The male condom acts as a physical barrier, covering the penis and blocking the passage of sperm into the vagina. All sexually active adolescents should be encouraged on regular condom use for the prevention of sexually transmitted infections and HIV, as well as increased contraceptive efficacy. However, in typical use, the male condom alone has an efficacy rating of only 82% in the first year and 57% thereafter.(8) For this reason, a more reliable form of contraception should be counseled as first line.
A soft, loose polyurethane sheath with two rings on either side – one is place in the vagina, the other placed outside the introitus. These devices are available over the counter. Efficacy is poor with a typical use failure rate of 21%. (8)
A dome-shaped flexible rubber cup. Spermicide is applied to the dome and the device is inserted into the vagina prior to intercourse so that the posterior rim rests in the posterior fornix and the anterior rim fits behind the pubic bone with the dome of the device covering the cervix. The diaphragm must be sized and prescribed by a physician. Once in position, it can provide contraceptive protection for up to 6 hours before additional spermicide is required. After intercourse, if should be left in place for at least 6 hours, but should not be left in place for a combined duration of longer than 24 hours due to a rare risk toxic shock syndrome. The diaphragm also has a lower efficacy rating with typical use failure rates of 12 percent. However, this may be a good option in a subset of patients with hormone sensitive cancers and an aversion or contraindication to the copper IUD (8).
Spermicidal gels, creams and foams are available for use with the diaphragm, but can also be used solely for contraception. Spermicidal suppositories can be used alone or with condoms. The efficacy is low with a failure rate of 18% with perfect use and 28% with typical use, when used alone for contraception. (8)