What is the Diaphragm?
The diaphragm, a shallow silicone cap is a barrier method of birth control for females. Inserted deep within the vagina, the diaphragm creates a seal against the cervix to prevent sperm from entering the uterus. Spermicidal cream or jelly is applied onto the diaphragm before insertion to immobilize and kill sperm before they enter the uterus. Once professionally fitted by a healthcare provider, the diaphragm may be used repeatedly. The diaphragm should be checked annually during a gynecological exam and replaced every two years or when there are/or any signs of damage.
The diaphragm does not offer protection against the transmission of sexually transmission of sexually transmitted infections (STIs), so it should be used with a latex male condom, diagrams are available only with a prescription.
A licensed clinician will fit each female with the proper size and style diaphragm. At the initial fitting, the clinician will have you practice inserting and removing the diaphragm yourself. Women who choose this birth control method should therefore feel comfortable inserting fingers their vagina and should be able to locate their cervix. The diaphragm needs to be rechecked once each year at a gynecological exam. Do not wear the diaphragm when arriving to appointments. You may need to schedule for another diaphragm fitting with your healthcare provider if you
- experience pain or discomfort
- have difficulty urinating or frequent UTIs
- have a pregnancy, miscarriage, or abortion
- have pelvic surgery
- gain or lose 15-20 pounds
How To Use the Diaphragm
The diaphragm can be inserted hours before intercourse, but the efficacy of spermicidal cream or jelly reduces over time. If it has been more than six hours after the diaphragm was inserted or you have intercourse more than once, use an applicator to insert more spermicide deep into the vagina. Be sure to leave the diaphragm in place as more spermicide is inserted. The diaphragm must remain in place for at least six hours after intercourse. Diaphragms should be removed at least once every 24 hours to avoid foul odor and toxic shock syndrome. Toxic shock syndrome is a rare but life threatening complication of various types of bacterial infections. Often toxic shock syndrome results from toxins that are released by staph or strep bacteria. If you experience a sudden high fever, low blood pressure, and vomiting contact your healthcare professional.
Consider the following steps to accurately and safely insert a diaphragm:
- Empty your bladder and wash your hands with soap and water.
- Inspect the diaphragm for holes or damage by stretching it with your fingers and holding it up to the light. If there is a hole, light will shine through the diaphragm. You can also inspect for holes by filling the cup with water and checking for leaks.
- Hold the diaphragm with the dome facing downward. Place about one tablespoon of spermicide into the cup. Spread it around the inside of the cup and along the edges. Do not place Vaseline, hand lotion, or oil-based lubricant along the diaphragm because these products do not protect against pregnancy and will damage the diaphragm.
- Find a comfortable position for insertion. You could squat, lie on your back, or stand with one foot propped up onto something. Pinch the rim of the diaphragm between your thumb and fingers. Be sure not to squeeze out any of the spermicidal cream or jelly.
- With your other hand, spread the inner lips of your vulva. Carefully insert the diaphragm into the vagina with the hollow side facing upward. Push the diaphragm up the vaginal canal as far back as it will go until you reach the cervic.
- Use your finger to tuck the edge of the rim behind the pubic bone, and make sure the diaphragm lays snugly against the cervix. After insertion, you should not be able to feel the device. If the fit feels uncomfortable, remove the diaphragm, and repeat the insertion process. If it continues to be uncomfortable contact your doctor about size adjustment and refitting.
With a little bit of practice, removing the diagram after intercourse will become a simple process.
- Wait at least six hours following your last act of intercourse before removing the diaphragm.
- To remove the diaphragm, use your index finger to lift the front rim of the diaphragm away from the cervix.
- Pull the diaphragm down and out.
After removal, wash the diaphragm thoroughly with mild soap and warm water. Perfumed soaps and powders should not be used because they may weaken the rubber or cause vaginal infections. Allow the diaphragm to air dry. The diaphragm should be stored in its plastic container in a cool, dry place. Though the rubber may become discolored or distorted over time, the diaphragm will remain effective. With proper care and use, one diaphram can last up to two years.
Advantages of the Diaphragm
The diaphragm is a relatively cheap form of birth control, it is reusable, has little to no side effects, allows immediate return to fertility, and does not introduce artificial hormones. Because it does not introduce artificial hormones, females who are breastfeeding can use the diaphragm for contraception. The diaphragm allows for some spontaneity because it may be inserted up to six hours before intercourse and left in place for up to 24 hours. Most couples report that they cannot feel the diaphragm during sex.
Disadvantages of the Diaphragm
The diaphragm may be difficult for some females to insert or remove. Some couples find that the diaphragm becomes dislodged during sex due to certain sexual positions or penis sizes. If this occurs, stop action immediately and reposition the diaphragm. The diaphragm might also be difficult to use properly while intoxicated. Furthermore, the diaphragm is not a recommended form of birth control for people who
- Are allergic to silicone, latex, or spermicidal creams or jelly
- Are at a high risk of or have HIV/AIDS
- Are at a high risk for pregnancy. (e.g.,Women who are younger than age 30, have sex three or more times per week, have had previous contraceptive failures with vaginal barrier methods, and are unlikely to consistently use the diaphragm are considered to be a at high risk for pregnancy)
- Have vaginal or pelvic organ abnormalities that interfere with the fit and retention of the diaphragm
- Have a vaginal or pelvic infection
- Have frequent urinary tract infections (UTIs)
- Have a history of toxic shock syndrome (TSS)
- Have recently given birth, had a miscarriage, or had an abortion
Cost and Pricing
A diaphragm is one of the most cost effective types of barrier method for contraception. Prices of the diaphram vary based on your health care coverage and location. In the United States, thanks to the Affordable Care Act, if you have insurance it is likely that you can acquire a diagram free of charge or at a significantly reduced cost. Without insurance a diaphragm costs approximately $15-$75 plus the cost of an exam and fitting as well as the cost of additional spermicide. This translates to only $1.25-$6.25 per month if kept for only one year.
- “Birth Control Method: Diaphragm.” Bedsider. N.p., n.d. Web. 22 May 2014.
- LeVay, S., Baldwin, J., Baldwin, J. (2009). Contraception and abortion. Discovering human sexuality (pp.278-279). Sunderland, MA: Sinauer Associates, Inc.
- “Diaphragm :: Planned Parenthood.” Diaphragm :: Planned Parenthood. Web. 03 June 2014.
- “Diaphragm.” Doctors, Patient Care, Health Education, Medical Research. Web. 04 June 2014.
- Planned Parenthood
- Palo Alto Medical Foundation
Last Updated 22 May 2014.