The Caya Diaphragm

What is a diaphragm?

A diaphragm is a barrier method of contraception. It is a dome of soft silicone with a flexible rim that is placed inside the vagina to cover the cervix (the lower part of the uterus or womb). The Caya® diaphragm, which is a single size diaphragm, is the only one available in Australia.

How does it work?

The diaphragm forms a barrier which prevents sperm from getting into the uterus. It is inserted before sexual intercourse and is left in place for at least 6 hours afterwards. It takes 6 hours for the sperm to die in the acidic environment of the vagina.

How effective is the diaphragm?

Caya® diaphragms are between 82% to 86% effective. This means that if 100 people use the diaphragm for a year between 14 and 18 will have a pregnancy.

What are the key factors in effectiveness?

The key factors in using a diaphragm to make it as effective as possible are:

1. Using it every time you have sexual intercourse.
2. Making sure it is covering your cervix.
3. Leaving it in place for a minimum of 6 hours after intercourse.

How do I use the diaphragm?

You use the diaphragm by squeezing the rim together, then inserting it into the vagina. Push it back and upwards as far as it will go and then check to make sure that it is covering your cervix.

This check is particularly important and is the only way that you can be sure the diaphragm will work effectively. Occasionally it may be difficult to do this and if this is the case your partner may be willing to assist you to check that the diaphragm is covering your cervix. If you are using a personal lubricant make sure that it is a water-based lubricant and use it after you have inserted the diaphragm. Other personal lubricants such as oil or silicone can damage the diaphragm.

You can insert the diaphragm many hours before or just before sex, whatever works best for you. You can remove it any time after the minimum 6 hours although it should not be left in for more than 24 hours.

Using a contraceptive gel with a diaphragm

To increase effectiveness the manufacturer of Caya® diaphragms recommends the use of Caya® Gel with your diaphragm. Caya® Gel is a water-based lubricant that contains lactic acid, it is not a contraceptive spermicide. The gel is placed inside the rim of the diaphragm before you insert it.

What are the advantages of diaphragms

• They provide an alternative if you are unable to or choose not to use a hormonal contraceptive
• You can use a diaphragm if you or your partner are sensitive to latex
• You can use it just when it is needed at the time of sex
• You can use it together with fertility awareness methods to increase their effectiveness
• They last for 2 years before they need replacing

What are the disadvantages of diaphragms?

• They have a significantly lower rate of effectiveness than most other methods of contraception
• Some people may have difficulty using them or may not like putting them into their vagina
• They may not be suitable for some people for anatomical or medical reasons

 Does the diaphragm have any side effects?

The diaphragm has very few side effects but can occasionally cause irritation of the vagina or penis and may increase the risk of bladder infections in some people.

Who cannot use a diaphragm?

Most people can use a diaphragm safely, however there are some things which may mean a diaphragm may not be suitable for you.

These include:

• If you have a sensitivity to silicone
• If you have frequent bladder infections
• If you have a history of toxic shock syndrome
• If it is less than 6 weeks since you have given birth
• If you have had recent surgery to your cervix
• If you have weak pelvic floor muscles or your individual shape does not suit a diaphragm

Remember a diaphragm does not protect you from sexually transmissible infections or HIV. Condoms can be used simultaneously to provide this protection and further reduce pregnancy risk.

How do I get a diaphragm?

If you have never had a diaphragm before it is strongly advised that you have a trial fitting with a trained health professional to ensure that the Caya® diaphragm is suitable for you. The nurses at Sexual Health & Family Planning ACT are specially trained to do this. Once you have checked that a diaphragm is suitable for you, Caya® diaphragms are readily available to purchase online. (The average cost is between $100 and $135 at the time of publication).

Can I wear my diaphragm ‘around-the-clock’?

If you wish, you can wear your diaphragm continuously, removing it for cleaning every 24 hours. Be careful not to remove it before the minimum 6 hours have passed after intercourse. Also, you will need to check before each occasion of intercourse that the diaphragm is still covering your cervix.

How do I look after my diaphragm?

After removing the diaphragm from your vagina, wash it in warm water with mild soap, rinse it in clean water, dry it carefully and store in a dry container away from heat.

Can I use my diaphragm during my period?

You should continue to use your diaphragm during your period as it is still possible to become pregnant at this time. However, during menstruation, you should only wear your diaphragm for 6 hours at a time before removing it for cleaning. It is not advisable to use it continually as there is a small risk of developing toxic shock syndrome.

Will I be able to feel my diaphragm?

You should not be aware of your diaphragm if it is correctly positioned over your cervix. Your partner may be aware of it during intercourse, but if they are aware of it, most do not find this uncomfortable.

Accidents and using emergency contraception

If you have had intercourse and forgotten to put your diaphragm in or discovered after intercourse that the diaphragm was not covering the cervix properly, you may be at risk of pregnancy. Using emergency contraception can reduce the risk of pregnancy.

The Levonorgestrel emergency contraceptive pill can be taken up to 96 hours (4 days) after unprotected intercourse, but is more effective within the first 72 hours, and best within 24 hours. The Ulipristal emergency contraceptive pill can be taken up to 120 hours (5 days) after intercourse.

Both are available over the counter at pharmacies. Importantly, the sooner you take emergency contraception the more effective it is. The copper IUD can also be used as an emergency contraceptive up to five days after unprotected intercourse and is highly effective. If you are interested in this please call SHFPACT on 02 62473077.

When should I replace my diaphragm?

Your diaphragm should last up to two years. While silicone is a durable material it is advisable to check your diaphragm regularly for holes or deterioration. You can do this by holding your diaphragm up to a light. If it does develop a hole or tear do not use it and get a new one as soon as possible.

References: Contraception: An Australian clinical practice handbook 4th Edition Faculty of Sexual & Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists UK. hfsrh.org

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