A diaphragm is a barrier method of birth control, designed as a shallow, dome-shaped cup crafted from soft, flexible silicone. It is meticulously positioned inside the vagina to fit snugly over the cervix, which is the lower part of the uterus that extends into the vagina. The primary function of a diaphragm is to prevent pregnancy by acting as a physical barrier, blocking sperm from entering the uterus and reaching an egg.
Diaphragm Explained: How it Works for Contraception
Diaphragms work through a simple yet effective mechanism. Inserted into the vagina, the diaphragm creates a physical barrier directly over the cervix, preventing sperm from passing into the uterus. To enhance its effectiveness, it is always used in conjunction with spermicide. Spermicide, a cream or gel that immobilizes or kills sperm, is applied to the diaphragm before insertion, both within the dome and around the rim. This dual-action approach—physical barrier plus spermicidal agent—significantly reduces the chance of sperm fertilizing an egg.
For optimal use, a diaphragm can be inserted up to two hours before sexual intercourse. It is crucial to leave the diaphragm in place for at least six hours following intercourse to ensure all sperm are inactivated. However, it should not remain in the vagina for more than 24 hours due to potential health risks. If intercourse is repeated while the diaphragm is in place, additional spermicide must be applied into the vagina using an applicator, without removing the diaphragm, to maintain effective contraception.
Effectiveness of Diaphragms in Preventing Pregnancy
When used consistently and correctly with spermicide, diaphragms can be an effective method of birth control. However, like many contraceptive methods, the effectiveness of a diaphragm is influenced by user diligence. With typical use, meaning not always using it correctly or every time, about 12 out of 100 women may become pregnant in a year. With perfect use, which involves using it correctly every single time, the pregnancy rate is lower.
Several factors play a crucial role in how well a diaphragm works:
- Proper Fit: A diaphragm must be correctly sized and fitted by a healthcare provider to ensure it adequately covers the cervix. An ill-fitting diaphragm may not provide effective contraception.
- Consistent Use: For maximum effectiveness, the diaphragm must be used every time you have vaginal intercourse.
- Spermicide Application: Spermicide must be used with each act of intercourse while the diaphragm is in place to kill or immobilize sperm.
- Care and Maintenance: Proper cleaning and storage of the diaphragm are essential. After each use, it should be washed with mild soap and water, rinsed thoroughly, and air-dried. It should be stored in its case when not in use. Avoid using oil-based lubricants, baby powder, or certain vaginal creams as they can damage the diaphragm material. Diaphragms should be replaced every two years and regularly checked for damage like holes or weak spots.
Diaphragms and Protection Against Sexually Transmitted Infections (STIs)
It is important to note that diaphragms are designed to prevent pregnancy and do not offer protection against sexually transmitted infections (STIs). For STI protection, using condoms in conjunction with a diaphragm is necessary if you or your partner are at risk of STIs.
Abstinence, meaning not engaging in sexual intercourse, remains the only method that completely prevents both pregnancy and STIs.
Potential Downsides and Side Effects of Diaphragm Use
While diaphragms are generally safe for most women, some potential side effects and drawbacks are associated with their use:
- Irritation from Spermicide: Spermicide can cause vaginal and surrounding skin irritation or allergic reactions in some individuals.
- Vaginal Discharge or Odor: If a diaphragm is left in place for longer than recommended, it can lead to unpleasant odors or vaginal discharge.
- Allergic Reaction to Diaphragm Material: Although rare, some individuals may experience an allergic reaction to the silicone or latex material of the diaphragm.
- Increased Risk of Urinary Tract Infections (UTIs): Diaphragm use has been linked to a slightly increased risk of UTIs in some women.
- Toxic Shock Syndrome (TSS): In extremely rare cases, leaving a diaphragm in for an extended period significantly increases the risk of toxic shock syndrome, a serious bacterial infection.
Is a Diaphragm the Right Contraceptive Choice for You?
A diaphragm can be a suitable birth control option for women who:
- Are comfortable with inserting and removing the device.
- Can reliably use it every time they have sex.
- Are able to plan ahead for sexual activity.
- Prefer a hormone-free birth control method.
However, a diaphragm may not be ideal for women who:
- Are uncomfortable touching their genitals or inserting something into their vagina.
- Have frequent urinary tract infections.
- Are unable to consistently use spermicide.
- Are experiencing their menstrual period.
It’s essential to discuss your health history and lifestyle with a healthcare provider to determine if a diaphragm is the right contraceptive method for you.
Accessing a Diaphragm: Prescription, Fitting, and Consultation
Diaphragms are prescription devices, meaning you need to get a prescription from a healthcare provider, such as a doctor, gynecologist, or nurse practitioner. A proper fitting is crucial to ensure the diaphragm is effective and comfortable. The fitting process typically involves a pelvic exam where the healthcare provider will determine the correct size diaphragm for you. They will also teach you how to properly insert, remove, and care for your diaphragm.
Regular check-ups, ideally during your annual exam, are recommended to ensure the diaphragm still fits correctly, especially after events like weight changes, pregnancy, abortion, or if your sexual activity status has changed since the initial fitting. If any of these changes occur, it’s advisable to get refitted sooner rather than waiting for a routine exam.
Understanding the Cost of a Diaphragm
The costs associated with a diaphragm can vary. The diaphragm itself may range from $0 to around $250, which usually includes the office visit for fitting and training. Many health insurance plans often cover the cost of diaphragms and related services under preventive care or contraceptive coverage. Family planning clinics, like Planned Parenthood, may offer services at a reduced cost, particularly for those with limited income. In addition to the diaphragm, you will need to purchase spermicide, which typically costs around $0.50 to $1.50 per application. Remember that a diaphragm needs to be replaced approximately every two years.
When to Contact Your Healthcare Provider
If you are using a diaphragm, it’s important to contact your healthcare provider if you experience any of the following:
- Suspect you might be pregnant.
- Notice a change in the odor or color of your vaginal discharge.
- Develop symptoms of a urinary tract infection (UTI), such as pain or burning during urination, or a frequent urge to urinate.
- Experience unexplained fever or chills.
- Have persistent belly or pelvic pain.
- Experience pain during sexual intercourse.
- Show signs of toxic shock syndrome (TSS), which can include a sunburn-like rash, body aches, fever, diarrhea, vomiting, or dizziness.
Consulting with a healthcare provider is essential for proper fitting, guidance on use, and addressing any concerns or health issues related to diaphragm use.
