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 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 may find this difficult. If this is the case your partner may be willing to assist in checking that that the diaphragm is covering the cervix. If you are using lubricant with the diaphragm, use it after you have inserted the diaphragm and make sure that it is a water based or silicone lubricant, not oil based as this can damage the diaphragm. You can insert the diaphragm just before sex, or many hours before sex, whatever works best for you.
HOW EFFECTIVE ARE DIAPHRAGMS?
Diaphragms are between 82 -86% effective. This means that if 100 people use the diaphragm for a year between 14 and 18 may have a pregnancy.
WHAT ARE THE 3 MOST IMPORTANT FACTORS IN EFFECTIVENESS?
The most important factors in using a diaphragm to make it as effective as possible are:
- Using it every time you have intercourse.
- Making sure it is covering your cervix.
- Leaving it in place for a minimum of 6 hours after intercourse.
WHAT ARE THE ADVANTAGES OF DIPHRAGMS?
- They are suitable for those who cannot or choose not to use a hormonal contraceptive or an IUD.
- They are suitable when breastfeeding.
- 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 together with fertility awareness methods.
WHAT ARE THE DISADVANTAGES OF A DIAPHRAGM?
- They have a higher failure rate than most other methods of contraception.
- Some may have difficulty using them or may not like putting them into the vagina.
- They may not be suitable for some people for anatomical or medical reasons.
DOES THE DIAPHRAGM HAVE ANY SIDE EFFECTS?
The diaphragm has very few side effects but can occasionally cause irritation of the vagina or penis and may increase the risk of bladder infections in some people.
WHO CAN USE A DIAPHRAGM?
Most people can use a diaphragm safely, however there are some things which may mean a diaphragm may not be suitable for you.
- If you have a sensitivity to silicone.
- If you have frequent bladder 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 weak pelvic floor muscles or your individua shape does not suit a diaphragm.
Remember a diaphragm does not protect you from sexually transmissible infections or HIV.
HOW DO I 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.
Regular 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 diaphragm that you need and will give you information about buying one online.
WHAT ABOUT 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.
The Caya diaphragm is a single size diaphragm and is the only diaphragm available in Australia. The Caya diaphragm is used with a gel called Caya Gel. There is little research on the effectiveness of the Caya diaphragm, but early trials show it is around 82-86%.
We recommend that you have a professional fitting for the Caya 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 or purchased at some pharmacies.
CAN I WEAR MY 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.
HOW DO I LOOK AFTER MY DIAPHRAGM?
After removing the 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.
CAN I USE MY DIAPHRAGM DURING MY 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.
WHAT SHOULD I DO IF MY 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 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 need to find another method of contraception that suits you better.
ACCIDENTS AND USING EMERGENCY CONTRACEPTION
If you have had intercourse and forgotten to put your diaphragm in or discovered after intercourse that the diaphragm was not covering the cervix properly, you may be at risk of pregnancy. Using emergency contraception can reduce the risk of pregnancy.
The Levonorgestrel emergency contraceptive pill can be taken up to 96 hours (4 days) after unprotected intercourse, but is more effective within the first 72 hours, and best within 24 hours. The Ullipristal emergency contraceptive pill can be taken up to 120 hours (5 days) after intercourse.
Both are available over the counter at pharmacies. Importantly, the sooner you take emergency contraception the more effective it is.
The copper IUD can also be used as an emergency contraceptive up to five days after unprotected intercourse and is highly effective.
WHEN SHOULD I REPLACE MY DIAPHRAGM?
Your diaphragm should last up to two 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, and possibly replaced following a pregnancy, pelvic surgery, or if you lose or gain more than 3kg in weight.