A diaphragm is a shallow, dome-shaped rimmed cup that is placed in the vagina to cover the cervix, which blocks the uterine opening to prevent pregnancy. This method of birth control requires the use of spermicide to stop the sperm from moving and fertilizing an egg.
What is a diaphragm and is it effective?
When used correctly and consistently, the rate of pregnancy with diaphragm use is 6 out of 100. However, when the diaphragm is not consistently used correctly and as directed, the rate of pregnancy doubles to 12 out of 100.
In order for the diaphragm to be effective, it not only has to fit well but it also needs to be used correctly each time by covering the entire the cervix and used with spermicide.
A diaphragm can be placed in the vagina approximately 1 hour prior to having sex and should remain in place for 6 hours; do not leave the diaphragm in the vagina for more than 24 hours.1,2 Additionally, your sex partner can use a condom or pull out prior to ejaculation to further decrease the risk of pregnancy.1
To get a good fit, your health care provider will examine and fit you for a diaphragm.2 Your health care provider will also issue you with instructions on how to use the diaphragm correctly; speak with them if you have difficulty with insertion and removal of the diaphragm so that an inserter can be provided to you.1
It is important to note that diaphragms do not provide protection from contracting sexually transmitted diseases; condoms will reduce this risk.1
Is a diaphragm safe?
Diaphragms are usually safe to use, however, the following is a list of some conditions in which the use of a diaphragm may not be indicated and include:
Women who are uncomfortable with having to touch their vagina and vulva
Silicone or spermicide sensitivity
Uterine and or vaginal abnormalities
Difficulty with insertion of the diaphragm
Women who have given birth within the last 6 weeks or recent abortion after the first trimester of pregnancy
Frequent urinary tract infection
History of toxic shock syndrome
Poor vaginal muscle tone
Recent surgery to the cervix.
What are the pros and cons of diaphragm use?
As with any form of birth control, the use of a diaphragm has benefits and disadvantages. You will need to determine if the pros outweigh the cons when discussing with your health care provider if this method of birth control is best for you. The diaphragm is a good choice for breastfeeding women because it does not rely on hormones and does not have any effect on breast milk production, unlike the combination pill.
Benefits of using a diaphragm include:
Safe to use during breastfeeding
Easily carried in a pocket or purse
No effect on hormone levels
Immediate efficacy and reversal
Can be inserted several hours prior to vaginal intercourse and is most often not felt by you or your partner.
Disadvantages to the use of a diaphragm include:
Difficulty with insertion
Possibility for the diaphragm to be moved due to penis size, sexual position or heavy thrusting
Diaphragm needs to be in place during every act of vaginal intercourse
Diaphragm may need to be intermittently refitted.
You may need to be refitted for a new diaphragm after a full term pregnancy, abdominal or pelvic surgery, miscarriage, abortion after 14 weeks or a weight change of 20%. Diaphragms should be replaced every 1 to 2 years.
Risks and side effects
Most often diaphragms do not pose a major health risk and serious problems rarely occur. However, there are some side effects that women may experience with diaphragm use and include frequent urinary tract infections (UTI) and vaginal irritation.
To prevent a UTI, it is recommended that urination occur prior to using the diaphragm and after intercourse.
Vaginal irritation may be caused by silicone sensitivity or by the spermicide used and it is recommended that if vaginal irritation occurs, try using a different spermicide.
It is important to note that most spermicides contain nonoxynol-9, which can become an irritant when used several times per day and by those with HIV, and can increase the risk of contracting HIV and/or other sexually transmitted diseases.
If either UTI’s or vaginal irritation become a concerning problem, speak with our office.
If you experience symptoms such as burning with urination, discomfort when diaphragm is in the vagina, irregular spotting or bleeding, genital irritation, red or swollen vulva/vagina, have any unusual vaginal discharge or have a high fever, it is important to speak with our office.