Diaphragm

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Diaphragm placement

The diaphragm is a reusable, dome-shaped rubber cup with a flexible rim. It's inserted into the vagina so that it fits behind the cervix and also behind the pelvic bone (symphysis pubis), completely covering the cervix and holding spermicide against the cervix. It's held in place by vaginal muscles.

Effectiveness rate. With the use of spermicide, the typical effectiveness rate for the diaphragm is 84 percent. In other words, 16 out of 100 women using the diaphragm for one year will get pregnant.

Side effects and health risks. Women rarely experience side effects while using the diaphragm. Some women report vaginal irritation caused by the latex rubber or the spermicides used with the device. Other risks include:

• Urinary tract infection
• Vaginal infection
• Toxic shock syndrome with prolonged use

How to use the diaphragm. If you decide on the diaphragm, your doctor determines which size diaphragm best fits your body. Weight gain, weight loss or changes in vaginal tone affect how the diaphragm fits. Have your doctor reassess your diaphragm's fit each year at the time of your regular pelvic exam. With proper care, your diaphragm could last up to two years before it needs to be replaced.

The diaphragm must be used with spermicide. It does not provide protection against pregnancy without the use of spermicide. The diaphragm may be inserted up to an hour before sex. Once in place, it provides effective contraceptive protection for up to six hours.

Here are some additional tips for diaphragm insertion:

• Hold the diaphragm with the dome down. Squeeze about 1 teaspoon of spermicide into the dome and spread a little bit around the rim with your finger.
• Squeeze the diaphragm so that it folds. Spread your labia with your other hand and insert the folded diaphragm into your vaginal canal. This can be done standing, with one foot propped up, squatting or lying on your back.
• Push the diaphragm downward and along the back wall of your vagina as far as it will go. Then tuck the front rim up along the roof of your vagina behind your pubic bone.
• If the diaphragm is correctly placed, the back rim is below and behind the cervix and the front edge of the rim is tucked up behind the pubic bone. You shouldn't be able to feel it except with your fingers.

After sex, leave the diaphragm in place for at least six hours but for no more than 24 hours. After removal, wash the diaphragm with mild soap and warm water and allow it to air-dry. Use only water-based lubricants with the diaphragm, and examine it regularly for holes, tears or leaks.

Some women may not be suited for the diaphragm due to:

• Frequent urinary tract infections
• Poor vaginal muscle tone
• An infection or, in rare circumstances, a scar from a cut or tear in the pelvic area

Don't wear the diaphragm during any kind of vaginal bleeding, including your menstrual period.

Cost and availability. The diaphragm itself generally costs $30 to $50. The initial examination that's required for a diaphragm fitting costs $50 to $200.