What is a Diaphragm?
A diaphragm is a thin rubber dome with a springy and flexible rim. It is inserted into the vagina, fits over the cervix and is held in place by vaginal muscles. A diaphragm holds spermicide in place over the cervix (opening to the uterus). Spermicide kills sperm, preventing fertilization. After intercourse, it should be left in place for 6-8 hours. Diaphragms are 86-94% effective as birth control.
Use:
Getting a diaphragm requires a fitting in a clinic. During the fitting, a fitting ring is inserted into the vagina. The largest ring that fits comfortably is usually the one chosen. Different types of diaphragms are available. You and your medical provider can decide between coil, flat, or arcing spring diaphragms.
Diaphragms can be inserted up to 2 hours before sex because spermicide is only effective for 2 hours. If you insert your diaphragm more than 2 hours before intercourse, you will have to insert more spermicide into your vagina. To do this, leave your diaphragm in and use an applicator to add more spermicide directly into the vagina. Every time a woman has intercourse, she will need to add more spermicide to her vagina with an applicator.
Insertion:
To increase effectiveness, practice inserting your diaphragm before sexual play with your partner. Your medical provider will show you how to place it correctly. Insertion can be awkward at first, but becomes easy with practice. You can try it standing with one foot on top of a chair, sitting with your knees apart, or lying down with your knees bent.
Before inserting the diaphragm, place a tablespoon of spermicidal jelly or cream on the inside of the dome. Squeeze the rim of the diaphragm and keep the spermicide facing up. Use one hand to spread your lips. The other hand can slide the diaphragm into your vaginal canal and over your cervix. You can check its placement by feeling for your cervix through the rubber dome.
Spermicide has a bad taste and may leak out of the diaphragm during insertion. Before oral sex, you may want to use a damp washcloth to wipe away excess spermicide on your genitals.
Removal:
Your diaphragm should be left in for 6-8 hours after the last act of intercourse. You can remove the diaphragm by hooking your finger around the front rim and pulling down and out. If you have long nails, be careful not to tear the rubber.
Do not douche while the diaphragm is in place. It weakens the spermicide.
Care:
After using a diaphragm, wash it with mild soap and warm water. To maintain effectiveness, diaphragms must not have holes or cracks. Holding it up to the light or filling it with water are two ways you can check the condition of your diaphragm.
Oil-based creams, including some vaginal medications, can damage diaphragms, so avoid contact with those materials.
Since it can be hard to tell how much spermicide is left in a tube, it's a good idea to keep an extra package on hand.
Refitting:
Pregnancy and weight changes can affect the way a diaphragm fits. It is recommended that a medical provider check the fit of a diaphragm every few years. Women who have gained or lost more than ten pounds, have had vaginal surgery, or given birth may need a new size.
Cautions:
Diaphragms are not recommended for women who have had Toxic Shock Syndrome.
Side Effects:
If you or your partner have any discomfort when the diaphragm is in place or if you experience genital itching or irritation, unusual vaginal discharge or frequent bladder infections, call the clinic for information and options. Bladder infections are the most frequent side effect of the diaphragm.
Some women may experience allergic reactions to the rubber of the diaphragm or the spermicide they use. If this happens and your spermicide has nonoxynol-9, try a spermicide without this chemical.
