Non-hormonal contraception

About non-hormonal contraception

If you're a woman of childbearing age, almost any time you have sex without using contraception there is a chance you might get pregnant.

Non-hormonal contraception can prevent you from getting pregnant by either stopping sperm from fertilising an egg, or by preventing a fertilised egg from attaching to the lining of your womb (uterus).

There are three main methods of non-hormonal contraception: barrier methods, the intrauterine device (IUD) and natural family planning. The intrauterine system (IUS) is different to the IUD. The IUS is a contraceptive device that is placed in the womb. It can also help women who suffer from very heavy periods (menorrhagia).

Barrier methods

These are physical barriers that stop the sperm from entering the womb.

Condoms (male and female)

Condoms act as a barrier to sperm to prevent pregnancy and also protect both partners against sexually transmitted infections (STIs).

A male condom is made of thin rubber (latex) or plastic (polyurethane) and is used by rolling it onto an erect penis before making contact with the vaginal area.

A female condom is a thin, soft, polyurethane pouch that is fitted inside the vagina before the penis makes contact with the vaginal area. It’s held in place with a ring that lies outside the vagina.

There are several things you need to be aware of when using condoms. For example:

  • if you're using a latex condom, don’t use medicated creams or gels, or oil-based lubricants such as petroleum jelly or baby oil, as these can weaken the latex and cause it to tear
  • you should always check a used condom for leaks and tears before throwing it away

If you notice a tear, or think the condom has leaked or slipped during sex, you may wish to use emergency hormonal contraception. Ask your pharmacist or GP for advice.

Even if used correctly, each year two in 100 women will get pregnant when their partner is using a male condom, and five in 100 women will get pregnant when using a female condom. Always read the instructions that come with the condoms. If a condom isn’t used correctly, the failure rate is much higher.

Diaphragms and caps

Diaphragms and caps are made of latex or silicone and are inserted into the upper part of the vagina to cover the cervix (neck of the womb). They act as a barrier to sperm to prevent pregnancy but don’t protect against STIs.

Diaphragms and caps come in different shapes and sizes. Diaphragms are usually dome-shaped and fit in the vagina; caps are smaller and fit over the cervix.

If you want to try this form of contraception, visit your GP or family planning clinic so you can have a diaphragm or cap fitted that is right for you. Your GP or nurse will teach you how to put it in and check it’s positioned correctly.

The cap or diaphragm needs to be put into place before you have sex. You must use a spermicidal cream with this form of contraception. You can put the cap or diaphragm in at any time before you have sex. But if you have sex three hours or more after fitting it, you should apply some more spermicidal cream. You will need to leave the cap or diaphragm in place for at least six hours after you’ve had sex.

There are several things you need to be aware of when using a diaphragm or cap. For example:

  • don’t use it during your period and never use it without a spermicide
  • have it refitted or checked by your GP or nurse after a pregnancy, abortion or if you noticeably gain or lose weight – more than 3kg (seven pounds)
  • don’t use medicated creams or gels, or oil-based lubricants such as petroleum jelly or baby oil, as these can weaken the latex or silicone and cause it to tear
  • you should always check for tears before putting it in place

If you see a hole or tear in your diaphragm or cap, you must throw it away and get a new one. Even if used correctly, each year between four and eight in 100 women will get pregnant when using a diaphragm or cap. Always read the instructions that come with the diaphragm or cap. If a diaphragm or cap isn’t used correctly, the failure rate is much higher.

IUD

The IUD (also known as the coil) is a small plastic and copper device that is fitted into your womb by a GP or nurse. It has one or two threads that hang down from your womb and into the upper part of your vagina.

The IUD is designed to prevent sperm meeting the egg and to stop a fertilised egg attaching to the lining of your womb. The main advantage of an IUD is that once fitted, and as long as it remains in place, it can be left for five to 10 years. An IUD doesn’t protect against STIs.

There are several things you need to be aware of when using an IUD. For example, it:

  • protects you from getting pregnant as soon as it’s fitted
  • won’t affect your weight
  • can make your periods heavier and/or more painful, although this may improve over time
  • can increase your risk of pelvic infection in the first three weeks after having it fitted, particularly if you’re at risk of STIs
  • can damage or go through (perforate) your womb or cervix when it’s fitted, but this is rare
  • can be pushed out by your womb or it can move, but this is rare – your GP or nurse will teach you how to feel for the threads to check it is positioned correctly

The IUD is very effective and fewer than two in 100 women using it will get pregnant over five years. If you do get pregnant while using an IUD, there is a small risk of an ectopic pregnancy. This is when pregnancy occurs outside the womb, for example in one of the fallopian tubes.

If your periods are heavy, your GP or nurse may advise an alternative type of coil called the intra-uterine system (IUS). This releases a hormone called levonorgestrel to thin the lining of the womb. For more information about the IUS, see Hormonal contraception.

