Barrier methods and fertility-awareness methods — Rapid

Synopsis

Explain barrier and fertility-awareness methods without overstating efficacy, including correct use, STI protection, emergency action, fertile-window interpretation and situations that make observation unreliable.

External and internal condoms reduce STI transmission and pregnancy risk; no other contraceptive method provides this dual protection.
External condoms are about 82% effective in typical use and 98% with correct use; internal condoms are about 79% and 95% respectively.
Put an external condom on before any genital contact, pinch the reservoir, unroll fully, use a new condom for each act and hold the base during withdrawal.
Do not use an external and internal condom together because friction can cause displacement or breakage. Avoid oil-based lubricant with latex; use water- or silicone-based compatible lubricant.
A diaphragm or cap must be correctly fitted, cover the cervix and be used with spermicide for every episode according to product timing; it does not provide reliable STI protection.
Fertility-awareness methods require trained teaching and daily interpretation of cycle length, cervical mucus and basal temperature, with abstinence or a barrier throughout the identified fertile window.
Typical-use natural family planning is about 76% effective. Irregular cycles, postpartum change, perimenopause, illness, shift work and medicines affecting cycles or temperature reduce interpretability.
After any barrier or fertile-window failure, discuss copper-IUD and oral emergency contraception promptly and arrange pregnancy testing 21 days after the last at-risk intercourse.

Key red flags

Non-consensual condom removal, deliberate damage or pressure to avoid contraception can be reproductive or sexual coercion and requires a private, trauma-informed safety assessment.

A retained internal condom, diaphragm or cap associated with severe pain, fever, offensive discharge or systemic illness requires prompt examination and removal assessment.

A missed period, pregnancy symptoms or pelvic pain after method failure requires pregnancy testing and urgent ectopic assessment when pain, bleeding, dizziness or collapse is present.

Genital ulceration, discharge, pelvic pain, dysuria or a known STI exposure needs targeted sexual-health evaluation even when a condom was used.

Investigation priorities

Pregnancy-risk timelineFirst step

Determine whether emergency contraception is indicated after incorrect or unprotected intercourse.

Management branches

Condom usePrevent failure before contact

External or internal condoms are chosen for pregnancy or STI prevention.

Select an in-date quality-marked product and compatible lubricant, check latex allergy and practise correct orientation, placement and removal before reliance.
Use one new external or internal condom from before genital contact through completion of each act; never use the two types together.
After split, slip, misrouting or late application, stop, assess pregnancy and infection exposure promptly and offer emergency care without blame.

Key medicines

Contraceptive spermicide for diaphragm or cap useApply the product-specified amount to the correctly fitted diaphragm or cap before every episode of vaginal intercourse, add further spermicide as directed and maintain the required post-intercourse retention time.Follow the exact device and spermicide instructions, avoid exceeding retention time, refit after anatomical change and explain that this method does not provide reliable STI protection.

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