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Diaphragm, cervical cap, and sponge

Robert L Barbieri, MD
Deborah A Bartz, MD, MPH
Section Editor
Courtney A Schreiber, MD, MPH
Deputy Editor
Kristen Eckler, MD, FACOG


Barrier contraception prevents pregnancy by blocking sperm from entering the female reproductive tract. Female-controlled barrier methods include the diaphragm, cervical cap, sponge, and the female condom. These methods are often used with a spermicide to create a chemical barrier to sperm and thus increase efficacy.

This topic will review the diaphragm, cervical cap, sponge, and spermicide. Information on female condoms, male condoms, and choosing a contraceptive method is presented separately. (See "Female condoms" and "Male condoms" and "Contraceptive counseling and selection".)


Barrier contraceptives provide a physical barrier to migration of sperm from the vagina to the upper reproductive tract, where fertilization occurs. Concomitant use of spermicides enhances contraceptive efficacy by immobilizing sperm, thus creating a chemical "barrier." (See 'Spermicide' below.)


In choosing a method of contraception, the advantages and disadvantages of the method need to be assessed and compared with advantages and disadvantages of alternative methods. Selection of a contraceptive method balances many patient preferences and is reviewed in detail separately. (See "Contraceptive counseling and selection".)

Selection of barrier method — In selecting a barrier contraceptive, we discuss the method failure rates, protection from sexually transmitted infections, cost, and product availability with the woman (table 1). For women who desire a barrier contraceptive, we suggest the wide-seal diaphragm with spermicide because it has the lowest typical-use pregnancy rate compared with the other barrier contraceptives (figure 1). However, as contraceptive selection includes many patient preferences, we defer to the patient's wishes for the final choice.

