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Effectiveness: 84 to 94 percent when used with spermicidal cream or gel (6-12 pregnancies per 100 women each year.)

What is it? It's a soft, flexible latex dome or cup about 2½ inches across that you fill with spermicide and insert into your vagina over your cervix.

How does it work? Used with spermicide, the diaphragm creates a physical and chemical barrier. The combination of diaphragm and spermicide physically blocks and kills sperm, preventing fertilization. You put 1 to 2 teaspoons of spermicidal cream or gel into the cup of the diaphragm and insert it over the cervix. It can be inserted up to 2 hours before sex and should be left in place for 6 to 8 hours after sex. Add more spermicide before each act of intercourse.

STD protection: No; you will still need to use condoms if you are concerned about STDs.

Benefits: Readily available, easy to use and easy to carry. It does not affect your natural hormones and can be used during breastfeeding. Because it can be inserted up to 12 hours before sex, it doesn't need to interrupt foreplay. It is effective immediately and should stay in place for 6 hours after you have sex. It generally can’t be felt by your or your partner.

Disadvantages: May irritate your vagina if you are allergic to spermicide. Some research indicates that frequent use of spermicide may increase the risk of HIV infection by irritating the vagina. It can be dislodged due to penis size, vigorous thrusting or some sexual positions. It may need to be refitted periodically. It should not be used if you are bleeding vaginally, including during your period, because it may increase your risk of toxic shock syndrome. Certain other conditions may make the diaphragm an inappropriate choice, such as physical problems with your vagina or uterus (see Notes below). Serious complications are rare, but always talk with your health care provider about risks and benefits.

Availability: Requires a visit to your health care provider to fit you for a diaphragm. Then diaphragms are available by prescription at drugstores and clinics.

Cost: $15 to $75 for diaphragm; lasts up to 2 years.* Spermicide costs vary, starting at about $8 per kit.*

Notes: It is not recommended if you have had toxic shock syndrome or are allergic to latex or spermicide. It may not be recommended if you are not comfortable touching your vagina; have certain problems with your vagina or uterus; have frequent urinary tract infections; recently gave birth or had an abortion; or recently had surgery on your cervix. It is more effective if you are taught how to use it and have help from a health care provider in practicing how to put it over your cervix. It’s important to clean and store your diaphragm properly after use and check it regularly for signs of wear. Use only water-based lubricants with your diaphragm.

* The Affordable Care Act requires insurance companies to cover with no co-pay any FDA-approved contraceptive method prescribed by your doctor, including barrier methods, hormonal methods, implanted methods, emergency contraception, female sterilization and patient education and counseling. These estimated costs apply to women who do not have insurance coverage or who work for a "religious employer," who may be exempt from providing contraceptive coverage. For details about what your insurance covers, contact your benefits coordinator or health insurance provider.

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