Combination Methods - Sexual Health Peer Resource Center

Combination methods are usually the combination of a barrier method and a chemical method in order to increase the effectivity of both methods. In most cases, the diaphragm and the cervical cap are considered the main combination methods, however using a condom with additional spermicidal inserts is also a combination method and is more effective against preventing pregnancy than a condom alone.

Diaphragm

How it works: The diaphragm is a round, flexible latex cap that covers the cervix. The diaphragm must be used with contraceptive cream or jelly. The latex dome acts as a physical barrier to prevent sperm from joining an egg; the accompanying contraceptive cream or jelly immobilizes sperm to prevent it from fertilizing an egg. Diaphragms come in different sizes and a woman must be fitted with the correct one by a trained practitioner.

Effectiveness (failure rate): 6%-20%. Of 100 women using diaphragms, 20 will become pregnant during the first year of use. 6 will become pregnant with perfect use. The diaphragm can be more effective if a backup method of contraception is used during a woman’s most fertile times.

Contraindications: Allergy to either latex or spermicide, anatomic abnormalities of the cervix or uterus that would make a correct fitting impossible, history of Toxic Shock Syndrome, tendency towards UTIs, poor vaginal tone

Possible side effects, risks, and considerations:

Increased risk of TSS
Frequent UTIs
Increased risk of vaginitis
Allergic reaction to latex or spermicide
May be dislodged during sex
Privacy for inserting it and soap and water for washing are necessary

Benefits:

Provides some protection against STDs
Generally cannot be felt by either partner during sex
Can be inserted up to 6 hours before intercourse so as not to interrupt sex play

How to use it:

Wash hands with soap and water
Put about a teaspoon of contraceptive cream or jelly in the cup of the diaphragm and spread some around the rim. Separate the labia with one hand and with the other, pinch the rim of the diaphragm to fold it in half.
Push the diaphragm as far up in the vagina as possible, tuck the front rim of the diaphragm behind the pubic bone, and make sure the cervix is covered by the rim.
You should not be able to feel a properly inserted diaphragm
Insert the diaphragm no more than 6 hours before intercourse; do not leavve it in longer than 24 hours
Apply new spermicide each time you have intercourse

How to get it: The diaphragm is available by prescription from your health care practitioner. A pap smear and a pelvic exam are required before receiving a prescription.

Cost: Diaphragms cost between $15-30. Stanford students receive the diaphragm fitting free of charge

Cervical Cap

How it works: The cervical cap is a latex, dome-shaped device which is smaller than the diaphragm. It fits snugly over the cervix, held in place by a seal formed between the cap and the cervix, and by support from the vaginal wall. It holds spermicide against the cervix. It works as a phsycial barrier by covering the cervix so that sperm cannot pass from the vagina into the uterus. The spermicide then acts as a chemical barrier by killing any sperm that get around the cap.

Effectiveness (failure rate): 8%-27%. Out of 100 women who use cervical caps for a year, 27 will get pregnant with typical use. 8 will get pregnant after perfect use. Much of the variance in failure rates can be attributed to incorrect and inconsistent use of this method.

Contraindications: Allergy to latex or to spermicide, anatomic abnormalities making the fitting impossible, a cervix which does not fit one of the four currently available cap sizes, having given birth within the last 6 weeks, cervical biopsy or cryosurgery within the last 6 weeks, recent abortion, history of TSS, HPV, UTI, PID, or vaginitis, inability to insert the cap, lack of privacy when inserting it

Possible side effects, risks, and considerations:

Odor if left in too long
Increased risk of TSS, HPV (if already existent), UTI, PID, or vaginitis
Possible allergic reaction to latex or spermicide
May be dislodged during intercourse
Time and effort to insert and remove cap

Benefits:

Provides some protection against STDs
Can be worn for 48 hours continuously. No additional spermicide needs to be inserted for additional acts of intercourse within this time

How to use it:

Wash your hands
Fill cap 1/3 full of spermicide and fold rim of cap. Insert as far into vagina as it will go. Press the rime of the cap around the cervix until it is completely covered
Allow for 30 minutes of suction before having intercourse
Leave cap in for 6-8 hours after last act of intercourse
To remove, press on rim to break seal
Use a backup method during times of fertility
Do not use cap during menstruation

How to get it: The cervical cap cannot be obtained without a prescription, given after a pelvic exam and a cap fitting. The fitting is free at Vaden for students.

Costs: The cap costs approximately $35, and spermicide ranges from $3-5.


