Diaphragm (contraceptive) Totally Explained

Everything about Diaphragm Contraceptive totally explained

The diaphragm is a cervical barrier type of birth control. It is a soft latex or silicone dome with a spring molded into the rim. The spring creates a seal against the walls of the vagina.

Use

Anyone inserting or removing a diaphragm should first wash their hands, to avoid introducing harmful bacteria into the vaginal canal.
The rim of a diaphragm is squeezed into an oval or arc shape for insertion. A water-based lubricant (usually spermicide) may be applied to the rim of the diaphragm to aid insertion. One teaspoon (5mL) of spermicide may be placed in the dome of the diaphragm before insertion, or with an applicator after insertion.
The diaphragm must be inserted sometime before sexual intercourse, and remain in the vagina for 6 to 8 hours after a man's last ejaculation. For multiple acts of intercourse, it's recommended that an additional 5mL of spermicide be inserted into the vagina (not into the dome - the seal of the diaphragm shouldn't be broken) before each act. Upon removal, a diaphram should be cleaned with warm soapy water before storage. The diaphragm must be removed for cleaning at least once every 24 hours. to three years. Silicone diaphragms may last much longer - up to ten years.

Fitting

Diaphragms come in different sizes. A fitting appointment with a health care professional is necessary to determine which size a woman should wear.
   A correctly fitting diaphragm will cover the cervix and rest snugly against the pubic bone. A diaphragm that's too small might fit inside the vagina without covering the cervix, or might become dislodged from the cervix during intercourse or bowel movements.
   Diaphragms should be re-fitted after a weight change of 4.5 kg (10 lb) or more.
   Diaphragms should also be re-fitted after any pregnancy of 14 weeks or longer. The correct size for a woman is the largest size that she can wear comfortably throughout her cycle.
   In the United States, diaphragms are available by prescription only. Many European countries don't require prescriptions.

Mechanism of contraception

The spring in the rim of the diaphragm forms a seal against the vaginal walls. The diaphragm covers the cervix, and physically prevents sperm from entering the uterus through the os.
   Traditionally, the diaphragm has been used with spermicide, and it's widely believed the spermicide significantly increases the effectiveness of the diaphragm. Insufficient studies have been conducted to determine effectiveness without spermicide.
   It is widely taught that additional spermicide must be placed in the vagina if intercourse occurs more than six hours after insertion.
   It has long been recommended that the diaphragm be left in place for at least six or eight hours after intercourse. No studies have been done to determine the validity of this recommendation, however, and some medical professionals have suggested intervals of four hours or even two hours are sufficient to ensure efficacy. Interestingly, one manufacturer of contraceptive sponges only recommends leaving the sponge in place for two hours after intercourse. However, such use of the diaphragm (removal before 6 hours post-intercourse) has never been formally studied, and can't be recommended.
   It has been suggested that diaphragms be dispensed as a one-size-fits-all device, providing all women with the most common size (70mm). However, only 33% of women fitted for a diaphragm are prescribed a 70mm size, and correct sizing of the diaphragm is widely considered necessary.

Effectiveness

The effectiveness of diaphragms, as of most forms of contraception, can be assessed two ways: method effectiveness and actual effectiveness. The method effectiveness is the proportion of couples correctly and consistently using the method who don't become pregnant. Actual effectiveness is the proportion of couples who intended that method as their sole form of birth control and don't become pregnant; it includes couples who sometimes use the method incorrectly, or sometimes not at all. Rates are generally presented for the first year of use. Most commonly the Pearl Index is used to calculate effectiveness rates, but some studies use decrement tables.
For all forms of contraception, actual effectiveness is lower than method effectiveness, due to several factors:

mistakes on the part of those providing instructions on how to use the method
mistakes on the part of the method's users
conscious user non-compliance with method. For instance, someone using a diaphragm might be fitted incorrectly by a health care provider, or by mistake remove the diaphragm too soon after intercourse, or simply choose to have intercourse without placing the diaphragm.

