The diaphragm is a female contraceptive device consisting of a soft dome-shaped cup with a flexible rim. Diaphragms are now made of silicone in the United States, but latex diaphragms may be available elsewhere. Before coitus, the hollow of the dome is partially filled with a spermicidal cream or jelly and then the diaphragm is inserted deep into the vagina and positioned so that it fits over the cervix (figure 1). Contraception results from both a barrier effect and the spermicidal action of the spermicide .
The percentage of reproductive-aged women using the diaphragm is decreasing . This decrease is probably due to the higher contraceptive effectiveness of oral contraceptives and condoms, the convenience and privacy of hormonal contraception, and the broader protection against sexually transmitted diseases afforded by male and female condoms.
Most women can use the diaphragm; however; it is not a good method for those who have an allergy/sensitivity to its components (eg, latex, silicone, spermicides); significant pelvic organ prolapse (uterine prolapse, cystocele, rectocele, poor vaginal tone); frequent urinary tract infections; HIV infection or are at high risk for acquiring HIV; or have difficulty with the insertion process. A history of toxic shock syndrome is a contraindication to this method of contraception. Most cases of toxic shock syndrome associated with diaphragm use involved leaving the diaphragm in the vagina for more than 24 hours .
Adolescents generally are not good candidates for using a diaphragm because it requires a high level of motivation and some skill and affords less protection from sexually transmitted infections than condoms. Privacy is also an issue since the diaphragm needs to be stored and transported to sites of potential sexual encounters. Older women in monogamous relationships are more likely to choose this method and use it successfully .
Women choose to use the diaphragm after weighing the advantages and disadvantages and comparing this method to alternatives. (See "Overview of contraception".)