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Factsheet

Diaphragms

Date 08 February 2008

Inserting your diaphragm

The diaphragm is a barrier method of contraception that is placed inside the vagina to cover the entrance to the womb. When the man ejaculates (cums) inside the woman, the diaphragm stops the sperm getting into the womb which prevents pregnancy. The diaphragm is left in place for a further six hours (or longer if wished) during which time any sperm in the vagina die.

It is difficult to give an accurate failure rate for the diaphragm as this depends on many different things, such as the age of the women, and how regularly the diaphragm is used. If 100 women used a diaphragm as their method of contraception for a year, between six and 16 of them would have an unexpected pregnancy.

Perfect use: 94%
Typical use: 84%

WHAT IS A DIAPHRAGM?

A diaphragm is a shallow dome of thin rubber with a firm, flexible rim. It is placed in the vagina so that it covers the cervix (entrance to the womb) and tucks in behind the pubic bone. It is held in position by the pelvic muscles.

Two types of diaphragms are presently available in Australia - the coil-spring and the arcing-spring or 'all-flex' diaphragm.

LOOKING AFTER YOUR DIAPHRAGM

After removing your diaphragm, wash it in warm water with mild soap, rinse it in clear water, dry it carefully and keep it in a firm container away from heat. Remember that your diaphragm is made from rubber which is perishable, so dry it thoroughly before you store it and keep it in a cool place. A little cornflower sprinkled in the container helps to keep the diaphragm dry. Don't use talcum powder because this contains perfumes and preservatives that may damage the rubber.

Avoid contact with oil-based lubricants and some intravaginal medications such as pessaries for thrush.

Check the diaphragm regularly for holes by holding it up to the light. Check for tackiness too; rubber becomes sticky or tacky when it is beginning to perish. As an extra precaution take your diaphragm along to be checked when you have your Pap test. If you do notice a hole or tear in your diaphragm or if it feels tacky, don't rely on it to protect you against pregnancy, use another form of contraception, such as condoms, and get a new diaphragm as soon as possible.

If you want to wear your diaphragm continuously (removing it once a day for washing), it is a good idea to have two diaphragms so you can alternate them. This will reduce the chance of the diaphragm developing an odour.

SPERMICIDE AND THE DIAPHRAGM

Although traditionally the diaphragm has been used with spermicide, many women use the diaphragm on its own. There is no good evidence that using spermicide makes the diaphragm more effective, so using spermicide is your choice.

If you decide to use spermicide, you only need to use it when you are putting your diaphragm in. There is no need to insert extra spermicide each time you have sex during the time the diaphragm would normally be left in place.

USING THE DIAPHRAGM DURING YOUR 'UNSAFE' TIME ONLY

Some women use their diaphragms only during their fertile ('unsafe') time and use no contraception during the rest of their cycle. If you want to do this, it is vital that you know how to recognise your 'safe' and 'unsafe' times. Don't guess. For information about this contact Family Planning NSW or a Natural Family Planning centre.

USING THE DIAPHRAGM DURING YOUR PERIOD

You should continue to use your diaphragm if you have sex while you are menstruating as it is still possible to become pregnant at this time (see above). It is best to remove it after 12 hours as there is some evidence that wearing a diaphragm for long periods while you are menstruating could increase the small risk of toxic shock.

IF YOUR DIAPHRAGM IS UNCOMFORTABLE

If your diaphragm has been fitted properly and is in the correct position in the vagina, you should not feel it. Your partner may be able to tell it is there during intercourse but most men do not find this a problem. If your diaphragm is uncomfortable (for you or your partner) or you feel sore after using it, see your nurse or doctor. You may need a different size or type of diaphragm or it could be that some other method of contraception suits you better.

SIDE EFFECTS

It is very rare, but some women may be allergic to the rubber the diaphragm is made of, or to the spermicide, if this is used. It is possible to have an increased incidence of urinary tract infections caused by the presence of the diaphragm, particularly if you have a past history of recurrent infections.

ACCIDENTS

If you have had sex and forgotten to put your diaphragm in, or discovered after having sex that the diaphragm was not covering the cervix, you could get pregnant. Emergency contraceptive pills are available. They can be taken up to 120 hours after unprotected intercourse but are more effective the earlier they are taken.

Contact your doctor or Family Planning NSW centre as soon as possible if you want to use this method.

WHEN TO GET A NEW DIAPHRAGM

Your diaphragm should normally last about two years unless you are wearing it continuously, in which case it may deteriorate more quickly.

You should have your diaphragm refitted if you gain or lose more than five kilograms or if you have a pregnancy or pelvic surgery. It is also a good idea to have the fitting checked when you go for your Pap test.

FITTING THE DIAPHRAGM

When you are fitted for a diaphragm make sure you are shown how to insert it, check it is in the correct position, and remove it. You should practise doing this in the clinic or surgery so that the nurse or doctor can help with any problems you might have. The diaphragm can be put in at any convenient time before you have sex but it must be left in place for at least six hours after intercourse.

INSERTING AND REMOVING YOUR DIAPHRAGM

If you are using spermicide, squeeze about a teaspoonful into the diaphragm bowl, avoiding the rim.
Get into the position you find easiest (standing with a foot on a chair, squatting or lying down).
Squeeze the opposite sides of the rim together so that the diaphragm is narrow enough to slide into the vagina. (If you are using spermicide, or have an arcing diaphragm, the inside of the bowl should face upwards).
Holding the diaphragm with one hand, spread apart the vaginal lips at the entrance to the vagina and slide the diaphragm in as far as it will go, slanting it towards the small of your back (Diagram 1A). Tuck the front rim up behind the pubic bone (Diagram 1B).
Reach into your vagina with your index finger and check that you can feel the cervix through the diaphragm. It will feel like a gently rounded, soft knob. If you cannot reach far enough, try squatting or bearing down to push the cervix forwards.
To remove the diaphragm put your finger behind the front rim and pull it down and out

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For further information

Contact the Healthline on 1300 658 886.