Explaining How To Use The Diaphragm - Family Planning

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Introduction
- Welcome to FPHandbook.org!
- Foreword From the World Health Organization
- Foreword From the United States Agency for International Development
- Acknowledgements
- WHO’s Family Planning Guidance
- Human Rights: Family Planning Providers’ Contribution
- Gender Equality and Gender Inclusiveness
  - Gender Equality and Gender Inclusiveness - Introduction
  - Gender Inclusiveness
  - Considerations for Transgender and Gender-Diverse Clients
  - References for the Section on Gender Equality and Gender Inclusiveness
- Collaborating and Supporting Organizations
Chapters
- Combined Oral Contraceptives
  - Combined Oral Contraceptives - Introduction
  - Side Effects, Health Benefits, and Health Risks
  - Correcting Misunderstandings
  - Facts About Combined Oral Contraceptives and Cancer
  - Who Can and Cannot Use Combined Oral Contraceptives
  - Medical Eligibility Criteria for Combined Oral Contraceptives
  - Using Clinical Judgment in Special Cases
  - Providing Combined Oral Contraceptives
  - Giving Advice on Side Effects
  - Explaining How to Use
  - Supporting New and Continuing Users
  - Come Back Any Time: Reasons to Return
  - Managing Any Problems
  - Extended and Continuous Use of Combined Oral Contraceptives
  - Questions and Answers About Combined Oral Contraceptives
- Progestin-Only Pills
  - Progestin-Only Pills - Introduction
  - Side Effects, Health Benefits, and Health Risks
  - Correcting Misunderstandings
  - Who Can and Cannot Use Progestin-Only Pills
  - Medical Eligibility Criteria for Progestin-Only Pills
  - Using Clinical Judgment in Special Cases
  - Providing Progestin-Only Pills
  - Giving Advice on Side Effects
  - Explaining How to Use
  - Supporting New and Continuing Users
  - “Come Back Any Time”: Reasons to Return
  - Managing Any Problems
  - Questions and Answers About Progestin-Only Pills
- Emergency Contraceptive Pills
  - Emergency Contraceptive Pills - Introduction
  - Side Effects, Health Benefits, and Health Risks
  - Correcting Misunderstandings
  - Who Can Use Emergency Contraceptive Pills
  - Providing Emergency Contraceptive Pills
  - Pill Formulations and Dosing
  - Giving Emergency Contraceptive Pills
  - How Can a Partner Help?
  - When to Start or Restart Contraception After ECP Use
  - Supporting Users
  - Questions and Answers About Emergency Contraceptive Pills
- Progestin-Only Injectables
  - Progestin-Only Injectables - Introduction
  - How Effective?
  - Side Effects, Health Benefits, and Health Risks
  - Correcting Misunderstandings
  - Delivering Injectable Contraception in the Community
  - Who Can and Cannot Use Progestin-Only Injectables
  - Medical Eligibility Criteria for Progestin-Only Injectables
  - Using Clinical Judgment in Special Cases
  - Providing Progestin-Only Injectables
  - Giving Advice on Side Effects
  - Giving Intramuscular Injection with a Conventional Syringe
  - Giving the Injection with Subcutaneous DMPA in Uniject (Sayana Press)
  - Self-Injection Can Be an Option
  - How to Give Yourself an Injection with Sayana Press
  - Supporting New and Continuing Users
  - Managing Any Problems
  - Questions and Answers About Progestin-Only Injectables
- Monthly Injectables
  - Monthly Injectables - Introduction
  - How Effective?
  - Side Effects, Health Benefits, and Health Risks
  - Correcting Misunderstandings
  - Who Can and Cannot Use Monthly Injectables
  - Medical Eligibility Criteria for Monthly Injectables
  - Using Clinical Judgment in Special Cases
  - Providing Monthly Injectables
  - Giving Advice on Side Effects
  - Giving the Injection
  - Supporting New and Continuing Users
  - Managing Any Problems
  - Questions and Answers About Monthly Injectables
- Combined Patch: Only the Essentials
  - Combined Patch: Only the Essentials - Introduction
  - How Effective?
  - Side Effects, Health Benefits, and Health Risks
  - Providing the Combined Patch
  - Supporting New and Continuing Users
- Combined Vaginal Ring: Only the Essentials
  - Combined Vaginal Ring: Only the Essentials - Introduction
  - How Effective?
  - Side Effects, Health Benefits, and Health Risks
  - Providing the Combined Vaginal Ring
  - Supporting New and Continuing Users
- Progesterone-Releasing Vaginal Ring: Only the Essentials
  - Progesterone-Releasing Vaginal Ring: Only the Essentials - Introduction
  - How Effective?
