For the purpose of this review, ¿barriers¿ are defined as any method used during or after intercourse that physically or chemically isolates semen. Latex condoms for men are the best studied physical barrier and offer high efficacy as both a contraceptive and as protection against several major sexually transmissable diseases (STD), particularly human immunodeficiency virus (HIV). Limited acceptability and dependence on male cooperation limit their ¿use effectiveness¿ in non-commercial sex or when the receptive partner is disempowered. Polyurethane male condoms may improve acceptability and prove stronger and more durable. Female-dependent methods require further study which may net real benefits for containing the spread of STD/HIV infections in the short to medium term. Female condoms and newer non-toxic intravaginal chemicals offer much promise. Similarly, the female diaphragm warrants further investigation and should be given more prominence at least as a second-line measure. Withdrawal and post-coital intravaginal chemical prophylaxis may have been previously underestimated as occasionally useful strategies, particularly for reducing the risk of pregnancy and HIV infection for those that were otherwise unprepared for sex. The only role for vasectomy is as a contraceptive measure, while vaginal or anal douching is contraindicated as a reproductive health measure because of the risk of pelvic inflammatory disease and other ectopic pregnancy. There is ample room for developing a more diverse range of better barrier products as well as better promoting those methods that already exist. We already have the means available to us to halt the spread of HIV. Moral arguments against barrier methods have no scientific basis.
PIP: 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.