Birth Control Bingo: Cervical Barriers
Cervical barriers are one of the oldest forms of birth control. The first cervical barriers were pessaries, made from things like crocodile dung, honey or beeswax, or lemon halves. Barriers we have now like cervical caps and diaphragms, which are blessedly crocodile-dung-free and instead made of latex or silicone, were both developed around 1850. They were first called "womb veils." (And not Jaunty Cervical Chapeaus, which makes me sad.) During the 1920s and 1930s in the United States, cervical barriers were the most widely used form of contraception.
- 94% effective in one year of perfect use; 6 out of every 100 people become pregnant each year
- 86% effective in one year of typical use: 14 out of every 100 people become pregnant each year
Additional Sources for Effectiveness Ratings and Use:
- 88% typical use/94% perfect use: Contraceptive Technology, 20th Revised Edition; Hatcher, Trussell, Stewart, Nelson, Cates, Guest, Kowal: Ardent Media, 2011.
- 80% typical use/94% perfect use (when used with spermicide): Cervical Barrier Advancement Society
- 84% typical use/over 94% perfect use: Planned Parenthood
Cervical caps are:
- 91% effective in one year of perfect use; 9 out of every 100 people will become pregnant
- 84% effective in one year of typical use: 16 out of every 100 people will become pregnant
Additional Sources for Effectiveness Ratings and Use:
- 84% typical use/91% perfect use: Contraceptive Technology, 18th Revised Edition; Hatcher, Trussell, Stewart, Nelson, Cates, Guest, Kowal: Ardent Media, 2004.
- 80% typical use/91% perfect use (when used with spermicide): Cervical Barrier Advancement Society
- 84% typical use (for those who have never given birth): Planned Parenthood
What's typical or perfect use mean? Effectiveness rates of contraceptive methods are all figured based on one full year of use, not for each single incident of sex or use of a method. Perfect, or proper, use of a method means that in one year, that method was always used, and always used following the directions for that method to the letter. Perfect use of most methods in one full year is unusual, except for methods like the IUD or implant where a user does not have to do anything. Typical use means that in one year, sometimes a method has not been used according to the directions, or was not always used. Typical use is called that because that is most typically how methods are used in a full year, since people aren't perfect.
The What, the Why, the Where, the When, and the How-to: Diaphragms and cervical caps are barrier methods of birth control -- made of latex or silicone -- which a person uses by inserting into the vagina, after filling the method with spermicide. They work in two ways: by creating a barrier (duh) that covers the cervix, preventing sperm cells from entering, and a backup method through added spermicide which will kill any sperm cells which manage to get around that barrier.
Diaphragms and cervical caps require a fitting from a sexual healthcare provider to determine which size is right for the user. With both diaphragms and cervical caps, there are also a couple different types in terms of how the method is made and with what material it is made (so, if you have a sensitivity to one material, you likely still have an option with a device made of something else). Diaphragms and caps are very cost-effective: they are reusable devices which you purchase once -- and simply wash between uses -- and unless you damage the device, have a substantial change in your body weight or give birth, they should fit you and be a method you can use without buying a new one for years. You will, however, have to continue to purchase spermicide to use with the device.
Using diaphragms or caps is usually easy once you get the hang of it, but just like using menstrual cups or tampons, it usually takes practice to get the hang of it, and the first few times you use them, you may have some difficulty, or make a bit of a mess putting them in. Just as with condoms, it's important for the user not to feel under pressure to quickly put a method in: partners should allow the time needed to get the device in comfortable and correctly.
Some benefits of cervical barriers people usually enjoy are:
- You can put either in as much as two hours before intercourse, and they need to be left in for 6-8 hours afterwards. So long as you add more spermicide (to your vagina, not by removing the device), they can be used for more than one act of intercourse.
- Other than the possible risk of more frequent bladder infections, they don't pose any side effects, nor do they alter your normal body chemistry in any way.
- They're easy to keep in a bag or purse, and are also reusable, which makes them both very cost-effective and environmentally-friendly
- If a diaphragm, specifically, used during menstruation, a person can have sex using a method which keeps menstrual flow inside of it, reducing mess (cervical caps cannot be used during menstruation)
Since they are barrier methods, they don't carry any big possible side effects. Those who have had toxic shock syndrome (TSS) should not use them, not should those who are sensitive or allergic to spermicides. Some may find they cause them to experience more frequent bladder or urinary tract infections. Some partners report being able to feel the devices during use, and that may occur more frequently in younger people who are more nervous during sex, and thus less aroused, so the device may be closer to the vaginal opening than it would be otherwise.
Diaphragm or Cervical Cap?
Diaphragms are wider, dome-like devices (though only as wide as fits you) which are held in place by the pubic bone. They come in an array of sizes, and which size you used is determined by a fitting in your sexual healthcare provider's office, which you can have done at the same time you're getting your yearly pelvic exam and pap smear. You insert a diaphragm by first filling it with spermicidal jelly, then you fold it like a taco and slide it into the vagina, being sure the rim is behind the pubic bone. A diaphragm needs to be left in at least 6 hours after intercourse, and is removed by hooking your finger under an edge of the rim and sliding it out.
