User Acceptability, Drug Interactions, Assessment of Client Suitability, Examination

DGRefHelp - NHS Dumfries & Galloway
NHS Dumfries and Galloway

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.

Drug interactions

Silicone diaphragms/caps are unaffected by oil-based lubricants but the manufacturer of Caya® and Singa® advises only water based lubricants should be used.

Assessment of client suitability (excluding Caya)

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.

Examination

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

Editorial Information

Last reviewed: 31/03/2022

Next review date: 30/09/2025

Author(s): West of Scotland Managed Clinical Network for Sexual Health Guidelines Group.

Version: 6.1

Approved By: West of Scotland Managed Clinical Network for Sexual Health