Talking to your kids about sex can be daunting, no matter how close you are. But discussing issues like abstinence, sexually transmitted diseases (STDs), and birth control can help lower teens' risk of an unintended pregnancy or contracting an STD.

The American Academy of Pediatrics (AAP) supports sex education that includes information about both abstinence and birth control. Research has shown that this information doesn't increase sexual activity among teens, but does promote and increase the proper use of birth control methods among those who are sexually active.

How and when you discuss sex and birth control is up to you. Providing the facts is vital, but it's also wise to tell your kids where you stand. Remember, by approaching these issues like any other health topics, not as something dirty or embarrassing, you increase the odds that your kids will feel comfortable coming to you with any questions and problems. As awkward as it might feel, answer questions honestly. And if you don't know the answers, it's OK to say so, then find out and report back.

If you have questions about how to talk with your son or daughter about sex, consider consulting your doctor. Lots of parents find this tough to tackle, and a doctor may offer some helpful perspective.

What Is a Diaphragm?

A diaphragm is a dome-shaped bowl made of thin, flexible rubber that sits over the cervix, the part of the uterus that opens into the upper part of the vagina.

How Does a Diaphragm Work?

A diaphragm keeps sperm from entering the uterus by blocking the cervix. For added protection, spermicide is put into the bowl of the diaphragm and along its edges before inserting the diaphragm high into the vagina so it covers the cervix.

The diaphragm is inserted up to 6 hours before having sex. More spermicide must be used each time a young woman has sex while wearing the diaphragm. Additional spermicide should also be used if she is going to have sex more than 3 hours after she inserted the diaphragm. After sex, the diaphragm must be left in for at least 6 hours, but no longer than 24 hours. The diaphragm can be removed by placing a finger into the vagina to pull it out.

After the diaphragm is removed, it must be washed (with mild soap and water), rinsed, and air dried, then stored in its case. It should not be dusted with baby powder and should never be used with oil-based lubricants such as mineral oil, petroleum jelly, or baby oil, which can cause the rubber to become brittle and crack. Other vaginal creams, such as yeast medicines, can also damage the rubber.

A diaphragm should be replaced at least every 2 years. It should be examined regularly for holes or weak spots, and replaced as needed.

How Well Does a Diaphragm Work?

Over the course of a year, 16 out of 100 typical couples who rely on the diaphragm with spermicide to prevent pregnancy will have an accidental pregnancy. Of course, these are average figures and the chance of getting pregnant depends on whether it's used correctly every time.

In general, how well each type of birth control method works depends on many things. With a diaphragm, some of the most important things are that it fits correctly, that it is used every time a couple has sex, and that spermicide is used appropriately.

Protection Against STDs

The diaphragm does not protect against STDs. Couples having sex must always use condoms along with the diaphragm to protect against STDs.

Abstinence (not having sex) is the only method that always prevents pregnancy and STDs.

Possible Side Effects

Most young women who use a diaphragm have no problems with it, but possible side effects include:

• Spermicides may irritate the vagina and surrounding skin or cause an allergic reaction.
• Strong odors or vaginal discharge may appear if the diaphragm is left in too long.
• The rubber or latex in the diaphragm may cause an allergic reaction (this is rare).
• Diaphragms and spermicides may make urinary tract infections more likely.
• Toxic shock syndrome (TSS) is a rare complication if the diaphragm is left in too long.

Who Uses Diaphragms?

A young woman who can take responsibility for sex in advance can use a diaphragm. With a diaphragm, she must always have a supply of spermicide. The diaphragm isn't good for anyone who is uncomfortable or uneasy with the thought of reaching into her vagina. And it may not be a good choice if there are certain medical conditions present, such as frequent urinary tract infections. The diaphragm should not be used when a young woman has her period.

Where Are Diaphragms Available?

A diaphragm has to be fitted by a doctor. During a pelvic exam the doctor will measure the vagina to determine which diaphragm size is the right fit, then teach the patient how to insert and remove it. Some doctors may even have the woman insert the diaphragm at home, then come in while wearing it to check that it's positioned correctly. A diaphragm that's inserted incorrectly or doesn't fit properly can result in pregnancy.

During the annual exam, the doctor will make sure the diaphragm still fits correctly. It may not fit if a girl has gained or lost 10 pounds, had a baby, had an abortion, or was fitted when she was a virgin and she is now having sex. If any of these things have changed since her last exam, a young woman should see her doctor to have the fit of the diaphragm checked rather than waiting until her annual exam.

How Much Does a Diaphragm Cost?

A diaphragm usually costs about $15-$75. It should be replaced every 2 years. There is also the cost of the doctor's visit and a fitting fee. Many health insurance plans cover these costs and family planning clinics (such as Planned Parenthood) charge much less. In addition, the cost of spermicide is about $0.50 to $1.50 per use.

Reviewed by: Larissa Hirsch, MD
Date reviewed: April 2010