Diaphragm

Overview

The diaphragm is a small, dome-shaped rubber shield that sits over the cervix and rests on the pubic bone. The diaphragm works by keeping sperm from entering the cervix and going into the uterus. It does this with the help of spermicidal jelly or cream. It must be used with a spermicidal jelly or cream--think of it as a spermicide holder.

Spermicide is put inside the bowl of the diaphragm and around the edges. A good tablespoon is enough. Spread it all over the diaphragm and also around the rim. The diaphragm is folded in half and inserted into the vagina, high enough so it is covering the cervix. Always, check with your finger and feel that the latex of the diaphragm is covering the cervix. The cervix will fell like the tip of your nose.

The diaphragm must be placed into the vagina before sex and left in place for 6 to 8 hours after sex. It can be inserted right before and up to an hour before sex. More spermicide must be used for any additional time you have sex while wearing the diaphragm. Use the applicator to insert more spermicide, if you have intercourse again; Do not remove the diaphragm to insert more spermicide.

The diaphragm is removed by placing a finger into the vagina to pull it out. The diaphragm must be washed, rinsed, dried, then stored in its case after use. It should never touch petroleum jelly or baby oil, since these substances can cause the rubber to break down. Be sure your healthcare provider shows you how to properly insert it and you show him/her or the nurse that you can do it properly before you leave their office.

The Process

The diaphragm is a very effective method when used correctly. It can be inserted up to 2 hours before intercourse, so it doesn't interrupt sex as much as other barrier methods and it is less expensive per month than the pill. Condoms should be used with a diaphragm and spermicide when you are at risk. You must be properly "fitted" by a healthcare professional for a diaphragm and that makes them difficult and even embarrassing to get. A prescription to buy one is required although, some clinics will have them for sale after you are "sized." A diaphragm needs to be replaced about every 2 years.

Diaphragms carry a failure rate of 2 percent when they are used correctly every time the woman has intercourse (the typical failure rate is 18 percent). Do not use a diaphragm if you don't know how to use it or are not going to use it every time you have sex.

Spermicides may irritate or cause an allergic reaction in the vagina. Any irritation should go away after you stop using it. Try another brand of spermicide if you get a rash from one, as you may be allergic to the fragrance. If you have gained or lost 10 lbs., have the "size" checked by a healthcare provider. People who are allergic to latex may have a reaction to the diaphragm, but this is rare.

A diaphragm properly fitted by a doctor will not be painful to insert. The rim is a flexible rubber-covered spring which will not hurt the vagina or the penis during intercourse. It passes easily through the vaginal opening. Once in place, it conforms to the internal shape of the vagina and doesn't constrict the urinary passage or the rectum. When properly fitted and placed, the woman is unaware of it and can urinate normally.

It is not safe to remove the diaphragm immediately after intercourse. For maximum effectiveness, it should be left in place for at least 6 hours after the last ejaculation. If it is removed before that time, viable sperm remaining in the vagina may cause conception. Since the normal vaginal environment is hostile to sperm, the longer the sperm remain in the vagina and are unable to pass into the cervix, the greater the likelihood that they will be destroyed. If spermicidal jelly is used along with the diaphragm, the effectiveness of the diaphragm is increased. During sexual excitement and intercourse, the vagina changes shape. This may cause the diaphragm to slip or to become dislodged, allowing sperm to reach the cervix. If spermicidal jelly has been used, any sperm reaching the cervix will likely be destroyed. If intercourse is repeated later, the diaphragm should be left in place and another applicator-full of jelly (cream or foam) inserted prior to intercourse. With the passage of time, the original jelly loses its effectiveness.