Contraceptive Technology reports that the method failure rate of the diaphragm with spermicide is 6% per year.
The actual pregnancy rates among diaphragm users vary depending on the population being studied, with yearly rates of 10% to 39% being reported.

Unlike some other cervical barriers, the effectiveness of the diaphragm is the same for women who have given birth as for those who have not.

Types

Diaphragms are available in diameters of 50mm to 105mm (about 2-4 inches). They are available in two different materials: latex (currently manufactured by Ortho and Reflexions) and silicone (currently manufactured by Milex and Semina). Diaphragms are also available with different types of springs in the rim.
An arcing spring folds into an arc shape when the sides are compressed. This is the strongest type of rim available in a diaphragm, and may be used by women with any level of vaginal tone. Unlike other spring types, arcing springs may be used by women with mild cystocele, rectocele, or retroversion. Arcing spring diaphragms may be easier to insert correctly than other spring types. Examples of arcing spring diaphragms are the Ortho All-Flex

and the Milex Wide-Seal Arcing

.
   A coil spring flattens into an oval shape when the sides are compressed. This rim isn't as strong as the arcing spring, and may only be used by women with average or firm vaginal tone. While some providers may still have Ortho White diaphragms in stock, the only current manufacturer of a flat-spring diaphragm is Reflexions.
   The diaphragm is less expensive than many other methods of contraception.
   Because pelvic inflammatory disease (PID) is caused by certain STIs, diaphragms may lower the risk of PID. Cervical barriers may also protect against human papillomavirus (HPV), the virus that causes cervical cancer, although the protection appears to be due to the spermicide used with diaphragms and not the barrier itself.
   Diaphragms are also considered a good candidate as a delivery method for microbicides (preparations that, used vaginally, protect against STIs) that are currently in development. Urinating before inserting the diaphragm, and also after intercourse, may reduce this risk. For this reason, some advocate use of lactic acid or lemon juice based spermicides, which might have fewer side effects. Although these alternative spermicides have been shown to immobilize sperm in the laboratory, their effect on pregnancy rates in humans has never been studied.
   It has also been suggested that, for women who experience side effects from nonoxynol-9, it may be acceptable to use the diaphragm without any spermcide. One study found an actual pregnancy rate of 24% per year in women using the diaphragm without spermicide; however, all women in this study were given a 60mm diaphragm rather than being fitted by a clinician. Other studies have been small and given conflicting results. The current recommendation is still for all diaphragm users to use spermicide with the device. However, the diaphragm - which stays in place because of the spring in its rim, rather than hooking over the cervix or being sticky - is of much more recent origin.
   An important precursor to the invention of the diaphragm was the rubber vulcanization process, patented by Charles Goodyear in 1844. In the 1880s, a German gynecologist C. Haase published the first description of a rubber contraceptive device with a spring molded into the rim. Haase wrote under the pseudonym Wilhelm P.J. Mensinga, and the Mensinga diaphragm was the only brand available for many decades.
   American birth control activist Margaret Sanger fled to Europe in 1914 to escape prosecution under the Comstock laws, which prohibited sending contraceptive devices, or information on contraception, through the mail. Sanger learned about the diaphragm in the Netherlands, and introduced the product to the United States when she returned in 1916. Sanger and her second husband, Noah Slee, illegally imported large quantities of the devices from Germany and the Netherlands. In 1925, Slee provided funding to Sanger's friend Herbert Simonds. Simonds used the funds to found the first diaphragm manufacturing company in the U.S., the Holland-Rantos Company.
   Diaphragms played a role in overturning the federal Comstock Act. In 1932, Sanger arranged for a Japanese manufacturer to mail a package of diaphragms to a New York physician who supported Sanger's activism. U.S. customs confiscated the package, and Sanger helped file a lawsuit. In 1936, in the court case United States v. One Package of Japanese Pessaries, a federal appellate court ruled that the package could be delivered.

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