A physician fitting and prescription are necessary to use the diaphragm. In addition, a woman must be taught insertion and removal techniques and be comfortable touch­ing her genitals. The diaphragm has also been found to increase the risk of toxic shock syndrome, urinary tract infection, and postcoital drip (Hatcher et al., 2004). It may also move during different sexual positions and become less effective or develop a foul odor if left in place too long. An allergic reaction to the spermicide may also develop.

Cross-Cultural Use

Because diaphragm use is low in the United States, it shouldn’t come as any surprise that it also has low usage rates outside the United States. This is possibly due to the neces­sity of physician fitting, availability of spermicidal cream or jelly, cost, and the necessity of touching the genitals. Many women in other cultures are not comfortable touching the vagina or inserting anything into it (in fact, tampon use is also much lower in coun­tries outside the United States). A shortage of physicians to fit diaphragms may also in­hibit their use. There are exceptions to low usage however. The diaphragm remains a popular contraceptive method in Australia (Coates, 2004).