The goal of contraception (or birth control) is to prevent an unplanned pregnancy. The majority of methods of contraception enable sexually active couples to temporarily avoid pregnancy. Permanent birth control is accomplished through sterilization. Be sure you know and understand the different types of birth control available to you, the risks and benefits of each, and any side effects, so that you can make an informed choice.
The diaphragm is made of thin, soft rubber, latex or silicone material in a shape of a shallow cup or dome, with a flexible metal or plastic rim that fits over a woman's cervix, providing a physical/mechanical barrier to semen trying to enter the uterus and killing sperm before they can fertilize an egg.
When contraceptive spermicide gel or cream is used with the diaphragm, its efficiency is significantly increased since the spermicide kills any sperm that may get past the rim of the diaphragm. The spermicide is place around the rim and some is included in the dome part of the diaphragm, coating the diaphragm.
Cervical Cap VS Diaphragm placement.
Studies involving some 2,800 U.S. women suggest that, during typical use, the diaphragm may be somewhat more effective than the contraceptive sponge or cervical cap. However, disadvantages of conventional diaphragms are that they must be fitted by a health care provider and the correct size prescribed to ensure a snug seal with the vaginal wall. Although they can be unwieldy to insert and remove, they are easier for some women to use than a cervical cap device because of their size. They do not sit directly on the cervix itself, but is kept into place by the pubic bone and rear wall of the vagina, blocking sperm from entering the uterus. The diaphragm should not be left in place for longer than 24 to 48 hours (some sources state 24 hours, others state 48 hours - read product insert with your specific type of diaphragm or consult with your health care provider to find out how long you can keep your specific diaphragm in before having to remove it).
The diaphragm is a flexible disk with a rigid rim. Diaphragms range in size from 2 to 4 inches in diameter, depending on the brand, come in a variety of sizes. They are designed to cover the cervix during and after intercourse so that sperm cannot reach the uterus. Spermicidal jelly or cream must be placed inside the diaphragm for it to be effective. The spermicide kills live sperm and prevents them from fertilizing an egg if they should happen to make it past the barrier. If intercourse is repeated, additional spermicide should be added with the diaphragm still in place. The diaphragm should be left in place for at least six hours after intercourse.
Women who have intercourse infrequently, or whose fertility is low because of age, will find the diaphragm a good choice for contraception. Couples who have intercourse frequently (more than three times weekly) may find the diaphragm less effective than those who have sex sporadically, mostly due to inconsistent and incorrect use. The diaphragm is also very effective for women who have not had children, but higher failure rates apply for women who wait to begin using the diaphragm until after they have given birth. The diaphragm used with spermicide has a failure rate of from 6 to 18 percent.
The diaphragm is small and portable (can be dropped into a woman's handbag or purse) and is a good option to hormonal contraception. It offers some protection against certain types of sexually transmitted infectious disease such as gonorrhea, chlamydia, and certain precancerous conditions of the cervix, however, the diaphragm does not prevent the transmission of many other STDs, including herpes, HPV or HIV.
In addition to the possible allergic reactions or irritation common to all barrier methods, there have been some reports of bladder infections with this method. As with the contraceptive sponge, toxic shock syndrome (TSS) is an extremely rare side effect. Some women may experience a disruption of the vaginal skin from the frequent use of spermicides, increasing the risk of infections and abnormal pap results.
STI Protection: Barrier methods may provide considerable protection from sexually transmitted infections (STIs) such as gonorrhea, chlamydia and certain pre-cancerous conditions of the cervix; Women who frequently use spermicides may experience disruption in the vaginal skin, increasing the risk of STIs and abnormal pap results.
Using a female barrier method (like the diaphragm and cervical cap) with spermicides can give some protection against some STDs. Women using these methods may have less gonorrhea and chlamydia infections and certain pre-cancerous conditions of the cervix.
The diaphragm does not prevent the transmission of many other sexually transmitted infections such as herpes, HPV or HIV. However, further studies need to be done to know whether these methods reduce a woman's risk of getting HIV. The best method for reducing the risk of STDs is a condom. A diaphragm is inserted into the vagina and fits over the cervix behind the pubic bone and rear wall of the vagina, keeping the diaphragm in place, blocking sperm from entering the uterus. It must used with a spermicidal cream or jelly to inactivate any sperm that may happen to move around the rim.
