Diaphragms

A diaphragm is a soft dome-shaped rubber cup with a flexible rim, which fits in the vagina so that it covers the cervix. It comes in different sizes.

How does it work?

It's a barrier method of contraception that stops sperm from entering the uterus and fertilising an egg. The diaphragm is inserted before having sexual intercourse and left in place for at least 6 hours after intercourse.

How effective are diaphragms?

A correctly fitted diaphragm used every time you have intercourse is an effective method of contraception, possibly up to 94% effective. If not used correctly the effectiveness may be as low as 84%. Diaphragms are less effective than other methods. The use of spermicide with the diaphragm is recommended.

What are the good things about using a diaphragm?

• It contains no hormones.
• It has no effect on your menstrual cycle or fertility.
• It has no effect on breastfeeding or breast milk.

What are the not-so-good things about a diaphragm?

• You need to have it with you at any time you have intercourse.
• You need to insert it before intercourse.
• Allergies to rubber and/or spermicide can be a problem.
• You need to attend a clinic to be fitted with a diaphragm and to learn how to fit it yourself.
• You need to be comfortable about feeling inside your vagina with your fingers to check the diaphragm is in place.
• Some women develop bladder infections or constipation from wearing a diaphragm.
• Sometimes it is difficult to get a good fit.

How do I get a diaphragm fitted?

Go to a doctor who is experienced in fitting diaphragms or a SHine SA clinic. At this visit a trial diaphragm will be fitted for practise use only for one or two weeks. Don't rely on it for contraception during this time.

During this time:

• practise putting the diaphragm into your vagina, as well as wearing and removing it
• wear the diaphragm for at least 6-8 hours, during both night and day, to make sure it is comfortable
• the diaphragm should not interfere with passing urine or having a bowel action.
• the diaphragm should not be felt during intercourse

You will need to come back to the clinic one to two weeks after the initial fitting with your diaphragm in place so that its size and position can be checked. At this visit, you should discuss any problems you have noticed.

How to use a diaphragm

• Wash your hands carefully with soap and water.
• You can place about one teaspoon of spermicidal jelly on the side of the diaphragm that is in contact with the cervix.
• Insert (while standing, squatting or lying) by squeezing the diaphragm so it is long and thin. Separate the lips of the vagina with the other hand and insert, downwards and along the back wall of your vagina as far as it will go. The front rim tucks up behind the pubic bone just inside the opening to the vagina.

• Check that it's in correct position by placing two fingers in your vagina and feel the cervix (feels like the tip of your nose in the shape of a cherry or plum) through the rubber of the diaphragm.
• If not in position, remove and try again.
• The diaphragm needs to be left in place for at least 6 hours after sexual intercourse.
• If intercourse is repeated or occurs more than 3 hours after insertion more spermicide is required and should be inserted with an applicator without removing the diaphragm.
• It should not be left in place for longer than 30 hours without being removed for cleaning and replacing spermicide.
• Diaphragms should not be used during a period; if used, it should be removed as soon as possible after the 6 hours.

How to take care of your diaphragm

• Wash the diaphragm in warm water with a mild, unscented soap.
• Rinse thoroughly in clear water and dry carefully.
• Check the diaphragm for pinholes, tears and damage to the rubber by holding it up to the light and gently stretching it. The shape must remain round.
• Do not use Vaseline, oil-based lubricants, anti-thrush or hormonal creams when using your diaphragm as they may damage the rubber.
• If lubrication is needed during intercourse use water-based lubricant.

When should I get the diaphragm checked?

• when you have a sexual health check-up and/or smear test
• if you lose or gain 3 kg or more in weight
• after a pregnancy, miscarriage or abortion
• if the diaphragm is uncomfortable for you or your partner
• if the diaphragm slips or moves during sexual intercourse

You will need to replace your diaphragm immediately if it is damaged or no longer fits well. Remember, a diaphragm must fit well and be in good condition to prevent pregnancy. if properly looked after diaphragms can last for up to 2 years.

Sometimes accidents happen ...

If you did not use your diaphragm, or if it slips out of place, and you are worried about getting pregnant, emergency contraception (EC) is available over-the-counter at pharmacies, SHine SA clinics, Clinic 275 and some public hospital Emergency Departments.

EC is most effective if it is taken within 24 hours of unprotected sex, but can be taken up to 5 days (120 hours) after unprotected intercourse.

Am I at risk of sexually transmitted infections?

Diaphragms do not protect you against sexually transmitted infections (STIs). Practise safer sex. Using condoms reduces the risk of STIs.

This information is available to download in leaflet format as Diaphragms (PDF).