Women's Clinic


DIAPHRAGM

A diaphragm is a latex dome with a flexible rim that holds spermicide against a woman’s cervix. There are 7 different sizes and the size diaphragm a woman needs depends on how many times she has given birth and other factors that affect the size and elasticity of the vaginal wall. A diaphragm must be fitted and prescribed by a clinician.

HOW IT WORKS:

A diaphragm works in two ways. It provides a physical barrier that prevents sperm from entering the uterus and holds a spermicide which kills sperm. It may protect against some sexually transmitted infections such as chlamydia and gonorrhea, but it does not protect against HIV and other viruses.

HOW TO USE:

A clinician will work with a woman in the office until she learns how to insert and remove the diaphragm correctly.

Before inserting the diaphragm, inspect it for tears and holes. Holding it up to a light will make it easier to see holes. Fill it with water and look for leaks to find out if there are any tears that are not visible. Make sure to check around the rim.

Place one to two tablespoons of spermicide in the dome and spread it around the inside and the rim. Spermicide can also be placed on the outer side, but this is not required. Do not use any oil-based products, it will destroy the latex.

To insert the diaphragm, fold it in half and insert it into the vagina. This can be done lying down or with one foot up on a toilet seat or bed. Push it all the way to the back. The front rim should hook behind the pubic bone and the dome should cover the cervix. To feel the cervix through a diaphragm, push on the center of the diaphragm. The cervix should feel like the tip of your nose. If the diaphragm can be felt in the vagina it is either not inserted correctly or it is the wrong size. Try reinserting it.

If you are having intercourse more than 6 hours since the diaphragm has been inserted or are having additional intercourse, more spermicide needs to be used. Do not take the diaphragm out. Use an applicator to insert more spermicide to the outside of the diaphragm.

Leave the diaphragm in place for at least 6 hours after last having intercourse, but do not leave it in the vagina for more than 24 hours at a time.

To remove the diaphragm, hook a finger under the rim and pull it out. Wash it with soapy water and pat dry with a clean towel. Storing the diaphragm in its original case will protect it against damage.

EFFECTIVENESS:

The failure rate for a diaphragm depends upon how well it is used. For a woman who uses it exactly as instructed, the failure rate is 6%. This means that during the first year of use, 6 out of 100 women who use a diaphragm will become pregnant. For a woman who does not always use it as instructed, the failure rate is 20%. A woman needs to be refitted for a diaphragm if she has a weight change of ten pounds or more and after a pregnancy. It should be replaced every two years.

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