Diaphragm

What is the diaphragm?
Diaphragms are barrier methods of contraception. 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 to prevent pregnancy. This not available in Malta.

How does the diaphragm work?
Diaphragms fit in your vagina and cover your 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 time by a health professional.

Types of diaphragm:
There are three main types of diaphragm. They come in different sizes and shapes. Diaphragms are circular domes made of silicone with a flexible rim.

Type include:

• Flat spring diaphragm - It is suitable for women with an anterior or mid-plane positioned cervix.
• Spring diaphragm - It is suitable for women with a shallow symphysis pubis.
• An arcing spring diaphragm - It is suitable for women with a posterior positioned cervix, or where a woman has difficulty feeling her cervix.

What is the efficacy of the diaphragm?
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 in preventing pregnancy in the first year when used with a spermicide. Failure rates for the diaphragm depend on how effectively the woman uses it, 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 make a significant difference. However, current guidelines indicating the use of spermicide remain.

How do I put a diaphragm in?
Discuss your doctor or nurse to show you how to put it in before starting to use it.

• Wash your hands with soap and water.
• Follow the instructions provided with the diaphragm.
• Get into a comfortable position, like when you’re putting in a tampon. You may want to squat or put one foot on a chair.
• Put a small amount of spermicide on the upper surface of the diaphragm.
• Put your index finger on top of the diaphragm and squeeze the diaphragm between your thumb and other fingers.
• Slide the diaphragm into your vagina upwards and backwards.
• Tuck the edge of the diaphragm behind your pubic bone.
• For the diaphragm to be effective it needs to cover the cervix.
• If you do not manage, hook your finger under the rim or loop and pull it downwards.

How many times can it be used?
The diaphragm is intended for multiple use, however, it must be taken care of by washing with mild soap and water, and dried before being bent back into shape and kept in its case for 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 must be renewed every year. It must also be renewed in the event of a vaginal infection to prevent re-infection.

How do I take my diaphragm out?
The diaphragm should be left inside the vagina for a minimum of 6 hours after sexual intercourse but for 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 contraceptive 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. Follow the instructions on the information sheet provided with the cap. Take it out by gently hooking your finger under the rim or strap and pulling downwards.

What are the disadvantages and advantages of a diaphragm?
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 Transmitted Infections.
• No systemic side effects.
• Provides vaginal lubrication.
• Can be used during menstruation.
• Gives a woman permission to touch and explore her body.

Who cannot make use of a diaphragm?
Most people can use a diaphragm; however, it may not suit you if you:

• Pregnant.
• Have undiagnosed genital tract bleeding which must be investigated and treated first.
• Have poor vaginal muscle tone or prolapse.
• Have abnormalities of the vagina or the cervix existing since birth (congenital).
• Are allergic to rubber or spermicide.
• Have a present vaginal, cervical, or pelvic infection which must be investigated and treated.
• Recurrent urinary tract infections.
• History of toxic shock syndrome.
• Are unable to touch your genital area because of personal or religious reasons.

What are the side-effects of the diaphragm?

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

I have just had a baby. Can I use a diaphragm?
Yes, but wait until at least six weeks after the birth. You may need a different size of diaphragm after you have had the baby. Speak to a doctor or a nurse to check that the size is correct.

Can I use a diaphragm after a miscarriage?
Yes, you may need a different size of diaphragm after a miscarriage. Speak to a doctor or a nurse to check that the size is correct.

I have lost/gained weight. What do I have to do?
If you gained or lost 3 kgs, you may need a different size of diaphragm.

Can I have a bath when I am wearing a diaphragm?
No. Water may dislodge it or wash away the spermicide.

Sexually Transmitted Infections
This contraceptive does not protect you from any STI. Only condoms can help against STIs.