Diaphragm (contraceptive)
Encyclopedia
The diaphragm is a cervical
Cervix
The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall...

 barrier
Barrier contraception
Barrier contraception methods prevent pregnancy by physically preventing sperm from entering the uterus.-History:The earliest recorded barrier methods are those of stem pessaries, found in Egypt. The diaphragm and reusable condoms became common after the invention of rubber vulcanization in the...

 type of birth control
Birth control
Birth control is an umbrella term for several techniques and methods used to prevent fertilization or to interrupt pregnancy at various stages. Birth control techniques and methods include contraception , contragestion and abortion...

. It is a soft latex
Latex
Latex is the stable dispersion of polymer microparticles in an aqueous medium. Latexes may be natural or synthetic.Latex as found in nature is a milky fluid found in 10% of all flowering plants . It is a complex emulsion consisting of proteins, alkaloids, starches, sugars, oils, tannins, resins,...

 or silicone
Silicone
Silicones are inert, synthetic compounds with a variety of forms and uses. Typically heat-resistant and rubber-like, they are used in sealants, adhesives, lubricants, medical applications , cookware, and insulation....

 dome with a spring molded into the rim. The spring creates a seal against the walls of the vagina.

Use

Anyone inserting or removing a diaphragm should first wash their hands 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
Teaspoon
A teaspoon, an item of cutlery, is a small spoon, commonly part of a silverware place setting, suitable for stirring and sipping the contents of a cup of tea or coffee...

 (5mL
Litre
pic|200px|right|thumb|One litre is equivalent to this cubeEach side is 10 cm1 litre water = 1 kilogram water The litre is a metric system unit of volume equal to 1 cubic decimetre , to 1,000 cubic centimetres , and to 1/1,000 cubic metre...

) of spermicide
Spermicide
Spermicide is a contraceptive substance that eradicates sperm, inserted vaginally prior to intercourse to prevent pregnancy. As a contraceptive, spermicide may be used alone. However, the pregnancy rate experienced by couples using only spermicide is higher than that of couples using other methods...

 may be placed in the dome of the diaphragm before insertion, or with an applicator after insertion.

The diaphragm must be inserted sometime before sexual intercourse
Sexual intercourse
Sexual intercourse, also known as copulation or coitus, commonly refers to the act in which a male's penis enters a female's vagina for the purposes of sexual pleasure or reproduction. The entities may be of opposite sexes, or they may be hermaphroditic, as is the case with snails...

, and remain in the vagina for 6 to 8 hours after a man's last ejaculation. For multiple acts of intercourse, it is recommended that an additional 5mL 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 warm mild soapy water before storage. The diaphragm must be removed for cleaning at least once every 24 hours 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.

Natural latex rubber will degrade over time. Depending on usage and storage conditions, a latex diaphragm should be replaced every one to three years. Silicone diaphragms may last much longer – up to ten years.

Fitting

Diaphragms come in different sizes. A fitting appointment with a health care professional is necessary to determine which size a woman should wear.

A correctly fitting diaphragm will cover the cervix
Cervix
The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall...

 and rest snugly against the "Glen" of the Pelvis 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. It is also more likely that a woman's partner will feel the anterior rim of a too-small diaphragm during intercourse. A diaphragm that is too large will place pressure on the urethra
Urethra
In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...

, preventing the bladder from emptying completely and increasing the risk of urinary tract infection
Urinary tract infection
A urinary tract infection is a bacterial infection that affects any part of the urinary tract. Symptoms include frequent feeling and/or need to urinate, pain during urination, and cloudy urine. The main causal agent is Escherichia coli...

. A too-large diaphragm may also rub a sore on the vaginal wall.

Diaphragms should be re-fitted after a weight change of 4.5 kg (10 lb) or more. 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.

Diaphragms should also be re-fitted after any pregnancy of 14 weeks or longer. Full-term vaginal delivery especially will tend to increase the size diaphragm a woman needs, although the changes to the pelvic floor
Pelvic floor
The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the levatores ani and coccygei, with which may be included the...

 during pregnancy mean even women who experience second-trimester miscarriage, or deliver by C-section
Caesarean section
A Caesarean section, is a surgical procedure in which one or more incisions are made through a mother's abdomen and uterus to deliver one or more babies, or, rarely, to remove a dead fetus...

