Contraception Diaphragms

Overview

A diaphragm is a soft, dome-shaped cup, usually made of silicone, that a person puts inside their vagina before sex. It sits over the cervix (the opening of the womb) and blocks sperm from getting in, so it helps prevent pregnancy. It is a barrier method of contraception — meaning it works by putting a physical barrier in the way rather than by changing your hormones. Diaphragms are usually used with a spermicide (a gel or cream that stops sperm working), although what is available varies between countries, so your clinician or pharmacist will tell you what is recommended where you live. A cervical cap works in a similar way but is smaller. Unlike hormonal methods, a diaphragm does not change your periods or your body's natural cycle, and you only use it when you have sex.

Diaphragms are less commonly used than pills, implants or condoms, but they remain a well-established and reliable option. They are a good choice for people who prefer not to use hormones, who like being in control of contraception at the time of sex, or who want a method they can use only when needed.

Anyone with a vagina and a cervix who wants to avoid pregnancy can consider a diaphragm, including people who cannot or prefer not to use hormonal contraception. It is not suitable for everyone — for example, some people find it hard to insert, or it may not fit well if the vagina or pelvic floor has changed. Your clinician can help you work out whether it suits you.

Symptoms

Common symptoms

• Most people feel nothing at all once it is in place.
• Some notice mild cramping or a pressure sensation when putting it in or taking it out.
• A little irritation or discharge can happen, especially in the first few weeks while you get used to it.
• Some people find it slightly fiddly at first — practice makes a big difference.

Symptoms in children

• Not applicable — diaphragms are a method of contraception for people who could become pregnant, and are not used by children.

Symptoms in older adults

• Diaphragms can be used until menopause. If periods have stopped and pregnancy is no longer possible, contraception is no longer needed — but you may still want to use a barrier method for other reasons.
• Pelvic floor changes, vaginal dryness or mobility problems can make insertion harder. Lubricant or a different method may help, and it is worth talking to a clinician.

Causes

Main causes

• This section explains why a diaphragm can fail rather than why a condition develops. A diaphragm prevents pregnancy by covering the cervix so sperm cannot reach the womb.
• It can fail if it is the wrong size, if it is put in too close to sex or taken out too soon afterwards, or if it develops a small hole or tear.
• Using it without spermicide, or without extra spermicide for a second round of sex, also lowers how well it works.
• Oil-based products (such as some massage oils or baby oil) can damage latex diaphragms — silicone ones are less affected, so ask what yours is made of.

Risk factors

• Not having had a proper fitting, or not being shown how to insert and check it
• Weight change of around 3 kilograms or more since the fitting
• Pregnancy, birth, miscarriage or abortion since the fitting
• Keeping the same diaphragm for longer than recommended without checking it for damage
• Difficulty reaching or feeling the cervix, or limited hand mobility
• A history of repeated urine infections or of toxic shock syndrome

When to see a doctor

See a doctor urgently if:

• The diaphragm gets stuck and you cannot remove it
• Fever with a rash, vomiting or feeling faint while it is in place — call your local emergency number
• Severe belly pain, or pain with heavy bleeding
• Burning or pain when passing urine that is getting worse

Book a routine appointment if:

• You want to start using a diaphragm, or want a fitting or a refit
• Your weight has changed by around 3 kilograms or more, or you have been pregnant or given birth since your last fitting
• You are unsure whether the diaphragm is in the right place
• You experience irritation, discharge or discomfort that does not settle
• A condom slipped, or you had sex without contraception — emergency contraception may be an option, and it works best the sooner you act
• You are approaching menopause and want to review whether you still need contraception

Diagnosis

There is no test or scan involved. A diaphragm is 'diagnosed' in the sense that a trained healthcare professional examines you to find the right size and type, and teaches you how to use it. This is called a fitting. It usually happens at a sexual health clinic, family planning clinic, or your GP surgery.

Tests that may be done

• A pelvic examination to check the shape and position of your cervix and to measure the right size
• A 'trial run' where you practise putting it in and taking it out, and learn to check it is covering the cervix
• Sometimes a check with the diaphragm in place after you have inserted it yourself, to make sure it sits correctly
• A review appointment is often offered so you can ask questions once you have tried it at home

What to expect at your appointment

The fitting is usually quick and private. You will be asked to empty your bladder and undress from the waist down, and you can have a chaperone with you if you would like one. The clinician will explain each step before doing it. You may feel some pressure, but it should not be painful — tell them if it is. You will leave knowing how to insert it, how to check it is in place, how long to leave it in, and how to clean and store it. It can feel like a lot to remember, so it is fine to ask them to repeat anything.

