Editing Diaphragm (birth control) (section)

==Medical use==
Before inserting or removing a diaphragm, one's hands should be washed<ref name="pp">{{cite web|last=Johnson|first=Jennifer|title=Diaphragms, Caps, and Shields|publisher=Planned Parenthood|date=December 2005|url=http://www.plannedparenthood.org/birth-control-pregnancy/birth-control/diaphragms-caps-and-shields.htm|access-date=2006-10-15|url-status=dead|archive-url=https://web.archive.org/web/20061012053633/http://www.plannedparenthood.org/birth-control-pregnancy/birth-control/diaphragms-caps-and-shields.htm|archive-date=2006-10-12}}</ref> 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 [[Litre|mL]]) of [[spermicide]] may be placed in the dome of the diaphragm before insertion, or with an applicator after insertion.<ref name="afp">{{cite journal|last=Allen|first=Richard|title=Diaphragm Fitting|journal=American Family Physician|volume=69|issue=1|date=January 2004|url=http://www.aafp.org/afp/20040101/97.html|access-date=2006-10-15|pmid=14727824|pages=97–100|url-status=live|archive-url=https://web.archive.org/web/20070929100035/http://www.aafp.org/afp/20040101/97.html|archive-date=2007-09-29}}</ref>

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.<ref name="fwhc">{{cite web|title=Diaphragm|publisher=Feminist Women's Health Center|date=January 2006|url=http://www.fwhc.org/birth-control/diaphram.htm|access-date=2006-10-15|url-status=dead|archive-url=https://web.archive.org/web/20061020084323/http://www.fwhc.org/birth-control/diaphram.htm|archive-date=2006-10-20}}</ref> 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 mild soap and warm water before storage. The diaphragm must be removed for cleaning at least once every 24 hours<ref name="afp" /> 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.<ref name="fwhc" />

Natural latex rubber will degrade over time. Depending on usage and storage conditions, a latex diaphragm should be replaced every one to three years.<ref name="OrthoPI">{{cite press release|publisher=Ortho-McNeil Pharmaceutical|year=2004|url=http://www.ortho-mcneilpharmaceutical.com/ortho-mcneilpharmaceutical/shared/pi/diaph_patient.pdf#zoom=100|format=PDF|title=After your doctor or health care provider prescribes your Ortho diaphragm|access-date=2007-07-22|url-status=dead|archive-url=https://web.archive.org/web/20070926084423/http://www.ortho-mcneilpharmaceutical.com/ortho-mcneilpharmaceutical/shared/pi/diaph_patient.pdf#zoom=100|archive-date=2007-09-26}}</ref><ref name="old method">{{cite journal|author1=S. Marie Harvey |author2=Sheryl Thorburn Bird |author3=Meredith Roberts Branch |title=A New Look at an Old Method: The Diaphragm| journal=Perspectives on Sexual and Reproductive Health|volume=35|issue=6|date=November–December 2004|doi=10.1363/3527003|pages=270–3|pmid=14744659}}</ref>  Silicone diaphragms may last much longer—up to ten years.

===Effectiveness===
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 table]]s.

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.<ref name="hatcher">{{cite book|first=RA|last=Hatcher|author2=Trussel J|author3=Stewart F|year=2000|title=Contraceptive Technology|edition=18th|publisher=Ardent Media|location=New York|isbn=978-0-9664902-6-8|url=http://www.contraceptivetechnology.com/table.html|display-authors=etal|url-status=live|archive-url=https://web.archive.org/web/20080531095926/http://www.contraceptivetechnology.com/table.html|archive-date=2008-05-31}}</ref>

The actual pregnancy rates among diaphragm users vary depending on the population being studied, with yearly rates of 10%<ref>{{cite journal|author1=Bulut A |title=Assessing the acceptability, service delivery requirements, and use-effectiveness of the diaphragm in Colombia, Philippines, and Turkey|journal=Contraception|volume=63|issue=5|pages=267–75|year=2001|pmid=11448468| doi=10.1016/S0010-7824(01)00204-9|last2=Ortayli|last3=Ringheim|last4=Cottingham|last5=Farley|last6=Peregoudov|last7=Joanis|last8=Palmore|last9=Brady|last10=Diaz|last11=Ojeda|last12=Ramos}}</ref> to 39%<ref>{{cite book|first=John|last=Kippley|author2=Sheila Kippley|year=1996|title=The Art of Natural Family Planning|edition=4th addition|publisher=The Couple to Couple League|location=Cincinnati, Ohio|isbn=978-0-926412-13-2|pages=146}}, which cites:<br>
:{{cite journal|last=Guttmacher Institute|title=Choice of Contraceptives|journal=The Medical Letter on Drugs and Therapeutics|volume=34|pages=111–114|year=1992|pmid= 1448019|issue=885}}</ref> 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.<ref>{{cite journal| author1=Trussell J |author2=Strickler J |author3=Vaughan B|title=Contraceptive efficacy of the diaphragm, the sponge and the cervical cap|journal=Fam Plann Perspect|volume=25|issue=3| pages=100–5, 135|year=1993|pmid=8354373|doi=10.2307/2136156|jstor=2136156 }}</ref>

===Advantages===
The diaphragm does not interfere with a woman's menstrual cycle, therefore, no reversal or waiting 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.<ref name="pp" />

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.<ref name="afp" />

===Sexually transmitted infections===
There is some evidence that the cells in the cervix are particularly susceptible to certain [[Sexually transmitted disease|sexually transmitted infections]] (STIs).  Cervical barriers such as diaphragms may offer some protection against these infections.<ref name="old method" /> 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.<ref name="new role">{{cite web|title=QUESTIONS & ANSWERS: The MIRA Diaphragm Trial Results|url=http://www.cervicalbarriers.org/documents/MIRA_QA-7-12.doc|format=DOC|publisher=Cervical Barrier Advancement Society|date=July 2007|access-date=2007-07-22|url-status=live|archive-url=https://web.archive.org/web/20070802070004/http://www.cervicalbarriers.org/documents/MIRA_QA-7-12.doc|archive-date=2007-08-02}}</ref>

Because [[pelvic inflammatory disease]] (PID) is caused by certain STIs, diaphragms may lower the risk of PID.<ref>{{cite journal|last=J|first=Kelaghan|author2= G.L. Rubin, H.W. Ory and P.M. Layde|date=July 1982|title=Barrier-method contraceptives and pelvic inflammatory disease|journal=Journal of the American Medical Association |volume=248|issue=2|pages=184–187|doi=10.1001/jama.248.2.184|pmid=7087109}}</ref> 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.<ref>{{cite journal| author=Hildesheim A |title=Barrier and spermicidal contraceptive methods and risk of invasive cervical cancer |journal=Epidemiology|volume=1|issue=4|pages=266–72|year=1990|pmid=2083303|doi=10.1097/00001648-199007000-00003|last2=Brinton |last3=Mallin |last4=Lehman |last5=Stolley |last6=Savitz |last7=Levine |s2cid=30392531 }}</ref>

Diaphragms are also considered a good candidate as a delivery method for [[microbicide]]s (preparations that, used vaginally, protect against STIs) that are currently in development.<ref name="old method" />