How to Insert a Diaphragm: A Comprehensive Guide to Confident Contraception

The diaphragm is a reusable barrier contraceptive method that, when used correctly with spermicide, can effectively prevent pregnancy. It’s a shallow, dome-shaped cup made of silicone that you insert into your vagina to cover your cervix. This guide provides a detailed, step-by-step explanation on how to insert a diaphragm properly, ensuring you’re using it effectively for pregnancy prevention.

Understanding the Diaphragm

Before diving into the insertion process, let’s cover some crucial aspects of the diaphragm:

• Prescription Required: You’ll need a prescription from your doctor or healthcare provider to obtain a diaphragm. They will measure you to ensure you get the correct size.
• Spermicide is Essential: Diaphragms are always used with spermicide. Spermicide is a chemical that kills sperm. It’s crucial for increasing the effectiveness of the diaphragm.
• Effectiveness: The diaphragm is most effective when used consistently and correctly. With typical use (which accounts for human error), it is about 88% effective. With perfect use, its effectiveness increases to about 94%.
• STI Protection: A diaphragm does not protect against sexually transmitted infections (STIs). You’ll still need to use condoms to protect against STIs.
• Duration of Use: A diaphragm must be left in place for at least six hours after intercourse. However, it should not be left in for more than 24 hours due to the risk of toxic shock syndrome (TSS).
• Cleaning and Storage: Proper cleaning and storage are essential for maintaining the diaphragm’s integrity and preventing infections.

Materials You’ll Need

• Your Diaphragm: Make sure it’s the correct size and type prescribed by your doctor.
• Spermicide: Use the spermicide recommended by your doctor or pharmacist. Gels, creams, or foams are commonly used.
• Clean Hands: Thoroughly wash your hands with soap and water before handling the diaphragm.
• (Optional) Applicator: Some diaphragms come with an applicator to aid in insertion. If yours does, familiarize yourself with its use.

Step-by-Step Guide to Inserting a Diaphragm

Follow these steps carefully to ensure correct diaphragm insertion:

Step 1: Prepare for Insertion

1. Empty Your Bladder: This will make the insertion process more comfortable.
2. Wash Your Hands: Thoroughly wash your hands with soap and warm water for at least 20 seconds. Rinse well and dry them with a clean towel.
3. Gather Your Supplies: Have your diaphragm, spermicide, and applicator (if using) readily available.
4. Choose a Comfortable Position: Find a position that is comfortable for you. Common positions include:
   • Squatting: Squatting can help you reach your vagina easily.
   • Lying Down: Lie on your back with your knees bent and slightly apart.
   • Standing: Stand with one leg propped up on a chair or toilet seat.

   Choose the position that gives you the best access and control.

Step 2: Apply Spermicide

1. Check Your Diaphragm: Before each use, inspect your diaphragm for any holes, tears, or other damage. If you notice any defects, do not use it.
2. Apply Spermicide: Squeeze approximately one tablespoon (or the amount recommended on the spermicide package) of spermicide into the dome of the diaphragm and around the rim. This ensures that the cervix is completely covered and that the spermicide is in direct contact with the vaginal walls.

Step 3: Insert the Diaphragm

1. Hold the Diaphragm: Hold the diaphragm between your thumb and fingers, with the dome facing upward (towards your body). If using an applicator, follow the applicator’s instructions. Generally, you’ll compress the rim of the diaphragm to insert it into the applicator.
2. Separate Your Labia: Use your other hand to gently separate the labia (the folds of skin around your vagina) to expose the vaginal opening.
3. Insert into the Vagina: Insert the diaphragm into your vagina as far as it will comfortably go. Angle it downward and backward toward your tailbone. This mirrors the natural angle of the vaginal canal.
4. Push Behind the Pubic Bone: Once the diaphragm is in place, use your finger to push the front rim up behind your pubic bone. You should feel the bone behind the rim. This ensures the diaphragm is properly positioned to cover the cervix.

Step 4: Check the Placement

1. Feel for Coverage: After insertion, use your finger to feel around the rim of the diaphragm to make sure it’s in place and covering your cervix. You should be able to feel your cervix through the silicone dome. It will feel like a small, firm bump.
2. Comfort Check: The diaphragm should feel comfortable once inserted. You shouldn’t feel it when you walk, sit, or move around. If you feel any discomfort, it might not be inserted correctly. Try removing it and re-inserting it, paying close attention to the placement.

Step 5: After Intercourse

1. Leave it in Place: Leave the diaphragm in place for at least six hours after intercourse. Even if you have intercourse more than once during that time, leave the diaphragm in for the full six hours.
2. Do Not Exceed 24 Hours: Do not leave the diaphragm in for more than 24 hours. Leaving it in longer increases your risk of toxic shock syndrome (TSS).
3. Consider Additional Spermicide: If you have intercourse again while the diaphragm is in place (but before the required six hours have passed), insert additional spermicide into your vagina. Follow the instructions on the spermicide package.

