diaphragms and cervical caps

There are two main types of contraceptive caps:

• the diaphragm.
• the cervical cap.

Diaphragms are a good deal bigger than cervical caps – they’re about as wide as the palm of your hand. You put the diaphragm into your vagina before sex, positioning it so that it keeps sperms from getting anywhere near your cervix.
Cervical caps are much smaller – about the size of a small egg-cup. You have to put the cervical cap directly onto your cervix, so as to stop sperm getting in. Cervical caps are much less commonly used than diaphragms - they’re mainly for women who, because of the shape of their vaginas, find it difficult to keep a diaphragm in place.

Diaphragms

What exactly are diaphragms?

Diaphragms are ‘domes,’ made of thin, soft rubber, or silicone. They form an excellent physical ‘barrier’ to sperms – though you have to use a spermicide (chemical) with them as well.
You can’t just buy a diaphragm ‘off the peg’ at a chemist – for the simple reason that women’s vaginas come in various sizes (particularly after they’ve had children). So you need to have your vaginal size assessed by a doctor or family planning nurse. She or he will then prescribe the size you need.
Most importantly, she or he must teach you exactly how to put the diaphragm inside – and how to get it into exactly the right place. If you haven’t been taught how to do this, you’ll probably position it so that it doesn't cover your cervix; this would leave you wide open to conception.
The diaphragm is far less popular than it was before the introduction of the Pill, but even in 2008 , it is still used by a sizeable minority of women in the UK – particularly those in their 30s and 40s. The most recent survey carried out by the Office for National Statistics showed that 3 per cent of women aged 16 to 49 were using it.
Used properly, the diaphragm is an efficient and safe type of contraception. It has a success rate of roughly 95 per cent per year among women who’ve been trained to use it correctly. But if you just ‘stick it in’ at the last moment, without being too sure where it’s going, then your success rate will be much lower.
In general, if you are a sexually-active woman, there’s a lot to be said for inserting your diaphragm every night before you go to bed (and leaving it in all night) – in case you make love.
Each diaphragm will last several years if it is carefully looked after, so this is an inexpensive contraceptive method, apart from the expense of the spermicidal cream or gel that must always be used with it. (However, you can obtain the cream or gel free of charge on an NHS prescription.)

Who can use the diaphragm?

Diaphragms can be used by most women without any kind of inconvenience or discomfort. So this is a good option for a woman who dislike condoms, or who cannot take the Pill for some reason or another, or for women who can’t use IUDs. It’s also popular with women who are older, and whose fertility is therefore a little lower.

How do you use a diaphragm?

The diaphragm looks like a little hat without a brim. It is ‘bendy,’ and can be folded so that it goes into the vagina easily. Before you insert it, you need to smear spermicidal cream or gel onto it, to give you adequate protection – in other words, to prevent sperms from creeping round the edge. A diaphragm without spermicidal cream will not be very effective in preventing pregnancy.
You put your diaphragm high up in your vagina, so that it covers the cervix. The top end of the dome goes behind your cervix, and the bottom end of the dome is tucked up behind your pubic bone.
When the diaphragm is placed correctly like this, it cannot be felt by either the woman or the man during intercourse.
It is quite easy to take the diaphragm out after use – simply by hooking your fingertip round it. The nurse or doctor will show you how to do this. Generally speaking, you’re safer not to take it out until the morning.
After taking it out, you wash it, dry it and put it away in its box, which is rather like a make-up compact.

What are the advantages to this method?

One of the key advantages to the diaphragm is that it can allow sex to be spontaneous. A woman can easily insert the diaphragm whenever she expects she may be having sex that day. But if you insert it more than three hours before you make love, you should put in some extra spermicide – before your man enters you.
Diaphragms should always be left in place for at least six hours after sex
However, if sex does not occur, it is quite safe for a woman to leave her diaphragm in, and even to go to sleep wearing it. But a diaphragm should not be left inside you for more than 30 hours, as this might possibly cause an infection and/or a discharge.
There is another advantage for the many women who feel particularly sexy during their periods, but whose men might be squeamish at the sight of blood during intercourse. With a diaphragm in place, there is usually no sign at all that the woman has a period, so the couple can make love as normal.

