Birth Control: How to Use Your Diaphragm
The diaphragm is a reusable dome-shaped cup that fits over the opening to the cervix and prevents pregnancy.
For effective birth control, your diaphragm (see pictures below) has to fit well. Your doctor will examine you to find the correct size.
To be sure that you know how to use your diaphragm, you will need to practice putting it in and taking it out while you are in your doctor’s office. Your doctor will check to see that the diaphragm fits right.
To lower your risk of getting pregnant, you must use your diaphragm correctly and use it every time you have sex. You must also use the diaphragm with spermicide (a gel or cream that kills sperm trying to enter the cervix) in order to prevent pregnancy. You can put the diaphragm in your vagina up to two hours before you have sex. If you put it in more than two hours before having sex, you will need to put more spermicide into your vagina.
Getting Your Diaphragm Ready
Before you put the diaphragm in your vagina, put about one tablespoon of spermicidal gel or cream in the cup (see picture below). Smear some of the gel around the rim of the diaphragm. Do not use petroleum jelly or oil-based vaginal creams (such as Monistat). These can make tiny holes in the diaphragm.
Inserting Your Diaphragm
You can put your diaphragm in while you are lying down, squatting, or standing with one leg up on a chair. Your legs need to be fairly wide open. Bending your knees can help. Once you’re in position, follow these steps:
- Use one hand to fold the diaphragm in half with the dome pointing down (see picture below). Hold your vagina open with your other hand.
- Put the diaphragm into your vagina, aiming for your tailbone (see picture below). Push the diaphragm as far back into your vagina as you can.
- Use one finger to push the front rim of the diaphragm up behind your pubic bone, aiming for your belly button.
Checking Placement of Your Diaphragm
With your finger, feel for your cervix through the dome of the diaphragm. The cervix will feel firm, but not bony. It feels a bit like the tip of your nose.
If the diaphragm does not cover your cervix or if you cannot feel your cervix at all, the dome is not in the right place. This means that you need to remove the diaphragm, put more spermicidal gel on it, and insert it again.
The diaphragm should not fall out when you cough, squat down, sit on the toilet, or walk around. If your diaphragm stays in place when you do these things, the front rim is most likely in the right place above the pubic bone (see picture below).
After You Have Sex
The following are some important points to remember after you have sex:
To remove the diaphragm, “hook” the front rim with your finger and pull down and out. Be careful not to tear a hole in the diaphragm with your fingernails. You should not wear your diaphragm during your menstrual period. You will need to use another method of contraception during this time.
- Leave the diaphragm in place for at least six hours after you have sex.
- If you have sex again within six hours, put spermicidal gel in your vagina, but do not take your diaphragm out to put gel in the dome.
- Do not leave the diaphragm in your vagina for more than 24 hours. Doing so can cause infection, irritation, or even a complication called toxic shock syndrome.
- Do not douche while the diaphragm is in your vagina.
Taking Care of Your Diaphragm
After you take the diaphragm out of your vagina, wash it with mild soap and water, rinse it, and allow it to air dry. Always store your diaphragm in its container. Store the container in a cool, dry place, away from sunlight.
Check your diaphragm often for holes, tears, or leaks. To do this, fill the dome with water and look for tiny leaks.
Replace your diaphragm after one to two years. Every year, your doctor should check to see that your diaphragm still fits correctly. You will need to be measured again if you have a baby, have pelvic surgery, or gain or lose more than 15 pounds.
When to Call Your Doctor
Call your doctor if you have any of the following problems:
You also should call your doctor if your diaphragm gets a hole in it or does not seem to fit right. If your diaphragm has any of these problems, it needs to be replaced. If you keep using it, you could increase your risk of getting pregnant.
- Trouble urinating, or painful or frequent urination
- Vaginal itching, discharge, or discomfort
- High fever (which can be a sign of toxic shock syndrome)
- Diaphragm Fitting by Richard E. Allen, M.D.( 01/01/04, http://www.aafp.org/afp/20040101/97.html)
Copyright © American Academy of Family Physicians
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.