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How to Choose the Right Contraceptive Method

How They Work; Pros and Cons

Barrier Methods

Composition- Latex or silicone.
Mechanism of Action- All three devices act as a true barrier to sperm with additional spermicide used to supplement their contraceptive effectiveness.
Dosage- The diaphragm and the cervical cap must be sized by a physician or family planning expert. The Lea's shield is available in one size only. All three must be inserted prior to intercourse along with spermicide and should be removed no sooner than 6-8 hours after the last coital act. The maximum wear time is 24 hours for the diaphragm and the Lea's shield but the cervical cap can be left in up to 48 hours. Additional spermicide must be inserted into the vagina without removing the device before repeat acts of intercourse when using the diaphragm or Lea's shield.
Advantages-
  1. Offers some protection from sexually transmitted diseases.
  2. No hormonal additives.
  3. Can be used in breastfeeding women.
Disadvantages/Side Effects-
  1. Coitus dependent.
  2. Can be dislodged during intercourse
  3. Can be messy.
  4. Toxic shock syndrome can occur (extremely RARE).
  5. Women must be comfortable with insertion as well as assertive enough to insist on the timing of insertion and removal.
  6. Recurrent urinary tract infections may occur in diaphragm users and persistent vaginal discharge may occur in cervical cap users.
  7. The diaphragm and cervical cap must be refitted after a full term pregnancy or a major change in weight.
  8. The diaphragm and cervical cap cannot be used with any oil-based lubricants.
  9. Vaginal irritation from spermicide.
Efficacy-

The Pearl Index is 4-20 (failures per 100 women using this method for a year) for each of these devices.

The wide variation in Pearl Index is a function of both the age of the user and diligence of use, which includes proper use of a spermicide.
Contraindications/Poor candidates-
  1. Latex allergy for women considering the cervical cap as well as many of the diaphragms.
  2. Women with sensitivities to spermicides.
  3. Women with some physical disabilities, or with neurological impairment, which limits their flexibility to insert and remove the device.
  4. Women unable to consistently use the device correctly.
Follow-up- Within the first few months of use to ensure correct placement of the device in the vagina and discuss side effects as well as overall tolerability. A new device is recommended every two years. See Handout on "Care of Your Diaphragm".

Last Modified: September 5, 2006