Barriers to conception and disease
Donovan, B.
Annals of the Academy of Medicine Singapore 24(4): 608-614
1995
ISSN/ISBN: 0304-4602 PMID: 8849197 Document Number: 303820
The increase in female-dependent contraceptive methods (e.g., the pill) usurped often older and less use-effective barrier methods, perhaps explaining the increase in sexually transmitted diseases (STDs) and their consequences. Barrier methods tend to afford STD protection for both partners. Most male condoms are made of latex. Polyurethane male condoms are stronger, more durable in storage, and allow more sensation than latex condoms. Condom use has increased with the emergence of AIDS. Consistent condom usage can provide 100% protection from HIV. Acceptability of the polyurethane female condom has not been assured. It appears that its contraceptive efficacy matches that of the diaphragm, cervical cap, or spermicidal sponge. Diaphragms used with a spermicide provide a moderate protective effect against some common STDs (e.g., trichomoniasis). There are no data on the STD/HIV preventive efficacy of cervical caps. There have been tentative links between the cervical cap and progression of cervical dysplasia and cervical lacerations, which could theoretically facilitate entry of HIV. The detergent effect of nonoxynol-9 and other surfactants disrupts cell membranes, including those of HIV and other STDs. Yet, nonoxynol-9 causes a dose-related epithelial disruption and inflammation. Other possible spermicide/microbicides include gramicidin and cholic acid (present in uterine secretions toward the end of the luteal phase). Postcoital chemical prophylaxis is perhaps another option. Since HIV transmission is more efficient from the insertive to the receptive partner and HIV concentrates in semen, withdrawal may provide some protection for the unprotected receptive partner. Douching, be it anal or vaginal, increases the risk of STDs and HIV. Vasectomy protects against pregnancy but there is no evidence that it protects against STD/HIV. Use of a combination of barriers has increased as a result of the AIDS epidemic. There is a need to develop a more diverse range of better barrier methods and to better promote existing methods. The means to stop the spread of HIV exist. There is no scientific basis to support moral arguments against barrier methods.