, 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.

A woman might be fitted with a different size diaphragm depending on where she is in her menstrual cycle
Menstrual cycle
The menstrual cycle is the scientific term for the physiological changes that can occur in fertile women for the purpose of sexual reproduction. This article focuses on the human 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
Ovulation
Ovulation is the process in a female's menstrual cycle by which a mature ovarian follicle ruptures and discharges an ovum . Ovulation also occurs in the estrous cycle of other female mammals, which differs in many fundamental ways from the menstrual cycle...

. 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 prescription
Medical prescription
A prescription is a health-care program implemented by a physician or other medical practitioner in the form of instructions that govern the plan of care for an individual patient. Prescriptions may include orders to be performed by a patient, caretaker, nurse, pharmacist or other therapist....

 only. Many other countries do not require prescriptions.

Mechanism of contraception

The spring in the rim of the diaphragm forms a seal against the vaginal walls. The diaphragm covers the cervix
Cervix
The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall...

, and physically prevents sperm from entering the uterus
Uterus
The uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...

 through the os
External orifice of the uterus
The external orifice of the uterus is a small, depressed, somewhat circular aperture on the rounded extremity of the vaginal portion of the cervix. Through this aperture, the cervical cavity communicates with that of the vagina.The external orifice is bounded by two lips, an anterior and a posterior...

.

Traditionally, the diaphragm has been used with spermicide, and it is widely believed the spermicide significantly increases the effectiveness of the diaphragm. Insufficient studies have been conducted to determine effectiveness without spermicide.

It is widely taught that additional spermicide must be placed in the vagina if intercourse occurs more than six hours after insertion. However, there has been very little research on how long spermicide remains active within the diaphragm. One study found that spermicidal jelly and creme used in a diaphragm retained its full spermicidal activity for twelve hours after placement of the diaphragm.

It has long been recommended that the diaphragm be left in place for at least six or eight hours after intercourse. No studies have been done to determine the validity of this recommendation, however, and some medical professionals have suggested intervals of four hours or even two hours are sufficient to ensure efficacy. Interestingly, one manufacturer of contraceptive sponges only recommends leaving the sponge in place for two hours after intercourse. However, such use of the diaphragm (removal before 6 hours post-intercourse) has never been formally studied, and cannot be recommended.

It has been suggested that diaphragms be dispensed as a one-size-fits-all device, providing all women with the most common size (70mm). However, only 33% of women fitted for a diaphragm are prescribed a 70mm size, and correct sizing of the diaphragm is widely considered necessary.

Effectiveness

The effectiveness of diaphragms, as of most forms of contraception
Birth control
Birth control is an umbrella term for several techniques and methods used to prevent fertilization or to interrupt pregnancy at various stages. Birth control techniques and methods include contraception , contragestion and abortion...

, 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
Pearl Index
The Pearl Index, also called the Pearl rate, is the most common technique used in clinical trials for reporting the effectiveness of a birth control method.-Calculation and usage:...

 is used to calculate effectiveness rates, but some studies use decrement table
Decrement table
Decrement tables, also called life table methods, are used to calculate the probability of certain events.-Birth control:Life table methods are often used to study birth control effectiveness...

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.

The actual pregnancy rates among diaphragm users vary depending on the population being studied, with yearly rates of 10% to 39% 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.

Types

Diaphragms are available in diameters of 50mm to 105mm (about 2-4 inches). They are available in two different materials: latex
Latex
Latex is the stable dispersion of polymer microparticles in an aqueous medium. Latexes may be natural or synthetic.Latex as found in nature is a milky fluid found in 10% of all flowering plants . It is a complex emulsion consisting of proteins, alkaloids, starches, sugars, oils, tannins, resins,...

 (currently manufactured by Reflexions) and silicone
Silicone
Silicones are inert, synthetic compounds with a variety of forms and uses. Typically heat-resistant and rubber-like, they are used in sealants, adhesives, lubricants, medical applications , cookware, and insulation....

 (currently manufactured by Ortho
Ortho-McNeil Pharmaceutical
The company was formed from the merger of Ortho Pharmaceutical and McNeil Pharmaceutical in 1993. Both of these pharmaceutical companies are pioneers and leaders in areas such as pain management, acid reflux disease, and infectious diseases...

