How to Use Your Diaphragm Birth Control

How to Use Your Diaphragm Birth Control

A diaphragm is a soft, latex or silicone dome-shaped barrier that is placed in the vagina with sperm-killing (spermicidal) jelly before intercourse. It covers the cervix, kills sperm, and blocks the passage of sperm into the cervix. This method does not protect against STIs (sexually transmitted infections).

The diaphragm is a reusable dome-shaped cup that fits over the opening to the cervix and prevents pregnancy.

For effective birth control, your diaphragm has to fit well. Your doctor will examine you to find the correct size.

What are the advantages of using a diaphragm?

• You can use it while breastfeeding.
• It is not felt by your sexual partner.
• It does not interfere with your female hormones.
• It works immediately and is not permanent.
• It has few side effects or risks associated with its use.
• When used properly, it is safe and effective.

What are the disadvantages of using a diaphragm?

• It is sometimes difficult to insert.
• It may shift out of place during sex.
• It requires a prescription, and you must have it fitted and refitted by your health care provider.
• It may increase the risk of urinary tract infections.
• There is an increased risk of toxic shock syndrome if it is left in place for more than 24 hours.
• It should not be used during your menstrual period.
• It may cause you pain or discomfort during sex.
• It does not protect against STIs, including HIV (human immunodeficiency virus). Using a condom is recommended to reduce these risks.

To be sure that you know how to use your diaphragm, you will need to practice putting it in and taking it out while you are in your doctor’s office. Your doctor will check to see that the diaphragm fits right.

To lower your risk of getting pregnant, you must use your diaphragm correctly and use it every time you have intercourse. You must also use the diaphragm with spermicide (a gel or cream that kills sperm trying to enter the cervix) in order to prevent pregnancy.

The diaphragm can be inserted up to 2 hours before intercourse . If it is inserted more than 2 hours before intercourse , the spermicide must be applied again.

A diaphragm must be fitted by a health care provider during a pelvic exam. The health care provider will measure your vagina before prescribing a diaphragm.

During the exam, you will also learn about the use and care of a diaphragm as well as possible problems. It is important to have the diaphragm rechecked and possibly refitted if you:

• Become pregnant.
• Have significant weight changes (you gain or lose 20% of your body weight), such as gaining or losing 32 lb (14 kg) after weighing 160 lb (72 kg).

The diaphragm should be replaced every 2 years, or sooner if damaged.

Getting Your Diaphragm Ready

Before you put the diaphragm in your vagina, put about one tablespoon of spermicidal gel or cream in the cup. Smear some of the gel around the rim of the diaphragm. Do not use petroleum jelly or oil-based vaginal creams (such as Monistat). These can make tiny holes in the diaphragm.

How to Insert Your Diaphragm

You can put your diaphragm in while you are lying down, squatting, or standing with one leg up on a chair. Your legs need to be fairly wide open. Bending your knees can help. Once you’re in position, follow these steps:

• Use one hand to fold the diaphragm in half with the dome pointing down (see picture below). Hold your vagina open with your other hand.
• Put the diaphragm into your vagina, aiming for your tailbone (see picture below). Push the diaphragm as far back into your vagina as you can.
• Use one finger to push the front rim of the diaphragm up behind your pubic bone, aiming for your belly button.

How to Check Placement of Your Diaphragm

With your finger, feel for your cervix through the dome of the diaphragm. The cervix will feel firm, but not bony. It feels a bit like the tip of your nose.

If the diaphragm does not cover your cervix or if you cannot feel your cervix at all, the dome is not in the right place. This means that you need to remove the diaphragm, put more spermicidal gel on it, and insert it again.

The diaphragm should not fall out when you cough, squat down, sit on the toilet, or walk around. If your diaphragm stays in place when you do these things, the front rim is most likely in the right place above the pubic bone (see picture below).

After You Have intercourse

The following are some important points to remember after you have sex:

• Leave the diaphragm in place for at least six hours after you have intercourse .
• If you have sex again within six hours, put spermicidal gel in your vagina, but do not take your diaphragm out to put gel in the dome.
• Do not leave the diaphragm in your vagina for more than 24 hours. Doing so can cause infection, irritation, or even a complication called toxic shock syndrome.
• Do not douche while the diaphragm is in your vagina.

To remove the diaphragm, “hook” the front rim with your finger and pull down and out. Be careful not to tear a hole in the diaphragm with your fingernails. You should not wear your diaphragm during your menstrual period. You will need to use another method of contraception during this time.

How to Take Care of Your Diaphragm

After you take the diaphragm out of your vagina, wash it with mild soap and water, rinse it, and allow it to air dry. Always store your diaphragm in its container. Store the container in a cool, dry place, away from sunlight.

Check your diaphragm often for holes, tears, or leaks. To do this, fill the dome with water and look for tiny leaks.

Replace your diaphragm after one to two years. Every year, your doctor should check to see that your diaphragm still fits correctly. You will need to be measured again if you have a baby, have pelvic surgery, or gain or lose more than 15 pounds.

Follow these instructions at home:

• Wash the diaphragm with mild soap and warm water. Rinse it thoroughly and dry it completely after every use.
• Only use water-based lubricants with the diaphragm. Oil-based lubricants can damage the diaphragm. Water-based lubricants do not contain silicone, wax, or oil.
• Do not use talc on the diaphragm.
• Do not use the diaphragm if:
  • You had a baby in the last 2 months.
  • You have a vaginal infection.
  • You are having a menstrual period.
  • You had a recent surgery on your cervix or vagina.
  • You have vaginal bleeding of unknown cause.
  • Your sexual partner is allergic to latex or spermicides.

Contact a health care provider if:

• You have pain during sexual intercourse when using the diaphragm.
• The diaphragm slips out of place during sex.
• You have blood in your urine.
• You have burning or pain when you urinate.
• You find a hole in the diaphragm.
• You develop abnormal vaginal discharge.
• You have itching or irritation in your vagina.
• You cannot remove the diaphragm.
• You think you may be pregnant.
• You need to be refitted for a diaphragm.

Summary

• A diaphragm is a soft, latex or silicone dome-shaped barrier that is placed in the vagina with sperm-killing (spermicidal) jelly before sex.
• This method does notprotect against STIs (sexually transmitted infections).
• A diaphragm requires a prescription, and you must have it fitted and refitted by your health care provider.
• The diaphragm can be inserted up to 2 hours before sex.
• Leave the diaphragm in for 6–8 hours after having sex. Before sex can occur again during these 6 hours, spermicide must be reapplied.

When to Call Your Doctor

Call your doctor if you have any of the following problems:

• Trouble urinating, or painful or frequent urination
• Vaginal itching, discharge, or discomfort
• High fever (which can be a sign of toxic shock syndrome)

You also should call your doctor if your diaphragm gets a hole in it or does not seem to fit right. If your diaphragm has any of these problems, it needs to be replaced. If you keep using it, you could increase your risk of getting pregnant.

Diaphragm Fitting by Richard E. Allen, M.D.( 01/01/04,http://www.aafp.org/afp/20040101/97.html  )