What are the disadvantages?

Some women do have difficulty in coming to terms with the idea of putting a rubber dome inside their vaginas. But with a bit of practice, they usually become quite happy about it.
Also, if you suddenly find yourself in a sexual situation and have to insert your diaphragm in a hurry before intercourse, that can interfere with spontaneity. Furthermore, there’s a risk that if you’re in a rush, you may not put it in correctly!
Some couples have difficulty in remembering to ‘top up’ the spermicide if love-making goes on for several hours, or if they have sex more than once in any one session.

Is the diaphragm an effective type of contraception?

Yes, a diaphragm is indeed an effective form of contraception - if spermicidal cream is always applied before sexual intercourse, and if the device is left in the vagina for six to eight hours after the intercourse has finished.
If used correctly, the diaphragm is generally reckoned to be 92 to 96 per cent effective against pregnancy. Obviously, the pregnancy rate is higher if it is not used properly. But it is lower if you’re in your late 30s or your 40s - which is when many women use it.

Are there any side effects?

• A very few women have an allergy to the material that the diaphragm is made from.
• Cystitis is a problem for a few users – possibly because the front of the diaphragm presses against the urinary passage.
• Some people are sensitive to spermicides.

What types of diaphragms are there?

In the UK, there are five brands:

• Refexions flat spring.
• Arcing silicone.
• Omniflex coil spring silicone.
• Ortho coil spring.
• Ortho All-Flex.

It’s mainly up to the doctor or family planning nurse to decide which type suits your vagina – and what size you need. (Sizes range from 55mm diameter to 100mm diameter.)

How long will your diaphragm last?

Given luck, several years. You should keep an eye on your diaphragm to make sure it is OK. Get a replacement immediately if it has perished or if it gets damaged in any way. Do not attempt DIY repairs!
You will need to see your doctor for re-measurement if your weight changes by more than seven pounds (about 3kg) either way (since that may alter your vaginal ‘fit’) - or if you resume wearing a diaphragm after a pregnancy.
Please note that if for any reason the diaphragm doesn't suit your particular vaginal shape, there is the alternative of a cervical cap (see below).

Cervical cap

What is a cervical cap?

The closely related 'cervical cap' is also a good method, but is used by fewer women. It is much smaller than the diaphragm, and looks rather like a very large thimble.
It fits over your cervix - like an egg-cosy over a boiled egg - so you have to be very sure that you can find your own cervix with your fingers, and put the cap snugly over it.
Nearly all cervical caps are prescribed and fitted in Family Planning Clinics though a few GPs now fit them. The doctor or family planning nurse will help you find a cap which is right for the shape of your vagina and cervix, and will advise you what size you need.
In Britain, there are four brands which are widely available.

• The Dumas Vault cap (sizes 1 to 5).
• The Prentif Cavity Rim (sizes 22mm, 25mm, 28mm and 31mm).
• The Vimule (sizes 1 to 3).
• The Femcap (soft silicone, sizes 22mm. 26mm and 30mm).

How do I put a cervical cap in?

The family planning nurse or doctor will teach you how to do this.
Before insertion, you need to fill the little cap one third full of spermicide. Then you squeeze it between finger and thumb in order to get it into your vagina. Finally, you put it over your cervix – where it is held in place by suction. Finally, put some more spermicide into your vagina.
The clinic staff will also show you how to ‘hook’ the cervical cap out with your finger, which is usually not too difficult. (As is the case with a diaphragm, it should stay in all night after love-making.)

Warning!

There is a rare infection called 'Toxic shock syndrome' (TSS), which is often associated with tampon use. If you have ever had TSS, it is doubtful whether you should use a diaphragm or cap.