Silicone diaphragms/caps are unaffected by oil-based lubricants but the manufacturer of Caya® and Singa® advises only water based lubricants should be used.
User Acceptability, Drug Interactions, Assessment of Client Suitability, Examination
Warning
Variable and discontinuation rates can be high.
Advantages
- non hormonal
- no serious side effects
- use is under the user’s control
- silicone is suitable for clients or sexual partners with latex allergy or latex sensitivity
- only need to be inserted prior to intercourse and retained for 6 hours afterwards
- Caya ® and Femcap® are available to purchase over the counter or on line. They come with illustrated fitting instructions.
Perceived disadvantages
- messiness
- problems with insertion / removal
- irritation from spermicide
- lack of sexual spontaneity
- patients should initially be assessed for type and correct size of Singa diaphragm by a trained health professional. Size may need changed after pregnancy
- No good evidence of protection against HIV/STI or CIN. As only the cervix is covered by these methods, they do not prevent exposure of the vaginal mucosa to semen or exposure of the penis to cervico-vaginal secretions.
In this context the history should include: relevant social and sexual history (to assess risk of sexually transmitted infections – STIs), the importance attached to avoiding pregnancy and willingness to insert the device.
Prolapse, small or absent retropubic recess The diaphragm may not fit adequately with a prolapse or small /absent retropubic recess but a cap is suitable. Caya’s manufacturer states Caya cannot be used with severe pelvic floor or uterine descent.
Caya’s manufacturer does not recommend its use in people who previously used a diaphragm size of 85mm and larger, or 60mm and smaller.
Acute frequent bladder infections Diaphragm use has been linked to urinary tract infection. A diaphragm should be chosen that will ensure a correct fit but which does not put undue pressure on or obstruct the urethra.
Toxic Shock Syndrome The CEU Clinical Effectiveness Unit consider menstruation a contraindication to diaphragm use. The manufacturer of the Caya® diaphragm report it is safe to use during menstruation
Postpartum use
Manufacturer advice re earliest post partum fitting
- Caya and Singa: 6 weeks
- Femcap: 10 weeks
There is no evidence that nonoxynol-9 is teratogenic. Its use in lactation has not been
studied.
Pelvic examination is required to identify the appropriate size and type of Singa®
diaphragm
Caya® is one-size. Femcap size is based on parity
Clients may wish help ensuring they have fitted the device correctly