Diaphragms

What is a diaphragm and how does it work?

The diaphragm is a dome-shaped rubber cap that is worn in the vagina during sexual intercourse to prevent pregnancy. Spermicidal jelly is applied to the inside of the diaphragm which then covers the cervix, holding the jelly against the cervix. This acts as a barrier to sperm.

Effectiveness

The failure rate varies from 6-20% within the first year of use, 4-8% with longer use. The effectiveness of this method is dependent upon consistence and the correct use of the diaphragm, experience in using it, and the correct fitting of the diaphragm. The diaphragm must be used with spermicidal jelly or the failure rate may increase.

How is the diaphragm used?

The diaphragm may be inserted within 6 hours before sexual intercourse. Because sperm can survive in the vagina for a number of hours, the diaphragm must not be removed until at least 6 hours after the last act of intercourse. Do not leave it in place for more than 24 hours as this may result in an increased risk of Toxic Shock Syndrome (TSS). During menstrual periods, it should not be left in place longer than 12 hours. Before each additional act of intercourse, you must insert more spermicide into the vagina in order for it to be effective.

How long does it last and when should it be refitted?

If the diaphragm is properly cared for it should last for a year, possibly longer. It should be rechecked and possibly refitted:

• 6 weeks after giving birth
• If there has been a weight gain or loss of around 10 pounds
• If it is uncomfortable for the woman or her partner when it is in place
• If you have difficulty or pain with urination
• If you have vaginal surgery
• After an abortion or miscarriage
• You should bring it to your yearly exam to be checked

Advantages

• Side effects are rare
• No effect on fertility
• Inexpensive
• Simple

Disadvantages

• Higher risk for vaginal and urinary tract infections
• Possibility of difficulty learning insertion technique
• Higher risk for TSS

How to take care of the diaphragm

After each use, the diaphragm should remain in the vagina for at least 6 hours after the last act of intercourse. It should be washed with plain soap and water, along with the spermicidal inserter. After cleaning, check for holes, tears, or cracks. Let the diaphragm dry thoroughly and then sprinkle with cornstarch before putting it into its case.

You should not use any oil-based products with the diaphragm such as mineral oil, vegetable oil, baby oil, petroleum jelly (Vaseline), or butter. You should also avoid Monistat Cream, Vagisil, Estrogen creams, powder, any perfumed soaps, and douching. Any of these products have the potential to damage the diaphragm.

What if the diaphragm is damaged during sex?

If the diaphragm becomes dislodged or breaks, emergency contraception may be used to decrease the risk of pregnancy. Emergency contraceptive pills are effective up to 72 hours after sexual intercourse.

Are diaphragms appropriate for all women?

Diaphragms are appropriate for women who:

• Accept a higher risk of pregnancy
• Want contraception only when required
• Cannot take hormonal methods of birth control

Diaphragms are not appropriate for women who:

• Need highly effective protection against pregnancy
• Suffer from recurrent urinary tract infections
• Have poor muscle tone in the pelvic floor
• Have vaginal or uterine abnormalities
• Are unable to insert the diaphragm or feel the cervix
• Have a history of TSS
• Have an allergy to rubber or latex

Source: Contraceptive Technology