What is a diaphragm?
A diaphragm is a small, soft latex or silicone cup with a covered flexible spring at the outer edge. It must be used with a spermicidal gel or cream. The diaphragm holds the spermicide close to the cervix. Proper use of the diaphragm and contraceptive cream or gel prevents the male sperm from entering the uterus thus reducing chance of pregnancy.
This is a prescription method of contraception. Diaphragms come in different sizes. A fitting appointment with a health care professional is necessary to determine which size a woman should wear.
How effective is the diaphragm?
For women who use the diaphragm correctly and every time, the diaphragm can be 94% effective. User surveys place the typical effectiveness rate of the diaphragm at 80%.
How do you use the diaphragm?
- Wash your hands with soap and water before inserting, checking or removing your diaphragm.
- Hold the diaphragm with the dome down (like a cup). Squeeze about a tablespoon of gel or cream from the tube into the dome. Spread a little bit around the rim of the diaphragm with your finger.
- Your diaphragm may be inserted just before intercourse, or up to six hours beforehand. With one hand, hold the diaphragm dome down (spermicide in the dome) and squeeze the rim together so that the diaphragm folds. Spread the lips of your vagina with your other hand, and insert the folded diaphragm in to your vaginal canal. This can be done standing with one foot propped up (on the edge of the bathtub or toilet), squatting or lying on your back. Push the diaphragm downward and back along the wall of your vagina as far as it will go. Then tuck the front rim up along the roof of your vagina behind your pubic bone. Once it is in place properly, you and your partner should not be able to feel the diaphragm. If it is uncomfortable or you can feel it, then most likely it is not in the correct position; take it out and reinsert it. If discomfort continues it may be the result of a) some abnormal pelvic condition or irritation b) constipation or c) incorrect diaphragm size. Contact your health care provider about the discomfort.
- When it is correctly placed, the back rim of the diaphragm is below and behind the cervix and the front edge of the rim is tucked up behind the pubic bone. Often it is not possible to feel the back rim. You should check to be sure that you can feel your cervix covered by the soft rubber dome of the diaphragm and that the front rim is snugly in place behind your pubic bone. The spermicidal gel or cream should be next to your cervix.
- Leave the diaphragm in place for at least six hours, and then remove it when convenient for you. If you have intercourse more than once within the six hour period, use an additional application of contraceptive gel or cream each time. Do not remove the diaphragm. Use the plastic applicator to insert fresh contraceptive gel or cream in front of the diaphragm. Do not leave diaphragm in for more than 24 hours, but remember to allow the minimum of six hours after intercourse before removing it.
- To remove the diaphragm, place your index finger behind the front rim of the diaphragm and pull down and out. Be careful not to puncture the diaphragm with a fingernail. If you find it hard to hook your finger behind the diaphragm, try a squatting position and push down ward with your abdominal muscles. In other words, bear down as though you were having a bowel movement. Some women find it easier to remove the diaphragm by inserting a finger between the diaphragm and the pubic bone to break the suction created by the diaphragm. Practice repeatedly during the first weeks, until you do so easily and are confident about checking its position.
- After removing the diaphragm, wash it with mild soap and water, rinse it and dry it with a towel. Store it in its plastic container. Do not use talcum powder or perfumed powder as they may damage the diaphragm or may be harmful to your vagina or cervix.
- A diaphragm will last for two or three years with proper care. Check your diaphragm for tears or holes each time you use it. Hold it up to the light and stretch the dome gently to see any defects in the rubber.
- Have your diaphragm size checked annually under any of the following conditions:
- If you have become pregnant, even if you have a miscarriage or terminate a pregnancy.
- If you gain or lose 10 pounds or more.
- If you have pelvic surgery.
- Your diaphragm should not interfere with normal activities. Urination and bowel movement should not affect its position, but you can check its placement afterwards if you wish. It is fine to bathe or shower with the diaphragm in place.
- Use the diaphragm whenever you have intercourse, even during your period. If your flow is heavy and cramping occurs, remove the diaphragm three or four hours after intercourse (instead of six hours).
- If you begin to have bladder infections, check with your health care provider. You may need a different birth control method.
- Some women and men may have a sensitivity to the latex, silicone or the spermicide used. If sensitivities occur, it may be important to consider using another form of birth control.
- Toxic Shock Syndrome is very rare for women who use diaphragms. However, if you experience any of the danger signs, you should remove the diaphragm and contact your health care provider.
- You should not use a diaphragm if you have had toxic shock syndrome in the past. Danger signs include:
- Sudden, high fever
- Vomiting, diarrhea
- Weakness or feeling faint
- Aching muscles or joints, sore throat
Extra Information for Diaphragm Users:
* Used with permission from Planned Parenthood ® Federation of America, Inc. © 2008 PPFA. All rights reserved.