Removing the Diaphragm

Removing the diaphragm is as important as inserting it correctly.

Step 1: Wash Your Hands

As with insertion, wash your hands thoroughly with soap and warm water.

Step 2: Find a Comfortable Position

Choose a position that allows you easy access to your vagina, similar to the positions used for insertion.

Step 3: Locate the Diaphragm

Reach into your vagina with your finger. Hook your finger behind the front rim of the diaphragm.

Step 4: Gently Pull Down and Out

Gently pull the diaphragm down and out. Avoid pulling too hard, as this could cause discomfort.

Step 5: Clean the Diaphragm

Immediately after removal, clean the diaphragm according to the manufacturer’s instructions and your doctor’s advice. Generally, this involves:

1. Rinsing: Rinse the diaphragm with lukewarm water.
2. Washing: Wash the diaphragm with mild, unscented soap and warm water. Avoid using harsh soaps, detergents, or perfumed products, as these can damage the diaphragm and irritate your vagina.
3. Rinsing Again: Rinse the diaphragm thoroughly to remove all traces of soap.
4. Drying: Pat the diaphragm dry with a clean towel or allow it to air dry completely before storing it.

Step 6: Store the Diaphragm

Store the clean, dry diaphragm in its case in a cool, dry place, away from direct sunlight and extreme temperatures. Proper storage will help prolong its lifespan.

Important Considerations and Tips

• Practice Makes Perfect: It may take a few tries to become comfortable with inserting and removing the diaphragm. Don’t get discouraged if you don’t get it right the first time.
• Communication with Your Doctor: Talk to your doctor about any concerns or difficulties you experience with your diaphragm. They can provide personalized guidance and ensure you’re using it correctly.
• Regular Check-ups: Have your diaphragm checked regularly by your doctor to ensure it still fits properly, especially after childbirth, significant weight changes, or pelvic surgery.
• Diaphragm Lifespan: A diaphragm typically lasts for one to two years, depending on how frequently it is used and how well it is cared for. Inspect it regularly for any signs of wear and tear.
• Toxic Shock Syndrome (TSS): While rare, toxic shock syndrome (TSS) is a serious bacterial infection that can be associated with diaphragm use. To minimize your risk of TSS:
  • Never leave the diaphragm in for more than 24 hours.
  • Wash your hands thoroughly before inserting and removing the diaphragm.
  • Do not use a diaphragm during your menstrual period.
  • If you develop any symptoms of TSS (sudden high fever, vomiting, diarrhea, rash, dizziness, muscle aches), remove the diaphragm immediately and seek medical attention.
• Allergies: Be aware of potential allergies to spermicide ingredients. If you experience any itching, burning, or irritation after using spermicide, discontinue use and consult your doctor. There are different types of spermicide available; your doctor can help you choose one that is right for you.

When to Seek Medical Advice

Contact your doctor or healthcare provider if you experience any of the following:

• Difficulty inserting or removing the diaphragm.
• Pain or discomfort during insertion, use, or removal.
• Signs of infection, such as vaginal discharge, itching, or odor.
• Symptoms of toxic shock syndrome (TSS).
• Suspected allergic reaction to spermicide.
• Concerns about the fit or effectiveness of the diaphragm.

Diaphragm vs. Other Contraceptive Methods

It’s important to consider the diaphragm in comparison to other available contraceptive methods to determine the best option for your individual needs and lifestyle. Factors to consider include:

• Effectiveness: As mentioned earlier, the diaphragm is 88% effective with typical use and 94% effective with perfect use. Other methods, such as IUDs and implants, offer higher effectiveness rates (over 99%). Birth control pills, patches, and rings also generally have higher effectiveness rates than the diaphragm.
• Ease of Use: Some women find the diaphragm easy to use, while others find it cumbersome. Methods like IUDs and implants require minimal user involvement after insertion.
• Hormonal vs. Non-Hormonal: The diaphragm is a non-hormonal method, which is appealing to women who want to avoid the side effects associated with hormonal contraceptives.
• STI Protection: The diaphragm does not protect against STIs. Condoms are the only contraceptive method that offers significant protection against STIs.
• Cost: The cost of a diaphragm includes the initial prescription and fitting, as well as the ongoing cost of spermicide. The overall cost can be comparable to other methods, but it’s important to factor in all expenses.
• Convenience: The diaphragm requires planning and insertion before intercourse. Some women may find this inconvenient compared to methods like the pill, which are taken daily, or long-acting methods like IUDs and implants.

Conclusion

The diaphragm can be a safe and effective contraceptive option when used correctly and consistently with spermicide. By following this comprehensive guide, you can confidently insert and remove your diaphragm, contributing to responsible family planning. Remember to consult with your doctor or healthcare provider to determine if the diaphragm is the right choice for you and to receive personalized guidance on its proper use.