Natural family planning

The rhythm method

This involves planning when to have sex around your menstrual cycle to try to reduce the chances of you becoming pregnant. To be as effective as possible, the rhythm method should be taught by a trained health professional.

The rhythm method works by observing and recording your body’s natural signs, such as body temperature, mucus from your cervix and the time of your menstrual cycle. Fertility monitoring devices can help to measure these signs – you can buy these from a pharmacy. They work by recording changes in your temperature, urine or saliva.

There are several things you need to be aware of when using the rhythm method. For example:

  • it limits you from having sex at certain times of the month
  • you need to monitor your body’s natural signs on a daily basis
  • illness, lifestyle, stress and age (particularly when approaching the menopause) can interfere with your body’s natural signs, making them difficult to interpret
  • it doesn’t protect you against STIs

The rhythm method varies in how effective it is. If used correctly, only one in 100 women will get pregnant each year. However, it can be difficult to get the method right and if sex is timed incorrectly, the risk of pregnancy is high.

For more information about the rhythm method, speak to your GP or nurse.

The withdrawal method

This involves withdrawing the penis before ejaculation (coitus interruptus). It’s not considered a method of contraception because it’s unreliable. But if used correctly, it can help reduce the chance of pregnancy – however, there is always the risk sperm may have leaked out of the penis before ejaculation. It can also be a cause of sexual frustration because it means ‘pulling out’ at the last moment.

Sterilisation

Both men and women can have operations to permanently prevent fertilisation. Women can have their fallopian tubes cut or blocked, and men can have a vasectomy to stop sperm being present in the semen.

Sterilisation is only recommended if you and your partner are sure you don’t want to have any, or more, biological children. Ask your GP or family planning clinic for more advice.

What is a spermicide?

Answer

A spermicide is a chemical that kills sperm.

Explanation

The most common type of chemical used as a spermicide is nonoxinol-9. It’s available as a cream, gel, sponge or pessary (a tablet that is inserted into the vagina).

A spermicide isn’t a reliable method of contraception on its own and doesn’t protect you against sexually transmitted infections (STIs). However, a spermicide is recommended for use with a diaphragm or cap to increase their effectiveness. You usually need to smear the spermicidal cream or jelly onto the diaphragm or cap before you fit it into place.

You can buy spermicides from a pharmacy without a prescription.

Should I use a spermicide with a condom?

Answer

No, you don’t need to use a spermicide with a condom.

Explanation

At one time, it was widely recommended to use a spermicide with a condom. However, this advice has now changed – if used correctly, condoms should give enough protection without the need for a spermicide.

Spermicidal-lubricated condoms are now being phased out as research has shown that spermicidal condoms (containing the spermicidal chemical nonoxinol-9) offer no additional benefits and may be less effective against STIs.

How long can I leave a diaphragm or cap in for?

Answer

This depends on the exact type you’re using – some can be left in place for up to 30 hours and others for up to 48 hours.

Explanation

Diaphragms and caps must be left in place for at least six hours after you’ve had sex to be effective. This allows the spermicide enough time to kill any remaining sperm and prevent them from entering your cervix (neck of the womb).

You can leave a diaphragm or cap in for longer than the minimum of six hours. This can be up to 30 hours for those made of latex and up to 48 hours for those made of silicone. You should check the information leaflet that comes with your diaphragm or cap to find out the maximum recommended time for your particular device, as this can differ between products.

You can put the diaphragm or cap in place at any time before you have sex. However, you need to remove it at least once within the maximum stated time and wash it in mild soap and water before you put it back in.

How often will I need to get a new diaphragm?

Answer

You will usually be advised to have your diaphragm replaced every year. You may also need to get a new diaphragm if you gain or lose weight.

Explanation

Your GP or nurse will usually check to see if you need a new diaphragm once a year. You will probably only need a new one before this time if your current diaphragm has been damaged, or you need a different type. However, if you have put on or lost more than 3kg (seven pounds) in weight, you will also need to have your diaphragm checked by a GP or specially trained nurse.

Check your diaphragm regularly to make sure it’s in good condition. Do this by holding it up to the light and stretching it (being careful not to damage the rubber with your fingernails or jewellery). A change in colour and texture of the rubber is quite normal and doesn’t make it less effective. If there are any holes in the diaphragm, or you can’t return it to its normal shape, visit your GP or clinic to get a replacement.

I’m thinking of having an IUD fitted, but will my partner be able to feel it during sex?

Answer

No, your partner won’t be able to feel the IUD during sex. However, your partner may feel the threads attached to the IUD. If this happens, see your GP.

Explanation

The IUD has one or two threads that hang down from your womb and into the upper part of your vagina. These threads help you to check the IUD hasn’t slipped or moved. Your GP or nurse will teach you how to feel for the threads to make sure the IUD is still in place. You will usually be asked to do this several times in the first few weeks after having an IUD fitted and then after each period.

Your partner may be able to feel the threads of the IUD during sex. If this happens, make an appointment to see your GP and get them checked.