What is a Diaphragm?

A diaphragm is a soft, thin, dome-shaped latex or silicone cup with a flexible rim. Spermicidal jelly is placed inside the dome. The diaphragm is placed high in the vagina to hold the spermicide against the cervix. The diaphragm comes in various sizes and must be fitted by a clinician to be effective.

A diaphragm protects against conception for six hours. For intercourse after the six-hour period, or for repeated intercourse within this period, fresh spermicide should be placed in the vagina with the diaphragm still in place. The diaphragm should be left in place for at least six hours after the last intercourse

A diaphragm should not be left in place for more than a total of 24 hours because of the risk of toxic shock syndrome (TSS), a rare but potentially fatal condition. Symptoms of TSS include sudden fever, stomach upset, a sunburn-like rash, and a drop in blood pressure.

A diaphragm is a method of birth control used by women. About six out of 100 women will get pregnant with the diaphragm if they use it perfectly every time. Since most people make mistakes sometimes, the typical rate is more like 12 to 18 out of 100. That’s more effective than condoms or other barrier methods, but less effective than sterilization, intrauterine devices (IUDs), or birth control pills.

The diaphragm acts as a barrier between the opening of the cervix and the semen, which contains sperm. The fit may not be tight enough to stop all the sperm from getting past the diaphragm; therefore, the spermicide is used to kill the sperm.

The history should be used to assess the probability of compliance and discover possible contraindications to diaphragm use. The client should be instructed in anatomy and physiology of the vagina and cervix, mechanism of action as a barrier method, the importance of using spermicide with the diaphragm, length of time the diaphragm must be left in place, the possibility of slippage during intercourse, avoidance of petroleum products, proper care, checking for tears and holes, possible side effects, and diaphragm insertion.

Diaphragms come in different sizes, so you must visit a health professional to be fitted and get a prescription for the right size and type of diaphragm. The largest comfortable size should be selected. 

With clean hands, put a small amount of spermicide on the upper surface of the diaphragm (approximately two 2cm strips). Some women find that putting a little spermicide on the rim makes the diaphragm easier to put in.

Put your index finger on top of the diaphragm and squeeze it between your thumb and other fingers. Slide the diaphragm into your vagina upwards and backwards. This should ensure that the diaphragm covers your cervix.

Always check that your cervix is covered. It feels like the end of your nose. If your cervix is not covered, take the diaphragm out by hooking your finger under the rim or loop (if there is one) and pulling downwards and try again.

Some women squat while they put their diaphragm in. Others lie down or stand with one foot up on a chair. You will need to find out which position is easiest for you.

Proper fit is checked after women have walked around the room and exercised for 5 minutes. Most women can use either the coil spring or arc spring diaphragm comfortably. 

The woman should be able to insert the diaphragm properly, assess for placement, and remove it without difficulty. The women should return in 2 weeks for a recheck of the diaphragm's fit and placement.

The diaphragm should be checked annually or after loss or gain of more than 15 pounds, vaginal delivery or 2nd-trimester abortion, or lower abdominal surgery.

Some of the main advantages are that it:

• It does not affect future fertility for either the woman or the man.
• It only needs to be used when having sexual intercourse.
• It is safe to use while breastfeeding.
• It is less expensive than hormonal methods of birth control.
• It can be used by women who have health problems that would make estrogen use dangerous, and by women who smoke.
• It doesn’t affect your body’s natural hormones as it doesn't contain any hormones.
• It can be used more than once.
• It can protect against pregnancy straight away.
• You can choose to use a diaphragm when your partner doesn’t want to use a condom.
• If it’s inserted correctly, you and your partner can’t feel it.
• If you want to try to get pregnant, you can just stop using it.

Possible side effects for a small number of users can include: 

• Some people are sensitive to the chemicals in latex or spermicide. This may cause irritation of the vagina in some women or in the penis of a partner.
• Women who use diaphragms may get more bladder infections (urinary tract infections or UTIs). This is probably because the rim of the diaphragm presses on the urethra and may irritate it. A woman who gets frequent UTIs may need a smaller diaphragm or may prefer not to use the diaphragm.
• The diaphragm doesn’t protect against sexually transmitted diseases (STDs).
• You have to remember to reapply spermicide every time you have sex.
• It can be tough and messy to put one in and can take time to learn how to use it.
• You can use it during your period, but it may put you at higher risk for an infection if it isn't removed soon after sex.
• You might knock it out of place during sex.
• You have to see a doctor to get one.
• The diaphragm should not be used by women who have ever had toxic shock syndrome. It is important to check your diaphragm for any cracks, holes, or other damage that would reduce its effectiveness. Do not use any petroleum-based vaginal creams, oils, or ointments that can damage the rubber. Water-based personal lubricants, such as Astroglide and K-Y Jelly, are safe to use.

You can buy a diaphragm from some pharmacies, family planning clinics and online.

Diaphragms come in a variety of sizes, and some clinics may also charge an additional fitting fee. It’s a good idea to call your doctor ahead of time to discuss costs and options available to you.

It may cost you Rs 3,500 to 20,000, depending on the brand you are choosing to get.