Contraception- Diaphragm and Cervical Cap
- Are there specific times when a woman should not use the cervical cap?
- Can a lubricant be used when a diaphragm is being used?
- Can a woman who is breastfeeding use the cervical cap?
- Can a woman who is breastfeeding use the diaphragm?
- Can lubricants be used when a cervical cap is being used?
- Can the cervical cap cause toxic shock syndrome?
- Can the diaphragm cause toxic shock syndrome?
- Do cervical caps cause an increase in vaginal discharge?
- How can the effectiveness of the cervical cap method be increased?
- How can the effectiveness of the diaphragm method be increased?
- How can the health care provider determine the diaphragm size for individual users?
- How does a cervical cap work?
- How does a diaphragm work?
- How effective is the cervical cap as a contraceptive method?
- How effective is the diaphragm as a contraceptive method?
- How is a woman fitted for a diaphragm?
- How is the correct cervical cap size determined?
- How long before intercourse should the cap be inserted and how long after intercourse should the cap be removed?
- How long before intercourse should the diaphragm be inserted and how long after intercourse should the diaphragm be removed?
- Should a woman who gets recurrent urinary tract infections (UTI) while using the diaphragm switch to another form of contraception?
- What is a cervical cap?
- What is proper care for a cervical cap?
- What is the proper care for a diaphragm?
- What kind of follow-up is required after a woman is fitted for a cervical cap?
- What kind of follow-up is required after a woman is fitted for a diaphragm?
- What types of cervical caps are available?
- Where can I find a list of cervical barriers approved in Canada ?
- Where can I find a list of cervical barriers approved in Canada?
- Who are not good candidates for the diaphragm?
- Who is not a good candidate for the cervical cap?
Are there specific times when a woman should not use the cervical cap?
The cervical cap cannot be used within six weeks of a full-term delivery, after a recent abortion or miscarriage, or during any vaginal bleeding, including menstruation.
Can a lubricant be used when a diaphragm is being used?
Yes, but oil-based lubricants should be avoided as they can damage the diaphragm. Lubricants that should be avoided include:
- Baby Oil
- Petroleum Jelly (Vaseline)
- Coconut Oil/Butter
- Edible Oils
- Margerine/Butter
- Hemorrhoidal Ointments
- Mineral Oil
- Palm Oil
- Suntan Oil
- Vaginal Creams (e.g. Monistat)
- Fish Oil
Lubricants that can be used safely include:
- Aqua-lube
- Astroglide
- Aloe-9
- KY jelly
- Transi-lube
- Duragel
- H-R Lubricating jelly
- Marketed contraceptive foams, creams or gels
- Condom-mate
- Egg white
Can a woman who is breastfeeding use the cervical cap?
Yes. The cervical cap is suitable for use during lactation although care must be taken to ensure the use of a correctly sized cap and to ensure correct positioning each time. The cervical cap should not be used in the first 6 weeks post- partum or immediately after an abortion or miscarriage as the cervical size may be changing rapidly at this time. The cervical cap has a higher failure rate in women who have previously had a baby because it is more difficult to find an appropriate fit.
Can a woman who is breastfeeding use the diaphragm?
Yes. The diaphragm is suitable for use during lactation although careful fitting is required in the post-partum woman. The diaphragm should be refitted no sooner than six weeks post-partum.
Can lubricants be used when a cervical cap is being used?
Yes, but oil-based lubricants should be avoided as they can damage the cervical cap. Lubricants that should be avoided include:
- Baby Oil
- Petroleum Jelly (Vaseline)
- Coconut Oil/Butter
- Edible Oils
- Margerine/Butter
- Hemorrhoidal Ointments
- Mineral Oil
- Palm Oil
- Suntan Oil
- Vaginal Creams (e.g. Monistat)
- Fish Oil
Lubricants that can be used safely include:
- Aqua-lube
- Astroglide
- Aloe-9
- KY jelly
- Transi-lube
- Duragel
- H-R Lubricating jelly
- Marketed contraceptive foams, creams or gels
- Condom-mate
- Egg white
Can the cervical cap cause toxic shock syndrome?
