Diaphragms
and caps
Diaphragms and caps are barrier methods of contraception.
They fit inside your vagina and cover your cervix
(entrance to the womb). They come in different shapes
and sizes. Vaginal diaphragms are circular domes
made of thin, soft latex (rubber) or silicone with
a flexible rim. Cervical caps are smaller and are
made of latex or silicone. To be effective, diaphragms
and caps need to be used with a spermicide. Spermicides
are chemicals that kill sperm. How
effective are diaphragms and caps?
How does a diaphragm or cap
work?
Can anything make a diaphragm
or cap less effective?
What are the different types
of diaphragm and cap?
What are the advantages
of a diaphragm or cap?
What are the disadvantages
of a diaphragm or cap?
Can anyone use a diaphragm or
cap?
Where can I get a diaphragm or
cap?
How do I put a diaphragm
in?
How do I put a cap in?
How do I take my diaphragm
or cap out?
How do I look after my diaphragm
or cap?
Can I use my diaphragm or cap
during my period?
Can I have a bath when I've got
my diaphragm or cap in?
What is a practice diaphragm
or cap?
How often do I need to see a
doctor or nurse?
Can I use my diaphragm or
cap again after I've been pregnant?
How effective are diaphragms and caps?
How effective any contraceptive is depends on
how old you are, how often you have sex and whether
you follow the instructions.
If
100 sexually active women don’t use any
contraception, 80 to 90 will become pregnant in
a year. If used according to instructions, latex
diaphragms and caps are 92-96% effective when
used with spermicide. This means that between
four and eight women in 100 will get pregnant
in a year. The silicone cap FemCap is less effective.
If they are not used according to instructions,
more women will get pregnant.
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How does a diaphragm or cap work?
A diaphragm or cap stops sperm reaching an egg.
It covers your cervix while the spermicide kills
any sperm. To be more effective in preventing
a pregnancy, you must use spermicide with a diaphragm
or cap.
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Can anything make a diaphragm or cap less
effective?
A diaphragm or cap will be less effective if:
•
you don't use it every time you have sex
• it doesn't cover your
cervix
• you don't have the right
size
• you use it without spermicide
• you have sex three hours
or more after you put it in and you don't use
extra spermicide
• you don't use extra spermicide
with you diaphragm or cap every time you have
more sex
• you remove it too soon
(less than six hours after the last time you had
sex)
• you use oil-based products
such as baby lotion, bath oils or some vaginal
medicines (pessaries) with latex diaphragms or
caps. These can damage the latex.
If any of these happen, or if you have had sex
without using contraception, you can get advice
about emergency contraception.
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What are the different types of diaphragm
and cap?
There are three types of latex vaginal diaphragm:
flat, coil, or arcing spring. There are two silicone
diaphragms – a coil and arcing spring type.
All types come in different sizes.
There
are also three types of latex cap: vault, cervical
and vimule. There is currently one variety of
silicone cap (FemCap). Caps come in different
sizes. A doctor or nurse can help you decide which
is best for you after they have examined you.
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What are the advantages of a diaphragm
or cap?
• You only have to use
it when you have sex.
• It has no serious health
risks.
• You are in control of
your contraception.
• There is a choice of
different types.
• You can put it in at
any convenient time before you have sex.
• It may give you some
protection against cervical cancer and some sexually
transmitted infections.
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What are the disadvantages of a diaphragm
or cap?
• Putting it in at the
time of sex can be an interruption.
• Some people find the
spermicide messy.
• It can take time to learn
how to use it.
• Cystitis can be a problem
for some women who use a diaphragm. Ask the doctor
or nurse to check the size of your diaphragm if
you suffer from cystitis. Changing to a slightly
smaller or softer-rimmed (coil spring) diaphragm
or to a cervical cap may help.
• Some people are sensitive
to the chemicals in latex or spermicide. This
may cause irritation in some women and their partners.
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Can anyone use a diaphragm or cap?
Most women can use a diaphragm or cap. A diaphragm
or cap may not be suitable if you:
•
have vaginal muscles which can't hold a diaphragm
• have a cervix of an unusual
shape or in an awkward position or you cannot
reach it
• are sensitive to the
chemicals in latex or spermicide
• have repeated urinary
infections
• have a vaginal infection
(wait until after the infection has cleared)
• have ever had toxic shock
syndrome
• do not feel comfortable
touching your vagina.
If you have a high risk of getting a sexually
transmitted infection (STI), for example if you
or your partner has more than one partner, it
may be advisable not to use a diaphragm or cap.
Research shows that spermicide (Nonoxinol 9),
which needs to be used with a diaphragm or cap
to prevent pregnancy, does not protect against
STIs. It may even increase the risk of getting
an STI such as chlamydia or HIV.
