Female Barrier Methods
There are a number of barrier methods that are used by females in addition to the female condom we just covered. Each is based on physically blocking the sperm from reaching the egg, and each is intended to be used only with spermicides. These include the diaphragm, the sponge, and the cervical cap.
If any of these barrier methods fail (e.g., by slippage), use an emergency contraceptive. See chapter 10.
The diaphragm is a shallow, dome-shaped cup made of silicone. It is used with spermicide and inserted into the vagina, where it covers the cervix and keeps sperm away from the egg.
Spermicide added to diaphragm (a), folded in half (b) inserted into vagina (c) and pushed deep to ensure it sits over the cervix (d).
It has several advantages, namely that it can be used hours before sex, it doesn’t affect a woman’s hormones, and it is very discreet. However, you do need a prescription, and you have to use it each and every time. It can be tricky to get in or out, and if you react badly to either the spermicide or the silicon, you may not be able to use the diaphragm.
In addition, it can be pushed out of place by large penises, vigorous sex, or certain positions, and it won’t prevent disease transmission. Finally, some women find they get frequent urinary tract infections while using a diaphragm.
The failure rate of the diaphragm is 12%, but it can be higher if you have already had a child.
At full price, the diaphragm can cost as much as $90, and some clinics may charge for a fitting fee. However, it may be covered by health insurance or Medicaid, and clinics may offer them for reduced cost or even free. Further, with proper care, a diaphragm can last for years, making it very cost-effective in the long run.
A diaphragm can be inserted just before sex, but it can also go in hours before as well. But no matter when it goes in, you have to be sure to leave it in for at least six hours after you have sex. If you have sex again that day, leave the diaphragm in place, and add more spermicide deep in your vagina. Just don’t leave the diaphragm in for more than 24 hours.
- To use it, wash your hands with soap and water.
- Check the diaphragm for holes and weak spots. Fill it with water—if it leaks, throw it away.
- Put a tablespoon or so of spermicide in the cup, and spread some around the rim, too. Any kind of spermicide foam or gel will do, except for the film or insert/suppository types. Don’t forget to check the expiration date of the spermicide.
- Either sit or lay down, like you’re going to put in a tampon.
- Separate the outer lips of your vagina with one hand, and use the other hand to pinch the rim of the diaphragm and fold it in half.
- Put your index finger in the middle of the fold to get a good, firm grip. Yes — you may touch the spermicide.
- Push the diaphragm as far up and back into your vagina as you can, and make sure to cover your cervix.
- Leave in for at least 6 hours after sex, but no more than 24.
- If you have sex a second time, leave the diaphragm in place and insert more spermicide. Start the six-hour clock again.
- When the 6 hours have passed, remove the diaphragm. Again, wash your hands with soap and water.
- Put your index finger inside your vagina and hook it over the top of the rim of the diaphragm. This can be a bit of a stretch.
- Pull the diaphragm down and out.
- If you have trouble with removing the diaphragm, ask your doctor about getting an inserter, or consider switching to another method.
- Finally, take good care of your diaphragm and it can last for several years. After you take it out, wash it with mild soap and warm water and allow to air dry. Do not use with powders or oil-based lubricants (like Vaseline or cold cream) or silicon-based lubricants.
A cervical cap is a silicone cup that covers the cervix to keep sperm out of the uterus. It is similar to the diaphragm, but smaller. Shape varies, but some cervical caps (e.g., the FemCap) have a shape like a sailor’s cap, but with a brim that is bigger on one side. The spermicide fits into the bowl, and is also used on the other side, between the brim and the dome. Because of the snug fit, there is no need to add spermicide each time you have sex.
Cervical caps are much less commonly used than diaphragms—they’re mainly for women who, because of the shape of their vaginas, find it difficult to keep a diaphragm in place.
The retail cost of the cap is about the same as the diaphragm ($90), and clinics may also charge for the exam or a fitting fee. However, it may be covered by health insurance or Medicaid, and clinics may offer it at reduced cost or even free.
