Birth Control Bingo: Cervical Barriers

DIAPHRAGMS:

  • 94% effective with perfect use; 6 out of every 100 women will become pregnant each year
  • 86% effective with typical use: 14 out of every 100 women will become pregnant each year

Additional Sources for Effectiveness Ratings and Use:

  • 86% typical use/94% perfect use: Contraceptive Technology, 18th Revised Edition; Hatcher, Trussell, Stewart, Nelson, Cates, Guest, Kowal: Ardent Media, 2004.
  • 86% typical use/ 94% effective perfect use: Feminist Women's Health Center
  • 84% typical use/over 94% perfect use: Planned Parenthood

CERVICAL CAPS:

  • 91% effective with perfect use; 9 out of every 100 women will become pregnant each year
  • 84% effective with typical use: 16 out of every 100 women will become pregnant each year

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.
  • 84% typical use/ 91% perfect use (for women who have never given birth): Feminist Women's Health Center
  • 84% typical use (for women who have never given birth): Planned Parenthood

LEA'S SHIELD:

  • 91 - 94% effective with perfect use; 6 - 9 out of every 100 women will become pregnant each year
  • 85% effective with typical use: 15 out of every 100 women will become pregnant each year

The What, the Why, the Where, the When, and the How-to: Diaphragms, the Lea's Shield and cervical caps are all barrier methods of birth control -- made of latex or silicone -- which a woman uses by inserting into her vagina, after filling the method with spermicidal jelly. They work in two ways: by creating a barrier that covers the cervix, preventing sperm from entering, and a backup method through the added spermicide which will kill any sperm who may make their way around that barrier.

Think or know you used this method improperly, or know that you have had a pregnancy risk due to unprotected sex? It might not be too late for you to prevent an unwanted pregnancy with a method of emergency contraception.

Diaphragms and some cervical caps require a fitting from your sexual healthcare provider to determine which size is right for you. 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, Lea's Shield 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 a few years. You will, however, have to continue to purchase spermicidal jelly to use with the device.

The Lea's Shield is a cervical barrier/cap which does not need to be sized for you by a healthcare provider -- it comes in only one size and which you can also get without seeing a healthcare provider via online or mail ordering. In some countries Lea's Shield is available for purchase over-the-counter via pharmacies.

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 a bit of 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. Too, just as can happen with men and condomss, it's important for the user not to feel under pressure to quickly put a method in: partners should allow a woman the time she needs to get the device in comfortable and correctly.

Some benefits of cervical barriers women 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 used during menstruation, a woman can have sex using a method which keeps her period inside of it, reducing mess

Since they are barrier methods, they don't carry any big possible side effects. Women who have had toxic shock syndrome (TSS) should not use them, not should women who are sensitive or allergic to spermicides. Some women may find they cause them to experience more frequent bladder or urinary tract infections. With the Lea's Shield more than other cervical caps or diaphragms, some male partners report being able to feel the device during use, and that may occur more frequently in younger women 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, Cervical Cap or Lea's Shield?

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 a decent array of sizes, and which size you used is determined by a fitting in your sexual healthcare provider's office, which you can easily 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 just 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 work with has said to me that the healthiest cervixes she sees are in women who have used diaphragms as their method of birth control).

Cervical caps are smaller devices which are places 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, and 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.

Lea's Shield is a silicone device held in place by the muscles of the vagina: it is not affixed to the cervix like cervical caps, nor held in place by the public bone like diaphragms, which is why it does not need to be sized. The vaginal muscles are both strong and the vagina contracts to hold what is within it easily. You insert the device very similarly to how you insert a tampon, by just sliding it in and back, and it can be left in place for up to 48 hours, but needs to be left in for at least 6 hours. To remove it, you just use the loop on the end to slide it out. The Shield also has a valve as part of the device which may help to prevent odor or vaginal infections related to cervical barrier use.

For information on the Lea's Shield from the manufacturer, including how to order one, click here. Some Planned Parenthood branches may also carry Lea's Shield.

Cervical caps and the Lea's Shield have been found to be less effective for women who have given birth, so diaphragms may be a better choice for those women.

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 a pain in the butt, 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).

Every now and then, you may find that you need a partners help to remove a cervical barrier. Taking them out is usually 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.

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:

Other methods you might like if you like the diaphragm or cervical cap:

Why would a cervical barrier be a good option for me? If any of the following are true:

  • You don't have an issue with touching your own genitals
  • 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

For a very brief overview of all BC methods, have a look at Margaret Sanger's Disneyland: Choosing Contraceptives.

This is part of Scarleteen's Birth Control Bingo. Need to start over or anew? Click here.

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.

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