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CONTRACEPTION: BARRIER METHODS
The diaphragm. A close relative of the condom, the diaphragm is also a latex device, but is designed to fit over the cervix. In order to make as sperm-proof a cover as possible, the correct size must be worn. Initially a woman should be ‘fitted’ for a diaphragm by a doctor to ensure she buys the right size. A change of size may be necessary after a woman has had a baby, or pelvic surgery, or significant (more than 5 kilograms) weight change. But generally, once she has the right size diaphragm, the woman can re-use this over and over again. She should be re-fitted and buy a new diaphragm every two years as the latex can perish. The only added expense is spermicidal cream or jelly, which is recommended for use with the diaphragm (like the condom, the latex of the diaphragm is damaged by oil-based substances).
Prior to intercourse the diaphragm should be inserted, with spermicidal cream placed inside the dome. It can be inserted just before sexual activity, or in the morning of any day you are likely to have sex. The diaphragm must then be left in place for at least four hours after last having sex, before being removed and washed. If it is left in for more than twenty-four hours at a time you may notice a slightly smelly vaginal discharge.
When fitted properly the diaphragm cannot be felt by either partner. However, as with all other methods, there are those who don’t like it. According to some it is too messy, requires quite a deal of practice and motivation to be successful and, like the condom, can ‘interrupt the flow’ of events.
On the other hand, it is fairly free of side-effects, is cheap and, like the condom, can be relatively reliable in capable hands. True failure rates again depend on the user, but it is probably similar to the condom; between six and twenty pregnancies per 100 women years, with the better score going to the couples who are practised and motivated. Like periodic abstinence, diaphragms are
probably best suited to couples spacing families. If, however, a greater degree of accurate contraception is required, other methods may be more suitable.
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