This FAQ Fact Sheet was compiled by CBAS based on the evaluation of the CBAS website conducted in 2005 as well as inquiries received from CBAS website users since its establishment in 2004. It will be updated on a regular basis to reflect the various questions that website users have about cervical barriers and related issues. Please also note that the Fact Sheet: FAQs about Cervical Barriers provides more general information about cervical barriers including current research on whether they may provide protection against STI/HIVs.

Cervical Barriers and Spermicide

What do I need to know about the spermicide Nonoxynol-9?
Nonoxynol-9 (N-9) is the active ingredient in all over-the-counter spermicidal products available in the U.S., including suppositories, foam, film, gel, and cream. Diaphragms and caps are approved by the United States Food and Drug Administration (FDA) for use in conjunction with spermicidal gels and creams. N-9 is also used with some condoms as a spermicidal lubricant. N-9 has long been considered a safe and effective contraceptive method. It is still considered a safe method for women at low risk of sexually transmitted infections (STIs), including HIV, who do not use the product more than once a day.

However, after more than a decade of research, N-9 is not recommended as a STI/HIV prevention method. Further, evidence indicates that N-9 may increase the risk of contracting STIs/HIV among women already at high risk, such as sex workers, due to increased incidence of “microtears” in the vagina. Research also suggests that N-9 is considerably more damaging, resulting in increased risk of infection, when used rectally. Some condom manufacturers have discontinued adding N-9 to their products because of these reasons.

For more information on N-9 and STIs/HIV, see the fact sheet What You Need to Know About Nonoxynol-9.

How effective are cervical barriers as contraception when used without a spermicide?
Given that women at high risk of HIV infection should be advised against using the diaphragm with an N-9 spermicide, research is needed on whether cervical barriers used with a non-spermicidal lubricant are effective contraceptives or offer any STI/HIV protection. Inadequate research has been conducted to determine contraceptive effectiveness of cervical barriers used without a spermicide and thus results to date have been inconclusive. Current clinical recommendations remain to use cervical barriers with a contraceptive gel for contraception.

Cervical Barriers and STIS/HIV

How effective are cervical barriers as protection from STIs/HIV?
Condoms are the only proven method to reduce the risk of STI/HIV infection. However, negotiating condom use remains difficult for many people, especially women and girls. Therefore, there are a number of studies looking at viable alternatives to provide more female-controlled STI/HIV options. Cervical barrier methods have proven contraceptive benefits, and some data suggest that they may also offer some protection against STIs/HIV. See the “Preventing STI/HIV” section of this website for more information on why cervical barriers are being researched as potential female-controlled methods for STI/HIV prevention.

There have been several observational studies (case-control or cross-sectional designs) that report that using the diaphragm is associated with a reduced risk of STIs and associated long-term sequelae. The MIRA trial investigated whether the diaphragm would reduce male-to-female STI/HIV transmission; however results did not support the addition of the diaphragm to current HIV prevention strategies.

Choosing a cervical barrier method

What is the difference between arcing, coil, flat spring and wide seal diaphragms, and which is the best choice for me?
The flat spring diaphragm has a gentle spring strength, and is suitable for women with very firm vaginal muscle tone. The coil spring diaphragm has a firm spring strength and is suitable for women with average muscle tone and average pubic arch depth. These two types can be inserted with a plastic diaphragm introducer. The arcing spring diaphragm has firm spring strength, and is often suitable for women with lax muscle tone. Many women find the arcing spring diaphragm easier to insert, since it bends in two planes rather than one. The wide-seal diaphragm, available with either an arcing spring rim or a coil spring rim, has a flexible flange approximately 1.5cm wide attached to the inner edge of its rim, which holds spermicide in place and creates a better seal between the diaphragm and the vaginal wall. Contraceptive efficacy is the same across all types, provided that the diaphragm is correctly fitted. Some women may need to use a particular type, while other women can use any design. Your provider will tell you at your diaphragm fitting session if one diaphragm type is particularly suited to your body.

Using Cervical Barrier Methods

How do I use my diaphragm or cervical cap?
These fact sheets in the download center explain how to insert, remove, and care for your cervical barrier method.
Contraception report (diaphragm use) (pdf)
Contraception report (cervical cap use) (pdf)

Can the internal/female condom be used with the diaphragm or cap?
According to the manufacturer, the Female Health Company, female condoms cannot be used with cervical barriers because only one method at a time can be placed against the cervix.

Accessing Cervical Barrier Methods

How can I access cervical barrier products that are not available in my area? While CBAS does not recommend any specific suppliers, cervical barriers can often be ordered from the manufacturer’s website or from other online sources on the internet. CBAS website users have suggested the following websites as helpful supply sources: www.ladytobaby.com, www.kessel-marketing.de, www.birthwithlove.com, www.westons.com, www.anarreshealth.ca, or www.fpsales.co.uk. Providers can purchase cervical barriers and supplies from www.idis.co.uk.

How can I access cervical barrier products that have been discontinued? Your local family planning clinic may have discontinued products in stock, or they can sometimes be ordered online. If you can’t find the product you want, talk to your provider about finding a suitable replacement. Also, because products sometimes return to the market after being discontinued, you can check for product availability updates on the CBAS website.

How can I access the Ovés cap or Lea’s Shield in the US? To the best of our knowledge these products are no longer available for purchase online. You may ask your provider about other alternatives.

How can I access the Today sponge in the US? As of 2019, Mayer Labs, the manufacturer of the Today sponge has reported that they are out of stock due to a mechanical failure and delay in repairs due to the COVID-19 pandemic. You can contact the manufacturer for updates at www.todaysponge.com.

How can I access the Prentif cervical cap in the US? Cervical Cap, Ltd was the sole distributor of the Prentif cap in the US, which has now closed. (See this CBAS press release for details). To the best of our knowledge this product is no longer being produced in any country. You may ask your provider about other alternatives.

More Information

Where can I connect online with other people who have experience with cervical barriers and spermicides? Although CBAS cannot recommend information that it is not available on its website, many CBAS website users are members of the Yahoo! Group “Diaphragms and Caps”. Membership is free. This is a group of women mostly from the United States, Europe and Australia who exchange information about their experiences using diaphragms, caps, spermicides, etc.