The diaphragm and cervical cap are individually fitted by a skilled health-care prac­titioner. The practitioner should also teach women how to insert it properly so that they are confident about using it on their own (Hollander, 2006). In contrast, the FemCap and Lea’s Shield do not have to be fitted. However, unlike the case in several other countries, where they are available over the counter, they require a prescrip­tion in the United States. All barrier devices are used with spermicidal cream or jelly placed inside the dome of the cup and on the rim. Do not use oil-based lubricants with a diaphragm or cervical cap because these devices are made of latex and will deteriorate when used with oil-based lubricants. (The FemCap and Lea’s Shield are made from silicone.)

Squeeze spermicide into Squeeze rim together;

dome of diaphragm and insert jelly-side up.

around the rim.

I Figure 10.6 Cervical barrier devices.

To insert any of these barrier devices, squeeze the sides of the rim together with one hand, and use your other hand to open the lips of the vulva, as shown in Figure 10.6e. With the spermicide side up, push the device into the vagina. After you have inserted it, you or your partner need to feel inside the vagina to make sure the dome covers the cervix. Some women prefer to insert the dome ahead of time, in privacy, whereas others share the insertion with their partners.

All cervical barrier devices should remain in the vagina for at least 8 hours to provide time for the spermicide to kill sperm in the folds of the vagina. If intercourse occurs again before 8 hours elapse, leave the device in place and apply additional spermicide inside the vagina. Recommendations vary by method for the length of time before inter­course for insertion and after intercourse for removal:

Hours Before Intercourse

Hours After Intercourse

Diaphragm

Up to 6

At least 8, no more than 24

Cervical cap

Up to 6

At least 8, no more than 24

FemCap

Up to 8

At least 8, no more than 48

Lea’s Shield

Up to 8

At least 8, no more than 48

chapter 10

To remove the diaphragm or cervical cap, put a finger under the front rim to break the air seal, then pull the device out of the vagina. The FemCap and Lea’s Shield have flexible loops for removal. After removal, wash the device with a mild soap and warm water and then dry it. The diaphragm and cervical cap can last for several years, but the FemCap and Lea’s Shield are usable for only one year. Take the device with you to your annual exam and Pap smear so that your health-care practitioner can evaluate its fit and condition. A pregnancy (including a miscarriage or an abortion) or a weight change of more than 10 pounds may require a different diaphragm.