	SHPRC	About SHPRC Sexual Beings Working Yesterday STDs Making Babies Not Babies
	Choosing a Method Non-Methods Barrier Methods Hormonal Methods Chemical Methods Combination Methods Intrauterine Device Natural Family Planning Emergency Contraceptive Pill Fertility Charting Abstinence Sterilization	Combination Methods Combination methods are usually the combination of a barrier method and a chemical method in order to increase the effectivity of both methods. In most cases, the diaphragm and the cervical cap are considered the main combination methods, however using a condom with additional spermicidal inserts is also a combination method and is more effective against preventing pregnancy than a condom alone. Diaphragm How it works: The diaphragm is a round, flexible latex cap that covers the cervix. The diaphragm must be used with contraceptive cream or jelly. The latex dome acts as a physical barrier to prevent sperm from joining an egg; the accompanying contraceptive cream or jelly immobilizes sperm to prevent it from fertilizing an egg. Diaphragms come in different sizes and a woman must be fitted with the correct one by a trained practitioner. Effectiveness (failure rate): 6%-20%. Of 100 women using diaphragms, 20 will become pregnant during the first year of use. 6 will become pregnant with perfect use. The diaphragm can be more effective if a backup method of contraception is used during a woman’s most fertile times. Contraindications: Allergy to either latex or spermicide, anatomic abnormalities of the cervix or uterus that would make a correct fitting impossible, history of Toxic Shock Syndrome, tendency towards UTIs, poor vaginal tone Possible side effects, risks, and considerations: Increased risk of TSS Frequent UTIs Increased risk of vaginitis Allergic reaction to latex or spermicide May be dislodged during sex Privacy for inserting it and soap and water for washing are necessary Benefits: Provides some protection against STDs Generally cannot be felt by either partner during sex Can be inserted up to 6 hours before intercourse so as not to interrupt sex play How to use it: Wash hands with soap and water Put about a teaspoon of contraceptive cream or jelly in the cup of the diaphragm and spread some around the rim. Separate the labia with one hand and with the other, pinch the rim of the diaphragm to fold it in half. Push the diaphragm as far up in the vagina as possible, tuck the front rim of the diaphragm behind the pubic bone, and make sure the cervix is covered by the rim. You should not be able to feel a properly inserted diaphragm Insert the diaphragm no more than 6 hours before intercourse; do not leavve it in longer than 24 hours Apply new spermicide each time you have intercourse How to get it: The diaphragm is available by prescription from your health care practitioner. A pap smear and a pelvic exam are required before receiving a prescription. Cost: Diaphragms cost between $15-30. Stanford students receive the diaphragm fitting free of charge Cervical Cap How it works: The cervical cap is a latex, dome-shaped device which is smaller than the diaphragm. It fits snugly over the cervix, held in place by a seal formed between the cap and the cervix, and by support from the vaginal wall. It holds spermicide against the cervix. It works as a phsycial barrier by covering the cervix so that sperm cannot pass from the vagina into the uterus. The spermicide then acts as a chemical barrier by killing any sperm that get around the cap. Effectiveness (failure rate): 8%-27%. Out of 100 women who use cervical caps for a year, 27 will get pregnant with typical use. 8 will get pregnant after perfect use. Much of the variance in failure rates can be attributed to incorrect and inconsistent use of this method. Contraindications: Allergy to latex or to spermicide, anatomic abnormalities making the fitting impossible, a cervix which does not fit one of the four currently available cap sizes, having given birth within the last 6 weeks, cervical biopsy or cryosurgery within the last 6 weeks, recent abortion, history of TSS, HPV, UTI, PID, or vaginitis, inability to insert the cap, lack of privacy when inserting it Possible side effects, risks, and considerations: Odor if left in too long Increased risk of TSS, HPV (if already existent), UTI, PID, or vaginitis Possible allergic reaction to latex or spermicide May be dislodged during intercourse Time and effort to insert and remove cap Benefits: Provides some protection against STDs Can be worn for 48 hours continuously. No additional spermicide needs to be inserted for additional acts of intercourse within this time How to use it: Wash your hands Fill cap 1/3 full of spermicide and fold rim of cap. Insert as far into vagina as it will go. Press the rime of the cap around the cervix until it is completely covered Allow for 30 minutes of suction before having intercourse Leave cap in for 6-8 hours after last act of intercourse To remove, press on rim to break seal Use a backup method during times of fertility Do not use cap during menstruation How to get it: The cervical cap cannot be obtained without a prescription, given after a pelvic exam and a cap fitting. The fitting is free at Vaden for students. Costs: The cap costs approximately $35, and spermicide ranges from $3-5.