Diaphragm

A diaphragm is a contraceptive device made of soft, thin rubber or latex. It's shaped like a cup and has a flexible ring around the outer edge. Designed to hold a spermicidal jelly or cream, the diaphragm is placed over the cervix each time you have sex. It prevents pregnancy by keeping sperm from reaching the egg.

Diaphragms are available only by prescription. Since they come in various sizes, your doctor must fit the diaphragm to your body. If it's too small, it may slip out of place. If it's too large, it may be uncomfortable. The spermicide that must be used with the diaphragm is available without a prescription.


Effectiveness
Diaphragms are 94 percent effective in preventing pregnancy when used exactly as directed, and 84 percent effective with typical use (which allows for the fact that they may not always be used correctly). The effectiveness increases if your partner uses a condom, which also increases your protection from sexually transmitted diseases (STDs).

When a diaphragm may not be appropriate
Diaphragms aren't recommended for women who have poor vaginal muscle tone or a sagging uterus. Also, a diaphragm shouldn't be used if you:
have a history of toxic shock syndrome (TSS, a rare bacterial infection)
have a history of repeated abnormal Pap smears or precancer of the cervix
have been diagnosed with a vaginal or cervical infection
are menstruating or experiencing other vaginal bleeding
If youred from pregnancy and childbirth sufficiently. If you used a diaphragm before the pregnancy, don't use it until you check with your doctor. Your cervix will have changed and you may need a different size. Remember, an improperly sized diaphragm may not protect you from pregnancy.

Instructions
The first few times you use the diaphragm, also use a backup method of birth control -- such as a condom -- in case you have trouble with the diaphragm.
To use your diaphragm, carefully follow the manufacturer's instructions. Here are some guidelines:

Wash your hands thoroughly with soap and water.

Inspect the diaphragm for holes, cracks or tears by holding it up to the light or filling it with water. (Be sure to dry it thoroughly before use, however.) Don't use the diaphragm if you detect any damaged areas.

Hold the diaphragm with the dome facing downward, as if you were holding a cup. Thoroughly coat the rim, and place the amount of contraceptive jelly or cream recommended by the manufacturer into the dome of the diaphragm.

Before sexual contact, insert the diaphragm into your vagina. The front rim should be properly positioned in the lower pelvic area, behind the pubic bone. The back rim should be below and behind the cervix. Run your index and middle fingers over the surface of the diaphragm to make sure your cervix is covered. If it's properly inserted, the diaphragm should be comfortable. If it's uncomfortable, it's probably not positioned correctly. If the discomfort persists, the diaphragm may have been improperly fitted to your body. See your doctor for an evaluation.

The diaphragm may be inserted up to six hours before sex. If it's been more than two hours since you inserted the diaphragm, however, insert a new applicator full of spermicide into your vagina before having sex. If you have repeated sexual contact, leave the diaphragm in place. Being careful not to dislodge it, check it again for proper positioning, and insert an applicator full of spermicide into your vagina before having sex again.

The diaphragm must remain in place for at least six hours after sex. Don't douche during these six hours. The diaphragm shouldn't interfere with normal activities, such as showering, urinating or having a bowel movement. The diaphragm shouldn't be left in place for more than 24 hours, however. This could cause you to develop a foul-smelling discharge or vaginitis (inflammation of the vaginal tissue), as well as increase the risk of toxic shock syndrome (TSS).

Wash your hands before removing the diaphragm. If it feels out of place or dislodged, insert more spermicide into your vagina and call your doctor. Emergency contraception may be recommended.

After you remove the diaphragm, wash it with mild soap and water, rinse it in clear water and dry it thoroughly. To help keep the rubber from decomposing, store it in a cool, dry place that's out of the sun.
If you use a lubricant, be sure to use the water-soluble variety (such as Atroglide or K-Y lubricant). Oil-based lubricants (such as petroleum jelly, mineral oil, body lotion or baby oil) can weaken the latex in a diaphragm or latex condom, making them susceptible to tears. Some vaginal yeast or antibiotic creams can have the same effect.


Benefits
A diaphragm provides a generally reliable method of birth control that doesn't involve hormones. Diaphragm use has been associated with a decreased risk of both pelvic inflammatory disease (an infection of the uterus, ovaries and fallopian tubes) and changes of the cervix that may lead to cervical cancer. Other studies have shown a slightly lower risk for the STDs chlamydia and gonorrhea. (You can increase your protection from STDs, including HIV, by using a condom along with the diaphragm.)

Risks/disadvantages
Some women find the diaphragm is awkward, although this generally improves with time and practice. Women who are obese or have arthritis may have more difficulty with insertion. You may also need to interrupt sexual activity to insert the diaphragm.
Some women have allergic reactions to spermicides or the rubber or latex in the diaphragm. The pressure of the diaphragm rim may lead to recurrent urinary tract infections. A different type of contraception may be recommended for women who are already prone to these infections.

Some researchers have raised the concern that diaphragms may be related to toxic shock syndrome, perhaps from leaving the diaphragm in place for more than 24 hours. Although studies haven't shown a direct association, it's important for diaphragm users to recognize the symptoms of TSS, including:

sudden fever of 102° F or higher
vomiting or diarrhea
dizziness
faintness
weakness
rash resembling a sunburn, especially on the palms and soles of the feet
confusion
Remember, don't use a diaphragm if you have a history of TSS or a current vaginal or cervical infection.


When to consult your doctor
See your doctor if you or your sexual partner find the diaphragm uncomfortable or you experience:
trouble keeping the diaphragm in place
irritation or itching in your genital area
frequent bladder infections
an unusual vaginal discharge
a fever that persists or has no accompanying symptoms after 24 hours
Your diaphragm should be checked at each annual exam. It should be replaced at least once every two years and after each pregnancy, a weight loss or gain of 10 pounds or more, and any type of pelvic surgery.