Remote Primary Health Care Manuals

Barrier contraception

Condoms

  • Male (external) condom — 88% effective, cheap and available over the counter
  • Female (internal) condom — 79% effective, more expensive and available over the counter

What

  • Male (external) condom — latex or non-latex sheath pulled onto erect penis
  • Female (internal) condom — loose-fitting polyurethane (non-latex) sheath inside vagina or anus

How it works

  • Prevents contact between eggs, sperm and some STIs
  • Correct use
    • In date and stored in cool place
    • Worn and removed carefully so contents don't spill

    • Disposed of carefully after use and out of reach of children — bury or burn used condom or put in can and flatten. Don't flush down the toilet

Timing — Single use only. New one needed each time they have sex

Who benefits — men and women who want

  • STI protection
  • Cheap and  non-hormonal contraception

Promoting condoms

  • Important that condoms are easy to get without shame
  • Offer condoms and talk about where they can get more
  • Talk with ATSIHPs, appropriate local staff and community members about good places to supply condoms (eg shop, clinic, garage, council, club, toilets)

Special issues

Type of male (external) condoms

  • Latex
  • Non-latex (eg polyurethane, polyisoprene)
    • May transmit body-heat and sensation better
    • Useful if latex allergy

Lubricants

  • Do not use oil-based lubricants — water-based or silicone-based lubricants are safe with all condoms
  • Medicines used inside the vagina (eg thrush cream) are oil-based and may weaken latex or polyisoprene (rubber) condoms if used 

Negotiating use

  • Men and women may feel shame to suggest or use condoms
  • Women or transgender people may have little power to negotiate — try to talk about this

Condom uncomfortable 

  • Could be too dry — use water-based or silicone-based lubricant (only on the outside of the male condom)
  • Could be latex allergy — try non-latex condoms
  • Less sensitivity — try polyurethane condoms
  • Check for thrush (candida) or STI

Breakage/slippage

  • Check they know how to use condoms properly — see male condom demonstration 
  • Check use-by date and that packet is intact
  • Use lubricant
  • Beware of sharp fingernails/teeth
  • Check size of condom
  • Offer woman ECP
  • Offer both partners STI check — man, woman, young person

Male (external) condom demonstration

Offer to demonstrate how to use condom

  • Check use-by date — Figure 7.2. Feel condom packet — should be 'squashy'. Open carefully

Figure 7.2   

Use-by date is usually on top of condom packet.

Figure 7.3   

Pinch tip of condom between finger and thumb to squeeze out air, just before applying.

Figure 7.4   

Slide tip of condom over glans of penis

Figure 7.5   

When condom completely unrolled, hold in place at base of erect penis.

  • Use water-based lubricant for anal sex or if extra lubrication needed for vaginal sex
    • Do not use oils or Vaseline — they weaken the rubber
  • After man has ejaculated ('cum', passed sperm) while penis still hard, hold condom on penis and take penis out of vagina or anus slowly
  • When penis soft, remove condom — Figure 7.6
  • Tie knot in condom — Figure 7.7, dispose of carefully
  • Wipe excess sperm from penis

Figure 7.6   

Hold bottom of condom while sliding off flaccid penis.

Figure 7.7   

Condom is tied in a knot before disposal.

Diaphragms

82% effective

  • Not commonly used by women in remote areas
  • If woman would like to try a diaphragm — get help. Woman needs informed discussion with knowledgeable practitioner

What

  • Dome-shaped silicone cap inserted in vagina to cover cervix (base of womb)
  • One size fits about 80% of women
  • Non-hormonal

How it works — prevents contact between egg and sperm if used correctly. Does not provide STI protection

Timing — inserted before sex, left in for 6 hours. Do not leave in for more than 24 hours

Figure 7.8   

diaphragm.jpg