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Sexual and Reproductive Health

Diaphragm

Diaphram  

What is a diaphragm?

A diaphragm is a barrier method of birth control that is put in the vagina prior to having sex. It covers the opening of the uterus (cervix) and stops sperm from entering the uterus. There are two types:

  • A fitted diaphragm is available by prescription from a healthcare provider.
  • A one size diaphragm (FemCap®, Caya SILCS®) is available without a prescription at some pharmacies.

A diaphragm is intended to be used with a 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?

  • If no method of birth control is used, there’s about an 85% chance of getting pregnant after 1 year of having 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 diaphragm works with acid buffering gel is unknown.
  • How well a one size diaphragm works to prevent pregnancy is unknown.
  • Diaphragms are less effective for people who have had a baby.
  • Think about getting emergency contraception to help prevent pregnancy if birth control wasn’t used or your diaphragm moved out of place.
  • Diaphragms don’t protect you from sexually transmitted infections (STIs) and HIV.
  • Use a condom every time you have sex (anal, oral, vaginal) to lower your risk of STIs and HIV.

How do I use a diaphragm?

When you buy a diaphragm, always read and follow the enclosed manufacturer’s directions.

You need to use an acid buffering gel with a diaphragm.

Fitted diaphragms come in different sizes. You need to get refitted 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

Inserting your diaphragm

  1. Check diaphragm for holes, cracks and tears by holding it up to the light. 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 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 or toilet.
  7. Squeeze the rim together and push the diaphragm into the vagina, as far as it will go towards the back bone.
  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 find 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’s likely not in the right place. Take it out and try again.
How to insert a diaphragm 

An extra application of gel needs to be inserted into the vagina each time you have sex or if it’s been more than 2 hours since the gel was originally applied. Do not remove the diaphragm to do this.

Taking Out Your Diaphragm

  1. It must stay in for at least 6 hours after sex. 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 gently to avoid damaging it.

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.
  • Replace your diaphragm every year or sooner if you notice any damage.
  • Water-based lubricant are safe with any diaphragm. Oil-based products can break down (or damage) latex diaphragms.

What are the benefits of a diaphragm?

  • The diaphragm doesn’t have hormones. There is no effect on a person’s natural hormones.
  • A diaphragm is reusable.

What are the disadvantages of a diaphragm?

  • Some people could have an allergy to latex, silicone, or spermicide.
  • Using a diaphragm might increase your risk of a bladder infection.
  • It can move out of place during sex. If this happens there is an increased chance of pregnancy.
  • People who use vaginal barrier methods for birth control have a slightly higher risk of toxic shock syndrome.

Did You Know

  • You have the right to make the decision to have sex or not.
  • You can plan ahead and talk to your partner about how to protect yourself and lower your risk of pregnancy, STIs, and HIV.
  • You can consider getting tested for STIs and HIV. Talk to your health care provider.

Many clinics offer low or no cost birth control.

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