Barrier Method: Diaphragm

Diaphragm and Spermicide

Diaphragm

Description

• A barrier-type contraceptive that mechanically blocks sperm from entering the cervix;
• Composed of a soft, latex dome that is supported by a round, metal spring on the outside;
• A diaphragm can be inserted up to 2 hours before intercourse;
• Optimum effectiveness is achieved by using it in combination with spermicidal jelly that is applied to ring of the diaphragm before it is inserted;
• Diaphragms are available in various sizes and must be fitted to the individual.

Advantages

• It is a good choice for people who choose not to use hormonal contraceptives or don't feel that they can be accurate in using natural family planning methods;
• When combined with spermicidal jelly, its effectiveness ranges from 80% to 90% for new users and increases to 97% for long term users;
• It causes few adverse reactions;
• It can help protect against STDs when used with spermicide;
• It does not alter the body's metabolic or physiologic process;
• It can be inserted up to 2 hours before intercourse;
• Providing it is correctly fitted and inserted, neither the partner can feel it during intercourse.

Disadvantages

• Some people dislike using a diaphragm because it must be inserted before intercourse;
• Although the diaphragm can be left in place for up to 24 hours, if intercourse is repeated before 6 hours (which is how long the diaphragm must be left in place after intercourse) more spermicidal gel must be inserted;
• The diaphragm can't be removed and replaced because this could cause sperm to bypass the spermicidal gel and fertilization could occur;
• It may cause more upper urinary tract infections (UITs) due to the pressure of the diaphragm on the urethra;
• The diaphragm must be refitted after birth, cervical surgery, miscarriage, dilatation and curettage (D&C), therapeutic abortion, or wieght gain or loss of more than 15 lb (6.8kg) because of cervical shape changes;
• It is contraindicated in people who have a history of cystocele, rectocele, uterine retroversion, proplapse, retroflexion, or anteflexion because the cervix position may be displaced, making insertion and proper fit questionable;
• It is contraindicated in people with a history of toxic shock syndrome (TSS) or repeated UTIs, vaginal stenosis, pelvic abnormalities, allergy to spermicidal jellies or rubber. It is also contraindicated in people who show an unwillingness to learn proper techniques for diaphragm care and insertion;
• it can't be used in the first 6 post-partum weeks.

Implications

• Intruct the person in proper insertion technique;
• Urge the person never to leave the diaphragm in place for longer than 24 hours;
• Instruct the individual to leave the diaphragm in place for about 6 hours after the intercourse;
• Advise the individual to use additional spermicide for additional intercourse;
• Urge the person to adhere to medical follow-up and to have the diaphragm refitted after birth, cervical surgery, miscarriage, D&C, therapuetic abortion, or weight gain or weight loss.