Barriers to conception and disease.

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.