What is a diaphragm?

A diaphragm is a type of birth control that is put in the vagina prior to having intercourse, each time. It covers the opening of the uterus (cervix) and stops sperm from entering the uterus.

A diaphragm:

• is made of latex, nylon or silicone
• is disc-shaped
• has a flexible rim

A diaphragm must be used with a special type of vaginal gel that kills sperm (spermicidal gel). There are no Health Canada approved spermicidal gels containing nonoxynol-9 available in Canada.

People who use a diaphragm should use an acid buffering gel (e.g. Contragel®, Caya Gel ®) which forms a barrier in front of the cervix, lowers pH of vaginal fluid which slows down sperm.

How well does a diaphragm work?

• There’s about an 85% chance of getting pregnant after one year of having unprotected sex.
• How well a fitted diaphragm works to prevent pregnancy differs depending on the study. Rates are based on use of spermicidal gel, which is not available in Canada.
• How well a one size diaphragm (FemCap®, Caya SILCS®) works to prevent pregnancy is unknown.
• The diaphragm doesn’t protect you from sexually transmitted infections (STIs) and HIV.
• Use a condom every time you have sex (vaginal, oral, anal) to lower your risk of STIs and HIV.
• Don’t use diaphragms if pregnancy would be hard for you or you have a medical condition for which pregnancy poses an unacceptable health risk. Talk to your health care provider about what type of birth control might be best for you.

How do I start using a diaphragm?​

One size diaphragms are available at some pharmacies. To get a fitted diaphragm, you will need to see your health care provider. You need a prescription to buy a diaphragm. Diaphragms come in different sizes. Your healthcare provider will fit you for a diaphragm.

You need to get fitted for a new diaphragm:

• after you have a baby
• if you gain or lose more than 10 lbs. (4.5 kg)
• after pelvic surgery
• as per manufacturers recommendations

You need to use an acid buffering gel (e.g. Contragel®, Caya Gel®) with a diaphragm.

Spermicides contain nonoxynol-9, which can cause your vagina to get irritated. This irritation can increase your risk of getting HIV and STIs.

How do I use a diaphragm?

• Put your diaphragm in before you have intercourse.
• It must stay in for at least 6 hours after intercourse.
• Don’t keep your diaphragm in for more than 24 hours.
• You will have to touch your vagina to put in and take out your diaphragm.

Putting Your Diaphragm In

1. Check diaphragm for holes, cracks and tears by holding it up to the light and check the expiry on the gel.
2. Empty your bladder before you put your diaphragm in to prevent a bladder infection.
3. Wash your hands with soap and water for at least 20 seconds.
4. Put spermicidal or acid buffering gel (e.g. Contragel® Caya®) inside the diaphragm. The gel needs to be on the side of the diaphragm that will be right next to the cervix.
5. Put your diaphragm in up to 2 hours before you have sex.
6. Lie down, squat, or raise one leg on a chair.
7. Squeeze the rim together and push the diaphragm into the vagina, as far as it will go towards the back.
8. When the diaphragm is most of the way in, let go of it and tuck the front edge of the diaphragm up behind the pubic bone.
9. Make sure you can feel your cervix (it feels like the tip of your nose) through the diaphragm.
10. If your diaphragm is in the right place you should not feel it. If it isn’t comfortable, it is likely not in the right place. Take it out and try again.

 

If you have intercourse more than once:

• leave the diaphragm in
• put an applicator of spermicidal cream or jelly into the vagina

Taking Out Your Diaphragm

1. The diaphragm must stay in for at least 6 hours after intercourse and don’t keep it in for more than 24 hours.
2. Wash your hands with soap and water for at least 20 seconds.
3. Hook your finger under the rim and pull the diaphragm down and out.
4. Be careful not to poke a hole in your diaphragm.

Caring for Your Diaphragm

• Wash your diaphragm after each use with mild, unscented soap and warm water.
• Rinse and dry it completely.
• Store it in a cool, dry place.
• Check it regularly for holes by holding it up to a light.
• Replace your diaphragm every year or sooner if you notice a hole, tear, rip, or the rim is bent. Replace silicone diaphragms when the silicone gets harder and loses elasticity.
• Water-based lubricant are safe with any diaphragm. Oil-based products can break down (or damage) latex diaphragms.
• When you buy a diaphragm, always read and follow the enclosed manufacturer’s directions.

What are the benefits of a diaphragm?

• The diaphragm doesn’t have hormones. There is no effect on a woman’s natural hormones. It is a good choice for a people who can’t use hormonal birth control.
• You can insert a diaphragm up to 2 hours before having sex.
• A diaphragm can be reused.

What are the disadvantages of a diaphragm?

• A diaphragm requires planning ahead and takes practice to use.
• Don’t use a diaphragm if you or your partner have an allergy to latex, silicone, or spermicide.
• Using a diaphragm might increase your risk of a bladder infection, yeast infection, or bacterial vaginosis.
• A diaphragm can move out of place during sex. If this happens the sperm can enter the uterus, which means there is a chance you could get pregnant.
• People who use vaginal barrier methods for birth control have a slightly higher risk of toxic shock syndrome.
• A latex diaphragm shouldn’t be used during and for 3 days after treatment with vaginally inserted yeast medicine, or any estrogen creams which can damage them.

Did You Know​ 

• You have the right to make the decision to have sex or not.
• Plan ahead and decide to protect yourself to lower your risk of pregnancy, STIs, and HIV.
• It is important to talk with your partner about how you can protect each other.
• Always use spermicide with another method of birth control (e.g., condoms).
• Natural vaginal spermicides might not be as effective. You can buy natural vaginal spermicides at some drugstores or online pharmacies. These spermicides are different than the ones described in this handout.
• Think about getting emergency contraceptive to help prevent pregnancy if your diaphragm moved out of place while you had sex or you have had unprotected sex.
• Only use water-based lubricants with a diaphragm. Oil-based products can break the diaphragm.

For More Information

• Health Link – Health Advice 24/7: 811