diaphragms and cervical caps

iVillage Member
Registered: 07-29-2004
diaphragms and cervical caps
5
Thu, 09-23-2004 - 2:48pm
hi, i've been reading through old posts and i saw a bunch of times that diaphragms and cervical caps are currently "unfashionable" with doctors, but actually a good form of birth control. that's making me curious now, because i was talking to my doctor recently about bc methods, and he was pushing pretty hard for hormonal methods. he gave me a bunch of numbers... with barrier methods, he said 6-9% of women would get pregnant in the first year, even if used perfectly every time! (that's compared to less than 1% of women on the pill).

so, a 9% failure rate is not nearly enough protection as far as i'm concerned. was my doctor exaggerating the ineffectiveness so i would choose the pill? that would be kind of unethical, wouldn't it?

can anyone clear this up for me? thanks.

iVillage Member
Registered: 08-11-2004
Thu, 09-23-2004 - 3:39pm
Here's what Planned Parenthood lists for failure rates:

http://www.plannedparenthood.org/bc/bcfacts2.html

Perfect use for a diaphragm is 6% compared to 16% for typical use. For cervical caps, if you haven't given birth then it's 9% for perfect use or 16% for typical. If you have given birth, then it's 26% for perfect or 32% for typical.

The pill is listed as 0.3% for perfect use and 8% for typical, although it's listing combined and mini pills in one category. Usually I've seen perfect failure rates of 0.1% for combined pills and 0.5% for mini pills, and typical failure rates of closer to 5% for combined and as high as 10-12% for mini.

The numbers he gave you are exactly what Planned Parenthood quotes. What method you should choose all depends on what failure rate you're comfortable with and how diligent you can be with the method. Methods that don't need you to remember something every day like the patch, the Nuva Ring, Depo Provera, or an IUD tend to have lower typical failure rates than methods that require precise timing or having to insert something every time you have sex.

iVillage Member
Registered: 03-19-2003
Fri, 09-24-2004 - 7:36am
My doctor is totally anti-barriers, at least anti-vaginal barriers! He seems to think they're too low-tech, I think "archaic" was the word he used. Diaphragms and cervical caps have been used as contraception for hundreds of years!

The key to using a diaphragm or cap successfully (and I know of a number of women who have used diaphragms for 10-20 years with only planned pregnancies) is getting a good fit. If your diaphragm or cap doesn't fit properly, it's obviously not going to protect you! But if the cap or diaphragm fits properly and you use it absolutely correctly and treat it like you're supposed to (watching for holes and leaks and if it's latex keeping it away from heat and petroleum-based products), it can be as effective as condoms, which many people use as protection without even thinking about it.

It's a very personal decision! Doctors tend to not like bc methods with a high opportunity for user error, and a vaginal barrier is DEFINITELY on that list. But Jill, our other cl, has been a cap/diaphragm user for what, almost two years now? She's VERY happy with them! Personally, I'm choosing to wait until after we get married and can afford (in terms of where we're at in life, not $$) to have a baby, then I'll probably investigate a cap.

Good luck!

Judie
Co-cl for Birth Control
Judie Cl for Birth Control 
iVillage Member
Registered: 12-30-2003
Fri, 09-24-2004 - 10:40am
As Judie said cervical barriers can be very effective. They can be a good choice for those of us who can’t or don’t want to take hormones and who aren’t good candidates for an IUD. Cervical barrier users are a very small percentage of the women using contraception; about 2% use a diaphragm and less than 1% a cervical cap. Other than having a correct fit, motivation is the biggest factor in minimizing ‘user failure’ (not using the barrier correctly and consistently) which is the major cause for unintended pregnancies while using a barrier. I’ve been using an Oves cap between menses and a Milex diaphragm during, for flow control and contraception, for 27 months and haven’t had a scare or any problems at all. It’s all in what the individual user wants in a method and how motivated she is to use it properly.

      Jill

    

iVillage Member
Registered: 07-29-2004
Fri, 09-24-2004 - 8:26pm
i don't know, now that i've seen the failure rate statistics... i'm really glad my doctor is so anti-barriers!

according to that planned parenthood chart, cervical caps fail in the first year for 9% of women who use them "perfectly". (i assume "perfect use" means none of the types of user error you describe and no poorly fitting caps - don't you think so?). it really does seem like this is one of the least effective methods out there.

please don't take this the wrong way - i really appreciate this board and found a lot of really useful info here, but i do think the FAQ on "diaphragms and cervical barriers" could be phrased a little differently. i myself found it misleading, anyway. it doesn't give any numbers, just says that barrier methods can be "very effective" - i guess that's a subjective term, but to me a 1 in 10 or even a 1 in 20 chance of pregnancy is not "very effective". maybe it should just state a statistic and let people decide for themselves if that's an amount of risk they're willing to take?

JMHO!!!

iVillage Member
Registered: 12-30-2003
Sat, 09-25-2004 - 9:59am
Hi mariafullofgrace,

>> according to that planned parenthood chart, cervical caps fail in the first year for 9% of women who use them "perfectly". (i assume "perfect use" means none of the types of user error you describe and no poorly fitting caps - don't you think so?).

Thanks for your thoughts. Studies are averages and there are a range of values that make up the average. I am familiar with the problems women have in finding an experienced fitter and getting a good fit and with some women being fitted who shouldn’t have been. In addition ‘perfect use’ sometimes isn’t quite perfect. Discipline and being highly motivated makes a significant difference in effectiveness. For a woman properly screened by an experienced fitter to ensure her anatomy makes her is a good candidate for a correctly fitting cervical barrier and who is highly motivated to use her barrier correctly and consistently her barrier can be as effective as condoms.

I do agree that for a woman wanting a very effective method of contraception that has minimal chance of user error a cervical barrier may not be the best choice for her. Anyone looking for an effective low maintenance method of contraception might want to consider NuvaRing or an IUD.

Take care,

      Jill