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Diaphragm (Birth Control)

Definition

Diaphragms are dome-shaped barrier methods of contraception that block sperm from entering the uterus. They are made of latex (rubber) and formed like a shallow cup. Since vaginas vary in size, each patient will need to be fitted by a doctor or nurse with a diaphragm that conforms to the shape and contour of the vagina as well as the strength of the muscles in the vaginal walls. Diaphragms must be used with spermicidal cream or jelly. The device should cause no discomfort, and neither the woman nor her partner should feel that it is there.

Purpose

The purpose of a diaphragm is to prevent access to the womb (uterus) by the sperm and thus prevent conception. The level of effectiveness is about 95%.

Precautions

Each client will undergo a physical examination and a Pap smear. If these are normal, the physician will fit the patient for the device and give instructions on how to insert, remove, and clean the object. She will also be taught the signs and symptoms of potential complications.

Description

Prior to insertion, the inside of the dome and the rim are covered with a thick layer (perhaps a tablespoon) of a spermicide that is compatible with the diaphragm being used. The domed area covers the opening into the uterus (cervix) and keeps the spermicide in place. As a result, any sperm that might get under the diaphragm will be destroyed.

Diaphragms may be inserted two-three hours prior to intercourse, and must be left in place for six to eight hours following sexual relations. During this time the woman may not swim, bathe, or douche, but she may shower. If she desires to have intercourse again before the six to eight hours have passed, the diaphragm should not be removed. Instead, an applicator full of spermicide should be deposited into the vagina.

A diaphragm will last for a year or more. It should be examined weekly for holes. This can be done by holding it up to the light or filling it with water.

Preparation

Before inserting the diaphragm, the woman should empty her bladder and wash her hands with soap and water. The device should be checked for leaks by filling it with water or holding it up to the light. A spermicidal jelly is then applied to the inside and outside, and especially around the rim. While standing with one foot elevated on a chair or step, lying down, or squatting, the woman folds the diaphragm inward toward the middle and inserts it into the vagina as far as it will go.

Aftercare

When removed, the diaphragm should be washed with a mild soap and water. After being dried, it can be dusted with corn starch before being returned to its container. The diaphragm should always be stored away from sunlight and heat in a cool, dry place. It should not be washed with harsh or perfumed soaps or used with perfumed powders because either of these substances can damage the diaphragm.

Risks

Although rare, wearing the diaphragm longer than the recommended time can result in toxic shock syndrome. The signs and symptoms of this serious illness include sudden onset of high fever, vomiting, diarrhea, dizziness, faintness, weakness, aching muscles and joints, and rash. The doctor must be notified immediately if any of these conditions appear. An allergic reaction to the spermicide or the material from which the device is made is also possible. Diaphragm use is also associated with an increased risk of bladder infections.

It should be noted that the diaphragm can become dislodged during intercourse, which could result in an unwanted pregnancy. To ensure a secure fit, a woman should be examined for a refitting if she gains or loses more than 10 lbs (4.5 kg), or after she gives birth.

Normal results

Consumers can expect an efficiency rate of about 95% in preventing pregnancy. Using a male condom in conjunction with the diaphragm decreases the potential for pregnancy. Diaphragms provide no protection against AIDS or other sexually transmitted diseases.

Resources

Organizations

Planned Parenthood Federation of America, Inc. 810 Seventh Ave., New York, NY, 10019. (800) 669-0156. http://www.plannedparenthood.org.

Other

"The Diaphragm." Cincinnati Women's Services. http://gynpages.com/cws/8.html.

"Guide to Safer Sex." Sexual Health InfoCenter. 〈http://www.sexhealth.org/infocenter/GuideSS/diaphragm.htm〉.

Key terms

Spermicide — A substance that kills sperm.

Toxic shock syndrome — An uncommon, but potentially fatal, disease that has been associated with the use of diaphragms and vaginal tampons. The symptoms include high fever, vomiting, and diarrhea.

diaphragm /di·a·phragm/ (di´ah-fram)

1. the musculomembranous partition separating the abdominal and thoracic cavities and serving as a major muscle aiding inhalation.

2. any separating membrane or structure.

3. a disk with one or more openings or with an adjustable opening, mounted in relation to a lens or source of radiation, by which part of the light or radiation may be excluded from the area.

4. a device of molded rubber or other soft plastic material, fitted over the uterine cervix before intercourse to prevent entrance of spermatozoa.diaphragmat´ic

contraceptive diaphragm diaphragm (4).

pelvic diaphragm the portion of the floor of the pelvis formed by the coccygeal and levator ani muscles and their fasciae.

polyarcuate diaphragm one showing abnormal scalloping of the margins on radiographic visualization.

Potter-Bucky diaphragm see under grid.

respiratory diaphragm diaphragm (1).

urogenital diaphragm traditional but no longer valid concept that fascial layers enclose the sphincter urethrae and deep transverse perineal muscles and together form a musculomembranous sheet that extends between the ischiopubic rami.

vaginal diaphragm diaphragm (4).

di·a·phragm (d

-fr

)

1. A musculomembranous partition separating the abdominal and thoracic cavities and functioning in respiration. Also called midriff.

2. A membranous part that divides or separates.

3. A contraceptive device consisting of a thin flexible disk, usually made of rubber, that is designed to cover the uterine cervix to prevent the entry of sperm during sexual intercourse.

4. A disk having a fixed or variable opening used to restrict the amount of light traversing a lens or optical system.

dia·phrag·matic (-fr

g-m

k) adj.

diaphragm

Top: during inhalation the diaphragm contracts downward, forcing air into the lungs

Bottom: during exhalation the diaphragm relaxes upward, forcing air out of the lungs

diaphragm (dī´

fram),

n 1. a musculotendinous partition that separates the thorax and abdomen.
n 2. a metal barrier plate, often of lead, pierced with a central aperture so arranged as to limit the emerging, or useful, beam of roentgen rays to the smallest practical diameter for making radiographic exposures. See also collimation; collimator; distance, cone.

diaphragm, lead,

n a collimating device with a small opening, designed to limit the size of the outgoing x-ray beam. It is usually made of lead one-eighth of an inch thick and located between the position-indicating device and the radiographic tube itself.

See grid, Potter-Bucky.

diaphragm

1. the musculomembranous partition separating the thoracic and abdominal cavities. On its sides, it is attached to the caudal ribs; ventrally to the sternum; at the back, to the spine. The esophagus, the aorta and vena cava, and nerves pass through the diaphragm. When relaxed, the diaphragm is convex but it flattens and moves caudally as it contracts during inhalation, thereby enlarging the chest cavity and allowing for expansion of the lungs. See also respiration.