Treatment

A diaphragm is not a treatment for an illness — it is a contraception method you use yourself. The key things are: a correct fitting, using it every time you have sex, adding spermicide as advised, leaving it in long enough, and checking it for damage regularly.

Self-care at home

• Put it in before sex — ideally not right at the last moment, as it needs to be sitting properly over the cervix.
• Check with a finger that your cervix feels covered by the dome, and that the front rim is tucked behind your pubic bone.
• Leave it in for at least six hours after the last ejaculation, and no longer than the time your clinician advises.
• If you have sex again within that time, you may need extra spermicide — ask your clinician what applies to your device.
• Wash it with warm water and mild unperfumed soap after each use, rinse well, and let it dry before storing it in its case, away from heat and sunlight.
• Hold it up to the light now and then to check for holes or tears, and replace it as often as your clinic recommends.
• Keep a spare, plus spermicide, in your bag so you are never caught out.
• Use condoms as well if you are not sure of your partner's sexual health — a diaphragm does not protect against infections.

Medical treatments

There are no medicines involved in using a diaphragm. Your healthcare professional's role is the fitting, teaching you correct use, and reviewing the fit when things change in your body. Some people are also given advice about spermicide, lubricant, or how to combine the diaphragm with another method for extra peace of mind. If a diaphragm does not suit you, there is a full range of other options — hormonal and non-hormonal, long-acting and on-demand — and you can switch at any time.

When is surgery considered?

Surgery is not part of using a diaphragm. If you are considering a permanent method of contraception, such as sterilisation, that is a separate decision to discuss with a clinician.

Living with this condition

Once you are used to it, a diaphragm becomes a quick part of your routine, like putting in a tampon. Many people keep it in its case with their toiletries so it is easy to find. The main thing to build into your life is remembering to leave it in afterwards — setting a quiet phone reminder can help if you tend to forget.

Lifestyle tips

• Carry it with you if there is any chance you will need it, along with spermicide if you use it.
• Avoid oil-based products with latex devices; use water-based or silicone-based lubricant instead.
• Store it away from direct sunlight and heat — not on a sunny windowsill or in a hot car.
• Pair it with condoms if you want protection from sexually transmitted infections as well as pregnancy.
• Tell a partner if you want to — many people find it helps them feel relaxed and in control.

Diet and exercise

No special diet or exercise is needed. The one thing that matters is weight: because the diaphragm sits against the vaginal walls, a change of around 3 kilograms or more can affect the fit, so it is worth booking a refit if your weight changes noticeably.

Mental health and emotional wellbeing

Contraception and sex can bring up a lot of feelings — worry about pregnancy, pressure from a partner, or discomfort talking about it. Those feelings are common and worth talking about. A diaphragm gives some people a real sense of control because they can decide to use it at the time. If anxiety about pregnancy or about sex is affecting your daily life, please speak to a healthcare professional; support is available and you do not have to manage alone.

Prevention

This section works a little differently for a contraception method. Instead of preventing a condition, the aim is to prevent unintended pregnancy. You can make a diaphragm work as well as possible by getting a proper fitting, checking the position every time, using spermicide as advised, leaving it in for long enough, replacing it when due, and using a backup method such as condoms if you are ever unsure.

Screening programmes

There is no screening test for diaphragm use, but regular sexual health checks are a good idea for anyone who is sexually active, and cervical screening (smear tests) should continue as normal when invited. Neither a diaphragm nor a cervical cap affects your cervical screening results.

Complications

If left untreated

• If a diaphragm is not used correctly — or not used at all — the main risk is an unintended pregnancy.
• Repeated urine infections or irritation can happen in some users, especially if the device presses on the urethra.
• Rarely, leaving a device in for far longer than advised can be associated with a serious infection; follow your clinic's instructions about how long to leave it in.
• Discomfort during sex is a sign to get the fit checked rather than to put up with it.

Long-term outlook

For people who get on well with it, a diaphragm is a dependable, hormone-free option that puts control in their hands. If it does not suit you, that is useful information rather than a setback — there are many other methods, and most people eventually find one that fits their body and their life. Whatever you choose, you deserve clear information and respectful support while you decide.

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