The Contraceptive Diaphragm

Advantages and Disadvantages of the Diaphragm

Last reviewed: 24 Feb 2019

Woman stood in front of a building checking her phone for information about the contraceptive diaphragm

Key takeaways

  • The contraceptive diaphragm is a small device that covers the entrance of your womb to stop sperm entering and causing pregnancy

  • The diaphragm should be used with spermicide (more should be added if the last application was more than 3 hours ago or if you plan to have sex again) and should be kept in place for at least 6 hours after sex. Diaphragms shouldn’t be left in place longer than the manufacturer recommends (we recommend reading the information leaflet that comes with your diaphragm)

  • The diaphragm is easy to use once you’ve learned how and has few side effects, but it doesn’t give full protection from STIs

  • The diaphragm can move out of place, can cause irritation, and isn’t right for you if you are allergic to the material, have a current vaginal infection, have HIV, or have a history of toxic shock syndrome. For some people this may also be unsuitable if the vaginal muscles can’t hold the diaphragm in place, they have recurrent urine infections, or the cervix is an unusual shape

Contents of this article

The contraceptive diaphragm is a small, dome-shaped cup made of rubber or silicone that covers the cervix (neck of the womb) to protect against pregnancy. To be effective, it has to be covered with a spermicide (jelly that kills sperm) so that it prevents sperm from entering in the uterus by blocking and/or killing it.

When used perfectly, the diaphragm offers 94% protection against pregnancy in the first year of use but it won't fully protect you against sexually transmitted diseases (STDs). Perfect use can be difficult to keep up in day to day life, and the rate of protection can decrease to 88% in the first year of use.

Using A Diaphragm Contraceptive

To obtain a diaphragm, you’ll need to visit a doctor, who can issue a prescription and show you how to use it (correct insertion and removal, use of the spermicide, and how to look after it). Your doctor will also establish the correct size.

The contraceptive diaphragm should be covered with spermicide and then inserted tightly against the cervix. You must leave it in place at for least 6 hours after sex. Although it is rare, there is a risk of toxic shock so you must also follow the instructions in your packet in regards to when to remove the diaphragm (usually within 24 hours of putting it in place).

Some studies suggest that diaphragms should not be used during your period due the increased risk of toxic shock syndrome and that condoms should be used instead.

Remember to use spermicide each time you insert the contraceptive diaphragm. If you’re having sex more than three hours after you've inserted it or having sex again after the last application of spermicide, you need to re-apply more spermicide.

Don't have a bath when the diaphragm is in place - this can wash away the spermicide. You can put the diaphragm in anytime, including right before having sex.

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Advantages of the contraceptive diaphragm

It’s fairly easy to use and doesn’t present too many risks or side effects. It can be put in place several hours before sex and you only use it when planning to have sex (unlike the pill, for example).

Disadvantages of diaphragm birth control

You have to learn how to use the diaphragm and it may take you some time to get used to it. Usually, your healthcare provider will give you one to practice with the first time (but it's not a real one so don't use it when having sex).

Sometimes women report that the rubber causes irritation and say that they find applying the spermicide inconvenient.

If it is left in place for more than 24 hours, there is also the risk of irritation, an allergic reaction or toxic shock syndrome.

Finally, you'll probably need to readjust the contraceptive diaphragm or look for a different size if you gain or lose more than three kilos.

There is little evidence that diaphragms give adequate protection from STIs.

Precautions

There is a risk that the contraceptive diaphragm can dislodge from its position, so you must be careful, especially during sex, when you walk, or when you cough. You may need emergency contraception if:

  • the diaphragm is removed, dislodged or breaks less than 6 hours after having sex
  • the diaphragm has been left in for more than 3 hours before sex and no additional spermicide has been applied or spermicide was not reapplied between episodes of sex
  • the diaphragm/ spermicide is in place and you have a bath or use vaginal pessaries, oil based lubricants/bath oils/baby lotion (these can damage latex diaphragms

Consult a doctor if you find the diaphragm painful during sex or if you find blood on the diaphragm after removing it (only if it's unrelated to your period), it might be a sign of irritation or infection.

The diaphragm is not recommended for people who have an allergy to rubber or silicone.

Likewise, women with a history of vaginal infection, cystitis or toxic shock syndrome are usually told to avoid using the diaphragm.

Finally, it's also not recommended if you suffer from vaginal abnormalities that might pose a problem in placing the diaphragm, or if you've recently given birth or had a miscarriage.

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Dr Clair Grainger studied at The University of Edinburgh from 2004 to 2009. She's worked in hospitals throughout Edinburgh and London before completing her GP training in North Middlesex Hospital in 2017.

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Last reviewed: 24 Feb 2019

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