Medical Background
The diaphragm and cervical cap are reusable contraceptive devices that work by covering the opening of the cervix and blocking the passage of sperm. The diaphragm is larger, bowl-shaped, and can be made of silicone or latex. The cervical cap is smaller, shaped like a ski hat, and made of silicone.
Spermicidal gel or foam is placed into the diaphragm or cervical cap to further reduce the chances of conception.
The contraceptive sponge is a small, round, disposable sponge permeated with spermicide. It works both by covering the opening of the cervix and by impairing the function of sperm cells.
A woman inserts a diaphragm, cervical cap, or sponge deep into the vagina before intercourse. She removes it no earlier than six hours after intercourse.
Efficacy
With typical use, the classic diaphragm together with spermicide is about 88% effective in preventing pregnancy. The newer one-size-fits-most Caya diaphragm, used together with Caya contraceptive gel, is about 83% effective.
As a point of comparison, typical use of a condom has an efficacy rate of about 82%.
The sponge is about 88% effective with typical use among women who have never given birth vaginally, but for women who have given birth vaginally, efficacy drops to about 76%. The cervical cap also has a gap between women who have and haven’t given birth vaginally, with slightly lower efficacy rates for both than for the sponge.
Fitting a Diaphragm or Cervical Cap
The sponge is one-size-fits-all and the Caya diaphragm is one-size-fits-most (requiring only confirmation of suitability by one’s healthcare provider), and both are available over-the-counter or online.
The classic diaphragm and cervical cap come in a variety of sizes, and are available only by prescription.
A woman should consult her healthcare provider as to correct sizing for a cervical cap, which usually corresponds to a woman’s pregnancy and childbirth history.
The diaphragm needs to be fitted by a physician or by a qualified nurse or midwife. A woman should have another fitting after each pregnancy, or if she experiences a significant weight change (more than about 5kg). It is usually best to seek a referral for fitting a diaphragm from one’s physician.
Please see here for a list in Hebrew of women in Israel qualified to fit diaphragms. Information in Hebrew on obtaining a diaphragm in Israel, including a list of women qualified to fit diaphragms, is also available here. It can sometimes be difficult to find a practitioner who can fit diaphragms in North America.
Side effects
One major advantage of barrier methods is their lack of side effects. However, some people are sensitive to latex or silicone, or to specific ingredients in some spermicides, and should take this into account when considering these methods.
FAM
Please see our article on the Fertility Awareness Method for discussion of integrating barrier methods into its practice.
Halachic Desirability
Contemporary halachic authorities differ in their rulings regarding the diaphragm and cervical cap. Some authorities consider them a halachically problematic method of birth control that interferes with the normal course of relations and thus should be used only in extenuating circumstances. Another concern is that their use may be similar to “casting seed on wood and on stones,” violating the prohibition against illegitimate expulsion of semen (hotza’at zera l’vatalah).
Other authorities consider them a permissible method of birth control, which may be used by any couple who are halachically permitted to use contraception. According to these authorities, intercourse with these devices is considered natural because they are inserted too deeply to interfere with relations, and, since semen enters the vagina normally when they are in place, there is no problem of “casting seed on wood and on stones.”
Our site follows this position, that the diaphragm and cervical cap are fully permissible as contraceptive methods. In some cases, as when a short-term method of contraception is needed or when there is particular concern about potential side effects of hormonal contraception and the IUD, these methods may be preferred to others.
Some halachic authorities prefer these methods in general, because they have less of an effect on a woman’s body than other methods.
The sponge fills more of the vaginal canal than the diaphragm or cervical cap, so it is more likely to be felt during relations. This means it is less preferred and less widely accepted. However, it is still inserted deeply enough that some halachic authorities, including the supervisors of this site, permit it when necessary.
Blood found on a contraceptive device
When a woman finds blood on an item that was inserted into the vagina (such as a bedikah cloth), halacha is stringent. The leniencies of external stains do not apply.
Therefore, it is best to remove and rinse a diaphragm or cervical cap without looking at it. Similarly, one can remove the sponge and dispose of it without looking. It can be easier to avoid looking if one removes the contraceptive device in a fairly dark room.
If a woman does find blood on such a device, and suspects it is from irritation to the cervix or vaginal wall, she should ask a halachic question.
Shabbat
It is permissible to squeeze spermicide out of a tube on Shabbat for use with a diaphragm or cervical cap. If the spermicide is fairly liquid (i.e., it pours out on its own and doesn’t retain a shape after exiting its container), then it may be spread freely on Shabbat.
If the spermicide is more of a gel, then applying it raises concerns of the prohibited labor of memarei’ach, spreading, on Shabbat. In this case, the diaphragm or cervical cap with spermicide can be inserted prior to Shabbat. Precise timing should follow the instructions on the package insert.
If necessary, spermicide gel can be squeezed in dabs directly onto the edges and middle of the diaphragm or cap on Shabbat, and left to spread itself following insertion.
It is permissible to use an applicator to top off spermicide for repeat acts of intercourse with a previously inserted diaphragm or cap on Shabbat.
The sponge is best inserted prior to Shabbat, because the sponge typically needs to be wetted and squeezed prior to insertion. This entails a rabbinic-level violation of the prohibited labor of sechita, squeezing out a liquid. Again, this can typically be done hours prior to relations, and timing should be confirmed with the package insert.
