A diaphragm contraceptive is a soft, reusable cup that you put into your vagina before sex, where it covers the cervix. It has no hormones, you only use it when you have sex, and one lasts about two years. It is less reliable than most other methods, though, and it gives no protection from infection passed on during sex.
Key takeaways
- It is a hormone free cup, sold in one size, and you can buy it without a prescription.
- With typical use, about 18 in 100 people who rely on it become pregnant over a year.
- It goes in before sex, stays in for at least 6 hours afterwards and should not stay in longer than 24 hours.
- Condoms are still needed for protection from STIs.
What a Diaphragm Contraceptive Is
A diaphragm contraceptive is a shallow dome with a firm, flexible rim, inserted into the vagina before sex to block the way into the uterus. Only one type is sold in Australia, in a single size that fits most people, and it lowers the chance of pregnancy without hormones. So what is a vaginal diaphragm made of, and how does it compare with a condom? The table sets it out.
| Feature | Diaphragm | External condom |
|---|---|---|
| Made from | Soft silicone | Latex or a synthetic material |
| Hormones | None | None |
| Reuse | Washed and reused for about two years | Used once |
| Protection from STIs | None | Good when used every time |
| Main health risk | A bladder infection, and rarely toxic shock syndrome if left in too long | Allergy, for latex types |
How a Diaphragm Blocks Sperm at the Cervix
A diaphragm works as a physical barrier over the cervix, the opening of the uterus at the top of the vagina. You fold it, slide it up and back, and tuck the front of the rim behind your pubic bone, so the dome covers that opening and sperm cannot pass. A teaspoon of the gel made for it goes into the cup first. It then stays in for at least 6 hours after sex, while any remaining sperm die.
What Causes Diaphragm Contraceptive Failure?
Most failures come from how a diaphragm is used rather than from the device. A pregnancy can happen when it is not put in every time, does not cover the cervix, is taken out less than 6 hours after sex, moves during sex, or has a small hole or tear. After giving birth, the shape of the vagina can change so it no longer sits correctly. Leaving it in for longer than 24 hours adds no protection and raises the risk of infection, including, rarely, toxic shock syndrome.
Barrier Device Types: Diaphragm and Cervical Cap
Barrier methods of contraception work without hormones, and the two that sit inside the vagina are the diaphragm and the cervical cap. The diaphragm sold here is a single size that fits most people, so it does not need the fitting older latex types did. A doctor or nurse at a sexual health clinic can still check it sits well and show you how to place it correctly.
A cervical cap is a smaller, deeper cup that clings to the cervix itself, and caps are hard to find in Australia now. Using a diaphragm or cap follows the same rules: put it in before sex, leave it for 6 hours afterwards, and never longer than a day.
How to Treat Diaphragm Contraceptive Problems
Most diaphragm problems are simple to manage. If it slipped, came out early or was not used, emergency contraception works best the sooner it is taken, and a pharmacist can supply the pill without a prescription. Burning when you pass urine can mean a bladder infection, which a doctor should assess. Itch or an unusual discharge from the vagina may be thrush. A diaphragm gives no protection from sexually transmitted infections, so a test after a new partner makes sense.
How Effective a Diaphragm Is With Typical Use
A diaphragm prevents pregnancy for about 82 in every 100 people who use it for a year in everyday life. It works better when it is used correctly every time, but even then it sits well behind the implant, an IUD, the injection and the pill. If you use a diaphragm, adding a condom gives more protection, including from sexually transmitted infections. A doctor can talk through longer acting options if you would rather not plan contraception before sex.
Symptoms That Need a Doctor's Review
See a doctor if you get burning when you urinate, pain low in your belly, soreness, itch or an unusual discharge, or discomfort each time the diaphragm is inserted. Bleeding after sex, or a sore that does not heal, also needs checking, as these can be signs of a sexually transmitted infection. A sudden high fever with vomiting, diarrhoea, a rash like sunburn or feeling faint while it is in, or soon after, needs urgent care: take it out and call 000.
Summary
A diaphragm contraceptive is a hormone free barrier that only works when it is in place every time, and it gives no protection from infection. This guide covered how it works, why it fails, the cervical cap, common problems, how well it works and the warning signs. If you are weighing up a diaphragm contraceptive or another method, a Medio doctor can talk it through by phone and, where the doctor thinks it right, arrange tests or an eScript.
Frequently asked questions
Why aren't diaphragms popular anymore?
Diaphragms are less popular because most people want a method they do not have to think about before sex, and many of those work better. A diaphragm must go in beforehand, stay in for hours afterwards and still fails more often, which is why more people don't choose one.
Do people still use diaphragms for contraception?
Yes, some people still do, usually because they want a hormone free method they only use when needed. Diaphragms are available without a prescription from some pharmacies, sexual health and family planning clinics, and online. A clinic can show you how to insert a diaphragm and check how it sits.
Can a doctor help with diaphragm contraceptive?
Yes. In a telehealth consult by phone, a Medio doctor can talk through whether a diaphragm suits you, assess problems such as a bladder infection, and discuss other methods, sending an eScript where the doctor thinks it right. A fitting check or insertion practice needs a clinic in person.
What are the disadvantages of using a diaphragm?
The main disadvantage is that it does not work as well as most other methods. Diaphragms prevent pregnancy for about 82 in 100 people a year with typical use, and caps do no better, so both are less effective than the pill or an IUD. It also needs planning before sex and some practice to place.
Can a man feel the diaphragm during birth control?
Usually not. When a diaphragm sits in the right place, tucked behind the pubic bone, most partners cannot feel it during sex. If a partner does feel it, or it is uncomfortable for you, it may not be in the right place, so ask a clinic to check how you insert it, and think about emergency contraception if it moved during sex.
What are the downsides of using diaphragm birth control?
The health downsides are a higher chance of a bladder infection and, rarely, a serious infection if it stays in too long. To take care of your diaphragm, wash it in warm, mild soapy water, let it air dry, store it in its case and check it for holes. To remove it, hook a finger under the rim and gently pull it down and out.
Keep reading
Ready to get started?
Book a telehealth consultation with an AHPRA-registered doctor.
Book consultation