Diaphragms, Cervical Caps and Shields

Diaphragm, cervical caps, and shields all block sperm from getting inside the uterus.  They must be used with spermicidal cream, foam, or jelly to be most effective.  The spermicide works by killing the sperm.  There are several kinds of cervical barriers, and they each work similarly but are all a little different.

·The diaphragm is a cup-shaped rubber disk with a flexible rim that covers the cervix.

·The cervical cap is a soft rubber cup with a round rim that fits snugly around the cervix.  The brand name for the cervical cap is FemCap®.

·The shield is a cup shaped rubber disk with a valve and loop that is held in place by the vaginal wall.  The brand name for the shield is Lea’s Shield®.

All of these methods are types of cervical barriers. Using these methods can take practice. Your doctor will talk with you about how to insert and remove your cervical barrier and help you practice in the office.

How to insert a diaphgram

  • Check the diaphragm for holes. To do this, you can hold it up to the light and look for tiny holes, or fill it with water and look for leaks.

  • Squeeze about one teaspoon of spermicidal jelly or cream into the cup of the diaphragm.

  • Spread a little bit of spermicide around the rim of the diaphragm with a finger.

  • Hold it with the cup facing down.  Squeeze the opposite sides of the rim so that the diaphragm folds.

  • With one hand, spread the lips of the vagina.  With the other hand, gently insert the folded diaphragm into the vagina.

  • Push the diaphragm backwards until it reaches the back wall of the vagina.  The diaphragm will be in place when the front rim is tucked behind the pubic bone.

  • If the diaphragm can still be felt, push it farther into the vagina.  Don’t worry, it can’t get lost in there!

  • After sex, the diaphragm must be left in place for at least 6 hours, but don’t keep it in for more then 24 hours.

 

How to insert a cervical cap

  • Check the cervical cap for holes. To do this, you can hold it up to the light and look for tiny holes, or fill it with water and look for leaks.

  • Squeeze spermicidal jelly or cream into the cup of the cervical cap to 1/3 full.

  • To insert the cap, hold it with the cap facing down.  Squeeze the opposite sides of the rim so that the cap folds.

  • With one hand, spread the lips of the vagina.  With the other hand, gently insert the folded cap into the vagina.

  • Push the cap backwards until it reaches the back wall of the vagina.  Press the rim of the cap around the cervix until it is completely covered.  Test the position of the cap once it is inserted by pressing it to make sure that the cervix can be felt, and by running a finger around the rim to make sure that the cervix is completely covered.

  • After sex, the cap must be left in place for 6 to 8 hours, but no more then 48 hours.

 

How to insert a shield

 

  • Examine the shield carefully for holes.

  • Coat the inside of the shield’s bowl, the rim of the bowl and the valve with spermicidal jelly or cream.

  • To insert the shield, hold it with the bowl facing down.  Squeeze the opposite sides of the rim so that the rim folds together.

  • With one hand, spread the lips of the vagina.  With the other hand, gently insert the folded shield into the vagina.

  • Push the shield backwards until it reaches the back wall of the vagina.  Press the rim of the shield around the cervix until it is completely covered.  Test the position of the cervix by running a finger around the rim to make sure that the cervix is completely covered.

  • After sex, the shield must be left in place for 8 hours, but no more than 24 hours.

  • To remove the shield, grasp the loop with one finger and pull it gently out of the vagina.

Effectiveness

The diaphragm is 84% - 94% effective.

The cervical cap is 86% effective, unless a woman has had a baby and gave birth vaginally (the baby came through the vagina).  This is because if the baby comes out of the vagina there is some stretching that happens around the cervix that can cause the cervical cap to not fit as snugly.  If she has given birth vaginally the cervical cap will be 71% effective. 

The shield is 85% effective.

Cost

Diaphragm: $30 - $50.

Cervical caps: $70.

Shields: $65.

Spermicide: $10 - $15 for a kit.

If you have health insurance, it may pay for all or part of the cost. If you don't have health insurance or don't want to use your parents' insurance, family planning clinics may offer these methods for less.

It is recommended that the diaphragm and cap be replaced every one to two years.  The shield should be replaced every year.

Where to get

Women need to get a prescription and it has to be fitted by a trained doctor or health care provider. The doctor will also demonstrate how to put in and remove the cervical barrier and how to properly take care of it.

Things to think about

These methods are great options for women who prefer not to or can’t use hormonal forms of birth control. But some women don’t like the fact that they have to put it in before having sex and/or they have to put something into their vagina.  Also, some women have allergic reactions to spermicide.

Generally there are very few side effects.  Some women may experience vaginal irritation (which can put a woman at higher risk for STIs), allergic reactions, vaginal pain or discomfort, or vaginal or urinary tract infections.  Women using a cervical barrier method should never leave it in for longer than the recommended period of time because the risk of Toxic Shock Syndrome, a rare but serious disorder, increases if she leaves it inside for too long.

Remember, male and female condoms are the only forms of birth control that also offer protection against STIs.

 

Read about other Methods: