Contraceptive diaphragm

A woman can get pregnant if a man's sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart, or by stopping egg production. One method of contraception is the diaphragm.  

A contraceptive diaphragm is inserted into the vagina before sex, and it covers the cervix so that sperm can't get into the womb (uterus). You need to use spermicide with it (spermicides kill sperm).

The diaphragm must be left in place for at least six hours after sex. After that time, you take out the diaphragm and wash it (they're reusable). Diaphragms come in different sizes - you must be fitted for the correct size by a trained doctor or nurse.

At a glance: contraceptive diaphragm

• When used correctly with spermicide, a diaphragm is 92-96% effective at preventing pregnancy - this means that between four and eight women out of every 100 who use a diaphragm as contraception will become pregnant within a year.
• There are no serious health risks.
• You only have to think about it when you have sex.
• You can put a diaphragm in several hours before you have sex.
• It can take time to learn how to use it.
• Some women develop cystitis (a bladder infection) when they use a diaphragm. Your doctor or nurse can check the size - switching to a smaller size may help.
• If you lose or gain more than 3kg (7lbs) in weight, or have a baby, miscarriage or abortion, you may need to be fitted with a new diaphragm.
• By using condoms as well as a diaphragm, you'll help to protect yourself against sexually transmitted infections (STIs).  

How the contraceptive diaphragm works

Inserting a diaphragm 

Removing a diaphragm

Looking after your diaphragm

A diaphragm (like a cap) is a barrier method of contraception. It fits inside your vagina and prevents sperm from passing through the cervix (the entrance of your womb). Diaphragms are soft, thin domes made of latex (rubber) or silicone, and come in different shapes and sizes.

To be effective in preventing pregnancy, diaphragms need to be used in combination with spermicide, which is a chemical that kills sperm.

You only have to use a diaphragm when you have sex, but you must leave it in for at least six hours after the last time you had sex. You can leave it in for longer than this, but do not take it out before.

When you first start using a diaphragm, a doctor or nurse will examine you and advise on the correct size or shape to suit you. They will show you how to put in and take out a diaphragm, and also how to use the spermicide, which must be applied every time you use the diaphragm.

A diaphragm provides only limited protection against sexually transmitted infections (STIs). If you're at a high risk of getting an STI - for example, you or your partner has more than one sexual partner - you may be advised to use another form of contraception. 

Inserting a diaphragm

Your doctor or nurse will show you how to put in a diaphragm. Diaphragms come with instructions and are all inserted in a similar way:

• With clean hands, put a small amount of spermicide on each side of the diaphragm (also putting a little spermicide on the rim may make the diaphragm easier to put in).
• Put your index finger on top of the diaphragm and squeeze it between your thumb and other fingers.
• Slide the diaphragm into your vagina, upwards. This should ensure that the diaphragm covers your cervix.
• Always check that your cervix is covered - it feels like a lump, a bit like the end of your nose.
• If your cervix is not covered, take the diaphragm out by hooking your finger under the rim or loop (if there is one) and pulling downwards, then try again.
• Some women squat while they put their diaphragm in; others lie down or stand with one foot up on a chair - use the position that's easiest for you.
• You can insert a diaphragm up to three hours before you have sex - after this time, you will need to take it out and put some more spermicide on it.

You may be fitted with a temporary diaphragm by your doctor or nurse. This is for you to practise with at home. It allows you to learn how to use it properly, see how it feels and find out if the method is suitable for you. During this time, you are not protected against pregnancy and need to use additional contraception, such as condoms, when you have sex.

When you go back for a follow-up appointment with your doctor or nurse, wear the diaphragm so they can check that it is the right size and you have put it in properly. When they are happy that you can use a diaphragm properly, they will give you one to use as contraception.

Removing a diaphragm

A diaphragm can be easily removed by gently hooking your finger under its rim, loop or strap and pulling it downwards and out. You must leave all types of diaphragm in place for at least six hours after the last time you had sex.

