Contraceptive methods: diaphragm

Diaphragm

A diaphragm is a thin rubber dome with a springy and flexible rim. It is inserted into the vagina, fits over the cervix and is held in place by vaginal muscles. A diaphragm holds spermicide in place over the cervix (opening to the uterus). Spermicide kills sperm, preventing fertilization. After intercourse, it should be left in place for 6-8 hours. Diaphragms are 86-94% effective as birth control.

Diaphragms may offer some limited protection against reproductive tract infections and HIV/AIDS.

The diaphragm keeps sperm from entering the uterus by blocking the cervix. For added protection,spermicide is put into the bowl of the diaphragm and along its edges before inserting the diaphragm high into the vagina so it covers the cervix.

The diaphragm is inserted up to 6 hours before having sex. More spermicide must be used each time you have sex while wearing the diaphragm. After sex, the diaphragm must be left in for at least 6 hours, but no longer than 24 hours. The diaphragm can be removed by placing a finger into the vagina to pull it out.

Each time the diaphragm is removed, it must be washed, rinsed, and dried, then stored in its case. It should not be dusted with baby powder and should never be used with oil-based lubricants such as mineral oil, petroleum jelly, or baby oil. These substances can cause the rubber to become brittle and crack. Other vaginal creams, such as yeast medicines, can also damage the rubber.

A diaphragm should be replaced at least every 2 years. It should be examined regularly for holes or weak spots, and replaced as needed.

Use of the diaphragm

If you decide on the diaphragm, your doctor determines which size diaphragm best fits your body. Weight gain, weight loss or changes in vaginal tone affect how the diaphragm fits. Have your doctor reassess your diaphragm’s fit each year at the time of your regular pelvic exam. With proper care, your diaphragm could last up to two years before it needs to be replaced.

The diaphragm must be used with spermicide. It does not provide protection against pregnancy without the use of spermicide. The diaphragm may be inserted up to an hour before sex. Once in place, it provides effective contraceptive protection for up to six hours.

Here are some additional tips for diaphragm insertion:

Hold the diaphragm with the dome down. Squeeze about 1 teaspoon of spermicide into the dome and spread a little bit around the rim with your finger.
Squeeze the diaphragm so that it folds. Spread your labia with your other hand and insert the folded diaphragm into your vaginal canal. This can be done standing, with one foot propped up, squatting or lying on your back.
Push the diaphragm downward and along the back wall of your vagina as far as it will go. Then tuck the front rim up along the roof of your vagina behind your pubic bone.
If the diaphragm is correctly placed, the back rim is below and behind the cervix and the front edge of the rim is tucked up behind the pubic bone. You shouldn’t be able to feel it except with your fingers.

After sex, leave the diaphragm in place for at least six hours but for no more than 24 hours. After removal, wash the diaphragm with mild soap and warm water and allow it to air-dry. Use only water-based lubricants with the diaphragm, and examine it regularly for holes, tears or leaks.

Protection Against STDs

The diaphragm does not protect against sexually transmitted diseases. Couples having sex must always use condoms along with the diaphragm to protect against STDs.

Abstinence (not having sex) is the only method that always prevents pregnancy and STDs.

Possible Side Effects

Most women who use a diaphragm have no problems with it. The side effects that some women have include:

Spermicides may irritate the vagina and surrounding skin.
Strong odors or vaginal discharge may appear if the diaphragm is left in too long.
The rubber or latex in the diaphragm may cause an allergic reaction (this is rare).
Toxic shock syndrome(TSS) is a rare complication if the diaphragm is left in too long.

Care

After using a diaphragm, wash it with mild soap and warm water. To maintain effectiveness, diaphragms must not have holes or cracks. Holding it up to the light or filling it with water are two ways you can check the condition of your diaphragm.

Oil-based creams, including some vaginal medications, can damage diaphragms, so avoid contact with those materials.

Since it can be hard to tell how much spermicide is left in a tube, it’s a good idea to keep an extra package on hand.

Refitting:

Pregnancy and weight changes can affect the way a diaphragm fits. It is recommended that a medical provider check the fit of a diaphragm every few years. Women who have gained or lost more than ten pounds, have had vaginal surgery, or given birth may need a new size.

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