To assess a woman's eligibility for use of a diaphragm or cervical cap:

• In young women and women with special needs, assess their competence to decide, and support them in making their own decisions about contraception.
• For these individuals, the diaphragm and cervical cap might not be appropriate, given their higher failure rates compared to other methods.
• Take a clinical and drug history, and conduct a vaginal examination at the time of fitting.
• Assess the risk for sexually transmitted infection and, when appropriate, advise testing, promote safer sex, and/or refer for counselling.
• Check the UK Medical Eligibility Criteria to ensure that the assessment is complete and that the woman is eligible for a diaphragm or cervical cap.
• Women should use a diaphragm or cervical cap only after consultation with an expert in the following situations (they should not usually be used as the risks usually outweigh the advantages):
• HIV positive (with or without antiretroviral therapy).
• High risk of HIV infection.
• History of toxic shock syndrome.
• Non-latex diaphragms or caps should be used if there is sensitivity to latex proteins.

• Pelvic and genital examination:
• This is necessary to assess the size, shape and position of the vagina and cervix before fitting the diaphragm or cervical cap.
• The diaphragm and cervical cap are not appropriate in the following situations [Belfield, 1999; FFPRHC, 2007d]:
• Women who:
• Have very poor vaginal muscle tone (this may be a contraindication for the diaphragm).
• Have a shallow pubic ledge (this applies to the diaphragm only).
• Have an abnormality of the vagina.
• Cannot touch their genital area with comfort.
• Have an awkwardly positioned cervix.
• Note: these conditions are not highlighted in the UK MEC [FFPRHC, 2006a].
• Allergy of the woman or her partner to latex rubber or to the spermicides:
• A silicone diaphragm or cap should be considered in cases of latex allergy.
• Women at high risk of HIV infection or who are HIV positive.
• Women with a history of toxic shock syndrome.
• Women who have repeated urinary tract infection.
• Current medical treatment:
• Women who are using teratogenic drugs should consider alternative more effective contraceptive methods.
• Assessment of HIV risk and testing:
• The risk of HIV should be assessed from the history and clinical examination.
• The use of a diaphragm or cervical cap is generally not recommended for women are HIV positive or who are at high risk of HIV infection [FFPRHC, 2007d].
• Repeated and high-dose use of spermicide (nonoxynol-9) is associated with increased risk of genital lesions, which may increase the risk of acquiring HIV.
• For those at high risk of HIV infection, the results of HIV testing should be available before offering the diaphragm or cervical cap.
• If the diaphragm or cap are to be used, condoms should also be used to reduce the risk of transmitting HIV and other sexually transmitted infections.

• These recommendations are based on the guidance issued by the World Health Organization and the Faculty of Sexual and Reproductive Healthcare (FSRH), formerly the Faculty of Family Planning and Reproductive Healthcare (FFPRHC) [FFPRHC, 2002; FFPRHC, 2007d].