, Milex and Semina). Diaphragms are also available with different types of springs in the rim.

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
Cystocele
A cystocele is a medical condition that occurs when the tough fibrous wall between a woman's bladder and her vagina is torn by childbirth, allowing the bladder to herniate into the vagina. Urethroceles often occur with cystoceles....

, rectocele
Rectocele
A rectocele results from a tear in the rectovaginal septum . Rectal tissue bulges through this tear and into the vagina as a hernia...

, or retroversion
Retroverted uterus
A retroverted uterus is a uterus that is tilted backwards instead of forwards. This is in contrast to the slightly "anteverted" uterus that most women have, which is tipped forward toward the bladder, with the anterior end slightly concave.Between 1 in 3 and 1-in-5 women has a retroverted...

. Arcing spring diaphragms may be easier to insert correctly than other spring types. Examples of arcing spring diaphragms are the Ortho All-Flex and the Milex Wide-Seal Arcing.

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. 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. Examples of coil spring diaphragms are the Ortho Coil, the Milex Wide-Seal Omniflex, and the Semina diaphragm.

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. Ortho used to manufacture a flat-spring diaphragm called the Ortho White. While some providers may still have Ortho White diaphragms in stock, the only current manufacturer of a flat-spring diaphragm is Reflexions.

Variations on the traditional diaphragm are being tested. The SILCS diaphragm
SILCS diaphragm
The SILCS diaphragm is a silicone barrier contraceptive device which is inserted vaginally to cover the cervix. The SILCS device was developed by the Program for Appropriate Technology in Health and SILCS, Inc...

 is made of silicone, has an arcing spring, and a finger cup is molded on one end for easy removal. The Duet disposable
Disposable
A disposable is a product designed for cheapness and short-term convenience rather than medium to long-term durability, with most products only intended for single use. The term is also sometimes used for products that may last several months to distinguish from similar products that last...

 diaphragm is made of dipped polyurethane, pre-filled with BufferGel
BufferGel
BufferGel is the brand name of a spermicide and microbicide gel which is being tested for its potential development into a preventative medicine to stop the transmission of HIV.-Testing:...

 (BufferGel is currently in clinical trials as a spermicide and microbicide
Microbicides for sexually transmitted diseases
Microbicides for sexually transmitted diseases, are pharmacologic agents and chemical substances that are capable of killing or destroying certain microorganisms that commonly cause human infection, for example the human immunodeficiency virus....

). Both the SILCS and Duet diaphragms are one-size-fits-all.

Advantages

The diaphragm does not interfere with a woman's natural cycle, therefore, no reversal or wait 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
Barrier contraception
Barrier contraception methods prevent pregnancy by physically preventing sperm from entering the uterus.-History:The earliest recorded barrier methods are those of stem pessaries, found in Egypt. The diaphragm and reusable condoms became common after the invention of rubber vulcanization in the...

 such as the diaphragm over methods that require some action every day.

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 contraceptive diaphragm may be used as a menstrual device, much like the commercial product Instead
Menstrual cup
A menstrual cup is a type of cup or barrier worn inside the vagina during menstruation to collect menstrual fluid. Unlike tampons and pads, the cup collects menstrual fluid rather than absorbing it...

. Contact with blood will discolor the diaphragm, but will not affect its contraceptive effectiveness.

The diaphragm is less expensive than many other methods of contraception.

Protection from sexually transmitted infections

There is some evidence that the cells in the cervix are particularly susceptible to certain sexually transmitted infections
Sexually transmitted disease
Sexually transmitted disease , also known as a sexually transmitted infection or venereal disease , is an illness that has a significant probability of transmission between humans by means of human sexual behavior, including vaginal intercourse, oral sex, and anal sex...

 (STIs). Cervical barriers such as diaphragms may offer some protection against these infections. 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.

Because pelvic inflammatory disease
Pelvic inflammatory disease
Pelvic inflammatory disease is a generic term for inflammation of the uterus, fallopian tubes, and/or ovaries as it progresses to scar formation with adhesions to nearby tissues and organs. This may lead to infections. PID is a vague term and can refer to viral, fungal, parasitic, though most...

