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What Is a Diaphragm? A Midwife Explains How It Works and If It is Efficient

The primary time I ever got here throughout the idea of a diaphragm, I watched Sarah Jessica Parker as Carrie in an episode of Intercourse and The Metropolis. She was moments away from completely sudden intercourse and with no condoms in sight, she wanted contraception, ASAP. She had an ‘aha’ second and ran to her lavatory to tug a dusty container off the again of her lavatory shelf. As she blew away the mud atop the container the message was clear. This factor was old skool… and that’s precisely the repute and affiliation the diaphragm conjures up for a lot of. Nonetheless, I’m right here to let you realize—as an knowledgeable in contraception and prescribing contraception virtually every day at work—the diaphragm is again by widespread demand, and there are nice causes for it!

So, let’s begin with the fundamentals: what’s a diaphragm, the historical past, the way it works, and if it’s best for you. Prepared? Let’s go!

Historical past of the Diaphragm

Invented in 1842, the diaphragm served as a well-liked technique of contraception for over 100 years internationally. The diaphragm was initially dropped at, and popularized in the USA within the Twenties by contraception advocate, Margaret Sanger who would truly illegally imported and distributed diaphragms to ladies determined for management of their reproductive well being and household measurement. I extremely advocate studying about this inspiring girl if you happen to’re not acquainted. Within the early 1900s, contraception paraphernalia, together with condoms and diaphragms have been truly unlawful in line with a legislation qualifying them as “lewd and lascivious.” Think about a world with out entry to contraception for one second, and keep in mind that entry to dependable contraception is lower than 100 years outdated. Wild!

Again to diaphragms! Whereas extensively distributed and used for over 40 years as considered one of few out there choices, the diaphragm finally took a dive in recognition between the Nineteen Sixties to 80s after the arrival of the oral contraceptive capsule (the capsule) and the Intrauterine Gadget (IUD). Traditionally, when ladies had fewer choices and have been determined for contraception, they took what they might get, and loads of hormones was the secret. Nonetheless because the pendulum swings (and it at all times does) we’re pondering increasingly about what choices we’ve got, how our physique interacts with hormones, and we’re feeling pickier—and rightfully so my pals! 

The main focus of contraception now lies to find what works for you, fairly than doing precisely what your physician says or recommends. Discover your choices, particularly if the tactic you’re utilizing doesn’t really feel good for you. That being mentioned, utilizing hormones for contraception works for a lot of ladies and is an excellent and really dependable choice that I personally completely approve of—so that you do you, boo!

Most individuals requesting the diaphragm are searching for a non-hormonal birth control choice as a result of they don’t just like the uncomfortable side effects of hormones or have medical situations that disqualify them from utilizing one. We’re shifting rapidly right into a time the place maintaining issues pure is a giant deal for ladies. Extra advantages embody the truth that it’s completely managed by the person, (no extra oh sorry, I didn’t carry a condom second), is comparatively low-cost and straightforward to make use of, and it’s eco-friendly! Diaphragms additionally don’t lower sensation the best way condoms do which everyone knows is large. Alright pals… have I raised curiosity for this time-tested type of contraception? Questioning if it is likely to be match for you? Learn extra about how diaphragms are used and the way efficient they’re to resolve if it’s one thing you’d wish to attempt!

So… What’s a diaphragm? 

Diaphragms are categorized as a barrier technique of contraception (much like a condom), and may be prescribed by your midwife or OB-GYN in an annual or contraception seek the advice of go to. They’re reusable and “good” for as much as two years. Diaphragms are usually lined by insurance coverage. With out insurance coverage, a diaphragm might value between $40-100 {dollars} out of pocket. Diaphragms are designed to, and have to be used along with, a lubricating jelly referred to as spermicide to be as efficient as potential. Spermicide, because it sounds, is a contraceptive substance that immobilizes or kills sperm earlier than these little dudes can attain the uterus.

