Diaphragm: Teen Version

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KEY POINTS

• The diaphragm is a dome-shaped rubber cup with a flexible rim used by a woman to help prevent pregnancy.
• Diaphragms give immediate protection against pregnancy when used properly with spermicide. Always check your diaphragm for tears and holes and replace it when needed.
• Talk to your healthcare provider if you have any questions about the use of a diaphragm.

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What is a diaphragm?

The diaphragm is a dome-shaped rubber cup with a flexible rim. It is used to help prevent pregnancy. Before you have sex, you put contraceptive cream or jelly into the diaphragm and then put the diaphragm into your vagina. The contraceptive cream or jelly contains a chemical that kills sperm (spermicide). The diaphragm covers the cervix, which is the opening into the uterus. The diaphragm and spermicide work together to make a barrier that stops sperm from reaching the uterus.

There are several sizes and types of diaphragms. They may be made from latex or silicone rubber. You need a measurement and fitting by your healthcare provider to make sure that you get a diaphragm that fits correctly. The largest size that feels comfortable should be used.

How do I use a diaphragm?

Put the diaphragm into your vagina no more than 6 hours before you have sex.

1. Before you insert the diaphragm, urinate, and wash your hands.
2. Check the diaphragm for any holes or tears. If you find a hole or tear, use a different method of birth control until you get a new diaphragm.
3. Squeeze 1 to 2 teaspoons of spermicide into the dome of the diaphragm. Rub a small amount of the spermicide around the inside of the diaphragm and on the outside of the rim with your fingertip.
4. Get into a comfortable position. The 3 positions used most often are:
   • Lying on your back with your knees up
   • Squatting with your knees bent and wide apart
   • Standing with 1 foot resting on a stool or chair and your knees slightly bent
5. Fold the diaphragm in half by pressing the opposite sides together with the thumb and fingers of one hand. Hold the diaphragm with the dome hanging below the rim to keep the spermicide in the dome. Hold the folds of skin around your vagina open with your other hand. Gently slide the folded diaphragm into your vagina, using your index finger on the rim to guide it. Aim toward the small of your back, as if you were inserting a tampon.
6. Make sure that the diaphragm is in place. Put your finger into your vagina and touch the dome. You should feel the cervix through the dome of the diaphragm. The cervix feels firm, but not bony. You may also feel folds in the surface of the dome. Move your index finger to the front rim of the diaphragm and make sure it is firmly in place behind your pubic bone. The back rim must be behind the cervix so that the cervix is completely covered.

You can use water-based lubricants such as KY Jelly to help you insert the diaphragm. Don’t use oils, lotions, or Vaseline (petrolatum, or petroleum jelly) as lubricants with a diaphragm. They could weaken the material of a latex diaphragm, and then the diaphragm might not prevent pregnancy.

If you have sex more than once after putting in the diaphragm, you should put more spermicide into your vagina before each time. Do not remove the diaphragm to do this. A plastic applicator is sold with the spermicide. Use this applicator to put more jelly or cream into your vagina, in front of the diaphragm.

When and how should I remove the diaphragm?

Leave the diaphragm in place for at least 6 hours after you have sex. Remove it as soon after this as possible. A diaphragm should be removed and washed at least once every 24 hours. Do not douche with the diaphragm in place.

To take the diaphragm out, put your index finger in your vagina and hook it under the rim of the diaphragm. Gently pull the diaphragm down and out.

Wash the diaphragm with mild soap and water every time after you have sex. Dry it with a towel and put it in its case. Don’t use powders on the diaphragm. Store the diaphragm in its case away from heat.

How can I help prevent infections?

Incorrect use of the diaphragm can cause infections. To help prevent infections:

• Wash your hands carefully before you insert or remove the diaphragm.
• Don’t keep the diaphragm in your vagina longer than 24 hours at a time.
• Urinate right after you take the diaphragm out.
• Don’t use a diaphragm during your period or when you have abnormal vaginal discharge. Your partner can use condoms instead.
• Don’t use a diaphragm for the first 3 months after childbirth.

When do I need to get a new diaphragm?

You should get a new diaphragm every 1 to 2 years.

You should check your diaphragm carefully before each use to look for any holes or tears. If there are any holes or tears, use another form of birth control until you get a new diaphragm.

Ask your healthcare provider to check the way your diaphragm fits if you:

• Gain or lose more than 10 to 20 pounds
• Have pain or discomfort from your diaphragm
• Have been pregnant and had a baby since your last fitting
• Have had any kind of pelvic surgery

Your provider should check the way your diaphragm fits at least every 2 years because the size or shape of your cervix may change.

What are the benefits?

The benefits of a diaphragm are:

• Diaphragms give immediate protection against pregnancy when used properly. Hormonal methods of birth control, such as taking birth control pills, don’t protect against pregnancy until you have been using them for at least 1 menstrual cycle.
• Diaphragms may be inserted with spermicide up to 6 hours before sex so their use does not have to interrupt love-making.
• Diaphragms may offer some protection against sexually transmitted diseases or infections (STDs or STIs). However, to decrease your risk of getting an STI, you should also use condoms every time you have sex.

What are the disadvantages?

Some of the disadvantages of a diaphragm are:

• A diaphragm must be prescribed and fitted by a healthcare provider.
• If it is not correctly fitted, it may cause discomfort and possibly a urinary tract infection or pregnancy.
• You may not be comfortable with inserting and removing the diaphragm and checking its position.
• The diaphragm and spermicide must be inserted before having sex. If both you and your partner are not able to remember to do this every time you want to have sex, a diaphragm is not a good form of birth control for you. Even if you forget just one time, you could get pregnant.
• You must keep a supply of spermicide on hand at all times.

You should not use a diaphragm if you have ever been diagnosed with toxic shock syndrome. Don’t use a latex diaphragm if you have a sensitivity or allergy to latex.

Talk to your healthcare provider if you have any questions about the use of a diaphragm.