Diaphragms, caps, and shields are soft latex or silicone barriers that cover the cervix.

Diaphragm

FemCap

Lea's Shield

• The diaphragm is a shallow, dome shaped cup with a flexible rim. It fits securely in the vagina to cover the cervix.
  
• FemCap is a silicone cup shaped like a sailor's hat. It fits securely in the vagina to cover the cervix.
  
• Lea's Shield is a silicone cup with an air valve and a loop to aid in removal. It fits snugly over the cervix.

Each method of birth control must be used with spermicide cream or jelly.

Diaphragms, caps, and shields keep sperm from joining the egg.

• They block the opening to the uterus.
  
• The contraceptive cream or jelly stops sperm from moving.

Effectiveness

Sixteen out of 100 women who use the diaphragm will become pregnant during the first year of typical use.* Six will become pregnant with perfect use.**

Fourteen out of 100 women who have never been pregnant or given birth vaginally and use FemCap will become pregnant during the first year of typical use. Of 100 women who have given birth vaginally and use FemCap, 29 will become pregnant during the first year of typical use.*** Effectiveness rates for perfect use are not available.

Fifteen out of 100 women who use the shield will become pregnant during the first year of typical use. Effectiveness rates for perfect use are not available.

Protection may be increased by

• making sure the cervix is covered before each act of intercourse
  
• making sure spermicide is used as recommended
  
• using a latex condom

Diaphragms, caps, and shields offer no protection against sexually transmitted infection. Use a latex condom to reduce the risk of infection.

* Typical use refers to failure rates for women whose use is not consistent or always correct.
** Perfect use refers to failure rates for those whose use is consistent and always correct.
*** Effectiveness rates for FemCap are those for an earlier version of the device. Although no studies have been published yet, the manufacturers of FemCap report that the current device is likely to be more effective.

How to Get Them

You must see a health care provider. Your provider will examine you to make sure you do not have a condition that would rule out using a diaphragm, cap, or shield. Your provider will determine the correct size for diaphragms and caps, and will provide information about use, insertion, and removal.

Diaphragms are available in many sizes and designs. A new size may be needed after any of the following:

• a full-term pregnancy
  
• abdominal or pelvic surgery
  
• a miscarriage, or abortion after 14 weeks of pregnancy
  
• a 20-percent change in weight

FemCap is available in three sizes:

• small, for women who have never been pregnant
  
• medium, for women who have had an abortion or a cesarean delivery
  
• large, for women who have given birth vaginally

The shield only comes in one size.

Women should have regular pelvic examinations. It is a good idea to bring your diaphragm, cap, or shield to your examination.

Some Conditions that May Rule Out Use of Diaphragms, Caps, and Shields

• allergy to latex, silicone, or spermicide
  
• childbirth in the last six weeks (10 weeks for FemCap)
  
• difficulty with insertion
  
• discomfort with touching one's genitals
  
• history of toxic shock syndrome
  
• recent cervical surgery
  
• recent abortion after the first trimester (after any recent abortion for FemCap)
  
• sagging uterus
  
• vaginal obstructions

A woman may not be able to use a diaphragm if she has

• frequent urinary tract infections
  
• poor vaginal muscle tone

She may not be able to use FemCap if she has

• breaks in the vaginal or cervical tissue
  
• cancer of the uterus, vagina, or vulva
  
• a reproductive tract infection
  
• poor vaginal muscle tone

She may not be able to use a shield if she has

• breaks in the vaginal or cervical tissue
  
• frequent urinary tract infections
  
• a reproductive tract infection

Women should not use the diaphragm, cap, or shield during any kind of vaginal bleeding — including menstruation.

The diaphragm, cap, and shield are intended for each woman’s use.  Do not share them with friends.

Advantages and Disadvantages of Diaphragms, Caps, and Shields

Advantages

• can be used during breastfeeding
  
• easily carried in pocket or purse
  
• generally cannot be felt by either partner
  
• immediately effective and reversible
  
• no effect on a woman's natural hormones
  
• no interruption of sex play — can be inserted hours ahead of time

Special Advantages for Teens — Many teen women have vaginal intercourse only now and then.  Many of them prefer to use a prescription barrier method on those occasions.  That way they avoid the possible ongoing side effects of prescription methods with hormones.

Disadvantages

• cannot be used during menstruation
  
• may be difficult for some women to insert
  
• may be pushed out of place by some sexual positions, penis sizes, and thrusting techniques and angles
  
• must be in place every time a woman has vaginal intercourse
  
• diaphragms and caps may require refitting

Use of the spermicide nonoxynol-9 many times a day by people at risk for HIV, or for anal sex, may irritate tissue and increase the risk of HIV and other sexually transmitted infections.

Possible Side Effects

• Some women who use diaphragms and shields may develop frequent bladder infections. They should urinate before inserting the diaphragm or shield, and after intercourse. A woman who gets frequent bladder infections should also have her clinician check the fit of her diaphragm.
  
