2017 HCHB_digital

Contraception & Sexual Wellbeing
Contraception: barrier contraception
Barrier contraceptives prevent sperm from reaching a woman’s uterus and
fallopian tubes. Condoms are currently the only type of barrier contraceptive
available in New Zealand; diaphragms (silicone domes which cover the cervix)
are no longer sold here.
Condoms are made of either latex rubber, polyurethane, or polyisoprene. They
are put on over a man’s erect penis before intercourse to stop sperm entering a
woman’s vagina.
Latex condoms are more widely available and usually less expensive than nonlatex
polyurethane or polyisoprene condoms. However, they perish easily and can
only be used with water or silicone-based lubricants. Oil-based lubricants, such as
vaseline or baby oil can break down the latex increasing the risk of contraceptive
failure. Latex condoms must also be stored away from heat and sunlight, and
used before their expiry date.
Polyurethane is a non-latex plastic material. They tend to be thinner than some latex
condoms, so may offer better sensitivity; however, they are usually more expensive
than latex condoms and slightly less flexible so more lubrication may be needed. Oil,
water or silicone-based lubricants can be used with polyurethane condoms.
Polyisoprene is a synthetic material and condoms made from polyisoprene
have a soft, natural feel and conform to the skin easily, in a similar way to latex
condoms. They are suitable for people with latex allergies but must be kept away
from heat and sunlight. Strength is comparable to latex condoms and they are
reportedly easier to use than polyurethane condoms.
Although not 100% effective, condoms greatly reduce the risk of sexually
transmitted infections (STIs) such as HIV, chlamydia, and gonorrhoea, and lessen
the chances of contracting syphilis, herpes and genital warts. Male condom use
should be encouraged even during sex with women taking hormonal methods
of contraception or who are postmenopausal to reduce the risk of contracting
an STI. Hormonal contraceptives protect only against pregnancy, not STIs. The
chance of becoming pregnant depends a lot on how carefully the condom is
used; most sources quote a failure rate of between 2% and 18%. Spermicides
are no longer recommended to be used with condoms as they can cause irritation
and increase the risk of acquiring an STI.
The only type of female condom currently available in New Zealand is the FC2,
made of nitrile (latex-free). A flexible ring at each end keeps it in place.
Advice for customers
• If unprotected sex occurs, or if a condom breaks, women should see a doctor
as soon as possible.
»»
The ECP is available from accredited pharmacists and accredited nurses
without prescription, but must be taken within 72 hours of unprotected
sexual intercourse (see Contraception: Emergency).
• Remind customers to store condoms away from heat and sunlight (ie, not in a car
glove box), and to only use condoms that have not passed their expiry date.
• Suggest water-based lubricants to decrease the risk of latex condom breakage.
TREATMENT OPTIONS
Category Examples Comments
Male condoms (latex)
eg, Durex Extra Safe*, Ansell range, Marquis
Condoms
Home-made lubricants, such as vaseline or cooking oils, may damage latex condoms.
Condoms routinely no longer contain spermicide. Some vaginal antifungal creams can
damage condoms and diaphragms – refer to the pharmacist if the customer or their partner
is using this type of product. Many brands are fully subsidised on a prescription (144
condoms per script).
Male condoms (non-latex) eg, polyisoprene (Durex Real Feel*) Non-latex condoms are suitable for people with latex allergies and are safe to use with both
water and oil-based lubricants.
Female condoms eg, FC2 Latex-free. Strong, odourless and causes no allergic reactions. May be used with water or oil
based lubricants. Can be inserted up to eight hours prior to sex.
Lubricants eg, Anime Lubricant*, Durex Perfect Glide* Reduce friction during sexual intercourse enhancing pleasure and reducing the risk of
condom damage. Use only water or silicone-based lubricants with latex condoms.
Oral contraceptives (OC)
(desogestrel, ethinylestradiol,
levonorgestrel,
norethisterone)
Products for erectile
dysfunction
[Restricted when sold by suitably trained
pharmacists for women over the age of
16 previously prescribed an OC within the
last three years]
[Prescription medicine except when
supplied by a pharmacist who has
successfully completed training in the
treatment of ED in males aged 35–70]
eg, sildenafil (Silvasta, Vedafil)
Selected OCs must be supplied in a pack approved as a restricted medicine, containing no
more than six months' supply and including an explanation of side effects and when to seek
further medical advice. Refer women with newly identified contraindications to the OC to a
doctor and encourage regular cervical screenings and cardiovascular risk assessments.
Use the recommended screening tool to screen out at-risk men who are smokers, have
self-reported high cholesterol, have diabetes, and who have had a previous coronary
intervention. Provide encouragement for all men presenting with ED to visit their doctor for a
heart health and diabetes check.
Products with an asterisk have a detailed listing in the Sexual Wellbeing, Contraception and Lubricant section of OTC Products, starting on page 257.
EXPLORE THE
DUREX RANGE
OF CONDOMS
Page 40 HEALTHCARE HANDBOOK 2017-2018 Common Disorders