Barrier Methods

Abstract: According to many rabbinic opinions, barrier forms of contraception are more problematic in Jewish Law than hormonal methods. Therefore, contemporary halachic authorities disagree about the permissibility of the diaphragm. The contraceptive sponge is also controversial; some authorities consider it more problematic than the diaphragm. Condoms are prohibited as a method of contraception in almost all cases. Spermicides alone are generally permitted.

Discussion: Barrier methods of contraception are more problematic in Jewish Law than hormonal methods. There are two reasons for this. First, the use of barrier methods may violate the prohibition against illegitimate expulsion of semen (hotza'at zera levatalah). Second, these methods may prevent intercourse from taking place in a natural manner as required by halacha.

Contemporary halachic authorities disagree about the permissibility of the diaphragm. Some rabbis prohibit its use as being akin to "casting seed (sperm) on wood and on stones." Others maintain that, since semen enters the vagina normally when the diaphragm is in place, there is no problem of illegitimate expulsion of semen. They also argue that intercourse is considered natural because the diaphragm is inserted too deeply to interfere [1]. The concerns with the cervical cap are similar to those with the diaphragm, but as it covers only the cervix [1], there may be more cases in which its use would be permitted.

Since the diaphragm is a source of controversy, it is generally not the first choice method of contraception. However, if a woman cannot use hormonal methods for medical reasons, or because of persistent spotting [2] which prevents her from going to the mikveh for extended intervals, then it is more likely that the use of a diaphragm will be permitted. The doctor should explain to the woman any hormonal problems or unusual circumstances in her case, so she can ask for individual adjudication by her rabbi.

The contraceptive sponge [3] raises similar questions to the diaphragm. Some authorities consider it more problematic than the diaphragm, as it occupies more of the vaginal canal and is more likely to be felt during intercourse. The same is true for alternate vaginal barriers such as the FemCap [4].

Condoms, whether male or female, completely prevent the natural flow of semen into the vaginal canal and also impede natural sexual contact. Therefore, they are prohibited as a method of contraception in almost all cases. When required for infection control (e.g., one spouse is awaiting results of an HIV test following possible exposure, or the husband contracts CMV during the pregnancy of his CMV negative wife), they may be permitted temporarily according to some opinions (but not others).

Implications for Patient Care: Condoms are not an acceptable method of birth control in almost all cases. When needed for infection control, the doctor should be prepared to inform the rabbi of the consequences of the illness they are meant to prevent and for how long they will be needed. For short term contraception, spermicides or other methods, alone or combined with fertility awareness, are options that can be considered.

When it is felt that hormonal contraception is not appropriate for a particular patient, the doctor should be prepared to explain the risk involved in hormonal use in this woman, the risk of pregnancy at this time and for how long pregnancy needs to be delayed for medical indications.

Medical References

[1] Gallo MF, Grimes DA, Schulz KF. Cervical cap versus diaphragm for contraception. Cochrane Database Syst Rev 2002;(4):CD003551.

[2] Rosenberg MJ, Waugh MS. Oral contraceptive discontinuation: a prospective evaluation of frequency and reasons. Am J Obstet Gynecol 1998 Sep;179(3 Pt 1):577-82.

[3] Kuyoh MA, Toroitich-Ruto C, Grimes DA, Schulz KF, Gallo MF. Sponge versus diaphragm for contraception: a Cochrane review. Contraception. 2003;67:15-8.

[4] Mauck M, Callahan D, Weiner DH Dominik R. A comparative study of the safety and efficacy of FemCap a new vaginal barrier contraceptive, and the Ortho All-Flex Diaphragm. Contraception 1999;60:71-80.

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