Diaphragm (birth control)

Encyclopedia of Medicine by Donald Gardner Barstow

Definition

Diaphragms are dome-shaped barrier methods of contraception that block sperm from entering the uterus. They are made of latex (rubber) and formed like a shallow cup. Since vaginas vary in size, each client will need to be fitted by a doctor or nurse with a diaphragm that conforms to the shape and contour 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.

Purpose

The purpose of a diaphragm is to prevent access to the womb (uterus) by the sperm and thus prevent conception. The level of effectiveness is about 95%.

Precautions

Each client will undergo a physical examination and a Pap smear. If these are normal, the physician will fit the patient for the device and give instructions on how to insert, remove, and clean the object. She will also be taught the signs and symptoms of potential complications.

Description

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 woman may 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 be removed. Instead, an applicator full of spermicide should be deposited into the 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.

Preparation

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 up to the light. A spermicidal jelly is then applied to the inside and outside, and especially around the rim. While standing with 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 vagina as far as it will go.

Aftercare

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 its container. The diaphragm should always be stored away from sunlight and heat in 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 the diaphragm.

Risks

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.

Normal results

Consumers can expect an efficiency rate of about 95% in preventing pregnancy. Using a male condom in conjunction with the diaphragm decreases the potential for pregnancy. Diaphragms provide no protection against AIDS or other sexually transmitted diseases.

Key Terms

Spermicide

A substance that kills sperm.

Toxic shock syndrome

An uncommon, but potentially fatal, disease that has been associated with the use of diaphragms and vaginal tampons. The symptoms include high fever, vomiting, and diarrhea.

Further Reading

For Your Information

Books

• Dickason, Elizabeth Jean, Bonnie Lang Silverman, and Judith A. Kaplan. Maternal-Infant Nursing Care, 3rd ed. St. Louis: Mosby-Year Book, Inc., 1998.
• Gorrie, Trula Meyers, Emily Slone McKinney, and Sharon Smith Murray. Foundations of Maternal-Newborn Nursing, 2nd ed. Philadelphia: W.B. Saunders Company, 1998.
• Nichols, Francine H., and Elaine Zwelling. Maternal-Newborn Nursing: Theory and Practice. Philadelphia, PA.: W. B. Saunders Company, 1997.
• Olds, Sally B., Marcia L. London, and Patricia Wieland Ladewig. Maternal-Newborn Nursing: A Family Centered Approach. Menlo Park: Addison-Wesley, 1996.

  Organizations

• Planned Parenthood Federation of America, Inc., 810 Seventh Avenue, New York, NY,10019. (800) 669-0156.

  Other

• Cincinnati Women's Services. "The Diaphragm." http://gynpages.com/cws/8.html.
• Sexual Health InfoCenter. "Guide to Safer Sex." http://www.sexhealth.org/infocenter/GuideSS/diaphragm.htm.>