Diaphragm

The diaphragm is a latex rubber or silicone dome which is inserted into the vagina. It covers the cervix, acting as a barrier to sperm and therefore helping it to prevent pregnancy. Diaphragm could be left inside the vagina for a minimum of 6 hours after sexual intercourse but not more than 24 hours to avoid the risk of toxic shock syndrome and pressure ulcers forming. The application of spermicidal cream or gel is indicated with the use of the diaphragm. This will give contraception protection for 3 hours. After 3 hours if no sexual intercourse has taken place more spermicidal will need to be inserted, such as in vaginal pessary form.

The diaphragm is intended for multiple use, however must be taken care of by washing with mild soap and water, and dried before bent back into shape and kept in its case following use. Talcum powders, detergents and perfumes should be avoided as these will affect the natural flora in the vagina leading to infections. The diaphragm should be kept away from direct sunlight and heat sources as these may cause the diaphragm to perish. It should also be checked regularly for holes as this will reduce its effectiveness. The diaphragm has to be renewed every year. It must also be renewed in the event of a vaginal infection to prevent re-infection.

With careful consistent use the diaphragm is 94% effective when used with a spermicide in preventing pregnancy in the first year. With typical use where a woman does not use this method carefully, the efficacy is 84% effective when used with a spermicide in preventing pregnancy in the first year. Failure rates for the diaphragm depend on how effectively the woman uses it, such as whether it has been used consistently and whether it was placed correctly covering the whole cervix. Other factors which influence the failure rate of all methods are a woman’s age and how often she is having sexual intercourse. For example if a woman is aged 40 and uses a diaphragm as a contraceptive she is less fertile than a woman aged 25 so a diaphragm is a more effective contraceptive for her. The use of spermicide with a diaphragm has been debated amongst researchers as some have claimed it does not to make a significant difference. But current guidelines indicating the use of spermicide remain.

There are three main types of diaphragm.  The first is known as a flat spring diaphragm suitable for women with an anterior or midplane positioned cervix. The second is a coiled spring diaphragm suitable for women with a shallow symphysis pubis, and the third is an arcing spring diaphragm suitable for women with a posterior positioned cervix, or where a woman has difficulty feeling her cervix. A woman wanting to use the diaphragm would need to first have a vaginal examination and then be taught how to use it for the first times by a health professional. Routine visits and examination by a professional are indicated every 6 months. The number of women using diaphragms has dropped significantly since the 1960s with the introduction of the hormonal pill and modern intra uterine devices in the market, from one-third of American couples in the 1940s to 0.2% in 2002.

 


 

Disadvantages

  • Requires motivation
  • Needs to be used carefully and consistently for optimum efficacy
  • Needs to be used with a spermicide which may be perceived as messy
  • May increase the risk of cystitis and urinary tract infections.
  • No protection against HIV.


Advantages

  • Under the control of the woman.
  • May give some protection against cervical cancer and some Sexually Acquired Infections.
  • No systemic side effects
  • Provides vaginal lubrication
  • Can be used during menstruation
  • Gives a woman permission to touch and explore her body.

 

Contraindications

  • Pregnancy
  • Undiagnosed genital tract bleeding which must be investigated and treated first.
  • Poor vaginal muscle tone or prolapse
  • Abnormalities of the vagina or the cervix existing since birth (congenital)
  • Allergy to rubber or spermicide
  • Present vaginal, cervical, or pelvic infection which must be investigated and treated
  • Recurrent urinary tract infections
  • Past history of toxic shock syndrome
  • Women who feel unable to touch their genital area because of personal or religious reasons.

 

Side effects

  • Urinary tract infection
  • Toxic shock syndrome – associated with diaphragms being worn for more than 30 hours
  • Vaginal irritation