The diaphragm is a dome shaped soft rubber cup with a flexible rim. It is placed in the vagina, covering the cervix, with the front rim behind the pubic bone. The diaphragm must be used with a contraceptive jelly or foam. Various types of diaphragms are available. The diaphragm must be fitted by a doctor. This ensures the correct size so it will stay in place. The doctor will give a prescription for the device to be purchased from a pharmacy. The woman must be instructed on how to use it correctly. She should practice inserting it, removing it and the doctor should check that it is properly placed.

How does it work?

The diaphragm acts as a barrier to keep the sperm from getting into the cervix. The contraceptive jelly kills the sperm in the vagina. The diaphragm also may protect against sexually transmitted infections and cervical dysplasia. (cell changes)

How is it used?

• Put about one tablespoon of contraceptive jelly in the diaphragm and around the rim.
• Squeeze the sides of the rim together (dome side down).
• With one leg up on a stool/toilet seat, hold the lips of the vagina open and insert the diaphragm as far back as it will go, as you would a tampon.
• A plastic inserter can also be used to put the diaphragm in place.

When properly in place, you should be able to feel the cervix through the diaphragm. Neither the woman nor her partner should feel any discomfort from it. The diaphragm can be inserted up to six hours before intercourse. However, if it has been in place for more than two hours, an extra application of jelly/foam must be inserted.

If intercourse takes place more than once, extra contraceptive jelly/foam must be inserted into the vagina. The diaphragm must remain in place for six to eight hours after intercourse.

To remove, hook a finger or inserter under the rim and pull it out. Then wash it with mild soap and water, inspect it carefully for breaks and tears. Store in a cool, dry place.

How effective is it?

Studies show that the failure rate for a diaphragm is 12-18%. Condoms should be used for extra protection. Most diaphragms will last up to two years. Diaphragm size may change if you have had a pregnancy, abortion, lower pelvic surgery, lost or gained ten or more pounds.

What are the possible side effects and complications?

• allergy to rubber or spermicide
• urinary tract infections
• recurrent yeast infections
• toxic shock syndrome (if left in place more than a total of 24 hours)
• female on top during sex may cause the diaphragm to be dislodged
• Who should not use a diaphragm?
• Women should not use a diaphragm if they have:
• abnormalities of the vagina/uterus that prevent a proper fit of the diaphragm
• a history of toxic shock syndrome
• recurrent or persistent urinary tract infections or vaginitis (this can sometimes be corrected with a smaller diaphragm and urinating immediately after intercourse).

Use a condom to help prevent the spread of STIs and HIV.

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