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Where can I get a diaphragm or cap?
You can get a diaphragm or cap from some family
planning clinics and some general practices. If
you know the size and type of diaphragm or cap
you use, you can buy them from a pharmacy.
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How do I put a diaphragm in?
Instructions on how to use a diaphragm come with
it and a doctor or nurse will show you how to
put it in. The different types of diaphragm are
all used in a similar way. With clean hands, put
a small amount of spermicide cream or jelly on
each side of the diaphragm (approximately two
2cm strips). Some women find that putting a little
spermicide on some of the rim makes the diaphragm
easier to put in.
Put
your index finger on top of the diaphragm and
squeeze it between your thumb and other fingers.
Slide the diaphragm into your vagina downwards
and backwards. This should ensure that the diaphragm
covers your cervix.
Always
check that your cervix is covered. It feels like
the end of your nose. If your cervix is not covered,
take the diaphragm out by hooking your finger
under the rim or loop (if there is one) and pulling
downwards and try again.
Some
women squat while they put their diaphragm in.
Others lie down or stand with one foot up on a
chair. You will need to find out which position
is easiest for you.
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How do I put a cap in?
Instructions on how to use a cap come with it.
The different types of cap are all used in a similar
way. Fill one-third of the cap with spermicide,
but don’t put any spermicide around the
rim as this will stop the cap from staying in
place. FemCap has a groove between the dome and
the rim; some spermicide should also be placed
there. Squeeze the sides of the cap together and
hold it between your thumb and first two fingers.
The cap must fit neatly over your cervix. It stays
in place by suction. Always check that your cervix
is covered. Depending on the type of cap, you
may need to add extra spermicide after it has
been put in.
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How do I take my diaphragm or cap out?
You must leave all types of diaphragm and cap
in place for at least six hours after the last
time you had sex. You can leave it for longer,
but don’t leave a diaphragm or cap in for
more than the recommended time. For latex types
this is 30 hours, including the minimum six hours
and for FemCap, 48 hours including the minimum
six. Take it out by gently hooking your finger
under the rim, loop or strap and pulling downwards.
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How do I look after my diaphragm or cap?
When you take your diaphragm or cap out, wash
it in warm water with a mild unperfumed toilet
or baby soap. Then rinse it thoroughly. Dry it
carefully and keep it in its container in a cool,
dry place. Never boil your diaphragm or cap, never
use disinfectant or detergent to clean it or use
talcum powder with it. Do not use any oil-based
product with latex types as it will damage them.
Before
use, check your diaphragm or cap regularly for
tears or holes by holding it up to the light and
having a good look at it. Be careful with your
nails and jewellery. If your diaphragm goes out
of shape, squeeze it gently back into its circular
shape. Your diaphragm or cap may become discoloured.
But don’t worry, this will not make it less
effective.
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Can I use my diaphragm or cap during my
period?
Ideally diaphragms and caps should not be used
during your period because of a possible risk
of toxic shock syndrome (TSS). Never leave them
in for longer than the recommended time.
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Can I have a bath when I've got my diaphragm
or cap in?
Put your diaphragm or cap in after a bath rather
than before. This is because water may move its
position or wash away the spermicide. Have a shower
rather than a bath during the six hours that you
need to keep your diaphragm or cap in after you
have had sex.
The
effect of swimming or water sports has not been
studied, but it is likely to be small.
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What is a practice diaphragm or cap?
A doctor or nurse will sometimes fit you with
a practice diaphragm or cap that should be the
right size for you. Practice diaphragms and caps
give you time and privacy to find out if the method
is suitable for you and to learn how to use it
properly. While you are learning to use it, don’t
rely on it to stop you getting pregnant. You will
need to use another method of contraception, such
as condoms, if you have sex.
During
this time try putting the diaphragm or cap in
and check that it covers your cervix. You can
have sex with the diaphragm or cap in place and
leave it in for a few hours to find out if it
is comfortable for you and your partner. It is
also a good idea to use the spermicide jelly or
cream to see how this feels.
When
you go back to get it checked, wear the diaphragm
or cap so the doctor or nurse can check that you
have put it in properly and that it is still the
right size. Ask them any questions you have about
using the diaphragm or cap.
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How often do I need to see a doctor or
nurse?
Once you have a diaphragm or cap that you are
happy with, you only need to see a doctor or nurse
to replace it, usually once a year, or if you
have any questions or concerns. You may need a
different size diaphragm or cap if you put on
or lose more than 3kg (7 pounds) in weight.
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Can I use my diaphragm or cap again after
I've been pregnant?
You will probably need a different size diaphragm
or cap after you have a baby or after you have
a miscarriage or an abortion.
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