Diaphragms have been around since the 1830s. They were the first major breakthrough for women seeking personal control over their fertility. Since then, improvements in design and effectiveness have maintained their popularity.
- How it works
- How to use it
- Inserting a Coil-Spring Diaphragm
- Inserting an arcing or coil-spring diaphragm
- Inserting a flat-spring diaphragm
- Timing is important
- Care of your diaphragm
- Pros and cons
How it works. A flexible rubber device shaped like a shallow cup, the diaphragm is held in place over the cervix by the vaginal muscles. It serves to keep contraceptive cream or foam close against the cervix. Any sperm that find their way over the rim of the diaphragm will die when they encounter the spermicide. The diaphragm has a failure rate of 20 percent.
Diaphragms are available in two types of rim: a flat ring, that can be squeezed into a flat oval; or an arcing or coil spring, that forms a bent circle when squeezed. The flat-ring type comes with an applicator to make insertion easier. You can insert an arcing or coil spring diaphragm with your fingers.
You can't get a diaphragm without a doctor's prescription. The devices come in various sizes and must be fitted by a doctor or other health professional. First, you'll need an examination to determine the size that's best for you. You'll then be shown how to insert the device, how to make sure it is in place, and how to remove it. Some clinics and doctor's offices dispense diaphragms themselves, while others will give you a prescription that can be filled at a pharmacy.
How to use it. It takes experience to place a diaphragm correctly. Your doctor or nurse should let you practice putting it in and should check to see whether you've placed it correctly. At the least, be sure to practice a little on your own before you use a diaphragm for the first time.
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Inserting an arcing or coil-spring diaphragm.
Before inserting the diaphragm, squeeze out a small amount about a teaspoonful of spermicide into the rubber dome. Also spread a little around the inside of the rim. Take care not to put too much on the rim; this could cause the diaphragm to slip out of place. Find a comfortable positionlying on your back, standing with one leg raised on a chair, or squatting with your knees apart. Squeeze the sides of the rim together between two fingers. Angling it toward the small of your back, insert it into your vagina, pushing it up and back with one finger as far as it will go. Push the front edge of the rim up behind your pubic bone. When properly in place, the diaphragm should completely cover your cervix, with the back edge tucked between the cervix and the rear vaginal wall, and the front edge wedged behind your pubic bone. After inserting the diaphragm, feel your cervix with one finger to make sure it is completely covered. If it isn't, take out the diaphragm, apply a little more spermicide to the inside, and try again.
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Inserting a flat-spring diaphragm.
This type of diaphragm comes with a plastic applicator that has a series of small notches on one side. The notches are numbered to correspond to the size (the diameter in centimeters) of your diaphragm. To use the applicator, hold your diaphragm with the dome up and hook the rim onto the larger notch at the end of the applicator. Find the notch corresponding to the size of your diaphragm and hook the other end of the rim onto it. The diaphragm should be stretched into a flat oval, with the dome puckered into folds. Squeeze the spermicide into these folds and rub a little around the rim. With the spermicide facing up, insert the applicator into the vagina. Angle it toward the small of your back, pushing it gently along the rear wall of the vagina. You are aiming for the small space between your cervix and the rear wall. When you have pushed it as far as it will go, twist the applicator to release the diaphragm, then remove the applicator. With one finger, push the front edge of the rim up behind your pubic bone. Check to make sure that the diaphragm covers your cervix.
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Timing is important.
Insert the diaphragm no more than 6 hours before you have intercourse. Any longer and the spermicide will weaken. If sex is delayed more than 6 hours, don't remove the diaphragm, but do insert additional spermicide just before intercourse. If you have sex again within 6 hours, apply more spermicide beforehand, without removing the diaphragm. Wait at least 6 hours after intercourse before removing the diaphragm, but do not leave it in for more than 24 hours, as this increases your risk of a vaginal infection. Do not douche while the diaphragm is still in place; this can dilute the spermicide. To remove the diaphragm, reach inside your vagina with one finger, hook it around the edge of the diaphragm, and gently pull it out.
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Care of your diaphragm.
Do not use any product that is not intended specifically for use with a diaphragm. Petroleum jelly, for example, can disintegrate the rubber. Talk to your doctor or health care professional if you have questions about the possible effect of a particular product on your diaphragm. It is important to check the diaphragm carefully for tiny cracks, tears and holes before inserting it. Hold it up to a light and gently stretch the rubber apart with your fingers. Take care not to push a fingernail through the rubber. If you see any holes or cracks, substitute another birth control method until you can buy a replacement. After each use, wash your diaphragm with mild soap and warm (not hot) water. Dry it with a towel, dust it slightly with cornstarch (not powder), and store it in its case. Although a diaphragm should last 2 years, have your doctor recheck the size at least once a year. If you have gained or lost 10 pounds or more, delivered a baby, or had an abortion, you'll need to be measured sooner.
When used correctly, the diaphragm can be a fairly effective method of birth control. Many women rely on it for all or most of their childbearing years. Not only does it offer protection against unwanted pregnancy, it also appears to lower the risk of certain sexually transmitted diseases and of some types of precancerous changes in the cervix.
Unlike condoms and spermicides, a diaphragm can be inserted hours in advance of intercourse, permitting uninterrupted lovemaking. However, it does require some forethought, and you must have it in place every time you have sex. Leaking of spermicide and semen during the 6 hours after intercourse may prove to be uncomfortable, though wearing a panty liner can help.
Some women get repeated urinary tract infections while using the diaphragm. If your diaphragm is too large, the rim can press against the front wall of the vagina and irritate the urethra (the tube that carries urine from your bladder). Symptoms of a urinary tract infection include burning and pain during urination and a frequent urge to urinate. Call your doctor if you experience any of these problems. It may be a good idea to use another birth control method while you are undergoing treatment. After the infection has cleared up, make an appointment to get your diaphragm size rechecked.