When discussing birth control options with my patients, the diaphragm often comes up. The most important thing to know about using a diaphragm is that it’s most effective at preventing pregnancy ONLY when used with a spermicide. If you have a sensitivity or allergy to spermicide; the diaphragm may not be for you. Also, the diaphragm does not offer protection from sexually transmitted diseases. Effectiveness for pregnancy prevention varies anywhere between 85-94%. If used consistently and correctly with a spermicide, approximately 6 out of 100 women will get pregnant each year.
The diaphragm is a birth control (contraceptive) device that prevents sperm from entering the uterus. The diaphragm is a small, reusable rubber or silicone cup with a flexible rim that covers the cervix. Before sex, the diaphragm is inserted deep into the vagina so part of the rim fits snugly behind the pubic bone; it may be left inside the vagina for up to 24 hours after intercourse. It is recommended that spermicide be applied before each act of intercourse and the diaphragm be left inside the vagina for 6 hours after intercourse.

The diaphragm comes in different sizes. Your health care provider can fit you for the diaphragm and demonstrate how to insert and remove the diaphragm. I highly recommend practicing insertion and removal yourself while still in the office to make sure you are comfortable with it. I once had a patient decide the diaphragm was not for her after I left her in the office alone to practice with it. I have found that women who are not comfortable touching their genitals are least likely to be successful with the diaphragm. You may also want to use a backup method of contraception, i.e. — male condom when first using the diaphragm. Most women find it takes a couple of months before they’re fully comfortable and confident using a diaphragm.

Make sure you regularly check your diaphragm for puncture marks or cracks. To search for holes, hold your diaphragm up to the light and gently stretch the rubber between your fingers or fill the diaphragm with water. A diaphragm must be replaced every 2 years. It’s important to remember that throughout a woman’s lifetime her cervix and vagina changes shape and this can affect the effectiveness of the diaphragm. Proper fitting is extremely important so if you use a diaphragm I recommend bringing it with you to your yearly GYN exam and have your healthcare provider make sure you are using the proper size.


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