Occlusive diaphragms are barrier contraceptives placed in the vagina to block sperm from entering the cervix. They are most effective when used with a spermicide. Diaphragms must be left in place for at least 8 hours after sex and properly fitted to be effective. Refitting is required after childbirth or weight changes. The Dutch cap is a dome-shaped diaphragm made in varying sizes that fits over the cervix. Cervical caps also fit over the cervix but are preferred for women with prolapsed organs. While diaphragms are inexpensive and reusable, they do not prevent sexually transmitted infections like HIV.

1. BARRIER CONTRACEPTIVES

2. OCCULSIVE DIAPHRAGMS
Barrier in the vagina against direct insemination.
Effective when used in conjunction with a chemical spermicide in the form
of a jelly or cream.
Sufficient time is allowed for complete destruction of the sperms before the
diaphragm is removed.
Left in position for a minimum of 8 h after coitus.

3. Alterations in the size and type of diaphragm may be required as a result
of changes in
• weight
• illness
• delivery
• prolapse
Routine checking is advisable at suitable intervals, usually 6 months to 1
year.
A refitting of the diaphragm is always required after childbirth, and this can
be done about 6–8 weeks after confinement.

4. • The Dutch cap or diaphragm
Consists of a dome shaped diaphragm of thin rubber, with a rubber-
covered metal rim.
The diaphragm is made in a wide range of sizes (50 to 95 mm diameter)
and fit obliquely in the vagina, stretching from just behind the pubic ramus
into the posterior fornix, thus covering the cervix.
It is the easiest type of cap for the patient to use, causes no discomfort to
either partner when correctly fitted.

5. The anterior rim is pushed
up well behind the
symphysis pubis

6. Contraindications to use of diaphragm are:
prolapse
cystocele Because accurate fitting is not possible
rectocele
Recurrent urinary tract infection
Allergy to rubber or spermicidal agent.

7. Toxic shock syndrome (TSS) may occur if the diaphragm is left in the
vagina for a long period.
TSS is caused by staphylococcal pyogenic infection.
The failure rate of the Dutch cap is about 4–6 per 100 woman and is
nearly always associated with poor fitting and noncompliance.

8. • The cervical cap
Cup-shaped rubber like a thimble, with a solid rolled rubber rim.
Fits closely to the cervix and is suitable where the cervix is long and firm.
When a woman has a prolapse of uterus and vagina, a cervical cap is
preferred to the vaginal diaphragm.

9. Chronic cervicitis, erosion and cervical laceration contraindicate its use.
The cervical caps are available in four sizes, varying from
22 to 31 mm

10. • Dumas cap
Cup-shaped rubber with a thickened rim which fits well into the vault of
the vagina so that it encloses the cervix.
The size varies from
55 to 75 mm diameter

11. • Today: Vaginal Sponge
Mushroom-shaped polyurethane
disposal sponge
2 inches in diameter, 1.25 inches thick.
Contains 1 g of nonoxynol-9.
It is provided with a loop for its easy removal.

12. It should be placed high up in the vagina with the concave side covering
the cervix.
It can remain effective for 24 h. It is used only once.
It acts as a mechanical barrier and prevents entry of sperms into the
cervical canal, absorbs semen and contains a spermicidal agent.

13. Occlusive diaphragms are cheap and easy to use.
One diaphragm can be used for over a year if it is washed, dried and
kept properly after each use.
Diaphragm prevents transmission of STDs from one partner to another and
the incidence of cancer of the cervix is low in women using this
contraceptive.
It does not, however, prevent transmission of HIV, because it allows
vaginal secretion to mix with semen.