Women who have intercourse infrequently, or whose fertility is low because of age, will find the diaphragm a good choice for contraception. Couples who have intercourse frequently (more than three times weekly) may find the diaphragm less effective than those who have sex sporadically, mostly due to inconsistent and incorrect use. The diaphragm is also very effective for women who have not had children, but higher failure rates apply for women who wait to begin using the diaphragm until after they have given birth.
TYPES OF DIAPHRAGMS
Ortho-McNeil All-Flex® Latex Diaphragm:
( Ortho-McNeil Pharmaceutical)
The All-Flex® is a latex diaphragm with a shallow dome and a flexible rim with an arcing spring. It is available in nine diameter sizes, from 55 to 95mm, in 5mm increments. The All-Flex® diaphragm is available in the United States and elsewhere. It is the world market leader in diaphragm sales and distribution.
Ortho Coil Spring® Diaphragm:
( Ortho-McNeil Pharmaceutical)
The Coil Spring® is a latex diaphragm with a shallow dome and a flexible rim with a coil spring. It is available in nine diameter sizes, from 55 to 95mm, in 5mm increments. The Coil Spring® diaphragm is available in the United States and elsewhere. It is a popular method in the United Kingdom.
Milex Wide Seal® Diaphragm:
( Milex Products, Inc.
The Milex Wide Seal® is a silicone diaphragm with a shallow dome and a wide rim with an arcing or omniflex spring. It has a small skirt around the rim intended to hold gel in place and improve the seal. It is available in eight diameter sizes, from 60 to 95mm, in 5mm increments. The Wide Seal® diaphragm is available from the manufacturer and is distributed in the United States, Canada, Europe, Asia, and the Middle East.
( Semina Industries and Commerce Ltd.)
The Semina is a clear, silicone diaphragm with a visible coil spring. It is available in six diameter sizes, from 60 to 85mm, in 5mm increments. The Semina diaphragm is available in Brazil.
Reflexions Flat Spring® Diaphragm:
( Williams Medical Supplies)
The Reflexions Flat Spring® is a latex diaphragm with a rim that is similar to the coil spring but thinner and more delicate. It is available in seven sizes, from 65 to 95 mm, in 5mm increments. The Flat Spring is manufactured in Britain.
SILCS Barrier Diaphragm (under development):
SILCS is an intravaginal barrier device (pronounced "silks") currently under development. It is made of silicone with an arcing ring. SILCS has a pre-shaped rim to cling high in the vaginal vault and a finger cup on one edge for easy removal. It will be a one-size-fits-all device.
The SILCS intravaginal barrier is developed by the U.S.-based Program for Appropriate Technology in Health (PATH) and a private company called SILCS, Inc. and is being compared with the standard latex diaphragm in a CONRAD clinical trial. The SILCS barrier has a shape and dimpled surface intended to make insertion and removal easier. Its cost is expected to be relatively low, and its manufacturer has an agreement to develop it for use in developing countries.
BufferGel Duet (under development): ReProtect, LLC.
The BufferGel Duet is a disposable, one-size-fits-all, clear diaphragm made of dipped polyurethane. It will be marketed pre-filled with BufferGel, a candidate microbicide and contraceptive.
Available through LadyToBaby.com
The Lea's Contraceptive, called Lea's Shield does not compare with any other mechanical device on the level of form, volume or matter. Unlike other barrier contraceptives, it does not depend on vaginal dimensions or cervical size, which varies from woman to woman. Its exclusive design also eliminates discomforts associated with other barriers. Lea's Shield is a one-size-fits-all reusable vaginal barrier contraceptive device. Approximately the size of a diaphragm, it is composed entirely of medical grade silicone rubber. The device is washable and reusable.
Lea's Shield is a cup-shaped barrier with a loop for removal, can be left in place for up to 48 hours. It also features a one-way valve to allow for the passage of cervical secretions and assure a tight fit. It is available over-the-counter in Germany. In the U.S. it has recently been approved by the U.S. Food and Drug Administration (FDA), but is available at this time by prescription only. A study conducted by the U.S.-based Contraceptive Research and Development (CONRAD) Program and FHI indicated that pregnancy rates compared favorably with those reported in other studies of barrier contraceptive methods, including the cervical cap, sponge and diaphragm. CONRAD research found 12-month pregnancy rates associated with the use of Lea's Contraceptive to be 15 percent, compared with 10 percent to 21 percent for the use of a diaphragm with spermicide.
Research about the potential of diaphragm devices to reduce STD transmission is limited. Whether it protects against HIV is unknown. However, a diaphragm may provide some protection by covering the cervix, which may be the principal site of HIV transmission.
