Title: Diaphragm
Course: Level 3 - Family Planning > Section: Barrier methods of family planning

The diaphragm is a soft, flexible rubber cup shaped like a dome that is inserted into the vagina. The diaphragm blocks access to the cervix so that sperm cannot pass from the vagina into the uterus. The diaphragm must be covered on both sides and especially around its rim with spermicidal jelly, cream, or foam in order to form a tight seal around the diaphragm (see figure below).

Fig.5.5. Diaphragm.

Mechanism of action:

Diaphragm works by blocking sperm from entering the cervix; spermicide kills or disables sperm. Both keep sperm from meeting an egg.

Effectiveness:

As commonly used, about 16 pregnancies per 100 women using the diaphragm with spermicide over the first year. This means, that 84 of every 100 women using the diaphragm will not become pregnant.

Guidelines for the diaphragm insertion:

- Insert your diaphragm before intercourse. It can be inserted up to 6 hours before intercourse. Once inserted, it is immediately effective.
- Before inserting empty your bladder and wash your hands.
- Take the diaphragm and hold it up to the light. Check the diaphragm for any tears or holes in the cup or cracks along the rim before each use.
- Squeeze at least a tablespoon of spermicidal jelly into the cup, and spread it around the rim and inside the cup with a clean finger.
- Press the rim of the diaphragm together with the spermicide inside the dome.
- While standing, squatting, or lying, gently push it all the way into the vagina with the dome side facing down and the jelly side directed toward the cervix.
- Push the diaphragm in as far as it will go, making sure that the front rim is tucked up under the pubic bone. It should cover the cervix, which feels like the end of your nose.
- Now you are ready to have intercourse. You can use more spermicide or lubrication if you want. For extra lubrication, we recommend spermicidal jelly or a water-based lubricant such as KY jelly.
- If you put your diaphragm in more than 6 hours before having intercourse, you should insert more spermicide (such as an applicator of contraceptive jelly or foam,) into your vagina without removing the diaphragm.
- Before each act of intercourse, you should also insert more spermicide (as above) into your vagina, without removing the diaphragm.
- The diaphragm needs to be used with a spermicide every time you have intercourse. Keep the diaphragm in place at least 6 hours after having sex but no longer than 24 hours.
- To remove, slide a finger under the rim of the diaphragm to pull it down and out. Wash hands with mild soap and clean water, if Possible. Insert a finger into the vagina until the rim of the diaphragm is felt. Gently slide a finger under the rim and pull the diaphragm down and out. Use care not to tear the diaphragm with a fingernail. Wash the diaphragm with mild soap and clean water and dry it after each use.

Fig 5.6. How to use the diaphragm.