1.   Do spermicides cause birth defects? Will the fetus be harmed if a woman accidentally uses spermicides while she is pregnant?

No. Good evidence shows that spermicides will not cause birth defects or otherwise harm the fetus if a woman becomes pregnant while using spermicides or accidentally uses spermicides when she is already pregnant.

2.   Do spermicides cause cancer?

No, spermicides do not cause cancer.

3.   Do spermicides increase the risk of becoming infected with HIV?

Women who use nonoxynol-9 several times a day may face an increased risk of infection with HIV. Spermicides can cause vaginal irritation, which may cause small lesions to form on the lining of the vagina or on the external genitals. These lesions may make it easier for a woman to become infected with HIV. Studies that suggest spermicide use increases HIV risk have involved women who used spermicides several times a day. Women who have multiple daily acts of sex should use another contraceptive method. A study among women using nonoxynol-9 an average of 3 times a week, however, found no increased risk of HIV infection for spermicide users compared with women not using spermicides. New spermicides that are less irritating may become available.

4.   Is the diaphragm uncomfortable for the woman?

No, not if it is fitted and inserted correctly. The woman and her partner usually cannot feel the diaphragm during sex. The provider selects the properly sized diaphragm for each woman so that it fits her and does not hurt. If it is uncomfortable, she should come back to have the fit checked and to make sure that she is inserting and removing the diaphragm properly.

5.   If a woman uses the diaphragm without spermicides, will it still prevent pregnancy?

There is not enough evidence to be certain. A few studies find that diaphragm users have higher pregnancy rates when they do not use a spermicide with the diaphragm. Thus, using a diaphragm without spermicide is not recommended.

6.   Could a woman leave a diaphragm in all day?

Yes, although doing so is usually not recommended. A woman could leave a diaphragm in all day if she cannot put it in shortly before having sex. She should not leave the diaphragm in for more than 24 hours, however. This can increase the risk of toxic shock syndrome.

7.   Can a woman use lubricants with a diaphragm?

Yes, but only water- or silicone-based lubricants if the diaphragm is made of latex. Products made with oil cannot be used as lubricants because they damage latex. Materials that should not be used with latex diaphragms include any oils (cooking, baby, coconut, mineral), petroleum jelly, lotions, cold creams, butter, cocoa butter, and margarine. Oil-based lubricants will not harm a plastic diaphragm. Spermicides usually provide enough lubrication for diaphragm users.

8.   Do diaphragms help protect women from STIs, including HIV?

Research suggests that the diaphragm may help protect somewhat against infections of the cervix such as gonorrhea and chlamydia. Some studies have also found that it also may help protect against pelvic inflammatory disease and trichomoniasis. Studies are underway to assess whether incorporating a microbicide into the diaphragm would help to prevent HIV and other STIs. Currently, only male and female condoms are recommended for protection from HIV and other STIs.

9.   Is there a new diaphragm that does not require fitting?

Yes. The one-size SILCS diaphragm has been developed to fit most women without the need for a provider specifically trained to fit the diaphragm. Made of silicone, it can be easier to handle and more comfortable than conventional latex diaphragms. It is registered under the brand name Caya in 3 dozen countries. Used with a spermicidal gel, it offers similar protection to conventional diaphragms.

10. What is the vaginal sponge, and how effective is it?

The vaginal sponge is made of plastic and contains spermicides. It is moistened with water and inserted into the vagina so that it rests against the cervix. Each sponge can be used only once. It is not widely available.

Effectiveness depends on the user: Risk of pregnancy is greatest when a woman does not use the sponge with every act of sex.

Women who have given birth:

• One of the least effective methods, as commonly used.
• As commonly used, about 32 pregnancies per 100 women using the sponge over the first year.
• When used correctly with every act of sex, about 20 pregnancies per 100 women over the first year.

More effective among women who have not given birth:

• As commonly used, about 16 pregnancies per 100 women using the sponge over the first year.
• When used correctly with every act of sex, about 9 pregnancies per 100 women over the first year.