Diaphragm (contraceptive) - Risks

Risks

Women (or their partners) who are allergic to latex should not use a latex diaphragm.

Diaphragms are associated with an increased risk of urinary tract infection (UTI) Urinating before inserting the diaphragm, and also after intercourse, may reduce this risk.

Toxic shock syndrome (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, especially if the diaphragm is too large, and causing irritation and preventing the bladder from emptying fully. However, the spermicide nonoxynol-9 is itself associated with increased risk of UTI, yeast infection, and bacterial vaginosis. 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.