A diaphragm is a reusable, dome-shaped device made of flexible materials like silicone or latex, used as a barrier method of contraception. This shallow cup is inserted into the vagina before sexual activity to prevent pregnancy. It functions by mechanically covering the cervix, the opening to the uterus. This physical shield blocks the path sperm must travel to reach an egg.
The Dual-Action Mechanism of Prevention
The efficacy of a diaphragm relies on a combined physical and chemical approach to prevent fertilization. The primary function of the device is to serve as a physical barrier, achieved by positioning the dome to completely cover the cervix. This placement ensures that any semen deposited during intercourse is blocked from entering the uterine cavity.
The diaphragm is designed to work in synergy with spermicidal jelly or cream, which is applied directly to the device before insertion. This spermicide acts as the chemical component, containing agents that actively kill or immobilize sperm. The most common active ingredient is nonoxynol-9, which disrupts the sperm’s cell membrane.
The diaphragm holds the spermicidal agent against the cervix, ensuring it remains concentrated at the point of entry. This dual action increases the effectiveness compared to using either the diaphragm or spermicide alone. If the physical barrier is slightly displaced, the concentrated chemical barrier provides backup protection.
The Necessity of Proper Sizing and Fitting
A diaphragm requires a prescription and is not a one-size-fits-all product. The device is available in diameters from 50 to 105 millimeters and must be professionally fitted by a healthcare provider. This process determines the correct size that rests comfortably and securely within the vaginal anatomy.
If the diaphragm is too small, it may not create a complete seal over the cervix and can be easily dislodged during intercourse, compromising the barrier. Conversely, a diaphragm that is too large can cause discomfort or place undue pressure on the urethra, potentially increasing the risk of urinary tract infections. The correct fit ensures the rim rests snugly behind the pubic bone and the dome covers the cervix.
The vaginal anatomy can change over time, necessitating a re-evaluation of the diaphragm size. Changes in body weight, such as a gain or loss of ten pounds or more, may alter the fit. Events like pelvic surgery or giving birth also require a refitting appointment to ensure the device functions effectively.
Step-by-Step Guide to Application and Removal
Application begins by placing about a teaspoon of spermicidal gel into the dome and spreading a small amount around the rim. This ensures the spermicide is directly against the cervix and aids in forming a seal. The diaphragm is then folded in half and inserted into the vagina, pushing it up and back along the vaginal wall.
Once inserted, manually check the placement to confirm the cervix is fully covered by the dome. The diaphragm can be inserted up to two hours before intercourse. If a longer period elapses, additional spermicide should be applied into the vagina without removing the device to ensure the chemical barrier remains active.
After the last act of intercourse, the diaphragm must remain in place for a minimum of six hours to allow the spermicide time to immobilize remaining sperm. It should not be left inside for more than 24 hours to minimize the risk of toxic shock syndrome. If intercourse occurs again while the diaphragm is in place, a fresh dose of spermicide must be inserted into the vagina before each subsequent event.
Removal is accomplished by hooking a finger over the rim and gently pulling the device downward and out. Following removal, the diaphragm should be washed immediately with mild soap and warm water, rinsed, and allowed to air dry completely before storage. Regular cleaning and inspection for holes or tears are necessary to maintain its integrity and effectiveness.