Diaphragm: Teen Version

What is a diaphragm?

The diaphragm is a dome-shaped rubber cup with a flexible rim. It is used to help prevent pregnancy. Before intercourse the diaphragm is filled with a contraceptive cream or jelly and put into the vagina. The contraceptive cream or jelly contains a spermicide, a chemical that kills sperm. The diaphragm covers the cervix, which is the opening into the uterus. The diaphragm and spermicide work together to make a barrier that stops live sperm from reaching the uterus.

There are several sizes and types of diaphragms. They may be made from latex or silicone. You need a measurement and fitting by your healthcare provider to make sure that you get a diaphragm that fits correctly. The largest size that feels comfortable should be used.

How do I use a diaphragm?

Put the diaphragm into your vagina no more than 6 hours before you have sex.

1. Before you insert the diaphragm, urinate and wash your hands.
2. Check the diaphragm for any holes or tears. If you find a hole or tear, use a different method of birth control until you get a new diaphragm.
3. Squeeze 1 to 2 teaspoons of contraceptive cream or jelly into the dome of the diaphragm. Rub a small amount of the contraceptive cream or jelly around the inside of the diaphragm and also on the outside of the rim with your fingertip.
4. Get into a comfortable position. The 3 positions used most often are:
   • lying on your back with your knees up
   • squatting with your knees bent and wide apart
   • standing with 1 leg propped up with your foot resting on a stool or chair and your knees slightly bent
5. Fold the diaphragm in half by pressing the opposite sides together with the thumb and fingers of one hand. Hold the diaphragm with the dome hanging below the rim to keep the contraceptive cream or jelly in the dome. Hold the folds of skin around your vagina open with your other hand. Gently slide the folded diaphragm into your vagina, using your index finger on the rim to guide it. Aim toward the small of your back, as if you were inserting a tampon. You may feel the rim of the diaphragm pass over the cervix. Use your index finger to push the front rim up behind the pubic bone.
6. Make sure that the diaphragm is in place. Put your finger into your vagina and touch the dome. You should feel the cervix through the dome of the diaphragm. You may also feel folds in the surface of the dome. Move your index finger to the front rim of the diaphragm and make sure it is firmly in place behind the pubic bone. The back rim must be behind the cervix so that the cervix is completely covered.

Noncontraceptive lubricants can be used to help with insertion of the diaphragm, but they may lower the ability of the diaphragm to prevent pregnancy. Don’t use petroleum or oil-based lubricants with a diaphragm. They could weaken the material of a latex diaphragm and then the diaphragm might not prevent pregnancy.

If you have intercourse more than 6 hours after you put the diaphragm in your vagina, you will need to insert another dose of spermicide before you have sex.

When and how should I remove the diaphragm?

Leave the diaphragm in place for at least 6 hours after intercourse. Remove it as soon after this as possible. A diaphragm should be removed and washed at least once every 24 hours. Do not douche with the diaphragm in place.

If you have sex more than once after you inserted the diaphragm, you should insert more contraceptive cream or jelly into your vagina before each time. Do not remove the diaphragm to do this. A plastic applicator is sold with the contraceptive cream or jelly. Use this applicator to put more jelly or cream into your vagina, in front of the diaphragm.

To take the diaphragm out, put your index finger in your vagina and hook it under the rim of the diaphragm behind the pelvic bone. Gently pull the diaphragm down and out.

Wash the diaphragm after every time you have sex with mild soap and water. Dry it with a towel and put it in its case. Store the diaphragm in its case away from heat.

How can I prevent infections?

Incorrect use of the diaphragm can cause infections. To help prevent infections:

• Wash your hands carefully before you insert or remove the diaphragm.
• Do not keep the diaphragm in your vagina longer than 24 hours at a time.
• Urinate right after you take the diaphragm out.
• Do not use your diaphragm during your period or when you are having abnormal vaginal discharge. Your partner can use condoms instead.
• Do not use a diaphragm for the first 3 months after childbirth.
• Do not use a spermicide if it irritates you skin or causes a rash or itching.

When do I need to get a new diaphragm?

You should get a new diaphragm every 1 to 2 years. You should examine your diaphragm carefully before each use to look for any holes or tears. If there are any holes or tears, use another form of birth control until you get a new one.

Ask your healthcare provider to check your diaphragm fitting:

• If you gain or lose more than 10 to 20 pounds.
• If you have pain or discomfort from your diaphragm.
• If you have been pregnant and had a baby since your last fitting.
• If you have had any kind of pelvic surgery.
• At least every 2 years because the size or shape of your cervix may change.

What are the benefits?

The benefits of a diaphragm are:

• This method of birth control is 84 to 94% reliable in preventing pregnancy.
• Diaphragms may offer some protection against sexually transmitted diseases (STDs). However, you should consider using condoms with the diaphragm for better protection against infection.
• There are practically no side effects from the use of the diaphragm and spermicide. This is a very safe method of birth control.
• This method is relatively inexpensive compared to other choices.
• Diaphragms give immediate protection against pregnancy when used properly. Hormonal methods of birth control, like birth control pills, don’t protect against pregnancy until you have been using them for at least 1 menstrual cycle.
• Diaphragms may be inserted with spermicide up to 6 hours before sex so their use does not have to interrupt love-making.

What are the disadvantages?

Some of the disadvantages of a diaphragm are:

• A diaphragm must be fitted and prescribed by a healthcare provider.
• If it is not correctly fitted, it may cause discomfort and possibly a urinary tract infection or pregnancy.
• You may not be comfortable with inserting and removing the diaphragm and checking its position.
• The diaphragm and spermicide must be inserted before any genital contact. If both you and your partner are not able to exercise this willpower every time you want to have sex, this is not a good form of birth control for you. Even if you forget just one time, you could get pregnant.
• You must keep a supply of contraceptive cream or jelly on hand at all times.
• This method does not protect against some sexually transmitted diseases. To protect yourself against STDs, use a condom every time you have sex, even though you are also using a diaphragm.

You should not use a diaphragm if you have ever been diagnosed with toxic shock syndrome. Do not use a latex diaphragm if you have a sensitivity or allergy to latex.

When should I call my healthcare provider?

Call your provider right away if you have any of the following symptoms while your diaphragm is in place:

• unexplained fever over 101°F (38.3°C)
• vomiting
• abdominal pain
• lightheadedness or dizziness when you stand up
• diarrhea
• muscle aches
• rash
• burning or painful urination

Call during office hours if you have any questions about the use of your diaphragm.