Toxic shock syndrome is a very rare complication of the cervical cap, which is usually a consequence of failure to remove the cervical cap within 48 hours. The user should seek medical attention if any symptoms of toxic shock syndrome are displayed (sudden high fever, diarrhea, vomiting, dizziness, weakness, muscle aches or sunburn-like rash).
Can the diaphragm cause toxic shock syndrome?
Toxic shock syndrome is a very rare complication of the diaphragm, which is usually a consequence of failure to remove the diaphragm within 24 hours. The user should seek medical attention if any symptoms of toxic shock syndrome are displayed (sudden high fever, diarrhea, vomiting, dizziness, weakness, muscle aches or sunburn-like rash).
Do cervical caps cause an increase in vaginal discharge?
Cervical caps may cause more vaginal odour and discharge than diaphragms. The user should remove the cervical cap no later than 24 hours after insertion and should clean and dry the cervical cap between uses. If a woman is experiencing persistent vaginal discharge, despite these preventative measures, an alternate contraceptive device should be considered.
How can the effectiveness of the cervical cap method be increased?
As with other female barrier methods, using the cervical cap in combination with a male condom and spermicide may provide additional contraceptive efficacy and be of benefit to women at risk for sexually transmitted diseases.
How can the effectiveness of the diaphragm method be increased?
As with other female barrier methods, using the diaphragm in combination with a male condom may provide additional contraceptive efficacy and be of benefit to women at risk for sexually transmitted diseases.
How can the health care provider determine the diaphragm size for individual users?
The correct diaphragm size can be estimated by :
- inserting the index and middle fingers into the vagina until the posterior wall is reached (by middle finger)
- marking the point at which the index finger touches the pubic bone with the tip of the thumb to estimate vaginal length
- using this estimate of vaginal length to determine diaphragm size by placing one rim of the diaphragm on the tip of the middle finger
- the opposite side of the diaphragm rim should lie just in front of the thumb when the correct size is selected
Cervical caps are barrier methods of contraception. These devices place a physical barrier between sperm and the cervix by fitting snugly over the cervix. Spermicide is required with the initial application of the cap, however, additional spermicide is not necessary with subsequent acts of intercourse.
Diaphragms are barrier methods of contraception used by women, in conjunction with a spermicide. These devices place a physical barrier between sperm and the cervix by fitting snugly behind the pubic bone when inserted into the vagina. The spermicide is placed in the diaphragm prior to insertion and repeat applications are recommended with subsequent acts of intercourse. If additional spermicide is required it should be placed directly into the vagina and the diaphragm should be left in place.
How effective is the cervical cap as a contraceptive method?
If used perfectly the probability of failure during the first year of use for the cervical cap is 10 to 13 percent. The cervical cap has a substantially higher first year failure rate in women who have previously been pregnant because of difficulty in achieving an exact fit (26 to 27% failure in the first year). While consistent and correct use of these products is essential for effectiveness, approximately one-half of the failures of these methods occur despite diligent use. The Pearl index is 11-19/100 women years (failure rate for 100 women using the method for one year).
How effective is the diaphragm as a contraceptive method?
If used perfectly the probability of failure during the first year of use for the diaphragm is 4 -8%. While consistent and correct use of these products is essential for effectiveness, approximately one-half of the failures in diaphragm users occur despite diligent use. The Pearl index is 4-20/100 women years (failure rate for 100 women using the method for one year). The lower failure rates occur in older women probably because they have lower natural fertility with advancing age.
How is a woman fitted for a diaphragm?
A pelvic examination by either a physician or a skilled health care provider is required for fitting diaphragms. Fitting rings are produced by diaphragm manufacturers in various sizes and with different rim types. Sizes range from 50 to 105 mm. They are most commonly available in flat spring or coil spring rim types. Diaphragms between 60 -85 mm in diameter will provide the correct fit for most women. Initially the fitting ring size is estimated by clinical assessment of the vaginal length. Smaller or larger sizes are then inserted until the correct fit is achieved. It is important that each individual is fitted with the type of rim that she will ultimately use as the rim type can affect fit and ease of insertion. It should fit snugly into the upper half of the vagina, immediately behind the pubic bone, making contact with the lateral walls of the vagina and the posterior fornix. The anterior rim (behind the pubic bone) should not cause significant pressure and yet should not allow easy insertion of a finger between the diaphragm and the pubic bone. The user should practice insertion under supervision and placement should be inspected to ensure that the fitting ring is correctly positioned in the vagina. Fitting is best done without an empty bladder so that the user can test to ensure that urination is easily accomplished with the selected fitting ring in place. The diaphragm may require resizing following a full-term pregnancy, pelvic surgery, or abortion, or if there is a major change in weight.
