Caps – Dutch Cap / Diaphragm / Cervical Cap
What are caps and diaphragms?
Diaphragms and caps are domed devices, commonly made of latex or rubber. Shaped to fit over your cervix they act as an intravaginal (inside the vagina) barrier method of contraception.
There are different types:
The Dutch cap – flat or coil spring diaphragms;
Omniflex® and other arcing spring diaphragms;
Dumas® — vault cap;
Prentif® — cavity rim cervical cap;
Vimule® — cervical cap;
SILCS / Caya® Diaphragm — approved for use in Europe in 2013, this is the latest design, and a ‘one size fits (nearly) all’ device, made of silicone;
The Honey Cap® is available; but not given free at Sexual Health Clinics.
It is extremely expensive and not widely recommended.
Oves® cervical cap, in three sizes, is disposable and is made of silicone. It’s suitable for some women who get recurrent cystitis. It’s not available on the NHS, but can be purchased from a pharmacy or online.
Lea Shield® — a soft, silicone device — best used as a backup method when using a condom, for safer sex.
Contraceptive Sponges — impregnated with spermicide (chemical that kills sperm) — these are a barrier method that can stay in the vagina for up to 24 hours. Not to be used during a menstrual period.
(See information on The Sponge.)
How do caps and diaphragms work?
Caps and diaphragms, once inserted in to the vagina correctly, form a barrier between a woman’s eggs and a man’s sperm, thereby preventing pregnancy.
How reliable are caps and diaphragms?
Used correctly and carefully, they can be extremely reliable.
If you’re extremely organised and good about using yours correctly, every single time you have sex, this can be a very good method and can be over 90% effective.
But, they are not as reliable as the injection, the IUS, sterilisation, the combined Pill, patch, vaginal ring, progestogen only ,pill (POP), the IUD, IUS or the male condom.
They are more reliable if you put strips of spermicidal cream or gel (jelly) on both sides of the cap or diaphragm, before insertion.
It may be more effective if you wait until you are in your mid 20’s to 40’s; or in a long-term, stable relationship — but good motivation is the main factor as it has to be used carefully, correctly and consistently.
Who’s suitable to use this method?
It’s suitable for women:
— for whom a pregnancy would not be disastrous;
who can’t use, or don’t want to use, any other method of contraception; or
women who are very organised and for whom sex needs to be planned not spontaneous (as with pills etc).
Who’s NOT suitable to use this method?
It’s not suitable for women who get recurrent, common cystitis (inflammation of the bladder).
Women who really don’t want to be pregnant.
Or, women who are not prepared to touch their genital area.
Are there any non-contracpetive benefits?
Some women use it to contain the menstrual flow and protect their bedding, if they have sex during their period.
How do I use it?
Because vaginas come in different shapes and sizes a cap or a diaphragm must be fitted individually by a contraception (Family Planning) trained doctor or nurse.
You’ll be given a practise cap, shown how to use it and allowed to take it home for a week, to practice inserting and removing it on your own.
Even when practicing your insertion technique, you should add spermicidal cream or jel, before inserting it.
You shouldn’t rely upon it as a method of contraception in that time because the practise device may have a hole in it.
Why would a practice cap have a hole in it?
Holes prevent you from using the method for contraception until the doctor or nurse says you’ve inserted and removed it correctly.
This gives you time to learn the correct technique of insertion, how to check that it’s in the correct position and also to give your partner the opportunity to become familiar with this method of contraception.
Once you’ve mastered the technique, you’ll be given your own, new cap, without holes.
What if I want to have sex with my practice cap in?
If you want to have sex during practise either use a condom or other
reliable method of birth control. You can leave your practice cap in place to see how sex feels when it’s in place.
Will sex feel different with a cap?
No. Fitted correctly, you shouldn’t be aware that you’re wearing a cap when you’re having sex.
If it’s not the right size, nor positioned correctly, you MAY or may not notice a strange sensation.
Will my partner feel it during sex?
No, he shouldn’t feel a correctly fitted cap during sex.
Sometimes, the man notices a slight stinging sensation from the spermicide, if he’s not using a condom. If he notices this, change spermicides.
How long must I have it in, before I have sex?
You can insert it anytime up to 3 hours before you have sex.
If you exceed (go over) this time before having sex, simply put more spermicide into your vagina – or remove, wash and re-insert your cap.
