Female condom
A female condom (Femidom) is a thin, soft polyurethane pouch, which is fitted inside the vagina before sex. It has an inner ring that goes into the upper part of the vagina, and an outer one, which should be visible. The female condom is less likely to tear than the male condom.
If used according to the instructions, the female condom is 95% effective.
The diaphragm and the cap
The diaphragm and cap are devices made of thin, soft rubber that are inserted into the upper part of the vagina to cover the cervix (neck of the womb). They act as a barrier to sperm.
Caps are smaller than diaphragms, but both are available in several types and sizes. In the first instance the cap or diaphragm needs to be fitted by a doctor or family planning nurse, to make sure it’s the right size and is positioned correctly. After the initial fitting, they are put in place up to a few hours before sex. They need to be used with a spermicidal cream or pessary, and should be left in place for at least six hours after sex.
If used correctly, with spermicide, caps and diaphragms are 92 to 96% effective at preventing pregnancy.
Sponge
This is a small sponge impregnated with a spermicidal gel or cream. It is moistened with water before use, and then inserted high into the vagina to cover the cervix. It needs to be left in place for at least six hours after sex, and can be left for up to 30 hours, although there is a risk of infection if left for longer than that.
This method offers 70 to 90% protection.
Spermicides
These are creams, gels or pessaries (dissolvable tablets, inserted into the vagina) that contain a chemical that kills sperm. They can increase the effectiveness of barrier methods of contraception, but they do not provide reliable contraception when used alone. Spermicides can be bought without prescription at pharmacies. Some condoms have a coating of spermicidal lubricant.
The IUCD or coil
The intra-uterine contraceptive device (IUCD) – or coil – is a small plastic and copper device, which is fitted into the womb (uterus) by a doctor or nurse. It is designed to prevent the sperm meeting the egg, and may also make the egg move down the Fallopian tube more slowly and stop an egg settling in the womb.
The main advantage of a coil is that, once fitted, there is no need to worry about contraception. As long as the coil remains in place, it can be left for three to ten years. They are up to 98% effective.
There are, however, some disadvantages. Coils can make a woman’s periods heavier, longer or more painful. This may improve after a few months.
There’s a small chance of getting an infection during the first 20 days after a coil is put in. Many doctors will advise a check-up for any existing infection before they fit a coil. Infection can spread to the womb and Fallopian tubes, and can possibly result in infertility. For this reason, a doctor may not recommend the coil unless the woman has already had any children she wants.
Rarely, a coil might perforate the womb or cervix when it is fitted. This may cause pain but often there are no other symptoms. If this happens, the coil may need to be located with an X-ray and removed in a small operation.
If pregnancy does occur while using a coil, there is a small risk of an ectopic pregnancy. This is when the pregnancy develops outside the womb, usually in a Fallopian tube. Although this is rare, it is dangerous, so, if you miss a period, see your doctor. An IUCD does not protect against sexually-transmitted infections.
There’s also a coil available - the Mirena coil - which is impregnated with a hormone that prevents pregnancy. For more information on this form of hormonal contraception, see the separate BUPA fact sheet.
Natural family planning (NFP)
This involves reducing the chance of becoming pregnant by planning sex around the most fertile and infertile times during the woman’s monthly cycle.
If the woman has a regular cycle, it can be 80 to 98% effective at preventing pregnancy. To be as effective as possible, natural family planning should be taught by an experienced NFP teacher.
The key is for the woman to keep a diary to work out when she ovulates – the point of the cycle where sex is most likely to result in pregnancy. It involves recording the dates of her periods for three to six months. Ovulation occurs around 12 to 16 days before the start of the next period. The fertile period lasts for around eight or nine days around ovulation because, although an egg only lives for 24 hours, sperm can survive in the woman’s body for up to seven days.
Measuring and recording body temperature with an accurate thermometer each morning can help determine when ovulation is occurring. After ovulation, body temperature can rise by between 0.2 and 0.6 degrees Celsius. However, a higher temperature can happen for other reasons, such as illness, so it’s not a fail-safe indicator.
Cervical secretions also change during the monthly cycle, so the woman can monitor vaginal discharge to establish when ovulation has occurred.
There is a device available (called Persona) that measures body temperature and hormone levels in the urine. If used according to the instructions, the manufacturer claims it is 94% effective. It may not work well in women who have short or long cycles, or in women using certain medicines such as tetracycline (an antibiotic) or women who have certain medical conditions. Check with a pharmacist..
The withdrawal method
This involves withdrawing the penis before ejaculation. It is not a reliable method and cannot be considered as contraception because some sperm can leak out of the penis before ejaculation.
Sterilisation
This is an operation to permanently prevent fertilisation. It is therefore only recommended for people who are sure they do not want to have any more children. The failure rate of sterilisation is around one in 2,000 for men and about one in 200 for women. These operations are not easily reversible.
Men
Men are sterilised in a procedure called a vasectomy. This is a minor operation usually performed under local anaesthetic. It involves cutting or tying the tubes (vas deferens) which carry sperm from the testicles to the penis.
Women
This is an operation performed under general anaesthetic, usually as day case surgery. The Fallopian tubes are cut, tied or blocked, often through keyhole surgery. The alternative is a hysterectomy, removal of the womb, after which pregnancy is impossible
