Diaphragm Birth Control: Use, Advantages, And Risks

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Medically reviewed by Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT — Written by Lori Smith, MSN, BSN, WHNP-BC on June 20, 2017

What is a diaphragm?
How to use it
Is it safe and effective?
Pros and cons
Risks and side effects

A diaphragm is a barrier form of birth control. Combined with spermicide, it prevents pregnancy by blocking the uterine opening, and by stopping the sperm from moving and fertilizing an egg

The device is a shallow, dome-shaped, rimmed cup that is placed in the vagina to cover the cervix.

Used correctly, it can be 94 percent effective in preventing unintended pregnancy.

Fast facts about diaphragm birth control

Types of diaphragm include the arching spring, coil spring, and flat spring diaphragms.
They can be 94 percent effective against unwanted pregnancy.
A diaphragm needs to be perfectly fitted for full effectiveness, and applied from 1 hour before until 6 hours after sex.
They are an immediately effective and reversible form of birth control.
Spermicide may act as an irritant and inflame urinary tract infections (UTIs) in those already prone to infection.

What is a diaphragm?

Diaphragm Birth Control — Lalocracio/Getty Images

A diaphragm, or cap, is a reusable, dome-shaped cup that fits over the cervix. It is made from latex or silicone. It is used with spermicide, a cream or gel that prevents the sperm from successfully fertilizing an egg.

There are several types.

The arching spring diaphragm is the most common type. It has a firm rim it is easier to insert. It is suitable for women with poor vaginal muscle tone.

The coil spring diaphragm has a soft, flexible rim. It is suitable for a woman who has average vaginal muscle tone.

The flat spring diaphragm has a thin, flexible rim. It works best for women who have strong vaginal muscle tone.

The flat spring and coil spring diaphragms can both be inserted with an introducer tool.

The wide seal rim diaphragm is a silicone ring that is useful for women who are allergic or sensitive to latex. It is available in arching spring or coil spring shapes.

Different sizes are available, but the standard size is 75 millimeters (mm) across. To get a good fit, your health care provider will carry out a physical examination.

How to use it

A healthcare provider will normally explain how to use a diaphragm correctly. They can teach the user if there is difficulty inserting or removing the diaphragm. An inserter device may help.

To use the diaphragm:

Apply about a teaspoon of spermicide in the dome, and spread it around the rim.
Fold the diaphragm in half, with the dome pointing down, and so that the two sides of the rim are touching
Hold the vagina open with the other hand.
Push the folded diaphragm as far into the vagina as possible, aiming back toward the tailbone.
With one finger, push the front rim of the diaphragm up behind the pubic bone.
Check the position of the diaphragm by placing your finger on the dome. You should feel your cervix through it. The cervix is the part that feels firm, but not bony.

If it is not correctly positioned, you may have to remove it and start again, remembering to reapply the spermicide.

The diaphragm can be put in place around 1 hour before having sex, and it should remain in place for at least 6 hours after intercourse. It must not be left in the vagina for more than 24 hours.

If the user is going to have intercourse again within 6 hours, more spermicide should be placed in the vagina, without removing the diaphragm.

It is important to note that diaphragms do not provide protection from contracting sexually transmitted infections (STIs).

Using a condom in addition to the diaphragm will reduce this risk and provide extra protection against unwanted pregnancy.

Is it safe and effective?

Used correctly and consistently, the diaphragm can be 94 percent effective in preventing pregnancy.

However, to be effective, it has to:

fit well
be correctly placed over the cervix
be used with spermicide
stay in for at least 6 hours

To increase effectiveness, the man can use a condom or pull out before ejaculation to further decrease the risk of pregnancy. Using a condom also reduces the risk of a sexually transmitted infection (STI), because a diaphragm does not protect against this.

Diaphragms are safe for most women to use, but for some women, they may not be suitable.

These include:

women who are uncomfortable with touching their vagina and vulva
those with a latex, silicone, or spermicide sensitivity
some women with a uterine or vaginal abnormality
those who find it too difficult to insert the diaphragm
women who have given birth within the last 6 weeks or who have recently undergone an abortion after the first trimester of pregnancy
those with frequent urinary tract infections (UTIs)
history of toxic shock syndrome
poor vaginal muscle tone
recent surgery to the cervix

A doctor can advise about alternative options.

