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Contraception - Management
What are the advantages, disadvantages, and risks of the diaphragm and cervical cap?

  • Advantages:
    • Adverse effects are rare.
    • They can be inserted at a convenient time (up to 3 hours) before intercourse, so that spontaneity can be maintained.
    • The woman can control the use of contraception.
    • They may protect against cervical cancer, chlamydial infection and pelvic inflammatory disease.
    • These methods are not compromised by concurrent drug therapy (e.g. liver enzyme–inducing drugs).
  • Disadvantages:
    • Effectiveness is low compared with hormonal and intrauterine methods.
      • The user failure rates are higher.
      • For diaphragm with spermicide, this is 16%. For cervical cap plus spermicide, this is between 16–32%.
    • They require motivation and careful use on each occasion to be effective.
    • They require planning so that the diaphragm or cap is in place or readily available.
    • Cannot be used until 6 weeks post partum or 6 weeks following second trimester abortion.
    • The fit needs to be rechecked after weight gain/loss of more than 3 kilograms (7 pounds), or after giving birth.
    • Some women may be allergic to the material from which the diaphragm is made.
    • The incidence of urinary tract infection may be increased in some women who use diaphragms — this often relates to the fit and size of the diaphragm, which may put pressure on the urethra.
    • They do not offer protection against sexually transmitted infections, including HIV.
    • They must be used with spermicide, which may cause irritation or allergy.
    • They should not be used by women at high risk of sexually transmitted infections as spermicides can increase the risk of infection.
    • Some women find the method messy to use.

[Belfield, 1999SOGC, 2004; FFPRHC, 2007d]

Clarification / Additional information

Contraceptive efficacy:

  • Diaphragm plus spermicide:
    • The method failure rate for the diaphragm (plus spermicide) is 6% — that is, with consistent and correct use, 6 of 100 women will conceive during 1 year.
    • The typical user failure rate is 16% — that is, when user failure is added to method failure, 16 of 100 women will conceive during 1 year.
  • Cervical cap plus spermicide:
    • Parous women:
      • The method failure rate is 20% — that is, with consistent and correct use, 20 of 100 women will conceive during 1 year year.
      • The typical use failure rate is 32% — that is, when user failure is added to method failure, 32 of 100 women will conceive during 1 year.
    • Nulliparous women:
      • The method failure rate is 9%, and the user failure rate is 16%.
  • For comparison with other methods, see Effectiveness of contraceptives.

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