What is the diaphragm?
The diaphragm is a barrier method of contraception. It is a dome of soft silicone with a flexible rim which is placed inside the vagina to cover the cervix (the lower part of the uterus or womb). The diaphragm forms a barrier which prevents sperm from getting into the uterus. It is inserted before intercourse and left in place for a minimum of 6 hours after intercourse. It takes 6 hours for all sperm to die in the acid environment of the vagina.
How effective are diaphragms?
Diaphragms are between 88 -94% effective. This means that if 100 women use the diaphragm for a year between 6 and 12 will have a pregnancy.
The 3 most important factors in effectiveness:
- Using the diaphragm every time you have intercourse
- Making sure it is covering your cervix
- Leaving it in place for a minimum of 6 hours after intercourse
How do I use the diaphragm?
The diaphragm is inserted inside the vagina and then checked to ensure that it is covering the cervix. This check is very important and is the only way that you can be sure the diaphragm will work effectively. Occasionally some women may find this difficult. Your partner may be willing to assist in checking that it is covering the cervix if this is the case.
- What are the advantages of diaphragms?
- They are suitable for women who cannot, or choose not to use a hormonal contraceptive or an IUD.
- They are suitable for breastfeeding women.
- They can be used as needed at the time of sex.
- They last for up to 2 years before they need replacing.
- They can be used in conjunction with fertility awareness methods.
What are the disadvantages of a diaphragm?
- They have a higher failure rate than most other methods of contraception.
- Some women may have difficulty using them or may not ike putting them into the vagina.
- They may not be suitable for some women
How to get a diaphragm
If you have never had a diaphragm before we recommend that you have a fitting with a trained health professional to ensure that a diaphragm is suitable for you, and that you get the correct size. If you have had a diaphragm before but have gained or lost more than 3kg, had a baby, or had pelvic surgery since your last fitting then we recommend that you have another fitting. Fittings can be done by the specially trained nurses at SHFPACT. Diaphragms are no longer available for purchase in Australia. They are available overseas however. Once you have had a diaphragm fitted and know the correct size, you will then need to purchase one online. At your fitting the nurse will tell you the size you need and will give you the details of a supplier so that you can order online.
The Caya diaphragm is a single size diaphragm. There is little research on the effectiveness of the Caya diaphragm but early trials show it is around 82-86%. This means that if 100 women use this method for a year, between 12 and 18 will have a pregnancy. We recommend that you have a professional fitting for this diaphragm as well. Once it is confirmed that it is suitable for you and the one size available fits correctly then they can be ordered online.
Using contraceptive spermicide with a diaphragm.
A contraceptive spermicide is a gel which is toxic to sperm and can be placed into cup of the diaphragm before use. Use of a spermicide may increase the effectiveness of the diaphragm as a contraceptive. Contraceptive spermicide is not available in Australia but can be ordered online when you purchase your diaphragm.
Wearing your diaphragm ‘around-the-clock’
If you wish, you can wear your diaphragm almost continuously, removing it for cleaning once every 24 hours. Be careful not to remove it before the minimum six hours have passed after intercourse. Also, you will need to check before each occasion of intercourse, that the diaphragm is still covering your cervix.
Looking after your diaphragm
After removing your diaphragm from your vagina, wash it in warm water with mild soap, rinse it in clean water, dry it carefully and store in a dry container away from heat.
Using a diaphragm during your period
You should continue to use your diaphragm during your period as it is possible to become pregnant at this time. However during menstruation you should only wear your diaphragm for a total of 6 hours at a time before removing it for cleaning. It is not advisable to use it continually at this time as there is a small risk of developing toxic shock syndrome.
If your diaphragm is uncomfortable
You should not be aware of your diaphragm if the right size has been fitted and it is correctly positioned over your cervix. Your partner may be aware of it during intercourse, but if they are aware of it, most men do not find this uncomfortable. If your diaphragm is uncomfortable (for you or your partner) or you feel sore after using it, see your SHFPACT nurse. You may need a different size or you may find some other method of contraception suits you better.
Side effects and safety
Most women can use a diaphragm safely, however there are some things which may mean a diaphragm may not be suitable for you. These include:
- If you have a sensitivity to silicone.
- If you have frequent urinary tract infections.
- If you have a history of toxic shock syndrome.
- If it is less than 6 weeks since you have given birth.
- If you have had recent surgery to your cervix.
- If you have poor pelvic floor muscle tone or your individual shape does not suit a diaphragm.
If you have had intercourse and forgotten to put your diaphragm in, or discovered that after intercourse that the diaphragm was not covering the cervix properly, you may be at risk of pregnancy. Emergency contraception is available over the counter at pharmacies and at a reduced cost from SHFPACT after consultation with a nurse or doctor. It can be taken up to 4 days after unprotected intercourse, but is more effective within the first 72 hours, and best within 24 hours.
When to get a new diaphragm
Your diaphragm should last up to 2 years. While silicone is a durable material it is advisable to check your diaphragm regularly for holes or deterioration. You can do this by holding your diaphragm up to a light. If it does develop a hole or tear do not use it and get a new one as soon as possible. You will need to have your diaphragm refitted following a pregnancy, pelvic surgery, or if you lose or gain more than 3kg in weight.