A diaphragm is form of reusable birth control for women. It’s a small, dome-shaped cup you insert into your vagina to block sperm from entering your uterus. It’s a physical barrier that prevents the sperm from reaching the egg, making it a barrier method of birth control.
Diaphragms are meant to be used with spermicide for added protection against pregnancy. When used correctly, diaphragms can be up to 94 percent effective.
If you’re interested in trying a diaphragm for birth control, talk to your gynecologist. You need a prescription to get one, but many insurance companies cover all or some of the cost.
Before you put it in
A diaphragm is most effective when it’s used with spermicide. So, before you insert it, apply your spermicide. Place a teaspoon of spermicide into the dome and spread it around the rim.
It’s important that you don’t use petroleum jelly or other oil-based creams in your diaphragm. These products may create small holes in the silicone. Instead, try a brand such as Options Gynol II, which is specifically designed for use with diaphragms.
Be sure to check the spermicide’s expiration date before use. Spermicide that has expired may not be as effective.
How to put it in
Finding the best position to insert your diaphragm can take practice and patience. Inserting it is similar to inserting a tampon or menstrual cup. You can try lying down, squatting, or standing with one leg propped up. Whatever position you choose, the idea is that your legs should be wide open and your knees bent.
To use the diaphragm, follow these steps:
- Wash your hands thoroughly.
- Apply your spermicide to the diaphragm.
- Fold the diaphragm in half and hold it in one hand, with the dome pointing down. Use your other hand to hold your vagina open.
- Place the diaphragm into your vagina, aiming for your tailbone as you insert.
- Once it’s inside, use your fingers to push the diaphragm as far into the vagina as you can.
- Use your finger to wrap the front rim up, behind your pubic bone. It’s helpful to aim for your belly button.
After you place the diaphragm, you can check to see if it’s in correctly. Try inserting your finger into your vagina again to see if you can feel any part of your cervix. This part of your body is firm, like the tip of your nose. You should be able to feel your cervix only through the diaphragm. If any of your cervix isn’t covered by the device, remove the diaphragm and try reinserting.
Once it’s in place, you shouldn’t be able to feel the diaphragm. A properly placed diaphragm will stay in your body even if you cough, squat, sit, walk, or run.
If you’re having trouble inserting it, you can ask your doctor about getting an inserter or switching to another method altogether.
When to take it out
Leave your diaphragm in for at least six hours after having sex. If you plan to have sex again that same day, leave it in and apply more spermicide into your vagina beforehand.
You shouldn’t leave the device in for longer than 24 hours. Doing so may lead to a serious bacterial infection called toxic shock syndrome.
How to take it out
Wait at least six hours after having sex to remove your diaphragm. Then, follow these steps:
- Wash your hands thoroughly.
- Find a comfortable position — lying down, squatting, or standing with one leg propped.
- Place your index finger into your vagina. Hook it over the rim of the diaphragm.
- Gently pull the diaphragm down and out of your vagina. Be especially careful not to tear any holes in the device with your finger nails.
After you take your diaphragm out, take care to prevent bacteria from settling into the diaphragm. This will preserve the product’s longevity.
- Rinse it off and let it air dry.
- Inspect it for any holes or other damage. Try filling the dome with water to see if any water leaks through the silicone.
- Let it dry again before storing your diaphragm in a cool, dry container.
You shouldn’t use a damaged diaphragm. Any holes will allow sperm to enter the cervix and into the uterus.
Pros and cons
With typical to perfect use, a diaphragm is 88 to 94 percent effective at preventing pregnancy. This makes it a fantastic birth control option for many women. Still, one option doesn't always meet the needs of all couples. Here are some pros and cons to consider.
There are a number of advantages to using a diaphragm over other birth control options. First, it’s either free or low-cost and often covered under the Affordable Care Act.
It’s also convenient. You can insert your diaphragm hours before having sex and have sex multiple times before it needs to be taken out. And when placed correctly, neither you nor your partner should be able to feel the device.
Diaphragms don’t contain hormones, so they don’t alter your own hormone levels or menstrual cycle. This also makes a diaphragm a safe option if you’re breastfeeding or would soon like to get pregnant. You can discontinue use and try to get pregnant right away.
Diaphragms also decrease your risk of developing pelvic inflammatory disease and tubal infertility.
There are some drawbacks and other factors to consider about diaphragms. For example, if you’re allergic to silicone, this option won’t work for you. Some women are allergic to spermicide, as well.
Using a diaphragm also involves planning ahead for a prescription and placing the device before having sex. They aren’t necessarily a good option for spontaneous sex.
Some women find it difficult to insert the device into the vagina or that it causes uncomfortable irritation. Others find they get frequent urinary tract infections (UTIs) while using diaphragms.
You may need to get a new diaphragm if you gain or lose a significant amount of weight. The same goes after you have a baby, miscarriage, or abortion.
If you have health insurance, there’s a good chance that a diaphragm will be covered in full through your carrier. Diaphragms are also free for people on Medicaid. Without insurance, a diaphragm may cost upwards of $90.
Diaphragms come in a variety of sizes, and some offices may also charge an additional fitting fee. It’s a good idea to call your office or insurance provider ahead of time to discuss costs and options available to you.
Even at full price, a diaphragm works out to be approximately $0.42 to $2.08 per month over its lifetime, plus the cost of spermicide. If you’re still concerned about cost, many family planning clinics offer payment assistance programs. You can call ahead to ask about your options.
Choosing the right birth control for you
Make an appointment to chat with your doctor about a birth control option that will work best for you. Diaphragms are low-cost, convenient, and often a long-lasting option if you’re looking for reliable pregnancy protection. Still, they may not be the right choice for every lifestyle.
Some questions you might consider asking our doctor include:
- Are there any reasons why I shouldn’t use a diaphragm or spermicide?
- How effective are diaphragms at preventing pregnancy?
- How do I know if my diaphragm is placed correctly?
- What spermicides do you recommend using with diaphragms?
- What should I use to protect myself against STIs?
- What are my options if I end up getting irritation or UTIs from the device?
- What happens if I gain or lose weight? If I have a baby, miscarriage, or abortion?
- Does my insurance cover a diaphragm and associated costs?