Diaphragm

Diaphragm

an image of a diaphragm

A diaphragm is a shallow, dome-shaped cup made of silicone that is inserted into the vagina. Then it covers the cervix and keeps sperm out of the uterus. One super important thing to remember: for a diaphragm to work effectively, it must be used with spermicide.

    Details

    You’re comfortable with your body

    for those who aren't ok putting their fingers inside themselves, a diaphragm might not be the right option. It's a little like putting in a tampon, though.

    It takes discipline

    The diaphragm must be inserted every time a person has sex, so it takes a bit of self-discipline and planning.

    Availability

    There are two kinds of diaphragm, Caya (aka SILCS) and Milex, currently available on the US market. For those interested, it may be a good idea to call in advance to make sure the provider or pharmacy has diaphragms in stock.

    Allergy issues

    Those allergic to silicone or spermicide shouldn't use a diaphragm.

    The pregnancy question

    A person's return to fertility will happen immediately after the diaphragm is removed, which is great for those looking to conceive. But for those who aren't ready or interested in getting pregnant, an alternative method will be required. 

    Thanks to the Affordable Care Act, for those with health insurance, chances are good that IUDs are available without out-of-pocket costs. Explore all insurance options at HealthCare.gov or at a state-based marketplace. With proper care—and if you don’t gain or lose a lot of weight—a diaphragm will last for up to ten years, making it a great birth control value for your buck at the equivalent of 42 cents to $2.08 a month (plus the cost of spermicide).

    Prices:

    • This method may be free or low-cost.
    • With Medicaid: free.
    • Without insurance: depending on a person's income, they may be able to go to a low-cost clinic to get the diaphragm at reduced cost.


    At full price, the diaphragm can cost as much as $90; some clinics may charge extra for a fitting fee. To see how this translates over a year, here’s what it would cost to pay for a diaphragm month-to-month at full price:

    • Cost per month over one year: $0 - $7.50
    • Cost per month over two years: $0 - $3.75
    • Payment assistance: Check with a local family planning clinics and find out if they offer free or low cost birth control (most do).

    A diaphragm can be inserted just before sex, but it can also go in hours before you get to it so that it doesn't get in the way of the moment. But no matter when it goes in, it must stay in for at least six hours after sex. If you're going to have sex again that day, just leave the diaphragm in place and insert more spermicide way up in your vagina. However, don't leave your diaphragm in for more than 24 hours.

    Before you put it in

    Add about a teaspoon of spermicide to the inner part of the diaphragm, and spread a little of it around the rim, as well. Options Gynol II is specifically designed for diaphragms, and comes with an applicator you can use if you’re going to have sex more than once within six hours. Any kind of contraceptive gel or spermicide will do, however, except for the film or insert/suppository types. Don’t forget to check the expiration date.

    How to put it in

    Inserting a diaphragm may sound difficult, but with a bit of practice, it's not so tough.

    1. Wash your hands with soap and water; no shortcuts.
    2. Check your diaphragm for holes and weak spots. Filling it with water is a good way to check—if it leaks, you've got a hole, which means it will not work to prevent pregnancy. 
    3. Put a tablespoon or so of spermicide in the cup, and spread some around the rim, too.
    4. Get comfy, like you're going to put in a tampon.
    5. Separate the outer lips of your vagina with one hand, and use the other hand to pinch the rim of the diaphragm and fold it in half.
    6. Put your index finger in the middle of the fold to get a good, firm grip.
    7. Push the diaphragm as far up and back into your vagina as you can, and make sure to cover your cervix.
       

    Having another go at it?

    You need to leave the diaphragm in for six hours after sex. If you have sex a second time within those six hours, first insert more spermicide. Then the six-hour clock starts again, counting from the last time you have sex.

    How to take it out

    1. Wash your hands again.
    2. Put your index finger inside your vagina and hook it over the top of the rim of the diaphragm.
    3. Pull the diaphragm down and out.


    Still having trouble? Ask a health care provider about getting an inserter, or consider switching to another method.

    Finally, take good care of your diaphragm and it can last up for several years.

    1. After you take it out, wash it with mild soap and warm water.
    2. Let it air dry.
    3. Don't use powders or oil-based lubricants (like Vaseline or cold cream) on your diaphragm.
       

    Every method has its own positives and negatives, and because everyone's birth control is different what one person experiences may not be the same as another's experiences.

    The Positive

    • You can put a diaphragm in hours in advance.
    • You can have sex as many times as you like while it's in.
    • Neither you nor your partner should be able to feel it.
    • Doesn't affect your hormones.
    • Decreases the risk of pelvic inflammatory disease and tubal infertility.
    • Can be used while breastfeeding.

    The Negative

    • Some people have a hard time inserting it.
    • Can cause vaginal irritation.
    • Some people wind up getting frequent urinary tract infections.
    • You have to use it every time you have sex, no matter what.
    • If you're allergic to spermicide or silicone, you shouldn't use a diaphragm.
    • Can get pushed out of place by large penises, heavy thrusting, or certain sexual positions.
    • You need a prescription.
    • Hard to remember to use if you’re drunk.
    Do you have questions about Diaphragm? Visit Bedsider.org for answers to many of the most popular questions about this method of birth control.