Diaphragms and Caps

What are diaphragms and caps?

• Diaphragms are dome-shaped devices. They are usually made from soft rubber or silicone. They are put into the vagina and cover the cervix during sex. They stop sperm from entering the uterus (womb). There are various different types and sizes.
• Caps are basically just smaller and firmer than diaphragms. They cover just the cervix. They are used much less often than diaphragms. They may be used by women who are troubled with cystitis (bladder infection) when using a diaphragm.

You should also use a spermicide each time you use a diaphragm or cap. (Spermicide kills sperm.)

How effective are diaphragms and caps?

They are about 92-96% effective if used correctly. This means that 8 women in 100 will become pregnant each year with this method of contraception. (Compare this to when no contraception is used. More than 80 in 100 sexually active women who do not use contraception become pregnant within one year.)

Other methods of contraception are more reliable than this. Several other methods of contraception are more than 99% effective. However, some women prefer to use a diaphragm or cap.

What are the advantages of the diaphragms and caps?

They are easy use and do not have any serious medical risks. They may help to protect you from sexually transmitted infections. You only have to use them when you have sex. The advantage over a male condom is that you can put it into the vagina at any time before sex.

What are the disadvantages of diaphragms and caps?

You have to learn how to use them properly. Some women get cystitis (bladder infection) after using a diaphragm. The spermicide and rubber may be messy and may irritate.

Although the diaphragm and cap can protect against some sexually transmitted infections, they do not protect against HIV infection. The use of a diaphragm or cap by women who have HIV or AIDS, or who are at high risk of HIV infection, is not generally recommended.

How are diaphragms and caps used?

A doctor or nurse will examine you and advise on the correct size and shape that would suit you. They will show you how to put in and take out the diaphragm or cap. They will also show you how to use the spermicide which must be used every time you use the diaphragm and cap. You need to be confident that you can put it in correctly over your cervix, and know how much spermicide to use and how to use it.

You are likely to be given a 'practice' diaphragm or cap by the doctor or nurse. This is for you to practice at home putting it in and out. This is not to be used for contraception. At a follow up appointment the doctor or nurse will check that everything is fine, and then give you a real one for contraceptive use.

Some useful points about diaphragms and caps:

• You can insert a diaphragm or cap at any time before sex. However, you need to use extra spermicide if you have sex more than three hours after you put it in.
• It must be left in place for at least six hours after last having sex.
• Use extra spermicide if you have sex again before taking it out.
• Do not leave it in for more than 30 hours in total. (This is to prevent the possibility of toxic shock syndrome. This is a very rare but serious type of blood poisoning caused by toxin-producing bacteria.)
• Don't have a bath with the diaphragm or cap in place. The water may wash away the spermicide or move the cap out of position. Showers are fine.

Who cannot use diaphragms or caps?

• If your vagina is lax and cannot hold the diaphragm or cap in place.
• If you have an unusual shape or position of your cervix. The doctor or nurse will advise about this when they examine you for correct fitting.
• If you are allergic or sensitive to rubber or spermicide.
• It may not be advisable if you are troubled with repeated cystitis (urine infections).
• If you have ever had toxic shock syndrome.

Looking after rubber diaphragms and cap

• Wash it with warm water and mild soap after use. Rinse with lots of water.
• Dry gently and keep it in the box provided.
• Never use detergents, boiling water, disinfectants, etc, which can damage the rubber.
• Check it for damage, tears, etc, before using. Hold it up to the light to check there are no holes.
• Depending on how often it is used, it may need replacing every year or so.

Some other points about diaphragms and caps

• Size - you may need a different size if you gain or lose more than 3 kg in weight or have a baby. See a doctor or nurse to re-assess your size.
• Lubricants - don't use oil based products such as vaseline, body oils, lotions, etc, during sex. They can damage rubber. If you want to use a lubricant then use KY Jelly or extra spermicide.
• Infection - don't use it if you have a vaginal infection such as thrush. Wait till the infection clears.

You doctor or nurse may give you emergency contraception to have in advance. This can be useful, for example if you were to take the diaphragm out earlier than six hours after having sex.

Further information

Your GP and practice nurse are good sources of information if you have any queries.

The fpa (formerly the family planning association) also provide information and advice.
fpa's helpline: 0845 310 1334 or visit their website www.fpa.org.uk