Diaphragms (rubber or latex domes with a springy ring) are designed to provide a physical barrier between sperm and egg in conjunction with contraceptive jelly or creams to provide contraception by both barrier and spermicidal actions.
_ Approximately 2% of women using contraception choose this method.
_ Known or suspected allergy to latex or other materials used in the contraceptive device.
Diaphragms are not a good contraceptive choice for those who have significant pelvic floor support failure or those unwilling or unable to actively participate in the placement or removal process.
_ Diaphragms must be fitted to the individual patient, choosing the largest size that may be comfortably accommodated.
_ Diaphragm fitting begins with a gentle, bimanual examination of the patient using the lubricated, gloved examining finger to measure the approximate distance from the back of the symphysis to the posterior vaginal fornix.
_ A fitting ring that approximates this diameter should be selected, lubricated, and inserted into the vagina.
_ The fitting ring should be removed (by gentle traction on the retropubic edge of the ring.
_ In use, the diaphragm must be inserted before sexual intercourse commences and it must be left in place for 6 to 8 hours after.
_ Vaginal infection, urinary retention, toxic shock (2.4/100,000 when left in place >24 hours), vaginal wall trauma or erosions are all possible but unlikely with a properly fitted diaphragm that is removed at the proper intervals.