Following persistent publicity about the possible side effects of hormonal contraceptives, intrauterine devices, and even sterilisation, many women contemplate the use of a diaphragm as their possible chosen method of contraception. In this article the practical aspects of fitting a diaphragm are described.
PIP: The most important aspect of fitting a woman for a contraceptive diaphragm is to ensure that she is aware of its advantages and disadvantages. The effectiveness of the method is dependent on motivation and correct use. The client should then be examined to exclude any pelvic disorders. If the device is too large then the next smaller size should be inserted, if it is loose, the next larger size should be tried. It is then important that the client practice inserting the diaphragm as well as removing it. The Family Planning Association of Victoria recommends that a small amount of spermicidal cream should be added to the cervical aspect of the diaphragm only. Sometimes an introducer may be used to place the diaphragm. These are supplied by the manufacturer and consist of a plastic device with a notch on one end and a hook on the other. The rim of the diaphragm should be inserted into the notch on one end and into the appropriate notch on the handle that corresponds to diaphragm size. The contraceptive jelly or cream can then be placed on the cervical side of the diaphragm and the introducer can then push the posterior aspect of the rim into the posterior fornix. Once the diaphragm appears to be in place, the introducer is twisted to disengage it from the diaphragm and the introducer is removed. The diaphragm should be left in place for a minimum of 4 hours after intercourse. To remove the diaphragm, the rim should be grasped by a finger and the diaphragm should be drawn out. The diaphragm should then be rinsed and dried, and stored in its plastic container. It is also important to check regularly to make sure the diaphragm is intact and that there are no holes.