Editing Diaphragm (birth control) (section)

==Types==
Diaphragms are available in diameters of 50&nbsp;mm to 105mm (about 2–4&nbsp;inches). They are available in two different materials: [[latex]] and [[silicone]]. Diaphragms are also available with different types of springs in the rim.<ref name="cbas diaphragm">{{cite web |title=Diaphragms |work=Cervical Barrier Advancement Society |year=2000 |url=http://www.cervicalbarriers.org/information/diaphragms.cfm |access-date=2006-10-18 |url-status=live |archive-url=https://web.archive.org/web/20061005063906/http://www.cervicalbarriers.org/information/diaphragms.cfm |archive-date=2006-10-05 }}</ref>

An ''arcing spring'' folds into an arc shape when the sides are compressed. This is the strongest type of rim available in a diaphragm, and may be used by women with any level of vaginal tone. Unlike other spring types, arcing springs may be used by women with mild [[cystocele]], [[rectocele]], or [[Retroverted uterus|retroversion]].<ref name="owh">{{cite web |title=Diaphragms |work=Ortho Women's Health |publisher=Ortho-McNeil Pharmaceutical |year=2001 |url=http://www.orthowomenshealth.com/products/diaphragmsprods.html |access-date=2006-10-18 |url-status=dead |archive-url=https://web.archive.org/web/20061016162727/http://www.orthowomenshealth.com/products/diaphragmsprods.html |archive-date=2006-10-16 }}</ref> Arcing spring diaphragms may be easier to insert correctly than other spring types.<ref>{{cite journal|title=Women find arcing-spring diaphragm easier to insert, studies indicate|journal=Contracept Technol Update|volume=7|issue=4|pages=41–2|year=1986|pmid=12340681}}</ref>

A ''coil spring'' flattens into an oval shape when the sides are compressed. This rim is not as strong as the arcing spring, and may only be used by women with average or firm vaginal tone.<ref name="afp" /> If an arcing spring diaphragm is uncomfortable for a woman or, during intercourse, her partner, a coil spring may prove more satisfactory. Unlike the arcing spring diaphragms, coil springs may be inserted with a device called an introducer.

A ''flat spring'' is much like a coil spring, but thinner. This type of rim may only be used by women with firm vaginal tone. Flat spring diaphragms may also be inserted with an introducer for women uncomfortable using their hands.<ref name="afp" /> Ortho used to manufacture a flat-spring diaphragm called the Ortho White.<ref name="fpn">{{cite web|title=Contraceptive Diaphragm|work=Family Practice Notebook|year=2000|url=http://www.fpnotebook.com/GYN14.htm|access-date=2006-10-18|archive-url= https://web.archive.org/web/20060902071412/http://www.fpnotebook.com/GYN14.htm|archive-date=2006-09-02}}</ref> Reflexions also manufactured a flat-spring diaphragm up until 2014.<ref name="cbas diaphragm" /><ref name="owh" />

There are a number of variations. The SILCS diaphragm is made of silicone, has an arcing spring, and a finger cup is molded on one end for easy removal. The Duet [[disposable]] diaphragm is made of dipped polyurethane, pre-filled with [[BufferGel]] (BufferGel is currently in clinical trials as a spermicide and [[Microbicides for sexually transmitted diseases|microbicide]]).<ref name="cbas diaphragm"/> Both the SILCS and Duet diaphragms come in only one size.

