The diaphragm, like the male or female condom, is a barrier method of contraception and prevents pregnancy by preventing sperm from reaching the egg. The diaphragm is a ring-shaped device that fits inside the vagina and covers the cervix.

There are a variety of types of contraceptives including the flat or coil spring type, and the arching spring type. Diaphragms must be fitted to the individual patient. The fit of your diaphragm may change and should be checked if you gain or lose a significant amount of weight, following pregnancy, or after pelvic surgery.

Because the diaphragm must be used with each episode of intercourse, it is imperative that you are comfortable inserting and removing your diaphragm, and that you understand its proper placement. You should be able to feel the cervix through the dome of the diaphragm.

The proper use of the diaphragm requires the combined use of a contraceptive jelly or cream type spermicide to the center and rim of the device. The diaphragm must be inserted prior to intercourse. It may be inserted up to 1 hour before intercourse, and must be left in place for 6 to 8 hours afterward. It is then removed, washed with soap and water and stored in a case at room temperature. If you have more than one episode of intercourse during the 6 to 8 hour waiting time, additional spermicide should be applied without removing the diaphragm.

The failure rate with the use of the diaphragm is about 2% to 3%. Failure with the diaphragm is usually the result of improper placement or because the diaphragm is not used. There are other potential risks with the use of the diaphragm. Women who use diaphragms are about twice as likely to develop urinary tract infections, and some women have an increased number of vaginal infections.

Use of the diaphragm when combined with a spermicide reduces the risk of transmission of becoming infected with a sexually transmitted disease such as gonorrhea. In addition, it may reduce the risk of HIV infection.

Thomas G. Stovall, M.D.

Dr. Stovall is a Clinical Professor of Obstetrics and Gynecology at the University of Tennessee Health Science Center in Memphis, Tennessee and Partner of Women’s Health Specialists, Inc.