Contraceptive diaphragm: action, advantages, what is it?

The diaphragm is a hormone-free contraceptive which slips inside the vagina, in contact with the cervix, before sexual intercourse. Reusable and easy to apply, it blocks the passage of sperm to the inside of the uterus, preventing ovulation. We sometimes hear the expression “menstrual diaphragm“, which is not an exact term. There may indeed be a confusion between a contraceptive diaphragm, a cup that acts as contraception and a menstrual cup (the shape may resemble), a cup that collects blood during menstruation.

What is a contraceptive diaphragm?

The contraceptive diaphragm is a flexible and very thin latex or silicone cup which is placed inside the vagina, above the cervix, before penetrative sexual intercourse. This contraceptive is relatively easy to use : the fact that it is flexible guarantees its correct positioning and its small gripping studs make it easier to insert into the vagina.

How does a diaphragm work?

The diaphragm follows the shape of the cervix: it is able to block the penetration of sperm into the uterus, thus preventing ovulation. He always used with a contraceptive gelalso called a spermicidal gel, which is spread on the walls of the diaphragm, which destroys or inactivates the spermatozoa.

The diaphragm is placed just before intercourse: no more than two hours before the report! Remember to always wash your hands when handling it.

► Before first use, wash it with mild soap and clear water.

► Then pour approx. 4 ml (one teaspoon) of contraceptive or spermicidal gel on the membrane and spread some on the edges and on the dome.

► Put yourself in a comfortable position (squatting, lying down, standing with one leg at an angle, etc.) and introduce the diaphragm into your vagina. Often, a small arrow is drawn on the diaphragm to know in which direction to position it. With your free hand, spread the lips of your vagina, then introduce it along the back wall of the vagina, like a tampon.

► Check if the cervix seems covered by the membrane and make sure that the diaphragm does not move. Normally, the diaphragm is supposed to adhere to the wall of the cervix and cover it like a hat. If it seems to move, it is badly positioned. Likewise, if it slips during intercourse, is that it is either incorrectly installed or that its size is not suitable. If, after replacing it, it still moves, use another form of contraception such as a condom and ask your doctor for advice.

If you want to opt for a diaphragm, it is best to seek the advice of your gynecologist, doctor or midwife. It is this healthcare professional who will decide if this contraception is suitable for you and will determine the size and shape of the contraceptive according to the size of your cervix. If some contraceptives have a standard size, supposed to be suitable for all women, it is better to choose a really suitable model (a larger size for women who have already had several children by natural means, or a smaller one for nulliparous women for example. ..). The doctor will also be there to bring you explanations and advice on its installation, its removal, its advantages or disadvantages, as well as its handling. Finally, he will be able to tell you when it will be necessary to replace the diaphragm (usually after two years). It is important to reassess the size of your diaphragm after weight loss or gain, pregnancy, and miscarriage.

When to remove a diaphragm after intercourse?

The diaphragm should be left for 8 hours after sex. It can be withdrawn up to 24 hours after intercourse at the latest. A removal notch (or a handle depending on the model) makes it easier to remove the contraception by simply pulling on it in order to detach it from the walls and extract it from the vagina. After removing it, wash it with soap and water and let it air dry (be careful not to leave it in the sun as the heat could damage it). The diaphragm is sold with a box which protects it from external contamination.

Diaphragm installation diagram

How effective is a diaphragm?

If used perfectly and systematically with a spermicidal gel, the diaphragm is 94% effective. However, the lack of habit, handling errors or oversights at certain times of the cycle cause its current effectiveness to drop to 88%.

Do you need a prescription to get a diaphragm?

Yes, the diaphragm requires a doctor’s prescription from a general practitioner, a gynecologist or a midwife, specifies thearticle L5134-1 of the Public Health Code.

What are the benefits of a diaphragm?

► Hormone-free birth control: Being hormone-free, this method has no known side effects (if properly used, cleaned, and handled with clean hands) and is suitable for women who want – or can only use – hormone-free contraception.

► An ecological and economical contraception: Cleaned well between each report, this contraception is sometimes reusable for up to 2 years. It is also your gynecologist or your doctor who will tell you when it will be necessary to change it. Before each use, always check the condition of your diaphragm: is it not holed or cracked? You can run water inside to check for leaks.

► Silicone models are suitable for women with allergic reactions to latex.

► The diaphragm can be placed discreetly in advance, up to 2 hours before intercourse. Thus, it does not interrupt the spontaneity of the report and has no influence on sexual pleasure.

What are the disadvantages of a diaphragm?

The diaphragm is suitable for women who are not bothered by vaginal manipulations. Indeed, the installation, the removal or the various checks require putting your fingers in your vagina and touching your genitals. This is why this contraceptive method may not be very recommended for young girls starting their sexual life because its installation can be delicate and impose a good knowledge of one’s body. However, it is not contraindicated for them.

What are the contraindications?

This birth control is not recommended for women:

• for which pregnancy would pose a serious risk such as heart disease. The efficiency of the diaphragm is not 100%. These women must seek the advice of their gynecologist in order to define together an appropriate contraception.
• suffering from recurrent urinary tract infections or having a genital prolapse (descending of organs).
• in the first 6 weeks after delivery

Where to buy a diaphragm?

The diaphragm can be bought in pharmacy (sometimes on order) or in a Planning or Family Education Center (CPEF).

How much does a diaphragm cost? Is it reimbursed?

The diaphragm costs between 30 euros (latex model) and 45 euros (silicone model). It is only reimbursed on the basis of 3.14 euros. Note that the spermicidal gels that accompany the diaphragm are also sold in pharmacies (without a prescription) between 7 and 19 euros and are not reimbursed.