Vaginal Diaphragm

What is a vaginal diaphragm?

A vaginal diaphragm is a flexible, reusable dome-shaped cup that you place inside your vagina to prevent pregnancy. Like condoms, sponges and cervical caps, vaginal diaphragms are a barrier method of birth control. They prevent pregnancy by blocking sperm from reaching your uterus and fallopian tubes, where fertilization occurs. Diaphragms should always be used with spermicide, a chemical that immobilizes or kills sperm so that they can’t swim to your uterus.

You’ll need a prescription from your provider to get a vaginal diaphragm. You can purchase spermicide without a prescription.

Vaginal diaphragms can reduce your risk of pregnancy, but they don’t prevent sexually transmitted infections (STIs). To reduce your risk of contracting an STI, use a condom with your diaphragm.

What are vaginal diaphragms made of?

Vaginal diaphragms are made of rubber, silicone or latex. Tell your provider if you are sensitive to these materials (like a latex allergy). Use water-based or silicone-based products if you use a lubricant during sex. Oil-based lubricants may damage the material, causing your diaphragm to break or tear. Using a damaged diaphragm during intercourse puts you at risk of pregnancy.

How do vaginal diaphragms work?

Diaphragms cover your cervix, which is the opening between your vagina and uterus. They create a barrier separating sperm ejaculated into your vagina during intercourse and your uterus. Vaginal diaphragms are used with spermicide. Spermicides are available as a foam, cream, gel, or suppository that you can apply to your diaphragm. Spermicide immobilizes sperm so they don’t reach your uterus.

How do you use a vaginal diaphragm?

You’ll need a prescription from your healthcare provider to get a vaginal diaphragm. During your visit, your provider may perform a pelvic exam to ensure it fits correctly. They’ll teach you how to insert and remove your diaphragm.

How do you insert a diaphragm?

Wash your hands with a mild (unscented) soap and water and add the spermicide to your diaphragm. The amount of spermicide you need varies depending on the kind you’re using, so read the instructions carefully. Place the spermicide inside the dome of the diaphragm. Apply spermicide to the rim of the diaphragm.

To insert the diaphragm:

1. Find a position that’s comfortable for you. It may be easier to insert when lying on your back, squatting or standing with one leg propped on a chair or counter. Choose a position that would work if you were inserting a menstrual cup or a tampon without an applicator.
2. With one hand, part your vaginal lips (inner labia) to access your vaginal opening. Hold the diaphragm with your other hand so that the dome part points toward your palm.
3. Pinch the sides of the diaphragm together so that it’s small enough to fit inside your vaginal opening. Slide the diaphragm gently inside your vagina, along the back wall. Aim in the direction of your tailbone. Push the diaphragm as far back as it will go.
4. Once the diaphragm is inside your vagina, use your index (pointer) finger to nudge the rim so that it’s covering your cervix. You should be able to feel your cervix through the dome of the diaphragm. It may feel like a soft lump or even like the tip of your nose. A diaphragm that's placed correctly should fit snugly above your pubic bone and shouldn’t cause irritation.
5. After you’ve inserted the diaphragm, apply spermicide inside your vagina.

You shouldn’t be able to feel a diaphragm inside you — including when you walk, sneeze or have intercourse. If you feel your diaphragm, double-check with your provider to ensure it’s the right size and inserted correctly.

How do you remove a diaphragm?

First, wash your hands with soap and water. Then:

1. Insert your index (pointer) finger inside your vagina and feel for the rim of the diaphragm.
2. Slide your finger underneath the rim to break any suction between your diaphragm and vaginal walls, and pull downward and out.
3. Wash your diaphragm with soap and water and allow it to air dry. Place it in its container and store it in a cool, dry place, away from direct sunlight.

When should you insert and remove a vaginal diaphragm?

• Insert your diaphragm a few hours before intercourse. A good rule of thumb is to have intercourse within two hours of inserting your diaphragm. Waiting too long to have sex after inserting your diaphragm may cause the spermicide to become less effective. If it’s been longer than two hours, reapply spermicide to your vagina. If you have intercourse more than once while wearing your diaphragm, reapply spermicide to your vagina each time.
• Remove your diaphragm between six to 24 hours after intercourse. Removing it too early may prevent the spermicide from killing all the sperm, putting you at risk of pregnancy. Keeping it in place for too long increases your risk of infection and toxic shock syndrome (TSS).

Avoid douching or wait until six hours after intercourse to douche. Douching can rinse out the spermicide too early.

How often should I replace my diaphragm?

