A diaphragm is a latex or silicone medical contraceptive in the form of a shallow, flexible cup with a soft rim and placed inside the vagina. The thin diaphragm membrane covers the cervix during sex to prevent pregnancy.

The size of the diaphragm to be used varies according to the women: it must therefore be chosen with the help of the doctor, midwife or gynecologist. This size should be reassessed after childbirth or following significant weight loss or gain – over 5 kg. There are also one-size-fits-all diaphragms, suitable for all.

Easy to use, this hormone-free method of contraception can only be used during intercourse and should only be replaced every two years.

The contraceptive action of the diaphragm is mechanical. It acts as a physical barrier against sperm: by covering the cervix, it prevents them from reaching the egg.

In order to ensure its effectiveness, it must be used with a spermicide – a cream or gel that contains chemicals that prevent sperm from moving.

The diaphragm is fitted by the user on the advice of the doctor.

It should be used every time you have sex and it will become easier to fit over time. Here are the different stages:

• Wash hands with soap and water;
• Apply the spermicide to the diaphragm cup – following the instructions on the diaphragm package insert;
• Get into a comfortable position – similar to that adopted for inserting a tampon;
• Spread the lips of the vulva with one hand and with the other, pinch the edge of the diaphragm to fold it in half;
• Insert the diaphragm into the vagina: push it as far up as possible, with the dome pointing down, then place the rim of the diaphragm behind the pubic bone;
• Check that the cervix is ​​well covered.

The effectiveness of the contraceptive diaphragm will be enhanced if the following tips are implemented:

• The diaphragm should be used with each intercourse;
• A spermicide either be associated with the use of the diaphragm;
• The diaphragm must be placed before sexual intercourse, up to two hours before – beyond that, the spermicide will lose its effectiveness;
• The diaphragm should cover the cervix.

In addition, another method of contraception can be used in addition to the diaphragm in order to avoid pregnancy: the partner can withdraw before ejaculating or wear a condom.

The diaphragm should remain in the vagina for at least 6 hours after intercourse – but no longer than 24 hours. If new sexual intercourse takes place, the diaphragm can be left in place but a new dose of spermicide should be applied into the vagina.

To remove the contraceptive diaphragm:

• Insert a finger into the vagina and hook it onto the top of the rim of the diaphragm to counter the suction effect;
• Gently pull the diaphragm down;
• Clean the diaphragm with warm water and neutral soap, then allow it to air dry – the use of disinfectant is not necessary.

Store the diaphragm in its storage box to protect it from extreme heat and direct sunlight. It is not necessary to sterilize the diaphragm between each use.

A diaphragm can be used for two years if it is properly maintained.

Warning: check the diaphragm from time to time for holes, cracks, folds or points of weakness. At the slightest anomaly, its replacement will be necessary.

In order to guarantee optimum efficiency of the diaphragm, i.e. 94%, it must be used with each intercourse and combined with a spermicidal gel or cream.

When the installation instructions and the regularity of use are not followed, its effectiveness rate drops to about 88%: 12 people out of 100 will become pregnant each year.

Apart from a possible allergy to latex or silicone, the diaphragm can sometimes cause chronic urinary tract infections: a change in diaphragm size can solve this problem.

Adverse effects of spermicides

Spermicides also contain chemicals – most spermicides contain nonoxynol-9 – which can cause unwanted effects:

• Irritation of the vagina;
• Increased risk of contracting a sexually transmitted infection or disease;
• Spermicide allergy – another brand can then be tried.

Adverse effects of the diaphragm

An appointment with the doctor or the gynecologist is necessary in the event of:

• Burning during urination;
• Discomfort when wearing the diaphragm;
• Abnormal bleeding;
• Pain, itching or redness in the vulva or vagina;
• Abnormal vaginal discharge.

When to consult urgently?

Finally, immediate removal of the diaphragm and an emergency consultation is necessary in the event of:

• Sudden high fever;
• Rash that looks like sunburn;
• Diarrhea or vomiting;
• Sore throat, muscle or joint pain;
• Dizziness, fainting, and weakness.

The diaphragm may not be a satisfactory contraceptive solution for people who:

• Are uncomfortable putting their fingers in the vagina or have recurring difficulty placing the diaphragm;
• Are sensitive or allergic to latex, silicone or spermicide;
• Have given birth in the past six weeks;
• Have HIV / AIDS – user or partner;
• Have had an abortion in the second or third trimester of pregnancy within the past six weeks.

The diaphragms are space-saving, reusable and hormone-free. They are effective immediately and allow pregnancy as soon as they are abandoned.

On the other hand, the use of spermicides several times a day is not advised.

Finally, it does not protect against sexually transmitted diseases or infections: a condom must be used in addition.

The diaphragm is prescribed by prescription in a pharmacy or in a Planning and Family Education Center (CPEF) after a consultation with a doctor – general practitioner or gynecologist – or a midwife. Some websites offer the purchase of diaphragms online but it is advisable to consult a doctor beforehand.

The cost of a diaphragm is around 33 € in latex and 42 € in silicone. It is reimbursed by social security on the basis of € 3,14.

Spermicides are available without a prescription in pharmacies and cost between 5 to 20 euros for several doses. They are not reimbursed by social security.