• Provide information:
• On the advantages and disadvantages of the male condom.
• About contraceptive efficacy of the male condom and the method currently used.
• To put on the condom on before the penis contacts the partner's genitals, anus, or mouth.
• To not use oil-based lubricants with latex condoms.
• To not use in combination with a spermicide.
• To use a lubricant (not oil-based) for anal sex.
• Should the condom slip or break, the need to consider the chance of:
• Infection and the possible need for post-exposure prophylaxis against HIV infection.
• Pregnancy and the possible need for emergency contraception (to be taken as soon as possible). For further information, see the CKS topic on Contraception - emergency.
• To check that the package has relevant safety markings (e.g. BS Kitemark) and appropriate expiry date.

In depth

• For someone (either partner) with suspected allergy or sensitivity to latex:
• Confirm the cause if genital irritation appears to be associated with condom use.
• Check the type of condom being used and if is prelubricated with spermicide — reactions to spermicide are more common than reactions to latex.
• Advise the person to use condoms made from polyurethane or synthetic polyisoprene. Deproteinized male latex condoms can also be considered.
• Consider skin latex sensitivity tests and/or specific serum IgE antibodies against latex.

In depth

• Provide information on:
• The advantages and disadvantages of the female condom.
• Correct use of the female condom.
• Efficacy of the female condom in preventing pregnancy, and in preventing sexually transmitted infections.
• Female condoms are likely to prevent transmission of all sexually transmitted infections if used consistently and correctly.
• However, male latex condoms are recommended as being more effective in preventing transmission of HIV, genital herpes simplex virus, syphilis and gonorrhoea.
• Precautions that may be necessary should the condom be displaced or break:
• If there is a risk of infection, post-exposure prophylaxis against HIV infection should be considered.
• If there is a risk of pregnancy, emergency contraception should be considered. For further information, see the CKS topic on Contraception - emergency.
• Checking the expiry date.
• Consider demonstrating use of the condom.

In depth

• 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

• Gygel^® vaginal cream is the only licensed spermicide marketed in the UK. It contains 2.0% nonoxinol-9.

In depth

• Spermicides should be used in conjunction with barrier methods such as a diaphragm or cervical cap.
• A diaphragm or cervical cap can be inserted with spermicides any time before intercourse.
• If sexual intercourse is repeated or occurs more than 3 hours after insertion, additional spermicide should be applied using an applicator without removing the diaphragm or cervical cap.
• The diaphragm or cervical cap must be left in situ for at least 6 hours after the last episode of intercourse.

In depth