Birth Control Options for Women - Spermicidal and Barrier Contraception

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Advantages of the Diaphragm. The diaphragm can be carried in a purse, can be inserted up to an hour before intercourse begins, and usually (although not always) cannot be felt by either partner. It does not interfere with a woman’s hormones.

Disadvantages and Complications of the Diaphragm. Some disadvantages or complications are as follows:

• Failure rates are high, about 16% with typical use.
• Some women dislike having to insert the device every time intercourse occurs or have trouble mastering the insertion and removal process.
• The diaphragm can be dislodged during sex.
• Frequent urinary tract infections and vaginal infections are a problem for some women. This difficulty can sometimes be resolved by a refitting, by urinating before inserting the device, or by urinating after intercourse.
• Some women may have allergic reactions to the latex or spermicides.
• Although rare, cases of toxic shock syndrome have been reported among diaphragm users. To be safe, the diaphragm should not stay in place for more than 24 hours and should not be used during menstrual periods. (For pregnancy protection, however, the diaphragm should stay in place for 6 - 8 hours after intercourse.)
• The diaphragm does not protect against sexually transmitted diseases.

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Cervical Cap

The cervical cap (FemCap) is a thimble-shaped latex cup that fits over the cervix. It is always used with a spermicidal cream or gel. It is similar to a diaphragm, but smaller, and is available in only four sizes. The cap is sold by prescription and requires a pelvic examination, Pap test, and fitting by a health care provider.

Insertion and Use of the Cervical Cap. After a small amount of spermicide is placed in the cap, the device is inserted by hand. As in diaphragm use, instruction and practice is required. The cap must be kept in the vagina for 8 hours after the final act of intercourse. Caps wear out and should be replaced every 1 - 2 years. A refitting may also be needed when a woman experiences certain changes in her health or physical status.

Click the icon to see an image of a cervical cap.

Candidacy for the Cervical Cap. Because of the restricted range of available sizes, about 1 in 5 women will not be able to be fitted for the cap. The cap is not widely used, and some women, particularly those who live in sparsely populated areas, may not have access to health care professionals who are trained in fitting this device. Other conditions that can preclude cap use include:

• An abnormal Pap test
• A history of toxic shock syndrome
• A sexually transmitted or reproductive tract infection
• Inflammation of the cervix
• The cap has little value for women who have had children, because the stretching of the vagina and cervix makes a proper fit more difficult and failure rates are high.

Advantages of the Cervical Cap. Among women who have never given birth, the cap's failure rate is similar to that of the diaphragm. The cap in general is also similar to the diaphragm in terms of cost, ease of use, and also the potential for latex or spermicidal allergies. But unlike the diaphragm, the cap can safely remain in the vagina for up to 48 hours (twice the time limit for a diaphragm), so it can be inserted well in advance of intercourse. The cap is rarely associated with urinary tract infections.

Disadvantages of the Cervical Cap. The following are disadvantages of the cervical cap:

• May be difficult to insert
• May be pushed out of place during sex
• Cannot be used during menstruation
• High failure rates (32% typical use) for women who have given birth

Lea’s Shield. Approved in 2002, Lea’s shield is similar to a cervical cap but contains an air valve that helps it stick to the vaginal walls and allow for the passage of cervical mucus. Unlike cervical caps, it is available in only one size and does not need to be fitted. Lea’s shield is made of silicone, and its cup-shaped bowl completely surrounds the cervix without resting on it. The shield is as effective as the diaphragm and cap when used with spermicide. Its advantages are:

• One size fits all
• Can be left for 48 hours after intercourse
• Reusable for 6 months

The Sponge

The sponge is a disposable form of barrier contraception. It is made of soft polyurethane foam coated with spermicide, is round in shape, and fits over the cervix like a diaphragm, but is smaller and easily portable. The Today sponge is the only brand of contraceptive sponge available in the United States.

The Today sponge originally came on the U.S. market in 1983, but was withdrawn in1994 because of problems at the company's manufacturing facility. In 2009, after several failed attempts, the Today sponge was relaunched and is now available in drugstore chains throughout the United States.

Use and Insertion. To use the sponge, the woman first wets it with water, then inserts it into the vagina with a finger, using a nylon cord loop attachment. It can be inserted up to 6 hours before intercourse and should be left in place for at least 6 hours following intercourse. The sponge provides protection for up to 12 hours. It should not be left in for more than 30 hours from time of insertion.

The sponge should not be used during menstruation, after childbirth, miscarriage, or termination of pregnancy, or by women with a history of toxic shock syndrome.

Advantages and Disadvantages. The sponge is easy to use, is not felt during intercourse, and can be inserted up to 6 hours before intercourse. However, because it contains the spermicide nonoxynol-9, it does not protect against sexually transmitted diseases and may increase the risk for vaginal irritation and transmission of HIV. [See Spermicides section.]

Review Date: 09/28/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).