Is generally effective for contraceptive (82-94 percent). It is a reliable form of contraception. Proper and consistent usage increases the effectiveness. However, most couples will find the diaphragm to be, on average, 80 percent effective at preventing pregnancy.
Easily transported. Small and portable.
May be used only when needed. Can be inserted up to an hour before sex. Wearer can have intercourse an unlimited number of times with each wearing.
May be used during light menstruation to temporarily contain the menstrual flow. However, this is not recommended for any length of time (no more than a few hours) as it may contribute to toxic shock syndrome if left in for longer periods of time. Using another form of contraception is recommended during your period.
Does not involve the hormones, used in some other forms of birth control, that can have side effects.
May be left in place and effective up to 24 to 48 hours following intercourse, depending upon the type of diaphragm you purchase.
Low cost and long wearing (should last about 2 years with proper care).
Offers some protection against sexually transmitted diseases (STDs).
Not 100 percent effective for birth control.
Must be obtained from and fitted by a health care provider.
Putting in the diaphragm may be awkward at first. It does become quicker and easier with time. Some women may find it difficult to insert properly or cannot be fitted for a diaphragm or cannot easily reach their cervix.
Must be used simultaneously with a spermicide. The discharge from the cream or jelly can be a nuisance.
May develop undetectable flaws.
Disagreeable to some couples to use spermicidal jellies and creams during oral sex.
May become dislodged (slip out of place) during intercourse.
May contribute to urinary tract infections. May increase the risk for yeast infection, allergic reaction to latex or rubber, toxic shock syndrome, vaginal infection or inflammation of the cervix.
Most be left in place for at least 6 to 8 hours after intercourse, but no longer than 48 hours.
The diaphragms made of rubber or latex cannot be used with oils, lubricants or gels unless the lubricant packaging specifically states it is safe to use with latex or rubber.
A new fitting may be necessary after pregnancy, miscarriage, abortion or weight gain of over 15 pounds.
OBTAINING A DIAPHRAGM
Most health departments, family-planning clinics and gynecologists can help you. Some midwives may also be able to fit you and provide you with a diaphragm. If you have any questions, don't be afraid to ask your health care provider. Once you health care provider has fitted you, you can obtain the diaphragm and spermicide at most clinics, drugstores or pharmacies.
INSTRUCTIONS FOR USE
Be carefully fitted by a competent medical person. The diaphragm comes in various sizes to accommodate the majority of women.
Take your diaphragm to your health care provider and obtain a repeat fitting under these situations:
- Every 2 years.
- After childbirth.
- Miscarriage or abortion after the first three months of pregnancy.
- Any surgical operation involving the female genitals or pelvis.
- Weight gain or loss of 10-12 or more pounds.
- If you have problems with bladder infections.
- If you have pain when using the diaphragm.
The diaphragm can be inserted at least 6 hours before intercourse.
Leave the diaphragm in place at least 6 hours after intercourse. You may leave it in place for up to 24 hours if you choose. Do not leave it in place beyond the initial time period if you are menstruating.
1. To insert:
- Before using the diaphragm, check it for holes, tears or cracks. Fill it with water to see if it leaks. Also, it can be stretched and looked at it in front of a bright light to look for holes. If there any holes or tears, do not use it. Use another form of contraception until you can obtain a new diaphragm.
- Before insertion, place 1 teaspoonful to 1 tablespoonful of spermicide cream or jelly into the shallow cup. Put a continuous line of spermicide around the rim of the cup.
- Never use a petroleum lubricant. Do not use oil-based vaginal medications or lubricants when using the cap or diaphragm. Vaseline, hand lotion, Monistat and other oil-based products can damage these devices. For extra lubrication you can use contraceptive cream or gel.
- Either you or your partner can put it in before the penis enters the vagina. The diaphragm can be put in just before intercourse, or up to 18 hours before. If more than 6 hours pass by before intercourse or if you have intercourse more than once, you need to use the spermicide applicator to add more contraceptive gel or cream. Do not remove the diaphragm to do this, but add the spermicide directly into the vagina near the cervix each time before the penis is inserted into the vagina.
- Always wash your hands before putting the diaphragm inside the vagina.
- Crouch, squat, stand with one foot propped up on a chair, or recline with your legs apart. Squeeze the diaphragm, dome down, into a long narrow shape with one hand while holding the lips of the vagina open with the other. Insert the diaphragm with the rim facing upwards. Push it into the vagina as far as it will go.
- Slide the diaphragm deeply into the vagina until the lower part of the rim passes the cervix.
