Chapter 241 Diaphragm Fitting
DESCRIPTION
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.
CONTRAINDICATIONS
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.
TECHNIQUE
Diaphragms must be fitted to the individual patient, choosing the largest size that may be comfortably accommodated. (Diaphragms come in sizes that range from 50 to 105 mm in diameter, graduated in 5-mm increments. The most common size prescribed is 75 mm.) The optimal size may change with significant weight change (10 to 15+ pounds), vaginal birth, or pelvic surgery. Following delivery, diaphragms may be fitted at the 6- to 8-week postpartum visit. Diaphragms are made with coiled spring or with a flat or arcing type of rim that somewhat alters the fit. The flat type is better suited to those with a less well-defined subpubic arch; the arcing spring is best for those with less muscle tone.
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