Description
A diaphragm is a strong, thin, soft, rubber dome with a flexible rim. It is used to block the opening of the cervix to prevent sperm from entering into the uterus to cause pregnancy. It is most effective when used with a spermicidal cream or jelly. The combination is generally provides a 90%-98% effectiveness protecting against pregnancy.
Effectiveness
The ultimate effectiveness of the diaphragm is based about how reliable the user is. Failures occur primarily when the diaphragm is used improperly. For example, when it is not used because one or the other partner desires spontaneity or when it is inserted too soon before having intercourse for it to function properly.
How the Diaphragm Works
The diaphragm fits snugly over the cervix (the opening to the uterus) acting as a mechanical barrier. The spermicidal cream or jelly is used along the rim of the diaphragm for two purposes to kill sperm and to create a seal which holds the diaphragm up against the vaginal wall. The diaphragm also serves to hold the spermicide in place so that is most effective.
Fitting the Diaphragm
Each woman must be fitted individually. There are number of sizes running from very small to very large. The diaphragm is a prescription item so that it must be fitted by a doctor or nurse practitioner and then a prescription is issued.
Fittings should be checked yearly and after pregnancy, miscarriage or an abortion. It should be refitted if there is a weight gain or loss of greater than 20 pounds.
I always teach women how to insert and remove the diaphragm before leaving the office. Once learned insertion should be practiced for a while before counting on its contraceptive function. Using another form of contraception until you are secure is essential for preventing undesired pregnancy.
Instructions
1. Insertion:
An approximate tablespoons worth of spermicidal jelly is inserted into the center of the diaphragm. A bead of jelly is then run around the entire rim of the diaphragm. The diaphragm is then squeezed into an elongated form and inserted high into the vagina. This can either be done by hand or using a diaphragm inserter. You will have practiced this several times before you leave our office so that it is comfortable. The diaphragm must be inserted no less than 15-20 minutes prior to intercourse. After insertion check that the diaphragm is correctly applied by inserting one finger and feeling the cervix behind the diaphragm.
2. Time Limit for Effectiveness of Jelly:
The diaphragm should not be inserted more than 45 minutes before intercourse. If more than 45 minutes passes before intercourse occurs an additional application full of spermicidal jelly should be inserted into the vagina to ensure protection.
3. Intercourse:
a) A well fitted diaphragm should not slip nor be felt by either partner during intercourse.
b) Before each additional act of intercourse insert another applicator full of spermicide into the vagina. Do Not remove or displace the
diaphragm.
c) It is important to establish a routine of using the diaphragm. For instance, you could insert it every night before going to bed, thus avoiding interruption in lovemaking and allowing spontaneity. You could also have your partner insert it for you as part of the love play. This is often valuable for sharing the responsibility of using this method. It also involves the partner in the experience therefore reducing negative feelings and maximizing positive feelings.
4. Removing the Diaphragm:
The diaphragm must be left in place for at least 6 hours after the last sexual act. Under no circumstances should it be left in for more than twenty-four hours. Early removal risks failure of the method and undesired pregnancy.
5. Care of the Diaphragm:
Before inserting the diaphragm fill it with water. Look for any leaks. Wash it gently and then hold it up to the light and look for holes or cracks. The most likely place of wear and tear is around the base of the rim, check this area around the entire diaphragm thoroughly.
Upon removal the diaphragm should be washed with a mild soap and then thoroughly rinsed with water, dried, powdered lightly with corn starch and returned to its case for protection.
6. Additional Benefits:
The diaphragm can be used just before and during your period to catch and hold blood thereby protecting you from soiling accidentally or at time when it would be undesirable.
The diaphragm and spermicidal jelly have an additional affect of protecting against sexually transmitted diseases such as gonorrhea and chlamydia.
Remember: The diaphragm is at-the-time barrier protection only. You must use it correctly and insert it before intercourse. You can insert it up to 45 minutes ahead but it should not be removed until six hours after last intercourse .
To Be Protected All the Time, Use Your Diaphragm All the Time and Use it Right Every Time.
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