The diaphragm itself is a dome-shaped shallow cup made of sentimental, skinny, versatile silicone, and inserting one doesn’t really feel a lot totally different than utilizing a menstrual cup. The silicone is thinner than a menstrual cup however not as skinny as latex utilized in condoms. The circumference of the diaphragm has a flexible, springy really feel to it and is barely thicker than the remainder of the system. This springy design helps to carry the diaphragm in place along with your pelvic flooring muscular tissues within the vagina. As soon as the diaphragm is accurately in place, deep within the vagina, overlaying the cervix appropriately, the person shouldn’t be capable of really feel it. On the word of sensation, one profit to the diaphragm over condoms is that there’s extra sensation for each companions having penetrative intercourse because it doesn’t cowl the penis. The diaphragm nevertheless doesn’t shield in opposition to sexually transmitted infections as condoms do. Diaphragms are completely protected to make use of with breastfeeding or for individuals who have medical situations that exclude them from utilizing hormones as they’re hormone-free. 

Picture through ABC Everyday

*Anatomy reminder, the cervix is a small, donut-shaped opening of the uterus that sits on the far most inner finish of the vagina. There’s a small opening within the cervix often known as the cervical os. The os is the place sperm enter the uterus and fallopian tubes to satisfy an egg for fertilization and being pregnant. Ever questioned what within the heck a cervix seems like? Take a look at this article that reveals photographs of a cervix by means of a typical cycle.

Methods to use a diaphragm? 

Every diaphragm could have barely totally different directions however the fundamentals are the identical. I actually like this planned parenthood article on tips on how to use a diaphragm accurately. Under is the verbal description I give my sufferers throughout an appointment when prescribing them. 

  1. Holding the diaphragm in your palm so it seems like a cup, not a bubble, cowl the circumference of the system in spermicide and deposit some contained in the cup as effectively. (Precise quantities are particular to the kind of system you’re utilizing.)
  2. Squeeze the system lined in spermicide in half, so it seems extra like the form of a tampon.
  3. Stand with one leg up on a bathroom, chair, or counter. You may additionally squat or lie in mattress along with your legs again, all per your choice. 
  4. Holding the diaphragm folded closed, place the system within the opening of the vagina, maintaining it folded, proceed to push it in and up till your entire diaphragm is inserted throughout the vagina.
  5. If you take away your fingers from the vagina and let go of the system it would retake its unique type and ‘spring open’ across the cervix. It must be fairly deep within the vagina for use accurately. The entrance needs to be in direction of your pubic bone, the again needs to be in direction of your rectum.
  6.  Utilizing two fingers if potential, the person ought to push and faucet the diaphragm as far into place deep throughout the vagina as potential, overlaying the cervix fully.
  7. As soon as in place, the person shouldn’t really feel something exterior of regular—much like a menstrual cup or a tampon! 
Graphic showing a uterus, cervix, pubic bone, and an inserted diaphragm cupping the cervix opening.
On this picture word a diaphragm efficiently in place over the cervix, blocking the doorway to the uterus. 
Picture through ABC Everyday

When do I insert a diaphragm and different widespread questions

When to insert 

It’s possible you’ll insert your diaphragm along with spermicide as much as two hours previous to sex. It’s finest to insert the diaphragm if you find yourself not already aroused.

When to take away

Wait six hours after intercourse to take away the diaphragm, it’s simpler to get out than it’s to place it in. Eradicating it any earlier will increase your threat for being pregnant, as sperm should still be alive and in a position swim up into the uterus to seek out an egg. 

What if it’s been greater than two hours since insertion?

For those who insert the diaphragm earlier than a date or anticipated sexual encounter, and don’t find yourself having intercourse till higher than two hours after insertion, depart the diaphragm in place—you solely have to insert one other dose of spermicide into the vagina previous to having intercourse. *Spermicide is available in pre-dosed applicators to make this simple.

What if we’ve got intercourse greater than as soon as?

You will have sex as many occasions as you’d like with the diaphragm in place, simply you’ll want to reapply spermicide each two hours and don’t take away the diaphragm till six hours after your final episode of intercourse. Don’t depart the diaphragm in for greater than 24 hours. 

Oops! What if I overlook to take it out?

Diaphragms mustn’t keep within the vagina for greater than 24 hours. Leaving them in for longer will increase your threat for toxic shock syndrome. That is uncommon and unlikely however does happen. Learn the hyperlink about TSS (poisonous shock syndrome) and preserve an eye fixed out for any indicators or signs in your individual physique. In case you have any of those signs name your physician or go to the emergency room instantly. 

How do I clear it and retailer it?

