R. Wayne Whitted MD, MPH
Paul A. Pietro MD
Marina Santana MMS, PA-C
8740 N Kendall Dr. Suite 101
Miami, Florida 33176
Phone: 305-596-3744
Birth Control: How to Use Your Diaphragm
For effective birth control, your diaphragm (see Picture 1 below) has to fit well. Your doctor will measure
your vagina to find the correct size and fit for you.
Your doctor or a nurse will teach you how to put the diaphragm in and take it out. You also should read
the directions from the company that made your diaphragm.
To be sure that you know how to use your diaphragm, you will need to practice putting it in and taking it
out while you are in your doctor's office. Your doctor also might check to see that the diaphragm fits
To lower your risk of getting pregnant, you must use your diaphragm correctly and use it every time you
have sex. You can put the diaphragm in your vagina right before you have sex or up to 6 hours before you
have sex.
Getting Your Diaphragm Ready
Before you put the diaphragm in your vagina, put about 1 teaspoon of spermicidal gel or cream in the cup
(also called the dome) (see Picture 2 below). Smear some more gel around the rim of the diaphragm. Do
not use petroleum jelly or oil-based vaginal creams (such as Monistat). These can make tiny holes in the
Picture 1
Picture 2
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Inserting Your Diaphragm
You can put your diaphragm in while you are lying down, squatting, or standing with one leg up on a
chair. Your legs need to be fairly wide open. Bending your knees can help. Once you're in position,
follow these steps:
Use one hand to fold the diaphragm in half with the dome pointing down (see Picture 3 below). Hold your
vagina open with your other hand.
Put the diaphragm into your vagina, aiming for your tailbone (see Picture 4 below). Push the diaphragm as
far back into your vagina as you can.
Use one finger to push the front rim of the diaphragm up behind your pubic bone, aiming for your belly
Picture 3
Picture 4
Checking Placement of Your Diaphragm
With your finger, feel for your cervix through the dome of the diaphragm. The cervix will feel firm but
not bony. It feels a bit like the tip of your nose.
If the diaphragm does not cover your cervix or you cannot feel your cervix at all, the dome is not in the
right place. This means that you need to remove the diaphragm, put more spermicidal gel on it, and insert
it again.
The diaphragm should not fall out when you cough, bear down, sit on the toilet
or walk around. If your diaphragm stays in place when you do these things, the
front rim is most likely in the right place above the pubic bone (see Picture 5 to
the right).
Picture 5
After You Have Sex
The following are some important points to remember after you have
Leave the diaphragm in place for at least 6 hours after you have sex.
If you have sex again within 6 hours, put spermicidal gel in your
vagina, but do not take your diaphragm out to put gel in the dome.
Take the diaphragm out of your vagina 6 to 12 hours after you have
Do not leave the diaphragm in your vagina for more than 24 hours. Doing so can cause infection, irritation
or even a problem called toxic shock syndrome.
Do not douche while the diaphragm is in your vagina.
To remove the diaphragm, "hook" the front rim with your finger and pull down and out. If you have long
fingernails, be careful that you do not tear a hole in the diaphragm.
Taking Care of Your Diaphragm
After you take the diaphragm out of your vagina, wash it with mild soap and water, rinse it and dry it
well. Always store your diaphragm in its container. Store the container in a cool, dry place, away from
sunlight and out of the air.
Check your diaphragm often for holes. To do this, fill the dome with water and look for tiny leaks.
Replace your diaphragm after 1 to 2 years. Every year, your doctor should check to see that your
diaphragm still fits right. You will need to be measured again if you have a baby, have pelvic surgery, or
gain or lose more than 15 pounds.
When to Call Your Doctor
Call your doctor if you have any of the following problems:
Trouble urinating, or painful or frequent urination
Vaginal itching, discharge or discomfort
High fever (which can be a sign of toxic shock syndrome)
You also should call your doctor if your diaphragm falls out, gets a hole in it or does not seem to fit right.
If your diaphragm has any of these problems, it needs to be replaced. If you keep using it as is, you
could increase your risk of getting pregnant.
Diaphragm Fitting (American Family Physician January 1, 2004, http://www.aafp.org/afp/20040101/97.html)