Diaphragm

Is The Diaphragm for Me?

All of us who need birth control want to find the method that is best for us. And every woman has different needs when choosing a method. Whether you're thinking about using the diaphragm, you're using the diaphragm, you're a concerned partner, or you're just someone who's curious about it, you may have many questions.

Here are some of the most common questions we hear women ask about the diaphragm. We hope the answers help you decide if it is right for you.

What Is the Diaphragm?

The diaphragm (DIE ah fram) is a shallow, dome-shaped cup with a flexible rim. It is made of latex. You insert it into the vagina. When it is in place, it covers the cervix.

How Does the Diaphragm Work?

Diaphragms prevent pregnancy by keeping sperm from joining with an egg. In order to be as effective as possible, the diaphragm must be used with spermicide cream or jelly.

Diaphragms work in two ways:

• The diaphragm blocks the opening to the uterus.
• The spermicide stops sperm from moving.

How Effective Is the Diaphragm?

Effectiveness is an important and common concern when choosing a birth control method. Like all birth control methods, the diaphragm is more effective when you use it correctly.

• If women always use the diaphragm as directed, 6 out of 100 will become pregnant each year.
• If women don't always use the diaphragm as directed, 16 out of 100 will become pregnant each year.

You can make the diaphragm more effective if you

• Make sure it covers your cervix before each time you have intercourse.
• Make sure spermicide is used as recommended.

Your partner can help you make the diaphragm more effective by using a latex condom or pulling out before ejaculation.

Keep in mind that diaphragms do not protect you from sexually transmitted infections. Use a latex condom to reduce the risk of infection.

How Safe Is the Diaphragm?

Most women can use the diaphragm safely. But some conditions may make it difficult or impossible for some women to use a diaphragm.

The diaphragm may not be right for you if you

• are allergic to latex or spermicide
• are not comfortable touching your vagina and vulva
• gave birth in the last six weeks
• have certain physical problems with your uterus or vagina
• have difficulty inserting the diaphragm
• have frequent urinary tract infections
• have a history of toxic shock syndrome
• have poor muscle tone in your vagina
• recently had surgery on your cervix
• recently had an abortion after the first trimester of pregnancy

Your health care provider can help you decide if the diaphragm is likely to be safe for you.

You should not use the diaphragm when you have any kind of vaginal bleeding — including during your period. It could increase your risk of toxic shock syndrome.

Toxic Shock Syndrome

Toxic Shock Syndrome (TSS) is a rare but serious condition. Women who use the diaphragm have a very small risk of TSS.

The symptoms of TSS include

• diarrhea
• dizziness, faintness, weakness
• sore throat, aching muscles and joints
• sudden high fever
• a sunburn-type rash
• vomiting

If you have any of these symptoms, remove the diaphragm and call your health care provider immediately.

Only for You

Your diaphragm should be used by you and only you. Do not share it with friends. And don't ever use anyone else's diaphragm.

What Are the Benefits of the Diaphragm?

Using a diaphragm is safe, simple, and convenient. Women like the diaphragm because

• It can be used during breastfeeding.
• It can be carried in your pocket or purse.
• It generally cannot be felt by you or your partner.
• It is immediately effective and reversible.
• It has no effect on a woman's natural hormones.
• There is no interruption of sex play — it can be inserted hours ahead of time.

What Are the Disadvantages of the Diaphragm?

Many of us like to weigh the benefits against the risks of using a type of birth control. Now that you're familiar with the benefits, let's look at the possible disadvantages.

The diaphragm

• cannot be used during your period
• may be difficult for some women to insert
• may be pushed out of place by some penis sizes, heavy thrusting, and certain sexual positions
• must be in place every time a woman has vaginal intercourse
• may need to be refitted

Using Spermicide

Most spermicides that are used with the diaphragm contain nonoxynol-9. Nonoxynol-9 has certain risks. If it is used many times a day, or by people at risk for HIV, it may irritate tissue and increase the risk of HIV and other sexually transmitted infections.

Side Effects

Most women can use the diaphragm with no problems. Serious problems are very rare. But some women may experience some side effects.

