Choosing a Birth Control Method – Diaphragm

(Updated June 2014)

Description

The diaphragm is a flexible latex or silicone dome-shaped device filled with spermicide and inserted into the upper vagina covering the cervix. It creates a spermicidal barrier at the cervical opening.

Use

Diaphragms require a prescription and a fitting for the correct size, ranging from 50 to 95 mm in diameter. They should be refitted after:⁸⁵

• Full-term pregnancy
• Abdominal or pelvic surgery
• Miscarriage or abortion after 14 weeks of pregnancy
• Weight change after pregnancy of 20 percent or more

The clinician should teach each patient how to apply spermicide to the device, insert it, and check it for correct placement. Women should practice inserting and removing the device in the clinician’s office until they feel comfortable. They should also learn how to check the diaphragm for tears and holes before each use and to clean and store the device properly.

Women can insert the diaphragm up to 6 hours before intercourse and should leave it in place for at least 6 hours but no more than 24 hours after the last act of intercourse. If the patient has additional acts of intercourse before 6 hours have elapsed, she should insert fresh spermicide onto the rim of the diaphragm with her finger without removing the device. She should not rinse the vagina or douche while wearing the diaphragm and for at least 6 hours after the last act of intercourse.

Effectiveness

This method is effective. With correct and consistent use, the failure rate is 6 percent. Typical use is associated with a 12 percent failure rate.¹⁹

Risks

The incidence of urinary tract infections (UTIs), bacterial vaginosis, and vaginal candidiasis may be increased in some women who use a diaphragm.^{86, 87}

Side Effects

None

Contraindications and Precautions

Advantages

• Relatively discreet (can be inserted ahead of time)
• Easily reversible
• After up-front cost, relatively low ongoing cost for spermicide
• After initial fitting and instruction, no need for repeated visits to health care provider other than for replacement every 2 years

Disadvantages

• Requires prescription
• Required with every act of intercourse
• Lower efficacy than some other methods with typical use
• Increased risk of UTIs and vaginal infections
• For some women, difficulty in learning insertion and removal techniques
• No protection against STIs

Counseling Messages

• Consistent and correct use is essential to the effectiveness of the diaphragm.
• Oil-based lubricants damage latex and therefore should never be used with the latex diaphragm.
• This method does not protect against STIs.