The Diaphragm
The diaphragm is a round rubber dome that fits inside a woman’s vagina and covers her cervix. It must be used with spermicide (a sperm-killing cream or jelly).
The diaphragm is a barrier method of birth control that prevents pregnancy by placing a physical and chemical “wall” between the sperm and the cervix. It must always be used with a spermicidal cream or jelly. Be sure that the jelly or cream you purchase is a spermicide containing nonoxynol-9.
The diaphragm is NOT the most effective form of birth control. Effectiveness includes the use of spermicide. Among perfect users (women who use the diaphragm EVERY time they have sex), about 6 in 100 women (6%) is expected to become pregnant over the first year of use. Among typical users, 18 in 100 women will become pregnant over one year of use. However, using a condom along with the diaphragm will increase the effectiveness AND provide protection from sexually transmitted disease.
The diaphragm is worth considering if you cannot or prefer not to use hormonal birth control. You must be able to use it every time you have sex.
The diaphragm may not be a good choice for you if you are unlikely to use it correctly every time you have sex. You may not be able to use it if you or your partner is sensitive to the chemicals used in spermicides or has a latex allergy. You may have a higher failure rate if you have intercourse three or more times per week.
- Increased risk of urinary tract infections
- Yeast infections and bacterial vaginosis
- Sensitivity due to latex allergy
- almost no side effects and does not affect your hormonal pattern
- lower risk of cervical cancer and pre-cancerous conditions of the cervix
- Wash your hands carefully with soap and water before inserting the diaphragm. Apply spermicidal cream or jelly around the rim and inside the dome of the diaphragm. You may put spermicide on both sides of the diaphragm, but make certain to apply a generous amount of spermicide the side of the diaphragm facing or in contact with the cervix.
Squeeze the rim of the diaphragm between your fingers and insert it into your vagina. When the diaphragm is pushed up as far as it will go, the front part of the rim should be up behind a bone you can feel in front of your pelvis (the pubic bone). Tuck the front rim of the diaphragm up as far as it will comfortably go.
Check to see if your cervix is covered. To do this, reach inside and touch your cervix. The cervix feels something like the tip of your nose. After the diaphragm is in place, the cervix should be completely covered by the rubber dome.
The diaphragm may be placed up to 6 hours before you have sex. No matter when you insert the diaphragm, always be sure to use a spermicide. Diaphragms should not be used without this added protection. If you have put in the diaphragm more than 2 hours before having sex, you must insert a fresh supply of spermicide into your vagina just before intercourse. To do this, insert the spermicide with an applicator while the diaphragm is in place. An applicator usually comes with the spermicide. You must also check the position of the diaphragm and add more spermicide before each act of intercourse, no matter how closely together they occur. Do not use oil-based lubricants such as petroleum jelly; they can damage the diaphragm. Water-based lubricants such as KY jelly or Astroglide are fine.
The diaphragm must be left in place for 6 hours after you have sex, but should NOT be worn for more than 24 hours. To remove the diaphragm, pull gently on the front rim. Wash it with mild soap and water, rinse the soap off well (soap can harm the rubber), dry it, and put it back in its case.
The diaphragm may become discolored over time, but it can still be used unless you notice any holes in the rubber. To check for holes, hold the diaphragm up to the light and stretch the rubber gently between your fingers. Filling the diaphragm with water is another way to check for holes. You should get a new diaphragm about every 2 years. Your diaphragm should be rechecked at your yearly exam and should be refitted if you have:
- had pelvic surgery
- been recently pregnant
- gained or lost a lot of weight
- trouble with the diaphragm slipping out of place, pain or pressure during sex
There is a slight increased risk of toxic shock syndrome in diaphragm users if it is worn for more than twenty-four hours. Call your doctor if you have any of the following problems:
- sudden high fever
- vomiting, diarrhea
- dizziness, faintness, weakness
- sore throat, aching muscles and joints
- rash (like a sunburn)