Contraception - The Diaphragm

The diaphragm is a contraceptive device that has quite a few benefits. The diaphragm is a dome shaped rubber device that is placed into the vagina, positioned so that it sits neatly over the cervix, preventing the passage of semen through to the uterus. This stops the sperm reaching the female's egg, making conception impossible. It is best used with spermicide (a cream that destroys sperm on contact). Its protection rate of contraception is around 92-96% effective (only when used with a spermicide). A woman must be correctly fitted for a diaphragm by her doctor or gynecologist in order for it to be efficient. The correct fitting is extremely important, as every woman's cervix can be a different size, and the diaphragm must be an accurate fit in order to prevent the movement of sperm through the cervix, and into the uterus. Being fitted for a diaphragm is quite invasive, it's a bit like having a Pap smear, only it may take a little longer. It is important once you have the correct size, to be aware that if you gain or lose more than 3kg (1/2 a stone) that you may need to be refitted again. This is because the cervix size may alter, which can cause the diaphragm to fit incorrectly, and therefore the chances of falling pregnant are increased.

How is it used?

It is inserted into the vagina before having sex, ensuring that it is fitted snuggly over the cervix (spermicide can be placed around the rim of the device). Your doctor will show you how it should be placed in when you are fitted for one. It can be inserted at any time during the day, if you think that there is a possibility that you and your partner may be having sex at a later stage. However if you don't have sex within three hours of inserting the diaphragm, then more spermicide needs to be used (this may be via an applicator). The diaphragm can also be inserted right before having sex. However it is important that it remains in place for at least 6 hours after sex. This is to ensure that any remaining sperm has been destroyed by the spermicide. It can stay in overnight, which can make it convenient for the woman.

Benefits

• There are no physiological side effects, as this form of contraception is a barrier method.
  
• It does not interrupt sex because if sex that day/night is anticipated you do not have 'break the moment' to put the diaphragm in.
  
• You can use it during your period; it will actually prevent the blood flow if your period is not too heavy. However if you use it this way, don't leave the diaphragm in for too long before you have sex (as too much blood may accumulate). It is best taken out in the shower. You still must leave it in four at least 6 hours after sex.
  
• If placed in correctly, you should not be able to feel it.
  
• It can reduce (not prevent) the likelihood of STDs such as chlamydia, as the diaphragm can prevent the infection of reaching the uterus.
  

Downsides

For the diaphragm to work correctly the woman must be very careful and precise about the way in which it is used. If she follows the rules of fitting it correctly, with the use of spermicide and leaving it in for 6 hours or longer, then there should be no problems. However if these rules are not followed, pregnancy can occur quite easily. It only takes one of these guidelines to be ignored to drastically reduce the effectiveness of this contraceptive device. Therefore if this method is chosen, care must be taken.

There is also a link between the use of spermicides and diaphragms with urinary tract infections (UTIs). Sometimes a diaphragm can place pressure on the bladder, making it difficult to urinate. When sensation to urinate is ignored, the urine in the bladder has more time to breed some nasty little organisms that may cause UTIs.

Another problem that may arise is that a small percentage of women and men may not tolerate spermicides, however this is uncommon. If you use one, and you or you partner find some kind of irritation; see your doctor for another suggestion for a different type of spermicide that may be less irritating.

These devices, due to their specific material, are at risk of wear and tear. It is important that no holes develop, as this would defeat the complete reason for using a diaphragm. It is good to fill it with water and watch for any leaks. A diaphragm has a life of between 1-2 years, depending on how much it is used.

In general this is a good contraceptive device. But you must remember, it cannot guarantee the protection against HIV and other STDs, therefore if you are not in a monogamous relationship, you should probably be on the safe side, and use condoms. If you trust your partner, then this is a great contraceptive device.


- Louise Ganey