Natural Approaches and Barrier-type Contraceptives 

Written by: Lisa Cheng

Table 1. Summary of methods or devices for birth control based on their class, frequency of use, and whether they offer protection against sexually transmitted infections.

Before we get into the nitty gritty of birth control, we first need to understand the menstrual cycle and how the 3 major reproductive hormones in female, estrogen, progesterone, and follicle-stimulating hormone (FSH) influence each other. For a detailed explanation, please see "Scientific Introduction to Female Reproductive System and Birth Control". Here, it’s important to understand that estrogen, progesterone, and FSH all play essential roles in female reproductive functions.

Natural Approaches of Contraception

Predicting the natural cycle of menstruation

Predicting the natural cycle of menstruation may be a way of birth control. In this method, women would need to be aware of their bodily changes, either by using a calendar or observing symptoms, to identify her fertile window (known as fertility awareness). During this window, abstinence is the best approach to mitigate the possibility of a pregnancy. However, menstrual cycles may not be reliable because they can be influenced by external factors (e.g., stress, extreme exercise, medication, and major changes in eating habits) (1). A woman cannot predict, with certainty, when ovulation happens, indicating that this method is not reliable. Moreover, sperm can live in the reproductive tract for approximately 3 to 5 days. If the egg is released during the time that the sperm is still alive in the reproductive tract, the sperm can still fertilize the egg and consequently lead to pregnancy.

Withdrawal

Withdrawal is another form of birth control – the man would withdraw their penis right before ejaculation. As one of the least effective birth control methods, individuals are advised to evaluate the associated risks associated (2). This approach, if executed with perfection, stops sperm from being introduced into the reproductive tract whereby no sperm will fertilize the egg.

Barrier-type Contraception

Barrier-types of contraception can be used alone but are often used together with a hormonal-type contraception (3).

Condoms

Condoms are the most accessible, convenient, and popular barrier-type of contraception amongst adolescents (4). In addition to preventing unintended pregnancies, they offer protection from sexually transmitted infections (including human immunodeficiency virus [HIV]) that hormonal-type contraception cannot provide.

There are two types of condoms: internal and external. Internal condoms are inserted to the vagina or anus at up to eight hours before intercourse whereas external condoms are placed around the erect penis (usually immediately before intercourse). Men and women should be aware if they are allergic to the condom material (e.g., latex) before use. Both types of condoms therefore do not impede processes within the menstrual cycle, but rather ensure that the sperm does not enter the reproductive tract in the vicinity of the egg. They are all one-time use, meaning that need to be used each time of intercourse. With correct use, this method of contraception is highly effective.

Cervical caps, diaphragms, and sponges

Cervical caps, diaphragms, and sponges are other forms of birth control that block off access to the cervix, thereby physically stopping the sperm from coming in contact with the egg. Women will need to contact a physician for diaphragms and cervical caps because they need to be properly fitted to be effective. There are some one-size-fits-all diaphragms that are becoming increasingly available, and their use do not require fitting. It is also important to note that women who have previously given birth should not consider cervical caps as their first choice of birth control because they are much less effective; cervical caps are comparably more effective in women who have not given birth (2).

Moreover, spermicides are typically used with condoms, diaphragms, and cervical caps as an additional form of protection.