What is a Diaphragm

If you are exploring birth control options then the diaphragm might be an option.

The diaphragm is a dome-shaped device made of latex or silicone that is used to prevent pregnancy. The device is placed inside the vagina to serve as a mechanical barrier by holding spermicidal preparation in place within the vagina. It is, therefore, a barrier form of birth control (combined with spermicide) that work by blocking the uterine opening to prevent the sperm from swimming up the uterus to fertilize an egg. The barrier is used concurrently with a spermicide that kills the sperms.

The diaphragm is a reusable single-sized device with a nylon spring that folds easily with less effort making it easy to insert and remove. The device acts as a barrier only when inserted in the vagina before sex. It covers the cervix and a contraceptive gel is used to block sperm from reaching the uterus, thereby preventing pregnancy. The best thing is that it is non-hormonal and it is easy to use

 

Is diaphragm the same as a cervical cap?

A cervical cap is similar to a diaphragm but smaller. They are both used for pregnancy protection, however, a diaphragm is worn inside the vagina, covering the cervix and the cervical cap is worn over the cervix.

You need to be fitted for a cervical cap and the diaphragm and also need a prescription from your Gynecologist.
They are both effective as birth control methods but do not offer protection against sexually transmitted infections. While the diaphragm has a shallow dome-shape, the cervical cap has a shape similar to a sailor`s hat. Furthermore, a diaphragm should not be left inside the vagina for more than 24 hours as it can cause toxic shock syndrome, likewise, a cap should be used for up to 48 hours. Although the two devices are almost similar, they are fitted differently, a diaphragm covers the cervix and the area around while a cervical cap fits in snugly on the cervix itself.

 

Effectiveness of  the Diaphragm 

There are many factors that you need to considered prior to choosing the most appropriate method for birth control such as affordability, accessibility, effectiveness, acceptability, and safety. Your choices should be well-informed for dual protection against STDs and pregnancy. It is important to note that hormonal contraceptives are highly effective in preventing pregnancy, but do not prevent STDs and HIV transmission.

A diaphragm is 92-96 % effective at preventing pregnancy when used correctly and concurrently with spermicide. Meaning, in every 100 women, only between 4 and 8 of them using a diaphragm will become pregnant in a year. The device may offer limited protection against STDs because they cover the cervix where they protects the cervix from direct contact with bacteria or viruses. The condom offers an effective method for STD protection, the man can wear a condom while the woman wears a diaphragm to reduce the risks of sexually transmitted infections. Moreover, he can use the withdrawal method to reduce the risks of pregnancy.

How to make a diaphragm effective

• Consistently use a diaphragm every time you have vaginal sex
• Concurrently use a diaphragm with a contraceptive cream or jelly for every act of vaginal sex
• Leave the diaphragm in the vagina for at least 6 hours after the last act of intercourse
• Ensure that the diaphragm has no holes or is not damaged before each use.
• Ensure it fits well, that it is correctly placed over the cervix
• Use a spermicide
• Double-up to increase the effectiveness

Facts

• A diaphragm cannot prevent STDs
• Those with poor vaginal tone cannot use the diaphragm
• Avoid the diaphragm if you had recent surgery of the cervix
• Visit the clinic if you find them difficult to insert the diaphragm
• Avoid the diaphragm if you have frequent urinary tract infections.
• Avoid them if you are sensitive to latex, silicone, or spermicide
• You should not use a diaphragm if you have a vaginal or pelvic infection
• Avoid the diaphragm in case of vaginal or uterine abnormality
• Visit the clinic after 14 weeks of full-term pregnancy for refit
• Visit the clinic after an abdominal or pelvic surgery
• Check-in with a doctor after an abortion or miscarriage before fitting a diaphragm
• Visit a doctor when you add or lose more than 3kgs to replace a new diaphragm
• Ensure you are properly trained on how to use a diaphragm
• A diaphragm is non-hormonal method of birth control
• It does not affect the milk supply during breastfeeding
• It can be inserted a few hours before sex. The hours will depend on the instructions given on the package diaphragm
• Use the diaphragm only when you want to have sex.
• You don’t have to remove the diaphragm to reapply spermicide after a sexual act
• A woman feels more in control of her family planning responsibility
• If used correctly, it has less serious health risks or side effects
• It does not affect the menstrual cycle
• It is easily reversible
• Unlike the IUDs, the diaphragm cannot be felt by either partner during sex

