Diaphragm (birth control)

Contraceptive diaphragm.jpg
An arcing spring diaphragm in its case, with a quarter added for scale.
First use1880s[1]
Failure rates (first year with spermicide)
Perfect use6%[2]
Typical use12%[2]
User remindersInserted before sex with spermicide.
Left in place for 6–8 hours afterwards
Advantages and disadvantages
STI protectionPossible
PeriodsCatches menstrual flow
BenefitsMay be reused 1 to 3 years
RisksUrinary tract infection, toxic shock syndrome (rare)

The diaphragm is a barrier method of birth control.[3] It is moderately effective, with a one-year failure rate of around 12% with typical use.[4] It is placed over the cervix with spermicide before sex and left in place for at least six hours after sex.[5][6] Fitting by a healthcare provider is generally required.[5]

Side effects are usually very few.[6] Use may increase the risk of bacterial vaginosis and urinary tract infections.[3] If left in the vagina for more than 24 hours toxic shock syndrome may occur.[6] While use may decrease the risk of sexually transmitted infections, it is not very effective at doing so.[3] There are a number of types of diaphragms with different rim and spring designs.[7] They may be made from latex, silicone, or natural rubber.[7] They work by blocking access to and holding spermicide near the cervix.[7]

The diaphragm came into use around 1882.[1] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[8] In the United Kingdom they cost the NHS less than 10 pounds each.[9] In the United States they cost about 15 to 75 USD and are the birth control method of 0.3% of people.[10] These costs do not include that of spermicide.[11]

Medical use

Before inserting or removing a diaphragm, one should first wash one's hands[12] to avoid introducing harmful bacteria into the vaginal canal.

The rim of a diaphragm is squeezed into an oval or arc shape for insertion. A water-based lubricant (usually spermicide) may be applied to the rim of the diaphragm to aid insertion. One teaspoon (5 mL) of spermicide may be placed in the dome of the diaphragm before insertion, or with an applicator after insertion.[13]

The diaphragm must be inserted sometime before sexual intercourse, and remain in the vagina for 6 to 8 hours after a man's last ejaculation.[14] For multiple acts of intercourse, it is recommended that an additional 5 mL of spermicide be inserted into the vagina (not into the dome—the seal of the diaphragm should not be broken) before each act. Upon removal, a diaphragm should be cleansed with warm mild soapy water before storage. The diaphragm must be removed for cleaning at least once every 24 hours[13] and can be re-inserted immediately.

Oil-based products should not be used with latex diaphragms. Lubricants or vaginal medications that contain oil will cause the latex to rapidly degrade and greatly increases the chances of the diaphragm breaking or tearing.[14]

Natural latex rubber will degrade over time. Depending on usage and storage conditions, a latex diaphragm should be replaced every one to three years.[15][16] Silicone diaphragms may last much longer—up to ten years.


The effectiveness of diaphragms, as of most forms of contraception, can be assessed two ways: method effectiveness and actual effectiveness. The method effectiveness is the proportion of couples correctly and consistently using the method who do not become pregnant. Actual effectiveness is the proportion of couples who intended that method as their sole form of birth control and do not become pregnant; it includes couples who sometimes use the method incorrectly, or sometimes not at all. Rates are generally presented for the first year of use. Most commonly the Pearl Index is used to calculate effectiveness rates, but some studies use decrement tables.

For all forms of contraception, actual effectiveness is lower than method effectiveness, due to several factors:

  • mistakes on the part of those providing instructions on how to use the method
  • mistakes on the part of the method's users
  • conscious user non-compliance with method

For instance, someone using a diaphragm might be fitted incorrectly by a health care provider, or by mistake remove the diaphragm too soon after intercourse, or simply choose to have intercourse without placing the diaphragm.

Contraceptive Technology reports that the method failure rate of the diaphragm with spermicide is 6% per year.[17]

The actual pregnancy rates among diaphragm users vary depending on the population being studied, with yearly rates of 10%[18] to 39%[19] being reported.

Unlike some other cervical barriers, the effectiveness of the diaphragm is the same for women who have given birth as for those who have not.[20]


The diaphragm does not interfere with a woman's natural cycle, therefore, no reversal or wait time is necessary, if contraception is no longer wanted or needed.

The diaphragm only has to be used during intercourse. Many women, especially those who have sex less frequently, prefer barrier contraception such as the diaphragm over methods that require some action every day.[12]

Like all cervical barriers, diaphragms may be inserted several hours before use, allowing uninterrupted foreplay and intercourse. Most couples find that neither partner can feel the diaphragm during intercourse.

The diaphragm is less expensive than many other methods of contraception.[13]

Sexually transmitted infections

There is some evidence that the cells in the cervix are particularly susceptible to certain sexually transmitted infections (STIs). Cervical barriers such as diaphragms may offer some protection against these infections.[16] However, research conducted to test whether the diaphragm offers protection from HIV found that women provided with both male condoms and a diaphragm experienced the same rate of HIV infection as women provided with male condoms alone.[21]

Because pelvic inflammatory disease (PID) is caused by certain STIs, diaphragms may lower the risk of PID.[22] Cervical barriers may also protect against human papillomavirus (HPV), the virus that causes cervical cancer, although the protection appears to be due to the spermicide used with diaphragms and not the barrier itself.[23]

Diaphragms are also considered a good candidate as a delivery method for microbicides (preparations that, used vaginally, protect against STIs) that are currently in development.[16]

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