Diaphragm

What is a diaphragm?

The diaphragm is a dome-shaped rubber cup with a flexible rim. Before intercourse the diaphragm is filled with a contraceptive cream or jelly and inserted into the vagina. (The contraceptive cream or jelly contains a spermicide, a chemical that kills sperm.) The diaphragm covers the cervix (the opening into the uterus) and, together with the spermicide, provides a barrier that prevents live sperm from reaching the uterus, thus preventing pregnancy.

How do I use a diaphragm?

1. Insert the diaphragm no more than 6 hours before intercourse.
2. Before you insert the diaphragm, urinate and wash your hands.
3. Squeeze 1 to 2 teaspoons of contraceptive cream or jelly into the dome of the diaphragm.
4. Rub a small amount of the contraceptive cream or jelly around the inside and outside of the entire diaphragm rim with your fingertip.
5. Get into a comfortable position. At first, the easiest position may be lying on your back with your knees up.

   If you stoop to insert the diaphragm, keep your heels on the floor and your knees wide apart. To insert it while you're standing, prop one leg up on a stool and keep the other knee slightly bent.

6. Fold the diaphragm in half by pressing the opposite sides together with the thumb and fingers of one hand. Hold the diaphragm with the dome hanging below the rim to keep the contraceptive cream or jelly in.
7. Hold the lips of your vagina open with your other hand. Gently slide the folded diaphragm into your vagina, placing your index finger on the rim to guide it. Aim toward the small of your back, as if you were inserting a tampon. You may feel the rim of the diaphragm pass over the cervix. Use your index finger to push the front rim up behind the pubic bone.
8. Make sure that the diaphragm is in place. Insert your index finger into your vagina and touch the dome. You should feel the cervix underneath. You may also feel folds in the surface of the dome. Move your index finger to the front rim of the diaphragm and make sure it is firmly in place behind the pubic bone. The back rim must be behind the cervix.

When and how should I remove the diaphragm?

Leave the diaphragm in place for at least 6 hours after intercourse. Remove it as soon after this as possible. Do not douche with the diaphragm in place.

If you have intercourse more than once, or if more than 6 hours have passed since insertion, you should insert more contraceptive cream or jelly into your vagina. Do not remove the diaphragm to do this. A plastic applicator is sold with the contraceptive cream or jelly. Use this applicator to insert more jelly or cream into your vagina, in front of the diaphragm.

To remove the diaphragm, put your index finger in your vagina and hook it under the rim of the diaphragm. Gently pull the diaphragm down and out.

Wash your diaphragm every time after intercourse with plain mild soap and water. Dry it with a towel and put it in its case. Store the diaphragm in its case away from heat.

How can I prevent infections?

• Wash your hands carefully before you insert or remove the diaphragm.
• Do not wear the diaphragm more than 24 hours at a time.
• Do not use your diaphragm during your period or when you are having abnormal vaginal discharge. Have your partner use condoms during this time instead.
• Do not use a diaphragm for the first 3 months after childbirth.

When do I need to have the diaphragm refitted?

Return to the doctor to have your diaphragm fitting checked:

• if you gain or lose more than 10 to 20 pounds
• if you experience pain or discomfort from your diaphragm
• if you have been pregnant since your last fitting
• if you have had any kind of pelvic surgery
• at least every year because the size or shape of your cervix may change.

What are the advantages and disadvantages?

Advantages

• This method of birth control is 80% to 90% reliable in preventing pregnancy.
• Diaphragms may offer some protection against sexually transmitted diseases (STDs), but use of condoms with the diaphragm is encouraged for better protection.
• There are practically no side effects from the use of the diaphragm and spermicide. This is a very safe method of birth control.
• Diaphragms provide immediate protection against pregnancy.
• Diaphragms may be inserted with spermicide up to 3 hours before intercourse.

Disadvantages

• You must be comfortable inserting and removing the diaphragm from your vagina and checking its position.
• The diaphragm and spermicide must be inserted BEFORE any genital contact. If both you and your partner are not able to exercise this willpower EVERY time, this is not a good form of birth control for you. Even if you forget just one time, you could get pregnant.
• This method does not protect against some sexually transmitted diseases. To protect yourself against STDs, use a condom every time you have sex, even though you are also using a diaphragm.

When should I call the doctor?

Call IMMEDIATELY if you develop any of the following symptoms while your diaphragm is in place:

• unexplained fever over 101°F (38.4° C)
• vomiting
• lightheadedness or dizziness when you stand up
• diarrhea
• muscle aches
• rash.

Your physician will advise you on whether or not to remove your diaphragm if it is in place.

Call during office hours if:

• You have any questions regarding the use of your diaphragm.