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A-Z Health Information - Diaphragm

Diaphragm

What is a vaginal diaphragm?

A vaginal diaphragm is a soft, rubber dome with a flexible rim, that is filled with a spermicidal jelly or cream. It is inserted into the vagina prior to intercourse to cover the cervix, the opening at the bottom of the uterus. The diaphragm works to prevent pregnancy in two ways: it acts as a barrier to stop sperm from entering the cervical canal, and it holds a jelly or cream, which kills the sperm before they enter the uterus and fertilize an egg.

Each woman's body requires special measurement and fitting to make sure that a diaphragm will fit correctly and protect against pregnancy. A health care provider will need to examine you and prescribe a diaphragm that will fit your body correctly.

How is it used?

The diaphragm can be put in place up to 6 hours before intercourse. It must be used with spermicide gel that should be applied in the middle and around the rim of the diaphragm. Never use oil based lubricants (Vaseline) because they will damage the latex. Find a comfortable position - stand with one foot on a chair, lie down, or squat. Separate the labia with one hand. Pinch the rim of the diaphragm to fold it in half with the other hand. Place index finger in the center of fold for a firmer grip. The spermicide must be inside the fold. Push as far up and back in the vagina as possible. Tuck behind the pubic bone. Make sure the cervix is covered.

Your health care provider will instruct you how to position the diaphragm with the back rim fitting behind the cervix and the opposite rim resting against the upper edge of your pubic bone.

You must leave the diaphragm in place for 6 hours after intercourse so that the spermicide can destroy any sperm. If intercourse is to be repeated within this time frame, insert more cream or jelly with an applicator. Wait 6 hours after the last act of intercourse before removing. Wearing the diaphragm for longer then 24 hours is not recommended because of the possible risk of TSS (toxic shock syndrome).

To have intercourse safely again after 6 hours, remove the diaphragm, wash it with soap and water, re-coat it with spermicide and then reinsert it.

To take out the diaphragm, pull the rim gently with your index finger, dislodge it, and remove it from the vagina. After each use, wash and dry the diaphragm. Store it in a dry container. You should check the diaphragm before use for any weak areas, small tears, or holes that may allow sperm to leak through. The size of the diaphragm should be checked at each annual exam after a weight gain or loss of more than ten pounds. The diaphragm should last at least one to two years. The FDA suggests that they be replaced yearly.

It is a good idea to urinate before inserting the diaphragm and after taking it out. This helps reduce the chance of getting an infection.

How effective is the diaphragm?

With perfect use effectiveness of the diaphragm is 94%.  This rate is based on studies that have been done to determine how effective a method itself can be, apart from user behaviors. With typical use effectiveness rate is 80%, which reflects what happens to the pregnancy rate in a group of people who do not use this method correctly some of the time and who do not use this method every time they have intercourse.

What are the benefits?

  • inserted up to 6 hours before intercourse
  • no side effects or serious health risks
  • reusable and relatively inexpensive
  • small and easy to carry
  • can be used during your menstrual period

What are the disadvantages?

  • requires a prescription from a health care provider, who determines the proper type and size after examining you
  • requires practice to become comfortable and skilled in using a diaphragm
  • requires a supply of spermicidal jelly or cream on hand at all times
  • causes a sensation of burning, itching, or redness in some cases
  • size of the diaphragm may need to be changed so that is fits correctly after childbirth, abortion, pelvic surgery, or significant weight loss or gain
  • in rare cases causes discomfort and reduces pleasure during intercourse
  • limited effectiveness when used without a condom
  • may cause urinary tract infections
  • no protection from STI’s

Source: Robert A. Hatcher, et al. Contraceptive Technology, 17th ed. (New York: Irvington Publishers, Inc., 1998)
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