Spermicide: substance with chemicals placed in the vagina.
How it works
Diaphragm: Forms a barrier to prevent sperm and egg from meeting
Spermicide: kills or immobilizes sperm.
Effectiveness to prevent pregnancy
Diaphragm (with spermicide): 94% with correct and consistent use, 88% as commonly used
Spermicide (alone): 82% with correct and consistent use, 72% as commonly used
Comments
Diaphragms and cervical caps are generally to be used with spermicide.
Diaphragms / Cervical Cap
Women with conditions that make pregnancy an unacceptable risk should be advised that barrier methods for pregnancy prevention may not be appropriate for those who cannot use them consistently and correctly because of their relatively higher typical-use failure rates.
MEC categories for contraceptive eligibility
Category 1
A condition for which there is no restriction for the use of the contraceptive method
Category 2
A condition where the advantages of using the method generally outweigh the theoretical or proven risks
Category 3
A condition where the theoretical or proven risks usually outweigh the advantages of using the method
Category 4
A condition which represents an unacceptable health risk if the contraceptive method is used
There is no medical reason to deny sterilization to a person with this condition.
C = caution
The procedure is normally conducted in a routine setting, but with extra preparation and precautions.
D = delay
The procedure is delayed until the condition is evaluated and/or corrected. Alternative temporary methods of contraception should be provided.
S = special
The procedure should be undertaken in a setting with an experienced surgeon and staff, equipment needed to provide general anaesthesia, and other back-up medical support. For these conditions, the capacity to decide on the most appropriate procedure and anaesthesia regimen is also needed. Alternative temporary methods of contraception should be provided if referral is required or there is otherwise any delay.
No breastfeeding status was selected using the "Women’s characteristics" filters.
Breastfeeding
Category
Clarifications/Special considerations
Diaphragm
Spermicide
a) < 6 weeks postpartum
1
NA
Clarification: The diaphragm and cap are unsuitable until uterine involution is complete.
b) ≥ 6 weeks postpartum
1
1
Non-breastfeeding
Category
Clarifications/Special considerations
Diaphragm
Spermicide
a) < 6 weeks postpartum
1
NA
Clarification: The diaphragm and cap are unsuitable until uterine involution is complete.
b) ≥ 6 weeks postpartum
1
1
Medical Condition:
No medical conditions were selected using the "Women’s characteristics" filters.
Cardiovascular disease
Category
Clarifications/Special considerations
Current and history of ischaemic heart disease
1
Stroke
1
Diabetes
Category
Clarifications/Special considerations
a) History of gestational disease
1
b) Non-vascular disease
1
i) non-insulin dependent
1
ii) insulin dependent
1
c) Nephropathy/retinopathy/neuropathy
1
d) Other vascular disease or diabetes of > 20 years’ duration
1
Headaches
Category
Clarifications/Special considerations
a) Non-migrainous (mild or severe)
1
b) Migraine
i) without aura, at any age
1
ii) with aura, at any age
1
HIV WHO Stage 3 or 4
Category
Clarifications/Special considerations
Diaphragm
Spermicide
Severe or advanced HIV clinical disease (WHO stage 3 or 4)
3
3
Hypertension
Category
Clarifications/Special considerations
a) History of hypertension, where blood pressure CANNOT be evaluated (including hypertension in pregnancy)
1
b) Adequately controlled hypertension, where blood pressure CAN be evaluated
1
c) Elevated blood pressure levels (properly taken measurements)
1
i) systolic 140-159 or diastolic 90-99 mm Hg
1
ii) systolic ≥ 160 or diastolic ≥ 100 mm Hg
1
d) Vascular disease
Obesity
Category
Clarifications/Special considerations
a) > 30 kg/m2 BMI
1
b) Menarche to < 18 years and ≥30 kg/m2 BMI
1
Pelvic infection
Category
Clarifications/Special considerations
a) Past PID (assuming no current risk factors for STIs)
i) with subsequent pregnancy
1
ii) without subsequent pregnancy
1
b) PID – current
1
c) Current purulent cervicitis or chlamydial infection or gonorrhoea
1
d) Other STIs (excluding HIV and hepatitis)
1
e) Vaginitis (including Trichomonasvaginalis and bacterial vaginosis)
1
f) Increased risk of STIs
1
Tuberculosis
Category
Clarifications/Special considerations
a) Non-pelvic
1
b) Pelvic
1
Venous thromboembolism
Category
Clarifications/Special considerations
a) History of DVT/PE
1
b) Acute DVT/PE
1
c) DVT/PE and established on anticoagulant therapy
1
d) Family history (first-degree relatives)
1
Drug Interactions:
No drug interactions were selected using the "Women’s characteristics" filters.