How is the correct cervical cap size determined?
A bimanual, pelvic examination must be performed to ascertain the position and size of the uterus and cervix. Speculum examination allows visualization of the cervix, which is helpful in estimating the internal cap diameter. Two or more cervical cap sizes should be tried to achieve the optimal fit. A cervical cap that fits too tightly can cause trauma to the cervix, and one that fits too loosely will be more likely to become dislodged or to not form a secure seal. When fitted properly, a vacuum is created and the cervical cap cannot turn. It is estimated that six to thirty percent of women may experience difficulty achieving a good fit with the limited size selection of available cervical caps.
How long before intercourse should the cap be inserted and how long after intercourse should the cap be removed?
The cervical cap can be inserted from immediately before up to 6 hours before intercourse and should be removed no sooner than 8 hours after intercourse. It may be left in place for up to 48 hours after intercourse. Additional spermicide is NOT required with subsequent acts of intercourse.
How long before intercourse should the diaphragm be inserted and how long after intercourse should the diaphragm be removed?
The diaphragm can be inserted immediately before or up to 6 hours before intercourse and should be removed no sooner than 6 hours after intercourse. It can be left in place for up to 24 hours after intercourse. Additional spermicide is required with subsequent acts of intercourse. If more spermicide is required it should be placed in the vagina and the diaphragm should be left in place.
Should a woman who gets recurrent urinary tract infections (UTI) while using the diaphragm switch to another form of contraception?
Diaphragms may occasionally result in recurrent urinary tract infection because pressure from the rim on the urethra may result in incomplete bladder emptying. If the woman is experiencing recurrent UTIs, a refit or change of rim type may help. There are three types of diaphragms available. The most frequently used diaphragm is the coil spring because of its ease of insertion. Other options include the arcing spring and flat spring. For some women, UTIs may be a reason to switch from or avoid this family planning option.
A cervical cap is a small barrier contraceptive device made of rubber. It is held in place over the cervix by suction and must be snugly fitted. Spermicide is placed in the cervical cap with initial insertion.
What is proper care for a cervical cap?
After each use the cervical cap should be washed with warm water and a mild soap. It should be air dried and stored in its case, away from obvious sources of heat and excessive light. The cervical cap should be dusted with powder or cornstarch prior to storage. Disinfectants, carbolic soaps and detergents should be avoided when caring for the cervical cap. Before each use the cervical cap should be checked for small holes or tears by holding it up to a light. The cervical cap does need to be replaced periodically after approximately one or two years or at any time that the device appears damaged.
What is the proper care for a diaphragm?
After each use the diaphragm should be washed with warm water and a mild soap. It should be patted dry and stored in its case, away from obvious sources of heat and excessive light. The diaphragm should be dusted with powder or cornstarch prior to storage. Disinfectants, carbolic soaps and detergents should be avoided when caring for the diaphragm. Before each use the diaphragm should be checked for small holes or tears by holding it up to a light. The diaphragm does need to be replaced periodically after approximately one or two years or at any time the device appears damaged or bent.
What kind of follow-up is required after a woman is fitted for a cervical cap?
Cervical cap users do not require any special follow-up other than a refitting after a full-term pregnancy, pelvic surgery or abortion, or if there is a major change in weight. Routine gynecologic exams should be part of the woman's yearly physical exam. Pap smears may show cervical inflammation secondary to the cervical cap use and therefore should be performed yearly. Cervical cap users also need to understand proper maintenance of their cervical cap including checking the integrity of the cervical cap periodically.
What kind of follow-up is required after a woman is fitted for a diaphragm?
