• Clinical science

Nonhormonal contraception

Summary

Nonhormonal contraceptive methods are a birth-control option for individuals who do not tolerate or wish to avoid the use of hormones. These methods include behavioral methods, barrier methods, spermicides, and surgical sterilization. Behavioral methods, such as coitus interruptus, periodic abstinence, and lactational amenorrhea are inexpensive and readily available but are associated with a high failure rate because of poor compliance and unreliability. Condoms are the only contraceptive method that additionally prevents sexually transmitted infections, including HIV. Surgical sterilization techniques and copper intrauterine devices have the lowest failure rate with regular use. Other nonhormonal contraceptive methods discussed in this article include the vaginal douche method, diaphragm, cervical cap, and spermicides.

Overview

All contraceptive methods listed below have the benefit of avoiding adverse effects associated with hormone use.

Effectiveness of nonhormonal contraceptive methods

Overview of nonhormonal contraceptive method
Method Failure rate with typical use (based on CDC data) Pros Cons
Behavioral methods
Lactational amenorrhea
  • ∼ 2%
  • Reversible
  • Inexpensive
Coitus interruptus
  • ∼ 22%
  • Reversible
  • Inexpensive
  • Readily available
  • No side effects
Fertility awareness-based methods
  • ∼ 24%
  • Reversible
  • Inexpensive
  • Readily available
  • No side effects
Vaginal douche
  • No data available
  • None
Intrauterine device
Nonhormonal copper device
  • ∼ 1%
Barrier methods
Diaphragm
  • ∼ 12%
  • Reversible
Condom
  • High risk for poor compliance
  • Risk of incorrect use and complications thereof
  • Female condom: difficult placement
Sponge
  • ∼ 12% (nulliparous)
  • ∼ 24% (parous)
  • Reversible
  • Does not require professional fitting
Spermicides
  • ∼ 28%
  • Reversible
Cervical cap
  • ∼ 20–40%
  • Reversible
Surgical sterilization
Vasectomy
  • ∼ 0.15%
Female sterilization
  • ∼ 0.5%

References:[1][2][3][4][5]

Behavioural methods

For the pros and cons of individual contraception methods see overview of nonhormonal contraceptive methods above.

Coitus interruptus

Fertility awareness-based methods

Vaginal douche

  • Unreliable method of contraception, although still practiced by over 20% of women in the US. Not a recommended form of contraception, but many women in the US still have this misconception
  • Risk of promoting unintentional pregnancy by pushing semen into the cervical canal
  • Method: The vagina is flushed with water or other products immediately after male ejaculation during intercourse in an attempt to theoretically flush semen out

Lactational amenorrhea

References:[1][2][3][5][6]

Intrauterine device

Nonhormonal copper device

Barrier methods

For the pros and cons of individual contraception methods see overview of nonhormonal contraceptive methods above.

Condom

  • Description
    • A thin sheath that is placed over the shaft of the penis (male condom) or in the vaginal canal (female condom) prior to sexual intercourse
    • Acts as a physical barrier between penile, vaginal, and/or anal secretions
  • Contraindication: latex allergy for latex condoms
  • Complications: unintentional pregnancy or infection due to breakage (usually related to incorrect use)

Diaphragm (contraceptive)

  • Description
    • Dome-shaped latex, metal, or plastic device that holds spermicide
    • Placed into the anterior and posterior fornix of the vagina prior to sexual intercourse; must be kept in place for 6 hours after intercourse
    • Prevents passage of semen into the cervix
  • Contraindications: cervical anomalies or abnormalities (e.g., infection, malignancy), spermicide or latex allergy
  • Complication: toxic shock syndrome (use for ≥ 24 hours is not recommended)

Cervical cap

  • Description
    • Cup shaped latex, metal, or plastic device that holds spermicide
    • Placed over the base of the cervix; inserted up to ∼ 8 hours before sexual intercourse and must be removed after 48 hours
    • Prevents passage of semen into the cervical canal
  • Contraindications: cervical anomalies or abnormalities, spermicide or latex allergy
  • Complication: toxic shock syndrome, cervical erosion (resulting in spotting)

Sponge

  • Description
    • Foam disk containing spermicidal fluid; activated by moistening with tap water and gently squeezing before inserting into the vagina
    • Inserted up to 24 hours before intercourse; should not be worn > 30 hours
    • Prevents entry of semen into the cervix and has spermicidal effects
  • Contraindications: cervical anomalies or abnormalities, spermicide allergy
  • Complication: vaginal irrigation, toxic shock syndrome (rare)

Spermicide

  • Description
    • Foams or jellies that are inserted into the vagina prior to sexual intercourse
    • The active ingredient disrupts surface membranes → spermicidal effect
  • Contraindication: spermicide allergy
  • Complication: vaginal irritation

References:[2][3][7][8]

Surgical sterilization

For the pros and cons of individual contraception methods see overview of nonhormonal contraceptive methods above.

Female sterilization

  • Description: surgical interruption of the fallopian tubes
  • Methods
  • Can be performed under neuraxial or general anesthesia

Vasectomy

References:[5][9]