What are diaphragms
and how do they work?
The diaphragm
is a soft latex barrier that fits over a woman's cervix. It is in
the shape of a shallow dome-shaped cup with a flexible spring rim.
It fits inside a woman's vagina, and holds a spermicidal cream or
gel over the cervix. Diaphragms act as both a chemical and a
physical barrier to sperm swimming through the cervix and into the
uterus. Diaphragms come in a number of sizes and must be fit for
you by your medical provider.
When
you use a diaphragm, you first coat it with spermicide and insert
it into the vagina to cover the cervix before intercourse. This
blocks the entrance to the uterus, and the jelly or cream immobilizes
sperm, preventing it from joining an egg.
You must
leave your diaphragm in place for 6 to 8 hours after intercourse,
but you can leave it in place for up to 24 hours. If intercourse
is repeated or occurs more than six hours after the diaphragm is
inserted, use an applicator to put another application of spermicide
into the vagina (so that the diaphragm is not removed).
How
do I use a diaphragm?
The diaphragm
is a type of contraceptive that requires you to be comfortable enough
with your body to use your fingers to insert and remove the diaphragm.
If this is not something you feel ok doing, you might want to try
another option. To protect you from pregnancy, the diaphragm and
spermicidal cream or gel must be used every time intercourse occurs.
And you do not want to use a diaphragm if you have any kind of vaginal
bleeding, including menstruation.
Step
1: Check your diaphragm
Inspect your diaphragm carefully each time before you use it to
make certain there are no holes or tears. The best way to do this
is to hold the diaphragm up to a light. Pull the diaphragm at
the rim on all sides to make sure there are no holes. Or, you
can fill the diaphragm with water; if there is a problem, you
will see a leak. Look closely at your diaphragm. If there are
puckers, especially near the rim, this could mean a thin spot
in the rubber.
Step
2: Inserting your Diaphragm
Place about one tablespoon of spermicidal cream or gel in the
cup of the diaphragm and spread it on the inner cup up to the
rim. Insert the diaphragm by squeezing it closed and inserting
it into the vagina. Guide the back rim past the cervix and then
press the front rim up behind the bony arch that guards the front
wall. Make sure you can feel that the cervix is covered by the
diaphragm. At first, it may be easier to lie on your back to insert
it. The diaphragm may also be inserted from a standing or sitting
position.
You
can insert the diaphragm and spermicide up to 4 hours before intercourse.
But if 4 hours or more pass before you have intercourse, you should
use a plastic applicator to insert more spermicide. The diaphragm
may become dislodged when using some positions, but this is not
likely to occur if the fit is tight and insertion is done properly.
You
must leave the diaphragm in place for 6 to 8 hours after intercourse
to assure that all the sperm have been killed. If you have intercourse
more than once in that period of time, insert more spermicide
each time by using a plastic applicator. Do not remove the diaphragm
to insert more spermicide because you will lose your contraceptive
protection.
Step 3: Removing your Diaphragm
To remove the diaphragm, insert your finger into your vagina,
up and over the topside of the diaphragm rim and slightly to one
side. Hook your finger firmly on the rim of the diaphragm and
break the suction. Pull the diaphragm down and out.
Step
4: The Ongoing Care of Your Diaphragm
After removing your diaphragm, wash it in warm water with a mild
soap such as Ivory. Steer clear of perfumed soaps--the ingredients
may weaken the rubber.
After
washing it, dry your diaphragm thoroughly with a towel. Then dust
the entire diaphragm with cornstarch; do not use baby powder or
other talc powders because they may weaken the rubber.
Store
the diaphragm in its plastic case and keep it away from heat sources.
With time and use, the rubber of the diaphragm may darken, but
as long as you take good care of it, it will stay elastic. We
suggest getting a new diaphragm approximately every two years.
You
should have your diaphragm checked once a year by a medical provider,
particularly if you lose or gain more than 10 lbs, have a pregnancy,
an abortion or abdominal surgery.
How effective are
diaphragms in preventing pregnancy and STIs?
When diaphragms
are used perfectly--this means with they are used correctly with
spermicide every time a couple has intercourse--the chance of becoming
pregnant is 6%. But, not every couple uses the diaphragm perfectly
every time. If the diaphragm isn't inserted correctly, is bumped
out of place or is removed too soon, the risk of pregnancy increases.
The average risk of becoming pregnant is 20%.
Because
the diaphragm only covers a woman's cervix it offers limited protection
against STIs. We recommend you also use a condom to give you and
your partner the greatest protection.
What
are some advantages of using a diaphragm?
Once you
have learned how to properly insert your diaphragm and you are comfortable
using it, the diaphragm offers many advantages:
It
doesn't affect a woman's hormone levels.
It
doesn't interrupt sex play if a woman has inserted it ahead of
time.
It
generally cannot be felt by either partner.
It
is a relatively cheap form of birth control.
It
may reduce your risk of cervical cancer.
It
offers some protection against pelvic inflammatory disease (PID).
It
can be used when a woman is breast-feeding.
Are there any problems
with using a diaphragm?
The diaphragm
is a contraceptive option with no side effects, but certain women
might have the following problems:
It
may be difficult for a woman to insert the diaphragm correctly.
A
woman must use a diaphragm every time she has vaginal intercourse.
A
diaphragm must be fitted by a medical provider and might have
to be refitted.
Diaphragms
can be pushed out of place with various positions and penis sizes.
Some
women may develop bladder infections.
Women
with latex allergies may not be able to use diaphragms.
If you
experience any of the following symptoms while using your diaphragm,
contact your medical provider:
Discomfort
when the diaphragm is in place
Burning
sensations while urinating
Irritation
or itching in the genital area
Unusual
discharge from the vagina
Irregular
spotting and bleeding
Redness
or swelling of the vulva or vagina
How much does it
cost and where can I get it?
Brown students can
set up an appointment with a medical provider here at Health Services to be fitted for a diaphragm by calling 401.863-3953. The medical provider will show you
how to insert your diaphragm and have you practice using it. It
will cost approximately $49.50 for the diaphragm (without insurance) and
approximately $15 for spermicide.
Links you can use
For more
information about diaphragms, you can visit:
Disclaimer: Health Education is part of Health Services at Brown University. Health Education maintains this site as a resource for Brown students. This site is not intended to replace consultation with your medical providers. No site can replace real conversation. Health Education offers no endorsement of and assumes no liability for the currency, accuracy, or availability of the information on the sites we link to or the care provided by the resources listed. Health Services staff are available to treat and give medical advice to Brown University students only. If you are not a Brown student, but are in need of medical assistance please call your own health care provider or in case of an emergency, dial 911. Please contact us if you have comments, questions or suggestions.
