
What is a 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.
See Cervical Barriers Advancement Society for the latest information.
Use Care Refitting Cautions Side Effects
Advantages Disadvantages Your Cervix
Further
References PDF Version
Use
Getting a diaphragm requires a fitting in a clinic.
During the fitting, a fitting ring is inserted into the vagina. The largest ring
that fits comfortably is usually the one chosen. Different types of diaphragms
are available. You and your medical provider can decide between coil, flat, or
arcing spring diaphragms.
Diaphragms can be inserted up to 2 hours before
sex because spermicide is only effective for 2 hours. If you insert your diaphragm
more than 2 hours before intercourse, you will have to insert more spermicide
into your vagina. To do this, leave your diaphragm in and use an applicator to
add more spermicide directly into the vagina. Every time a woman has intercourse,
she will need to add more spermicide to her vagina with an applicator.
Insertion:
- To increase effectiveness, practice inserting your diaphragm before
sexual play with a partner. Your medical provider will show you how to place it
correctly. Insertion can be awkward at first, but becomes easy with practice.
You can try it standing with one foot on top of a chair, sitting with your knees
apart, or lying down with your knees bent.
- Before inserting the diaphragm,
place a tablespoon of spermicidal jelly or cream on the inside of the dome. Squeeze
the rim of the diaphragm and keep the spermicide facing up. Use one hand to spread
your lips. The other hand can slide the diaphragm into your vaginal canal and
over your cervix. You can check its placement by feeling for your cervix through
the rubber dome.
- Spermicide has a bad taste and may leak out of the diaphragm
during insertion. Before oral sex, you may want to use a damp washcloth to wipe
away excess spermicide on your genitals.
Removal:
- Your diaphragm should be left in for 6-8 hours after the last act
of intercourse. You can remove the diaphragm by hooking your finger around the
front rim and pulling down and out. If you have long nails, be careful not to
tear the rubber.
- Some types of sex play may dislodge the diaphragm. If
your diaphragm moves during intercourse, consider taking Emergency
Contraception.
Do not douche while the diaphragm is in place.
It weakens the spermicide.
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.
Cautions
Diaphragms are not recommended for women
who have had Toxic Shock Syndrome.
If you or your partner have any discomfort
when the diaphragm is in place or if you experience genital itching or irritation,
unusual vaginal discharge or frequent bladder infections, call the clinic for
information and options. Bladder infections are the most frequent side effect
of the diaphragm.
Some women may experience allergic reactions to the rubber
of the diaphragm or the spermicide they use. If this happens and your spermicide
has nonoxynol-9, try a spermicide without this chemical.
Advantages
- Can be inserted 2 hours before
sex.
- Easy to carry around, comfortable.
- Does not alter menstrual
cycles.
- Does not affect future fertility.
- May help you better
know your body.
Disadvantages
- Does not protect against HIV/AIDS.
- Requires a fitting in a clinic.
- Needs occasional refitting.
- Possible allergic reaction.
- May
increase risk of bladder infections.
- Can be messy.
Emergency Contraception (The "Morning After" Pill - "Plan B" - "EC")
You can prevent pregnancy after sexual intercourse by taking Emergency Contraception pills (Plan B). Plan B works by giving the body a short burst of synthetic hormones that disrupt the hormone patterns needed for a pregnancy to start. Some types of regular birth control pills will work. Emergency Contraception is most effective 24-48 hours after unprotected intercourse but it can work for several days.
To find a clinic, doctor or pharmacy close to you, call the nationwide Emergency Contraception Hotline at 1-800-584-9911, 24 hours a day in English or Spanish (also at 1-888-NOT-2-LATE and ec.princeton.edu).
If you already have birth control pills in your possession, ask the hotline how to use them as emergency contraception. Or call our clinics at 800-572-4223 and ask how to use the birth control pills you already have to prevent pregnancy after sex.
In Washington State you can get Plan B directly from your pharmacy without first getting a prescription from a doctor. Call ahead to make sure they have it in stock and a trained person available to give it to you.
Women's health activists are working to make Plan B available over-the-counter nationwide so that one day soon you could purchase it at your neighborhood drug store.
Some women are buying Plan B in advance (it costs around $35-40) so they will have it on hand if they need.

The cervix is the opening to
the uterus where menstrual blood, babies, and sperm pass. It is also the opening
through which abortions are performed. Barrier
methods of birth control, including the diaphragm, cervical cap, and female condom, work by covering the
cervix and preventing sperm from entering the uterus. Hormonal methods of birth
control, including oral contraceptives, Implanon, Depo Provera, and Lunelle, affect the mucus around the
cervix and make the opening more resistant to sperm.
Women's bodies also
naturally produce hormones that change the cervix during a menstrual
cycle. You can learn more about your cervix using a speculum to perform a self-exam.
Further
References
July 2, 2008
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