1 year of 4.8%, is expected to be available within the next 2 years. It is important for clinicians to be informed of new options becoming available for those patients who may be good candidates for these barrier methods.
PIP: Reproductive health providers have long overlooked barrier and spermicide contraceptives, but they are rather effective when used consistently and correctly, have relatively few side effects, and protect against sexually transmitted diseases (STDs) and HIV. The mean percentage of women who have an unplanned pregnancy during the first year, if they have correctly and consistently used condoms is 2%, 3% for spermicides, 6% for cervical cap and diaphragm, 6% for nulliparous users of the sponge, and 9% for parous users of the sponge. If they do not use these methods and/or spermicides properly, however, failure rates increase 3-7 times. New barrier methods and spermicides should help people overcome obstacles, e.g., sensitivity or allergy to latex. One condom manufacturer is developing nonlatex male condoms for those who are sensitive or allergic to latex or the chemicals added to latex during the manufacturing process. Another manufacturer has altered the male condom by adding a silicone-lubricated pouch of latex to fit loosely around the glans penis, thereby reducing sensation loss. A new barrier method is the cervical cap which fits and covers the cervix snugly. Female condoms empower women to protect themselves against pregnancy, STDs, and HIV. They should be available to the US market soon. Some research indicates that spermicide use with barrier methods poses a risk of urinary tract infections, but the benefits exceed the risk. Barrier and spermicide methods appear to protect against cervical cancer and pregnancy complications. In conclusion, reproductive health providers need to realize their role in controlling patient use of barriers and spermicides, as well as the important role barrier methods play in protecting against pregnancy and STDs. Therefore, they should encourage patients to use the new methods and teach them to use them effectively.