Diaphragm

What is a diaphragm?

The diaphragm is a dome-shaped rubber cup with a flexible rim. It is used to help prevent pregnancy. Before intercourse the diaphragm is filled with a contraceptive cream or jelly and inserted into the vagina. The contraceptive cream or jelly contains a spermicide, a chemical that kills sperm. The diaphragm covers the cervix, which is the opening into the uterus. The diaphragm and spermicide work together to provide a barrier that stops live sperm from reaching the uterus.

Several sizes and types of diaphragms are available. Each woman's body requires special measurement and fitting by a medical professional to make sure that the diaphragm fits correctly. The largest size that feels comfortable should be used.

How do I use a diaphragm?

1. Insert the diaphragm no more than 2 hours before intercourse.
2. Before you insert the diaphragm, urinate and wash your hands.
3. Check the diaphragm for any holes or tears. If you find a hole or tear, use another method of birth control.
4. Squeeze 1 to 2 teaspoons of water-based (not oil-based) contraceptive cream or jelly into the dome of the diaphragm. Rub a small amount of the contraceptive cream or jelly around the inside and outside of the entire diaphragm rim with your fingertip. If you have sexual intercourse more than 2 hours after insertion of the diaphragm you will need to insert another dose of spermicide.
5. Get into a comfortable position. The positions usually suggested are:
   • lying on your back with your knees up
   • stooping with your knees bent and wide apart
   • standing with one leg propped up on a stool or chair with your knees slightly bent
6. Fold the diaphragm in half by pressing the opposite sides together with the thumb and fingers of one hand. Hold the diaphragm with the dome hanging below the rim to keep the contraceptive cream or jelly in the dome.
7. Hold the lips of your vagina open with your other hand. Gently slide the folded diaphragm into your vagina, placing your index finger on the rim to guide it. Aim toward the small of your back, as if you were inserting a tampon. You may feel the rim of the diaphragm pass over the cervix. Use your index finger to push the front rim up behind the pubic bone.
8. Make sure that the diaphragm is in place. Insert your index finger into your vagina and touch the dome. You should feel the cervix underneath. You may also feel folds in the surface of the dome. Move your index finger to the front rim of the diaphragm and make sure it is firmly in place behind the pubic bone. The back rim must be behind the cervix.

When and how should I remove the diaphragm?

Leave the diaphragm in place for at least 8 hours after intercourse. Remove it as soon after this as possible. Do not leave it in longer than 24 hours. Do not douche with the diaphragm in place.

If you have sex more than once after you inserted the diaphragm, you should insert more contraceptive cream or jelly into your vagina before each time. Do not remove the diaphragm to do this. A plastic applicator is sold with the contraceptive cream or jelly. Use this applicator to insert more jelly or cream into your vagina, in front of the diaphragm.

To remove the diaphragm, put your index finger in your vagina and hook it under the rim of the diaphragm behind the pelvic bone. Gently pull the diaphragm down and out.

Wash the diaphragm every time after intercourse with plain mild soap and water. Dry it with a towel and put it in its case. Store the diaphragm in its case away from heat.

How can I prevent infections?

Improper use of the diaphragm can cause infections. To help prevent infections:

• Wash your hands carefully before you insert or remove the diaphragm.
• Do not wear the diaphragm more than 24 hours at a time.
• Do not use your diaphragm during your period or when you are having abnormal vaginal discharge. Have your partner use condoms during this time instead.
• Do not use a diaphragm for the first 3 months after childbirth.
• Do not use a spermicide if it causes a rash, itching or skin irritation.

When do I need to have the diaphragm refitted?

Return to your healthcare provider to have your diaphragm fitting checked:

• If you gain or lose more than 10 to 20 pounds.
• If you have pain or discomfort from your diaphragm.
• If you have been pregnant and had a baby since your last fitting.
• If you have had any kind of pelvic surgery.
• At least every 2 years because the size or shape of your cervix may change.

You should get a new diaphragm every 1 to 2 years.

What are the benefits?

The benefits of a diaphragm are:

• This method of birth control is 84 to 94% reliable in preventing pregnancy.
• Diaphragms may offer some protection against sexually transmitted diseases (STDs). Use of condoms with the diaphragm is encouraged for better protection against infection.
• There are practically no side effects from the use of the diaphragm and spermicide. This is a very safe method of birth control.
• Diaphragms provide immediate protection against pregnancy when used properly.
• Diaphragms may be inserted with spermicide up to 2 hours before sex so their use does not have to interrupt love-making.

What are the disadvantages?

Some of the disadvantages of a diaphragm are:

• A diaphragm must be fitted and prescribed by a healthcare provider.
• If it is not correctly fitted, it may cause discomfort and possibly a urinary tract infection or pregnancy.
• You must be comfortable inserting and removing the diaphragm and checking its position.
• The diaphragm and spermicide must be inserted BEFORE any genital contact. If both you and your partner are not able to exercise this willpower EVERY time, this is not a good form of birth control for you. Even if you forget just one time, you could get pregnant.
• You must keep a supply of spermicidal jelly or cream on hand at all times.
• This method does not protect against some sexually transmitted diseases. To protect yourself against STDs, use a condom every time you have sex, even though you are also using a diaphragm.

When should I call the healthcare provider?

Call your provider right away if you develop any of the following symptoms while your diaphragm is in place:

• unexplained fever over 101°F (38.4°C)
• vomiting
• lightheadedness or dizziness when you stand up
• diarrhea
• muscle aches
• rash
• burning or painful urination

Call during office hours if you have any questions about the use of your diaphragm.