The diaphragm is a barrier method of contraception, and it must be used with a spermi­cidal jelly to ensure that sperm do not live if they should get past the barrier. Diaphragms come in a variety of different sizes and shapes, and they must be prescribed by a physi­cian or other healthcare provider to ensure a proper fit over the cervix.

Prior to insertion, the diaphragm rim is covered with spermicidal jelly, and 1 table­spoon of the jelly is put into the dome of the diaphragm. Although healthcare providers generally advise women to insert more spermicidal jelly if a second intercourse will take place, the evidence to support this practice is weak (Hatcher et al., 2004). The di­aphragm is folded in half and inserted into the vagina while a woman is standing with one leg propped up, squatting, or lying on her back (see Figure 13.5). The diaphragm is pushed downward toward the back of the vagina, while the front rim is tucked under the

Figure 13.5

Instructions for proper insertion of a diaphragm.

 

(a)

 

(b)

 

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How It WorksПодпись:Подпись:How It Workspubic bone. The diaphragm can be inserted by the woman or her partner, and insertion may take place immediately prior to sexual intercourse or up to 6 hours before.

Once a diaphragm is in place, a woman should not be able to feel it; if she does, it is improperly inserted. The diaphragm must be checked to ensure it is properly placed on the cervix. This is done by inserting two fingers into the vagina and feeling for the diaphragm covering the cervix.

After intercourse, the diaphragm must be left in place for at least 6 to 8 hours, but never more than 24 hours. To remove the diaphragm, a finger is hooked over the front of the diaphragm rim, and then it is pulled down and out of the vagina. The diaphragm must be washed with soap and water and replaced in its container. If properly cared for, diaphragms can last for several years. However, if a woman loses or gains more than 10 pounds or experiences a preg­nancy (regardless of how the pregnancy was resolved—through birth, miscar­riage, or abortion), she must have her diaphragm refitted by her healthcare provider.

Question: Is it okay to borrow someone else’s diaphragm if I can’ find mine?

Absolutely not. The diaphragm works by creating a suction on the cervix, which prevents sperm from entering the uterus. To get this suction, a healthcare provider must measure the cervix and prescribe the right size diaphragm for each individual woman. If you use some­one else’s diaphragm, it may be the wrong size and thus ineffective. Also, because of the risk of acquiring an STI, it is not a good idea to share diaphragms.