The diaphragm is a barrier method of contraception. It is a small soft rubber dome with a flexible rubber 'O'-ring moulded into the edge which the user fills with a spermicide (sperm killer) before placing it in the vagina to wall off the cervix (the opening to the uterus), thus preventing sperm from entering. A diaphragm is very soft and flexible, and can be gently squeezed from its normal circular shape into a thin 'melon-slice' shape for easy insertion. When fully inserted, the rim of this flexible cup (made of latex or medical silicone) sits an inch or so behind the pubic bone, and the rest of the rubber ring then naturally expands into a soft elliptical shape and settles against the front wall of the deepest part of the vagina, surrounding the cervix. It is most effective when used in tandem with spermicide, but if used alone, it is far more effective than spermicide alone. The spermicide should be applied just before insertion, and should be applied to the centre of the dome (which contacts the opening of the cervix) and around the contact surface of the rim.
 Position of diaphragm
Normal Use
The diaphragm must be inserted sometime before sexual intercourse and must remain in the vagina for 6 to 8 hours (depending on the strength of contraceptive jelly/foam used) after the man's last ejaculation for the spermicide to do its job. The diaphragm is then gently pulled out, washed in warm soapy water, and put away into its case (like a powder compact) ready for the next time. Each diaphragm lasts from six months to two years in normal use.
Comparisons
Diaphragms are different from cervical caps, which are smaller, thimble-shaped and placed directly over the cervix. Some women with especially long (or rather, deep) vaginas may find it difficult to position cervical caps properly, as their cervixes may be too far back to reach easily. In these cases, using a diaphragm may be more comfortable. The latest variation on diaphragms and cervical caps is Lea's shield, a one-size-fits-all device which stays in place because of suction at the end of the vagina and by this covering the cervix.
The diaphragm is an option for couples in which the woman cannot use hormonal forms of contraception (including the pill, norplant, and Depo Provera) for any of a variety of reasons, including having recently undergone a minor cervical procedure (e.g. abnormal cell removal).
Diaphragms have advantages and disadvantages when compared to condoms. It does require a little forward-thinking on the part of the woman to insert her diaphragm if she feels that intercourse is likely soon. However, once inserted, intercourse can commence at any time during the next several hours without any pause to apply the condom between foreplay and intercourse. Unlike with condoms, there remains direct intimate skin-to-skin contact, and so the diaphragm does not impair the natural physical sensations of sexual intercourse for either partner. Unlike condoms, diaphragms do not protect against STDs.
Availability
In the US, Diaphragms are available by prescription only, as the correct size must be chosen to suit the individual woman's internal dimensions. They must be initially test-fitted by a health care professional to ensure a good fit. Many European countries do not require prescriptions.
Risks
Diaphragms can lead to an increased risk of Urinary Tract Infections, cystitis, and the rare Toxic Shock Syndrome. Although the reasons for this are not fully understood, some evidence suggests these are reactions to the spermicide used in the diaphragm, rather than the device itself. Alternative explanations include pressure from the rim of the diaphragm pushing on the neck of the bladder, or the diaphragm trapping bacteria and secretions in the vagina.
Diaphragms made of latex must not be used with oil-based lubricants, as they may cause the latex to weaken and crack. Water-based lubricants are safe for use with latex, and are available in most pharmacies.
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