The diaphragm is a barrier method, used in a variety of sizes and shapes since the 1900's. Except for improvements in spermicides, diaphragm technology has changed little since that time. Any woman, in whom a good fit may be obtained and this is most women, can use a diaphragm. It has no effects on future fertility, no systemic effects, and does not alter hormones. Used correctly and consistently, the diaphragm is 80 - 94% effective in preventing pregnancy and offers some protection of the cervix from sexually transmitted diseases. The cost per two years is approximately $50 - 150, including office visit, fitting, and the diaphragm itself.
The diaphragm needs to be properly sized for each woman. Your practitioner will measure the appropriate fit and insert the diaphragm initially. Being comfortable with your body and able to locate your cervix ( the mouth of the uterus ) are important to successful diaphragm use. At the initial fitting, you will insert and remove the diaphragm yourself. Use the diaphragm for a few weeks, with a back up method, then return to the clinic wearing it. It is very important to have the size re-checked. Then, you only need to return once a year at your annual exam. Bring it with you then, not wearing it.
You may need a different size diaphragm and to be seen by your health care provider if:
Before using, inspect the diaphragm for holes or defects by gently stretching it with your fingers and holding it up to the light.
You may insert the diaphragm up to 4 hours before intercourse, though just prior is preferable. It is effective as soon as it is inserted. If more than 6 hours pass before intercourse, you must take it out and start over, or add additional spermicide intravaginally. Use your diaphragm every time you have in ter course, including during and around the time of menstruation.
Hold the diaphragm with the dome down and squeeze a tablespoon or so of contraceptive cream or jelly into the cup. Only contraceptive cream or jelly is acceptable. Anything else can degrade the diaphragm. Spread it around inside and around the rim. Occasionally, a woman or her partner will find spermicidal cream or jelly irritating. Changing to another brand may resolve the problem.
Position yourself either squatting, lying down, sitting, or standing with one leg propped up on some thing. Then, with one hand, hold the diaphragm so that the dome/cup is facing toward your palm. Press the opposite sides of the rim together so that it folds, spread the lips of your vagina with the other hand and insert the folded diaphragm into the vaginal canal down and back as far as it will go. Tuck the front rim behind the pubic bone. As you use your diaphragm more, this procedure should become easier, so relax.
Each time you insert, you must check for proper position by feeling for the cervix behind the rubber dome. This also pushes the spermicide up against the cervix where it belongs. Once it is in place, you should not be able to feel it, except with your fingers. If it is uncomfortable, repeat the insertion, checking again for position.
The diaphragm must be left in place for 6 - 8 hours after intercourse before removal. If you have intercourse more than once in that period, insert another applicator of cream or jelly, or use foam or a condom, without removing the diaphragm. Do not douche during this time.
To remove, place your index finger either over or under the front rim and pull down and out. If you find it is difficult to remove, try squatting and push down with your abdominal muscles.
Wash with a mild soap and water after each use, dry thoroughly, and store in its plastic container, away from heat. It is suggested that the plastic container not be kept shut except when needed for travel. The rubber may discolor, but a diaphragm should last one to two years with good care.
If you have any questions or if any of this information is unclear, please be sure to speak with one of the providers in the Women's Health Program. The telephone number for an appointment is 603/646-9401.
Last Updated: 3/22/10