 (PID)is caused by certain STIs, diaphragms may lower the risk of PID. Cervical barriers may also protect against human papillomavirus
Human papillomavirus
Human papillomavirus is a member of the papillomavirus family of viruses that is capable of infecting humans. Like all papillomaviruses, HPVs establish productive infections only in keratinocytes of the skin or mucous membranes...

 (HPV), the virus that causes cervical cancer
Cervical cancer
Cervical cancer is malignant neoplasm of the cervix uteri or cervical area. One of the most common symptoms is abnormal vaginal bleeding, but in some cases there may be no obvious symptoms until the cancer is in its advanced stages...

, although the protection appears to be due to the spermicide used with diaphragms and not the barrier itself.

Diaphragms are also considered a good candidate as a delivery method for microbicide
Microbicide
Microbicides for sexually transmitted diseases, are pharmacologic agents and chemical substances that are capable of killing or destroying certain microorganisms that commonly cause human infection, for example the human immunodeficiency virus....

s (preparations that, used vaginally, protect against STIs) that are currently in development.

Risks

Women (or their partners) who are allergic to latex
Latex
Latex is the stable dispersion of polymer microparticles in an aqueous medium. Latexes may be natural or synthetic.Latex as found in nature is a milky fluid found in 10% of all flowering plants . It is a complex emulsion consisting of proteins, alkaloids, starches, sugars, oils, tannins, resins,...

 should not use a latex diaphragm.

Diaphragms are associated with an increased risk of urinary tract infection
Urinary tract infection
A urinary tract infection is a bacterial infection that affects any part of the urinary tract. Symptoms include frequent feeling and/or need to urinate, pain during urination, and cloudy urine. The main causal agent is Escherichia coli...

 (UTI) Urinating before inserting the diaphragm, and also after intercourse, may reduce this risk.

Toxic shock syndrome
Toxic shock syndrome
Toxic shock syndrome is a potentially fatal illness caused by a bacterial toxin. Different bacterial toxins may cause toxic shock syndrome, depending on the situation. The causative bacteria include Staphylococcus aureus and Streptococcus pyogenes...

 (TSS) occurs at a rate of 2.4 cases per 100,000 women using diaphragms, almost exclusively when the device is left in place longer than 24 hours.

The increase in risk of UTI's may be due to the diaphragm applying pressure to the urethra
Urethra
In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...

, especially if the diaphragm is too large, and causing irritation and preventing the bladder from emptying fully. However, the spermicide nonoxynol-9
Nonoxynol-9
Nonoxynol-9, sometimes abbreviated as N-9, is an organic compound that is used as a surfactant. It is a member of the nonoxynol family of nonionic surfactants. N-9 and related compounds are ingredients in various cleaning and cosmetic products. It is widely used in contraceptives for its...

 is itself associated with increased risk of UTI, yeast infection
Candidiasis
Thrush redirects here. For the hoof infection see Thrush .Candidiasis or thrush is a fungal infection of any of the Candida species , of which Candida albicans is the most common...

, and bacterial vaginosis
Bacterial vaginosis
Bacterial vaginosis or less commonly vaginal bacteriosis is a disease of the vagina caused by bacteria. The U.S. Centers for Disease Control and Prevention states it is not clear what role sexual activity plays in the development. However, it is known that BV is associated with having a new sex...

. For this reason, some advocate use of lactic acid or lemon juice based spermicides, which might have fewer side effects. Although these alternative spermicides have been shown to immobilize sperm in the laboratory, their effect on pregnancy rates in humans has never been studied.

It has also been suggested that, for women who experience side effects from nonoxynol-9, it may be acceptable to use the diaphragm without any spermicide. One study found an actual pregnancy rate of 24% per year in women using the diaphragm without spermicide; however, all women in this study were given a 60mm diaphragm rather than being fitted by a clinician. Other studies have been small and given conflicting results. The current recommendation is still for all diaphragm users to use spermicide with the device.

History

The idea of blocking the cervix to prevent pregnancy is thousands of years old. Various cultures have used cervix-shaped devices such as oiled paper cones or lemon halves, or have made sticky mixtures that include honey or cedar rosin to be applied to the cervical opening. However, the diaphragm - which stays in place because of the spring in its rim, rather than hooking over the cervix or being sticky - is of much more recent origin.