  - Side Effects, Health Benefits, and Health Risks
  - Providing the Progesterone-Releasing Vaginal Ring
  - Supporting New and Continuing Users
- Implants
  - Implants - Introduction
  - How Effective?
  - Side Effects, Health Benefits, and Health Risks
  - Correcting Misunderstandings
  - Who Can and Cannot Use Implants
  - Medical Eligibility Criteria for Implants
  - Using Clinical Judgment in Special Cases
  - Providing Implants
  - Giving Advice on Side Effects
  - Inserting Implants
  - Supporting New and Continuing Users
  - Follow-up Visits With Implant Users
  - Managing Any Problems
  - New Problems That May Require Switching Methods
  - Removing Implants
  - Questions and Answers About Implants
- Copper-Bearing Intrauterine Device
  - Copper-Bearing Intrauterine Device - Introduction
  - How Effective?
  - Side Effects, Health Benefits, Health Risks, and Complications
  - Correcting Misunderstandings
  - Who Can and Cannot Use the Copper-Bearing IUD
  - Medical Eligibility Criteria for Copper-Bearing IUDs
  - Using Clinical Judgment in Special Cases
  - Screening Questions for Pelvic Examination Before IUD Insertion
  - Assessing Women for Risk of Sexually Transmitted Infections
  - Providing the Intrauterine Device
  - Preventing Infection at IUD Insertion
  - Giving Advice on Side Effects
  - Inserting the IUD
  - Supporting New and Continuing Users
  - "Come Back Any Time": Reasons to Return
  - Post-Insertion Follow-Up Visit (3 to 6 Weeks)
  - Managing Any Problems
  - New Problems That May Require Switching Methods
  - Removing the Intrauterine Device
  - Switching From an IUD to Another Method
  - Questions and Answers About the Intrauterine Device
- Levonorgestrel Intrauterine Device
  - Levonorgestrel Intrauterine Device - Introduction
  - How Effective?
  - Side Effects, Health Benefits, Health Risks, and Complications
  - Correcting Misunderstandings
  - Who Can and Cannot Use Levonorgestrel IUDs
  - Medical Eligibility Criteria for Levonorgestrel IUDs
  - Using Clinical Judgment in Special Cases
  - Screening Questions for Pelvic Examination Before IUD Insertion
  - Assessing Women for Risk of Sexually Transmitted Infections
  - Providing the Levonorgestrel Intrauterine Device
  - Giving Advice on Side Effects
  - Inserting the LNG-IUD
  - Supporting New and Continuing Users
  - "Come Back Any Time": Reasons to Return
  - Post-Insertion Follow-Up Visit (3 to 6 Weeks)
  - Managing Any Problems
  - New Problems That May Require Switching Methods
  - Removing the Intrauterine Device
  - Switching From an IUD to Another Method
  - Questions and Answers About the LNG-IUD
- Female Sterilization
  - Female Sterilization - Introduction
  - How Effective?
  - Side Effects, Health Benefits, Health Risks, and Complications
  - Correcting Misunderstandings
  - Who Can Have Female Sterilization
  - Medical Eligibility Criteria for Female Sterilization
  - Providing Female Sterilization
  - Ensuring Informed Choice
  - Performing the Sterilization Procedure
  - Supporting the User
  - "Come Back Any Time": Reasons to Return
  - Managing Any Problems
  - Managing Ectopic Pregnancy
  - Questions and Answers About Female Sterilization
- Vasectomy
  - Vasectomy - Introduction
  - How Effective?
  - Side Effects, Health Benefits, Health Risks, and Complications
  - Correcting Misunderstandings
  - Who Can Have a Vasectomy
  - Medical Eligibility Criteria for Vasectomy
  - Providing Vasectomy
  - Vasectomy Techniques
  - Performing the Vasectomy Procedure
  - Supporting the User
  - "Come Back Any Time": Reasons to Return
  - Managing Any Problems
  - Questions and Answers About Vasectomy
- Male Condoms
  - Male Condoms - Introduction
  - How Effective?
  - Side Effects, Health Benefits, and Health Risks
  - Bringing Up Condom Use
  - Correcting Misunderstandings
  - Who Can and Cannot Use Male Condoms
  - Providing Male Condoms
  - What Condom Users Should Not Do
  - Lubricants for Latex Condoms
  - Supporting New and Continuing Users
  - "Come Back Any Time": Reasons to Return
  - Managing Any Problems
  - New Problems That May Require Switching Methods
  - Questions and Answers About Male Condoms
- Female Condoms
  - Female Condoms - Introduction
  - How Effective?