You can leave them in for longer than this, but do not leave them in for longer than the recommended time of 30 hours (including the minimum six). 

Looking after your diaphragm 

After using, you can wash your diaphragm with warm water and mild unperfumed soap. Rinse it thoroughly, then leave it to dry. You will be given a small container for it, which you should keep in a cool, dry place.

• Never boil a diaphragm.
• Do not use disinfectant, detergent, oil-based products or talcum powder to keep it clean, as these products can damage it. 
• Your diaphragm may become discoloured over time, but this does not make it less effective.
• Always check your diaphragm or cap for any signs of damage before using it. 

You can visit your GP or nurse when you want to replace your diaphragm. Most women can use the same diaphragm for a year before they need to replace it. You may need to get a different size diaphragm if you gain or lose more than 3kg (7lb) in weight, or if you have a baby, miscarriage or abortion.

Who can use a diaphragm?

Most women are able to use a diaphragm. However, they may not be suitable for you if you: 

• have an unusually shaped or positioned cervix (entrance to the womb), or if you cannot reach your cervix 
• have weakened vaginal muscles (possibly as a result of giving birth) that cannot hold a diaphragm in place
• have a sensitivity or an allergy to latex or the chemicals in spermicide 
• have ever had toxic shock syndrome (a rare but life-threatening bacterial infection) 
• have repeated urinary tract infections (infection of the urinary system, such as the urethra, bladder or kidneys) 
• currently have a vaginal infection (wait until your infection clears before using a diaphragm or cap) 
• are not comfortable touching your vagina 
• have a high risk of getting an STI - for example, if you have multiple sexual partners

Research shows that spermicides which contain the chemical nonoxynol-9 do not protect against STIs and may even increase your risk of getting an infection.

A diaphragm may be less effective if:

• it is damaged - for example, it is torn or has holes 
• it is not the right size for you
• you use it without spermicide 
• you do not use extra spermicide with your diaphragm every time you have more sex 
• you remove it too soon (less than six hours after the last time you had sex)
• you use oil-based products, such as baby lotion, bath oils, moisturiser or some vaginal medicines (for example, pessaries) with latex diaphragms - these can damage the latex

If any of these things happen, or you have had sex without contraception, you may need to use emergency contraception.

You can use a diaphragm after having a baby, but you may need a different size. It is recommended that you wait at least six weeks after giving birth before using a diaphragm. You can use a diaphragm after a miscarriage or abortion, but you may need a different size.

Advantages and disadvantages

A diaphragm has the following advantages:

• You only need to use a diaphragm when you want to have sex.
• You can put it in at a convenient time before having sex (but do not forget to use extra spermicide if you have it in for more than three hours).
• There are no serious associated health risks or side effects.
• You are in control of your contraception.

A diaphragm has the following disadvantages:

• It is not as effective as other types of contraception.
• It only provides limited protection against STIs.
• It can take time to learn how to use it.
• Putting it in can interrupt sex.
• Cystitis (bladder infection) can be a problem for some women who use a diaphragm.
• Latex and spermicide can cause irritation in some women and their sexual partners.

Risks 

There are no health risks associated with using a contraceptive diaphragm.

Where you can get a diaphragm

Most types of contraception are free in the UK. Contraception is free to all women and men through the NHS. Places where you can get contraception include:

• most GP surgeries - talk to your GP or practice nurse
• community contraception clinics 
• some genitourinary (GUM) clinics
• sexual health clinics - they also offer contraceptive and STI testing services
• some young people's services (call the Sexual Health Line on 0300 123 7123 for more information)

Find your nearest sexual health clinic by searching by postcode or town. Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacists won't tell your parents (or carer) as long as they believe you fully understand the information you're given, and your decisions. Doctors and nurses work under strict guidelines when dealing with people under 16. They'll encourage you to consider telling your parents, but they won't make you. The only time that a professional might want to tell someone else is if they believe you're at risk of harm, such as abuse. The risk would need to be serious, and they would usually discuss this with you first.

Article provided by NHS Choices

See original on NHS Choices