Cons

• It does not offer reliable prevention of sexually transmitted infections.
• The spermicide used can cause vaginal irritation or vaginal burning
• The use of diaphragm and spermicide can increase the risk for urinary tract infection
• It can cause toxic shock syndrome especially if left in the vagina for more 24 hours
• It is not as effective as other types of family planning.
• Some women find it difficult to insert
• It can cause bladder infections for some women
• It can interrupt sex since some women feel uncomfortable when touching their vagina or vulva
• There are some possibilities for the diaphragm to move during intercourse, depending on the penis size, sexual position, and heavy thrusting.

 

How to use a diaphragm

1. Clean your hands
2. Remove the diaphragm from the package
3. Put a few strips of spermicide on the upper side of the diaphragm
4. Put your index finger onto the diaphragm and squeeze it between the thumb and the other fingers
5. Fold the diaphragm in half so that the two sides of the rim touch each other
6. Use the other hand to separate the labia
7. Slide the diaphragm as far as possible into the vagina aiming back toward the tailbone and ensure it covers your cervix. A lubricating gel may be used during the fitting.
8. Push the front rim of the diaphragm using the other finger up behind the pubic bone.
9. Ensure it covers the cervix. You should feel your cervix through the diaphragm as the part that feels firm (not bony).
10. If it is not correctly placed, remove and reinsert

How to remove a diaphragm

Hook your finger under the rim or loop and pull downwards

Sizes

There are different types of diaphragms such as latex arcing, coil spring, and flat spring, and the silicone wide seal rim. The diaphragms have a standard fitting of 75mm, but depending on the type the fitting ring range from 60-90mm in size

 

Dos and Don’ts

• Do visit the clinic after delivery to refit the diaphragm
• Do visit the clinic after pelvic or abdominal surgery or after an abortion or miscarriage for refitting
• Do use a spermicide for the diaphragm to be effective
• Do double up with a condom if you are at high risk of STD or pregnancy
• Do remove the diaphragm in case you feel unwell with a fitted diaphragm
• Do notify your health care provider when you experience discomfort
• Do not share
• Do not use a diaphragm if you are sensitive to its products
• Do not use if you have a history of toxic shock syndrome
• Do not use if you have a history of prolapse
• Do not use if you have multiple sexual partners or at a high risk of sexually transmitted infections
• Do not leave it in the vagina for more than 24 hours

Conclusion

The diaphragm is highly effective in preventing pregnancy. Therefore, there is a need for patient education and motivation in diaphragm fitting to promote compliance and success. Proper training and consistent use make the diaphragm effective. In addition, combining with other contraceptive methods including the concurrent use of male condoms with spermicides increases its effectiveness. However, women who are sensitive to diaphragm products should not use them.

 

References

Allen, R. E., & Alberta, C. (2004). Diaphragm fitting. American Family Physician, 69(1), 97-100. Retrieved from www.aafp.org/2004/0101/p97.html

Amy. (2010, August 16). What is the difference between a cervical cap and a diaphragm?. Retrieved from http://www.plannedparenthood.org/learn/teens/ask-experts/what-is-the-difference-between-a-cervical-cap-and-a-diaphragm

National Health Service (NHS). (n.d.). Contraceptive diaphragm or cap. Retrieved from http://www.nhs.uk/conditions/contraception/contraceptive-diaphragm-or-cap/

Prevention and Health Promotion Administration-Maryland. (2016). Diaphragm. Retrieved from http://phpa.health.maryland.gov/mch/FP_Guidelines_2016/1.8 Contraception, Diaphragm source

Smith, L. (2017, June 20). All about diaphragm birth control. Retrieved from http://www.medicalnewstoday.com/articles/295727.php

Teen Source. (n.d.). Diaphragm and cervical cap. Retrieved from http://www.teensource.org/birth-control/diaphragm-cervical-cap

The American College of Obstetrician and Gynecologists (ACOG). (2018). Barrier methods of birth control: Spermicide, condom, sponge, diaphragm, and cervical cap. Retrieved from http://www.acog.org/Patients/FAQs/Barrier-Methods-of-Birth-Control-Spermicide-Condom-Sponge-Diaphragm-and-Cervical-Cap/