  - Side Effects, Health Benefits, and Health Risks
  - Correcting Misunderstandings
  - Who Can Use Female Condoms
  - Providing Female Condoms
  - Lubricants for Female Condoms
  - Supporting New and Continuing Users
  - "Come Back Any Time": Reasons to Return
  - Managing Any Problems
  - Questions and Answers About Female Condoms
- Spermicides and Diaphragms
  - Spermicides and Diaphragms - Introduction
  - How Effective - Spermicides?
  - Side Effects, Health Benefits, and Health Risks - Spermicides
  - Correcting Misunderstandings - Spermicides
  - Who Can and Cannot Use Spermicides
  - Providing Spermicides
  - Supporting the Spermicide User
  - Diaphragms
  - How Effective - Diaphragms?
  - Side Effects, Health Benefits, and Health Risks - Diaphragms
  - Correcting Misunderstandings - Diaphragms
  - Who Can and Cannot Use Diaphragms
  - Using Clinical Judgment in Special Cases of Diaphragm Use
  - Providing Diaphragms
  - Explaining the Fitting Procedure
  - Explaining How to Use the Diaphragm
  - Supporting the Diaphragm User
  - Tips and Follow-up for Users of Spermicides and the Diaphragm
  - Managing Any Problems
  - Questions and Answers About Spermicides and Diaphragms
- Cervical Caps: Only the Essentials
  - Cervical Caps: Only the Essentials - Introduction
  - How Effective?
  - Side Effects, Health Benefits, and Health Risks
  - Providing Cervical Caps
- Fertility Awareness Methods
  - Fertility Awareness Methods - Introduction
  - How Effective?
  - Side Effects, Health Benefits, and Health Risks
  - Correcting Misunderstandings
  - Who Can Use Calendar-Based Methods
  - Providing Calendar-Based Methods
  - Explaining How to Use Calendar-Based Methods
  - Who Can Use Symptoms-Based Methods
  - Providing Symptoms-Based Methods
  - Explaining How to Use Symptoms-Based Methods
  - Supporting New and Continuing Users
  - Managing Any Problems
  - Questions and Answers About Fertility Awareness Methods
- Withdrawal: Only the Essentials
  - Withdrawal: Only the Essentials - Introduction
  - How Effective?
  - Who Can and Cannot Use Withdrawal
  - Using Withdrawal
- Lactational Amenorrhea Method
  - Lactational Amenorrhea Method - Introduction
  - How Effective?
  - Side Effects, Health Benefits, and Health Risks
  - Correcting Misunderstandings
  - Who Can Use the Lactational Amenorrhea Method
  - The Lactational Amenorrhea Method for Women With HIV
  - Providing the Lactational Amenorrhea Method
  - When Can a Woman Use LAM?
  - Explaining How to Use
  - Supporting New and Continuing Users
  - Managing Any Problems
  - Questions and Answers About the Lactational Amenorrhea Method
- Serving Diverse Groups
  - Serving Diverse Groups - Introduction
  - Adolescents
  - All Contraceptives Are Safe for Young People
  - Men
  - Many Ways to Help Men
  - Women Near Menopause
  - When a Woman Can Stop Using Family Planning
  - Relieving Symptoms of Menopause
  - Clients with Disabilities
- Sexually Transmitted Infections, Including HIV
  - Sexually Transmitted Infections, Including HIV - Introduction
  - Who Is at Risk for STIs?
  - What Causes STIs?
  - Symptoms of Sexually Transmitted Infections
  - Common Vaginal Infections That May Not Be Sexually Transmitted
  - Avoiding STIs
  - Contraceptives for Clients with STIs, Including HIV
  - Cervical Cancer
  - Questions and Answers About STIs, Including HIV
- Family Planning for Adolescents and Women at High Risk for HIV
  - Family Planning for Adolescents and Women at High Risk for HIV - Introduction
  - Who is at High Risk for Acquiring HIV?
  - What Family Planning Methods Can Be Used by Adolescents and Women at High Risk for HIV?
  - Providing HIV Testing and Prevention Services
  - Who Should Be Offered an HIV Test?
  - Talking about HIV Testing
  - HIV Testing Options
  - Preventing HIV Acquisition
  - Male Partner HIV Testing and Prevention Messages
  - Questions and Answers about Family Planning for Adolescents and Women at High Risk for HIV
- Maternal and Newborn Health
  - Maternal and Newborn Health - Introduction
  - Planning Pregnancy
  - During Pregnancy
  - Planning for Family Planning After Delivery
  - Preparing for Childbirth and Complications
  - After Childbirth
  - Earliest Time That a Woman Can Start a Family Planning Method After Childbirth
  - Preventing Mother-to-Child Transmission of HIV
  - Managing Any Breastfeeding Problems
- Reproductive Health Issues
  - Reproductive Health Issues - Introduction
  - Family Planning in Postabortion Care
  - Help Women Obtain Family Planning
  - When to Start Contraceptive Methods
  - Violence Against Women
  - What Can Providers Do?
