Diaphragm (birth control)

Diaphragms are dome-shaped barrier methods of contraception that blocksperm from entering the uterus. They are made of latex (rubber) and formed like a shallow cup. Since vaginas vary in size, each patient needs to be fitted by a doctor or nurse with a diaphragm that conforms to the shape of the vagina as well as the strength of the muscles in the vaginal walls. Diaphragms must be used with spermicidal cream or jelly. The device should cause no discomfort and neither the woman nor her partner should feel that it is there. Thelevel of effectiveness is about 95%.

Before receiving a diaphragm, patients must undergo a physical examination and a Pap test. If these are normal, the physician will fit the patientfor the device and give instructions on how to insert, remove, and clean it.She will also be taught the signs and symptoms of potential complications.

Prior to insertion, the inside of the dome and the rim are covered with a thick layer (perhaps a tablespoon) of a spermicide that is compatible with the diaphragm being used. The domed area covers the opening into the uterus (cervix) and keeps the spermicide in place. As a result, any sperm that might get under the diaphragm will be destroyed.

Diaphragms may be inserted 2-3 hours prior to intercourse, and must be left in place for 6-8 hours following sexual relations. During this time the womanmay not swim, bathe, or douche, but she may shower. If she desires to have intercourse again before the 6-8 hours have passed, the diaphragm should not beremoved. Instead, an applicator full of spermicide should be deposited intothe vagina.

A diaphragm will last for a year or more. It should be examined weekly for holes. This can be done by holding it up to the light or filling it with water.

Before inserting the diaphragm, the woman should empty her bladder and wash her hands with soap and water. The device should be checked for leaks by filling it with water or holding it to the light. A spermicidal jelly is then applied to the inside and outside, and especially around the rim. While standingwith one foot elevated on a chair or step, lying down, or squatting, the woman folds the diaphragm inward toward the middle and inserts it into the vaginaas far as it will go.

When removed, the diaphragm should be washed with a mild soap and water. After being dried, it can be dusted with corn starch before being returned to itscontainer. The diaphragm should always be stored away from sunlight and heatin a cool, dry place. It should not be washed with harsh or perfumed soaps or used with perfumed powders because either of these substances can damage it.

Although rare, wearing the diaphragm longer than the recommended time can result in toxic shock syndrome. The signs and symptoms of this serious illness include sudden onset of high fever, vomiting, diarrhea, dizziness, faintness,weakness, aching muscles and joints, and rash. The doctor must be notified immediately if any of these conditions appear. An allergic reaction to the spermicide or the material from which the device is made is also possible. Diaphragm use is also associated with an increased risk of bladder infections.

It should be noted that the diaphragm can become dislodged during intercourse, which could result in an unwanted pregnancy. To ensure a secure fit, a woman should be examined for a refitting if she gains or loses more than 10 lbs (4.5 kg), or after she gives birth.

Using a male condom in conjunction with the diaphragm decreases the potentialfor pregnancy. Diaphragms provide no protection against AIDS or other sexually transmitted diseases.

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