===Fitting===
[[Image:Fem isa 3.gif|thumb|upright=1.4|1: [[urinary bladder|bladder]], 2: [[Pubis (bone)|pubic bone]], 3: [[urethra]], 4: [[vagina]], 5: [[uterus]], 6: [[Fornix vaginae|fornix]], 7: [[cervix]], 8: '''diaphragm''', 9: [[rectum]]]]
Diaphragms usually come in different sizes and require a fitting appointment with a health care professional to determine which size a woman should wear.  Single size diaphragms that do not require fitting also exist.<ref>{{cite web|title=A new kind of diaphragm|year=2015|url=http://www.path.org/projects/silcs.php|access-date=2015-11-08|url-status=dead|archive-url=https://web.archive.org/web/20151026065737/http://www.path.org/projects/silcs.php|archive-date=2015-10-26}}</ref>

A correctly fitting diaphragm will cover the [[cervix]] and rest snugly against the [[Pubis (bone)|pubic bone]]. A diaphragm that is too small might fit inside the vagina without covering the cervix, or might become dislodged from the cervix during intercourse or bowel movements.<ref name="afp" /> It is also more likely that a woman's partner will feel the anterior rim of a diaphragm that is too small during intercourse. A diaphragm that is too large will place pressure on the [[urethra]], preventing the bladder from emptying completely and increasing the risk of [[urinary tract infection]].<ref name="afp" /> A diaphragm that is too large may also cause a sore to develop on the vaginal wall.<ref>{{cite web|title=Diaphragms: Management of Side Effects|work=PocketGuide for Family Planning Service Providers: Barriers and Spermicides|publisher=Reproductive Health Online|year=2003|url=http://www.reproline.jhu.edu/English/6read/6multi/pg/barr7.htm#Vaginal%20lesion|access-date=2007-09-15|url-status=live|archive-url=https://web.archive.org/web/20070416010609/http://www.reproline.jhu.edu/english/6read/6multi/pg/barr7.htm#Vaginal%20lesion|archive-date=2007-04-16}}</ref>

Diaphragms should be re-fitted after a weight change of 4.5&nbsp;kg (10&nbsp;lb) or more.<ref name="fwhc" /> The traditional clinical guideline is that a decrease in weight may cause a woman to need a larger size, although the strength of this relationship has been questioned.<ref>{{cite journal|author=Kugel C, Verson H|title= Relationship between weight change and diaphragm size change|journal=Journal of Obstetric, Gynecologic, & Neonatal Nursing|volume=15|issue=2|pages= 123–9|year=1986|pmid=3517255|doi=10.1111/j.1552-6909.1986.tb01377.x|last2= Verson}}<br>
{{cite journal|author=Fiscella K|title=Relationship of weight change to required size of vaginal diaphragm |journal=The Nurse Practitioner|volume=7|issue=7|pages=21, 25| year=1982|pmid=7121900|doi=10.1097/00006205-198207000-00004}}</ref>

Diaphragms should also be re-fitted after any pregnancy of 14 weeks or longer.<ref name="pp" /> Full-term vaginal delivery especially will tend to increase the size diaphragm a woman needs, although the changes to the [[pelvic floor]] during pregnancy mean even women who experience second-trimester miscarriage, or deliver by [[Caesarean section|C-section]], should be refitted.

''Vaginal tenting'', an increase in the length of the vagina, occurs during arousal. This means that during intercourse, the diaphragm will not fit snugly against the pubic bone because it is carried higher up the vaginal canal by the movement of the cervix. If the diaphragm is inserted after arousal has begun, extra care must be taken to ensure the device is covering the cervix.<ref name="OrthoPI" />

A woman might be fitted with a different size diaphragm depending on where she is in her [[menstrual cycle]]. It is common for a woman to wear a larger diaphragm during menstruation. It has been speculated that a woman may be fitted with a larger size diaphragm when she is near [[ovulation]].<ref name="tcoyf">{{cite book|first= Toni|last=Weschler|year=2002|title=Taking Charge of Your Fertility|url= https://archive.org/details/takingchargeofyo00toni|url-access= registration|pages=[https://archive.org/details/takingchargeofyo00toni/page/232 232]|edition=Revised|publisher=HarperCollins|location=New York|isbn=978-0-06-093764-5}}</ref> The correct size for a woman is the largest size that she can wear comfortably throughout her cycle.

In the United States, diaphragms are available by [[Medical prescription|prescription]] only. Many other countries do not require prescriptions.