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Pros and cons

All forms of birth control have both advantages and disadvantages.

A diaphragm can be a good option because it:

gives a woman control over her decisions to become pregnant
is safe to use during breastfeeding
is easily carried in a pocket or purse
has no effect on hormone levels
is immediately effective and immediately reversible
can be inserted several hours before vaginal intercourse
is not usually felt by either partner
is less invasive than an IUD or hormonal treatment and does not need regular doctor’s visits

It can be safer than oral contraceptives for use by women over the age of 35 years and those who smoke, because there is no risk of cardiovascular problems.

Disadvantages

Disadvantages of using a diaphragm include:

difficulty with insertion
the possibility of the diaphragm moving, due to penis size, sexual position, or heavy thrusting
it needs to be inserted before every act of vaginal intercourse

A woman needs to be refitted for her diaphragm after each full-term pregnancy, abdominal or pelvic surgery, miscarriage, abortion after 14 weeks or a weight change of 20 percent, or around 15 pounds.

A diaphragm should be replaced every 1 to 2 years.

Some substances, such as petroleum jelly, should not be used with a diaphragm, as they can cause erosion in the material.

Risks and side effects

A diaphragm is unlikely to pose a health risk, and serious problems are rare.

However, some problems may occur.

Urinary tract infections (UTIs) and vaginal irritation have been linked to diaphragm use.

Urinating before applying the diaphragm and after intercourse can help prevent a UTI.

Vaginal irritation may occur due to silicone sensitivity or as a reaction to the spermicide. If vaginal irritation occurs, it may be a good idea to use a different spermicide.

Most spermicides contain nonoxynol-9. This can become an irritant when used several times in a day, or if the user has HIV. It can increase the risk of contracting HIV and other STIs.

Anyone who is concerned about a UTI or vaginal irritation should speak to their health care provider.

Toxic shock syndrome (TSS) affects around 2.4 users in every 100,000, but this is usually after leaving the device in for over 24 hours.

It is important to consult a physician if the following symptoms occur:

burning with urination
discomfort when using the diaphragm
irregular spotting or bleeding
genital irritation
red or swollen vulva or vagina
unusual vaginal discharge
a high fever

Does it always work?

According to Planned Parenthood, diaphragm used perfectly is 94 percent effective. Overall, it is 88 percent effective, as people do make mistakes.

Other estimates put the success rate between 70 and 99 percent.

It is important to remember also that any birth control method that is not used according to the instructions may not be successful in preventing pregnancy.

A diaphragm is available from a health care provider or a family planning clinic and must be fitted by a health care provider.

Birth Control / Contraception
Pregnancy / Obstetrics
Sexual Health / STDs
Women's Health / Gynecology

How we reviewed this article:

SourcesMedical News Today has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Allen, R. E. (2004, January 1). Diaphragm fitting. American Family Physician 69 1, 97-100http://www.aafp.org/afp/2004/0101/p97.html
Birth control: How to use your diaphragm. (2017, May)https://familydoctor.org/birth-control-how-to-use-your-diaphragm/
Diaphragm. (n.d.)http://www.plannedparenthood.org/learn/birth-control/diaphragm
How effective are diaphragms? (n.d.)https://www.plannedparenthood.org/learn/birth-control/diaphragm/how-effective-are-diaphragms
What are the disadvantages of diaphragms? (n.d.)https://www.plannedparenthood.org/learn/birth-control/diaphragm/what-are-the-disadvantages-of-diaphragms

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Medically reviewed by Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT — Written by Lori Smith, MSN, BSN, WHNP-BC on June 20, 2017

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Diaphragm Birth Control: Use, Advantages, And Risks

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Fast facts about diaphragm birth control

What is a diaphragm?

How to use it

Is it safe and effective?

Pros and cons

Disadvantages

Risks and side effects

Does it always work?

How we reviewed this article:

Latest news

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