• Three types of diaphragm are available:
• Flat spring: suitable for women with normal vaginal muscular support, and are generally offered first-line.
• Coil spring: can be considered in those for whom a flat spring diaphragm is not suitable, provided that the woman has good vaginal muscle tone. Coil spring diaphragms are more flexible and can be more comfortable than flat springs.
• Arcing spring: useful for women with poor vaginal muscular support or those in whom the length or position of the cervix makes fitting a coil spring or flat spring diaphragm more difficult.
• Cervical caps made of latex or silicone are available.

In depth

• Enquire about the woman's preferences and any concerns about using the diaphragm or 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 woman is eligible to use the diaphragm or cap. A woman should use a diaphragm or cervical cap only after consultation with an expert if she is HIV positive, at high risk of HIV infection, allergic to latex, or has a history of toxic shock syndrome.

In depth

• Diaphragms and caps should initially be fitted by a trained and competent healthcare professional.
• Initially the diaphragm or cap should be used together with another method (e.g. condoms) until the woman is confident that she can use it correctly.

In depth

• Reassess after 1–2 weeks; review the device's fit and the woman's skills in using it.
• When inserted correctly, neither partner should be able to feel the diaphragm or cap.
• If it can be felt or is uncomfortable, the woman should return to reassess fit, or to consider an alternative diaphragm or cap, or another method of contraception.
• The diaphragm or cap should be replaced immediately if there are any holes or puckering.
• The fit of the diaphragm or cap should be rechecked by a trained healthcare professional after childbirth, abortion, or miscarriage, or if the woman gains or loses >= 3 kg in weight, because the vagina and cervix can change shape or size.

In depth

• Before insertion, check for any holes or deterioration.
• Use a spermicide in conjunction with the diaphragm and cap.
• Do not allow oil-based products to contact latex diaphragms and caps, as they rapidly damage rubber.
• If sexual intercourse is repeated or occurs more than 3 hours after insertion, insert additional spermicide into the vagina without removing the device.
• Leave the diaphragm or cap in place for at least 6 hours after last episode of sexual intercourse, and remove within 30 hours of insertion.
• After use, wash the item with mild unscented soap, rinse well, and dry carefully before storing in a cool place.
• Should the diaphragm or cap be used incorrectly (including premature removal), consider the possibility of pregnancy and whether emergency contraception is appropriate. See the CKS topic on Contraception - emergency.

In depth