Diaphragm

The diaphragm is a device used for birth control (contraception). It is specifically designed to prevent sperm from entering the uterus.

It is a small, reusable rubber silicone cup with a flexible rim that covers the cervix. Prior to sex, the diaphragm is inserted deep into the vagina so that part of the rim fits snugly behind the pubic bone.

The diaphragm is most effective at preventing pregnancy when it is used with spermicide.

Here are the most common reasons to use a diaphragm.

The diaphragm is an important and useful device in contraception. It also has the following benefits:

• It allows a prompt return to fertility.
• Can be used as a backup method of birth control.
• Can be used during breast-feeding beginning six weeks after childbirth.
• Can be inserted six hours before sex and can be left in place for up to 24 hours.
• Does not require a partner's cooperation.
• Has a few, if any, side effects. However, the diaphragm is not meant for everyone.

Your health care provider might discourage the use of the diaphragm in the following cases:

• If you are allergic to silicone, latex or spermicide.
• If you are at a high risk of HIV/AIDS.
• If you are at a high risk of pregnancy, i.e. you are younger than 30 years, you have sex three or more times a week, you have had a previous contraceptive failure with vaginal barrier methods, or you will not be consistent with using the diaphragm.
• If you have certain vaginal abnormalities that interfere with fit, placement or retention of the diaphragm.
• If you have frequent urinary tract infections.
• If you have a history of toxic shock syndrome.
• If you have significant pelvic organ prolapse, such as uterine prolapse (when the uterus descends into the vagina from its normal position in the pelvis).
• If you recently gave birth, had a miscarriage or an abortion.

Along with undergoing a diaphragm procedure comes potential risks.

The diaphragm is not known for providing any protection against sexually transmitted infections (STIs).

It has been estimated that in a year of typical use of the diaphragm and spermicide, 21 out of 100 women will get pregnant.

However, without the use of spermicide, an estimated 29 out of 100 women will get pregnant within a year of using a diaphragm. For the diaphragm to be effective, it must be used correctly and consistently.

For instance, you may get pregnant when using a diaphragm in the following cases:

• You do not use the diaphragm every time you have sex.
• The diaphragm gets dislodged from the cervix during sex.
• You do not use spermicide.
• You remove the diaphragm six hours after having sex.

Spermicide applied to the diaphragm rarely causes damage to the cells lining the vagina, causing:

• An increased risk of contracting an STI.
• Vaginal irritation.
• Urinary tract or vaginal infection.

Contact our health care provider in the following cases:

• The diaphragm slips out of place when you walk, sneeze, cough or strain.
• You partner experiences pain during or after using the diaphragm.
• You have signs and symptoms of toxic shock syndrome, such as, sudden high fever, diarrhea, dizziness, vomiting and muscle aches or rash that looks like sunburn.
• You are not able to remove the diaphragm.

In preparing for your diaphragm, you must follow your doctor’s orders. 

There are several sizes that a diaphragm can come in. Your health care provider will fit you for the diaphragm and demonstrate how to insert and remove it.

He or she may confirm that the diaphragm is in the correct position by carrying out a pelvic exam. Before using the diaphragm for the first time, practice inserting it until you know you are comfortable with it.

You may also want to apply another backup method of contraception, such as a male condom when you are using the diaphragm for the first time. Always use the diaphragm with a spermicide.

Avoid using body lotions near your vagina or vaginal medications when using the diaphragm. If you are using a diaphragm and douche, wait for at least six hours after sex to prevent washing away spermicide.

Make sure you regularly check your diaphragm for puncture marks or cracks. To search for any holes, hold your diaphragm up to the light and gently stretch the rubber between your fingers.

You can also do this by filling the diaphragm with water. Replace your diaphragm ate least every two years.

You may need to have your diaphragm checked and possibly refitted in the following cases:

• Your diaphragm does not fit snugly or is not comfortable anymore.
• You have given birth or had an abortion.
• You have had pelvic surgery.
• You have gained or lost more than 20 pounds (about 9 kilograms).
• You have repeated urinary tract infections.
• You or your sex partner feels pain or pressure during sex.

Here you can find out what to expect from your diaphragm.

You must follow the following steps to use a diaphragm:

• Apply spermicide.
• Fill the bowl of the diaphragm with about 1 tablespoon (about 15 milliliters) of spermicide.
• Spread a thin layer of spermicide around the rim of the diaphragm with your finger. You must only use water-based lubricants.
• Insert the diaphragm.
• Find a comfortable position, such as standing with one foot propped up, squatting or lying on your back.
• With one hand, separate your labia and with the other, hold the diaphragm with the bowl facing upward and squeeze the diaphragm between your thumb and your index and middle fingers.
• Slide the diaphragm into your vagina and push it along the back wall of the vagina as far back as it will go.
• Use our index finger to push the front rim of the diaphragm up behind your pubic bone.
• Check the position of the diaphragm before sex.
• Make sure you can feel your cervix through the soft dome of the diaphragm.
• After inserting the diaphragm, apply spermicide inside your vagina before engaging in sex.
• If the diaphragm is dislodged during sex, reapply spermicide.
• Gently remove the diaphragm.
• Leave the diaphragm in position for up to 24 hours after sex.

To remove the diaphragm, hook your finger under the front rim of the diaphragm and gently pull it down and out of your vagina.

If you have difficulties removing the diaphragm, insert your finger between the rim of the diaphragm and your vaginal wall to break any suction.

After removal, wash the diaphragm with mild soap and warm water and allow it to air-dry. Store the diaphragm in its provided container.