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.
Diaphragms may offer some limited protection against reproductive tract infections and HIV/AIDS.
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 a 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.
- Some types of sex play may dislodge the diaphragm. If your diaphragm moves during intercourse, consider taking Emergency Contraception.
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.
Advantages
- Can be inserted 2 hours before sex.
- Easy to carry around, comfortable.
- Does not alter menstrual cycles.
- Does not affect future fertility.
- May help you better know your body.
Disadvantages
- Does not protect against HIV/AIDS.
- Requires a fitting in a clinic.
- Needs occasional refitting.
- Possible allergic reaction.
- May increase risk of bladder infections.
- Can be messy.
Who Uses It?
Young women who can take responsibility for sex in advance use diaphragms. You must also always have a supply of spermicide if you choose to use a diaphragm. In addition, the diaphragm is good for anyone who wants to have sex during her period - the diaphragm catches the blood before it leaves the vagina. The diaphragm isn't good for anyone who is uncomfortable or uneasy with the thought of reaching into her vagina.
How Much Does It Cost?
A diaphragm usually costs about $30 to $50. It should be replaced every 2 years. There is also the cost of the doctor's visit and a fitting fee. Many health insurance plans cover these costs and family planning clinics (such as Planned Parenthood) charge much less. In addition, the cost of spermicide is about $0.25 per use.
How Do You Get It?
A doctor must fit a girl with a diaphragm. During a pelvic exam the doctor will measure a girl's vagina and then determine which size of diaphragm is right for her. The doctor or nurse will then teach her how to insert and remove the diaphragm. Some doctors may even ask a girl to practice at home and then come in while wearing the diaphragm to check that she has done it right. A diaphragm that's inserted incorrectly can result in pregnancy.
During the annual exam, the doctor will check that the diaphragm still fits correctly. The diaphragm may not fit correctly if a girl has gained or lost 10 pounds, had a baby, had an abortion, or was fitted when she was a virgin and she is now having sex.
The above article was adapted from the following web sites:
http://kidshealth.org/teen/sexual_health/contraception/contraception_diaphragm.html
http://www.fwhc.org/birth-control/diaphram.htm
