Do Diaphragms Really Work? Everything You Need to Know About The Hormone-Free Birth Control Option

We at Bustle love giving you tips for how to tap into your sexual potential and troubleshoot when things aren’t going your way in the bedroom. But what about finding solutions to those stressful sexual health situations that inevitably crop up when you’re getting down? Emma Kaywin, a Brooklyn-based sexual health writer and activist, is here to calm your nerves and answer your questions. No gender, sexual orientation, or question is off limits, and all questions remain anonymous. This week’s topic: how diaphragms really work.

Q: I’m coming off a really bad experience with hormonal birth control (serious mood swings, weight gain, the works) and am looking into non-hormonal birth control options. I don’t love condoms, particularly right now because my boyfriend and I are all set with STD tests and really like the feeling of skin against skin. It looks like my alternatives are pretty limited to copper IUDs, but then my mom mentioned the diaphragm ... apparently she used one in the '80s? She said it’s a good option, but it sounds kinda weird and I can’t wrap my head around how it works, or how you even put it on. How safe is it, and how effective?

A: The diaphragm. It’s a solid birth control method — it’s hormone-free, reusable (which is exciting to those of us who are environmentally conscious, or just don’t like going to the pharmacy all the time), and hypoallergenic. So why don’t you know about it? Because it’s out of vogue right now. Ask anyone with a vagina who was sexually active a few decades ago, and you’ll hear a different story. While only 3.1 percent of Americans with uteruses had ever checked out a diaphragm in 2010, back in 1982 that number was 17.1 percent!

So what’s the deal with the diaphragm? Does it deserve to go the way of all things, or should you consider checking it out? Let’s learn about it so you can decide for yourself.

How Does It Work?

A diaphragm is in essence a tiny hat for your cervix. No seriously, it’s a dome made of flexible silicone that you insert into your vagina to cover your cervix. The diaphragm acts as a seal around your cervix, which is the passageway into your uterus. Capping your cervix means that sperm can’t get in your uterus, which is where they would potentially join an egg (if one is around) and make a cluster of cells that eventually grow into a real live tiny human.

Additionally, you need to pair your diaphragm with spermicide, which is basically a freeze ray for sperm, (by which I mean it’s a chemical that stops sperm from being able to swim, which is how they get to the egg). Spermicide that’s compatible with diaphragms comes in cream, foam, gel, and jelly forms.

How Reliable Is It?

The great news about the diaphragm is that if you use it correctly it works very well, and it starts working the moment you put it in — no need for the lag time that comes with hormonal birth control. With perfect use, aka remembering to use it every time, putting it in correctly, remembering the spermicide, not letting it slip out, and not taking it out too early, you’re looking at a 94 percent effectiveness rate. (Typical use is 88 percent.)

A couple things that can reduce the efficacy: oil-based lubricants don’t play well with silicone, so don’t use them. Also, large penises can push it out of place, as can certain positions or intense thrusting.

Finally, it’s important to remember that diaphragms do not stop sexually transmitted infections (STIs) — only pregnancy. If you are worried about getting an STI, protect yourself with a condom.

What Are The Benefits?

The diaphragm is a compelling option for a number of reasons, other than the main fact which is that it prevents pregnancy. It’s non-hormonal, which is great if hormonal birth control gives you side effects you don’t like (such as a lower your sex drive) or if you’re currently breastfeeding. You can also put it in hours before you actually have sex, which means you don’t have to pause when things are getting hot and heavy. You can have sex multiple times without taking it out in between rounds. When it’s in, you shouldn’t be able to feel it, and your lover shouldn’t either. Finally, research shows that it can decrease your risk of pelvic inflammatory disease and tubal infertility.

Are There Any Side Effects?

Most humans who use a diaphragm report no side effects. However, some people are allergic to silicone or spermicide. If that sounds like you, the diaphragm isn’t the best option. Additionally, the diaphragm can result in vaginal irritation or urinary tract infection, and while spermicide is safe for most people, some people are allergic to it or find that it irritates their vagina (or the cock that goes inside it). Putting powders on your diaphragm also increases your risk of vaginal infection. Finally (shocker), spermicide isn’t delicious, so your partner may not be excited about giving you oral sex when you have those chemicals inside you.

How Do I Get One?

