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Definition
The diaphragm is a contraceptive device that prevents sperm from entering the uterus. The diaphragm is a small, reusable rubber or silicone cup with a flexible rim that covers the cervix. Before sex, the diaphragm is inserted deep into the vagina so part of the rim fits snugly behind the pubic bone. The diaphragm is held in place by the vaginal muscles.
The diaphragm is effective at preventing pregnancy only when used with spermicide, which blocks or kills sperm. The diaphragm doesn't reliably offer protection from sexually transmitted infections (STIs).
The diaphragm must be fitted and prescribed by a health care provider. Some women find the diaphragm difficult to insert.
Why it's done
The diaphragm helps prevent pregnancy. Among various benefits, the diaphragm:
- Can be used as a backup method of birth control
- Can be inserted up to six hours before sex
- Doesn't require a partner's cooperation or an erect penis
- Doesn't pose a risk of side effects
The diaphragm isn't appropriate for everyone, however. Your health care provider may discourage use of the diaphragm if you:
- Have an allergy to silicone, latex or spermicide
- Have vaginal abnormalities that interfere with the fit, placement or retention of the diaphragm
- Have an infection in your vagina or pelvic area
- Have frequent urinary tract infections
- Are at high risk of contracting HIV or you have HIV or AIDS
- Have a history of toxic shock syndrome
- Have significant pelvic organ prolapse, such as uterine prolapse — when the uterus descends into the vagina from its normal position in the pelvis
- Recently gave birth or had a miscarriage or an abortion
- Are at high risk of pregnancy — you're younger than age 30, you have sex three or more times a week, you've had previous contraceptive failure with vaginal barrier methods or you're not likely to consistently use the diaphragm
Risks
It's possible to become pregnant when using a diaphragm, especially if:
- You don't use spermicide
- The diaphragm becomes dislodged from the cervix during sex
- You remove the diaphragm less than six hours after having sex
The diaphragm doesn't offer reliable protection from sexually transmitted infections (STIs).
Use of the diaphragm and spermicide applied to the diaphragm may cause:
- Vaginal irritation
- Urinary tract or vaginal infection
- An increased risk of contracting STIs or toxic shock syndrome — a rare but serious bacterial infection
An estimated 16 out of 100 women who use the diaphragm for one year will get pregnant.
Contact your health care provider if:
- The diaphragm slips out of place when you walk, sneeze, cough or strain
- You notice blood on the diaphragm after you remove it that isn't related to your period
- You or your partner experience pain during or following use of the diaphragm
- You have signs or symptoms of toxic shock syndrome, such as sudden high fever, diarrhea, dizziness, vomiting, fainting or a rash that looks like sunburn
- You're unable to remove the diaphragm
How you prepare
The diaphragm comes in different sizes. Your health care provider will fit you for the diaphragm and demonstrate how to insert and remove the diaphragm. He or she may confirm that the diaphragm is in the correct position by doing a pelvic exam.
Make sure you regularly check your diaphragm for puncture marks or cracks. To search for holes, hold your diaphragm up to the light and gently stretch the rubber between your fingers or fill the diaphragm with water. Replace your diaphragm at least every two years. You may need to have your diaphragm refitted if:
- Your diaphragm no longer fits snugly behind your pubic bone
- You've given birth or had an abortion
- You've had pelvic surgery
- You've gained or lost more than 10 pounds (4.5 kilograms)
- You have repeated urinary tract infections
- You or your partner feels pain or pressure during sex
Always use the diaphragm with spermicidal cream, foam or gel. Avoid use of body lotions near your vagina and vaginal medications when using the diaphragm. If you're using a diaphragm and douche, wait until at least six hours after sex to avoid washing away spermicide. Use a backup method of contraception, such as a male condom or oral contraceptives, when you first use the diaphragm.
What you can expect
To use the diaphragm:
- Apply spermicide. Fill the diaphragm's bowl with about 1 tablespoon (15 milliliters) of spermicide. Spread a thin layer of spermicide around the rim of the diaphragm with your finger. Use only water-based lubricants with the diaphragm.
- Insert the diaphragm. Find a comfortable position, such as standing with one foot propped up, squatting or lying on your back. Separate your labia with one hand. With the other hand, hold the diaphragm with the bowl facing upward and squeeze the diaphragm between your thumb, index and middle fingers. Slide the diaphragm into your vagina and push it along the back wall of your vagina as far as it will go. Use your index finger to push the front rim of the diaphragm up behind your pubic bone.
- Check the diaphragm's position before sex. Make sure you can feel your cervix through the soft dome of the diaphragm. After inserting the diaphragm, apply spermicide inside the vagina before each time you have sex. If the diaphragm is dislodged during sex, reapply spermicide.
- Gently remove the diaphragm. After sex, leave the diaphragm in place for at least six hours and up to 24 hours. To remove the diaphragm, hook your finger under the front rim of the diaphragm and gently pull it down and out of your vagina. If the diaphragm is difficult to remove, insert your finger between the rim of the diaphragm and your vaginal wall to break any suction. After removal, wash the diaphragm with mild soap and warm water and allow it to air dry. Store the diaphragm in its provided container.
Last Updated: 2010-01-23
