Diaphragm for birth control

Diaphragm

As a birth control method, a diaphragm is about 94 percent effective, and physically blocks sperm from entering the cervix. You’ll need to replace the diaphragm every two years, and it’s a good idea to have emergency contraception pills on hand in case the diaphragm slips out of place.

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What is a diaphragm for birth control?

A diaphragm is a shallow dome-shaped device made of silicone or latex that you partially fill with spermicidal jelly or cream and insert into your vagina before sex.

How effective is the diaphragm for birth control?

When used consistently and correctly, the diaphragm is about 94 percent effective. This means that about 6 out of 100 women who use it properly will get pregnant in the first year of use.

Typically, about 12 percent of women who rely on the diaphragm for contraception end up getting pregnant during the first year they use it. This includes women who don’t use the diaphragm every time they have sex as well as those who insert it incorrectly or neglect to use spermicide.

Because the diaphragm has a relatively high failure rate even when used correctly, you may want to use an additional method, such as condoms, or consider using a more reliable method of contraception.

If you’re relying on the diaphragm for birth control, it’s a good idea to have emergency contraception pills on hand, so you’ll be prepared if your diaphragm slips out of place or you forget to use it. The sooner you take these pills after unprotected sex, the more likely they are to be effective.

How does a diaphragm work?

The diaphragm is a barrier method of contraception. It physically blocks sperm from entering the cervix and holds spermicide near the cervix to kill off any sperm that might get around the rim.

You’ll need to replace your diaphragm at least every two years, or sooner if it shows any signs of deterioration. Be sure to check for holes, tears, and cracks each time you use it.

Bring your diaphragm with you when you go for your annual checkup so your healthcare provider can check the fit. (Don’t use your diaphragm for two days before your exam because it can make it hard to get a good Pap smear. Use another method or abstain during this time.)

Also have your provider check the fit of your diaphragm after you’ve undergone pelvic surgery, lost or gained 20 percent or more of your body weight, had an abortion or miscarriage, or given birth. These things can change the size and shape of your cervix and vagina enough to make a new diaphragm necessary.

How do I use a diaphragm?

Here are some general instructions about how to use a diaphragm, though it’s a good idea to refer to the written instructions and illustrations that came with it.

Preparing to use your diaphragm

When you first bring your diaphragm home, and before using it during sex, try inserting and wearing it for six hours or so. You want to make sure the diaphragm remains comfortable even after many hours. If it doesn’t, you’ll need to return to your caregiver to check the fit before using it for contraception.

Before you use a diaphragm, make sure it’s in good condition. Don’t use it if it’s more than two years old or it looks worn, feels brittle, or has any cracks, tears, or holes. Holding the diaphragm up to a light or filling it with water is a good way to check for holes.

It’s important to use a backup method — such as condoms — the first few times you use the diaphragm, in case you have unexpected problems and it becomes dislodged during sex. Also make sure you have plenty of spermicidal jelly or cream and an applicator you can use to insert more spermicide if you have intercourse more than once.

Inserting your diaphragm

You can insert your diaphragm up to two hours before sex. When you’re ready, empty your bladder and wash your hands with soap and water. Then squeeze about a tablespoon of spermicidal jelly or cream into the dome of the diaphragm and spread some around the rim. Always use spermicide with the diaphragm.

To make insertion easier, you can squat, lie down with your knees raised, or stand with one foot on a chair. Hold the diaphragm by the rim and squeeze the opposite sides together. Then spread the lips of your vulva and push the diaphragm in with the dome side down.

Slide the diaphragm along the bottom wall of your vagina as far as it will go, so that the leading rim is inserted deep in the vagina behind and below the cervix, and then tuck the front rim up just behind the pubic bone.

Once the diaphragm is in, check to make sure that the dome is covering your cervix. Insert a finger into your vagina and feel for your cervix through the dome of the diaphragm – your cervix will feel somewhat like the tip of your nose.

If your cervix isn’t covered or the diaphragm feels uncomfortable, remove it, add more spermicide, and try again. If you’re not sure whether you’re inserting it correctly or it feels uncomfortable, schedule an appointment with your provider and use another method of birth control in the meantime.

If you want to use lubricant when you have sex, be sure to use a water-based lubricant, as some oil-based lubricants can damage the diaphragm.

After you have intercourse

Your diaphragm must be left in for at least six hours after you last have sex so the spermicide has a chance to destroy all the sperm. If you’re worried the diaphragm has become dislodged, see below about what to do.

A diaphragm can be left in for up to 24 hours after you initially insert it, but it’s best to take it out six to eight hours after intercourse. The longer you leave it in, the higher your risk for a rare but very serious disorder called toxic shock syndrome.

If you want to have sex again before six hours have passed, check that your diaphragm is still properly in place and then insert more spermicide into your vagina with an applicator without removing the diaphragm. Some experts recommend doing this with each repeated act of intercourse, even if it happens right away.

Or you may have your partner use a condom instead of inserting more spermicide because using spermicide more than once a day may cause vaginal irritation. If your partner uses a condom, you still need to leave your diaphragm in place for the full six hours after the last time you have sex.

Removing your diaphragm

To remove the diaphragm, wash your hands with soap and water, insert your index finger into your vagina, reach up behind your pubic bone, hook your finger behind the front rim, and pull down and out.

If you’re having difficulty removing your diaphragm, try bearing down with your pelvic muscles as you try to pull the diaphragm out, or insert your finger between the rim and your vaginal wall to break the suction before reaching for the top rim to pull it out.

Caring for your diaphragm

After each use, wash the diaphragm with plain, unscented soap and water, and check it again for holes or tears. Dry it thoroughly with a clean cloth and return it to its case. (You can dust it with a little cornstarch to protect it from moisture if you want, but never use baby powder or any other kind of powder on it.)

Keep the case in your bedroom or a closet rather than in the bathroom. It’s important to store your diaphragm away from moisture, heat, and light.

A diaphragm should not be used during your period (or any other time you have any vaginal bleeding) because the risk of toxic shock syndrome is higher during menstruation.

What are the pros and cons of using a diaphragm for birth control?

The diaphragm is a good choice for breastfeeding women because it doesn’t rely on hormones and doesn’t have any effect on breast milk production, unlike the combination pill. If you’re exclusively breastfeeding and meet all of the other criteria for the lactational amenorrhea method (LAM), the addition of a diaphragm offers you a high level of pregnancy protection.

Your caregiver can try fitting you for a diaphragm at your six-week postpartum visit, though you may have to wait a little longer if she determines that your vagina hasn’t yet regained enough muscle tone to get a good fit. (To speed up this process, do your Kegels!)

Even if you’ve used a diaphragm before, you’ll need to go in for a fitting because you may need a different size after giving birth. In the meantime, use another method, such as condoms.

In terms of cons, a diaphragm does not prevent sexually transmitted infections (STIs). If you’re at risk for STIs, you should be using latex condoms or, if they aren’t a good option for you, polyurethane male or female condoms. What’s more, if you’re at high risk for infection, you shouldn’t be using spermicide because frequent use can cause genital irritation that may make you more susceptible to HIV and other STIs if you’re exposed.

Where can I get a diaphragm for birth control?

You’ll have to be custom-fitted for your diaphragm by a healthcare provider. They’ll do a pelvic exam to estimate the size your diaphragm should be. Then they’ll insert diaphragms (or fitting rings) of various sizes — they can range from 50 to 105 millimeters across — to find the one that best fits your body.

Once your provider determines the correct size and type, they’ll show you how to use the diaphragm, have you practice inserting it yourself, and check that you’ve done it correctly. Then they’ll write you a prescription for your own diaphragm that you can fill at a pharmacy if her office or family-planning clinic doesn’t stock them. (Save the instructions that come with the diaphragm because you may want to refer to them later.)

What should I do if my diaphragm becomes dislodged during sex?

If your partner has already ejaculated inside your vagina and you find out afterward that your diaphragm became dislodged during intercourse, you’re chances of pregnancy are higher.

If this is the case, insert more spermicidal jelly or cream right away. Though you certainly can’t count on this to prevent pregnancy, it’s probably worth a try.

The only way to significantly reduce your risk of getting pregnant is to use emergency contraception and the sooner you use it, the more likely it is to be effective. So if you have some on hand, take it right away. (See our complete article on emergency contraception.)

Are there any side effects of using a diaphragm?

Using a diaphragm can make you more susceptible to urinary-tract infections (UTIs), yeast infections, and bacterial vaginosis.

To help guard against these infections, keep your diaphragm in no longer than necessary – for pregnancy protection, you need to leave it in at least six hours after sex. Urinating just after intercourse may help prevent a UTI. Let your healthcare provider know if you think you have a UTI so you can be tested and treated.

If you have recurrent UTIs while using a diaphragm, they may be related to the pressure that the rim puts on the urethra or to the spermicide, which can change the acidity and balance of bacteria in the vagina and allow bad bacteria to multiply. Your provider will recheck the fit and prescribe a different rim type or size, if appropriate. If that doesn’t solve the problem, you’ll need to switch to a birth control method that doesn’t require spermicide.

If you’re having vaginal irritation but testing shows no evidence of an infection, it may be due to an allergy or a sensitivity to the spermicide. If it’s the latex, you might try switching to a silicone diaphragm. If the spermicide is the culprit, you can try another brand. If that doesn’t help, you’ll need to find another method of birth control. You’ll also need to make a change if your partner is allergic or sensitive to latex or spermicide.

Diaphragm use is associated with an increased risk of toxic shock syndrome, a rare but severe illness caused by common bacteria that release toxins into the bloodstream. To reduce your risk, be sure to follow the instructions carefully, removing your diaphragm six to eight hours after having sex, and never leave it in for more than 24 hours after you first inserted it.

Signs of toxic shock include: a sudden high fever, vomiting, diarrhea, dizziness, weakness, sore throat, achiness, redness of the eyes, and a rash like a sunburn. Call your practitioner right away if you have a high fever and any of these other symptoms.

Who shouldn’t use a diaphragm for birth control?

You won’t be able to use a diaphragm if:

  • You’re uncomfortable touching yourself or have trouble inserting the diaphragm correctly.
  • Either you or your partner is allergic or sensitive to spermicide.
  • You’ve ever had toxic shock syndrome.
  • Your cervix, vagina, or uterus has an unusual shape that doesn’t allow for a good fit or your vaginal tone is too lax, so that the diaphragm doesn’t stay in place.
  • You have recurrent UTIs while using a diaphragm and the problem persists even after trying a new size or type of diaphragm.
  • You’re at high risk for HIV or other STIs.

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