Diaphragms

Diaphragms

Diaphragms: Definition

A dome-shaped latex (rubber) cup that is inserted into the vagina before intercourse and covers the cervix

Types of Diaphragms
* Flat spring (flat metal band)
* Coil spring (coiled wire)
* Arching spring (combination metal spring)

Diaphragms: Mechanism of Action
Prevent sperm from gaining access to upper reproductive tract (uterus and fallopian tubes) and serve as holder for spermicide

Diaphragms: Contraceptive Benefits
* Effective immediately
* Do not affect breastfeeding
* Do not interfere with intercourse (may be inserted up to 6 hours before)
* No method-related health risks
* No systemic side effects

Diaphragms: Noncontraceptive Benefits
* Some protection against STDs (e.g., HBV, HIV/AIDS) especially when used with spermicide
* Contain menstrual flow when used during menses

Diaphragms: Limitations

* Moderately effective (6B201 pregnancies per 100 women during the first year of use if used with spermicide)
* Effectiveness as contraceptives depends on willingness to follow instructions
* User-dependent (require continued motivation and use with each act of intercourse)
* Pelvic examination by trained service provider (may be nonphysician) required for initial fitting and postpartum refitting
* Associated with urinary tract infections in some users
* Must be left in place for 6 hours after intercourse
* Supplies must be readily available before intercourse occurs
* Resupply must be available (spermicide required with each use)

Who Can Use Diaphragms
Women who:

* Prefer not to use hormonal methods or who should not use them (e.g., smokers over 35 years of age)
* Prefer not to or should not use IUDs
* Are breastfeeding and need contraception
* Want protection from STDs and whose partners will not use condoms
Couples:

* Who need a temporary method while awaiting another method
* Who need a backup method
* Who have intercourse infrequently
* In which either partner has more than one sexual partner (at high risk for STDs), even if using another method

Diaphragms: Conditions Requiring Precaution (WHO Class 3)
Diaphragms are not recommended unless other methods are not available or acceptable if a woman has:

* A history of Toxic Shock Syndrome (TSS)
* An allergy to rubber or spermicides
* Repeat urinary tract infections (UTIs)
* Uterine prolapse
* Vaginal stenosis
* Genital anomalies

Diaphragms: Who May Require Additional Counseling

* Women whose age, parity or health problems make pregnancy high risk
* Women with physical disabilities or who find it unpleasant to touch their genitals
* Women who do not want any inconvenience
* Couples who want a highly effective method of contraception
* Couples who want a method not related to intercourse
* Couples not willing to use correctly and with each act of intercourse
* Couples who do not have soap and water readily available

Diaphragms: Management of Side Effects
Toxic Shock Syndrome (TSS):

* Examine for signs/symptoms of TSS (e.g., fever, rash, nausea, vomiting, diarrhea, conjunctivitis, weakness, decreased blood pressure and shock).
* If suspected, refer client to center where intravenous fluids and antibiotics are available.
* Give oral rehydration as needed and a non-narcotic analgesic (NSAID or aspirin) if fever is high (> 38EC).
Urinary tract infection (UTIs):

* Treat with appropriate antibiotic.
* If client has frequent UTIs and diaphragm remains her first choice for contraception, advise emptying bladder (voiding) immediately after intercourse.
* Offer client postcoital prophylactic (single-dose) antibiotic. Otherwise, help client choose another method.

Diaphragms: Management of Side Effects continued

* Suspected allergic reaction to diaphragm or spermicide:
* If allergic, help client choose another method
* Pain from pressure on bladder or rectum B Assess diaphragm fit. If current device is too large, fit with smaller device. Follow up to be sure problem is solved.
Allergic reactions, although uncommon, can be uncomfortable and possibly dangerous.

Diaphragms: Management of Side Effects continued
* Vaginal discharge and odor if left in place for more than 24 hours:
* Check for STD or foreign body. If not, advise client to remove diaphragm as early as is convenient after intercourse, but not less than 6 hours after last act.
* If symptoms recur, counsel regarding vaginal hygiene.
* Vaginal lesion caused by diaphragm rim pushing against vaginal wall:
* Temporarily stop use and provide backup method. When healed, check diaphragm fit (may be too large).

Diaphragms: Client Instructions

* Use diaphragm every time you have intercourse.
* First, empty your bladder and wash your hands.
* Check diaphragm for holes by pressing rubber and holding it up to light or filling with water.
* Squeeze small amount of spermicidal cream or jelly into cup of diaphragm.
* To make insertion easier, place small amount of cream/jelly on leading edge of diaphragm or in vaginal opening. Squeeze rim together.

Diaphragms: Client Instructions continued

* The following positions may be used for inserting diaphragm:
* One foot raised up on a chair or toilet seat
* Lying down
* Squatting
* Spread lips of vagina apart.
* Insert diaphragm and cream/jelly back in vagina and push front rim up behind pubic bone.

Diaphragms: Client Instructions continued

* Put your finger in the vagina and feel the cervix (feels like your nose) through the rubber to make sure it is covered.
* The diaphragm can be placed in the vagina up to 6 hours before having intercourse.
* If intercourse occurs more than 6 hours afterwards, another application of spermicide must be put into vagina.
* Additional cream or jelly is needed for each repeated intercourse.
* Leave diaphragm in for at least 6 hours after the last time intercourse occurs. Do not leave it in more than 24 hours after intercourse.
* Vaginal douching is not recommended at any time. If done, it should be delayed for 6 hours after intercourse.
* Remove diaphragm by hooking finger behind front rim and pulling it out. If necessary, put your finger between diaphragm and pubic bone to break the suction before pulling out.
* Wash diaphragm with mild soap and water and dry it thoroughly prior to returning it to container.

When to Consider Emergency Contraception

If a client does not wish to be pregnant, and she:

* forgot to use the diaphragm when she had intercourse
* thinks she may have used the diaphragm incorrectly
* had intercourse more than 6 hours after inserting the diaphragm but did not apply more spermicide
* did not leave the diaphragm in for 6 hours after having intercourse

Diaphragms.ppt