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Recommendations for Contraceptive Use |
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Barrier Methods |
Classification of Selected
Procedures for Barrier Methods
| Procedure |
Class |
Class |
Class |
Rationale |
| |
Diaphragm |
Condom |
Spermicide |
|
| Pelvic
examination (bimanual and speculum) |
A |
C |
C |
- A pelvic exam is required for diaphragm/cap
fitting.
- A pelvic exam is not required for safe use
of other barrier methods.
|
| Blood pressure |
C |
C |
C |
Barrier method
use does not affect blood pressure1. |
| Breast
examination |
C |
C |
C |
Barrier method
use does not affect breast cancer risk1. |
| STD screening by lab
tests (for asymptomatic persons) |
C |
C |
C |
- Presence of an STD will not affect the safe use of
barrier methods.
- If an infected person chooses to have
intercourse, use of a barrier may reduce the risk of transmission to the partner2-4.
|
| Cervical cancer
screening |
C |
C |
C |
- Cervical screening is not needed for the safe use
of barrier methods1.
- Use of barrier methods may reduce the risk of
developing cervical cancer5-6.
|
| Routine mandatory lab
tests (e.g., cholesterol, glucose, liver function tests) |
D |
D |
D |
Routine lab tests are
not applicable to the use of barrier methods for contraception. |
| Proper infection
prevention procedures |
A |
C |
C |
Proper infection
prevention procedures are not applicable to barrier method use, except for fitting of
diaphragms. |
Specific counseling points for barrier method
use:
- correct use of method
- efficacy
- what to do in the event of condom breakage, or discomfort following
spermicide or barrier method use
- STD protection (when/as appropriate)
|
A |
|
|
- Accurate client education is essential for maximum quality of FP
services.
- Appropriate counseling about contraceptive side effects at the time of
method selection can lead to improved client satisfaction and contraceptive continuation7.
- Clients should know that only barrier methods can protect against STDs.
Consistent condom use reduces the risk of becoming infected with any STD8-11.
Spermicidal methods, including diaphragms and caps, probably reduce the risk of bacterial
STDs and may have an effect against viral STDs8,12-16.
- The woman should be encouraged to return if she has any problems or at
any time she has questions or concerns.
|
| |
|
B |
B |
- For condoms and spermicides, counseling is
desirable, but perhaps not feasible for over the counter use. However, it should be
encouraged.
- When methods are dispensed in clinical settings,
counseling should be provided.
|
KEY:
Class A = essential and mandatory or otherwise
important in all circumstances, for safe and effective use of the contraceptive method
Class B = medically/epidemiologically rational in
some circumstances to optimize the safe and effective use of the contraceptive method, but
may not be appropriate for all clients in all settings
Class C = may be appropriate for good preventive
health care, but not materially related to safe and effective use of the contraceptive
method
Class D = not materially related to either good
routine preventive health care or safe and effective use of the contraceptive method
Citations for Procedures Table:
- World Health Organization. Improving
access to quality care in family planning: medical eligibility criteria for contraceptive
use. Geneva: WHO, 1996.
- Cates W Jr, Stone KM. Family planning,
sexually transmitted diseases and contraceptive choice: a literature update-part 1. Family
Planning Perspectives 1992;24:75-84.
- Hatcher RA, Trussell J, Stewart F,
Stewart GK, Kowal D, Guest F, et al. Contraceptive Technology. New York: Irvington
Publishers, 1994.
- Feldblum PJ, Morrison CS, Roddy RE,
Cates W Jr. The effectiveness of barrier methods of contraception in preventing the spread
of HIV. AIDS 1995;9(Suppl A):S85-S93.
- Hildesheim A, Brinton LA, Mallin K,
Lehman HF, Stolley P, Savitz DA, et al. Barrier and spermicidal contraceptive methods and
risk of invasive cervical cancer. Epidemiology 1990;1(4):266-72.
- Coker AL, Hulka BS, McCann MF, Walton
LA. Barrier methods of contraception and cervical intraepithelial neoplasia. Contraception
1992;45(1):1-10.
- Cotten N, Stanback J, Maidouka H,
Taylor-Thomas JT, Turk T. Early discontinuation of contraceptive use in Niger and Gambia.
InternationalFamily Planning Perspectives 1992;18(4):145-9.
- Update: barrier protection against HIV
infection and other sexually transmitted diseases. Morbidity and Mortality Weekly Report
1993;42:589-91, 597.
- Saracco A, Musicco M, Nicolosi A,
Angarano G, Arici C, Gavazzeni G, et al. Man-to-woman sexual transmission of HIV:
longitudinal study of 343 steady partners of infected men. Journal of Acquired Immune
Deficiency Syndrome 1993;6:497-502.
- de Vincenzi I, for the European Study
Group on Heterosexual Transmission of HIV. A longitudinal study of human immunodeficiency
virus transmission by heterosexual partners. New England Journal of Medicine
1994;331(6):341-6.
- Soper DE, Shoupe D, Shangold GA,
Shangold MM, Gutmann J, Mercer L. Prevention of vaginal trichomoniasis by compliant use of
the female condom. Sexually Transmitted Diseases 1993;20:137-9.
- Niruthisard S, Roddy RE, Chutivongse
S. Use of nonoxynol-9 and reduction in rate of gonococcal and chlamydial cervical
infections. Lancet 1992;339:1371-5.
- Weir SS, Feldblum PJ, Zekeng L, Roddy
RE. The use of nonoxynol-9 for protection against cervical gonorrhea. American Journal of
Public Health 1994;84:910-4.
- Kreiss J, Ngugi E, Holmes K,
Ndinya-Achola J, Waiyaki P, Roberts PL, et al. Efficacy of nonoxynol 9 contraceptive
sponge use in preventing heterosexual acquisition of HIV in Nairobi prostitutes. Journal
of the American Medical Association 1992;268:477-82.
- Zekeng L, Feldblum PJ, Godwin SE,
Oliver RM, Kaptue L. HIV infection and barrier contraceptive use among high-risk women in
Cameroon. AIDS 1993;7:725-31.
- Feldblum PJ, Weir SS. The protective
effect of nonoxynol-9 against HIV infection (letter). American Journal of Public Health
1994;84:1032-4.
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