Diaphragm

Immediately effective, no hormones, can be inserted up to 6 hours before sex.

Diaphragms are shallow, dome-shaped cups made of latex or silicone. They’re off-white and only a few inches in diameter. You insert this method into your vagina before sex and it covers your cervix and keeps sperm out of your uterus. One super important thing to remember: For this method to work effectively, you need to use spermicide.

Effec­tive­ness

Fairly effective—better with spermicide.

Perfect Use

94%

Typical Use

88%

Side Effects

Usually no side effects. Some women might experience irritation or discomfort.

Effort

It must be in place every time you have sex.

Cost

Diaphragm: Anywhere from $0-$300, plus the ongoing cost of spermicide.

How do I get it?

Get fitted for the right size by your doctor or health center and then pick it up with a prescription.

Find a Clinic

Find your local health center here.

  • Comfortable with your body

    If you’re not okay with putting your fingers inside yourself, a probably isn’t for you. It’s a little like putting in a tampon, though: If you can do that, you can probably manage.

    It takes discipline

    You’ve got to remember to insert your diaphragm each and every time you have sex, so it takes a bit of self-discipline and planning. But at least you can carry it with you in your purse if you want.

    Allergy issues

    If you’re allergic to silicone or spermicide, you shouldn’t use this method.

    Not while you’re bleeding

    Don’t use a diaphragm while you’re having your period.

    The pregnancy question

    You’ll be able to get pregnant as soon as you stop using the diaphragm. So protect yourself with another method right away.

  • These methods may be free or low-cost for you.

    With proper care—and if you don’t gain or lose a lot of weight—you can keep your diaphragm for up to ten years, making it the best birth control value for your buck at the equivalent of 42 cents to $2 a month (plus the cost of spermicide).

    Prices:*

    • With Medicaid: Usually free
    • With insurance: $0. Great news. Preventive health services like birth control are covered for no additional charge now.
    • Without insurance: About $30 + $96 exam/fitting at Title X/low-cost health centers; $75 + $170 exam/fitting at other providers
    • Payment assistance: Check with your local family planning health centers and find out if they offer free or low-cost birth control (most do)

    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: $10 at Title X/low-cost health centers or $20 at other providers
    • Cost per month over five years: $2 at Title X/low-cost health centers or $4 at other providers
    • Cost per month over ten years: $1 at Title X/low-cost health centers or $2 at other providers

    * FYI: This info is based on a recent survey of Title X clinics in Colorado and birth control manufacturers. Your cost may vary. Some health centers accept private insurance; some don’t. If you don’t have private insurance, be sure to ask your doctor or health center about Title X (a federal family planning program), Medicaid, or other programs that could reduce the cost of your birth control.

  • 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, you have to be sure to leave it in for at least six hours after you have 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. Just 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. (Not too much, or it’ll be too slippery to hang on to.) Ortho 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 (you’ll need to add additional spermicide). Any kind of contraceptive gel or spermicide will do, 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.

    Here’s the deal:

    1. Wash your hands. 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 sort of defeats the whole purpose.
    3. Put a teaspoon 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. (And yes, you’ll be touching the spermicide.)
    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. (Ortho Gynol II comes with an applicator that measures how much you’ll need, and gets it where it needs to go.) Then the six-hour clock starts again, counting from the last time you have sex.

    How to take it out

    Of course, what goes in must come out. Here’s how:

    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 your doctor about getting an inserter, or consider switching to another method.

    Finally, take good care of your diaphragm and it can last 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.
    4. And don’t worry if it becomes discolored. It’ll still work.
  • There are positive and negative things to say

    about each and every method. And everyone’s different—so what you experience may not be the same as what your friend experiences.

    The Positive

    Positive “side effects”? You bet. There are actually lots of things about birth control that are good for your body as well as your sex life.

    • 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

    Everyone worries about negative side effects, but for most women, they’re not a problem.

    • Some women have a hard time inserting it
    • Can cause vaginal irritation
    • Some women 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
  • We’re here to get this method working better for you.

    And if it still doesn’t feel right, we’ve got ideas for other methods. Just remember: If you change methods, make sure you’re protected while you switch.

    It’s irritating me.

    The irritation could actually be from an allergy to spermicide. If the irritation is mild, you might try another type of spermicide. Also, you could be allergic to latex, the material that diaphragms are made from. If this is the case, you may need to switch to another birth control method.

    Still not working?
    If the irritation is more severe or sticks around once you try different types of spermicide, think about trying a method that doesn’t require any, like the IUD, shot, implant, pill, ring, or patch.

    It’s hard to insert and/or remove.

    This might get easier with practice. If you haven’t yet read our section on how to use it, you might want to check that out.

    Still not working?
    Sometimes you just have to do it more to get used to it. Practice a little more and do so when it’s not the heat of the moment. Hopefully you’ll soon find it easier to use.

    I keep getting urinary tract infections.

    Some women do get urinary tract infections from using the diaphragm. It might help if you pee before inserting the diaphragm and after you have sex. You might also check with your doctor to make sure your diaphragm fits correctly.

    Still not working?
    If you’re still having UTIs and want to switch methods, you might want to consider a method you don’t have to insert yourself each time you have sex. You might try the implant, patch, IUD, pill, or shot.

Real Stories (English)

Justin, 27

Justin and his girlfriend have been together for two and a half years. In the beginning, they were cautious about STIs and pregnancy, so they used condoms to protect against both. Now, as an exclusive couple with a clean bill of health, they use a diaphragm and go condom-free. (Except when she’s ovulating; that’s when they double up because women are more susceptible to getting pregnant around the time of ovulation.) In the heat of the moment — if his girlfriend hasn’t already inserted it — Justin admits that a diaphragm does require a certain level of accountability because they have to stop and put it in. But he also says the extra sensation from not having to wear condom is a very worthwhile perk.

Rachel, 25

Rachel’s first method of birth control was the the pill. She didn’t like the first brand she was tried, so she asked for another. Then another. Each had different side effects and eventually Rachel decided that hormonal methods just weren’t for her. After her doctor explained how a diaphragm works, Rachel decided to give it a go. And she’s been happy with her choice ever since. Rachel feels in control when using her diaphragm and finds it easy to put in—even when she’s already in the heat of the moment. She just excuses herself to “slip into something more comfortable.”

Nicole, 21

Nicole sums up the perks of her diaphragm like this: it’s easy to use, undetectable, and reliable. She likes that it’s there when she needs it, but there’s no long-term commitment. Even though the diaphragm is easy to hide once it’s in—and it’s important to Nicole that her choice of birth control stays private—at some point it has to be inserted. If Nicole’s already in the heat of the moment, she just has to be “clever” to secretly get it in there. When it’s necessary, Nicole doesn’t mind using a back-up method that’s harder to hide. She also uses male and female condoms—the only methods to prevent the spread of STIs.

Veronica, 24

Veronica has plans. To travel the world, rescue animals, and design clothing. Getting pregnant doesn’t fit in that plan. So she uses birth control every time. Veronica started with condoms, then added a diaphragm for back up. Knowing diaphragms do their best work with the help of spermicide, she always uses that, too. So every time she has sex, it’s one, two, three methods. Using all three is easy for Veronica, in part because the diaphragm can go in hours before having sex. Or it can go in 3 seconds before. You don’t have to have a “sex schedule”; you just have to have a plan.

Source: Bedsider.org