An important precursor to the invention of the diaphragm was the rubber vulcanization
Vulcanization
Vulcanization or vulcanisation is a chemical process for converting rubber or related polymers into more durable materials via the addition of sulfur or other equivalent "curatives." These additives modify the polymer by forming crosslinks between individual polymer chains. Vulcanized material is...

 process, patented by Charles Goodyear
Charles Goodyear
Charles Goodyear was an American inventor who developed a process to vulcanize rubber in 1839 -- a method that he perfected while living and working in Springfield, Massachusetts in 1844, and for which he received patent number 3633 from the United States Patent Office on June 15, 1844Although...

 in 1844. In the 1880s, a German
Germany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...

 gynecologist C. Haase published the first description of a rubber contraceptive device with a spring molded into the rim. Haase wrote under the pseudonym Wilhelm P.J. Mensinga, and the Mensinga diaphragm was the only brand available for many decades. In the United States, the physician Edward Bliss Foote designed and sold an early form of occlusive pessary under the name "womb veil
Womb veil
The womb veil was a 19th-century American form of barrier contraception consisting of an occlusive pessary made of rubber. It was a forerunner to the modern diaphragm and cervical cap. The name was first used by Edward Bliss Foote in 1863 for the device he designed and marketed...

" starting in the 1860s.

American birth control activist Margaret Sanger
Margaret Sanger
Margaret Higgins Sanger was an American sex educator, nurse, and birth control activist. Sanger coined the term birth control, opened the first birth control clinic in the United States, and established Planned Parenthood...

 fled to Europe in 1914 to escape prosecution under the Comstock laws, which prohibited sending contraceptive devices, or information about contraception, through the mail. Sanger learned about the diaphragm in the Netherlands
Netherlands
The Netherlands is a constituent country of the Kingdom of the Netherlands, located mainly in North-West Europe and with several islands in the Caribbean. Mainland Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east, and shares maritime borders...

 and introduced the product to the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...

 when she returned in 1916. Sanger and her second husband, Noah Slee, illegally imported large quantities of the devices from Germany and the Netherlands. In 1925, Slee provided funding to Sanger's friend Herbert Simonds, who used the funds to found the first diaphragm manufacturing company in the U.S., the Holland-Rantos Company.

Diaphragms played a role in overturning the federal Comstock Act. In 1932, Sanger arranged for a Japanese manufacturer to mail a package of diaphragms to a New York physician who supported Sanger's activism. U.S. customs confiscated the package, and Sanger helped file a lawsuit. In 1936, in the court case United States v. One Package of Japanese Pessaries
United States v. One Package of Japanese Pessaries
United States v. One Package of Japanese Pessaries, 86 F.2d 737 , was an in rem United States Court of Appeals case in the Second Circuit involving birth control.-Background:...

, a federal appellate court ruled that the package could be delivered.

Although in Europe, the cervical cap
Cervical cap
The cervical cap is a form of barrier contraception. A cervical cap fits over the cervix and blocks sperm from entering the uterus through the external orifice of the uterus, called the os.-Terminology:...

 was more popular than the diaphragm, the diaphragm became one of the most widely used contraceptives in the United States. In 1940, one-third of all U.S. married couples used a diaphragm for contraception. The number of women using diaphragms dropped dramatically after the 1960s introduction of the IUD
Intrauterine device
A copper IUD is a type of intrauterine device. Most IUDs have a plastic T- or U-shaped frame which is wrapped in copper wire, with the exception of Gynefix, which is a plastic string with several copper beads, affixed to the fundus of the uterus...

 and the combined oral contraceptive pill. In 1965, only 10% of U.S. married couples used a diaphragm for contraception. That number has continued to fall, and in 2002 only 0.2% of American women were using a diaphragm as their primary method of contraception. Diaphragms, both the Ortho brand and Reflexions, and the spermicidal gel used with them, can be purchased online. There is an e-mail community of users, where resources may be found, as well as tips on making one's own homemade spermicide, to be used with a barrier method.

External links

The source of this article is wikipedia, the free encyclopedia.  The text of this article is licensed under the GFDL.
 
x
OK