• Diaphragms should initially be fitted by a competent health professional.
• Diaphragms should be positioned so that the rim fits comfortably and not too
  loosely or tightly into the vaginal fornices. Ideally the anterior rim should sit in
  the grove behind the pubic bone.
• Clients need to be competent at removing the diaphragm before they leave
  the clinic.
• Clients should also be given the opportunity to insert the device themselves
  at the clinic.
• The method cannot be relied upon for contraception until the client has
  returned and demonstrated confidence in its use

Clients need to read the manufacturer’s instructions that come with the device

Spermicide use
Singa: two strips of spermicide ~2cm long to upper side of the diaphragm. A little spermicide on the leading rim can make inserting easier.
Caya: 4 mls of spermicide (a teaspoonful) into the silicone membrane and some spread around the external rim, prior to inserting into the vagina
Femcap: ¼ teaspoon spermicide in the bowl, and ½ teaspoon in the groove, then spread all over the cap except where the thumb and finger will be holding it for insertion.

Apply more spermicide (as a pessary or as cream using an applicator) if sex is to take place > 3hrs ( caya – 2 hours) since device was inserted or if sex is repeated whilst method in place

Timing of insertion

Singa/Caya can be inserted at any time with spermicide before sex and must remain
in place for at least 6 hours after the last episode of sex.

Femcap should be placed at least 15 minutes before sexual arousal.

After insertion the client must always check that the cervix is covered and if not the diaphragm should be removed and an attempt made at reinsertion.

Timing of removal
A diaphragm/cap must be left in place for at least 6 hours after the last episode of sex but not left longer that the recommended time:
Singa & Caya 24 hours
Femcap: 48 hours

The CEU advise that a device can be kept in until at least six hours has passed even if this means it will be in place for more than 24 hour

Water can wash away spermicide so if bathing after insertion, opt for a shower rather than bath.

Care of diaphragms and caps

• Wash the device after use in warm water with mild, unperfumed soap and dry
  with a soft clean clothStore device in its container in a cool dry place.
• Advise regularly checking the diaphragm/cap for signs of damage or
  perishing.

Emergency Contraception may be indicated in the following situations
Diaphragm or cap is dislodged or removed within 6 hours of sex
Diaphragm has been left in for longer than 3 hours before sex and no
additional spermicide applied
Discuss the advance provision of oral emergency contraception

The client’s record should be completed or updated on NaSH.

• Name and size of the diaphragm provided
• Written method information given to patient
• Permission should be sought as to whether the client’s GP can be notified