It has advantages and disadvantages similar to those of the diaphragm and sponge, but there are some differences. It doesn’t affect your hormones. You can put it in hours in advance, and you can have sex as many times as you like while it’s in without adding more spermicide. It can be left in place for up to 48 hours. Neither you nor your partner should be able to feel it.
However, it can be tricky to get in and out, and it causes irritation, allergies or urinary tract infections in some women. You have to use it every time you have sex, and it offers no protection against STIs. Plus, it can get pushed out of place by large penises, vigorous sex, or certain sexual positions. As with the other barrier methods, it is more effective if you have never had children (14% failure rate).
Cervical Cap Instructions
- To use it, first wash your hands with soap and water.
- Check the cervical cap for holes and weak spots by filling it with water. If it leaks, throw it away.
- Put a quarter teaspoon or so of spermicide in the bowl, and spread some around the rim, too.
- Flip it over to the side with the removal strap and put another half teaspoon in the indentation between the brim and the dome.
- Sit or lay down, like you’re going to put in a tampon.
- Put your index and middle fingers into your vagina and feel for your cervix, so you’ll know where to place the cap.
- Separate the outer lips of your vagina with one hand, and use the other hand to squeeze the rim of the cap together.
- Slide the cap in dome and strap side down with the long brim being inserted first.
- Push down toward your anus, then up and onto your cervix. Make sure your cervix is totally covered.
- Leave in for at least 6 hours after sex. To remove it, again wash your hands with soap and water.
- Put a finger inside your vagina, get a hold of the removal strap, and rotate the cap.
- Push on the dome a bit with your finger to break the suction.
- Hook your finger under the strap and pull the cap out.
- The cap can last up to two years if you take good care of it. Wash it with mild soap and warm water and allow to air dry.
- Don’t use powders or oil- or silicon-based lubricants on your cap.
The sponge is a round piece of white plastic foam with a little dimple on one side and a nylon loop across the top that looks like shoelace material. It’s pretty small—just two inches across—and it is inserted into the vagina before sex. The sponge works in two ways: it blocks the cervix to keep sperm from getting into the uterus, and it continuously releases spermicide.
Sponge (left) fitted into vagina over cervix (right).
The sponge has several advantages. It can be used up to 24 hours in advance, and you can have sex as many times as you like while it’s in. Neither you nor your partner should be able to feel the sponge. It doesn’t affect your hormones, and no prescription is necessary.
However, some women have a hard time inserting it, it can cause irritation, and it may make sex messier or even drier. Some women are allergic to the sponge itself or to the spermicide and can’t use the sponge.
The sponge is cost-effective, costing $3–8 each, but one sponge can last up to 24 hours, no matter how many times you have sex. It can be bought online (Amazon, CVS) and in some drug stores, and your local family planning clinics may offer free or low-cost sponges as well.
Failure rates vary with the sponge depending on whether or not you’ve already had a child. For women who haven’t given birth, the actual failure rate is 12%, but for women who’ve already had children, the failure rate is higher.
- To use a sponge, first wash your hands with soap and water.
- Wet the sponge with at least two tablespoons of water before you put it in. Give the sponge a gentle squeeze to activate the spermicide.
- With the dimple side facing up, fold the sponge in half upward.
- Slide the sponge as far into your vagina as your fingers will reach.
- The sponge will unfold on its own and cover the cervix when you let go.
- Slide your finger around the edge of the sponge to make sure it’s in place. You should be able to feel the nylon loop on the bottom of the sponge.
- You should only insert the sponge once (no repeat uses), but when it’s in, you can have sex as many times as you want.
- Wait at least six hours after sex to remove the sponge, then wash your hands with soap and water. Put a finger inside your vagina and feel for the loop. Once you’ve got the loop, pull the sponge out slowly and gently.
- Throw the sponge away in the trash. Don’t flush it!