It has recently also been found that diaphragms may reduce the risks of cervical infections, including HPV. (As an aside, a doctor I've worked with once said to me that the healthiest cervixes she sees are in people who have used diaphragms as a method of birth control).
Cervical caps are smaller devices which are placed over the cervix itself and held in place through suction. They can be left in place for longer than diaphragms, for up to 48 hours. They come in three sizes, small, medium and large; which you need will be determined by your sexual healthcare provider. To put one in, you fill it lightly with spermicide, being careful to keep the jelly off the rim. You'll then slide the device deep into the vagina, pushing it unto your cervix, and giving it a little tug once it's on to be sure it's secure. You need to leave the device in at least 8 hours after intercourse before removing it, by just breaking the suction and then pulling it out. Unlike other barriers, cervical caps cannot be used during menstruation.
All three cost around the same amount, between $50 and $70 for one device, as well as the ongoing, added cost of spermicidal jelly.
When Good Birth Control Does Bad Things: The most common reasons either of these methods fail is because they are not used at all for a given act of intercourse, are not used properly or used without spermicide, or because the wrong size is being used. Again, when you're first learning how to use them, they can be bit of a pain, which makes it a really good idea to practice by yourself at times when you aren't about to have sex: that way, you can get the hang of it without feeling any pressure from a partner waiting on you.
Too, be sure to always have an extra tube of spermicide sitting around: if you run out of spermicide when you need it and use the barrier without it, it is less likely to be effective. Be sure to replace them if they get any kind of tears or worn spots, and to check in with your sexual healthcare provider after a birth or weight change to be sure you still have a size that will work for you.
As well, even though the risk of TSS is slim because the devices are not absorbent, be sure to remember they're in there and not leave them in for any longer than they are supposed to be to reduce that risk. That also helps you avoid vaginal infections or imbalances from the device being left in too long (and the really funky odor that can happen when you do that).
Cervical caps have been found to be less effective for those who have given birth, but the same has not been found with diaphragms.
Every now and then, you may find that you need a partner's help - or they need yours -- to remove a cervical barrier. Taking them out is pretty easy enough once you've gotten the hang of it, but sometimes -- particularly with the diaphragm -- they may wind up lodged in a funny way, or with a suction that's a bit too strong, and you might need someone with better leverage than you to pull them out.
What will/might you need to discuss or negotiate with a partner?
- When to insert the cervical barrier, if not inserting in advance; sometimes you may also need a partner's help inserting or removing the barrier
- Latex or spermicide allergy or sensitivity
- STI status and history, especially if condoms are not also being used
For more information on cervical barriers from the Cervical Barrier Advancement Society, click here.
Other methods which can be used as a backup method with the diaphragm or cervical cap:
- Combined Oral Contraceptives (The Pill)
- the Contraceptive Implant (Implanon)
- the Contraceptive Patch
- Depo-Provera (The Shot)
- Emergency Contraception (Plan B or the Morning-After-Pill)
- Fertility Awareness (FAM)
- Progesterone-Only Oral Contraceptives (Minipills)
Other methods you might like if you like the diaphragm or cervical cap:
- the Contraceptive Implant (Implanon)
- Fertility Awareness (FAM)
- Intrauterine Devices (IUD, IUC or IUS)
- the Sponge
- the Vaginal Ring (Nuvaring)
Why would a cervical barrier be a good option for me? If any of the following are true:
- You are cool with with touching your own genitals, and do not have a condition like vaginismus, which makes putting anything inside the vagina difficult and painful
- You want or need a method which is non-hormonal and doesn't mess with your body chemistry or pose serious side effects
- You want a method which is easily reversible, and which you don't have to use at times you're not sexually active
- You want something which is environmentally-friendly
- You want something you can use as an easy backup method with condoms
- You are looking for a method which you are completely in charge of yourself, where you don't have to rely on a partner to help with or be responsible for birth control
- You want something you can use for a few years with a minimal financial investment
- You are looking for an inexpensive method of birth control, or one you do not have to commit to pay for regularly
- You want a method you only have to think about a bit in advance of or at the time of sex, rather than during sex, or at times when you are not sexually active or going to have intercourse, and which you can use for multiple acts of intercourse
Don't forget: Statistically, sexually active young adults are as, if not more, likely to acquire a sexually transmitted infection (STI) as you are to become pregnant. Although 15-24-year-olds represent only one-quarter of the sexually active population, they account for nearly half of all new STIs each year, and of the 18.9 million new cases of STIs each year, 9.1 million (48%) occur among 15-24-year-olds (AGI). Often people have some funny ideas about who is most likely to get an STI, but the fact of the matter is that younger people -- of any sexual orientation, any economic class, any kind of relationship -- have been the highest risk group for some time now.
Condoms are the only method of birth control which also provide protection against STIs. It's pretty typical for younger people to ditch condoms if they have another method of birth control, so just remember that STIs are still a risk if you're using another method. You can read all about safer sex here -- Safe, Sound & Sexy: A Safer Sex How-To -- but the rule of thumb most medical experts and prevention organizations suggest, which we also encourage at Scarleteen is six months of safer sex, six months of sexual monogamy, and then TWO full STI screenings for each partner -- once at the start of that six months, once at the end -- before ditching latex barriers.