Anticonvulsants
Category
Clarifications/Special considerations
a) Certain anticonvulsants,(phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine)
1
b) Lamotrigine
1
Antimicrobial Therapy
Category
Clarifications/Special considerations
a) Broad-spectrum antibiotics
1
b) Antifungals
1
c) Antiparasitics
1
Rifampin/rifabutin
1
Antiretroviral Therapy
Category
Clarifications/Special considerations
Diaphragm
Spermicide
a) Nucleoside reverse transcriptase inhibitors (NRTIs)
Abacavir (ABC)
3
3
Tenofovir (TDF)
3
3
Zidovudine (AZT)
3
3
Lamivudine (3TC)
3
3
Didanosine (DDI)
3
3
Emtricitabine (FTC)
3
3
Stavudine (D4T)
3
3
b) Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Efavirenz (EFV)
3
3
Etravirine (ETR)
3
3
Nevirapine (NVP)
3
3
Rilpivirine (RPV)
3
3
c) Protease inhibitors (PIs)
Ritonavir-boosted atazanavir (ATV/r)
3
3
Ritonavir-boosted lopinavir (LPV/r)
3
3
Ritonavir-boosted darunavir (DRV/r)
3
3
Ritonavir (RTV)
3
3
d) Integrase inhibitors
Raltegravir (RAL)
3
3
Other:
No other conditions were selected using the "Women’s characteristics" filters.
Adolescents
Category
Clarifications/Special considerations
Adolescents
1
Special consideration: Adolescents In general, adolescents are eligible to use any method of contraception and must have access to a variety of contraceptive choices. Read More
Adolescents
Special consideration:
Adolescents
Special consideration:
Adolescents
In general, adolescents are eligible to use any method of contraception and must have access to a variety of contraceptive choices. Age alone does not constitute a medical reason for denying any method to adolescents. While some concerns have been expressed regarding the use of certain contraceptive methods in adolescents (e.g. the use of progestogen-only injectables by those below 18 years), these concerns must be balanced against the advantages of avoiding pregnancy.
It is clear that many of the same eligibility criteria that apply to older clients apply to young people. However, some conditions (e.g. cardiovascular disorders) that may limit use of some methods in older women do not generally affect young people since these conditions are rare in this age group. Social and behavioural issues should be important considerations in the choice of contraceptive methods by adolescents.
For example, in some settings, adolescents are also at increased risk for STIs, including HIV. While adolescents may choose to use any one of the contraceptive methods available in their communities, in some cases, using methods that do not require a daily regimen may be more appropriate. Adolescents, married or unmarried, have also been shown to be less tolerant of side-effects and therefore have high discontinuation rates.
Method choice may also be influenced by factors such as sporadic patterns of intercourse and the need to conceal sexual activity and contraceptive use. For instance, sexually active adolescents who are unmarried have very different needs from those who are married and want to postpone, space or limit pregnancy. Expanding the number of method choices offered can lead to improved satisfaction, increased acceptance and increased prevalence of contraceptive use.
Proper education and counselling both before and at the time of method selection can help adolescents address their specific problems and make informed and voluntary decisions. Every effort should be made to prevent service and method cost from limiting the options available.
Smoking
Category
Clarifications/Special considerations
a) Age < 35 years
1
b) Age > 35 years
i) < 15 cigarettes/day
1
ii) > 15 cigarettes/day
1
Note: Some methods are unavailable for specific time ranges