Diaphragm users do not require any special follow-up other than a refitting after a full-term pregnancy, pelvic surgery or abortion, or if there is a major change in weight. Routine gynecologic exams should be part of the woman's yearly physical exam. Diaphragm users also need to understand the importance of proper maintenance of their diaphragm including checking the integrity of the diaphragm periodically.
What types of cervical caps are available?
Cervical caps are available in 22, 25 and 31 mm sizes, referring to the internal rim diameter. The restricted number of sizes is a limitation to the use of the cervical cap in the general population.
Where can I find a list of cervical barriers approved in Canada ?
A cervical cap is a barrier method of birth control that is not used very often these days but may be a good contraceptive option for some women.
Only one cervical cap, the silicone Oves cap, is approved by Health Canada . The latex Prentif cervical cap is more commonly used but is not officially approved by Health Canada . It is, however, approved by the American Food and Drug Administration (FDA) so women can get a prescription from their Canadian doctor and order it on-line.
Cervical caps are designed to fit over the cervix only (as opposed to a diaphragm, which covers some of the vagina as well) and provide a physical barrier preventing sperm from entering the cervix. Spermicidal jelly should be used with the cap at the time of insertion, but more spermicide is not necessary for further acts of intercourse, unlike the diaphragm. The cervical cap can be left in place for 48 to 72 hours (depending on the manufacturers instructions) and provides protection for unlimited sex in that time. It must be fitted by a health care professional.
The cap has a higher failure rate than some of the other methods, especially in women who have had a baby before. For women who have never had a baby, the failure rate with perfect use (meaning correct use with every single act of intercourse) is 9 % per year, while the failure rate with typical use is 16% per year. For women who have had a baby before, the failure rates are 26% with perfect use and 32% with typical use.
Some websites that may be helpful are: www.cervcap.com, www.oves.com.
Where can I find a list of cervical barriers approved in Canada?
A cervical cap is a barrier method of birth control that is not used very often these days but may be a good contraceptive option for some women.
Only one cervical cap, the silicone Oves cap, is approved by Health Canada . The latex Prentif cervical cap is more commonly used but is not officially approved by Health Canada . It is, however, approved by the American Food and Drug Administration (FDA) so women can get a prescription from their Canadian doctor and order it on-line.
Cervical caps are designed to fit over the cervix only (as opposed to a diaphragm, which covers some of the vagina as well) and provide a physical barrier preventing sperm from entering the cervix. Spermicidal jelly should be used with the cap at the time of insertion, but more spermicide is not necessary for further acts of intercourse, unlike the diaphragm. The cervical cap can be left in place for 48 to 72 hours (depending on the manufacturers instructions) and provides protection for unlimited sex in that time. It must be fitted by a health care professional.
The cap has a higher failure rate than some of the other methods, especially in women who have had a baby before. For women who have never had a baby, the failure rate with perfect use (meaning correct use with every single act of intercourse) is 9 % per year, while the failure rate with typical use is 16% per year. For women who have had a baby before, the failure rates are 26% with perfect use and 32% with typical use.
Some websites that may be helpful are: www.cervcap.com, www.oves.com.
Who are not good candidates for the diaphragm?
The diaphragm is poorly suited to women if they or their partners have allergies or sensitivities to latex, rubber or spermicides. Women with anatomic distortion due to large cystoceles, rectoceles or uterine prolapse are also poor candidates for the diaphragm. Women with some physical disabilities, or with neurologic impairment which limits their flexibility or fine motor control may also not be well suited to the diaphragm, as use of this method requires dexterity for proper diaphragm placement. Women who are not comfortable with insertion or do not have the assertiveness to insist on the timing of insertion and removal may also be poor candidates for the diaphragm.
Who is not a good candidate for the cervical cap?
The cervical cap is likely to cause problems for women (or their partners) who have allergies or sensitivities to latex, rubber or spermicides. Women with any cervical structural deformity or asymmetry, abnormal cervical cytology, chronic cervicitis and recurrent salpingitis are also poor candidates for the cervical cap. Women with some physical disabilities, or with neurologic impairment which limits their flexibility or fine motor control may also not be well suited to the cervical cap, as this method requires dexterity to properly fit the cervical cap. Women who are not comfortable with insertion or do not have the assertiveness to insist on the timing of insertion and removal may also be poor candidates for the cervical cap.