To get a diaphragm, you’ll need to visit your doctor to get a prescription. Additionally, if you’re getting the old-school Milex version, you’ll need to be fitted. The newer Caya version is one-size-fits-all.

Your doctor should have a conversation with you about whether the diaphragm is the best method of birth control for you. There are some reasons why it might not be. These include if you’re not comfortable touching yourself (because you really do need to get all up in there to put the diaphragm in place), find that you are having lots of trouble getting the diaphragm in place for whatever reason, are allergic to either silicone or spermicide, have weak vaginal muscles (because they help keep the diaphragm in place), already suffer from frequent urinary tract infections or have a history of toxic shock syndrome, had a baby in the past six weeks, or had a recent second or third trimester abortion. You may also need to return to your doctor to get refit after you birth a baby or carry one for more than 14 weeks, get surgery in your abdominal or pelvic regions, or experience a weight change that’s more than 20 pounds.

Finally, it’s important to remember that your diaphragm is just that — yours. Sharing is caring, but please don’t share your cervix hat.

How Much Will it Cost Me?

Depending on your insurance, your diaphragm may be free! (Thanks Obamacare). If you have to pay out of pocket, it may cost up to $90, and some clinics add a fitting fee on top of that. Talk to your doctor about the best way to make your diaphragm affordable.

How Do I Use It?

OK, so you want to try using a diaphragm … but how?! Here’s how you use it.

Step 1: Get Prepared

No, I don’t mean mentally prepared! It’s not that stressful of a situation, I promise. But I do mean wash your hands and check the diaphragm for holes (pro tip: fill it with water and see if anything comes out the bottom).

Step 2: Administer Spermicide

Hold the diaphragm so it looks like a bowl, and then fill it with approximately a teaspoon of spermicide. Spread a bit of the spermicide around the rim — not too much though, or it could get too slippery to put in!

Step 3: Put It All Up In There

Putting in a diaphragm is very similar to putting in a tampon ... if the tampon was filled with cream. Fold the spermicide-filled diaphragm in half and stick it into your vagina. Basically, you want to push it as far in as possible, back toward your tailbone — your cervix is the thing that it will bump into. Make sure the diaphragm covers your cervix, because that’s the whole point.

Step 4: Get Down!

Once you have a diaphragm covering your cervix, you’re ready to get down to business! And the good news is that you don’t even need to have sex right away — you can keep the diaphragm in for up to 24 hours at a time.

Step 5 (OPTIONAL): Get Down Again!

Another perk of the diaphragm is that you can have sex more than once without taking it out to wash it or do any other maintenance. All you have to do is shoot some more spermicide up your pussy to make sure you’re immobilizing those swimmers.

Step 6: Keep It In There

You need to keep the diaphragm in place inside you for at least six hours after you have sex. If you’ve had sex more than once, start the six-hour clock from the last round.

Step 7: Take It Out

After your six-hour waiting window is up, you can take out your diaphragm and let your cervix be free! Make sure to wash your hands first, and then stick your index finger up your vagina until you feel the rim of the diaphragm. If you’re using the newer version, called Caya, you’ll be feeling around for the removal tab, not the lip. Hook your finger around the lip or grab the tab and pull the diaphragm out of your body. You did it!

Step 8: Clean and Store It Properly

Wash your diaphragm with non-perfumed soap and warm water and stick it somewhere clean to let it air dry. Then put it somewhere safe and clean until you’re ready to use it again. You can carry it around in your bag so that you are always prepared. If you take care of it regularly, your diaphragm can last around two years!

What Should I Do If It Falls Out or Moves?

If your diaphragm slips out of place, it’s no longer doing its job to keep sperm out of your reproductive organs — remember that it’s supposed to be acting as a physical barrier. If you notice after sex that your diaphragm has slipped and you're at a fertile time in your cycle, it's a good idea to go out and get emergency contraception.

The Bottom Line

The diaphragm may feel vintage, but it’s definitely still a solid birth control option. And I say, the more (options) the merrier! If you’re excited about a birth control method that you and your partner can’t feel, that doesn’t interrupt the moment, and that lets you go multiple rounds before you have to deal with it, the diaphragm is a great way to go. Call up your doctor and start talking specifics, so you can get fitted (you look so beautiful in that hat, cervix!).

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Images: Caya, Giphy