- Push the front rim under the pubic bone, making sure the cervix is encircled. Feel your cervix through the diaphragm (it feels firm, similar in shape to the tip of your nose). When it is properly in place, you should not feel the diaphragm at all. Keep in mind that during your fertile days, your cervix moves up higher and may be harder to reach.
- Do NOT douche while the diaphragm is in place.
2. To remove:
- Wait at least 6 hours after intercourse. (Do not leave it in place past this initial period if you are menstruating.) Be sure to take it out by the end of 24 hours. Choose a comfortable position. Carefully force the diaphragm out by hooking your finger under the rim of the diaphragm, pulling on the lower rim behind the pubic bone. Pull it out of the vagina. Avoid puncturing the diaphragm with fingernails.
- The rubber diaphragm needs special care to keep it from drying out. Wash the cap with mild unscented soap and water. Dry it well. Dust it with corn starch if desired; never use a talcum powder or perfumes. Don't use Vaseline. These can destroy the rubber and cause vaginal infections. Don't use oil-based vaginal medications or lubricants when using the cervical cap or diaphragm. Vaseline, hand lotion, Monistat and other oil-based products can damage these contraceptive devices. For extra lubrication, use a contraceptive cream or gel.
- Hold up to the light after each removal to check for holes. If any defects are found, call the health care provider for advice or to obtain another diaphragm. Have your diaphragm's fit rechecked annually and after a pregnancy.
- Store in a dry place in its container.
Note: Follow the special written instructions that come with the diaphragm if they differ from those discussed in this instruction page.
Follow Up: Because diaphragms can increase your risk for certain types of infections or inflammations in the vaginal area, you'll want to have a Pap test taken within a few months after you begin using this method.
SIDE EFFECTS & COMPLICATIONS
- Some people may have allergies to the rubber or spermicide. This reaction can cause skin rashes, itching, burning or redness. Sometimes an allergy to the spermicide can go away if the couple uses a different type or brand.
- Bladder infections. These may occur if the diaphragm presses against the urethra. If you have recurring bladder infections, contact your health care provider and discuss refitting of your diaphragm or using a different type of contraception.
- Pelvic cramps or discomfort. This also may occur if the diaphragm does not fit right. Contact your health care provider and discuss refitting of your diaphragm or using a different type of contraception.
- Vaginal infection. This can happen if it is left in too long or not cleaned and dried well.
- Irritation of the vaginal tissue. This can happen if the diaphragm does not fit well. Contact your health care provider and discuss refitting of your diaphragm or using a different type of contraception.
The most serious complication that can result from using the diaphragm is toxic shock syndrome (TSS). This is a very rare but serious illness. It is caused by a bacteria. Women can help prevent it by not using the diaphragm during menstrual bleeding and by taking it out within 24 hours. It is important that all diaphragm users know the warning signs for TSS.
TOXIC SHOCK SYNDROME WARNING SIGNS:
- Sudden high fever
- Vomiting, diarrhea
- Dizziness, faintness and weakness
- Sore throat, aching muscles and joints
- Rash, which looks like a sunburn
If you notice any of these warning signs, remove the diaphragm and contact your health care provider as soon as possible.
MoonDragon's ObGyn Health Information: Toxic Shock Syndrome (TSS)
There are a few precautions that health care providers and midwives consider when deciding if a woman can safely use the diaphragm. Some women or men may have an allergy to the latex rubber or the spermicide. Some women may not be able to be fitted for physical reasons. Health problems such as bladder infections and a history of Toxic Shock Syndrome may be reasons why your health care provider or midwife might advise you to use a different method of contraception.
- Typical Use: 18 percent
For typical users, 18 women out of 100 may become pregnant when using the diaphragm for a year.
- Perfect Use: 6 percent
For those who always use the diaphragm correctly, every time, 6 women out of 100 may become pregnant in a year.
To make this method of contraception more effective, the diaphragm needs to be used correctly, every time a woman has sex to be most effective. Either the contraceptive cream or the contraceptive gel must also be used with the diaphragm, every time, in order for the method to work well. Lastly, if a woman has intercourse more than once after putting it in, she must remember to use the applicator to add more contraceptive cream or gel before she has sex.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You are interested in a diaphragm for contraception.
You find defects in a diaphragm you are using.
You develop signs or symptoms of infection or illness that may be associated with toxic shock syndrome.
MOONDRAGON'S RELATED LINKS
MoonDragon's Contraception Information: Contraception Index
MoonDragon's Contraception Information: Contraception Methods Compared
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