Efficacy, choice of device

Warning

Efficacy

Percentage of women experiencing an unintended pregnancy within the first year of use of barrier contraceptive methods1

 

Device Failure rate
Typical use Perfect use
Diaphragms (with spermicide cream
or jelly) excluding Caya*
12% 6% (range 4.3% to 8.4%)
Caya (pregnancy rates from 6 months of use
with spermicidal gel extrapolated to give an
estimated probability of pregnancy at 12 months)
17.8% 13.7%
Femcap®*  13%  7.7-11.2%
Male condom* 18% 2%
Internal condom* 21% 5%

*in the USA 

 

Choice of device

Diaphragm

Devices inserted into the vagina to lie diagonally across the cervix and vaginal vault and much of the anterior vaginal

All currently available products are made of silicone

  • Singa® is a dome shaped silicone diaphragm with a nylon spring ( sizes 55-95mm (in 5mm increments)
  • Caya®is a one size silicone contraceptive device with a polymer spring designed to fit 80% of women with a flexible rim, grip dimples and a removal dome.

Cap

A cap fits onto the cervix to create a barrier to sperm trying to enter the cervix
FemCap which is silicone, is the only currently available cervical cap.
There are 3 sizes:

  • 22mm: for clients who have never been pregnant
  • 26mm: for clients who have been pregnant but not delivered vaginally
  • 30mm: for cliets with at least one vaginal delivery

 

Spermicide

Diaphragms and Caps should be used with spermicide .Nonoxyl-9 spermicides are no longer recommended as they can cause vaginal irritation increasing the risk of STI acquisition. Current spermicidal gels products are acid buffering gels, which are thought to have similar efficacy and better tolerability. The manufacturer of Caya®  advises use with an acid buffering lubricant, Caya® Gel which contains lactic acid, sodium lactate, cellulose and sorbic acid which acts by reducing the motility of sperm cells (the acidic gel creates a hostile environment inside the vagina) and creating an additional physical barrier in front of the cervix (cellulose is a gel forming agent). Other brands are available such as Contragel  ( contains Water Lactic Acid Sodium Lactate (dairy-free) Methyl Cellulose Sorbic Acid Vanillum) 8

Spermicides are class IIa medical devices

NB VCF contraceptive film is a nonoxynol-9 containing product from the USA that can be bought on line in the UK

 

Editorial Information

Last reviewed: 30/09/2025

Next review date: 30/09/2028

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

Version: 8.1

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

Reviewer name(s): George Laird.