Spermicide in the form of a pessary – solid spermicide which melts at body temperature; or via an applicator – like a syringe without a needle; may be used.
Can I take the cap out straight after I have sex?
No, you can’t because of the risk of pregnancy.
After sex you must leave the cap in place for 6 hours for the spermicide to kill any ejaculated sperm, otherwise, you’ll just stun them.
What if I want to have sex again, within 6 hours?
If you have sex again in those 6 hours, you should leave the cap in place AND insert more spermicide into your vagina.
Start counting your 6 hours again, from the second time after you had sex.
How long can I keep the cap in for and ‘top up’ the spermicide?
Try not to keep it in for any longer than 30 hours because of the risk
of developing Toxic Shock Syndrome *TSS).
How do I take the cap out and what must I do with it?
To take out your cap, simply wash your hand, insert a finger into your vagina, hook the edge of your cap and pull it out.
When you’ve removed it, just wash it under running water and pat it dry with a towel before replacing it in its carrying box.
You should check it regularly for holes whilst cleaning it.
You should be shown how to look after your cap when you’re taught how to use it by the contraception nurse.
For how many years can I use it?
Caps usually have a life span of 12-24 months’ use.
However, should you develop a vaginal infection, you should ask for a new cap, to prevent reinfection.
Can anything damage the cap?
Some vaginal medication is oil-based, which can rot the latex of the cap (and condom), so you should avoid sex altogether when being treated.
If in doubt, always ask your local pharmacist or your condom supplier for advice.
For further information about potential interactions, turn to the list of lubricants and vaginal medication
Will it control my periods?
No, it won’t.
If you have your cap in when your period starts, your blood loss will collect inside your cap.
When does the cap NOT work?
You risk pregnancy: when it’s inserted incorrectly ie. if you don’t have your cervix covered;
when it’s inserted incorrectly ie. if you don’t have your cervix covered;
if you don’t use it every time you have sex;
if you use it without spermicide — it’s much less reliable;
if you take it out before the 6 hours are up, after sex;
if you fail to top-up with more spermicide and have sex again within your 6 waiting hours.
Is it affected by diarrhoea, vomiting or antibiotics?
No, but it can be affected by some vaginal oil-based medication.
Will it make my periods heavier or lighter?
It won’t affect your periods.
What should I be aware of if my girlfriend’s using a cap?
You should know how it should feel when it’s in her vagina correctly.
You should check, during foreplay, that the latex of the cap covers her cervix.
You will find her cervix approximately a fingers depth inside her vagina. It feels like a round hard lump with a dimple in the centre — similar to the end of your nose.
If you don’t think her cervix is covered, don’t enter.
At the fertile time of her cycle, you might feel safer if you use a condom, for extra protection against pregnancy.
Using a condom routinely with the cap would, though, greatly increase the success rate of this method of contraception.
Finally, you may find, as some men do, that having sex when your partner has a diaphragm in place produces an unexpectedly pleasurable sensation.
Do recreational drugs affect its reliability?
No, they don’t.
Drugs can, however, be bad for your long-term physical and mental health and can increase your risk of contracting sexually acquired infections.
If you dehydrate you are more likely to get thrombosis (blood clots).
Will it make me put on weight?
No, but if you lose or gain 7lbs (3 kg) or more, you should return to your clinic and have your cap checked for the correct fit.
Will it protect me from pregnancy AND infection?
You gain some protection to your cervix but it doesn’t prevent transmission of infection.
In the laboratory spermicide has been found to kill some germs but unless a condom is used, your vaginal surface area is still at risk of infection, as is your external genital area.
Using a condom AND a cap gives better protection against both pregnancy and infection.
Is it reversible?
Yes. As soon as it’s removed or; if it’s inserted incorrectly, you’re at risk of pregnancy.
When does it start to work?
It’s effective as soon as it’s in the correct position.
Can I use it safely if I smoke?
Yes, you can. But, for other reasons, smoking is not advised!
Do I have to have a check-up after I am fitted with my cap?
Yes, you should return a week after fitting, to see that you’re practiced
inserting and removing it correctly; and get a new cap (one without a hole) if you were not given one at the fitting.
Thereafter, many places advise that you don’t really need to have a check-up unless you lose or gain 7lbs or more in weight.
If you do, you should return for a check-up to make sure you are still using the correct size, with a snug fit.