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Non-hormonal Contraceptive Methods

(Published July 2013)

Section 2. Other Non-hormonal Methods

Barrier Methods

Diaphragm

Description

The diaphragm is a flexible latex or silicone dome-shaped device filled with spermicide and inserted into the upper vagina covering the cervix. It creates a spermicidal barrier at the cervical opening. (Caya® Diaphragm shown below.)

Use

Diaphragms require a prescription and a fitting for the correct size, ranging from 50 to 95 mm diameter. They should be refitted after:28

  • Full-term pregnancy (and should not be used postpartum until diaphragmuterine involution is complete)
  • Abdominal or pelvic surgery
  • Miscarriage, or abortion after 14 weeks of pregnancy (and should not be used until 6 weeks after a second-trimester abortion)
  • Weight change after pregnancy of 20 percent or more

The clinician should teach each patient how to apply spermicide to the device, insert it, and check it for correct placement. Women should practice inserting and removing the device in the clinician’s office until they feel comfortable with the procedure. They should also learn how to check the diaphragm for tears and holes before each use and to clean and store the device properly.

Women can insert the diaphragm up to 6 hours before intercourse and should leave it in place for at least 6 hours but no more than 24 hours after the last act of intercourse. If the patient engages in additional acts of intercourse before 6 hours have elapsed, she should insert fresh spermicide onto the rim of the diaphragm with her finger without removing the device. She should not rinse the vagina or douche while wearing the diaphragm and for at least 6 hours after the last act of intercourse.

Women who are severely obese may have difficulty placing the diaphragm in the vagina. In addition, women with certain anatomical abnormalities, such as prolapse, may not be able to use the diaphragm.

Effectiveness

This method is fairly effective. Typical use is associated with a 12 percent failure rate.7

Risks

  • The incidence of urinary tract infections (UTIs), bacterial vaginosis, and vaginal candidiasis may be increased in some women who use a diaphragm.29 
  • The risk of unintended pregnancy with this method is 12 percent.7

Side Effects

None

Contraindications and Precautions

Medical Eligibility Criteria for the Diaphragm
(restrictions associated with HIV risk are largely related to spermicides, which must be used with the diaphragm, rather than to the device itself)

Category 4
(unacceptable health risk if the contraceptive method is used)

  • High risk for HIV infection

Category 3
(theoretical or proven risks usually outweigh the advantages of using the method)

  • HIV infection or AIDS
  • History of toxic shock syndrome
  • Antiretroviral therapy
  • Allergy to latex
  • Allergy to spermicides

Source: Reference 10

Advantages

  • Relatively discreet (can be inserted ahead of time)
  • Easily reversible
  • After up-front cost, relatively low ongoing cost for spermicide.
  • After initial fitting and instruction, no need for repeated visits to health care provider other than for replacement every 2 years.

Disadvantages

  • Requires prescription
  • Required with every act of intercourse
  • Lower efficacy with typical use than some other methods
  • Increased risk of UTIs and vaginal infections
  • For some women, difficulty in learning insertion and removal techniques
  • Obese women may have trouble inserting the device
  • No protection against STIs

Counseling Messages

  • Consistent and correct use is essential to the effectiveness of the diaphragm.
  • Oil-based lubricants damage latex and therefore should never be used with a latex diaphragm.
  • This method does not protect against STIs.
  • Patients who use diaphragms should obtain emergency contraception (EC) in advance. (Note that patients who are less than 17 years old will need a prescription for EC.)