Barrier Methods, Spermicides, & Gels - Nishmat Yoatzot Halacha

Introduction

Some contraceptive methods work by creating a barrier that prevents sperm from entering the uterus. The diaphragm and similar devices are inserted before relations and cover the opening of the cervix. These methods are fully permitted by some halachic authorities. Others permit them only under certain circumstances. Condoms are very rarely permitted, although an individual question can be asked in very extreme circumstances.

Spermicides are used together with some barrier methods to increase their effectiveness. When used alone, spermicides present few halachic problems (where contraception itself is permitted), but are only about 80% effective.

Diaphragm, Cervical Cap, & Contraceptive Sponge

Medical Background

The diaphragm and cervical cap are reusable contraceptive devices that work by covering the opening of the cervix and blocking the passage of sperm. The diaphragm is larger, bowl-shaped, and can be made of silicone or latex. The cervical cap is smaller, shaped like a ski hat, and made of silicone.

Spermicidal gel or foam is placed into the diaphragm or cervical cap to further reduce the chances of conception.

The contraceptive sponge is a small, round, disposable sponge permeated with spermicide. It works both by covering the opening of the cervix and by impairing the function of sperm cells.

A woman inserts a diaphragm, cervical cap, or sponge deep into the vagina before intercourse. She removes it no earlier than six hours after intercourse.

Efficacy

With typical use, the classic diaphragm together with spermicide is about 88% effective in preventing pregnancy. The newer one-size-fits-most Caya diaphragm, used together with Caya contraceptive gel, is about 83% effective.

As a point of comparison, typical use of a condom has an efficacy rate of about 82%.

The sponge is about 88% effective with typical use among women who have never given birth vaginally, but for women who have given birth vaginally, efficacy drops to about 76%. The cervical cap also has a gap between women who have and haven’t given birth vaginally, with slightly lower efficacy rates for both than for the sponge.

Fitting a Diaphragm or Cervical Cap

The sponge is one-size-fits-all and the Caya diaphragm is one-size-fits-most (requiring only confirmation of suitability by one’s healthcare provider), and both are available over-the-counter or online.

The classic diaphragm and cervical cap come in a variety of sizes, and are available only by prescription.

A woman should consult her healthcare provider as to correct sizing for a cervical cap, which usually corresponds to a woman’s pregnancy and childbirth history.

The diaphragm needs to be fitted by a physician or by a qualified nurse or midwife. A woman should have another fitting after each pregnancy, or if she experiences a significant weight change (more than about 5kg). It is usually best to seek a referral for fitting a diaphragm from one’s physician.

Please see here for a list in Hebrew of women in Israel qualified to fit diaphragms. Information in Hebrew on obtaining a diaphragm in Israel, including a list of women qualified to fit diaphragms, is also available here. It can sometimes be difficult to find a practitioner who can fit diaphragms in North America.

Side Effects

One major advantage of barrier methods is their lack of side effects. However, some people are sensitive to latex or silicone, or to specific ingredients in some spermicides, and should take this into account when considering these methods.

FAM

Please see our article on the Fertility Awareness Method for discussion of integrating barrier methods into its practice.

Halachic Desirability

Contemporary halachic authorities differ in their rulings regarding the diaphragm and cervical cap. Some authorities consider them a halachically problematic method of birth control that interferes with the normal course of relations and thus should be used only in extenuating circumstances. Another concern is that their use may be similar to “casting seed on wood and on stones,” violating the prohibition against illegitimate expulsion of semen (hotza’at zera l’vatalah).

Other authorities consider them a permissible method of birth control, which may be used by any couple who are halachically permitted to use contraception. According to these authorities, intercourse with these devices is considered natural because they are inserted too deeply to interfere with relations, and, since semen enters the vagina normally when they are in place, there is no problem of “casting seed on wood and on stones.”

Our site follows this position, that the diaphragm and cervical cap are fully permissible as contraceptive methods. In some cases, as when a short-term method of contraception is needed or when there is particular concern about potential side effects of hormonal contraception and the IUD, these methods may be preferred to others.

Some halachic authorities prefer these methods in general, because they have less of an effect on a woman’s body than other methods.

The sponge fills more of the vaginal canal than the diaphragm or cervical cap, so it is more likely to be felt during relations. This means it is less preferred and less widely accepted. However, it is still inserted deeply enough that some halachic authorities, including the supervisors of this site, permit it when necessary.

Blood found on a contraceptive device

When a woman finds blood on an item that was inserted into the vagina (such as a bedikah cloth), halacha is stringent. The leniencies of external stains do not apply.

Therefore, it is best to remove and rinse a diaphragm or cervical cap without looking at it. Similarly, one can remove the sponge and dispose of it without looking. It can be easier to avoid looking if one removes the contraceptive device in a fairly dark room.

If a woman does find blood on such a device, and suspects it is from irritation to the cervix or vaginal wall, she should ask a halachic question.

Shabbat

It is permissible to squeeze spermicide out of a tube on Shabbat for use with a diaphragm or cervical cap. If the spermicide is fairly liquid (i.e., it pours out on its own and doesn’t retain a shape after exiting its container), then it may be spread freely on Shabbat.

If the spermicide is more of a gel, then applying it raises concerns of the prohibited labor of memarei’ach, spreading, on Shabbat. In this case, the diaphragm or cervical cap with spermicide can be inserted prior to Shabbat. Precise timing should follow the instructions on the package insert.

If necessary, spermicide gel can be squeezed in dabs directly onto the edges and middle of the diaphragm or cap on Shabbat, and left to spread itself following insertion.

It is permissible to use an applicator to top off spermicide for repeat acts of intercourse with a previously inserted diaphragm or cap on Shabbat.

The sponge is best inserted prior to Shabbat, because the sponge typically needs to be wetted and squeezed prior to insertion. This entails a rabbinic-level violation of the prohibited labor of sechita, squeezing out a liquid. Again, this can typically be done hours prior to relations, and timing should be confirmed with the package insert.

Spermicides and Gels

Medical Background

Spermicides and contraceptive gels are inserted into the vagina before marital relations. They do not kill sperm cells, but rather create a hostile environment that reduces their motility.

Spermicides are used on their own or in conjunction with barrier methods of contraception.

Spermicide comes in a variety of forms, including film (VCF), gel, cream, foam, or vaginal suppository. Contraceptive vaginal gel (Phexxi) works similarly, but has a different chemical formulation.

Spermicide is typically available over-the-counter, while Phexxi requires a prescription. Spermicides and gels need to be inserted before relations (generally at least 10-15 minutes, but no more than an hour, depending on the type).

A list of pharmacies in Israel that carry VCF, a particularly effective form of spermicide, can be found at https://www.safevcf.co.il/wheretobuy.

Efficacy and Use

Although efficacy varies somewhat among formulations, spermicides used alone are about 79% effective with typical use, and Phexxi about 86% effective. Spermicides are more effective when used in conjunction with barrier methods of contraception.

Despite their limited effectiveness, these methods can play a valuable role as short-term contraception where the consequences of pregnancy would not be catastrophic. This is the case especially when there are other factors at play that tend to reduce fertility, such as breastfeeding.

Spermicides may also be recommended as a backup method (e.g., if a woman missed a contraceptive pill).

Spermicides should only be used as directed in package inserts. It is best to practice in advance of actual use. Note that not all spermicides are suitable for use in conjunction with latex diaphragms or cervical caps.

Side Effects

Possible side effects can include irritation, burning, or itching (for both men and women), and yeast or bacterial infections (for women). Some people are sensitive to specific ingredients, so it may be worth trying a different formulation of spermicide if there are side effects.

Please see here for more information on the medical aspects of spermicides.

Halachic Desirability

Spermicides are not considered hotza’at zera levatalah and do not interfere with natural marital relations. Therefore, halachic authorities usually allow them when a couple is halachically permitted to delay pregnancy.

Safety is an important halachic consideration. Therefore, a woman for whom pregnancy would be dangerous should choose a more reliable contraceptive method.

Blood found on an applicator

Some spermicides, as well as Phexxi, are inserted with an applicator. When a woman finds blood on an item that was inserted into the vagina (such as a bedikah cloth), halacha is stringent. The leniencies of external stains do not apply. Therefore, it is best to discard or rinse the applicator after use without looking at it. If blood is found on an applicator, a halachic question should be asked.

Condoms

Medical Background

The male condom is a disposable latex or plastic sheath that fits over the penis during relations. The female condom is a disposable plastic pouch between two flexible rings – one is placed in the vagina and one is left outside the vaginal opening.

Both types of condom work by preventing the flow of semen into the vagina.

Efficacy

With typical use, the male condom is 87% effective and the female condom 79% effective.

Halachic Desirability

Both male and female condoms are prohibited by almost all authorities, except in very extenuating circumstances. They raise three main halachic concerns:

Condoms block semen from entering the vagina, so that relations with a condom are considered a violation of the prohibition against hotza’at zera l’vatalah.
By creating a perceptible barrier, condoms impede natural sexual contact.
Male condoms are used by men, who are directly obligated in the mitzva of procreation. Contraceptive methods used by women are usually halachically preferable.

Non-contraceptive functions

Many authorities permit using a sterile condom to collect sperm for fertility testing or treatment. Some halachic authorities prefer for condoms in this case to be perforated. (See here).

Some authorities permit condoms on a temporary basis to prevent the transmission of infectious diseases (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). Others prohibit condoms even in this type of case, and require the couple to avoid transmission by abstaining from relations. A couple in this type of situation should ask a specific halachic question.

Blood found on a condom

When blood is found on an item that was inserted into the vagina, halacha is stringent. The leniencies of external stains do not apply. Therefore, in the rare case where condoms are permitted, it is best to remove and discard a condom without looking at it. If blood is found on a condom, a halachic question should be asked.

This article was updated on 30 March, 2022.

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