Diaphragms

What are diaphragms and how do they work?

The diaphragm is a soft latex barrier that fits over a woman's cervix. It is a shallow dome-shaped cup with a flexible spring rim. It fits inside a woman's vagina over the cervix and holds a spermicidal cream or gel. Diaphragms act as both a chemical and a physical barrier to sperm swimming through the cervix and into the uterus. Diaphragms come in a number of sizes and must be fit for you by your medical provider.

A diaphragm, with spermicide applied inside the cup and on the rim, is inserted it into the vagina to cover the cervix before intercourse. This blocks the entrance to the uterus, and the spermicidal gel or cream immobilizes sperm, preventing it from joining an egg. You must leave your diaphragm in place for at least 6 to 8 hours after intercourse, but you can leave it in place for up to 24 hours. If intercourse is repeated or occurs more than six hours after the diaphragm is inserted, you would use an applicator to put another application of spermicide into the vagina (so that the diaphragm is not removed).

How do I use a diaphragm?

The diaphragm requires you to use your fingers to insert and remove the diaphragm. To protect you from pregnancy, the diaphragm and spermicidal cream or gel must be used every time intercourse occurs.

Step 1: Check your diaphragm
Inspect your diaphragm carefully each time before you use it to make certain there are no holes or tears. The best way to do this is to hold the diaphragm up to a light. Pull the diaphragm at the rim on all sides to make sure there are no holes. Look closely at your diaphragm. If there are puckers, especially near the rim, this could mean a thin spot in the rubber. You can also conduct a test by filling the diaphragm with water. If there is a puncture in the diaphragm, you will be able to see a leak.

Step 2: Inserting your diaphragm
Place about one tablespoon of spermicidal cream or gel in the cup of the diaphragm and spread it on the inner cup up to the rim. Insert the diaphragm by squeezing it closed and inserting it into the vagina. Guide the back rim past the cervix and then press the front rim up behind the bony arch that guards the front wall. Make sure you can feel that the cervix is covered by the diaphragm. At first, it may be easier to lie on your back to insert it. The diaphragm can also be inserted from a standing or sitting position.

You can insert the diaphragm and spermicide up to 6 hours before intercourse. But if 6 hours or more pass before you have intercourse, you should leave the diaphragm in place and insert more spermicide deep into the vagina.

During sex, it is possible that the diaphragm may become dislodged when using some positions, but this is not likely to occur if the diaphragm is properly inserted and the fit is tight.

You must leave the diaphragm in place for 6 to 8 hours after intercourse to ensure that all the sperm have been killed. If you have intercourse again in that period of time, you will need to insert more spermicide each additional time. Do not remove the diaphragm to insert more spermicide because you will lose your contraceptive protection.

Step 3: Removing your diaphragm
To remove the diaphragm, wait until at least 6-8 and no more than 24 hours after interourse, then insert your finger into your vagina and up and over the top side of the diaphragm rim and slightly to one side. Hook your finger firmly on the rim of the diaphragm and break the suction. Pull the diaphragm down and out.

Step 4: The ongoing care of your diaphragm
After removing your diaphragm, wash it with warm water and a mild soap such as Ivory. Avoid perfumed soaps--the ingredients may weaken the rubber. Allow your diaphragm to air dry.

Contact with oil-based products can deteriorate a diaphragm, so you should avoid using oil-based vaginal medications or lubricants (eg petroleum jelly, hand lotion or vaginal yeast creams) when you are using a diaphragm. You should also avoid using any powders on the diaphragm as they can cause infections.

Store the diaphragm in its plastic case and keep it away from heat sources. With time and use, the rubber of the diaphragm may darken, but as long as you take good care of it, it will stay elastic. We suggest getting a new diaphragm approximately every two years.

You should have your diaphragm checked once a year by a medical provider. You may need a new diaphragm if you have a 20% or more change in your weight, have a pregnancy, an abortion or abdominal surgery.

back to top

How effective are diaphragms in preventing pregnancy and STIs?

When diaphragms are used perfectly--this means with they are used correctly with spermicide every time a couple has intercourse--the chance of becoming pregnant is 6%. But, not every couple uses the diaphragm perfectly every time. If the diaphragm isn't inserted correctly, is bumped out of place or is removed too soon, the risk of pregnancy increases. The average risk of becoming pregnant is 12%.

The diaphragm does not offer protection against STIs. We recommend using condoms with the diaphragm to protect against sexually transmitted infections and to further decrease the risk of pregnancy.

What are some advantages of using a diaphragm?

Once you have learned how to properly insert your diaphragm and you are comfortable using it, the diaphragm offers many advantages:

  • It doesn't affect a woman's hormone levels.
  • It doesn't interrupt sex play if nserted ahead of time.
  • It generally cannot be felt by either partner.
  • It is a relatively cheap form of birth control.
  • It may reduce your risk of cervical cancer.
  • Because it blocks the cervix (the opening to the uterus) it offers some protection against pelvic inflammatory disease (PID).
  • It can be used when a woman is breast-feeding.

back to top

Are there any problems with using a diaphragm?

The diaphragm is a contraceptive option with no side effects, but some women might have the following problems:

  • It may be difficult to insert the diaphragm correctly.
  • A diaphragm must be fitted by a medical provider and might have to be refitted.
  • Diaphragms can be pushed out of place with some positions and penis sizes.
  • Some women may develop bladder infections.
  • Women with latex allergies may not be able to use diaphragms.
  • Diaphragms cannot be used during your period.

If you experience any of the following symptoms while using your diaphragm, contact your medical provider:

  • Discomfort when the diaphragm is in place
  • Burning sensations while urinating
  • Irritation or itching in the genital area
  • Unusual discharge from the vagina
  • Irregular spotting and bleeding
  • Redness or swelling of the vulva or vagina

How much does it cost and where can I get it?

Brown students can set up an appointment with a medical provider here at Health Services to be fitted for a diaphragm by calling 401.863-3953. The medical provider will show you how to insert your diaphragm and have you practice using it. It will cost $64.25 for the diaphragm (your insurance may cover some or all of this cost) and approximately $15 for spermicide.

back to top

Links you can use

For more information about diaphragms, you can visit:

Planned Parenthood

back to top

Disclaimer: BWell Health Promiotion is part of Health Services at Brown University. Health Promotion maintains this site as a resource for Brown students. This site is not intended to replace consultation with your medical providers. No site can replace real conversation. Health Promotion offers no endorsement of and assumes no liability for the currency, accuracy, or availability of the information on the sites we link to or the care provided by the resources listed. Health Services staff are available to treat and give medical advice to Brown University students only. If you are not a Brown student, but are in need of medical assistance please call your own health care provider or in case of an emergency, dial 911. Please contact us if you have comments, questions or suggestions.