Diaphragm

A Diaphragm is a thin silicone 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 opening to the uterus. Spermicide kills sperm, preventing fertilization. After intercourse, it should be left in place for six to eight hours. Diaphragms are 86 to 94 percent effective in preventing pregnancy. They offer limited protection against sexually transmitted infections, but do not protect against HIV/AIDS.

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 (firm tissue, feels like the end of your nose) through the 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 it.
  • 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.

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.

Caution

Diaphragms are not recommended for women who have had Toxic Shock Syndrome.

Side Effects

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 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.

Your Cervix

The cervix is the opening to the uterus where menstrual blood, babies, and sperm pass. It is also the opening through which an abortion is performed. Barrier methods of birth control, including the diaphragm, female condom, and cervical cap, work by covering the cervix and preventing sperm from entering the uterus. Hormonal birth control affects the cervical mucus making the opening more resistant to sperm.

Women’s bodies 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.

More Info