When you could have eliminated the diaphragm from the vagina after sex, rinse it with heat water and a mild, delicate cleaning soap and let it air dry both on a paper towel or within the case with the lid open. Don’t retailer the diaphragm moist within the case and don’t apply any powder to the diaphragm. 

Is it protected to make use of lubricants with a diaphragm?

Sure! So long as they’re water-based. DO NOT use any oil-based lubes equivalent to coconut oil, or silicone-based lubes (that are more and more widespread) as these two varieties can break down the diaphragm and make it much less efficient. To be protected, test the components on the lube you purchase from the shop or on-line earlier than utilizing something along with your diaphragm throughout intercourse.

How well do diaphragms prevent pregnancy?

According to Planned Parenthood (who’re thought of to be nationwide consultants in prescribing and managing contraception), the diaphragm is 94% efficient when used completely. Nonetheless, nobody and nothing is ideal so with typical use, it’s about 88% efficient. Meaning 12 in 100 individuals who use the diaphragm for contraception will turn into pregnant over a 12 months’s time. Diaphragm failure and being pregnant usually end result as a result of customers don’t use the diaphragm accurately, or don’t use it each time they’ve intercourse.

Usually when confronting the effectiveness of your birth control method (and making a call that feels best for you), I at all times advocate selecting a technique that matches your consolation degree and desires in the case of the prospect of getting pregnant. That’s the purpose proper? Use one thing that matches your present beliefs, which might change over an individual’s lifetime! For some individuals or {couples}, a 12% likelihood of being pregnant over a 12 months is not any large deal—they might be in a relationship, have already got children, and never thoughts the small likelihood of getting extra, or be open to the chance that if being pregnant occurs, it’s fantastic with them. For others, say maybe a single school pupil with no plans of beginning a household anytime quickly, this share is unacceptable! Preserve this in thoughts when figuring out if the diaphragm is an efficient match for you personally. I additionally advocate utilizing this technique along with cycle tracking to extend the effectiveness. You may add a condom, or use a condom as an alternative throughout your ovulatory window, and use the diaphragm if you’re much less prone to be ovulating.

To view a chart that compares many sorts of contraception efficacy (effectiveness), uncomfortable side effects, and being pregnant charges by the tactic of contraception chosen, take a look at this one by the FDA. 

Methods to decide a spermicide

Spermicide historically incorporates an ingredient referred to as nonoxynol-9 that works as an agent to kill sperm earlier than they enter the uterus. This type of spermicide works very effectively for a lot of ladies and is efficient at stopping being pregnant when used accurately with the diaphragm. Some ladies have sensitivities to nonoxynol-9 or could also be involved about utilizing this sort of substance of their our bodies for a wide range of causes. Due to this widespread concern, I’ll listing my favourite pure spermicide (which needs to be ordered from exterior the U.S.), in addition to an easy-to-access model of nonoxynol-9 containing spermicide offered all around the U.S. Think about using a extra pure choice if you happen to already know you could have delicate pores and skin or genitalia.

Contragel 

This spermicide works by altering the PH of the vagina to kill sperm. This will not be choice in case you have a historical past of power or frequent bacterial vaginosis an infection (BV). It isn’t out there in the USA or authorized by the FDA, therefore this can be a hyperlink to a Canadian pharmacy that ships to the US. I like to recommend it to all my purchasers they usually use it efficiently. 

VCF Spermicife Jelly 

This spermicide incorporates nonoxynol-9 as an lively ingredient and is extensively out there at pharmacies and grocery shops. The pre-filled applicator will assist you to use one dose at a time simply and with out contaminating the tube. 

——

I hope you’ve realized a bit about this old-school, tried and trusty technique of contraception that’s making a sizzling comeback! Maybe it’s match for you or somebody you realize, both now or later in life. Actually, in the case of non-hormonal choices there isn’t a ton, however with just a little apply and a focus to timing, this may be a wonderful match for individuals looking for a pure choice that places them in management and doesn’t lower sensation the best way condoms do. For those who’re thinking about utilizing a diaphragm ask your midwife or physician concerning the Caya diaphragm which is a one measurement matches all system now out there within the U.S! It’s my favourite and my sufferers appear to find it irresistible too. Hope you’re as much as nothing however knowledgeable, empowered, in-control intercourse!

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