You can wear a diaphragm for up to two years unless you experience a life event that requires replacing it. As your body changes, you may need a different size diaphragm to accommodate those changes. See your provider about checking and replacing your diaphragm if:

• You’ve had pelvic surgery.
• You’re getting frequent urinary tract infections (UTIs).
• You’ve lost or gained 10 pounds or more.
• Your diaphragm is slipping or seems ill-fitting.
• You’ve given birth or had an abortion or miscarriage.
• It’s causing pain or discomfort during intercourse.

You should replace your diaphragm if you notice any tears or holes. Use your fingers to stretch the silicone or latex under a direct light source and check for tears. Run water through your diaphragm and check for leaks. If you see any signs of breakage, it’s time to replace your diaphragm.

How effective are vaginal diaphragms?

Vaginal diaphragms can prevent pregnancy 94% of the time. This number reflects ideal conditions when you use your diaphragm consistently and correctly each time. With typical use, diaphragms prevent pregnancy 87% of the time.

Use your diaphragm with another birth control method, like condoms, to reduce your pregnancy risk. Condoms provide the added benefit of protecting against some STIs.

What are the benefits of using vaginal diaphragms?

Vaginal diaphragms are:

• Reusable: You can wash and reuse the same diaphragm for up to two years.
• Low-maintenance: You don’t have to worry about birth control on the days you’re not sexually active, as you would with birth control pills.
• Not hormonal: They don’t interfere with your body’s natural hormone production.
• Free of side effects: You shouldn’t experience side effects unless there’s a complication.
• Empowering: You don’t have to rely on your partner to remember to bring a condom to enjoy intercourse with pregnancy prevention.
• Good for sexual spontaneity: You can insert a vaginal diaphragm a few hours before intercourse so that you don’t have to interrupt the sexual “flow” to reach for a condom.

Also, regaining your fertility is as easy as removing your diaphragm. You don’t have to wait to try for a baby should you decide to become pregnant.

What are the disadvantages of using vaginal diaphragms?

Vaginal diaphragms may:

• Lead to pregnancy if you don't use them consistently and correctly.
• Become dislodged during intercourse, putting you at risk of pregnancy.
• Feel uncomfortable at first as you learn to insert your diaphragm correctly.

One of the biggest disadvantages of vaginal diaphragms is the learning curve. It may take some work at first to learn how to insert your diaphragm. While you’re getting the hang of it, use an additional form of birth control to prevent pregnancy.

What are the risks of using vaginal diaphragms?

Vaginal diaphragms don’t usually cause side effects with correct use. In some cases:

• The materials in the diaphragm and the chemicals in the spermicide may lead to skin irritation if you’re allergic.
• Spermicide may damage the lining of your vagina, causing vaginal irritation or burning. The damage may put you at increased risk of contracting an STI.
• Vaginal diaphragms may increase your risk of urinary tract infections (UTIs).
• Wearing diaphragms beyond 24 hours without washing them can put you at risk of TSS.

Who should not use vaginal diaphragms?

Don’t use a vaginal diaphragm if:

• You’ve given birth less than six weeks ago.
• You’re allergic to the material in the diaphragm (latex) or the chemicals in spermicide.
• You’re susceptible to UTIs or have an active vaginal infection or pelvic infection.
• You’re HIV-positive or at high risk for contracting an STI (like having more than one sexual partner or not using condoms).
• You’ve previously had TSS.

Vaginal diaphragms may not be the best choice if your body’s natural fertility and your sexual lifestyle increase your pregnancy chances. You may need a more effective form of birth control, like a LARC. Your chances of pregnancy increase if you’re under 30 and have sex frequently (three or more times a week).

When to call a doctor

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

• Symptoms of TSS (high fever, weakness, vomiting, diarrhea, a rash that resembles a sunburn).
• Symptoms of a UTI (painful or frequent urination, vaginal discharge).
• Blood in your diaphragm when you’re not on your period.
• Vaginal pain or itching.

Can a guy feel a diaphragm?

Usually, no. But it does happen in rare cases. See your provider if your diaphragm feels unpleasant or painful for either you or your partner. You may need a different size diaphragm, or you may need to ensure that you’re inserting it correctly. In some instances, you may need to try a different form of birth control.

A note from Cleveland Clinic

Weigh the pros and cons of getting a vaginal diaphragm with your provider. They aren’t as effective as other forms of birth control, like IUDs. Still, diaphragms greatly reduce your pregnancy risk when used correctly and consistently. Keep in mind that diaphragms don’t protect against some STIs like condoms do. Talk to your provider about your best options for preventing pregnancy while reducing your risk of STIs.