Birth Control Options for Women - Spermicidal and Barrier Contraception

Advantages of the Diaphragm. The diaphragm can be carried in a purse, can be inserted up to an hour before intercourse begins, and usually cannot be felt by either partner. It appears to protect against cervical gonorrhea, Chlamydia, and trichomoniasis, although more research is needed to confirm this. It does not provide protection against sexually-transmitted infections in areas other than the cervix.

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Disadvantages and Complications of the Diaphragm. Some disadvantages or complications are as follows:

Failure rates are high, about 20% with typical use.
Some women dislike having to insert the device every time intercourse occurs or have trouble mastering the insertion and removal process.
One potential worry is that the device may slip out of place when the woman is on top during intercourse.
Frequent urinary tract infections are a problem for some users. This difficulty can sometimes be resolved by a refitting, by urinating before inserting the device, or by urinating after intercourse.
Cases of toxic shock syndrome have been reported among diaphragm users, but it is very rare. To be safe, the diaphragm should not stay in place for more than 24 hours. (It is still important for pregnancy protection, however, to retain the diaphragm for six to eight hours after intercourse.)
Of note: it provides protection against sexually transmitted disease only in the cervix and women should not rely on it for protection against HIV.

Cervical Cap

The cervical cap (Prentif, FemCap) is a thimble-shaped latex cup that fits over the cervix and is always used with a spermicidal cream or gel. It is like the diaphragm, but smaller, and is available in only four sizes. The cap is sold by prescription and requires a pelvic examination, Pap test, and fitting by a health care provider.

Insertion and Use of the Cervical Cap. After a small amount of spermicide is placed in the cap, the device is inserted by hand. As in diaphragm use, instruction and practice is required. The cap must be kept in the vagina for eight hours after the final act of intercourse. Caps wear out and should be replaced every one to two years. A refitting may also be needed when a woman experiences certain changes in her health or physical status.

Click the icon to see an image of a cervical cap.

Candidacy for the Cervical Cap. Because of the restricted range of available sizes, about one woman in five will not be able to be fitted for the cap. The cap is not widely used, and some women, particularly those who live in sparsely populated areas, may not have access to health care professionals who are trained in fitting this device. Other conditions that can preclude cap use include the following:

An abnormal Pap test.
A history of toxic shock syndrome.
A sexually transmitted or reproductive tract infection.
Inflammation of the cervix.
The cap has little value for women who have had children, because the stretching of the vagina and cervix makes obtaining a proper fit more difficult and failure rates are high.