• Women who are allergic to latex, silicone, or some brands of spermicide may not be able to use diaphragms, caps, or shields. Women who have a mild reaction to spermicide may try switching brands to clear up the problem.
  
• Some women or their partners may feel pain or discomfort when using FemCap or the shield.

Check with your clinician if you have

• burning sensations while urinating
  
• discomfort when the diaphragm, cap, or shield is in place
  
• irregular spotting and bleeding
  
• irritation or itching in the genital area
  
• redness or swelling of the vulva or vagina
  
• unusual discharge from the vagina

How to Use the Diaphragm

• Wash hands with soap and water.
• Put about a tablespoon of spermicide in the cup. Spread some around the rim.
• Find a comfortable position — stand with one foot on a chair, sit on the edge of a chair, lie down, or squat.

• Separate the labia with one hand. Pinch the rim of the diaphragm to fold it in half with the other hand. Place index finger in the center of fold for a firmer grip. The spermicide must be inside the fold.

• Push as far up and back in the vagina as possible. Tuck behind the pubic bone. Make sure the cervix is covered.
• It must stay in place six hours after last act of intercourse.
• If intercourse is repeated or occurs more than six hours after insertion, leave the diaphragm in place and apply more spermicide.
• Do not leave the diaphragm in place for more than 24 hours.

• To remove, wash hands with soap and water. Hook a finger over the top of the rim to break the suction. Pull the diaphragm down and out.
• A special inserter can be used to help with placement and removal.

How to Use FemCap

• Wash hands with soap and water.
• Put one-quarter teaspoon of spermicide in the dome of FemCap, spread a thin layer on the brim, and put one-half teaspoon in the folded area between the brim and the dome.
• Find a comfortable position — stand with one foot on a chair, sit on the edge of a chair, lie down, or squat.
• Locate your cervix with index and middle fingers.

• Separate the labia with one hand and squeeze the rim together with the other.

• Slide FemCap into the vagina with the long brim entering first and the dome-side down. Push down towards the rectum and then up and onto the cervix. Make sure the cervix is completely covered. (Insertion is easier before sexual arousal).
• With each act of intercourse, check that FemCap is still covering the cervix. Apply more spermicide if you like.
• FemCap must stay in place six hours after the last intercourse.
• Do not leave FemCap in place for more than 48 hours.

• To remove, wash hands with soap and water. Squat down. Grip the removal strap and rotate FemCap. Push on the dome with your finger to break the suction. Hook your finger under the removal strap and pull the cap out.

How to Use the Shield

• Wash hands with soap and water.
• Coat the inside of the bowl around the hole, the front of the rim, and outer part of the valve with spermicide.
• Find a comfortable position — stand with one foot on a chair, sit on the edge of a chair, lie down, or squat.

• Separate the labia with one hand. Pinch the rim of the shield.
• Slide the shield into the vagina with the valve facing down and the thickest end inserted first.

• Push the shield up as far in the vagina as is possible and comfortable. Make sure that the loop is not sticking out of your vagina.
• The air between the cervix and shield will be vented out through the valve to create a proper fit. You can press on the valve a few times or walk a few steps after insertion to make sure that the air is removed.
• With each act of intercourse, check that the shield is still covering the cervix. Apply more spermicide if you like.
• The shield must stay in place eight hours after the last intercourse.
• Do not leave the shield in place for more than 48 hours.

• To remove, wash hands with soap and water. Squat down and relax the muscles in your vagina. Grasp the loop with your finger and rotate the shield slightly to break the suction. Or grasp the rim of the shield with your thumb and pointer finger. Pull the shield down and out of your vagina.

Care of Diaphragms, Caps, and Shields

With proper care, the diaphragm and FemCap may last about two years, and the shield may last about six months.

• After removal, wash with mild soap and warm water.
  
• Allow to air dry.
  
• Do not use powders — they can cause infections. Never use oil-based lubricants — such as Vaseline or cold cream — with diaphragms. They damage latex.

Examine regularly for small holes or weak spots by holding the device up to the light. Gently stretch the latex of the diaphragm between your fingers. Fill the cup of the diaphragm or cap with water and look for leaks.

Diaphragms, caps, and shields can still be used if the rubber becomes discolored. But if the rubber puckers — especially near the rim — it has become too thin.

Where to Get Them and What They Cost

Visit Planned Parenthood, aother family planning clinics, your HMO, or a private doctor for an exam and prescription. Diaphragms, caps, and shields may be purchased at a drugstore or clinic. An examination costs from $50 to $200. Diaphragms, caps, and shields average from $15 to $75. Spermicide jelly or cream costs from about $8 to $17 a kit.

Medicaid may cover these costs. Private health insurance coverage for birth control varies. Clinics may offer lower prices than private health care providers.