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Literature review current through: Nov 2017. | This topic last updated: Aug 21, 2017.
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  1. Black A, Guilbert E, Co-Authors, et al. Canadian Contraception Consensus (Part 1 of 4). J Obstet Gynaecol Can 2015; 37:936.
  2. Dehlendorf C, Foster DG, de Bocanegra HT, et al. Race, ethnicity and differences in contraception among low-income women: methods received by Family PACT Clients, California, 2001-2007. Perspect Sex Reprod Health 2011; 43:181.
  3. Harvey SM, Bird ST, Maher JE, Beckman LJ. Who continues using the diaphragm and who doesn't: implications for the acceptability of female-controlled HIV prevention methods. Womens Health Issues 2003; 13:185.
  4. Daniels K, Daugherty J, Jones J, Mosher W. Current Contraceptive Use and Variation by Selected Characteristics Among Women Aged 15-44: United States, 2011-2013. Natl Health Stat Report 2015; :1.
  5. Planned Parenthood: Birth Control. https://www.plannedparenthood.org/learn/birth-control (Accessed on February 17, 2016).
  6. Guttmacher Institute Fact Sheet. Contraceptive Use in the United States. July 2012. http://www.guttmacher.org/pubs/fb_contr_use.html (Accessed on June 12, 2013).
  7. Centers for Disease Control and Prevention: Effectiveness of family planning methods. http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/PDF/Contraceptive_methods_508.pdf (Accessed on February 18, 2016).
  8. Schwartz JL, Weiner DH, Lai JJ, et al. Contraceptive efficacy, safety, fit, and acceptability of a single-size diaphragm developed with end-user input. Obstet Gynecol 2015; 125:895.
  9. Bounds W, Guillebaud J, Dominik R, Dalberth BT. The diaphragm with and without spermicide. A randomized, comparative efficacy trial. J Reprod Med 1995; 40:764.
  10. Cook L, Nanda K, Grimes D. Diaphragm versus diaphragm with spermicides for contraception. Cochrane Database Syst Rev 2003; :CD002031.
  11. FDA 510(k) summary of Milex Wide-Seal contraceptive diaphragm. http://www.accessdata.fda.gov/cdrh_docs/pdf6/k063223.pdf (Accessed on February 18, 2016).
  12. Single-size contraceptive diaphragm. http://www.who.int/medical_devices/innovation/new_emerging_tech_20.pdf (Accessed on June 12, 2013).
  13. A new kind of diaphragm. http://www.path.org/projects/silcs.php (Accessed on August 25, 2015).
  14. Caya single-size contoured diaphragm product site. http://caya.us.com/ (Accessed on February 24, 2016).
  15. Caya availability in the United States. https://bedsider.org/features/733-it-s-official-caya-is-available-in-the-u-s (Accessed on February 17, 2016).
  16. Caya diaphragm and Caya Gel Safety http://www.caya.eu/triple-safety/ (Accessed on April 27, 2016).
  17. Mauck CK, Brache V, Kimble T, et al. A phase I randomized postcoital testing and safety study of the Caya diaphragm used with 3% Nonoxynol-9 gel, ContraGel or no gel. Contraception 2017; 96:124.
  18. Cervical barrier advancement society. http://www.cervicalbarriers.org/ (Accessed on April 17, 2012).
  19. Hatcher RA, Trussell J, Nelson AL, et al. Contraceptive Technology, 20th edition, Ardent Media, 2011.
  20. Mauck C, Lai JJ, Schwartz J, Weiner DH. Diaphragms in clinical trials: is clinician fitting necessary? Contraception 2004; 69:263.
  21. Hooton TM, Scholes D, Stapleton AE, et al. A prospective study of asymptomatic bacteriuria in sexually active young women. N Engl J Med 2000; 343:992.
  22. Bedsider.org birth control methods. https://bedsider.org/ (Accessed on February 18, 2016).
  23. Fihn SD, Boyko EJ, Normand EH, et al. Association between use of spermicide-coated condoms and Escherichia coli urinary tract infection in young women. Am J Epidemiol 1996; 144:512.
  24. Hooton TM, Scholes D, Hughes JP, et al. A prospective study of risk factors for symptomatic urinary tract infection in young women. N Engl J Med 1996; 335:468.
  25. Fihn SD, Boyko EJ, Chen CL, et al. Use of spermicide-coated condoms and other risk factors for urinary tract infection caused by Staphylococcus saprophyticus. Arch Intern Med 1998; 158:281.
  26. Schreiber CA, Meyn LA, Creinin MD, et al. Effects of long-term use of nonoxynol-9 on vaginal flora. Obstet Gynecol 2006; 107:136.
  27. Schwartz B, Gaventa S, Broome CV, et al. Nonmenstrual toxic shock syndrome associated with barrier contraceptives: report of a case-control study. Rev Infect Dis 1989; 11 Suppl 1:S43.
  28. American College of Obstetricians and Gynecologists: Barrier methods of birth control. http://www.acog.org/Patients/FAQs/Barrier-Methods-of-Birth-Control-Diaphragm-Sponge-Cervical-Cap-and-Condom (Accessed on February 17, 2016).
  29. Contraceptive efficacy rates for cervical barriers. http://www.cervicalbarriers.org/information/efficacyRates.htm (Accessed on February 17, 2016).
  30. Gallo MF, Grimes DA, Schulz KF. Cervical cap versus diaphragm for contraception. Cochrane Database Syst Rev 2002; :CD003551.
  31. Mauck C, Callahan M, Weiner DH, Dominik R. A comparative study of the safety and efficacy of FemCap, a new vaginal barrier contraceptive, and the Ortho All-Flex diaphragm. The FemCap Investigators' Group. Contraception 1999; 60:71.
  32. Kuyoh MA, Toroitich-Ruto C, Grimes DA, et al. Sponge versus diaphragm for contraception. Cochrane Database Syst Rev 2002; :CD003172.
  33. Centers for Disease Control and Prevention: Toxic shock and the vaginal contraceptive sponge. http://www.cdc.gov/mmwr//preview/mmwrhtml/00000273.htm (Accessed on February 18, 2016).
  34. Raymond EG, Trussell J, Weaver MA, Reeves MF. Estimating contraceptive efficacy: the case of spermicides. Contraception 2013; 87:134.
  35. Roddy RE, Zekeng L, Ryan KA, et al. Effect of nonoxynol-9 gel on urogenital gonorrhea and chlamydial infection: a randomized controlled trial. JAMA 2002; 287:1117.
  36. Kreiss J, Ngugi E, Holmes K, et al. Efficacy of nonoxynol 9 contraceptive sponge use in preventing heterosexual acquisition of HIV in Nairobi prostitutes. JAMA 1992; 268:477.
  37. Nonoxynol-9 spermicide contraception use-United States 1999. MMWR Morbid Mortal Wkly Rep 2002; 51:389.
  38. Einarson TR, Koren G, Mattice D, Schechter-Tsafriri O. Maternal spermicide use and adverse reproductive outcome: a meta-analysis. Am J Obstet Gynecol 1990; 162:655.
  39. Gallaway MS, Waller DK, Canfield MA, et al. The association between use of spermicides or male condoms and major structural birth defects. Contraception 2009; 80:422.