• Some women who use diaphragms may develop frequent urinary tract infections. To avoid infection, you can urinate before inserting the diaphragm and after intercourse. If you get frequent bladder infections, ask your health care provider to check to see if your diaphragm fits correctly.
• Some women who use diaphragms may develop vaginal irritation. This can be a sign of an allergy to latex or to spermicide. If you have a mild reaction, try switching brands of spermicide to clear up the problem. If that doesn't work, it may mean you have a latex allergy and are reacting to the diaphragm. Stop using the diaphragm until you speak with your health care provider.

Check with your health care provider if you

• feel a burning sensation while urinating
• are uncomfortable when the diaphragm is in place
• have irregular spotting and bleeding
• feel irritation or itching in the genital area
• have redness or swelling of the vulva or vagina
• have unusual discharge from the vagina

These symptoms may be a sign of infection or other condition. Most conditions are easily treated.

How Do I Use the Diaphragm?

With a little practice, the diaphragm is easy to use. Your health care provider will show you how to insert and remove your diaphragm and will then watch you insert and remove it. Practice inserting and removing it at home, too.

INSERTING A DIAPHRAGM

Wash your hands with soap and water.
Put about a tablespoon of spermicide in the cup. Spread some around the rim.
Find a comfortable position. You can stand with one foot on a chair, sit on the edge of a chair, lie down, or squat.
Separate the lips of your vulva with one hand. Pinch the rim of the diaphragm to fold it in half with the other hand.
Place your index finger in the center of the fold for a firmer grip. The spermicide must be inside the fold.
Push the diaphragm as far up and back in your vagina as possible. Tuck the edge of the diaphragm behind your pubic bone. Make sure your cervix is covered.

How long do I leave the diaphragm in? What if I have sex again?

The diaphragm must stay in place six hours after the last time you had vaginal intercourse.

If have intercourse again, or if you have intercourse more than six hours after you put the diaphragm in, leave the diaphragm in place and insert more spermicide deep into your vagina.

Do not leave the diaphragm in place for more than 24 hours.

REMOVING A DIAPHRAGM

Wash your hands with soap and water.
Hook a finger over the top of the rim to break the suction.
Pull the diaphragm down and out.

A special inserter can be used to help with placement and removal. If you are having trouble inserting the diaphragm, talk to your health care provider about getting an inserter.

Make Sure It Fits

Diaphragms are available in many sizes and designs. A new size may be needed after any of the following:

• a full-term pregnancy
• abdominal or pelvic surgery
• a miscarriage, or abortion after 14 weeks of pregnancy
• a 20-percent change in weight

How Do I Take Care of My Diaphragm?

If you take good care of your diaphragm, it may last about two years. Taking care of the diaphragm is simple.

• After you remove the diaphragm, wash it with mild soap and warm water.
• Allow it to air dry.
• Do not use any powders on the diaphragm — they can cause infections.
• Do not use oil-based lubricants — such as Vaseline or cold cream — with your diaphragm. They damage latex.

Be sure to examine the diaphragm regularly. You can look for small holes or weak spots by holding it up to the light. If there is a hole or weak spot, light will shine through the diaphragm. You can also fill the cup of the diaphragm with water and look for leaks.

Diaphragms can still be used if the latex becomes discolored. But if the latex is wrinkled — especially near the rim — it has become too thin.

Stop using your diaphragm if you find that it has holes, weak spots, or wrinkles. Talk to your health care provider about getting a replacement. In the meanwhile, use another form of birth control, such as a condom, female condom, or sponge.

How Do I Get a Diaphragm? How Much Does a Diaphragm Cost?

You must see a health care provider to get a diaphragm. Visit Planned Parenthood of Greater Orlando, a clinic, or a private health care provider for a diaphragm.

When you go to get your diaphragm, your provider will examine you to make sure you do not have a condition that would rule out using a diaphragm. Then your provider will find the correct size for you and will give you information about using, inserting, and removing the diaphragm. Your health care provider will give you a prescription for the diaphragm.

Diaphragms may be purchased at a drugstore or clinic with a prescription. An examination costs from $50 to $200. Diaphragms average from $15 to $75. Spermicide jelly or cream costs from about $8 to $17 a kit.

Medicaid and private health insurance may cover these costs. Family planning clinics may offer lower prices than private health care providers.