Sponge

The contraceptive sponge, approved by FDA in 1983, is made of white polyurethane foam. The sponge, shaped like a small doughnut, contains the spermicide nonoxynol-9. Like the diaphragm, it is inserted into the vagina to cover the cervix during and after intercourse. It does not require fitting by a health professional and is available without prescription. It is to be used only once and then discarded. The failure rate is between 18 and 28 percent. An extremely rare side effect is toxic shock syndrome (TSS), a potentially fatal infection caused by a strain of the bacterium Staphylococcus aureus and more commonly associated with tampon use.

Diaphragm

The diaphragm is a flexible rubber disk with a rigid rim. Diaphragms range in size from 2 to 4 inches in diameter and are designed to cover the cervix during and after intercourse so that sperm cannot reach the uterus. Spermicidal jelly or cream must be placed inside the diaphragm for it to be effective.

The diaphragm must be fitted by a health professional and the correct size prescribed to ensure a snug seal with the vaginal wall. If intercourse is repeated, additional spermicide should be added with the diaphragm still in place. The diaphragm should be left in place for at least six hours after intercourse. The diaphragm used with spermicide has a failure rate of from 6 to 18 percent.

Barrier methods, which work by keeping the sperm and egg apart, usually have only minor side effects.

In addition to the possible allergic reactions or irritation common to all barrier methods, there have been some reports of bladder infections with this method. As with the contraceptive sponge, TSS is an extremely rare side effect.

Cervical Cap

The cervical cap, approved for contraceptive use in the United States in 1988, is a dome-shaped rubber cap in various sizes that fits snugly over the cervix. Like the diaphragm, it is used with a spermicide and must be fitted by a health professional. It is more difficult to insert than the diaphragm, but may be left in place for up to 48 hours. In addition to the allergic reactions that can occur with any barrier method. 5.2 to 27 percent of users in various studies have reported an unpleasant odor and/or discharge. There also appears to be an increased incidence of irregular Pap tests in the first six months of using the cap, and TSS is an extremely rare side effect. The cap has a failure rate of about 18 percent.

Hormonal Contraception

Hormonal contraception involves ways of delivering forms of two female reproductive hormones--estrogen and progestogen--that help regulate ovulation (release of an egg), the condition of the uterine lining, and other parts of the menstrual cycle. Unlike barrier methods, hormones are not inert, do interact with the body, and have the potential for serious side effects, though this is rare. When properly used, hormonal methods are also extremely effective. Hormonal methods are available only by prescription.
 

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