Sexual Health > Reproductive Health > Birth Control

Condoms Aren't the Only Barrier Method of Birth Control

The cervical cap and diaphragm are vaginal options that might be worth considering.

Illustration by Jaelen Brock

Chances are you know all about condoms and hormonal birth control, but you might know less about some other contraceptive options, such as cervical caps and diaphragms.

About 64.9 percent of women ages 15 to 49 are on some sort of birth control, with 12.6 percent of that group taking the pill, according to the Centers for Disease Control and Prevention (CDC). Cervical caps and diaphragms fall into the category of "all other contraceptive methods," which make up 5.6 percent of women on birth control. While this group is small, it's worth understanding your myriad options for contraception.

It is important to note that neither cervical caps nor diaphragms prevent sexually transmitted infections (STIs), which are spread through contact with infected fluids, including semen, vaginal fluids and blood. Cervical caps and diaphragms cover the cervix, preventing fluids from entering the vagina, however, contact between the fluids and tissues can still result in the transmission of infection.

Who uses these methods?

"These methods of birth control are mainly for people who have had a serious reaction to hormonal birth control methods or for people who can't stand the side effects," said Vivila Yujuan Liu, M.A., a sexual health educator and researcher at SHORE Centre Ontario in Ontario, Canada.

The cervical cap and diaphragm provide benefits to the users, as well.

"People usually choose the cap or diaphragm because they both give you control over your body without interrupting sex, and are both portable, durable and hormone-free," said June Gupta, N.P., the senior director of medical standards at the Planned Parenthood Federation of America in Frederick, Maryland.

Getting fitted

Both cervical caps and diaphragms have to be prescribed for use, because your doctor has to examine you to make sure your cap or diaphragm is the right size. To fit you, your doctor does a pelvic exam to determine the size of your cervix.

"You will have a bimanual exam where the provider will be assessing all the pelvic organs, your uterus and ovaries, and measuring the distance from the back of the cervix to your pubic bone," said Debra Shapiro, M.D., a board-certified OB-GYN and health coach in Burlingame, California.

If the device is too large, the leading edge can compress the urethra behind the pubic bone; too small, and the device can slip out of place and possibly fall out.

"You will be asked to demonstrate that you can remove it and replace it yourself. And you will need to be able to feel the cervix behind the dome of the device so you know it is in the proper position," Shapiro added. "If you are comfortable doing this, you will receive a prescription for your own diaphragm [or cervical cap], and written directions for how to use it with the necessary spermicidal jelly."

Key differences between the two

Cervical caps and diaphragms both rely on the same idea to function: They both cover the cervix to block sperm and prevent pregnancy, Liu said.

"Cervical caps and diaphragms are similar in that they're both birth control methods called barriers that are placed into the vagina to cover the cervix, stopping sperm from joining an egg," Gupta added. "Both must be used with spermicide, a cream or gel that kills sperm, to be the most effective."

Some people are sensitive to the ingredients in spermicide, so be sure to check the ingredient list or talk to your doctor before use.

Despite the similarities between cervical caps and diaphragms, there are a couple of key differences between the two to consider.

Cervical caps

A cervical cap is a little cup made from soft silicone. Efficacy varies depending on whether the user has already had a child. About 13 to 16 out of 100 women who have never had a baby get pregnant during a year of cap use, compared with 23 to 32 out of 100 pregnancies among women who have given birth, according to Harvard Health.

"The cervical cap...becomes less effective after a pregnancy, so it's important to see a doctor or nurse after a pregnancy to be sure you don't need a cap of a different size," Gupta confirmed.

Although cervical caps are fitted, they are fitted to loosely cover the cervix, so there is a risk of the cap slipping.

"You also have to keep the cervical cap from slipping and sliding during sex, and make sure it stays in place, which can be difficult," Liu added.

A cervical cap can be left in for up to 48 hours, according to Planned Parenthood.

Diaphragms

A diaphragm is a shallow, bendable cup made out of soft silicone. The cup is bent in half and inserted into the vagina. Diaphragms are only a bit more effective than cervical caps. Approximately 17 out of 100 women get pregnant during a year of using a diaphragm, according to Harvard Health.

"Diaphragms may be slightly more effective because they cover part of the area surrounding the cervix, whereas the cervical cap fits onto the cervix," Gupta said.

The diaphragm needs to be removed after no more than 24 hours, Shapiro said.

"The diaphragm needs to be placed prior to having intercourse, hours before even, and should be left in for at least six hours after intercourse," Shapiro said.

Risks of cervical caps and diaphragms

Similar to condoms, cervical caps and diaphragms rely on consistent and proper use to be effective, so there is a higher risk of pregnancy with these methods of birth control.

"Just like the pill, condoms and every other birth control method, the cervical caps and diaphragms are most effective when used correctly every time you have sex. If you don't always follow the directions or use your cervical cap or diaphragm every single time you have sex, it won't work as well," Gupta said.

Toxic shock syndrome (TSS), a life-threatening condition where bacteria enter the bloodstream, potentially causing organ failure, is another concern with both of these methods.

"A big risk with these is sometimes people might forget them when they are inside," Liu said. "So toxic shock syndrome might happen with the use of a cervical cap or diaphragm."

Using a cap or diaphragm can also increase your risk of developing cervicitis, according to Liu. This is because they can cause irritation which can lead to inflammation.

Women who've recently had surgery on their cervix or vagina, or have an abnormally shaped cervix should not use a cervical cap or diaphragm. Other risk factors include a history of: