August 26, 2011

The diaphragm is a dome-shaped, flexible device inserted into the vagina that covers the cervix and prevents conception by blocking live sperm from entering the uterus and tubes. The diaphragm is a reversible, prescription, barrier method of contraception.

The most frequently used diaphragms are made of latex, but a silicone diaphragm is now on the market for those with latex sensitivity. It is designed to be used with spermicidal jelly.

Obtaining a diaphragm requires a medical appointment for proper fitting and a prescription. The device may be purchased at a pharmacy for $15-50. The cost for the medical appointment will add additional expense unless covered by insurance. In addition, the over-the-counter spermicidal jelly used with the diaphragm must also be purchased at additional cost. The diaphragm should be refitted following a full-term pregnancy, abdominal or pelvic surgery, a miscarriage, or abortion after 14 weeks of pregnancy, and/or weight gain or loss of 10 pounds or more.

The diaphragm is an excellent method of contraception for women who do not wish to or cannot use hormonal contraception. However, the use of the diaphragm is somewhat complicated and requires forethought to have supplies on hand. It may interrupt spontaneity if it is used at the time of intercourse, though it may be inserted up to 6 hours prior to having sex. About 20 out of 100 women will become pregnant using the diaphragm for one year of typical use, 6 out of 100 with perfect use. Therefore, those for whom unintended pregnancy may present serious consequences may wish to consider a more effective method of birth control. If a woman is not comfortable touching her genitals or has difficulty with placing the diaphragm correctly, she may wish to consider another method. The diaphragm should not be used:

  • following recent cervical surgery
  • less than 6 weeks after childbirth
  • following recent second trimester abortion
  • by those with uterine prolapse
  • by those with allergy to the spermicide or latex
  • by women who have had toxic shock syndrome

While it is not contraindicated entirely, women who have frequent urinary tract infections or have poor vaginal muscle control may wish to avoid using the diaphragm.

The diaphragm is used with spermicidal jelly and inserted prior to intercourse. Inspection of the diaphragm prior to placement ensures that it has no holes or tears. It is left in place for 6 hours following intercourse to assure that all sperm have been immobilized prior to removing the barrier. It may be left in for as long as 24 hours. However, if the initial act of intercourse occurs more than 6 hours after insertion or if
there are multiple acts of coitus, more spermicidal jelly must be inserted into the vagina prior to each act of intercourse. Oil-based lubricants should not be used with a latex diaphragm as this may weaken the latex and decrease the effectiveness of the method. Following removal, the diaphragm is cleaned with plain soap and water and allowed to dry thoroughly before replacing in the case. There is no need to use any type of powder or cornstarch on the diaphragm.

The diaphragm is often overlooked when considering methods of birth control. Diaphragms are inexpensive and an immediately reversible form of contraception. In addition, they may also provide some protection from cervical infections such as gonorrhea and chlamydia as well as human papillomavirus. Diaphragms are not considered as effective in this way as condoms. They are not as effective as hormonal or surgical methods of contraception but may be a wise choice for those who are not frequently sexually active, would not be devastated by an unintended pregnancy, need protection from infection, or who are unable or unwilling to use hormonal methods.

SEE ALSO: Birth control, Condoms, Pelvic organ prolapse, Toxic shock syndrome, Urinary tract infections

Suggested Reading

  • Hatcher, R., Trussel, J., Stewart, F., Cates, W., Stewart, G., Guest, F., et al. (1999). Contraceptive technology (p. 400). New York: Ardent Medica.
  • What’s in store for non-latex barrier methods. (1998). Contraceptive Technology Update, 19(3), 40-41.

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