What It Is

The diaphragm is a dome-shaped, rubber device that is inserted into the vagina so that it covers the cervix. This blocks the sperm from entering and fertilizing an egg. Used in combination with spermicidal jelly or cream, the diaphragm provides both a physical and a chemical barrier against sperm. When used correctly and consistently, it is an effective means of birth control, with an effectiveness rate 82 to 96.6 percent.

For women who don't want to use hormonal contraceptives, such as the Pill or the patch, and who find condoms uncomfortable, the diaphragm is a good option.

How It Works

The diaphragm is a barrier method of birth control that prevents sperm from entering the uterus and fertilizing an egg. It is used in combination with spermicidal jelly or cream, so that any sperm that comes near the cervix is destroyed. By itself, the diaphragm is not an effective method of birth control. That's why it's important to use contraceptive jelly or cream.

Advantages

• Can be inserted up to six hours before sex
• Requires only annual visits to a health-care professional
• Relatively inexpensive
• Needs replacing only every two years if your health and weight remain unchanged
• Can be used during breastfeeding
• Immediately effective

Disadvantages

• Requires a prescription
• Must be fitted by a clinician, doctor, or nurse practitioner
• Requires application of spermicide each time your have intercourse
• Some women may find it cumbersome and difficult to insert
• Does not protect against STIs or HIV
• Cannot be used during menstruation

Who Should Not Use a Diaphragm

You should not use a diaphragm if you have:

• abnormalities of the vagina that would prevent a proper fit
• poor vaginal or perineal muscle support
• a history of toxic shock syndrome
• recurrent cystitis
• pelvic inflammatory disease (PID)
• allergic reaction to latex or silicone
• high blood pressure or develop high blood pressure with the use of spermicides.

Possible Side Effects

The diaphragm poses no serious side effects. Some people may have an allergic reaction to the rubber, or may be irritated by the contraceptive jelly or cream. If the diaphragm is too large, it may cause cramps, discomfort, or pressure. And if the diaphragm is not cleaned and dried, you may develop vaginal infections.

Health Risks

Using a diaphragm may increase your risk for urinary tract infections, so it's important to urinate frequently when your diaphragm is in place and even when you are not using it. If you use a diaphragm during menstruation, it can increase your risk for Toxic Shock Syndrome (TSS), a potentially fatal bacterial infection. Symptoms of TSS include fever, vomiting, diarrhea, pain, dizziness, or rash. If you have any of these symptoms, take out the diaphragm right away and call your doctor.

How To Use the Diaphragm

Inserting the diaphragm correctly takes some practice. You might want to try inserting it several times during the first week until you can do it easily and confidently.

Always insert the diaphragm before having intercourse. Urinate before inserting it, and wash your hands. Then:

Check the diaphragm for holes or rips by holding it up to the light. Squeeze spermicide into the dome and onto the rim of the diaphragm. Apply it around the entire rim.

Stand with one foot on a chair toilet seat or bathtub rib. Squeeze the rim of the diaphragm between your fingers, so that it's folded, and insert it into the vagina. You can also insert it while squatting or lying on your back with your knees raised.

Push the diaphragm down and back into the vagina, as far as it will go. Tuck the front rim up behind your pubic bone.

Put your finger in and feel for your cervix, which feels like the tip of your nose.

If you feel your cervix through the rubber, the diaphragm is correctly in place. You may put your diaphragm and contraceptive jelly/cream in up to six hours before having intercourse.

If you have sex more than once, be sure to insert an applicator full of contraceptive jelly or cream into your vagina each time. Having sex more than six hours after inserting the diaphragm will also require another applicator of jelly or cream. You can leave the diaphragm in place.

Wait 6 to 8 hours after the last time you have intercourse before removing your diaphragm. Do not leave it in for more than 24 hours.

To remove the diaphgram, hook your finger behind the front rim and pull it down and out. You can also put a finger between the diaphragm and the pubic bone to break the suction, and then pull the diaphragm out.

How to Care for Your Diaphragm

Proper care of your diaphragm is important. After each use:

• Wash the diaphragm with soap and warm water. Do not use hot water.
• Dry it well.
• Store it in the case provided.
• You can dust the cap with cornstarch to keep it soft. Do not use talcum powder because it can ruin the rubber or irritate the vagina.

Most diaphragms can last two years. Your clinician or nurse practitioner will check its fit at your annual visit, so bring it with you. But you will need to refit or check the fitting of your diaphragm if:

• You gain or lose 10 pounds or more.
• You get pregnant or have a miscarriage or an abortion
• You have pelvic surgery
• The diaphragm causes discomfort or pain

How to Protect Against STIs and HIV/AIDS

The only way to guard against getting sexually transmitted infections (STIs) is not to have sex or to ave sex only with partners who you know are free of infection. If you do have sex, you should use a latex barrier, such as a male condom, afemale condom, or a dental dam, every time. Condoms provide protection against against STIs, including HIV, the virus that causes AIDs. Tapestry Health clinicians recommend using such barriers even in combination with other methods of birth control. Latex condoms are preferred to lambskin condoms for the prevention of STIs. Using a spermicide together with a latex barrier can also help keep you from getting an STI.

If you have any questions about the diaphragm, talk to your clinician.