  - Infertility
  - Preventing Involuntary Infertility
  - Counseling Clients With Fertility Problems
- Family Planning Provision
  - Family Planning Provision - Introduction
  - Successful Counseling
  - Who Provides Family Planning?
  - Infection Prevention in the Clinic
  - Make Infection Prevention a Habit
  - Managing Contraceptive Supplies
- Providing Family Planning Services During an Epidemic
  - Providing Family Planning Services During an Epidemic - Introduction
  - Maintaining Family Planning Services in an Epidemic
  - Safe Use of Contraceptive Methods in an Epidemic
  - Self-Care for Contraception
  - Use of Digital Health Technologies
Job Aids
- Comparing Combined Methods
- Comparing Injectables
- Comparing Implants
- Comparing Condoms
- Comparing IUDs
- If You Miss Pills
- Female Anatomy
- External Anatomy
- The Menstrual Cycle
- Male Anatomy
- Identifying Migraine Headaches and Auras
- Can a Woman With Migraines and/or Aura Use a Hormonal Method?
- Considering Progestin-Only Injectables Where HIV Risk Is High: Counseling Tips
- Ruling Out Pregnancy
- How and When to Use the Pregnancy Checklist and Pregnancy Tests
- Pregnancy Checklist
- Comparing Effectiveness of Family Planning Methods
APPENDIXES
- APPENDIX A - Contraceptive Effectiveness
- APPENDIX B - Signs and Symptoms of Serious Health Conditions
- APPENDIX C - Medical Conditions That Make Pregnancy Especially Risky
- APPENDIX D - Medical Eligibility Criteria for Contraceptive Use
  - APPENDIX D - Medical Eligibility Criteria for Contraceptive Use - Introduction
  - PERSONAL CHARACTERISTICS AND REPRODUCTIVE HISTORY
  - CARDIOVASCULAR DISEASE
  - NEUROLOGICAL CONDITIONS
  - REPRODUCTIVE TRACT INFECTIONS AND DISORDERS
  - HIV/AIDS
  - OTHER INFECTIONS
  - ENDOCRINE CONDITIONS
  - GASTROINTESTINAL CONDITIONS
  - ANEMIAS
  - DRUG INTERACTIONS
  - ADDITIONAL CONDITIONS
Glossary, Methodology, and WHO Guidance Document
- Glossary
- Methodology
- WHO Guidance Documents Used in Preparation of This Edition of the Handbook

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Basic Steps	Important Details
IMPORTANT: Whenever possible, show the woman the location of the pubic bone and cervix with a model or a picture. Explain that the diaphragm is inserted behind the pubic bone and covers the cervix.
1. Squeeze a spoonful of spermicidal cream, jelly, or foam into the diaphragm and around the rim	Wash hands with mild soap and clean water, if possible. Check the diaphragm for holes, cracks, or tears by holding it up to the light. Check the expiration date of the spermicide and avoid using any beyond its expiration date.
2. Press the rim together; push into the vagina as far as it goes	Insert the diaphragm less than 6 hours before having sex. Choose a position that is comfortable for insertion—squatting, raising one leg, sitting, or lying down.
3. Feel diaphragm to make sure it covers the cervix	Through the dome of the diaphragm, the cervix feels like the tip of the nose. If the diaphragm feels uncomfortable, take it out and insert it again.

4. Keep in place for at least 6 hours after sex	Keep the diaphragm in place at least 6 hours after having sex but no longer than 24 hours. Leaving the diaphragm in place for more than one day may increase the risk of toxic shock syndrome. It can also cause a bad odor and vaginal discharge. (Odor and discharge go away on their own after the diaphragm is removed.) For multiple acts of sex, make sure that the diaphragm is in the correct position and also insert additional spermicide in front of the diaphragm before each act of sex.
5. To remove, slide a finger under the rim of the diaphragm to pull it down and out	Wash hands with mild soap and clean water, if possible. Insert a finger into the vagina until the rim of the diaphragm is felt. Gently slide a finger under the rim and pull the diaphragm down and out. Use care not to tear the diaphragm with a fingernail. Wash the diaphragm with mild soap and clean water and dry it after each use.

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